Critical Issue: Linking At-Risk Students and Schools to Integrated Services

ISSUE: Many children live in vulnerable families and neighborhoods where the incidence of poverty, teen pregnancy, unemployment, substance abuse, and violence is widespread. Schools are increasingly recognizing that the educational performance of at-risk children will not improve unless efforts are made to remove the barriers to learning created by problems that begin outside the classroom walls. Linking students and schools to integrated health and human services is one strategy to do this.

OVERVIEW: In many communities, the comprehensive supports and services children and families need to succeed are often not available, affordable, or accessible. These comprehensive services and supports respond to the full range of child and family needs. They include opportunities to develop young people's talents and interests, formal and informal supports to prevent problems from getting out of hand, and specialized treatment and remediation services when prevention is not enough. As Ianni (1993) reports, "The problem for those at greatest risk is that the factors are often interconnected, combining and reinforcing each other with devastating effects on the life course....Even when the risks in one area are reduced, the lack of progress in another may render that success meaningless" (p. 29). Comprehensive services and supports should be designed to maximize the rates of success, not just minimize problems.

"Because effective services are not the norm today, communities are likely to find that they need to modify, expand, or create new services and supports, as well as to develop linkages among existing services....It is vital that the community's vision of the supports and services it needs for its families go beyond a list of formal, professionally-driven services delivered by a human services agency." (Improved Outcomes Project, 1994a, p. 12)

Even when services do exist, a fragmented service delivery system offers at-risk children too little, too late. An emphasis on measurable results sets the current wave of service integration initiatives apart from earlier efforts to improve services (Kagan with Neville, 1993). Today most practitioners and policymakers agree that "greater emphasis upon the client-focused outcomes of collaborative efforts is vital. As funders increasingly and rightfully demand accountability for spending, client outcomes data becomes increasingly significant" (Young, Gardner, Coley, Schorr, & Bruner, 1994, p. 7). On their own, schools are neither capable of, nor responsible for, providing more responsive services and ensuring better results for children and families.

Although young people spend much of their time in school, a variety of other community institutions share responsibility for creating the conditions in which young people can succeed. Schools, however, are increasingly recognizing their changing role as essential partners in establishing collaboratives and partnerships. Superintendents play a key role in developing collaborative initiatives. Alonzo Crim, former Atlanta superintendent, points out, "Superintendents need to aggregate power to get things done for children. We need to put things together, coordinate, collaborate, and provide a vision and a forum to talk about these issues....The major forces have to coalesce to get the job done; otherwise we will be tilting at windmills" (Clark, 1991, p. 2). The collaboration must be broad-based. According to Etta Lee Powell, former superintendent of the Cincinnati public schools, "All related organizations must come together in a roundtable; we must get away from one-on-one...we must identify the problem, get people to come together, assemble the resources, formulate a strategy, and provide for evaluation" (Clark, 1991, p. 2).

Charles Terrett, superintendent of Fulton County Schools in Hickman, Kentucky, describes how his school district set out to collaborate with different agencies in the community to deter the student dropout rate. [Audio file, 494k] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services, (NCREL, 1992). A text transcript is available.

Parents must be included in this effort for it to be successful. All partners must develop more effective services that are intense, comprehensive, and flexible. The separate services must be provided in an integrated delivery system in which services are connected through a variety of mechanisms so that children and families get the help they need, when and where they need it. An integrated system also ensures that the time and resources of service providers are used as efficiently as possible while meeting the full needs of children and families.

Charles Terrett, superintendent of Fulton County Schools, in Hickman, Kentucky, relays a positive comment made by a social services director, following the first case conference involving collaboration of the schools and different agencies. [Audio file, 204K] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (NCREL, 1992). A text transcript is available.

There is wide agreement that the governance of these initiatives--including fiscal, administrative, and operational systems--should be school-linked.

"In a school-linked approach to integrating services for children, (a) services are provided to children and their families through a collaboration among schools, health care providers, and social service agencies; (b) the schools are among the central participants in planning and governing the collaborative effort; and (c) the services are provided at, or are coordinated by personnel located at, the school or a site near the school." (Center for the Future of Children, 1992, p.7)

Whether the services themselves should be school-based, i.e., provided directly at the school, is a matter of some discussion. The most comprehensive approach to school-linked services combines school restructuring with service delivery in what some educators term "full-service schools."

"The vision of the full-service school puts the best of school reform together with all other services that children, youth and their families need, most of which can be located in a school building. The educational mandate places responsibility on the school system to recognize and innovate. The charge to community agencies is to bring into the school: health, mental health, employment services, child care, parent education, case management, recreation, cultural events, welfare, community policing, and whatever else may fit into the picture. The result is a new kind of 'seamless' institution, a community-oriented school with a joint governance structure that allows maximum responsiveness to the community, as well as accessibility and continuity for those most in need of services." (Dryfoos, 1994, p.12)

Glenda Cochrum, coordinator for the Fulton County KIDS Project, and Virginia Reddick, counselor for the Fulton County Schools, in Hickman, Kentucky, tell the story of a three-year-old girl named Ivy, one of the greatest successes resulting from their collaboration. [QuickTime slide show, 840k] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (NCREL, 1992). A text transcript is available.

In general, school-linked service delivery initiatives constitute part of a larger movement to strengthen the economic, social, and physical well-being of communities and to increase successful outcomes for all children and families. Service integration strategies and community development strategies often must go hand in hand. Experience has shown that system reform alone may not be enough to significantly transform educational, social, and health outcomes: "In some environments, system reform efforts must be augmented by social-capital and economic development initiatives that target the whole community...and increase the access of poor families to incomes, opportunity and work" (Annie E. Casey Foundation, 1995).

GOALS:

• School personnel will collaborate at every level with other institutions that share responsibility for meeting the needs of children, families, and their communities.

Monte Striver, superintendent of the South Bend School Corporation, in South Bend, Indiana, talks about the need to collaborate with other agencies. [Audio file, 231k] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (NCREL, 1992). A text transcript is available.

• Parents and community leaders will actively participate in the design, implementation, and evaluation of new service delivery strategies.
• Outcomes in key areas selected and prioritized by the community, based on their local circumstances, will improve measurably.
• All students will have access to affordable, high-quality services.

ACTION OPTIONS: Collaborative initiatives linking students to integrated services take many forms, depending on local needs and resources. They can vary along at least four dimensions: 1) the goals of the effort; 2) the nature of the services provided; 3) where services are located; and 4) who is responsible for their provision (Levy & Shepardson, 1992).

There are several ways to get collaboratives to work for students:

• Convene a collaborative that can develop a reasonable degree of internal trust.
• Develop a collective vision for linking students to integrated services.

Otis Johnson, director of the Chatham-Savannah Youth Futures Authority, in Chatham County, Georgia, talks about the importance of developing a community vision. [Audio file, 253k] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (NCREL, 1992). A text transcript is available.

• Gather information on the problem the collaborative wants to address and the results it hopes to achieve.
• Build support for its efforts both within participating organizations and across the community.
• Decide on needed services and supports and determine which service delivery strategies will be most effective and feasible.
• Create one-stop service centers that provide a range of services designed to reach a school, a cluster of schools, or a specific neighborhood.
• Build better linkages to existing service delivery through information and referral services.
• Streamline existing eligibility and intake procedures across several agencies.
• Offer some version of case management.
• Use a combination of the above strategies.
• Develop short-term and long-term funding strategies to ensure that successful interventions can be maintained and expanded.
• Begin implementation and continually fine-tune interventions.
• Provide appropriate technical assistance throughout the collaborative process to manage and support the strategy decided upon, designed, and implemented.
• Evaluate and make results public.

IMPLEMENTATION PITFALLS: Dozens of landmines lie in the path of collaborative efforts, at every stage in their development. In general, the most dangerous is the tendency of groups to rush into implementation before they have built a sufficiently strong political, technical, and fiscal foundation on which to base their efforts. Other major difficulties include:

• "Projectitis." The rush to implementation exacerbates the tendency for collaboratives to develop "projectitis." Collaboratives become so absorbed in creating new projects and programs that they fail to identify and lobby for needed changes in the policies, attitudes, and staff behaviors of major community institutions. While new services are often necessary, the day-to-day, across-the-board operation of existing systems must change to support, respect, and engage students and families more effectively. Add-on programs, even when they are highly successful, are often short-lived and have limited impact. Most rely on soft money and are limited to single sites. They are seldom replicated broadly throughout the community or incorporated as a permanent line item in institutional budgets.

• Time Constraints. For most school staff, participating in collaborative activities adds to an already jammed schedule. In the beginning, doing double duty may be inevitable, but success over the long haul depends on making sure that participants are supported in their efforts. Collaboratives operating at the policy level may hire staff, or partners may assign existing personnel to do collaborative work on a full- or part-time basis. At the service delivery level, substantial innovation may be necessary to ensure that teachers and other front-line staff have the time to participate. Surveys suggest that time-finding strategies in schools focus on 1) taking time that is now scheduled for other things; 2) adding additional time to the school day and/or school year; or 3) altering staff utilization patterns (Raywid, 1993).

• Unequal Power Relations. "Turf" issues are inevitable among groups that come to the table with different professional orientations, organizational agendas, and resources. Unequal power relations is a more serious matter. It stems from perceived inequalities in status among members and results in the reduced capacity of some groups to initiate and influence actions of the collaborative. This imbalance frequently occurs when representatives of large institutions with sizable budgets try to work together with parents or community members. When these latter groups bring essential resources--namely their ability to provide information about what is needed, what strategies are likely to be well received, and their ability to marshal community support--that are not acknowledged or valued, the legitimacy and effectiveness of the collaboration is severely undermined. Open conflict can erupt, and institutional leaders may leave the table. More frequently, the participation of parents and community representatives gradually erodes as their frustration and alienation grow (Bond & Keys, 1993).

• Confidentiality. Agencies serving the same child and/or family often must share relevant information if they are to provide services more effectively and efficiently. Administrators and front-line staff who have never worked together may be concerned about infringing on their clients' privacy rights. In addition, some partners see sharing information as an encroachment on professional privilege. Conflict can be minimized if partners 1) assume early on that strategies to protect privacy and to share essential information do exist; and 2) agree to postpone further discussion until they have designed their initiative and know what kind of information, under what circumstances, they want to share.

Linda Kunesh, former director of Early Childhood and Family Education at NCREL, comments on the way that Fulton County Schools in Hickman, Kentucky, dealt with the confidentiality issue when they began to work with several agencies from the community. [Audio file, 195k] Excerpted from the video series Schools That Work: The Research Advantage, videoconference #8, Integrating Community Services (NCREL, 1992). A text transcript is available.

Informed-consent protocols, with careful attention given to whose consent is required, and interagency agreements often are sufficient to permit the prudent, legal exchange of information. Legislative solutions also are possible (Center for the Future of Children, 1992). However, findings suggest that management issues, not the law, pose the primary barriers to effective and efficient information exchange (Hobbs, 1991).

• Evaluation. The evaluation of school-linked collaborative initiatives, while essential, is problematic. Impact evaluations are scarce, and conventional experimental designs do not capture the complexity of comprehensive efforts. Collaborative initiatives need to establish reasonable expectations for their efforts, learn more about how partnerships grow and develop, and help policymakers and the public understand how the initiatives will be held accountable. Substantial efforts are being made to respond to these problems. Work is being done to identify reliable intermediate indicators so that collaboratives can track short-term progress made in reaching large outcomes. Collaboratives also are devising techniques that monitor process--how their partnerships grow and develop--as well as outcomes.

DIFFERENT POINTS OF VIEW:

Even among those who support integrated services, not everyone agrees on:

• The Location of Services: Advocates of school-based services argue that services should be based in the schools or at nearby locations. Schools are where the children are; they offer a central location in which to group services provided by outside agencies. In addition, accessibility to children and families is presumed to be high. Proponents of community-based models do not necessarily object to school-based services but believe that effective service delivery requires multiple access points. They also are concerned that location in the schools may limit flexibility and innovation in the design and delivery of services, as well as family access (Chaskin & Richman, 1992).

• The Role of the Schools: Schools are clearly essential partners in collaborative efforts, but should they be first among equals? Schools often provide space for services, and staff play an active role in making referrals. Superintendents and principals are used to controlling activities that occur "on their watch," and many feel their accountability for what happens in the schools should give them special voice within the collaborative. Most observers, however, disagree. "For school-linked service efforts to be effective, their planning and implementation should not be dominated by any one institution--schools or health or social service agencies" (Center for the Future of Children, 1992, p. 10). Even strong proponents of school-based services believe that the fiscal and legal responsibility for the program should be an agency or entity other than the school (Dryfoos, 1994). Kirst (1994) cautions states against designating schools as lead agencies in collaborative efforts. It is all too easy for them to succumb to what he terms "the Sinatra Factor"--let's "do it my way." The consequence of this tendency is that other partners let them--and schools once again are left holding the bag.

• Targeted or Universal Services: There also are different views about who should receive services in school-linked service integration efforts. Some initiatives focus only on students; others provide services for whole families. Some interventions are limited to students defined according to specific at-risk criteria; others are available to the entire student body. Some of these decisions are predicated on views about how scarce resources should be used; others reflect differing opinions about the extent to which schools should engage in service delivery. The larger movement to strengthen communities, of which school-linked service delivery is part, is grounded in the notion that all children and families can benefit from more comprehensive services and more responsive community institutions. Even though initiatives may begin with a fairly narrow focus for pragmatic reasons, their overall aim should be to "roll out" innovations on a large enough scale to have universal impact.

ILLUSTRATIVE CASES: The following examples reflect the diversity found in school-linked initiatives. They are rural and urban, operate with a variety of state and local involvement, and reflect varying degrees of progress toward fully integrated service delivery.

• Kentucky's Family Resource and Youth Services Centers
• New Beginnings, San Diego, California

CONTACTS:

Center for the Study of Social Policy
1250 Eye St., N.W., Suite 503
Washington, DC 20005
(202) 371-1565
Fax: (202) 371-1472
E-mail: swatson400@aol.com
Contact: Sara Watson

Chapin Hall Center for Children
University of Chicago
1155 60th St.
Chicago, IL 60637
(312) 753-5900
Fax: (312) 753-5940

Child and Family Policy Center
Fleming Building, Suite 1021
218 Sixth Ave.
Des Moines, IA 50309
(515) 280-9027
Fax: (515) 244-8997
E-mail: hn2228@handsnet.org

Institute for Educational Leadership
1001 Connecticut Ave. N.W., Suite 310
Washington, DC 20036
(202) 822-8405
Fax: (202) 870-4050
Contact: Mary Marshall

National Center for Children in Poverty
Columbia University
School of Public Health
154 Haven Ave.
New York, NY 10032
(212) 927-8793
Fax: (212) 927-9162
E-mail: ejs22@columbia.edu
Contact: Carol Oshinshy or Beth Atkins

National Center for Service Integration Clearinghouse
Child and Family Policy Center
218 Sixth Ave., Suite 1021
Des Moines, IA 50309
(515) 280-9027
Fax: (202) 371-1472
E-mail: HN2228@connectine.com

References

Date posted: 1996