Health Care That’s Not for Dummies
Schools Alone Cannot Close Achievement Gap
A multifaceted strategy can complement school reform by addressing the many out-of-school factors that affect academic performance.
Gaps in student achievement are well documented. Members of some ethnic minority groups and low-income students consistently perform less well on achievement tests than their peers do. For example, a more than 20-point gap between white and Hispanic students G on National Assessment of Educational Progress tests in reading and mathematics has not changed significantly since 1990, and the gaps between black and white students have followed a similar pattern. Recent work has highlighted increases in the gaps among children of different income levels. Achievement gaps show up before children enter kindergarten: Children in the highest socioeconomic group entering kindergarten have cognitive scores 60% higher than those of children in the lowest socioeconomic group. The gaps in test scores and other measures persist throughout K-12 education, and corresponding gaps in high-school graduation rates, college matriculation and completion, and lifetime earnings demonstrate the impact that poor academic achievement has on young people’s lives. But, as Christopher Jencks and Meredith Phillips noted more than a decade ago in a study of test scores, such gaps are not “an inevitable fact of nature.”
A large volume of research has documented the associations between educational outcomes and factors associated with income and family and cultural background—most recently the collection Whither Opportunity?, edited by Greg Duncan and Richard Murnane and For Each and Every Child, a report from the Equity and Excellence Commission of the U.S. Department of Education. A picture is beginning to emerge of the specific ways in which economic resources influence education, but it has not yet resulted in policies that significantly narrow the gaps.
Schools clearly make a big difference. Research has established that the students most likely to lag behind academically are those who attend schools with less-qualified teachers and poorer resources. The rigor of the curriculum as it is implemented, the quality of teachers, class size, and teacher absence and turnover all have been shown to influence outcomes for students. In other words, what happens once children enter school may support those with disadvantages, or may perpetuate or exacerbate the gaps. (These issues are discussed in detail in a companion article by Natalie Nielsen.)
But there are other factors struggling students frequently share. For example, students whose families are not stable and supportive (those who change schools frequently, whose parents do not participate actively in their education, or whose families are disrupted by substance use or crime) are more likely to struggle in school. So too are students who live in poverty; whose neighborhoods are stressed by unemployment; and who feel unsafe at, and on the way to and from, their schools. The lack of adequate health care and adequate nutrition and untreated medical and mental health problems also are associated with school problems. Each of these sources of disadvantage may significantly impede a child’s academic progress, and these risk factors tend to cluster together, exacerbating their effects.
These important influences on children’s development have been the subject of considerable research, but less progress has been made in directly linking disadvantage that originates outside of school to educational outcomes. The National Research Council (NRC) has produced reports that synthesize research in areas that have important implications for the educational progress of children and adolescents. This article summarizes some of the messages from a body of work produced by the NRC since 2000 that offer insights about the out-of-school factors that may influence educational outcomes.
Produced primarily under the aegis of the Board on Children, Youth, and Families and the Committee on Law and Justice, these reports were not focused on addressing education issues and for the most part do not identify causal connections between out-of-school factors and academic achievement. They do, however, identify mechanisms by which specific sources of disadvantage impede students’ lives at school. As a group, they clearly point to important consequences of out-of-school factors for educational progress and to intersections among the different specific sources of disadvantage. The messages in these reports fall into a few broad categories.
Health and development
Research has vastly expanded understanding of development, particularly in early childhood and adolescence, and points to significant implications for education. Perhaps most important is the recognition that healthy development is a complex and interactive process that encompasses cognitive, psychological and emotional, biological, and behavioral processes, as well as environmental influences.
For example, as experts in early childhood care and education know, children who are ready for kindergarten have had the opportunity to develop the skills on which literacy and mathematical thinking will be built, but also the opportunity to form secure attachments and to develop social and self-regulation skills, so that they can develop successful relationships with their teachers and peers and take advantage of the classroom environment. The kinds of factors that frequently interfere with this development are closely associated with poverty: insecure housing and nutrition, unstable parenting and disruptions in relationships and care, and inadequate medical care.
The presence of extreme disadvantage, particularly when there are multiple sources, may be most harmful in the first years of life. Early experiences shape brain development, researchers have found, and the brain will adapt itself either to positive or to negative experiences. This means that infants and very young children who experience highly stressful family situations and associated risk factors can be permanently affected. These children will enter school at a significant disadvantage as compared with their peers and will present very different challenges to their teachers.
The early years are critical, but brain development continues into early adulthood, and it continues to interact with other factors. Researchers who study aspects of adolescence from different disciplinary perspectives are increasingly recognizing the importance during that phase of life of interactions among brain development, other biological processes, and social and environmental influences. Just as infants’ brains are particularly vulnerable to clusters of risk factors, older children and adolescents may respond to the same challenges in ways that threaten their engagement with school and their academic progress. Adolescents who are highly stressed are particularly prone to both emotional disturbances such as depression and a range of high-risk behaviors such as substance use and abuse. The combination of the initial stress and the mental health or other issue is likely to significantly impair a student’s engagement with school and capacity to keep up academically.
At the same time, disadvantaged children and young people often lack adequate care for medical and mental health problems. Adolescents who have two or more diseases, health conditions, or risky behaviors are particularly vulnerable, and their capacity to succeed academically is likely to be significantly compromised. Adolescents who already have other risk factors—those from low-income families; who are in the foster care system or are homeless; whose families have recently immigrated to the United States; who are lesbian, gay, bisexual, or transgender; and those in the juvenile justice system—tend to have more untreated health problems than their peers. These are young people who will also be likely to arrive at school unready to engage and learn, and to respond to academic setbacks or discipline problems by disengaging. Scholars who have focused on health care for adolescents stress that caregivers, teachers, and other adults who may come into contact with a student or a family are unlikely to have a complete picture of the stresses facing the family, even though the issues are likely to be interrelated and difficult to resolve in isolation.
Families and home environment
A closer look at stressors that can exist within the family illustrates their possible impacts on educational outcomes. For example, physical, sexual, and emotional abuse and neglect may have profound outcomes. Abuse may have neurological or medical impacts on children and young people, including brain damage, neurobiological effects, mental retardation, speech defects, handicaps, and other health problems. Such abuse may also have impacts on cognitive development that manifest themselves in lowered IQ, difficulties with attention, learning disorders, poor reading, poor school performance, or dropping out of school. Possible effects on behavior may include aggression, truancy, delinquency, running away, drug use, and crime and violence. Effects on young people’s psychological states or emotions may include anxiety, depression, dysthymia, low self-esteem, poor coping skills, or hostility.
Although this sort of abuse is an extreme stressor, it is distressingly prevalent. Researchers estimate that about one in seven children between the ages of 2 and 17 are victims of maltreatment in a given year, and that children in low-income families are more likely than others to be maltreated. Low-income children are also more likely than their peers to move (change residence and often school or district) frequently. Not all mobility is harmful in itself, apart from the associated factors that sometimes result in frequent moves, such as family disruption, housing stress, and poverty. Certain kinds of school mobility, however, have a negative effect on children’s educational progress. Negative effects are found in children who move the most frequently, with the impact increasing with each move. The impact of frequent moves is greatest on younger children and on children with other risk factors, such as homelessness. There is a significant relationship between mobility and both lower school achievement and dropping out, and student mobility has a negative impact on schools as well.
These connections are complex to isolate and tend to be obscured in national data, but researchers have found a decline in achievement test scores of approximately one-tenth of a standard deviation for each move a child makes. Dropout rates can increase by as much as 30% for students who have made three or more moves. The effect of high rates of mobility on schools is large. Students moving in and out of classrooms disrupts both the flow of instruction and the establishment of learning communities, and the effects on students of attending schools with high rates of student mobility are likely to persist throughout their school careers.
Children in families who have recently immigrated to the United States or whose first language is not English may also enter school in the United States at a disadvantage (although being bilingual is academically advantageous). English learners and many minority children have lower vocabularies than their peers, a factor that is associated with both lower socioeconomic status and lower achievement. Children who are either not fluent in English or whose home environment is not linguistically rich are likely to have academic difficulties until their language gaps are closed. There is ongoing theoretical debate over the best ways to address the needs of these students, but researchers agree that teachers often lack training in basic strategies for supporting language development.
Involvement in crime and the juvenile justice system is another obvious hindrance to academic progress and school completion. Causal links have not been established, but the importance of interactions among various risk factors is evident. For example, deficits in verbal and reading skills are linked to drug use, aggression, and delinquency. Students who fall behind in reading lose confidence in their capacity to succeed in school, and school failure undermines their engagement. Researchers have shown that young people who experience the familiar sources of disadvantage (prenatal exposure to drugs, low birth weight, and birth trauma; poor language development; abusive or neglectful parenting; and disorganized family and community environments) are those who are more likely to engage in delinquent or criminal behavior.
Delinquency is associated with poor school performance, truancy, and leaving school at a young age. Moreover, research suggests that some educational practices, such as grade retention, tracking, suspension, and expulsion, may intensify students’ disengagement from school. Such practices, which disproportionately affect minority groups, interfere with students’ attachment to school and with learning and unintentionally reinforce negative stereotypes. They can have long-lasting negative effects on academic achievement. One reason researchers in this area point to practices that isolate young people with disciplinary problems is that when those students are together they tend to reinforce one another’s antisocial impulses.
Researchers of delinquency note that the risk factors that make delinquent behaviors more likely tend to be most prevalent in particular neighborhoods, although research on the effects of differences in neighborhoods and their interactions with individual and family conditions is not yet settled. At the same time, students who live in relatively unstable communities in which weapons are readily available and crime is prevalent are more likely to associate with peers who engage in delinquent behavior and to do so themselves.
Other countries have focused on reducing the relationship between achievement and family background and have supported disadvantaged students in achieving to high academic standards. A recent report from the Organisation for Economic Cooperation and Development has shown that the highest-performing countries are those that invest in children’s early development and sustain the supports through secondary school. These supports include policies focused on public education as well as other areas, such as housing and welfare. Attention to the links among parents, communities, and schools encourages parents’ involvement in their children’s education, which in turn can make a difference in a range of outcomes.
In the United States, many sorts of programs have shown promise in supporting young people and families who are disadvantaged. These include parenting and home visiting programs designed to improve parenting skills and developmental outcomes for infants and very young children; comprehensive early education programs; interventions for disrupted families; and school-based programs focused on specific goals.
Out–of-home child care and other supports for families can provide opportunities for learning, stable relationships, and other resources that can be critical to the development of children who are at risk. Early Head Start, Head Start, and other high-quality preschool programs are among the interventions that have received a good deal of attention, most recently in President Obama’s 2013 State of the Union address. High-quality early childhood care and education programs that are successful with disadvantaged children share characteristics such as low child-to adult ratios, small group sizes, and a child-centered approach. Programs such as Head Start that focus on school readiness for low-income children provide services that address families’ health, nutrition, and social needs, as well as children’s cognitive and educational needs. They are designed to be responsive to families’ cultural and linguistic backgrounds and may include full-day services and home visits, as well as support and care from health care professionals and others.
Rigorous studies have documented benefits from such programs, including positive effects on cognitive and language skills; achievement test scores; high-school graduation rates; behavior problems, delinquency, and crime; and employment, earnings, and welfare dependency. Reductions in costs for public education, social services, the justice system, and health care have also been found. By one calculation, every dollar invested in high-quality early care and education yields $13.00 in savings to taxpayers. These effects decline over time, in the absence of other supports to sustain benefits, but are strong and remain discernable. For example, high-quality programs may close between 30 and 70% of achievement gaps, depending on how long children receive the services.
Head Start and some other programs attempt to address the multiple needs that struggling families face, but as children age out of the program, their families still experience challenges that may undermine their capacity to meet academic challenges. Many programs are available for older children. Some school-based programs address problem behaviors, such as aggression and substance abuse, and others provide support and training for parents designed to foster connections between school goals and disciplinary and other practices in the home. Many communities have explored possibilities for providing school-based health programs, particularly for adolescents.
Growing recognition of the importance of health and emotional well-being to young people’s academic potential has lead many communities to focus on wraparound programs designed to address a range of needs. Wraparound programs have developed in an ad hoc way and are difficult to define. Such programs might encompass parenting, wellness, and other supports, which may be as diverse as dental and mental health care, literacy classes and job training for parents, and extracurricular after school programs for students. These programs take many forms. One example is in California, where in many counties, children and families in need of support (identified through agencies concerned with children and families, mental and health care, probation, and the like) are given a plan of care and support that is modified as their needs change. The key to this program is coordination among county agencies and a commitment to continue the care as long as it is needed.
Wraparound programs are diverse, and research into their outcomes has varied, but summative analysis of the literature has shown the potential for a range of positive impacts on young people and their families for many approaches. Many individual programs, such as the Harlem Children’s Zone, have tracked their own outcomes and show promising results.
Many programs to support families are school-based. The concept of community schools, which, as defined by the U.S. Department of Education provide integrated comprehensive academic, social, and health services to students, their families, and members of the community, has grown in popularity. Community schools are designed to coordinate, for example, engaging instruction, extracurricular learning opportunities, health and social support, and guidance along pathways to college and a career. Advocates for community schools report promising results in improving academic achievement, reducing dropout rates, reducing disciplinary problems, and increasing parents’ involvement in their children’s education.
One approach to integrating services available to families is in North Carolina, where the Departments of Health and Human Services and Department of Public Instruction have collaborated to develop a program of Child and Family Support Teams. In this program, currently serving 21 out of 115 districts, a plan is developed for each student to coordinate supports from family, friends, and neighbors; as well as mental health and medical professionals, juvenile court counselors, social workers, or others who may be needed. Other states and communities (such as Hawaii, Louisiana, Kentucky, and Iowa) have explored ways to support students and families, but the research literature on such programs is limited.
Some of the reports reviewed for this article were early flags of issues that have merited further work, whereas the more recent ones provide syntheses of the most current thinking in various fields. As a group they demonstrate the magnitude of the resources that are already devoted to understanding and supporting children and adolescents and their families. This brief overview of a wide range of topics demonstrates the complexity of the disadvantages facing many children and young people in the United States. According to the National Center for Children in Poverty, 44% of U.S. children live in low-income families (below $44,700 for a family of four), whereas 22% (approximately 16 million children) live in families whose incomes are below the federal poverty level ($23,021 for a family of four).
Each of the risks discussed here is associated with low income, although they are not confined to young people whose family incomes are below these levels, and the negative effects of risk factors appear to be intensified when more than one is present. What else can be inferred from a review of this work?
• The effects of disadvantage are usually cumulative, so academic difficulties are likely to be symptoms of problems of long standing for students. It seems likely that negative influences from outside of school harm the educational experience, and that negative experiences in school may in turn exacerbate out-of-school problems. Researchers describe dropping out of school as a gradual process, rather than a sudden decision. Understanding of the risks to development in the first years of life provides a good reason to believe that in many cases, the difficulties that ultimately result in a student dropping out could begin that early.
• The interactions among developmental factors, environmental factors, and education practices and experiences may exacerbate harm or mitigate it. That is, there are many possible ways that a child may develop the resilience to thrive despite significant disadvantage, and although early development is critical, intervention that comes later can still be beneficial.
• Integration and coordination of the services available to children and families appears to be essential. A single student’s needs might span the full range of responsibilities that jurisdictions undertake—from health and mental care to the juvenile justice system. Only if these entities are in communication about individual students and their families can they be sure their programs are not working at cross purposes and that a critical aspect of the problem is not being overlooked.
This last point may be the most important. Experiencing multiple risk factors over extended times poses the highest risk to well-being and student achievement. The groups of children and adolescents who are in those circumstances have the greatest need for support that is coordinated across sectors. Any given adult—teacher, public health nurse, or probation officer—might be the one who interacts with a child at a critical point and has the opportunity to identify the need for intervention. It is vital that that individual have the knowledge and resources to quickly direct the student or family to the supports they need, even if the needs fall outside of his or her expertise. A community’s investment in the range of services it provides with the aim of helping young people enter adulthood healthy, educated, and ready to flourish, will be maximized if those services can be coordinated.
Many of the individual reports note the importance of establishing and improving links and communication among the entities that work with young people and families, but references to schools are relatively few. These reports nevertheless throw into high relief the reality that schools are unlikely to narrow the achievement gap on their own. The reality that the greatest achievement gaps are between students with different family income levels has been persuasively documented. These programs and reports demonstrate the potential value in focusing more closely on the specific ways that disadvantages impede the academic progress of low-income students.
Adolescent Health Services: Missing Opportunities (Washington, DC: National Research Council and Institute of Medicine, 2009).
Child Maltreatment Research, Policy, and Practice for the Next Decade: Workshop Summary (Washington, DC: National Research Council and Institute of Medicine, 2012).
The Early Childhood Care and Education Workforce: Challenges and Opportunities (Washington, DC: National Research Council and Institute of Medicine, 2012)
Education and Delinquency: Summary of a Workshop (Washington, DC: National Research Council and Institute of Medicine, 2000).
From Neurons to Neighborhoods: The Science of Early Childhood Development (Washington, DC: National Research Council and Institute of Medicine, 2000).
Juvenile Crime, Juvenile Justice (Washington, DC: National Research Council and Institute of Medicine, 2001).
Multiple Origins, Uncertain Destinies: Hispanics and the American Future (Washington, DC: National Research Council, 2006).
The Science of Adolescent Risk-Taking: Workshop Report (Washington, DC: National Research Council and Institute of Medicine, 2011).
Student Mobility: Exploring the Impact of Frequent Moves on Achievement: Summary of a Workshop (Washington, DC: National Research Council and Institute of Medicine, 2010).
A Study of Interactions: Emerging Issues in the Study of Adolescence (Washington, DC: National Research Council and Institute of Medicine, 2006).
Testing English-Language Learners in U.S. Schools: Report and Workshop Summary (Washington, DC: National Research Council, 2000).
Understanding Dropouts: Statistics, Strategies, and High-Stakes Testing (Washington, DC: National Research Council, 2001).
Alexandra S. Beatty (firstname.lastname@example.org) is a senior program officer at the National Research Council.