The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

An understanding of school-linked services today requires an understanding of the terminology involved as well as knowledge of the rationales and current experimentation.

The school-linked services effort is part of a larger movement for more integration of education, health, and social services for children. Integration does not typically mean the merger of these service systems, but rather increased collaboration among them—that is, a partnership in which a number of service agencies develop and work toward a common set of goals.⁶

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 services 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. Most often the school-linked approach requires agencies that typically provide health and social services off the school site to move some of their staff and/or services to the school. Although school personnel are actively involved in identifying children who need services, they are not typically the actual providers of the services.

A number of factors are often cited in support of integrating services for children, whether by the school-linked or another approach. Lisbeth Schorr, in her book Within Our Reach, identified many of these factors, as do several authors in this journal issue (see the articles by Morrill and by Levy and Shepardson).⁷ Proponents of integrated services are concerned that children's problems persist at disturbingly high rates despite decades of intervention and the creation of an extensive public support and service system. Some of these problems, such as juvenile delinquency and the need for foster care, have been getting worse over recent years.⁸ Other problems, although decreasing in frequency, are becoming more costly. For example, although school dropout and teen pregnancy rates have decreased for some groups in recent years, the rates remain high and are associated with increasing costs in terms of public benefit expenditures and lost productivity.⁹ (See Child Indicators in this journal issue for further analysis of dropout rates.)

Proponents of integrated services believe that poor education, health, and social outcomes for children result in part from the inability of the current service systems to respond in a timely, coordinated, and comprehensive fashion to the multiple and interconnected needs of a child and his or her family. A recent report, What It Takes, identifies such flaws in the current organization of services.¹⁰ First, the health, education, and social services systems are crisis-oriented; for example, a student may be ineligible for math tutoring until he fails his math course. Second, the systems divide the problems of children and families into rigid and distinct categories; separate and often conflicting eligibility standards govern the expenditure of funds for the different systems and militate against providing a comprehensive mix of health, education, and child welfare services to families that need multiple services. Third, there is little communication among the systems; their personnel have dissimilar professional orientations and beliefs about the needs of children, and they tend to concentrate only on those services that they are able to provide.

Finally, because each system provides specialized services, it is unable to craft comprehensive solutions to complex problems. For example, the school may be able to arrange for tutoring or job training for a teen parent; if the teen parent's child care needs are unmet, however, she may be unable to take advantage of these services. (See also the articles by Morrill and by Farrow and Joe in this journal issue.) As Farrow and Joe summarize, much of the failure of the current system can be blamed on "the iron triangle" of "specialized funding, specialized professional purviews, and specialized agency organization."

Generally, service integration is advocated as a strategy to reduce these systemic problems. Proponents contend that if agencies' services were not only co-located but also coordinated according to goals developed and shared by the family and all agencies involved, fewer of a child's needs would go unmet and his or her behavior and performance in school would improve.

A multitude of organizations, research centers, and foundations are actively exploring various methods for integrating services for children and their families.^11–13 In addition to the many papers and newsletters authored by these groups, several publications about collaboration and service integration have been recently distributed nationally.¹⁴

Beyond the arguments in support of integrating services, however, why is the specific school-linked approach becoming increasingly popular? First there are practical reasons: Schools are enduring, dominant institutions in the community. There is already a considerable history of schools providing health and social services (see the articles by Tyack and by Gomby and Larson in this journal issue). Schools continue today to provide a range of educational and noneducational services on a universal basis to children; this may position schools to provide more services with less stigma to at-risk families.

Focus on the school-linked approach is in part also due to the current attention to improving students' educational achievement. As Levy and Shepardson write in this journal issue: "[There] is virtually undisputed agreement that education is a good thing, indeed an irreplaceable element in achieving success in the current and future marketplace. . . . If supportive services can help ensure educational success and self-sufficiency, then the institution responsible for education should have a part in the provision of those services."

Several of the authors for this issue contend that there must be more recognition of the connection between improving academic performance and linking nonacademic services to the schools. As Jehl and Kirst write in this journal issue, if the central goal of education reform is to improve the academic performance of all students, this goal can only be met for high-risk students if their health and social needs receive proper attention. This connection is also discussed, although not emphasized, in President Bush's national education strategy, AMERICA 2000¹⁵

Beyond the basic definition of school-linked services set forth in a preceding section, there are many additional questions about what this approach involves. What is the optimum set of services that should be offered at the school? Who should receive these? How should they be delivered? What authority and responsibility should parents have in these efforts? What do school-linked services cost in both dollars and foregone opportunities? How can the effectiveness of services be determined? As the articles in this journal issue demonstrate, answers to these questions are still evolving.

Scores of initiatives have been launched nationally. The descriptions of six of these in the Levy and Shepardson article in this journal issue illustrate the diversity of the approaches undertaken to date. Some efforts target subgroups of children, such as those at risk of dropping out; others provide services to all students. Some provide direct services at the school site; others emphasize case management for referral and follow-up. Some are part of multi-site, statewide initiatives; others are individual, local efforts. Some involve the larger community; others do not. Throughout this journal issue, authors emphasize that there is no one formula or model for implementing school-linked services. Each effort must be tailored to the specific needs and strengths of the community to be served.

Successfully linking social and health services to the schools will be a slow and difficult process for many reasons. The education, health, and social services systems are massive and have been built up over decades, and each has a unique history and funding structure. They are guided by their own groups of professionals, specially trained and unaccustomed to sharing either responsibility or authority with other disciplines and professions. Furthermore, the health, education, and social services systems of today are struggling to develop appropriate services for children and families who have needs that are substantially different from those of the past.¹⁶ These efforts are occurring in a context of serious deficits in federal, state, and local budgets—deficits that often result in cutbacks in services for children. Finally, in addition to these systemic issues, a myriad of practical barriers inhibit the implementation of school-linked services. These barriers range from community resistance to lack of facilities and management information systems (in this journal issue see the discussions by Morrill, by Jehl and Kirst, and by Gardner).

Given these challenges and the limits of current experience with the school-linked service approach, whether this movement will have staying power is unknown. As Levy and Shepardson write in their article, it is yet to be determined "whether this movement becomes one more fad that failed or a sustained innovation that truly contributes to more successful outcomes for children and families."

There is much optimism and hope that this approach will in the long run make a difference in improving outcomes for children. There is interest in this approach, not only from the top leadership in schools and community agencies, but also from teachers and health and social services agency line workers. Finally, as the articles in this journal issue demonstrate, among proponents of school-linked services there is an emerging consensus regarding the criteria that should be met to maximize the effectiveness of these initiatives in improving education, health, and social welfare outcomes for children.