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The successful implementation of the ISP involved solving problems at each of the school sites by adapting planned activities to the realities of the setting. It also involved a somewhat changed role for the steering committee, which was reflected in changes in its composition. The following section addresses the issues confronted during implementation and how they were addressed. The section is organized in two parts. The first focuses on the steering committee and how it changed. The second addresses problems encountered at each school and how the ISP adjusted its activities to solve the problems.
In the two years that the steering committee met prior to receipt of EPP funding, its membership comprised high-level decisionmakers from the participating organizations. For example, the superintendent of schools and the chief executive officers of local not-for-profit social service organizations were members of the steering committee, as were the director of the Welfare Department, the director of public health, and the heads of key departments in the CU Schools of Medicine and Education. Once the partnership began operating, the steering committee grew to include individuals responsible for providing service at the school sites. Nurses from the school-based clinics, welfare caseworkers, and social workers from the university participated in the steering committee.
The original conception of the steering committee was that it would allocate resources and services. However, as problems were encountered at school sites, participating personnel expressed the desire for an opportunity to meet with the decisionmakers so they could express their concerns and work as part of a team to resolve the problems. The change of the steering committee from a policymaking to operational body was reinforced by staff development. The ISP addressed the issues of interorganizational collaboration by providing staff development to the steering committee. The professional development activities included some cross training, in which teachers learned the work of social workers and vice versa. This professional development increased participants' understanding of each other and the issues each must face. In addition, the cross training, coupled with the discussions among participants, led to some changes in services at the school level. The most notable of these changes was that social workers at Padres Middle School offered instruction in group dynamics to students.
The move from the policy focus to an operational focus had some costs. For example, accommodating welfare services at schools involved not only space allocation and additional telephone lines at the school sites, but also interaction with school personnel and the resolution of issues related to confidentiality. Simultaneously, the Welfare Department faced changes in how cases were assigned to workers and adaptations to the computer system. The operationally oriented steering committee was well able to deal with issues related to interaction, but policy decisions were required to address computer compatibility and case assignment. In the absence of an arena for discussions of how policy changes in case assignment might affect potential expansion of the ISP, the Welfare Department dealt with the problem unilaterally. This solution was successful throughout the term of the project, but begged the more basic question. Similarly, the issue of computer compatibility was addressed within the Welfare Department, and there was no discussion of the costs and benefits of ensuring that medical and school records were compatible with the welfare records.
On the positive side, the inclusion of service providers allowed difficult issues to be resolved. Perhaps the most difficult problem confronting the ISP was that the various service providers have different perspectives--and professional obligations--with regard to confidentiality. The foundation of understanding and trust built through work and steering committee meetings was the basis of the agreement that the health profession's policy of maintaining patient confidentiality would prevail. As a result, school administrators had minimal information about particular students and their situations, and required the administrators and health service providers to trust one another and their institutions. As various confidentiality issues arose, school administrators and other participants in the ISP shared information appropriately--and to all participants' satisfaction.
All schools faced the problem of providing space for the new services. The on-site coordinators, parent coordinator, social workers, caseworkers, and health professionals required space and resources to do their jobs. Because the ISP wanted the new services integrated into the day-to-day activities on campus, school principals made an effort to find space accessible to students, faculty, staff, and families.
The ISP supported a site coordinator at each school. The coordinator facilitated, coordinated, and communicated across institutions. Site coordinators were an immediate resource for all participants. The on-site coordinators were supported by the ISP coordinator, who interacted with both policymakers and service delivery personnel. The ISP coordinator identified common problems and helped people find their own solutions.
Each school presented different challenges to implementing the ISP, arising from differences in the ages of students, school demographics, prior experience with similar programs, and the culture of each school. As the challenges were addressed, the ISP adapted to each setting. The following section is organized according to the school site.
The Dodger Elementary School principal was willing to confront the challenges presented by the highly mobile school population. She welcomed the ISP and its services.
Perhaps because of her support, but also because of the age of the students, many aspects of the ISP were very successful at Dodger. For example, it was the most successful site for welfare services. The caseworker and on-site coordinator immediately established an effective working relationship. Additionally, the caseworker established rapport with most of the school staff, creating a comfortable environment for providing services.
The social workers took on an additional role at Dodger. As originally planned, the social workers counseled students who were referred to them. Each referral was discussed in a weekly ISP meeting at the school. According to the social workers, the weekly meetings facilitated communication among personnel from participating organizations. In addition to counseling, the social workers taught classes to fifth- and sixth-grade students that focused on group behavior. In part, the classes were a replacement for conflict resolution activities that were implemented in the other schools. The CCR believed that the types of services they provided were inappropriate for young children, but school staff felt strongly that some activities that addressed positive behavior in groups was needed, particularly in a school with high mobility. An added benefit from the teaching was the increased exposure of the social workers to the faculty, staff, and students of the school. As a result, teachers and other staff were comfortable referring students to the social workers for counseling. Through ongoing interaction with faculty and staff, the social workers were able to inform teachers and staff about behavior that may indicate problems that could be dealt with appropriately in counseling.
At Dodger, the parent coordinator's position changed over time. At first, the parent coordinator's primary duties were related to teaching and coordinating social services. This role entailed making home visits and coordinating social services for families. For example, the parent coordinator facilitated housing assistance, enabling families to remain in their homes and the children to remain at Dodger. Once the social workers began providing counseling, the parent coordinator increased her focus on services for parents. With the help of the on-site coordinator, parent activities were coordinated with existing programs, such as the PTA and Chapter 1. The parent coordinator became responsible for monthly parenting workshops sponsored by the PTA and field trips that were part of the Chapter 1 program.
The elementary school chose not to have a medical clinic on site. Instead, health services at Dodger focused on health education and school entry exams for kindergarten students, as requested by parents. Even so, school personnel and the on-site coordinator found it difficult to persuade families to come to school for their children's exams. School personnel attributed the low turnout for exams to the unease parents felt in the school environment.
The principal and assistant principal at Padres Middle School also welcomed the ISP. The school staff had been deeply involved in restructuring activities and, according to the assistant principal, believed that support services would provide needed help to students. With such help, they thought, students would be better able to concentrate on academic matters.
The school rearranged the nurse's and counselors' offices to accommodate the provision of health services. Although the rooms were not private because fire department regulations prevented full closure to the ceiling, the doctors adjusted by doing such things as playing the radio during private conversations so others could not overhear.
Much of the success of the middle school clinic was attributed to the work of the on-site coordinator and the nurse practitioner. Often, the health clinic was the initial point of contact for students, and frequently they were referred from the clinic to another service, such as counseling.
Despite support from the staff, the parent coordinator initially was unsure of how to provide parenting services to middle school children. She decided to coordinate a sibling group for sixth, seventh, and eighth graders, which provided information about baby-sitting. Over the course of the year, about half the sixth-grade students regularly attended the course, which was held during lunch.
Padres Middle School was the site of the most successful conflict resolution program. The conflict resolution program was tailored to individual student needs and was one of a menu of services offered to students referred for assistance. The conflict resolution activities were most useful for conflicts with parents or other caregivers.
The ISP had the most difficult time implementing programs at the high school. In part, this reflected the more difficult issues raised by adolescents. For example, health clinics faced the problem of providing contraceptives at the high school, an issue that did not arise at the other schools. In addition, there were project-specific problems at the school.
Giant High School was the last school to hire an on-site coordinator because of differences between the principal and the ISP coordinator about the type of person who would best fill the job. In addition to the slow start, the on-site coordinator found it difficult to fit into the structure of the high school. Consequently, communication in the high school was difficult. The number of counselors and assistant principals created a maze for the on-site coordinator to navigate. Additionally, the health clinic's operation at the high school predated the ISP and had established processes for referrals. Integrating established and new roles and structures made it difficult for the coordinator to facilitate ISP activities at the high school.
Three programs were successful at the high school. First, the school health clinic was already established at Giant so space and facility issues did not arise. Partly because other counseling services were available through the ISP, the principal was willing for the clinics to dispense contraceptives, although he wanted little publicity about it. The medical staff continued to operate as it had prior to the ISP and worked independently from other ISP staff.
Second, the social workers dealt with very serious counseling problems at Giant. Four students were hospitalized. Other students had problems related to AOD abuse and violent crimes.
Third, the parent coordinator sponsored a parenting course for pregnant and parenting students. Although the target population was young women, fathers and fathers-to-be occasionally participated. Approximately 40 students were part of the parent group. Speakers and workshops were coordinated with other social service agencies, and services were provided to students on campus. Fathers and fathers-to-be were referred to a service provider sponsoring an off-campus group specifically designed for teen fathers.
Neither the conflict resolution program nor the placement of welfare services at Giant worked very well. Giant High School had the highest truancy rate in the CPS. School administrators and staff from the CCR believed that conflict resolution techniques would be helpful in resolving conflicts (with parents, relatives, teachers, or other students) that hinder regular school attendance. However, the high school staff and faculty were unwilling to participate, and staff from CCR were unwilling to change their approach. Consequently, the program was underused. After a year, school staff decided to focus on students who were developing a truancy problem rather than the "hard-core" students. Staff seemed willing to work with the less hostile students. At the same time, CCR staff indicated willingness to modify their techniques to fit with the setting.
The environment at Giant was less supportive for the welfare caseworkers as compared to other schools. Three caseworkers were located at the high school from the beginning of the project. However, until the on-site coordinator was hired, there was no liaison with school administrators and other participants in the ISP. In addition, the computer equipment at the high school was slightly different from the computer the caseworkers used at the office, so the caseworkers experienced some problems. Further, the computer did not always work. When the coordinator came on board, some problems were eliminated, but both school administrators and ISP staff agree that more efforts were needed to integrate the caseworkers into the high school.
The ISP was affected by congressional action that cut funding to the EPP. As a result, the partnership received funds for a shorter period of time than anticipated. Nonetheless, the ISP achieved notable impacts on the participating institutions.
Perhaps most important, the ISP moved from conversation to action. EPP funding enabled individuals representing organizations that provide services to children and families to try out ideas that they had embraced. They found that doing was harder than talking, but that it was possible to overcome problems and work together. For example, school personnel were more willing to risk community reaction to providing contraception because of the support they received from others in the ISP. Similarly, the Welfare Department changed the methods they used to assign clients to caseworkers in order to facilitate school-based services. And, social workers saw an educational as well as a counseling component of their job.
The ISP served literally hundreds of children and families, providing parent education, health services, counseling, and conflict resolution. At least one suicide was prevented, according to health workers. Severely troubled students received services in a timely way.
Despite these outcomes, the ISP lasted too short a time to tell whether such integrated services help preserve families, encourage students to complete school, or increase overall health. Perhaps more important, the ISP operates with a focus on children in need, rather than on the system changes that might place fewer children in such circumstances.
Although ISP partners never assumed outside funding always would be present, they were surprised at Congress's failure to fund the EPP. Consequently, the steering committee was faced with decisions about hard money support during the early implementation of the ISP, before results could be known. Decisions about continued support were made by each participating organization, and the levels of commitment varied, depending on whether participation was simply a reallocation of resources or required new resources. The medical school decided to continue its services at the school-based health clinics, and the Welfare Department also committed to maintaining caseworkers at the school sites. For both organizations, participation simply meant assigning staff to different locales, with no major additional expenses. CPS agreed to provide continuing support for a coordinator but not for school site coordinators or other staff, including the parent coordinator.
One year after the EPP funding ended, the ISP existed in the three schools and additional schools may be added. However, the focus remains on individual children rather than on systemwide change. Further, the steering committee no longer meets. Like many of the EPP projects, the ISP has institutionalized a number of activities, but has not institutionalized the partnership.
Activities originally sponsored by the ISP continue to provide important services to students and their families. However, the services are not integrated in the way originally envisioned. That is, each organization serves students and their families according to its own guidelines, and referrals to other services exist as they did before the ISP. Because school site coordinators are no longer in place, no one is responsible for ensuring that families receive the full range of services that would help them. Even more important, the focus on individual children provides no impetus for organizations to work together in ways that might prevent the need for such support. As generally described, integrated service projects not only assist those in need, they work with schools and others to change their actions so they attend increasingly to prevention rather than treatment.
Despite its shortcomings, many of which may be attributed to the abrupt end of funding, the ISP provides several lessons to other partnerships. First, it demonstrates that many barriers to collaboration can be overcome with time, the appropriate structures, and commitment. ISP members were able to accept different approaches to confidentiality in a way that validated involvement in the collaborative and served students and their families. Second, the ISP illustrates the need to adjust project policies and procedures to adapt to each site, whether based in schools or other organizations. Although the project adhered to general principles, particular applications varied according to the history and culture of the location. In the ISP, when participants were rigid about their approaches, as was the CCR in the first year, little was accomplished. Third, the ISP shows that truly integrated services are difficult to deliver, but that coordinated service delivery accomplishes a great deal. Finally, the ISP is an example of a partnership that required external funding to get moving but was able to survive even an unexpected loss of outside money.
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[Storefront School Partnership Part A]
This page was last updated January 8, 2002 (jca)