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April 1, 1996
Vol. 53
No. 7

Full-Service Schools

In the library of the Salome Urena Middle Academy at Intermediate School 218, three-member teams are hard at work over Spanish lessons. Two members of each group—a student and a parent—are instructing a third member—a police officer from the local precinct. In return for lessons in the language of this Washington Heights neighborhood, the officers—mostly white and non-Hispanic—invite these families to visit the police station and to stay in touch. This mutually beneficial arrangement, which combines educational lessons with parental and community involvement, is the result of a collaboration between a school system and the Children's Aid Society in New York City.
All over the country, school and community people are putting the pieces together to help schools meet the varied needs of today's students and their parents. I call the product of these collaborative efforts "full-service schools," a term first used in Florida's landmark legislation (Department of Health and Rehabilitative Services 1991). The creation of one-stop centers where the educational, physical, psychological, and social requirements of students and their families are addressed in a rational, holistic fashion is attractive to both school people and social service providers. Community agencies can relieve schools of the burden of changing high-risk behaviors and have direct access to the students every day.
What's driving this movement? As anyone who works in a school knows, more and more children are arriving every day not ready to learn. Families who have difficulty clothing, feeding, and housing their children have little time for traditional family nurturing and enrichment. A second factor is the movement toward integrating programs. Everyone is fed up with categorical approaches that don't cure anything. One day it's substance abuse prevention, then teen pregnancy, AIDS, suicide, and, lately, violence. The demands for immunizations, pregnancy tests, mental health counseling, family counseling, and crisis intervention cannot possibly be met by existing school personnel.

Creating a Full-Service School

As the model in Figure 1 shows, full-service schools aim to provide both quality education and support services. Under the menu for quality education are various ingredients that the literature indicates are critical to revitalizing schools (Dryfoos 1994). These items generally fall into the educational domain, and schools systems assume fiscal responsibility for providing them.

Figure 1. The Full-Service School

Quality Education Provided by Schools

  • Effective basic skills

  • Individualized instruction

  • Team teaching

  • Cooperative learning

  • School-based management

  • Healthy school climate

  • Alternatives to tracking

  • Parent involvement

  • Effective discipline

Services Provided by Schools or Community Agencies

  • Comprehensive health education

  • Health promotion

  • Social skills training

  • Preparation for the world of work (life planning)

Support Services Provided by Community Agencies

  • Primary health services

  • Health screening

  • Immunizations

  • Dental services

  • Family planning

  • Individual counseling

  • Group counseling

  • Substance abuse treatment

  • Mental health services

  • Nutrition/weight management

  • Referral with follow-up

  • Basic services: housing, food, clothes

  • Recreation, sports, culture

  • Mentoring

  • Family welfare services

  • Parent education, literacy

  • Child care

  • Employment training/jobs

  • Case management

  • Crisis intervention

  • Community policing

  • Legal aid

  • Laundry

 

Under support services are examples of health, welfare, recreation, and life-enhancing programs that are in place in various combinations in schools around the country. Most of these programs are operated by community agencies that bring their own funding with them.
Other services, such as social skills training and life planning, might be provided by either schools or community agencies. The real challenge here is how to create a one-stop unfragmented collaborative institution. The answer is: with great patience and fortitude.
Various models of full-service schools are emerging in communities and schools with the greatest needs and the most disadvantaged populations. In such settings, the principal often acts not only as the leader in the restructuring, but also as the prime facilitator for assuring smooth integration of outside partners into the school environment. Security and maintenance are important issues.
Successful programs also rely on a full-time coordinator or program director, who builds a team of personnel sensitive to issues related to youth development, cultural diversity, and community empowerment. In many locations, bilingual staff are essential. A designated space such as a clinic or a center in a school acts as a focal point for bringing in services from the community. Indeed, the most important outcome of entering into the full-service schools process may be providing a magnet for other resources.

A Look at a Full-Service School

A recent conference on School-Linked Comprehensive Services for Children and Families identified 22 exemplary programs (U.S. Department of Education 1995). Intermediate School 218, mentioned earlier, is one of them. Let's look at some more ways that this New York City school is trying to serve its students and their families.
It's 7 a.m., and Intermediate School 218 is open for breakfast. Before school officially begins, students play sports or attend classes in dance and Latin band. Located in a new building in Washington Heights, the school offers students a choice of five self-contained academies: Business, Community Service, Expressive Arts, Ethics and Law, or Mathematics, Science, and Technology. A store in the school's attractive lobby sells supplies for students.
At the Family Resource Center, parents receive social services, including immigration, employment, and housing consultations. Social workers and mental health counselors are also on hand to serve students and their families. A primary health and dental clinic is on the premises.
After the official school day ends, the building stays open until 10 p.m. for educational enrichment, mentoring, sports, computer lab, music, arts, and entrepreneurial workshops. Teenagers are welcome to use the sports and arts facilities and to take classes along with adults on topics like English, computer work, and parenting skills. The school also stays open weekends and summers, offering the Dominican community many opportunities for cultural enrichment and family participation.
Intermediate School 218 is a true settlement house in a school, made possible through a partnership between the Children's Aid Society and Community School District 6.

More Exemplary Models

Another promising school-community collaboration can be found in Modesto, California. To better serve students and their families, this school system has formed partnerships with many outside agencies—public mental health, social services, health, probation, police, housing, and drug and alcohol agencies, as well as nonprofit health and service agencies.
The Hanshaw Middle School is open long hours to serve the needs of a deprived, largely Hispanic neighborhood (Modesto City Schools 1995). With support from Healthy Start—California's comprehensive school-linked services program—Hanshaw created a family resource center on the campus. The family center provides a wide range of activities—from aerobics classes to computer workshops. This center also houses an interagency case management team and a primary health care and dental clinic. A mental health clinician, on site every day, provides long-term family therapy and crisis intervention. After-school activities include sports and mentoring, and neighborhood outreach involves parents with school programs.
Another example of educational and support services provided under one roof can be found in the Bedford-Stuyvesant area of Brooklyn. The Decatur-Clearpool School, which opened in 1992, was designed to incorporate the Comer School Development Program (Knowles 1994). To provide varied services to its students and their families, this K–8 school collaborates with Clearpool, Sponsors for Educational Opportunity (both nonprofit organizations), and the Edwin Gould Foundation. An extended day program offers after-school activities for students. The Family Center offers many activities including mentoring, job training, and parent workshops. And, at the school's Health Center, run by the Brooklyn Hospital Center, students and their families receive medical, psychological, and social care.
The most unusual aspect of this school is a 335-acre residential center in the woods, the original Clearpool camp, which has been adapted for day trips and overnight academic retreats for Decatur students and their families. The year-round, two-campus school expects to add an extra 60-75 days to the school year.

Barriers to the Process

Attempting to provide so many services in one place, not surprisingly, is an immense undertaking. From the experiences of these and other promising models, we can learn about some of the obstacles to success.
Governance. As would be expected, the more complex the model, the more demanding the administrative arrangements. The mounting rhetoric calls for sophisticated collaborative organizations, whereby school systems and community agencies leave behind their parochial loyalties and pitch in to form a new kind of union (Melaville et al. 1993).
In reality, most emerging models are shaped by state and foundation proclivities. A grant goes either to a school system, which then subcontracts for services, or to a community agency (designated as the lead organization), which enters the schools through a memorandum of agreement. In neither case is governance changed.
New Beginnings in San Diego, which has completed its first evaluation, warns that it's "difficult to overestimate the amount of time collaboration takes" (Barfield et al 1994). The New Beginnings collaborative center brings together five major service agencies to run a center in the Hamilton School, staffed with family advocates. Participants there discovered that it was easier to get agencies to make "deals" to sign contracts to relocate workers to schools than to achieve permanent widespread changes in how services are delivered to families in San Diego.
Turf. Related to governance is turf: who owns the school building? When a whole new staff working for an outside agency moves onto school property, many territorial concerns arise. What role does the school nurse play in the school-based clinic? Why not hire more school social workers if family counseling and case management are needed? Issues arise over confidentiality, space, releasing students from classes, and discipline. It takes time and energy and, particularly, skilled principals and program coordinators to work through appropriate policies and practices.
Lack of continuity. To succeed, full-service schools depend on a stable group of people committed to the process. For example, the Decatur-Clearpool School, noted earlier, has operated effectively for several years, but the collaborative is currently facing challenges because of changing leadership. The district has had three superintendents and the school has had three principals in four years. Teacher turnover has been endemic, and each new faculty member must be oriented to the holistic, family-centered approach of the school.
Controversy. Another obstacle to creating full-service schools is communities and/or school boards that resist the idea of using the school building for anything but educational purposes. Experience throughout the country, however, has shown that this resistance has dissipated rapidly with the availability of state and foundation grants. A crucial aspect of launching full-service arrangements is to conduct extensive local needs assessments and planning prior to program development. In general, these early efforts equip parents and school personnel with the necessary data to convince decision makers and educate the media about the importance of integrating services in the school.
Funding. The annual cost for full-service school models ranges from $75,000 for Kentucky's Youth and Family Service Centers to $800,000 for the most comprehensive community-school. School-based clinics cost on the average $150,000 per year, not including large amounts of in-kind and donated goods and services. The annual cost for a school-based clinic user is about $100 per year, while the cost per student in a more complex arrangement is about $1,000.
States are major funders of these initiatives and, even with looming budget cuts, are moving ahead to support more comprehensive school-based programs. Except for a recent initiative in the Bureau of Primary Health Care, no federal grants go directly to communities and schools for integrated services. The full-service school concept has been recognized, however, in new legislative endeavors such as the revisions of Title 1, Empowerment Zone grants, and the Crime Bill (but the funding for after-school services did not survive the cuts). Federal regulations could be changed to facilitate the increased use of categorical dollars for integrated services, for example, Drug Free Schools, HIV prevention, special education, and mental health programs.
Many schools are already gaining access to Medicaid funds—for example, the Farrell Area School District near Pittsburgh, Pennsylvania, another comprehensive service provider. This small (1,280 students), extremely disadvantaged district has invited 57 partners to help operate a Family Center and several school-based clinics, which arrange for Medicaid reimbursement.
Two difficulties in using Medicaid money are eligibility determination and reimbursement procedures. The advent of managed care adds to the complexity, with school service providers struggling to establish either fee-for-service or per capita payment contracts with managed care providers. Legislation should guarantee that school-based centers can become "essential community providers" so that enrollees in managed care plans can obtain preventive services, such as mental health and health education, within these plans.
As pointed out by Modesto's superintendent, "the proof of any program funded by grant monies is sustainability after the grant ceases" (Enochs 1995). The Modesto City Schools have demonstrated how programs can be institutionalized. When their large grant from California's Healthy Start (about $400,000 per year over four years) expired, the school system was able to obtain continuing support from county agencies and the local health center while using Community Development Block Grant and Title I funds for core support.

Does Full-Service Have a Future?

While support for the concept of full-service schools is strong, even the most ardent advocates want assurance that centralizing services in restructured schools will make a difference in the lives of the children and their families. Evaluation results are spotty, not surprising given the early stages of program development and the difficulties inherent in program research. Much of the research has been on autonomous components such as school-based clinics or family resource centers (Dryfoos et al. 1996). Several states—Florida, Kentucky, and California—are beginning to produce reports on the more comprehensive programs that they sponsor (Wagner et al 1994).
In full-service schools with health clinics, clinic users have been shown to have lower substance use, better school attendance, lower dropout rates, and in a few places with targeted reproductive health services, lower birth rates. Students, parents, teachers, and school personnel report a high level of satisfaction with school-based services and particularly appreciate their accessibility, convenience, and confidentiality.
Early reports from the more comprehensive community-schools are encouraging. Attendance and graduation rates are significantly higher than in comparable schools, and reading and math scores have shown some improvement. Students are eager to come to schools that are stimulating, nurturing, and respectful of cultural values. Parents are heavily involved as classroom aides, and advisory board members, in classes and cultural events, and with case managers and support services. Property destruction and graffiti have diminished, and neighborhood violence rates have definitely decreased.
The full-service school is a home-grown product that can take many shapes: community schools, lighted school-houses called Beacons, school-based clinics, family resource centers. Relatively small investments by state governments and foundations are enabling innovative leaders to better use existing categorical resources to relocate personnel and devise more integrated delivery systems. Research will confirm that combining prevention interventions with school restructuring will create stronger institutions and schools will become neighborhood hubs, places where children's lives are enhanced and families want to go.
We know that the school's role is to educate and the family's responsibility is to raise the children. Many of today's parents need assistance in accomplishing that task. Full-service schools may be the most effective arrangement for achieving school, family, and societal goals.
References

Barfield, D., C. Brindis, L. Guthrie, W. McDonald, S. Philliber, and B. Scott. (1994). The Evaluation of New Beginnings: First Report, February 1994. San Francisco: Far West Laboratory for Educational Research and Development.

Department of Health and Rehabilitative Services and Department of Education. (1991).Request for Program Designs for Supplemental School Health Programs, Feb.1-June 30, 1991. Tallahassee: State of Florida.

Dryfoos, J. (1994). Full-Service Schools: A Revolution in Health and Social Services for Children, Youth, and Families. San Francisco: Jossey-Bass.

Dryfoos, J., C. Brindis, and D. Kaplan. (1996). "Evaluation of School-Based Health Clinics." In Adolescent Medicine: State of the Art. Health Care in Schools, edited by L. Juszak and M. Fisher. Philadelphia: Hanley and Belfus.

Enochs, J. (August 21, 1995). "Report on Implementation of SB-620 Three-Year Healthy Start Operational Grants to Develop Coordinated School-Based Interagency Services." Memo to Modesto City (California) Schools Board.

Knowles, T. (1994). "The Decatur-Clearpool School: Synthesizing Philosophy and Management." Paper prepared for the annual meeting of the American Educational Research Association meeting in New Orleans.

Melaville, A., M. Blank, and G. Asayesh. (1993). Together We Can: A Guide for Crafting a Profamily System of Education and Human Services. Washington, D. C.: U. S. Government Printing Office.

Modesto City Schools. (1995). "Modesto City Schools: 1994-95 Healthy Start Report. Hanshaw Middle School." Modesto, California, City Schools.

U. S. Department of Education. (1995). School-Linked Comprehensive Services for Children and Families. Washington, D. C.: Office of Educational Research and Improvement and American Educational Research Association.

Wagner, M., S. Golan, D. Shaver, L. Newman, M. Wechsler, and F. Kelley. (1994). A Healthy Start for California's Children and Families: Early Findings from a Statewide Evaluation of School-linked Services. Menlo Park, Calif.: SRI International.

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