As a child mental health advocate in New York State, Evelyn Frankford stood at the sometimes turbulent intersection between family crises and special education programs. Children whose behavior was affected by family breakdowns were often placed in special education classes, when support services and treatment could have been more effective. “The practice was to place any students who ‘acted out,’ whatever the reason, into special education,” she says, “but many of these children didn’t need or benefit from special education. Their behavior was treated as an education problem, but often the acting out was a mental health problem made worse by family and community conditions that affected the school.”
The problem, from Frankford’s perspective, was that schools were treating special education as a cure-all for behavioral problems, rather than part of a continuum of strategies to ensure that students were psychologically prepared to learn. In New York, she was instrumental in getting funding for preventive mental health programs at elementary and middle schools. Now at EDC, Frankford works with colleagues in EDC’s Health and Human Development Programs to promote prevention and health promotion models on a national scale. The project she directs, Making Health Academic, develops and disseminates coordinated school health and strong prevention strategies to administrators, educators, and policymakers around the country.
“The research shows that prevention is a series of strategies—working with the school, working with families, working with the community,” explains Frankford. “You involve people in making decisions, you promote healthy behaviors, and you ultimately create an environment that is positive and supportive rather than one that leaves people alienated and angry.”
A Preventative Approach
Students with emotional disabilities present a serious challenge to themselves, their families, and their schools. As many as a quarter of all American children—some 10 million—are at risk of failure in school because of social, emotional, and health handicaps. For many of these students, no help is available. For those whose problems stem from mental or emotional disturbances, and are able to access help, that help usually comes only from special education, which may or may not be the appropriate intervention, either clinically or educationally.
“For poor, often minority children, special education has meant a segregated environment. Even for middle-class families, who can negotiate the system better, many kids with behavior problems get labeled so they or their families can get services, when in fact at least part of the response might be a more preventive, social, environmental one,” says Frankford. “That’s the strength of the preventive approach of coordinated school health and the Making Health Academic project: It recognizes that school is a whole, complex world that can change a student’s educational or mental health outcome.”
Making Health Academic builds on the link between a child’s health and his or her ability to learn. Project staff work with states to overcome the failure of piecemeal efforts to improve children’s health, well-being, and academic success. The 1998 publication Health is Academic: A Guide to Coordinated School Health Programs (Teachers College Press), edited by EDC in conjunction with the Centers for Disease Control (CDC), the Health Promotion Division of Adolescent and School Health, and more than 300 professionals from nearly 70 national organizations, contains the basic conceptual framework for the current strategy.
Coordinated School Health
The Coordinated School Health Programs movement, dating from the late 1980s, sees the schools as “ground zero” in children’s health and development—the most effective place to integrate children’s learning, health, and well-being. “School is the place where children are,” says Frankford. “It’s where we can reach everybody.”
Even as the school health movement has entered the mainstream, so too has special education. Particularly following the 1997 amendments to the Individuals with Disabilities Education Act, special education has been recast as a vital and integral part of whole-school thinking, learning, and reform. Frankford’s emphasis is on prevention as part of the continuum of care that should be available, but she is clear that “once a child is diagnosed with a mental or emotional illness, the schools have an important role in trying to enable that child to function at his or her highest level.”
An example, she says, of one of the innovations in the last 10 years has been to have a personal aide accompany a child with an emotional disturbance: “You think of it when a child has a physical disability, that that child might need a personal aide, but a child with an emotional disturbance can function in a public school with an aide, too—a person who constantly gives feedback on behavior and what’s required, and calms down an out-of-control student or takes him or her out of the room.”
Perhaps the most powerful case for effective prevention is the argument, emphatically shared by Frankford, that well-constructed prevention and early intervention strategies can deter a wide range of behavioral and health problems. “Directives come down through the chain of command: ‘Do something about teen pregnancy, do something about violence, do something about dropouts.’ The fact is that they all require the same intervention, which involves teaching decision-making skills, providing services, changing the school environment, and creating an opportunity for a kid to succeed. There’s no pregnancy prevention intervention that’s different from a dropout or substance abuse prevention intervention. It all comes down to a comprehensive approach that supports children’s functioning at their highest possible levels,” Frankford says.
Originally published on June 1, 2000