Hotspot Schools

I want to make something clear: I do not agree with the Reformist’s premise that American Public Education is broken beyond repair and must be reinvented from the ground up, nor do I agree with their methods for “fixing” it, or, too often, their vision for what they want public education to become. There are problems that must be addressed. I just don’t agree with the Reformists what the problems are or what constitutes “solutions.”

I have said previously that I believe that Public Education is this nation’s crown jewel. Public Education is not an outmoded, discredited concept, but is, as a whole, reasonably healthy and does serve the nation well. Most schools do their job and serve most students pretty well. A few are truly exemplary. And some are indeed “broken”: so bad that they do not do anybody much good, students or teachers. But Waiting for Superman notwithstanding, I do not believe that worst cases represent public education as a whole. I am sure that if you were to evaluate schools on any reasonable criteria and plot the results, you would have something pretty close to a bell curve.

A few schools are doing just fine and should just continue doing what they are doing, because it obviously works. Most schools should pretty much continue what they are doing, but do it more and better; most schools have room for improvement and no doubt some pressing problems that need to be fixed. It is the schools on the bell curve’s back slope that are “broken” and require serious, urgent, but thoughtful attention.

I read in the January 24, 2011 New Yorker an article by Atul Gawande: “The Hot Spotters.”  http://www.camdenhealth.org/wp-content/uploads/2011/03/Gawande-Camden-Annals_17.pdf Jeffrey Brenner, a young Camden New Jersey physician, was asked to serve on a police reform commission. The commission undertook to study patterns of crime in the city by mapping assaults. Neither the police department nor the police union would cooperate with the mapping by making data available, and eventually the commission disbanded. But Brenner now had an idea.

He undertook to create his own maps by studying hospital records for emergency room admissions for assault. This led to making maps of health care costs around Camden, and the most expensive areas were designated “hot spots.” Next, the most expensive patients were identified, as well as what it was that made them expensive, both their individual medical ailments and the “system” that treated them. The idea then was to enlist the cooperation of doctors and social workers to work with the most expensive individual patients and, for example, to replace a reliance on expensive hospitalizations and emergency room visits with more pro-active primary care. To summarize, this initiative actually made more than a trivial difference in health care costs in Camden.

Now all this was very interesting because, if nothing else, it has great implications for containing Medicaid costs, while improving health care. But the real interest to me is the implications of this approach for school “reform” that will address real problems. Think of Brenner’s cost map of hospitals as an achievement map of schools. Think of that achievement map in medical terms – epidemiology.

I noted that Brenner did not proclaim American health care to be broken beyond repair, that more hospitals should be closed or doctors fired, rather that problems should be analyzed and addressed.

It got me to wondering if all the worst schools have really been identified. Basing identification on one or two tests may be misleading. Have the total programs been examined? Even the worst schools may be doing some good, for some students. A test score does not a program make. It indicates that problems exist, but it says relatively little about the nature of the problems (diagnostics), their causes (etiology), or effective remedies. The Reformists wave the bloody shirt of test scores, but they cite a limited body of research. They do not look very deeply. Their “reforms,” besides being heavy-handed will ultimately result in little actual improvement.

Find and identify the worst schools, especially the ones that seem to have been resistant to previous efforts to “improve” them. Start with them and really concentrate on them. Consider them public education’s “hot spots.” We will certainly learn things that will have applications elsewhere. But there is an important caveat.

According to Tolstoy, “Happy families are all alike; every unhappy family is unhappy in its own way.” When it comes to schools, Tolstoy had it half right: schools, both good and bad, are not all alike.  What good schools do that works for them may not translate directly to other schools, just as a medication may not be effective or even safe for all patients. The failures of bad schools may not be universal. Just as it is with patients in Camden, each is an individual with its own culture and its own complex of problems. No competent physician would utilize the same treatment with all patients, especially if the treatment addressed one symptom. Yet, most Politicians’ approach to Reform does essentially that.

How much do we really know about bad schools, both in general and particular bad schools?

How is a bad school bad? Yes, it has low test scores, like the patient has a fever. The fever is a symptom of an infection, but by itself, it can’t tell us much about that infection. We must look past that for what the real problems are. Has anyone really studied a bad school in depth? Really diagnosed it? Administration? Policies? Organization? Philosophy? Has philosophy ever been discussed, deliberated upon, eventually agreed upon, and set down on paper? What does the school think it is doing and why is it doing that? What should it be doing and why? The “is” and the “should be” are separate questions, but if they are widely divergent, that is both a problem and a starting point toward solutions. Faculty – collectively and individually, department by department? What mechanisms for change already exist, whether they are being utilized or not? How do teachers work and plan and brainstorm together? Are teachers even included in curriculum formulation? Do they have a voice in policy? What are individual teachers’ ideas about problems and possible improvements? What is the faculty culture? The student culture?

Study the school, for that matter, as a community. A class becomes a community after a while. The student body is a community, or an assemblage of interrelated communities, and the faculty is a community, or an assemblage of interrelated communities, for better or for worse, functional or dysfunctional.

Has anyone ever done a thorough, multi-part, multi-layered ethnographic study of a school, both good schools and bad? It would be quite the ambitious project. It would also be instructive. In the 1990s, Bruce Robbins and Driek Zirinsky of Boise State University did such a study of Nampa High School’s Language Arts Department (“Growing Into Leadership: Profiles from a ‘Good’ Department,” The English Journal, September 1996 http://www.jstor.org/pss/820706). The report was mostly laudatory, but the point is, it took a close look at how a school, or a department therein, actually works, in this case for better, in another case perhaps for worse.

Jeffrey Brenner could have been satisfied to lament that these “hot-spot” hospitals were inefficiently run and that “those people” “over-consume” health care.   The problem was more complex, and instead he chose to study it in a systematic manner, and on his findings base not just the treatment of individual patients, but the structure within which medical care is provided. The result, in Camden at least, seems promising. Costs for disrupting these patterns were more than offset by reductions in health-care costs in the areas studied. This seems counter-intuitive in the sense that we have all been taught “you can’t solve a problem by throwing money at it.” That is probably true if throwing money is the end, not the means, and if no attention is paid to targeting the money or evaluating the results. But it is also true that in too many cases, if no money is spent, nothing changes. No doubt there were many ways money could have been thoughtlessly spent in Camden without making one bit of difference. But relatively modest well thought out expenditures saved money in the end.

If we would identify the educational “hot spots” and the “sickest” students, if we would take care to diagnose the problems and distinguish the symptoms from the causes, if we would take the care to distinguish between healthy and diseased tissue (to continue the medical analogy), the results might well be better education for all, and more cost-effective education as well.

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