Miss Evers’ Boys (And Girls)

Most people who have ever been involved with human subjects’ rights know about the Tuskegee Syphilis Study. This was a study of untreated syphilis, in which 622 poor, African American sharecroppers, some with syphilis and some without, were evaluated over 40 years.

The study, funded and overseen by the U.S. Public Health Service, started in 1932. In 1940, researchers elsewhere discovered that penicillin cured syphilis. By 1947, penicillin was “standard of care” for syphilis, meaning that patients with syphilis received penicillin as a matter of course, anywhere in the U.S.

But not in Tuskegee. Not in 1940. Not in 1947. Not until 1972, when a whistle-blower made the press aware of what was happening. In the meantime, many of the men died of syphilis, 40 of their wives contracted the disease, and 19 of their children were born with congenital syphilis. The men had never even been told the nature of the study, they were not informed in 1940 or 1947 that there was now a cure, and they were not offered that cure. Leaders of the U.S. Public Health Service were well aware that there was a cure for syphilis, but for various reasons, they did not stop the study. Not in 1940, not in 1947, not even when whistle-blowers told them what was going on. They stopped it only when the press found out.

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In 1997 a movie on the Tuskegee Syphilis Study was released. It was called Miss Evers’ Boys. Miss Evers (actually, Eunice Rivers) was the African-American public health nurse who was the main point of contact for the men over the whole 40 years. She deeply believed that she, and the study, were doing good for the men and their community, and she formed close relationships with them. She believed in the USPHS leadership, and thought they would never harm her “boys.”

The Tuskegee study was such a crime and scandal that it utterly changed procedures for medical research in the U.S. and most of the world. Today, participants in research with any level of risk, or their parents if they are children, must give informed consent for participation in research, and even if they are in a control group, they must receive at least “standard of care”: currently accepted, evidence-based practices.

If you’ve read my blogs, you’ll know where I’m going with this. Failure to use proven educational treatments, unlike medical ones, is rarely fatal, at least not in the short term. But otherwise, our profession carries out Tuskegee crimes all the time. It condemns failing students to ineffective programs and practices when effective ones are known. It fails to even inform parents or children, much less teachers and principals, that proven programs exist: Proven, practical, replicable solutions for the problems they face every day.

Like Miss Rivers, front-line educators care deeply about their charges. Most work very hard and give their absolute best to help all of their children to succeed. Teaching is too much hard work and too little money for anyone to do it for any reason but for the love of children.

But somewhere up the line, where the big decisions are made, where the people are who know or who should know which programs and practices are proven to work and which are not, this information just does not matter. There are exceptions, real heroes, but in general, educational leaders who believe that schools should use proven programs have to fight hard for this position. The problem is that the vast majority of educational expenditures—textbooks, software, professional development, and so on—lack even a shred of evidence. Not a scintilla. Some have evidence that they do not work. Yet advocates for those expenditures (such as sales reps and educators who like the programs) argue strenuously for programs with no evidence, and it’s just easier to go along. Whole states frequently adopt or require textbooks, software, and services of no known value in terms of improving student achievement. The ESSA evidence standards were intended to focus educators on evidence and incentivize use of proven programs, at least for the lowest-achieving 5% of schools in each state, but so far it’s been slow going.

Yet there are proven alternatives. Evidence for ESSA (www.evidenceforessa.org) lists more than 100 PK-12 reading and math programs that meet the top three ESSA evidence standards. The majority meet the top level, “Strong.” And most of the programs were researched with struggling students. Yet I am not perceiving a rush to find out about proven programs. I am hearing a lot of new interest in evidence, but my suspicion, growing every day, is that many educational leaders do not really care about the evidence, but are instead just trying to find a way to keep using the programs and providers they already have and already like, and are looking for evidence to justify keeping things as they are.

Every school has some number of struggling students. If these children are provided with the same approaches that have not worked with them or with millions like them, it is highly likely that most will fail, with all the consequences that flow from school failure: Retention. Assignment to special education. Frustration. Low expectations. Dropout. Limited futures. Poverty. Unemployment. There are 50 million children in grades PK to 12 in the U.S. This is the grinding reality for perhaps 10 to 20 million of them. Solutions are readily available, but not known or used by caring and skilled front-line educators.

In what way is this situation unlike Tuskegee in 1940?

 Photo credit: By National Archives Atlanta, GA (U.S. government) ([1], originally from National Archives) [Public domain], via Wikimedia Commons

This blog was developed with support from the Laura and John Arnold Foundation. The views expressed here do not necessarily reflect those of the Foundation.

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Elementary Lessons from Junior Village

When I was thirteen, I spent a summer as a volunteer at a giant orphanage in Washington, DC. Every child was African-American, and from an extremely disadvantaged background. Every one had surely experienced unspeakable trauma: death or desertion of parents, abuse, and neglect.

I was assigned to work with fourth and fifth grade boys. We played games, sang songs, did crafts, and generally had a good time. There was a kind volunteer coordinator who gave each of us volunteers a few materials and suggestions, but otherwise, as I recall, each one or two of us volunteers, age 13 to 16, was responsible for about 20 kids, all day.

I know this sounds like a recipe for chaos and disaster, but it was just the opposite. The kids were terrific, every one. They were so eager for attention that everywhere I went, I had three or four kids hanging on to me. But the kids were happy, engaged, loving, and active. I do not recall a single fight or discipline problem all summer. I think this summer experience had a big impact on my own choice of career.

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There are two reasons I bring up Junior Village. First, it is to reinforce the experience that most elementary school teachers have, even in the most challenged and challenging schools. There are many problems in such schools, but the kids are great. Elementary-aged kids everywhere respond positively to just a little kindness and attention. I’ve visited hundreds of elementary schools over my career, and with few exceptions, these are happy and productive places with sweet and loving kids, no matter where they are.

Second, the observation that elementary-aged children are so wonderful should make it clear that this is the time to make certain that every one of them is successful in school. Middle and high school students are usually wonderful too, but if they are significantly behind in academics, many are likely to start a process that leads to disengagement, failure, acting out, and dropping out.

Evidence is mounting that it is possible to ensure that every child from any background, even the most disadvantaged, can be successful in elementary school (see www.evidenceforessa.org). Use of proven whole-school and whole-class approaches, followed up by one-to-small group and one-to-one tutoring for those who need them, can ensure success for nearly all students. A lot can be done in secondary school too, but building on a solid foundation from sixth grade forward is about a million times easier than trying to remediate serious problems (a privileged glimpse into the perfectly obvious).

Nationwide, we spend a lot more on secondary schools than on elementary schools. Yet investing in proven programs and practices in elementary school can ensure uniformly successful students leaving elementary school ready and eager to achieve success in secondary school.

I remember participating many years ago in a meeting of middle school principals in Philadelphia. The district was going to allocate some money for innovations. A district leader asked the principals if they would rather have the money themselves, or have it spent on improving outcomes in the elementary grades. Every one said, “Spend it early. Send us kids who can read.”

If you think it is not possible to ensure the success of virtually every child by the end of elementary school, I’d encourage you to look at all the effective whole-school, whole-class, one-to-small group, and one-to-one tutoring programs proven effective in the elementary grades. But in addition, go visit kids in any nearby elementary school, no matter how disadvantaged the kids are. Like my kids at Junior Village, they will revive your sense of what is possible. These kids need a fair shot at success, but they will repay it many times over.

Photo credit: By U.S. Fish and Wildlife Service Southeast Region [CC BY 2.0  (https://creativecommons.org/licenses/by/2.0) or Public domain], via Wikimedia Commons

This blog was developed with support from the Laura and John Arnold Foundation. The views expressed here do not necessarily reflect those of the Foundation.

For Drug and Alcohol Prevention, Good Intentions Are Not Enough

Every year, I learn something at the AERA meetings, but it never has anything to do with what’s on the program. Last year it was about recycling. This year, it was about ineffective but heart-tugging programs.

One morning in San Antonio, I came out of a restaurant after breakfast and there were two very sweet-looking middle school girls who were collecting money for their school’s DARE program. DARE (Drug Abuse Resistance Education) is a very widespread program that is designed to reduce drug and alcohol use. Police officers speak to students and get them to sign a pledge not to use drugs or alcohol. The girls told me DARE had now added a focus on preventing suicide. I was impressed by their presentation, and gave them twenty bucks.

Why do I consider this mundane transaction blog-worthy? The answer is that it just so happens that DARE is the very anti-poster child among advocates for evidence-based reform. It’s seen as an appealing-sounding yet ineffective program. According to Blueprints (www.blueprints.org), which rigorously reviews mostly drug, alcohol, and delinquency prevention programs, does not rate DARE as effective, and numerous reports of large-scale evaluations found no benefits. In 2001, the U.S. Surgeon General put DARE on a list of ineffective and sometimes counterproductive programs.

Further, Blueprints certifies alternatives to DARE that have been rigorously evaluated and found to be effective in reducing drug and alcohol use among teens. For example, Blueprints lists the following programs as meeting its “model” criterion or better for middle school students: Lifeskills Training (LST), Multisystemic Therapy (MST), Functional Family Therapy (FFT), and Positive Action. Several other programs met the Blueprints “Promising” standard.

Knowing all this, why did I contribute? Clearly, I contributed from my heart, not my mind. The girls were very sincere, and believe fervently in what they were doing. From their perspective they were not advocating for a specific program, they were taking a personal stand against drugs and alcohol abuse, and I think that was admirable, so I admired it, to the extent of $20.

At the same time, I recognized the irony, and also thought about how government and philanthropists must see DARE, and many other programs intended to improve social and educational outcomes for youth. They must equally see programs that are sincere, appealing, and clearly offered by good people to do good things. They are probably not aware that there are proven alternatives offered by equally good people to accomplish equally valuable goals, which happen to actually make a difference. Evidence just does not play much of a role, if any, in these decisions. Supporting good causes is inherently good, isn’t it?

The problem is that government and philanthropic resources and attention are limited, and if these resources are tied up in ineffective or untested programs, they are not going to support proven alternatives that could actually move the needle.

Worse, funding DARE instead of proven alternatives may eventually put the alternative programs out of operation, and convince good-hearted people who want to improve outcomes for youth that doing rigorous evaluations of their programs is foolish.

Neither those middle school girls nor their teachers nor probably their principals could change the situation in which they find themselves. Even if they knew full well that DARE has not been shown to be effective, it is morally irresponsible to do nothing about drug and alcohol abuse, and DARE may be the only approach they have on offer.

Yet at higher levels in the system, there is a responsibility to find out which drug and alcohol prevention programs are truly effective and to invest in those. Such programs are easily found on Blueprints, for example, if only our leaders were in the habit of consulting it. Those middle school girls could just as well have been collecting for a program that works. Had they been doing so, I would have been a lot happier about the fate of my 20 bucks, not only because it might actually reduce drug and alcohol abuse, but because it would also indicate a changed mindset, one that values actual impact rather than just good intentions.

This blog is sponsored by the Laura and John Arnold Foundation

The Message From Baltimore

Why Baltimore?

The tragic events of recent weeks could have happened in any big city in America. Rough treatment of minorities by police is hardly unique to Baltimore. Serious injuries and deaths are an all-too-common result. This is not to disparage individual law enforcement officers, who have to negotiate a complex and often hostile set of relationships that are not of their making. But again, this is not unique to Baltimore. After Ferguson, and New York, and North Charleston, a spark was bound to ignite somewhere, and that place happened to be Baltimore.

I have lived in Baltimore for more than 40 years. My wife and I have raised three children adopted from South America. One of them identifies himself as black. For years, he has told us stories of police harassment, being pulled over for “driving while black,” and being suspected of crimes he could not have committed. This is reality. I do not think there is any parent of a black child who does not understand this to be true, and who does not fear that an innocent act, a taunting remark, or simply being in the wrong place at the wrong time could end up with real harm at the hands of the police.

But this reality exists in every big city. Why was Baltimore the flashpoint?

One reason, ironically, is that Baltimore has been getting better. A down-at-the-heels port city in the 1970s, it is now improving economically, socially, and physically. Also, almost the entire power structure of the city is African-American. This includes the mayor, police chief, state’s attorney, and other leaders. An African-American middle class is growing rapidly but moving to the suburbs. Other middle-class people are moving into city neighborhoods and adding vitality and new businesses.

However, the people left in the inner city are not benefitting from all of this change. Many are unemployed or underemployed. Too many are dropouts or have such poor basic skills that they can only qualify for low-level jobs.

The anger and frustration of many Baltimoreans is understandable. They see people all around them, including people who look like them, entering the middle class. But from their point of view, the American dream remains unattainable.

My colleagues and I work in the schools that serve the very communities affected by the recent disturbances. The children who come to these schools start off bright-eyed and bushy-tailed, full of enthusiasm and confidence, like children everywhere. But then all too many of them experience failure. And all that motivation drains away. The majority of fourth graders read below the “basic” level on NAEP Reading. Poor reading skills make it almost impossible for children to grow up with confidence, graduate from high school, and go on to college or high-paying jobs.

None of this is surprising to any educator. But here is what should be infuriating: School failure is preventable. With every passing year we gain increasing evidence that virtually all children can learn to read and to succeed in other subjects. Using EDGAR standards, I count 28 elementary reading programs ready for use today that have at least moderate evidence of effectiveness. Yet none of these is used broadly enough to solve the reading problem in high-poverty schools. There is no reason that every Title I school in America should not be using proven programs.

The smoke rising over Baltimore in recent days is a signal to the whole country. Until we make opportunities available to all and treat everyone with respect and dignity, we can expect the frustrations of those who are shut out to boil over. Many things need to change, but one of the most fundamental is also among the easiest: Make sure that every child, whatever his or her background, learns to become a successful and confident reader. We know how to do it. Now let’s do it.

Hearts, Wallets, and Evidence

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Everyone knows that effective education is one of the best means of preventing all sorts of social ills. Yet when educational effectiveness reduces costs of special education or dropouts or police or prisons or unemployment, where do those savings go? Because most of the “pay me now” side of the equation is in school budgets and prevents “pay me later” in other budgets, “pay me now, pay me later” rhetoric is usually just that — rhetoric.

There’s something starting that may change this dynamic. It’s called social impact bonds. The idea is that investors purchase bonds to enable local governments to invest in services that are likely to save them a lot of money down the road. The services are rigorously evaluated, and if they are found to be effective, the investors get a return. David Bornstein recently covered this topic in a New York Times article. He says, “What’s most noteworthy about this approach is that, if it works, it creates incentives to finance prevention — the smartest and usually the cheapest way to address problems, but also the hardest thing to get governments to pay for. (Program costs are incurred immediately, but savings often accrue on someone else’s watch.)”

I have no idea whether social impact bonds make sense purely on a financial basis, but they make all kinds of sense for public-spirited investors who are willing to help their communities but want to be sure their money will be used effectively. They make all kinds of sense as a way to help government agencies fund needed services, and they make even more sense in building up the evidence base for replicable programs. Most of all, they make sense for kids, who benefit from increasingly effective programs.

So far, social impact bonds are showing up in areas such as delinquency prevention, where very big savings are possible within a few years. Recently, Goldman Sachs invested approximately $10 million in a New York City program for incarcerated youth, to reduce recidivism. If recidivism drops by more than 10%, Goldman Sachs could make up to $2.1 million in profit, far less than what New York City would save. In the UK, where the idea began, social impact bonds are being used in a broader range of preventive children’s services, including programs to reduce foster care, homelessness, and need for health care.

I’m sure that involving the private sector in this way will rub many people the wrong way, but if social impact bonds can bring the discipline of investors to social services and accelerate evidence-based reform, I’m all for it. Good hearts, good wallets, and good evidence have to add up to good outcomes for vulnerable children.

Why Not an Ounce of Prevention?

There’s an old story about a town that was planning to build a playground. In the town council, someone brought up the problem that the proposed site was at the edge of a cliff, so there was a danger that children might fall off. The council then got into a debate about whether to build a fence at the top of the cliff or station an ambulance at the bottom!

The point of the story, of course, is that it’s ridiculous to invest in remediation of problems that could have been prevented. Yet in education, that is what happens all the time. We spend billions on remediation and special education, not to mention damage caused by preventable delinquency and mental health problems, while investing relatively little in prevention, or research on which preventive approaches work.

There is plenty of evidence, for example, to the effect that early reading failure is catastrophic for students’ progress in school and in life. Further, there is plenty of evidence illustrating that most reading failure can be prevented using proven preschool, kindergarten, and primary-grades reading strategies using structured, phonetic one-to-one or small group tutoring, and whole-school reforms focusing on reading for all. Add to these the likely improvements in prevention that could result from ensuring that all children who need them have eyeglasses and other health services necessary to ensure that students are ready to learn every day.

There are good reasons to invest in proven educational programs at all levels and in all subjects, but when proven programs also reduce government expenditures within a few years, even the most bottom-line oriented administrator or legislator should see the need to invest in proven prevention. A fence is not only smarter and kinder than an ambulance – it’s also a lot cheaper.