Joshua Sharfstein initiated the last session by opening the discussion. The key themes from the discussion are listed in Box 6-1. Carla Alvarado of the National Academies of Sciences, Engineering, and Medicine (the National Academies) asked about discretionary funding line items and whether schools had the ability or flexibility to create and pilot new initiatives. She noted that within public health, there are various restrictions on grants and general budgets. Robby Dodd responded that he did not need approval to design or implement Project SUCCESS but instead secured teacher buy-in to support and lead its implementation. Dodd added that the implementation did not have significant funding implications but did require administrative adjustments, such as adding an extra teacher planning period, which required coordinating teaching and class schedules and involving the teachers’ union to negotiate with the administration.
Philip Alberti of the Association of American Medical Colleges reflected on the various three-tiered models throughout different sectors and the implications of creating a singular and comprehensive model. Sharfstein reiterated Alberti’s point that different sectors were discussing the same things but using different tools for evaluation and problem solving. Sharfstein said that collaboration could come in the form of using common measures and models. An unnamed participant added that at the University of Virginia’s The Equity Center, a multisector team approach is used to serve the community better. The center has begun to build shared language and terminology.
On the topic of evaluation, Sharfstein added that student engagement is a difficult concept to measure beyond absenteeism and a sense of safety. He noted that educators present at the workshop looked beyond traditional measures such as test scores. He described these types of outcomes as core measures of well-being, which produced better health outcomes later in life, and he wondered about the extent to which these nontraditional educational outcomes would be of interest in the education sector. Sharfstein also described the potential collaboration effort to share absenteeism data with students’ pediatricians. This could be used to measure outcomes, and he surmised that something similar could be developed to capture nontraditional outcomes.
One audience member made the point of distinguishing middle school from junior high school. They asserted that relationships and safety are a high priority in middle school, but academic achievement is paramount in junior high school. Another participant expressed that there is a movement to give these nontraditional measures the same importance as others, although it varies from district to district. Funding is often tied to standardized test scores and absenteeism, so while that structure is in place, there will continue to be an emphasis on these more traditional measures as opposed to ones relating to well-being, such as those mentioned by Sharfstein. Johanna Rosenthal of Cardea stated that these measures were becoming more prominent as states and districts mandate safe and inclusive learning environments, as California did in its California Healthy Youth Act 8329.
In response to this comment, Joaquin Tamayo noted that there was “implicit bias and structures built into the algorithms of the math itself.” Tamayo explained that many evaluation methods and tools, such as the idea that there is an “average learner,” are flawed. Tamayo shared information about the Methods and Measures Across the Developmental Continuum at the Science of Learning & Development Alliance at Tufts University in Massachusetts. He noted that this initiative will attempt to measure the trajectory of a child’s development without considering what “normal” is and while removing other biases.
Alina Baciu of the National Academies expressed her confusion, which Sharfstein later mirrored, about the Healthy People 2030’s proposed objective of including fourth-grade students in measuring social determinants of health or contributions to academic success. Healthy People 2030 proposes to increase the proportion of fourth-grade students whose reading and mathematics skills are at or above the proficient achievement levels for their grade (Healthy People, 2019). An unnamed workshop participant briefly mentioned that the National Academies’ Forum for Children’s Well-Being is looking at “whole vital signs” as indicators for children’s health and that aspects relating to the Healthy People 2030 objectives1 are being evaluated.
The last key point discussed was destigmatizing middle school and middle schoolers. Gary Gunderson of Wake Forest University and Tamayo emphasized the importance of using positive language when referencing this developmental phase and said there are tremendous opportunities for growth and development for students, their families, and schools.
1 For more information on Healthy People 2030, see https://www.healthypeople.gov/sites/default/files/ObjectivesPublicComment508.pdf (accessed December 15, 2020).
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