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Integrated services

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Title:
Integrated services a systemic response to children and families-at-risk
Creator:
Miller, Lynn D
Publication Date:
Language:
English
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xi, 174 leaves : illustrations ; 29 cm

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Subjects / Keywords:
Family services -- Colorado ( lcsh )
Family services ( fast )
Colorado ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 157-174).
General Note:
Submitted in partial fulfillment of the requirements for the degree, Doctor of Philosophy, Educational Leadership and Innovation.
General Note:
School of Education and Human Development
Statement of Responsibility:
by Lynn D. Miller.

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Source Institution:
|University of Colorado Denver
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|Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
38277480 ( OCLC )
ocm38277480
Classification:
LD1190.E3 1997d .M56 ( lcc )

Full Text
INTEGRATED SERVICES: A SYSTEMIC RESPONSE TO CHILDREN AND
FAMILIES AT-RISK
by
Lynn D. Miller
B. A., University of Colorado, 1980
M. A., University of Colorado, 1989
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Educational Leadership and Innovation
1997


1997 by Lynn D. Miller
All rights reserved


This thesis for the Doctor of Philosophy
degree by
Lynn D. Miller
has been approved
by
Robert L. Smith, Dissertation Advisor
John C. Buechner, University of Colorado President
Date L/j/A/7


Miller, Lynn D. (Ph. D., Educational Leadership and Innovation)
Integrated Services: A Systemic Response to Children and Families At-Risk
Thesis directed by Professor Robert L. Smith
ABSTRACT
This study examines integrated service programs detailed in the literature in
order to formulate common components and methods of program evaluation. While
integrated service programs have existed for decades, few have been studied for
commonalties. A synthesis of effective program components is offered and a case
study of a particular Communities in Schools program in Colorado provides additional
supporting evidence.
Twenty-four programs are compared in the literature in operation from 1989 -
1995. A case study of a program in Colorado was conducted with findings applied to
the literature on integrated service programs. This perspective provided a frame of
reference for comment on the potential for school and agency partnerships to affect one
aspect that appears to be integral to a childs academic success: self-esteem.
The case study approach, used in the Colorado portion of the study, includes
both qualitative and quantitative methods. Interviews were conducted with 18 people
working in the program during its inception as well as during the fourth full year of
operation. A self-esteem inventory was administered to 88 middle school students at
three different times. Findings of the inventory indicate that the students in the program
suffered from lower general self-esteem, and this score was significantly related to
IV


lower socioeconomic level. Another finding is that the overall self-esteem level rose
with years in the program.
This study generated the following conclusions: 1) Collaborating programs
have a unifying mission that addresses cooperation of disciplines and systemic
treatment of families and communities, and governing boards reflect participant
membership. 2) Planning time is critical. 3) Staffs need additional training in cross-
disciplinary service. 4) A mechanism for conflict resolution needs to be in place.
5) Parents and community are keys to success. 6) Programs either target services to
families with specific problems or make services generally available to all families.
7) Funding comes from a variety of sources. 8) A client-centered approach is
mandatory. 9) Programs run the gamut from single site integration to national, multiple
site implementation. 10) Programs offer a variety of services by more than four
collaborating agencies.
This abstract accurately represents the content of the candidates thesis. I recommend
its publication.
Signed
Robert L. Smith
v


DEDICATION
To Cole and Lane
You both have sacrificed much during this process. I appreciate your understanding
when I was busy working, writing, and doing anything that did not seem like it was
much fun. Now let the fun begin!
To Mom and Dad and my nuclear family
You have always been so quick with encouragement, support and love. I could have
never done this without your faith in me.
To Diann and Denise
For my sister Diann, who died shortly before I began my doctoral program, and for my
best friend Denise, who died shortly before I finished my defense. I have missed you
terribly and hope you are watching. Your gentle spirits have guided me more than
others would probably imagine.


ACKNOWLEDGMENTS
I would like to thank Robert Smith, my dissertation advisor, not only for guiding me
through this process, but for introducing me to the professional world of the
International Association of Marriage and Family Counselors, where I met many
counselor educators and Master marriage and family counselors. It is perhaps my
work with this group that has formed the foundation of my education, and where I
found my greatest support.
To the rest of my dissertation committee, Alan Davis, Andy Helwig, Stacy Kalamaros,
and John Buechner, thank you for you time, effort, and constant encouragement. The
new doctoral program was difficult to negotiate, and I appreciate the additional time and
effort that this dissertation required of you.
I would like to acknowledge the students, families, and school personnel of Adams
County School District 14 for allowing me the privilege of working in the Communities
in Schools program and learning about the process of an integrated services program.
Finally, I would like to acknowledge the graduate students in counseling at the
University of Colorado at Denver and at Boise State University for forgiving me for
occasional lapses in attention to my teaching duties.


CONTENTS
Tables..................................................... xi
CHAPTER
1. INTRODUCTION......................................... 1
Statement of the Problem...................... 9
Purposes of the Study........................... 12
Research Questions.............................. 13
Definition of Terms............................. 15
Delimitations and Limitations of the Study...... 16
Basic assumptions............................... 18
Methodology................................... 19
Identification and Description of Sample for Case Study.. 24
Instrumentation................................. 25
Collection of the Data.......................... 25
Organization of the Study....................... 26
2. REVIEW OF THE LITERATURE............................... 27
Integrated Services............................. 29
Historical Traditions........................... 31
Need for Integrated Services Programming........ 36
Self-Esteem..................................... 39
Benefits........................................ 42
Service Delivery Site: Schools or Community..... 43
Barriers........................................ 46
Systemic Issues........................... 46
Funding Issues............................ 47
Organizational Issues..................... 49
Philosophical Issues...................... 52
Access.................................... 53
vni


Problems of Evaluation.................... 54
Emerging Criteria for School-Linked Services..... 55
Unifying Mission.......................... 56
Planning Allotment........................ 57
Staff Needs............................... 58
Conflict Resolution....................... 59
Parent Involvement........................ 59
Community Involvement..................... 60
Target Population........................ 61
Financial Support......................... 62
Client-Centered Approach.................. 63
National Communities in Schools Projects......... 63
Funding................................... 65
How It Works.............................. 65
Communities in Schools, Adams County, Colorado.. 66
Academy of the Rockies.................... 66
Services Offered.......................... 67
Philosophy................................ 68
Summary.......................................... 69
3. METHODOLOGY........................................... 73
Research Questions............................... 73
Procedures Used for Study and Instrumentation... 75
Review of Integrated Services Literature.. 75
Interviews................................ 78
Standardized Instrument................... 79
Pictorial Protocol........................ 82
Identification and Description of Sample for Case Study.... 84
Collection of the Data........................... 86
Treatment of the Data............................ 86
Summary.......................................... 88


4. ANALYSIS OF DATA......................................... 89
Integrated Service Program Findings................ 90
Research Question One........................ 90
Chart of Integrated Programs.............. 91-100
Program Components........................... 101
Research Question Two........................ 104
Integrated Service Program Evaluation Design. 105
Research Question Three...................... 110
Interview Themes............................. Ill
Synthesis of Interview Responses............. 124
Data Collection.............................. 126
Self-Esteem Scores........................... 129
Summary of Case Study Quantitative Data: Relationship
to Research Questions.................. 135
5. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS.... 139
Summary............................................ 139
Review of the Literature..................... 140
Subjects, Instrumentation, and Statistical
Treatment of Data...................... 144
Summary of Findings................................ 145
Academy of the Rockies Participants.......... 146
Conclusions of the Study and Discussion
of the Findings........................ 147
Recommendations.................................... 149
APPENDIX
A. INFORMED CONSENT LETTER.................................. 150
B. CULTURE-FREE SELF-ESTEEM INVENTORY....................... 153
C. INTERVIEW QUESTIONS...................................... 155
REFERENCES........................................................... 157
x


TABLES
4.1 Gender by Cohort Crosstabulation........................ 127
4.2 Frequency Table of Ethnic Grouping...................... 128
4.3 Frequency Table of Socioeconomic Grouping............... 129
4.4 Mean Self-Esteem Scores for three cohorts............... 130
4.5 ANOVA Table............................................. 130
4.6 Multiple Regression Analysis Model Summary.............. 131
4.7 ANOVA................................................... 132
4.8 Multiple Regression Coefficients........................ 132
4.9 T-Test Paired Samples Statistics........................ 133
4.10 Paired Samples Correlations............................. 134
4.11 Paired Samples Test..................................... 134
xi


CHAPTER 1
INTRODUCTION
The role of American schools in the lives of children and families has expanded
over the last 100 years from being exclusively characterized by academic instruction to
include a variety of health, social services, and social training (Crowson & Boyd,
1993; Dryfoos, 1994; Jehl & Kirst, 1993). Recently different agencies that provide
nonacademic services have sought more ways to deliver comprehensive services to
families and children at a central location. This is service integration. Historically
agencies have provided distinct, separate services that are physically scattered
(Crowson & Boyd, 1993; Dryfoos, 1994; Kahne & Kelley, 1993). A consensus
among diverse groups and researchers has recommended that service integration,
especially at schools, is a formidable response to the many problems and barriers of the
current service delivery system operating in America.
This first chapter presents a brief overview of integrated service programs in the
United States, their history, a rationale for location of mental health services in schools,
and the problems associated with these programs. The purpose of the study is then
explained, and the three research questions are detailed. A definition of key terms
follows, then delimitations, limitations, and assumptions of the study are examined.
Methodology is presented. Identification and description of the sample for the case
1


study as well as instrumentation and collection of the data is found in the last pages of
this chapter.
Schools have responded to societal problems: Mass epidemics of contagious
diseases at the turn of the century brought health services to schools in the way of
inoculations; the world wars and the need to identify particular traits and skills of
incoming soldiers brought IQ tests, personality profiles and career planning programs
to high schools; and a rise in drug and alcohol use raised concern for youth so that
educational and affective programs of prevention in the 1970s were implemented
(Crowson & Boyd, 1993; Myrick, 1993). Some of these programs were dropped,
others became permanently integrated into curriculum, and some were increased. The
drug and alcohol prevention efforts, for example, increased in scope to provide AIDS
awareness and training. Programs usually become permanent when an organized
constituency advocates for their continuance when fundamental change in pedagogy is
not required (Jehl & Kirst, 1993).
The expanded role of American schools has often been met with resistance. For
example, a number of programs depend on outside funding, reflecting the economic
health of the nation or the agenda of a political party. Also, voices in the community
regularly shape the nature of what is appropriate for schools (Kindred, Bagin &
Gallagher, 1990). The basic role of schools in delivering social services is "an issue of
great controversy in communities where a vocal minority believes schools should not
address issues that are the exclusive province of the family" (Gardner, 1993, p. 152).
The "Back to Basics" movement is one example of the growing vocal minority in
today's education reform movement. Finally, outside service providers that offer
special programs continue to seek effective models of delivery in schools rather than the
2


present system that often is fragmented and fails to coordinate available services, such
as education, health care, juvenile justice, family counseling, and welfare, in ways that
provide children consistent and dependable support" (Kahne & Kelley, 1993, p. 187).
Despite the problems of funding, philosophy, and service delivery, schools still
operate as a viable avenue for integrating a variety of programs other than pure
academics (Crowson & Boyd, 1993; Smrekar, 1994; Soler & Shauffer, 1993). In
part, affective and social programs in the curriculum are a response to the tenor of
society. Families of the 1990s in the United States more so than other industrialized
nations suffer higher rates of fragmentation and indicators of at-risk youth behavior,
including: higher rates of divorce, higher rates of teenage pregnancy, higher rates of
suicide, higher rates of single parent homes, and higher rates of poverty
(Bronfenbrenner & Neville, 1994, p. 3). These social, demographic and economic
factors make it increasingly difficult for families to provide healthy, developmentally
appropriate environments for their children (Task Force on Comprehensive and
Coordinated Psychological Services for Children, 1994; White & Wehlage, 1995).
The issues confronting families are complex and often interrelated; rarely a family
suffers from one problem in isolation from other problems (Kahne & Kelley, 1991).
For instance, a child exhibiting poor academic performance at school often returns to a
home characterized by violence, substance abuse, or the confounding effects of
poverty. Families needing economic support may also need housing assistance, and/or
medical attention, and/or academic interventions at school. A response to one need may
not negate other remaining problems. A poorly performing child may receive after-
school tutoring to improve his/her academic record, and still go home to a distressing
environment.
3


Mental, physical and social services programs targeting at-risk youth often
work in an isolated and fragmented manner expecting students and their families to seek
aid from a variety of disconnected agencies. Families faced with multiple problems can
seek help from a variety of institutions: Social Services, Aid to Families with
Dependent Children (AFDC), Housing and Urban Development (HUD), Social
Security administration, assorted state and county programs, local community ventures,
companies and employers, religious organizations, private therapists, publicly funded
mental health agencies, welfare and food stamp programs, Medicare and Medicaid, and
other human service agencies. Despite the number of agencies offering service and aid,
barriers to access can be monumental. For a family in crisis, negotiating the maze of
service providers (which might include understanding which agencies provide
particular services; understanding lengthy, somewhat complicated paperwork;
discovering physical location of often geographically-distant providers) can prove so
daunting and overwhelming that families simply fail to take advantage of these
programs. Even if a family has medical insurance with mental health benefits, the
managed care system currently established in the United States can be very difficult to
understand and negotiate.
Families with complex, interrelated problems require comprehensive services
from a number of these agencies; they need integrated and sustained interventions
delivered by professionals who recognize and are able to respond to a family's multiple
problems and needs (National Commission on Children, 1991). Agranoff (1991, p.
533) defines service integration as the quest for the development of systems that are
responsive to the multiple needs of persons at-risk, while Kahn and Kamerman (1991,
p. 5) describe it as a systematic effort to solve problems of service fragmentation and
4


the lack of an exact match between an individual or family with problems and needs and
an interactive program or professional specialty. The fundamental philosophy of
service integration is one of cross-disciplinary professionals working as a team to share
knowledge about how best to provide services to children and families.
Although service integration models are varied, they all provide a venue for
offering a collaborative platform by a variety of independent institutions allowing for
academic, mental and physical health services. The assumption is that integrated,
comprehensive services will respond more effectively to interrelated needs of families,
reduce overlap of services, and make better use of community resources (Kahne &
Kelley, 1993). The other benefit is that families can locate and access resources more
readily in one building.
Integrated service delivery focuses on providing comprehensive mental,
physical, academic and social services to families by a panoply of service providers.
The center of service integration is a concern for the whole child. With this approach
children are not simply "diagnosed" and identified as having pathological problems. If
a child or family is failing, then the system is also seen as failing, including the family
and the school. Integrated service delivery recognizes that the system is as much at
fault for the increase in rising social problems.
Why should educators be interested in this problem? Why are schools
involved? Educators, long concerned with the development of the whole child, have in
large part understood that the mental health of a child is as critical to the child's healthy
development and growth as are reading, writing and arithmetic (Harter, 1994). The
social and emotional health of a child is tied to his/her academic performance, and
school personnel acknowledge this phenomenon (Crowson & Boyd, 1993;
5


Gottfredson, 1987; Illback, 1994; Kahne & Kelley, 1993). A child is less likely to
learn if he/she comes to school hungiy, tired, or disturbed from the violence in the
home or community. The impact of poverty, neglect, and violence on a child is
indeterminable. Studies support the finding that the academic arena is often a predictor
of success or failure: Children who fail in the educational system often experience
difficulties in other areas of their lives (Sole & Shauffer, 1993, p. 135). If the schools
want to increase the number of children who succeed, then they will have to recognize
and deal with other influential factors in a childs life.
This socioemotional development is inextricably linked to the education of
youth, and it is this process which is one of the primary objectives of schools and
communities. Marrett points out that in American society, "Schools, and especially
public schools, have had two general missions: to foster the development of
individuals, and to promote the general welfare" (Clune & Witte, 1990, p. 235). No
specific mention of academic training is listed in the mission. Academic training is
implicit. To achieve this dual goal of education of youth and their socioemotional
development, the educational system does not rely exclusively on the personnel within
the school, nor on isolated community support. A growing consensus affirms that
educating children requires commitment and resources from the whole community, not
only from schools (Family Resource Coalition, 1993, p. 2).
Parents, first, are a key factor in school success, as educators recognize that
"children of absent parents suffer most of all" (Dryfoos, 1994, p. 3). Therefore,
parental involvement is crucial. James Coleman is quite eloquent when he states, "For it
is this concern, this deep involvement of parents with their children's development, that
is the most precious asset of every society as it makes its way into the future" (Clune &
6


Witte, 1990, p. x). These researchers do not isolate the academic mission of the school
from the development of the whole child, but do recognize that the family and
community environments are foundational.
Just how the school mediates this connection of development and academic
achievement, however, is a question. "Schools are being asked to address the needs of
children and youth at a time when fundamental transformations of schooling structures
and outcome expectations are also being demanded. Restructured schools alone cannot
satisfactorily address the multidimensional needs of children and youth" (Task Force on
Comprehensive and Coordinated Psychological Services for Children, 1994, p. 18).
As one solution, educators have sought to increase affective instruction in schools. The
guiding philosophy is that the intellect will develop in a healthier manner if more
attention is paid to appropriate socioemotional development. It is generally recognized
that affective programming is vital to the education of the whole child (Harter, 1994).
A major variable most often studied in relation to affective education programs is self-
esteem (Benard, 1986; Bracken & Mills, 1994). Importantly, the literature reveals
direct correlations between levels of self-esteem, academic performance, classroom
behavior, and sociability (Canfield & Wells, 1976; Capuzzi & Gross, 1996; Curry &
Johnson, 1994; Glasser, 1990; Gottfredson, 1987; Kagan, 1990).
Low levels of self-esteem, aside from correlating with poor scholastic
performance and other at-risk behavior, have also been related to depression, beginning
with the psychoanalytic tradition (Bibring, 1953; Blatt, 1974; Freud, 1968). The
incidence of depression in children and adolescents mirrors that of the adult rate; this
10-12% rate in the population has become alarming. Because one in five children will
suffer from mental illness (Illback, 1994; Task Force on Comprehensive and
7


Coordinated Psychological Services for Children, 1994), schools are well-advised that
some sort of response to the mental health needs of children is necessary. Research has
found that families of children exhibiting school problems are reluctant, however, to
seek mental health services in settings outside of schools (Braden & Sherrard, 1987;
Conti, 1973, 1975). The managed care movement and the incidence of poverty make it
untenable for families to seek private mental health counseling. More and more
organizations are looking to schools as perhaps the only institution that affords direct
access to every family with school-aged children to provide the ideal site for systems
intervention.
It is apparent that schools, struggling under the weight of increasing federal
mandates (special education services, Equal Employment Opportunity Commission's
anti-discrimination acts, Family Education and Privacy Rights Act, etc.) remain
understaffed and underfunded. Thus the ability to deal with socioemotional needs of
students is hampered by the fact that school resources are stretched to the breaking
points by federal and state mandates. Academic instruction takes precedence over
affective program delivery. Additionally, affective programs have experienced criticism
in the age of educational conservatism and declining budgets (Beane, 1986; Brigman,
1996; Shafley, 1985). Perhaps this is due to a lack of information and understanding
about such programs, including their major components, effects on students and their
overall degree of effectiveness.
Despite these problems of funding, personnel and criticism, affective education
programs and self-esteem continue to be a concern among educators. The National
Association for the Education of Young Children published a position statement in
1987 offering guidelines for a high quality program: one which promotes social,
8


emotional, cognitive and physical development. The National Association of
Elementary School Principals, in its 1990 standards for quality education programs,
supports the "new basics, including helping to build a positive self-image, enhancing
social and emotional development" (Brigman, 1996, p. 9). And in 1990, the National
Association of Secondary Principals, the Association of Supervision and Curriculum
Development (ASCD), the US Department of Labor and the National Science
Foundation all described the importance of helping children develop social, emotional,
and personal skills and qualities (Brigman, 1996).
Schools have sought to meet the psychosocial needs of children by investigating
the possibilities and potential of community resources offered nt the school site. The
emphasis is on changing the delivery of the intervention, a cybernetic approach that
capitalizes on impacting greater numbers of families and children to provide social and
mental health services. Integrated services counteracts multiple family problems with a
collaborative response from as many social service helpers as is possible. While the
many providers have begun to collaborate on offering services in the community, often
this response is located at the school. Integrated service program philosophy is that
families need a variety of services to meet complex problems and existing agencies
provide resources and expertise. Integrated services recognize that the school building
can be a convenient location of services for the family.
Statement of the Problem
One attempt to address the complex problems of school children is to offer a
comprehensive set of experiences for children and families targeted "at risk," as an
9


integrated systems approach, often called full service schools, family resource centers,
school-linked schools or community schools (Crowson & Boyd, 1993; Gardner, 1993;
Kahne & Kelley, 1993). This is a systemic intervention using community resources
located at the school building. While the trend is growing to offer more and more
collaborative, comprehensive services to families and children in schools, the literature
in the field is not yet keeping pace with the efforts to describe effective practices or to
present successful models of service integration.
The challenge of defining service integration, specifying independent and
dependent evaluation variables, working with multiple professional service providers,
and understanding the differences between the promise of programs and the realities of
implementation remain as barriers to best practice literature and evaluation outcomes
(Knapp, 1995). Kagan (1991) states:
Since collaborations are designed to be flexible and meet
changing needs, their implementation is never complete.
No precise definition of implementation exists because it
is a highly idiosyncratic and mutable condition. Indeed,
the strength of collaborations is that they are tailored to
meet changing local circumstances. For example, it is
not uncommon to find collaborations that deem
themselves well implemented one day and fledgling the
next. Such changes are predictable and underscore the
evaluation dilemma; while implementation flux is a
practical necessity, it remains an empirical nightmare, (p.
74)
While the need seems clear for an integrated services approach to family and
child problems, and the logic of providing a streamlined systemic professional helping
response appears obvious, few formal models exist to offer professionals direction and
support. The literature is replete with case studies, but rarely compared across
programs (Crowson & Boyd, 1993; Gomby, 1992; Knapp, 1995). In the last two and
one half decades of integrated service program design, common themes certainly have


emerged. Lines of hierarchy, areas of responsibilities, job descriptions, liability
problems, issues of confidentiality, and basic differences between disciplines offer
contentious battle grounds. These problems have already established a history, albeit a
short one, which needs to be heeded for future programming efforts.
The Communities in Schools (CIS) model is one example, a national prototype
of an integrated services model, or as Dryfoos describes CIS, a "comprehensive one-
stop multicomponent effort" (1994, p. 45). The full-services school movement and the
CIS model offer two critical elements to success: delivery of services to families in
schools and collaboration of systems in an integrated fashion. The Communities in
Schools model proposes a process: "for the development of public/private
partnerships, for the effective and coordinated delivery of existing community services
through the schools, for cutting across institutional lines to provide 'holistic' services
and community support for children and families in need, and for systemic change"
(CIS Program brochure, 1996). This program operationalizes the concept of integrated
service delivery that includes affective components.
The Communities in Schools program in Adams County, Colorado, the
Academy of the Rockies, has been in operation since 1992. It has not yet been
examined for program effectiveness or responsiveness to community needs. It is a
strongly conceptualized integrated services approach that enjoys the luxury of a history
(admittedly brief) of implementation. Because research in integrated service programs
is scarce due to a plethora of problems, when sustained programs can be documented
and evaluated for their successes and weaknesses, it will be more likely this summative
evaluation can guide the formation and success of other integrated service programs.


Educators, particularly, are positioned to capitalize on beneficial strategies that make the
process of child development and guidance a healthy one.
Purposes of the Study
This study will contribute to a limited body of knowledge describing and
examining integrated service approaches. The literature to date is "fugitive . .various
attempts to capture what is there have been undertaken recently, among them several
comprehensive reviews .. selective analysis of effective practices ... annotated
bibliographies ... and the activities of several technical assistance centers" (Knapp,
1995, p. 6). The predominate contribution comes from case studies and single project
descriptions. A synthesis of these program studies describing similar and different
features of integrated services is warranted.
This study will also seek data about affective school programs and other
variables associated with "at-risk" students. In addition, the roles of service providers
will be examined with special attention to meeting the socioemotional needs of students.
The Communities in Schools model, like other community-based, school-linked
models, has rarely been studied for its impact on children and the families it seeks to
serve. While conventional wisdom presumes that small teacher/student ratios,
alternative learning climates, affective education elements, additional resources and
streamlined services make a difference in school success, few programs have
systematically examined and researched these outcomes. Few evaluation studies have
sought family response to these services. Are they wanted? Are they needed? Are
they effective? Knapp (1995) argues that evaluation research in this new tradition
12


requires a closer, collaborative relationship between the population studied and those
who are carrying out research.
The Communities in Schools in Adams County, Colorado ("The Academy"),
will serve as a case study of an integrated services program. It is examined by a
licensed, professional school counselor trained in family systems intervention, working
for one year within this integrated services program.
Research Questions
The research questions of this study are:
1. What are the components of Integrated Services programs?
Characteristics of models in operation from 1989 until 1995 will be
detailed. A systematic synthesis of program components will compare:
governance structures including collaborative personnel
number of children and families served
agencies/service providers included
funding sources
type and length of program services (e.g., education, health, social services,
mental health programs, counseling features, etc.)
other program features as suggested by Morrill, Reisner, Chimerine, and
Marks (1991) including location of services, commitment of participating
service organizations, parental and community participation, and composition of
target groups.


Program implementation will be studied, and a program perspective of how
these models try to address socioemotional needs of students will be described.
2. How are integrated services programs evaluated?
A summary of evaluation methods, including a descriptive analysis of
the process of evaluation, identification of independent and dependent variables,
and how participants define successful programs will be examined.
3. How does the Communities in Schools model serve as a case study of an
integrated services model?
How does the program design of the Academy of the Rockies mirror the
national model, and is this illustrative of an integrated services program (this
question will use the same framework as was used to answer question number
one above)? How is the Academy different from and similar to other national
programs? What additional information is provided by studying one integrated
service model? How does evaluation of this program compare to other national
programs (this question will use the same framework as was used to answer
question number two above)? Knapp (1995) suggests that qualitative case
descriptions are especially appropriate for "illuminating what collaborative
arrangements mean to participants, how such efforts differ from service-as-
usual, and what the nature of collaboration is" (p. 11). What have been the
barriers to implementation? What have been the successes of the program?
How do the participants define success? Can suggestions or recommendations
for other programs be made from this in-depth analysis?
14


Definition of Terms
For the purpose of this study, the following terms are used:
Integrated Services: A comprehensive program of mental health, physical health,
social and/or family services that are offered in a collaborative, coordinated fashion to
meet the complex needs of children and families. These services are offered by public
and private agencies, already targeting at-risk families and children. Kirst claims that
more effective programs have parties that are "coequals, participating in planned
communitywide collaborative programming" (1991, p. 615).
Communities in Schools: Communities in Schools (formerly Cities in Schools) is a
national program developed by William E. Milliken in 1977. It is based on a model
whereby private corporations and non-profit organizations form partnerships with
school districts which bring existing public and private human resources and services
into schools in order to prevent student drop-out.
Self-Esteem: An evaluation of the self, including attitudes of approval and
disapproval. It is the summation of feelings about one's worthiness, capability,
significance and effectiveness. The sense of worth an individual maintains about
him/herself, or the "disposition to experience oneself as competent to cope with the
challenges of life and as deserving of happiness" (Branden, 1992, p. 18).
Operationally defined in this study, self-esteem is determined by scores on the Culture-
Free Self-Esteem Inventory-2.
15


Self-Concept: A series or set of descriptors that one holds in relation to self. These
self descriptions are a "nonvaluative description of personal attributes and the roles one
plays or fulfills" (Beane and Lipka, 1980).
At-risk students: Students who are identified as more likely to leave school (drop
out) before receiving a high school diploma. These students are typically profiled by
having low educational aspirations, low self-esteem, an external locus of control, and
negative attitudes toward school along with a history of academic failure, truancy, and
misconduct, with no indication that they lack requisite aptitudes. These characteristics
are further accompanied by exogenous variables such as: a fractured family structure,
low socioeconomic status, membership in ethnic or racial minorities, and the incidence
of teen pregnancy or drug abuse" (Kagan, 1990, p. 106).
Full Service Schools: A school center in which "health, mental health, social and/or
family services are co-located" (Dryfoos, 1994, p. xvi). Other synonymous terms are
community schools, settlement house in a school and family resource centers. The
Communities in Schools model is seen as an attempt at the full services approach.
Delimitations and Limitations of the Study
A delimitation: Evaluations of and descriptions of integrated service programs are
scarce. This study investigates all programs which have been included in major


educational journals and agency reports. Other integrated service approaches may
exist, but if their reports are not included in a review of the literature, they will not be
treated in this study.
A limitation: In this study, only those programs that are reviewed in scholarly journals,
foundation reports, and other agency reports are included. Other highly instructive
programs may be in operation and not included here.
A delimitation: The national Communities in Schools (CIS) model does not require
annual evaluation reports. The information included in this study relies on information
sent to the CIS headquarters voluntarily from various sites.
A limitation: Other highly instructive Communities in Schools programs may be in
operation and not included here.
A delimitation: The population studied at the Academy of the Rockies was limited to a
specified affective education program (a school-within-a-school program for at-risk
middle school children, the Academy) providing for intergroup comparisons and
descriptions rather than utilizing control or outside group comparisons. This study
confines itself to interviewing people directly affected by this Academy.
A limitation: The purposive sampling procedure decreases the generalizability of
findings. This study will not be generalizable to all integrated service approaches.


A delimitation: The researcher was employed as a family school intervention specialist
in the CIS program for one year. Because of this familiarity with the population, every
care was made to be objective in analysis, however researcher bias is always a
consideration in participant evaluation.
Basic Assumptions
The following assumptions were made for this study:
1. The investigator accessed significant available relevant information on current
integrated service programs and models as reported in the literature from 1989
until 1995 using the ERIC database as well as privately funded project reports,
government documents, and state documents. As many funded projects are not
required to submit annual reports, this study assumes that the programs
included here are indicative of, and generalizable to, most integrated service
programs. Additionally, as the programs themselves are quite different, this
study assumes that paradigms can support complementary examinations of a
phenomenon (Knapp, 1995, p. 6).
2.
It was assumed that the subjects responded accurately and honestly to the
investigator interviews.


3.
It was assumed that the investigator had full access to and knowledge of the
integrated services program in order to accurately describe and evaluate all
components.
Methodology
The major purpose of this investigation is to study the various integrated
service programs in operation in the United States from 1989 1995, in order to
develop a framework for understanding key components and effective elements of
programs and related interventions with at-risk youth. A case study of the
Communities in Schools model is offered as a practical example of an integrated service
program in operation. Integrated Service programs are particularly troublesome to
evaluate due to confounding factors: multiple professional perspectives, specification
of independent and dependent variables, attribution of effects to causes, and sensitive
nature of the programmatic treatment. "Complexity derives from the sheer number of
players, stakeholders, levels of the system, multiple services lodged in different agency
or disciplinary contexts, each operating from its own premises about good practice"
(Knapp, 1995, p. 5). Knapp suggests that, based on the family support literature,
more radical critiques suggest a more participatory framework: a collaborative
relationship between those studied and those who carry out research. This research


was begun during an intensive, year-long internship at the Communities in School site
in Commerce City, Colorado.
Because of the complicating factors associated with integrated services
programs, a mixed-methodological design was used. By using a qualitative and
quantitative approach in a single study, often called triangulation, the researcher hopes
to neutralize any bias inherent in particular data sources, investigator, and method by
using other data sources and methods (Creswell, 1994). Creswell states that the
advantage of this approach is that it presents a consistent paradigm picture in this study
(the qualitative case study) and still gathers limited information to probe in detail one
aspect of the study (the review of components of other national programs and the
quantitative self-esteem component). This approach adds complexity, but perhaps
better mirrors the research process of working back and forth between inductive and
deductive models of thinking (Creswell, 1994). This approach also seeks to satisfy
recent criticisms of integrated service evaluations: Evaluations need to reflect a
collaborative relationship between those conducting the research and those studied
(Knapp, 1995). The study is formed from: (a) a review of the integrated services
literature; (b) extensive qualitative interviews with participants in the project; and (c) a
formal, standardized instrument called the Culture-Free Self-Esteem Inventory 2.
Like policy programs, which have a strong tradition of study, integrated
service programs and other social program evaluations require a broader scope and a
focus which "assumes that events in social settings are complex and require attention to
the context of the people or events to be studied .. Thus, qualitative approaches cut
across the boundaries between various institutions and the social and cultural contexts
in which they exist to tell a story of why things happen as they do" (Adler, 1992, p. 1).
20


Precisely because of the complex nature of integrated service programs and the
sometimes sensitive nature of the program itself, more data sources contribute to a
richer understanding of the programmatic features. Creswell concurs, and states that
combining methods adds breath and scope to a study, may seek convergence of results,
and can be complimentary, in that overlapping and different facets of a phenomenon
may emerge (Creswell, 1994, p. 175).
Specifically, in order to address the first research question, "What are the
components of integrated services programs?", a review of the relevant literature of
scholarly education journals as well as unpublished reports was undertaken using ERIC
(Educational Resources Information Center): CUE (Current Index to Journals in
Education) and RIE (Resources in Education). Key descriptive words were integrated
services, schools, and collaboration. Dissertation Abstracts International provided
information on other related dissertations. Additionally, the Communities in Schools
national headquarters provided all evaluation materials compiled to date to add to this
research base.
A synthesis of effective practice and program perspectives are incorporated into
a schema (a comprehensive charting system) that offers clarity for the following
components. Yin (1989) suggests that for case study research, one mode of data
analysis is to search for patterns by comparing results with patterns predicted from the
literature. A preliminary review of the literature reveals the following potential
categories of program comparison:
governance structures including collaborative personnel
number of children and families served
agencies/service providers included


funding sources
type and length of program services (e.g., education, health, social services,
mental health programs, counseling features, etc.)
other program features as suggested by Morrill, Reisner, Chimerine, and
Marks (1991) including location of services, commitment of participating
service organizations, parental and community participation, and composition of
target groups
Program implementation will be a studied category, and attention to how these models
try to address socioemotional needs of students will be described.
These categories emerged from a preliminary reading of case studies of several
programs, and as Tesch (1990) suggests, a list of all possible topics was made. The
similar topics were clustered. These topics formed columns. The above mentioned
categories or components offer a preliminary organizing scheme. As many programs
as possible from 1989-1995 were accessed through the literature and other reports were
then coded, using the columns as broad categories for program components. This
schema provided the framework for the data analysis.
The researcher took this voluminous information and reduced it to specific
patterns. This information was interpreted, based on the reading of the literature and on
the researcher's direct year-long experience in the CIS program in Adams County. The
categories stated above provided the schema for a matrix. Miles and Huberman (1984)
support the display of information, a spatial format or chart, for systematic
representation of various patterns. These displays are tables of information.
Relationships among categories of information can then be demonstrated (Creswell,
1994, p.154).
22


The second question, "How are integrated services programs evaluated?" also
came from the synthesis of the literature in a similar fashion to the data collection in
question one. Categories of information include at what point programs are being
evaluated (developmental), evaluation questions, standardized instruments used,
interview questions, reported program success, focus of program evaluation, and any
other program evaluation data.
For the third question, "How does the Communities in Schools model serve
as a case study of an integrated services model?" the researcher used the same coding
scheme used to answer dissertation questions 1 and 2. Again, the synthesis of the
literature helped to frame this case study, looking at components of the CIS program as
well as the program evaluation questions. The researcher's experience in a year-long
internship support the data, as well as information from the interviews, program
documents, and feedback from parents and the community.
Extensive face-to-face interviews were conducted with participants in key
positions of the Communities in Schools model: teachers in the school-within-a-school
Communities in Schools program (the Academy of the Rockies) as well as teachers in
the mainstream school, students, parents, administrators, social worker, counselor,
child advocate, secretary/receptionist, and district personnel. The participants in these
interviews were guaranteed anonymity. The interviews were conducted at the school
site during the month of April in 1994 and 1996.
Additionally, outcome research of an evaluation instrument, the Culture-
Free Self-Esteem Inventory 2, adds another component of quantitative evaluation.
This study examined the relationship of selected variables related to self-esteem, as
measured by the Culture-Free Self-Esteem Inventory 2. Attempts were made to
23


identify variables, including participation in the Communities in Schools model, that
predict scores on components of healthy self-esteem. Many programs for at-risk youth
claim to increase self-esteem. This study examines the self-esteem scores of three
cohorts of students involved in the Communities in Schools program.
Identification and Description of Sample for Case Study
The participants in this study were either adults working in or students enrolled
in the school-within-a-school, the Academy of the Rockies at Adams City Middle
School (ACMS) in Adams County School District #14, located in Commerce City,
Colorado.
The Academy of the Rockies is an alternative school program, part of the
Communities in Schools model, which is completely voluntary for students and their
families. The population studied included all students enrolled the first year of
operation, 1992-1993 (Cohort 1=17 students), the second year of operation, 1993-
1994 (Cohort 2 = 29 students) and the fourth year of operation, 1995-1996 (Cohort 3 =
38). All 84 students were enrolled in the middle school and aged 12-15 years.
All participants in the study, and their parent or guardian, were required to
sign an informed consent statement as part of admission to the Academy, administered
by the school district, Adams County School District #14. For the year 1995-9996, an
additional informed consent form drafted by this researcher was required in order to use
additional data for this study, and is included in Appendix A. The Culture-Free Self-
Esteem Inventory 2 (CFSEI 2) was administered in social sciences classes every


year. Every student completed the inventory within twenty minutes during the spring
of the first year of attendance at the Academy. In March 1996, students from Cohort 1
and Cohort 2 who were subsequently enrolled as ninth graders at Adams City High
School and the Lester Arnold Alternative High School were given a second
administration of the Culture-Free Self-Esteem Inventory 2 in a matched pre-post
fashion.
Instrumentation
The Culture-Free Self-Esteem Inventory 2 (Battle, 1992) (Appendix B) is a 60
item forced-choice pencil/paper inventory which purports to assess the following self-
concept subdomains: general, social/peers related, academic/school related,
parents/home related, and a lie scale.
Collection of the Data
Data were collected on the Communities in Schools model by the investigator.
Interventions, activities, collaborative efforts, and community involvement were
examined and documented. Descriptive information was obtained on the integrated
services model in order for other schools to replicate either all or certain components of
the model.
25


Organization of the Study
This chapter presented the purpose of the study and the significance that it may
have in terms of content and methodology. Also included in this chapter were
hypotheses, definition of terms, delimitations, and major assumptions of the study.
The following discussion was organized into four additional chapters. Chapter
2 reviews the related literature and explores its implications for this study. Chapter 3
describes the basic design and method of the study and the process by which it was
conducted. Chapter 4 presents an analysis of the data in tabular and narrative form.
Chapter 5 summarizes the study, develops conclusions, and suggests recommendations
for future study.
26


CHAPTER 2
REVIEW OF THE LITERATURE
Families of the 1990s in the United States suffer higher rates of fragmentation
and indicators of at-risk youth behavior than other industrialized nations: higher rates
of divorce, higher rates of teenage pregnancy, higher rates of suicide, higher rates of
single parent homes, and higher rates of poverty (Bronfenbrenner & Neville, 1994,
p. 3). The issues confronting families are complex and interrelated; rarely a family
suffers from one problem in isolation of other problems. For example, a child
exhibiting poor academic performance at school may return to a home characterized by
violence, substance abuse, or the confounding effects of poverty. Or teenage girls who
report intentionally getting pregnant not because they misunderstood the consequences
of their sexual activity, but rather to experience unconditional love, remain quite savvy
about their personal needs yet are lost in the system that specifically targets this
problem.
These young adults may need parenting skills, academic direction, health
commitments* housing, and a support system that offers what they never got at home.
Sharon Kagan states, We cannot separate care and education, (1989, p.l 12).
Families needing economic support also often need housing assistance, medical
attention, and academic interventions at school. Perhaps the most obvious
manifestation of caring and support at the community level is the availability of
resources necessary for healthy human development: health care, child care, housing,
27


education, job training, employment, and recreation ... the greatest protection we
could give children is ensuring them and their families access to these basic necessities
(Benard, 1991, p. 15). This directive is the domain of local communities, and the only
way communities have succeeded is through the building of social networks that link
not only the families and schools but agencies and organizations throughout the
community with the common purpose of collaborating (Garmezy, 1991).
By simply responding to one aspect of an endemic problem is not enough, and
a response to one need does not negate the effects of remaining problems. For
example, the Earned Income Tax Credit, a program aimed at giving low-income
families financial credit for children, will definitely help a struggling family financially
but will probably do little to mitigate the effects of poor school performance by the
children (Schorr & Both, 1991). While public safety, available jobs, school
improvement, and affordable housing are separate problems, they are also closely
related when we are talking about areas of concentrated poverty (Edelman & Radin,
1991, p. 64). Although a single intervention may be very successful and have impact,
comprehensive multiple service approaches are needed.
This second chapter gathers support for integrated service models by focusing
on the literature in the field: First a history of programs is examined, documentation is
presented that supports the need for integrated service programs, and a discussion of
the seemingly-critical construct of self-esteem is developed. The benefits of such
integrated service programs are described, and a rationale for maintaining these at the
school site is offered. Next, barriers of integrated service programs are reported such
as funding, organizational issues, problems of philosophy, access, and evaluation.
28


Emerging criteria is next detailed, and the chapter ends with a focus on a national model
program of Communities in Schools.
Integrated Services
Mental, physical and social services programs targeting at-risk children and
youth often work in an isolated and fragmented manner, expecting students and their
families to seek aid from a variety of disconnected agencies (Voydanoff, 1995). The
patchwork quilt of health and human services available in most communities has
complicated efforts to respond to needs in a thoughtful and integrated manner. The
present child service system tends to be fragmented, inaccessible, duplicative, and
ineffective (Illback, 1994, p. 414). Despite the number of agencies offering service
and aid, barriers to access can be monumental. Available services are often the wrong
ones, too cumbersome, too fragmented, too late, too meager, or too narrow in scope
(Schorr & Both, 1991, p. 25).
Families typically suffer complex, interrelated problems that rarely fit tidy
definitions or respond neatly to single interventions. Families need integrated and
sustained interventions delivered by professionals who recognize and are able to
respond to a family's multiple problems and needs (National Commission on Children,
1991; Voydanoff, 1995). For example, a family seeking housing asistance may also
benefit from food stamps. The agencies that offer assistance to this family are only
responsible for their own services and may not be informed of another agencys
regulations or qualifications or even ancillary services. Recently these different
29


agencies have sought to find more ways to deliver services based on family and child
need rather than an exclusively agency-provided service (Kahne & Kelley, 1993).
Too, schools and human service agencies have persevered to use their resources more
efficiently, effectively, and economically. To achieve both the goals of families and
that of service providers, communities from policy analysts to researchers to private
enterprise have urged collaboration amongst the schools and service providers (White
&Wehlage, 1995).
Although service integration models are varied, they all provide a venue for
offering a collaborative platform by a variety of independent institutions allowing for
academic, mental and physical health services. The assumption is that integrated
comprehensive services will respond more effectively to interrelated needs of families,
reduce overlap of services, and make better use of community resources. The
fundamental philosophy is one of cross-disciplinary professionals working as a team to
share knowledge about how best to provide services to children and families.
Problems affect youth in a ubiquitous manner. For example, when drug and
alcohol specialists team with social service workers to provide a comprehensive,
collaborative system of care, the teaming approach is driven by the understanding that
the one problem of alcohol affects many facets of a youths life, most probably the
home and school. At the very center of service integration is the idea of catering to the
whole child. Integrated service delivery is focused on an overarching philosophy and
execution of providing comprehensive mental, physical, and social services to families
by a panoply of service providers. The key point here is that collaboration is not the
same as merger: a collaborative effort retains different organizations with their separate
specialties and points of view (Golden, 1991, p. 88). The integrated services
30


approach does not imply a substitution of one service provider for another but rather
that each provider contributes a service, and/or helps another provider do their job more
effectively, and that a child and his/her family receives appropriate services.
Historical Traditions
Elements of integrated service have a long tradition in the United States
(Crowson & Boyd, 1993; Dryfoos, 1994; Illback, 1994; Tyack, 1992). Perhaps the
first seeds of collaboration between agencies was during the Progressive Era (1890-
1917), an era which was dominated by problems of vast numbers of immigration.
With the influx of immigrants came waves of diseases such as diphtheria, scarlet fever
and small pox. Mandatory schooling, child labor laws, and burgeoning numbers of
children and adults in close proximity of each other forced the government to combat
concomitant problems of infection and contagious disease with preventive medicine.
The ill-equipped school buildings, struggling to keep up with ever-increasing
enrollments, were identified as a health hazard due in part to poor heating and
ventilation. Advocates from many disciplines such as journalism and immigration
urged the government to take a strong role in upgrading the health of children by
transforming schools from rigid centers of academic training to places where the effects
of poverty might be mitigated. "Almost all modem professional community-based
services for children were established during this era of reform" (Dryfoos, 1994, p.
20). Schools were a logical target because: (a) the majority of schools were located in
local communities and (b) people had access to these institutions. The medical


community gained access to large numbers of people by offering inoculations to
children and families at schools. Beginning in 1870, the health department began to
collaborate with state Boards of Education to provide vaccinations to all school children
(Dryfoos, 1994). Thus began the first formal collaboration between health services and
public schools.
While the medical community attempted preliminary stages of collaboration with
the school system during the industrial revolution, as more and more families moved
from rural society into the cities, settlement houses were established. These were
described "as an experimental effort to aid in the solution of the social and industrial
problems which are engendered by modem conditions of life" (Weissbourd, 1994, p.
29). At this same time, self-help organizations such as Alcoholics Anonymous and
American Association for Retarded Children were established. The recognition of
stressors created by current trends in society, and the ability of the community to
respond with help, was firmly grounded at least as far as ninety years ago. AARC and
AA are two examples of the community response. A patchwork of programs such as
these two was operating in the larger community simultaneously as programs sought
integration into schools.
During the Depression of the late 1920s, services in schools were reduced,
limited to health inspections, assessment, and first aid. With the onset of World War
n, the late 1930s and early 1940s again enjoyed a resurgence of public health at the
school site. The Bureau of Child Hygiene and School Health merged with the Bureau
of District Health Administration which placed physicians in the public schools
(Dryfoos, 1994). Following this decade, and for the following years, school health
services ebbed and flowed depending on the political climate and funding priorities.


Programs emerged in response to perceived needs of an increasingly urban society.
The idea of "community-school," or the concept of "a school in which both the
curriculum and the ancillary activities were designed to interact with the needs of the
community" (Dryfoos, 1994, p. 29) began to receive limited attention during the
Depression. Rather than isolated medical interventions, programs tentatively
incorporated other agencies and community involvement into school programs.
Common characteristics of a community-school were detailed as early as the 1930s,
although these ideas did not achieve fruition until decades later: "the use of the school
building as a center all year around for leisure-time activities and intellectual stimulation;
willingness to accommodate space requirement for health clinics, counseling services,
and employment and legal aid centers; provision of opportunities for citizens to get
involved with solving community problems; and facilitation of open communication
between the school and the community" (Dryfoos, 1994, p. 29). Thus, advocates for
children saw early in our history the logic of locating the many helping services at the
public school.
The war years and after, from the late 1930s until the present, witnessed a host
of social and health-related programs authored by the different Presidents that sought
integration specifically in the schools: Roosevelts 1935 Social Security Act and Aid to
Dependent ChildrenAVelfare; Eisenhower's 1961 National Institutes of Health; the
Kennedy Administration's focus on mental retardation; the 1965 amendments to Social
Security included Medicaid and Medicare, the 1960s War on Poverty, Head Start, the
Elementary and Secondary Education Act (which provided funds for schools with
disadvantaged populations), and the Office of Child Development in the Department of


Health Education and Welfare (Johnson); and PL94-142 (now called the Individuals
with Disabilities Education Act, or IDEA) during the Nixon administration.
A liberal temperament of the years following the Viet Nam War in the 1970s
fostered a climate in the United States of social activism. Advocacy programs that
responded to the fragmentation of the family sprung up. Large scale antipoverty
programs, preventive programming such as Head Start, and low cost economic help
such as Legal Aid reflected the country's acknowledgment that society needed to
respond in concrete fashion to the complex problems facing our country (Edelman &
Radin, 1991a). The federal government, in an acknowledgment of rising social
problems and their influence on schools, funded training programs and positions for
school counselors (Myrick, 1993).
The Reagan years are perhaps best known for reducing programs in the human
services (Edelman & Radin, 1991b). Decreased programming of the 1980s was a
response to failed earlier social programs, a feeling that the magic silver bullet did not
work, so why bother (Edelman and Radin, 1991a)? There existed a persistent and
naive faith that a simple solution would fix a complex problem, and when this was
found untrue, cynicism towards programs grew.
These programs (with the exception of Head Start) continued to operate from a
deficit model, treating problems rather than looking at underlying causes or preventive
approaches. Programs were implemented based on individual needs, not considering
the sequelae effect of the family or of the community on the individual. "Largely
categorical in their approach, service providers had little or no contact with one another,
even when individuals or families had established ongoing relationships with several
institutions. The system was a maze of isolated programs, both too complex to
34


administer effectively and too simple in conception" (Weissbourd, p. 30). Soler and
Shauffer concur, adding a lack of coordination among agencies serving children and
families, a narrow focus on the labels that children receive when they enter the systems,
and a consequent failure to provide appropriate services are the rule rather than the
exception (1993, p. 129).
Research on the various social programs, however, found that success lay in
preventive approaches. The research community learned as much from failed social
programs including the tenets of the War on Poverty as well as from the successful
programming of Head Start. Family dysfunction was best addressed by preventive
programming rather than crisis-oriented, remedial approaches (Weissbourd, 1994). At
the same time, Bronfenbrenner (1979) elucidated a theory of ecological human
development, where the determinants of family functioning needed to be regarded in the
context of child, family, community and the larger society.
The events of a radically changing population, fueled by strong research
findings, supported a new wave of programs where innovation included new
understandings of child and family development as well as prevention and resilience.
We have swung between strategies of extremes. We have moved from an
environment of hope and possibility to one of limitations and despair. The fires of
change of the 1960s have been dampened by the rains of fear, complexity, and
cynicism ... the pendulum appears to be moving toward a new sense of activism and
social responsibility (Edelman & Radin, 1991, p. 62, a). A proliferation of programs
documented the enthusiasm over emerging family support programs (Center for the
Study of Social Policy, 1990; Crowson & Boyd, 1993; Knapp, 1995).


Most of the original programs in the late 1970s were guided by prevention
research and driven by the ecological approach. They had specific goals and foci. A
majority were dependent on grant funding, and depending on the funding stream,
maintained the agency's focus as the program focus. The trend responded to
community needs and requests. The growth of these community-driven projects was
so expansive that a national conference held in 1981 called Family Focus included more
than 300 attendees (Weissbourd, p. 32). The Family Resource Coalition, a
membership organization that offers national networking and provides advocacy
services, was established at that conference. Efforts to work directly with troubled
children and families "have been broad but they have not been deep" (Knitzer, 1993, p.
13). While practitioners continued to see the need for collaboration, and a few
visionaries implemented radical programs, the research community struggled to
document successful strategies to help with the new approach to service delivery.
Need for Integrated Services Programming
Slowly, service providers are beginning to collaborate on delivery of services.
This is in response to research that supports preventive programming, research that
emphasizes the positive effects of an ecological approach, and research documenting
troublesome problems experienced by families in the 1990s (Crowson & Boyd, 1993;
Kagan, 1990; Kahne & Kelley, 1993).
The problems confronting youth and families in America today are not abating.
It cannot be disputed that every generation has had to face problems associated with


man's inhumanity to man, starting with biblical times. From the Spanish Inquisition to
the extermination of six million Jews during World War II, human atrocities have
stunned the imagination and called for sociologists to determine the origin of
malcontent. While debate continues whether problems in the 1990s are worse or merely
more talked about, general consensus is that violence, drugs, alcohol use, suicide,
depression, divorce, and other social concerns are prevalent and disturbing to the
degree that more attention needs to be focused on their solution. Mary Pipher, a private
therapist and national lecturer who speaks about the assault on culture and communities
states that, "Parents do not know how to protect their children from crime, media,
poverty, alcohol and bad company . The culture of the 1990s is too hard for many
families to handle... the last decades of this century have produced families stressed
about time, money, lack of social supports, addictions and crime" (Pipher, 1996, p.
10-11). The threats to families today are different from those experienced during the
industrial revolution of the early 1900s, or of the 1920s depression, or of those during
the era of the world wars.
This is not a claim that problems today are worse, but they are different.
Achenbach and Howell in 1993 published one of the few empirical investigations with
the potential to test the popular impression that childrens behavior and emotional
problems are worsening. They conclude that there are small but pervasive increases in
the number of problems and decreases in child competency. Increasingly, problems of
society are being felt in the childhood of our citizens. The condition of children is
deteriorating (Hombeck, 1991, p. 105). The research community, the policy sector,
the media, and families themselves report complicating effects of life, distress, and
hardship in the 1990s (Hewlett, 1991; Kozol, 1991; National Commission on


Children, 1991). The lexicon of morbidity has evolved from being defined as
infectious diseases and "other physical scourges... [to] emotional and behavioral
problems that have emerged as a major concern of parents" (Costello & Pantino, 1987,
p. 288). Researchers report that the presence of one or more clinically significant
emotional or behavioral problems can be identified in 13% to 20% of children (Benard,
1991; Illback, 1994; Kauffman, 1993; Soler & Shauffer, 1993). Illback (1994) details
potential sources of these problems: Nearly one million infants are bom each year
without prenatal care; 250,000 babies have a low birth weight; 375,000 newborns are
affected by maternal substance abuse; less than 50% of young children in urban areas
are fully immunized; 35% of kindergartners come to school unprepared for formal
education; 2.7 million reports of child abuse and neglect each year; and 10%-12% of all
youth younger than 18 years of age suffer from a mental disorder. In 1991, 429,000
children were in foster homes, group homes, or institutional settings (up from 270,000
in the early 1980s). Further complicating conditions are the median income of young
families with children dropped 32% between 1973 and 1990; 1 in 4 children live in
conditions of poverty; and low income working families experienced a 25% decline in
the availability of health insurance from 1977 through 1987 (Illback, 1994, p. 413).
Finally, the social system programs that do exist are underfunded (Altman, 1991).
Denise Gottfredson explains that isolating youths in schools, in a "relatively
sterile, book-learning environment cultivates low commitment to the education process,
alienation, low levels of belief in the validity of social rules and laws, and low self-
esteem" (1987, p. 252). Gottfredson argues for an integrated services approach to
working with children and families, treating the whole child within an integrated
system.


Self-Esteem
Self-esteem is available often cited in programs that seek to reach students who
are alienated from the school system and the larger society (Harter, 1994). Self-esteem
has been touted as the panacea for children to do well in school as well as being a
critical factor in the development of contributing citizens. Research has not fully
supported the importance of this concept. Yet, many integrated service programs offer
to increase self-esteem and offer opportunities for children and families to build
healthier levels of self-esteem.
Much controversy exists over the definition of self-esteem. It has been a
difficult construct to establish because of numerous factors. Juhasz (1985) claims that
evaluations of self often include aspects of self on which esteem does not rest.
Measurement instruments, especially when used with an adolescent population, may
include values and traits that reflect adult assumptions. Selectivity is a related problem.
People generally have higher self-esteem by concentrating on areas in which they excel
(Rosenberg, 1979). The things that people cannot change often assume less
importance. The biological, familial, societal or individual aspects of one's social
identity may be of major importance and may contribute to negative self-esteem (Harter,
1994).
Self-esteem and feelings of self-worth are different from self-concept. A degree
of valuation is associated with esteem. Self-concept more often asks for self
descriptors while self-esteem implies a value judgment of those descriptors. This
evaluative component exacerbates the problem of measurement. An adolescent may
not have the maturity to express a complex and difficult concept such as self-worth.
(
3 9


The adolescent may have trouble not only identifying but also valuing self-esteem
related qualities. Furthermore, esteem may be fragmented into physical, mental,
relationship, school and family concerns (Harter, 1994).
To further complicate matters, gender and ethnic differences can be discerned
from existing self-esteem instruments. Studies have determined there are significant
declines for all school children on measures of self esteem, especially white, middle
class girls (American Association of University Women, 1991, 1992; Harter, 1993).
Significant declines are seen for age, as well. At the change from elementary school to
junior high, and again from junior high to high school, all school children suffer
decline in scores, but girls scores drop more precipitously than do boys. Hispanics
and Afro-American girls demonstrate less of a decline. Clear evidence indicates the
educational system is not meeting girls' needs: Girls lag behind boys in measures of
self-esteem, despite entering school roughly equal in measured ability on these scales
(American Association of University Women, 1991,1992). Carol Gilligan (1982)
postulates that the current measures of self-esteem typically are male indicators and the
community of researchers ignore strengths of women (i.e., collaboration, nurturing
instincts) in these formal measures.
Finally, adolescents who are measured on national, standardized instruments
of self-esteem tend to vary in results since self-esteem tends to develop over time and
become more stable with age (Harter, 1994). Many factors influence its development,
however, in much the same way that personality is shaped. Integrated service
programs incorporate interventions intended to affect self-esteem.
Adlerian psychology probably best provides a framework for understanding
the development of self-esteem and how an integrated services approach may contribute
40


to healthier levels of self-esteem. The ideas of self-esteem, which Adler (1979) called
"gemeinschaftsgefuhl" (mental health) develops only within the context of society,
which Adler labels social interest. Ansbacher in 1969 elaborated a three-stage
developmental model for social interest that describes how this developmental concept
can best be learned through training in the home, school, and community (Ansbacher,
1969; Christensen, 1993; Fenell & Weinhold, 1989; Nicoll, 1994). In order for
healthy self-esteem to develop, a comprehensive healthy experience in the home, school
and community must be made available to all children. An integrated service approach
seeks to address childrens problems at school, with the collaboration of community
resources, within the context of the family.
An effective integrated services approach can offer what Harter (1994)
declares the public arena, which appears to have a more direct effect on self-esteem
than emotional or instrumental support (p. 30). This indirect mechanism of support, a
school-community response to a childs socioemotional development, can contribute to
the childs gradual internalization of worth. Clearly, support has a major impact on
the self-system, which in turn has implications for the motivation that children and
adolescents display both in and outside of the classroom. Low self-esteem caused by
lack of support is also highly predictive of affective reactions, leading to depression and
hopelessness ... it will be critical to look to the support systems as one primary cause
and therefore an important arena for intervention (Harter, 1994, p. 32).
When self-worth is elevated, other problems of delinquency decline. An
effective integrated services system perhaps can intervene in this cycle. As Gibbs and
Bennett (1990) conceptualize a process that involves the larger community, we must


turn the situation around by translating negative risk factors into positive action
strategies (1990).
Benefits
When students participate in social and mental health programs, preliminary
research indicates long-term positive effects on attendance, school retention,
achievement, pregnancy and birthrate, and involvement with drugs (Benard, 1991;
Crowson & Boyd, 1993; Edelman & Radin, 1991). Other studies reveal the cost-
effectiveness of providing services to those who normally wouldn't get them (Kahne &
Kelley, 1993). Some programs tout the more efficient staffing mix of integrated
services. Effective programs need the full participation of family and are empowering.
The logic that drives the integrated service format is offering services that are available
and close, comprehensive and appropriate. Additionally, services need to be consistent
and effective with an emphasis on prevention and early implementation. As with the
other two arenas in which children are socialized, the family and the school, the
community which supports the positive development of youth is promoting the building
of the traits of resiliency social competence, problem solving skills, autonomy, and a
sense of purpose and future (Benard, 1991, p. 14). This philosophy relies on a
resiliency model of mental health and development, versus the current deficit model that
operates throughout the United States.
The debate continues to the present as to whether schools should provide
fundamental education (the "basics) or provide broader services to meet the child's
educational, health, emotional and other general welfare needs. The tradition of
physical welfare is strongly institutionalized today in the way of minimum standards in


that a child who wishes to enroll in a public school must provide documentation of
inoculation against childhood diseases (which have been eradicated to-date in the
United States) such as smallpox and chickenpox. If a child cannot show proof of
inoculation, the school can deny entrance to that student. Other signs of the presence of
physical welfare programs are vision and hearing screening, head lice treatment and
inspection, and nutritionally sound lunch programs. Some schools house medical
clinics in an area of the building where a medical staff offers treatment from first aid to
the distribution of condoms to complete physical evaluations. The mental health needs
of children similarly need to be operationalized and institutionalized in our schools.
Service Delivery Site: Schools or Community
Many integrated service models offer social and human resource services at the
school site. Others choose buildings located conveniently in the community (school-
linked or community-based). While there are benefits and barriers to either location
for delivery of services, this study focuses on school-based programs.
As discussed previously, physical health needs have been delivered at schools
since the beginning of the century. More recently, integrated service models which
include not only physical but mental health programming have concentrated efforts on
delivering programs at the school site. Jane Knitzer pleads a case for "establishing]
closer links with the family support movement and school as hub efforts grow across
the country .. increasingly there are efforts to integrate a range of supportive services


into regular education" (Knitzer, 1993, p. 13, 14). Some models connect businesses,
school systems, volunteer organizations, and already established social services from
local departments (such as health and human services, parks and recreation and
employment) with each other in order to better serve mental health needs of children
and families. The target population for these integrated services typically are the
financially neediest families and at-risk youth.
Delivery of services at the school site has a variety of benefits for both sides
(Crowson & Boyd, 1993; Diyfoos, 1994; Kirst, 1991; Jehl & Kirst, 1993). For those
delivering the services, the "repositioned" service worker sees the student in a familiar,
"natural" setting and gets a more complete picture of the specific problem. The worker
who has a contextual understanding of the problem may be influenced to choose a
particular intervention or goal for treatment. Reciprocally, the school can offer
"overhead" (usually office space) to the agency. A holistic approach to intervention is
stressed. The problems for the child are interrelated; the services offered in the school
are integrated.
Those receiving the services, the students and parents, may view the school as a
less threatening and more accessible venue for services than perhaps the traditional
setting (hospital, mental health center, social services building, police station). The
school setting is, at a minimum, geographically accessible (Kahne & Kelley, 1993;
Soler & Shauffer, 1993). Most communities have a centrally located school building,
typically within walking distance. In the present system of service delivery where
different agencies provide different services at different locations, problems abound for
the family seeking these services. Transportation to and from offices as well as being
able to arrive at established business hours may be problems that are insurmountable.
44


The truly disadvantaged may not even have the marginal resources necessary to
discover available programs and services or to pay for transportation to delivery sites
(Kahne & Kelley, 1993, p. 192). Provided a family can manage the time to arrive at an
appointment, and has transportation to reach this destination, if the office or agency is
in an urban neighborhood, the physical risk of walking through possible gang territory
probably outweighs the perceived benefits of a service such as family counseling.
Outreach efforts and access that result from service coordination for these individuals
can make a difference in utilization of programs.
What is good for the school is good for the society. As trite as the African
proverb, "It takes a whole village to raise a child" has become, the message that must
be transmitted is that educational affairs need to concern all. Successful
coordination effort requires the involvement of all interested sections of the community:
agency administrations, line staff, unions and other employee groups, community
groups, the courts, the legal community, legislators, and childrens advocates ...
cooperation not only across agency lines but across racial, ethnic, and linguistic lines
(Soler and Shauffer, 1993, p. 134). If a child or family is failing, then the system
should be seen as failing and the family as having an appropriate response to system
dysfunction. Even the label at-risk youth perpetuates a myth that targets individuals
rather than a family or community at-risk (Gardner, 1992). Children cannot continue to
be singled out and "diagnosed" or identified as having some pathological problem
without considering the environment and the community response. Neighborhood
institutions churches, hospitals, community centers, athletic teams, the "Y," citizen
groups, businesses should expand their mission beyond trash pick-up and political
campaigns.


An inventory of the children and their needs should be done by these groups to
find out what is needed or how individuals can be helped. Likewise, an inventory of
services and available sources of aide that these groups are willing to offer should be
compiled and offered to schools. As Dewey says in The School and Society. "When
the school introduces and trains each child of society into membership within such a
little community, saturating him with the spirit of service, and providing him with the
instruments of effective self-direction, we shall have the deepest and best guarantor of a
larger society which is worthy, lovely, and harmonious" (in Bellah, p. 152).
Barriers
Systemic Issues
The integration of institutions, disciplines and services is a formidable task and
has not been without problems (Chaskin & Richman, 1993; Crowson & Boyd, 1993).
There are drawbacks to having schools as the location of services. Many families
continue to see schools as a fortress and uninviting. Smrekar (1994) suggests that
schools need to recast negative images from the past and convey a more welcoming
atmosphere. For some, the school represents everything about a system that has been
denied to them, despite the rhetoric of education being free to all and a key to future
success. If the school serves as the service delivery site, do the problems of service
integration remain with the entire program or do these become the school's problems?
This problem of perception may turn out to be an insidious undermining factor if not
dealt with appropriately.
46


One of the primary objectives of schools and communities is the education of
their youth. James Coleman is quite eloquent when he states, "For it is this concern,
this deep involvement of parents with their children's development, that is the most
precious asset of every society as it makes its way into the future" (Clune & Witte,
1990, p. x). Marrett points out that, "in American society schools, and especially
public schools, have had two general missions: to foster the development of
individuals, and to promote the general welfare" (Clune & Witte, 1990, p. 235).
Bellamy suggests that, the primary objective of this community service function
[centers of community activities] is to stimulate parent and community involvement in
the school's educational effort. Schools achieve parent and community involvement
through two responsibilities: (a) support for families and (b) support for the
community" (Bellamy, 1993). The community must be made aware just how crucial
they are in the development and maintenance of schools and families.
Funding Issues
Funding of programs and mingling of funds can be problematic if not
contentious, with the clash of three institutions: the school system, the medical
community, and social service agencies. On the one hand, schools are large, de-
centralized, public institutions which are funded mostly by individual state dollars
(typically 50%), local dollars (typically 45%) and federal funds (typically 5%) (Morrill,
1992). Populations (kindergarten through age 16) are mandated to be in attendance.
This monolithic system of education differs from health providers which are largely
private and nonprofit, mostly financed through employer-based and other third-party
plans. Low income populations are primarily served through third-party public


programs which are funded mainly by federal and state governments. Typically
providers are used to offering services to individuals who need acute care, rather than
on-going treatment. Social Services are funded by all levels of government federal,
state and local. Social Services are purchased directly by consumers from a large
number of service providers (both for-profit private and nonprofit) with a relatively
narrow focus. Consistent information about the quantity of services provided and their
recipients is simply not available on a nationwide basis (Morrill, 1992).
Comprehensive programs for children and families are expensive (Edelman &
Radin, 1991). It is difficult to secure funding in the current era of budget
consciousness.
The goal or objective of the differing systems, historically defined and shaped
by funding availability, will need to be focused. The larger question is how to re-focus
categorical funding for specific problems versus support of a plan of comprehensive
care (Schorr, 1992)? The categorical nature of programs make it difficult to tailor
services to real needs (Altman, 1991, p. 74). The difference between repairing broken
bones or medicating for diseases from a health provider standpoint and offering help to
at-risk families is one of money, time and duration: the medical model is short-term
and intensive, where state-of-the-art medical research is brought to bear on the
problem. In this model a fee is charged, and the patient (or system) must pay.
On the other hand, a child from a family with abuse issues may be involved in
the judicial system, social services may intervene when the case load of workers
permits, and the school may offer free group counseling. One question is for what
problem(s) to treat/provide service? Who is the identified client/patient? Is the child
seen, is the family seen, or are both? When service is provided, usually it is on-going.
48


If high risk behavior becomes acute, it is often too late for help from the school or
social service agency, in instances of suicide or other life-threatening activities.
Oftentimes the medical community is involved at this stage.
Morrill (1992) maintains that the present functioning of these three institutions,
if there is to be an integration of services, can be improved via three methods: (a)
radical federal restructuring. (He suggests that this might be a lengthy process, if not
impossible); (b) expand existing categorical and targeted programs. This is essentially
putting more money into existing programs. (However, the present system has not
proven to be effective for those that it seeks to help); (c) reorganizing/reforming the
current tri-partite system. (This is what current models of service integration are
attempting to do).
However, despite the financial difficulties, other obstacles to service integration
are equally problematic. While the financial aspect is a hindrance, reforming this aspect
alone will not alleviate other barriers (Altman, 1991).
Organizational Issues
The various service providers enjoy an autonomy that is maintained by
professional differences in training, management, discipline, and sources of revenue
and funding (Crowson & Boyd, 1993; Shedd & Bacharach, 1991). The professionals
in these agencies are accustomed to a hierarchy of personnel that reinforces their
particular service. Jargon and professional ways of doing business are different. The
identified problem(s), priority of need or response, assessment of severity,
intervention(s), and goal(s) may differ from each professional's judgment. Agencies
maintain fierce protection of their own independence and establish vertical


relationships with bureaucracies and funding sources that were in turn protective of
their own sovereignty. While many of these centers are now defunct because of budget
cuts, the underlying turf boundaries are problems that have not disappeared with the
passage of time (Edelman & Radin, 1991, p. 59, a). This long history of legislation,
payment-for-services, and public approval contribute to turf issues: A (perceived)
hierarchy of professionals negotiating for their own clientele claiming better or more
effective service.
Other issues will need to be addressed. For example, the different reporting
forms, which historically have generated payment of services, will need to be aligned
or otherwise streamlined (Gardner, 1993; Soler & Shauffer, 1993). Many core issues
in comprehensive, collaborative programs are private matters (Knapp, 1995). Strict
adherence to issues of confidentiality may need to be reassessed when the different
providers are involved. Presently, in most states, a licensed professional enjoys the
client-provider privilege of confidentiality. Others on the team may not be afforded
the same privilege, but may be critical to the response/treatment team. Perhaps a need
to know provision will need to be afforded providers much like how confidentiality in
the school system is supported presently.
This is not an argument for the disciplines to blur in training, mission or
expertise. Differentiation between organizations and professions exists for a reason:
the different organizations are responding to different technologies, different
environments, different problems ... Success requires high levels of differentiation
(specialized expertise in very different fields) and integration (that is, collaboration to
further the common mission of the firm) (Golden, 1991, p. 92). Success will lie in
excellence of effective collaboration of differentiated professionals.


A lack of training in unknown areas will need to be bridged. If service
providers are to be effective, they will need to have more expertise in related fields
(Crowson & Boyd, 1993). A blurring of roles and distinct functioning within the
system may need to take place. Staffing ratios, physical space, and insurance liability
will need to be reassessed.
Additionally, most institutions offer specifically defined services based on
documented need (Voydanoff, 1995, p. 63). Understanding the needed documentation
and providing this can pose problems for those unfamiliar with the different agencies'
requirements.
Another organizational issue that needs to be addressed is one of leadership
(Jehl & Kirst, 1993; Levy & Shepardson, 1991). Traditionally a school principal's
role/priority has been one of education. S/he is empowered in this role by the school
board, a recognized extension of state law. The role of the principal will need to be
scrutinized: support for and success of programs can depend entirely on this leadership
area, since the principal sets the tone for the school building. If other agencies are to be
integrated, to what extent will the authority of community agency boards or other
provider governing structures extend? For example, will the foundation president have
equal latitude in decision-making as the principal? How will conflicts be resolved in
decision-making process? Chaskin and Richman foresee great problems in linking
services to schools, saying neither the schools nor any other institution should be
allowed to control or dominate the planning or governance of school-linked services.
In practice, however, the tendency for this to happen is great (1993, p. 201). They go
on to indicate that more often than not, programs housed in individual buildings tend to
reflect institutional goals, rather than the primary needs of families.


Philosophical Issues
A natural dilemma between empowerment of clients and providing resources for
clients is faced by providers. The empowerment movement seeks to help families at-
risk become more self-sufficient. Sometimes this process can make the families feel
disempowered if they see allocation of resources as handouts, thus engendering a
we/they system. This hostility can develop in part because the service providers may
lack cultural sensitivity, or if they unknowingly apply stereotypical misconceptions to
an entire population. One problem is that few families fall neatly and consistently into
problem categories. The possibility that this will become a growing source of friction
is great, as the population in the United States increasingly becomes more diverse.
Each year our classrooms contain increased numbers of poor, non-English speaking,
mainstream handicapped, culturally different, and single-parent children. Five states
will soon have minority majorities (California, Arizona, New Mexico, Texas, and
Florida) and in over 30 of the largest school districts in the United States, Caucasian
students have become the minority (Barr & Parrett, 1995, p. 5). A system whereby
families feel that they are an integral piece can lessen the possibility of
disempowerment.
Other potential pitfalls involve a clash of values. While many proponents of
school-based health clinics proclaim the benefits and accessibility of affordable medical
services, others see these same services as sex clinics. More fundamental will be the
conservative forces who support strict academic boundaries confronting more liberal


thinkers who maintain children need social supports in order to benefit from the
academic training.
Finally, there is some urgency associated with responding to these complex
problems facing todays families. The pressure of immediate payoff is at odds with
long-term preventive approaches (Schorr, 1991). Will this urgency force untried
methods of support since integrated service programs are not well documented or
researched? Does combined/collaborated/integrated effort necessitate better care, or a
higher quality of care? Collaboration might lead agencies to carry out their
differentiated, precollaborative missions less well (Golden, 1991, p. 85).
Collaboration with more systems and more staff typically, at least initially, will use
more of a very precious resource: Time.
AgqgSS
Access to services falls into two categories: technical access and physical
access. The technical problems associated with integrated programs are the strict rules
of eligibility of different funding sources that dictate which individuals, families or
households may qualify for benefits. Often eligibility rests on a minimum or maximum
qualifying income (Chaskin & Richman, 1993). Providers are used to offering
specialized case management (only service for presenting problem). Programs will
need to decide whether to target a specific problem-focused population or at-risk
population (i.e., students who have been adjudicated for using alcohol) or whether
services will be available to all who attend a certain school (i.e., school-wide
prevention efforts in the use of alcohol).


Physical access includes problems associated with timing of appointments,
transportation to service sites, and possible unsafe location of service(s). Most
institutions/agencies are geographically separate from one another. Appointments can
be difficult to secure, trying to match the providers schedule with a working parent
who may not have the luxury of taking time off in the day to get to the service provider.
A school is, therefore, one logical location for delivery of services. When services are
located at the local school, many of these problems of access are mitigated.
Problems of Evaluation
A final concern involves evaluation of services. The research community is
unable to keep up with the proliferation of programs now offered. Documentation of
successes and failures of programs, and their comparison across communities, is
complicated by several factors: True integrated service programs address the nature of
the community, rather than offer a pre-planned course of implementation. Different
programs target different problems, some isolating a particular disturbing behavior
while others offer a course of prevention (Crowson & Boyd, 1993; Knapp, 1995).
Programs offering a broad array of individualized interventions, which may be most
powerful in their interaction and which have multiple outcome objectives, may be
anathema to the evaluator faced with the task of designing a manageable and precise
evaluation plan. Often the scope of the inquiry becomes unduly narrow -- many
evaluation efforts attempt to identify a single effective ingredient in an immensely
complex and interactive system ... Because of the difficulty in measuring significant
outcomes, many evaluation efforts limit themselves to measuring or describing
processes' (Schorr & Both, 1991, p. 26-27).
54


Most programs still do not mandate an evaluation component. The sheer
number of participants, from funding agencies to front line providers to children to
families to teachers all can recount different impressions of the success (or failure) of
the program. The difficulty for those who wish to study comprehensive, collaborative
services, however labeled, stems from their complexity and flexibility, the nature of the
collaborative effort, and the convergence of different disciplines (Knapp, 1995, p. 5).
Oftentimes the confidential nature of the problem forces the reporting person to shield
participants relevant problem or other identifying characteristics.
Of those programs that do evaluations, Levy and Shepardson (1992) point out:
A distillation and promotion of models seems
premature. The very diversity of efforts in itself defies
categorization into a limited number of structures and
approaches. More over, because the movement is still so
young, there is a lack of hard evidence that what is being
tried is indeed effective... A final concern with respect
to the idea of models is that, even when the experience
and knowledge base is more mature, it is unlikely that
there will ever be one or two models that would or
should be reproduced cookie-cutter style throughout
the country, (p. 46)
Emerging Criteria for School-Linked Services
Despite problems facing evaluators, the literature has started to identify key
components of successful programs. The Center for the Future of Children, a group of
highly respected researchers from major educational institutions around the nation, are
committed to studying and disseminating timely information on major issues related to
childrens well-being, with special emphasis on objective analysis, evaluation,
translating existing knowledge into effective programs and policies, and promoting


constructive institutional change (The Future of Children, 1991, p. I). This Center
has developed a set of criteria for integrated service programs, culled from other
researchers and institutions. Schorr (1991) detailed the operation of seventeen
programs in the field of integrated services from 1962-1988. From this research, she
also defined essential attributes that effective programs for disadvantaged children and
families would need to incorporate in the future.
Uhl and Squires (1994) are the only researchers to tender a formal model of
collaboration, rather than a list of collaborative skills or a map of suggested stages
which other researchers have described. Uhl and Squires instead propose
cornerstones of a model which does not imply a hierarchical path or developmental
sequence. Their model suggests four cornerstones: they define engagement
(understanding of the collaboration), negotiation (action planning), performance
(implementation), and assessment and evaluation. This model incorporates most of the
qualities and components of an integrated service approach that others have merely
listed.
And finally, Soler and Shauffer (1993) from the Youth Law Center have also
begun a project which investigates the efforts to coordinate childrens services across
the country. The cumulative findings of this research can be summarized as follows.
Unifying Mission
Perhaps most importantly, collaborating organizations need to expand or
overlap conceptions of their mission (Golden, 1991; Soler & Shauffer, 1993). The
mission needs to be expanded past one with a discipline focus to one dealing with the
at-risk child involving the family and the environmental context of the community.
56


This requires a change in school culture rather than a simple structural modification
(Squires & Kranyik, 1995). With a unifying mission, each organization can then
determine what appropriate agency should participate in the collaboration, and then
proceed with offering the best possible resources. The coordination of services should
be family focused (Soler & Shauffer, 1993, p. 134) and help the family restore its
ability to function, rather than isolating the child and his/her problem.
Planning Allotment
The Center for the Future of Children suggests that participating agencies will
need to change how they deliver services to children and families. Rather than adding
on efforts to existing operations, providers need to begin with the planning stages of
service. When projectitis takes over planning, the project is likely to become merely
additive. Additive projects cannot change institutions, because they operate as new
activities grafted on top of the existing system (Gardner, 1993, p. 142). The planning
and implementation staff is a critical component. Implementers will have to change
how they work with each other. In order to be able to cooperate fully, the Center
suggests staff characteristics of experience in line and supervisory levels, so that staff
members understand the delivery point and the best level for decision making.
Training of future front-line workers will need to address academic and skill-building
deficits that hinder cross-discipline cooperation (Nelson, 1991). The quality of service
will be conditional on the fundamental training, skills, and values of these workers.
Kalafat and Illback (1993) studied ten integrated service sites and discovered that
57


coordinating personal characteristics and management styles were an integral piece of
effective programs. Effective leaders were able to become part of the community and
were able to translate their commitment.
Staff Needs
Staff members need full access to officials of the agency, rather than the
traditional hands off approach of agency boards of directors. Twenty-five percent of
the day needs to be devoted to planning, and workers need diplomatic and intercultural
skills in working across agency and disciplinary lines with professionals in other fields.
Schorr and Both (1991) underscore the need for staff to have the time, training, skills
and institutional support necessary to create an accepting environment that builds trust
with other service workers and the families that benefit from the service.
A balance should exist in the integrated staff so that no one agency can own
the process. A climate of openness needs to be encouraged so that no question is a
dumb question. The over-reliance on outside consultants in other programs have
convinced program evaluators that this is an unnecessary expense (Gardner, 1993).
Schorr (1991) agrees, and likens these experts as people and programs that parachute
into communities, perform their function, and disappear as soon as the program gets
underway. The expertise needs to rest with line level professionals who work with the
program and in the community every day. Soler and Shauffer (1993) support the idea
of interagency training/interdisciplinary training of staff as well as a person to act as
case manager who would have access to a wide range of services and authority to
engage those services on behalf of individual children and families.
58


Services need to be comprehensive and tailored to needs of individuals and their
families. No single staff person should be responsible for all services. In order for a
large number of staff people to deliver effectively a variety of services, training for line
level staff is required. Whatever combinations of services are offered will depend on
the community, as well as service intensity (short-term minimal service to long-term
intensive treatment). The planning team needs to respond to the particular cultural,
ethnic and economic diversity of children and families in their community.
Conflict Resolution
Perhaps because of the heightened opportunities for professional tension and
disagreement, conflict resolution processes should be in place (Golden, 1991; Soler &
Shauffer, 1993). Some mechanism needs to be instituted so that all participants,
professionals and families, have a voice and a process for resolving conflict. Schorr
and Both (1991) discuss overcoming fragmentation through staff versatility and
collaboration across bureaucratic and professional boundaries (p. 32). Not only does
the person working in this environment need to be of a certain character (i.e., flexible,
sensitive, versatile), but the conflict resolution model needs to be in place so that
differences of professional opinion can be addressed.
Parent Involvement
Other groups that need to be incorporated and included in the balance are
parents. Schools need to make parents/family a partner in all aspects: planning,
implementation, assessment of needs, and finally deciding on services needed. Schorr
59


points out that this can be a difficult mix, as these relationships of trust require training,
time, skills, and institutional support of the leaders.
Research indicates, however, that the more parents are involved both in a
childs education and school life, the greater outcomes for that child. Increases can be
seen in: school achievement, more positive interactions with school personnel,
standardized scores, participation in school events, communications between home and
school, attendance rates, and variables that contribute to positive school climate
(Achenbach & Howell, 1993; Hlback, 1994; Squires & Kranyik, 1995).
When parents are made to feel welcome and have an investment, they are more
likely to participate in school functions. When they are part of the process, they are
less likely to criticize outcomes because they have a greater understanding of the
system. Parent participation correlates with positive outcomes are part of the driving
force behing site-based management of schools in the 1990s (Squires & Kranyik,
1995).
Community Involvement
Community and neighborhood groups need to be included, intentionally
including representatives from many sectors so that influential groups do not feel
overlooked. A small but powerful constituency in opposition of a program can do
much harm to derail the best of efforts and innovation (Kindred, Bagin, & Gallagher,
1990). Finally, helpful and committed health and social service agencies should be a
part of the collaboration, however not all need to be integrated (Soler & Shauffer,
1993).
60


Collaborative partnerships between schools and health and social service
agencies will vary from site to site. People support what they help to create, therefore
program efforts need to reflect the personality of the community, rather than reflect
program developers expertise. Models forced onto a community, with rigid
expectations, will resemble programs that experienced little success in the past
(Edelman & Radin, 1991; Gardner, 1993). Because of this grass roots approach to
programming, little is known about effective models, governance, staffing, operations,
budget, or goals. Instead, the research community suggests parameters which guide
decisions of the planning staff. Good planning, reflection, particular community
resources and unique talents and energies, is perhaps the key to successful programs
(Gardner, 1993).
Target Population
Planners need to have a target population: Will services be available to all
children in a designated school/community or will efforts be targeted to children with
specific, identified needs? This decision often rests with the budget: Larger,
community-wide programs cost more than smaller pockets of special needs
populations. For instance, making counseling available to all students in a school
requires a certain counselor/student ratio as compared with counseling available only
for teen parents. The pyramid of needs (those students severely at-risk will be fewer
and at the top of the pyramid, while a larger, less seriously affected group will make up
the majority of the pyramid) will dictate some programmatic features. Gardner states
that, where to provide services on that pyramid is the first and most basic targeting


question (1993, p. 147). The key to targeting services is to be prepared and try not to
operate habitually in a crisis, financially prohibitive mode.
Financial Support
Whatever the program focus, successful programs report that, at highest risk,
individual services must be more individualized, intensive services must be made yet
more intensive, and comprehensive services must be made yet more comprehensive
(Schorr & Both, 1991, p. 34). Components of conventional programs historically
have fallen short of comprehensive services, partially due to the nature of being
disconnected from other service providers. Disadvantaged families with multifarious
problems need multifaceted services. One mechanism that forces agencies to begin to
collaborate asks each agency to re-direct some of its current funding in support of the
new collaboration. This co-mingling of funds will serve two purposes: A shift in
budget reliance to co-mingled funds will tend to lend stability or longevity to programs.
Second, the agencies investing funds in a new structure will tend to invest their
attention as well. Unpredictable funding needs to be balanced with a programs ability
to evolve and be flexible. The research literature suggests that better outcomes can be
achieved with reorganization of existing funds (Schorr, 1991; Soler & Shauffer, 1993).
The commitment of dollars spent in this manner speaks not only of financial support,
but philosophical support as well.
While schools are not particularly concerned with research and evaluation, due
to lack of expertise, lack of funding, and a lack of time, some collection of data is
critical in new integrated programs. The system should cut across agencies and,
ideally, should be the same system for all involved with identical or compatible intake
62


forms, computer programs and reporting formats. This information system must obtain
all relevant information from children and families, make those data readily accessible
to those who must make evaluations and secure appropriate services, and keep track of
the children and families both during and after the time they receive agency services
(Soler & Shauffer, 1993, p. 138). When evaluation measures identify what was
attempted, what was the produced outcome, and what were the costs associated with
collaborative efforts, the degree of accountability is heightened.
Client-Centered Approach
Finally, successful programs are guided by a theoretical foundation that
supports a client-centered approach (Dryfoos, 1994; Edelman & Radin, 1991; Shorr &
Both, 1991; Soler & Shauffer, 1993). Agencies provided a certain service or expertise
and this directed funding streams as well as responses to family problems. The current
thinking is that rather than have isolated service-driven agencies providing
unidimensional help, the clients and their needs should drive the agency response.
Thus, the systems becomes need driven rather than service driven.
National Communities in School Projects
One integrated service program is the Communities in Schools (CIS) model, the
largest non-profit drop-out prevention program in the nation. The Communities in
Schools program, in existence since 1977, was one of the first family support
programs to incorporate the elements of "full service schools": collaboration with
63


social service agencies, modifications in the academic program, and integration of
community/business resources at the local school. It is based on a model whereby
private corporations and non-profit organizations form partnerships with school
districts which bring existing public and private human resources and services into
schools in order to prevent drop-out. The CIS model acts as a broker for human
services in the schools. The CIS model depends on "leveraging of dollar
contributions" in that, "atypical CIS program costing $150,000 to $200,000 per year
can leverage as much as $1,000,000 worth of repositioned human service personnel
and various forms of in-kind assistance" (CIS Program brochure).
Communities in Schools is currently active in more than 140 communities (140
operational programs in 309 sites) around the nation (CIS Program brochure; Dryfoos,
1994). Training is provided free of charge to any school district that applies (via the
Superintendent's office). The National Center for Partnership Development at Lehigh
University in Bethlehem, Pennsylvania, collaborates with Iacocca Institute and the
College of Education to offer this training. The training uses state-of-the-art computer-
based multimedia technology to convey the concepts and practices that have been
successful in the CIS model. When the trainees return to their home communities, CIS
provides them with continuing follow-up training and technical assistance through a
network of Regional Offices and a growing number of independent state CIS
organizations.
The CIS model seeks to capitalize on the key elements of successful programs
to engage at-risk youth: community resources and helping agencies located at the
school; small student/teacher ratios; a tutor/home-visitor who seeks out kids who do not
come to school; teachers who work in inter-disciplinary teams; specialized curriculum
64


which is individualized and computer based in core academic subjects such as math,
reading, writing and verbal communication; employment job skills; and personal
enrichment opportunities to help build self-esteem and confidence.
Whether this program is successful remains to be seen. A 1986 critique of CIS
found little evidence that CIS had been successful at integrating services, in measuring
affecting youth, or in defending program rhetoric with program implementation
(Crowson & Boyd, 1993, p. 153). This critique stated that evaluation problems
abound in a long-term program such as CIS.
Funding
On a national level, CIS is funded by a combination of federal funds from
several federal agencies, and private funds from corporations. Locally, CIS
organizations form private/public partnerships resulting in 501(c)-3 tax-exempt, non-
profit corporations supported by local businesses, foundations, governmental agencies
and individuals.
How It Works
The partnerships connect businesses, school systems, volunteer organizations,
and already established social services from local departments (such as health and
human services, parks and recreation and employment). The target population for these
integrated services are at-risk youth. The key is access to services that potentially are
not within the reach of children with problems.
Services targeting at-risk youth often work in an isolated and fragmented
manner, requiring students and their families to seek out services from a variety of
65


disconnected agencies. The CIS model proposes that these same agencies "reposition"
workers in the school setting. This has a variety of benefits for both sides. The
"repositioned" worker sees the student in a familiar setting and gets a more complete
picture of the specific problem. Additionally, the school can offer "overhead" (usually
office space) to the agency. The students and parents see the school as less threatening
and more accessible for services than perhaps the traditional setting (hospital, mental
health center, social services building, police station). A holistic approach to
intervention is stressed; the problems for the child are interrelated so the CIS services
offered in the school are integrated.
Communities in Schools. Adams County. Colorado
Communities in Schools, Adams County, is a national model program.
Approximately 500 children are being served in 20 schools in Adams County. Helping
professionals from county agencies are "repositioned" to work in the schools:
15 mental health therapists
7 social service case workers
3 probation officers
3 nurse practitioners
20 police officers
3 juvenile diversion officers
5 counselors in substance abuse and employment
Academy of the Rockies
66


The Academy of the Rockies, the first corporate-sponsored school within-a-
school in the state of Colorado, is part of the Adams County Communities in Schools
program. It first opened its doors in August 1992 (ChalkTalk, October, 1993). It is
housed in a wing of Adams City Middle School, Adams County School District #14.
The Burger King Corporation gives $65,000 per year in salary for the Academy. The
Academy can serve approximately 50 students (38 are presently enrolled) in grades 7-8-
9 who have been identified as at risk of dropping out of school or who need a more
"nurturing" environment to meet their educational goals. The Academy is primarily
staffed by four full-time certified teachers (the lead teacher also acts as administrator),
one tutor/home-visitor who seeks out kids who do not come to school, and one full-
time secretary. The teachers work in inter-disciplinary teams similar to other middle
school models. The students who are enrolled cannot qualify for special education
status. Instead, students are referred mainly to the Academy for poor grades,
discipline problems and/or truancy problems district-wide. The day runs from 8:00
AM -1:15 PM with individual tutorial sessions in the afternoon. The specialized
curriculum is individualized and computer based in core academic subjects such as
math, reading, writing and verbal communication; employment job skills; and
personal enrichment opportunities to help build self-esteem and confidence. There are
presently 25 CIS Academies operating in 15 states /Commerce City Beacon. Feb. 10,
1993).
Services Offered
67


Student and family needs stated in program literature offered by the Academy
are:
student/parent/family involvement and support
mental health counseling
social services assistance
health services
drug and alcohol counseling
non-traditional instructional program
crisis coping skills, self-esteem building
support in transition to the high school altemative/regular programs
life skills and employment training
mentoring of students by adults in the community
ACSD 14 serves a transient population which is one of the most economically
deprived in the Denver metro area. The students come from homes where there is
minimal educational preparation. Compounding these problems, the Rocky Mountain
Arsenal poses questions from a health and well-being perspective. This is a community
in need from an educational, health, and financial perspective.
Philosophy
The Communities in Schools model is a prototype of an integrated services
model, or as Dryfoos describes CIS, "comprehensive one-stop multicomponent effort"
(p. 45). The full-service schools movement must figure out how to attract all segments
of the community. For example, how does one make the school a compelling place for
68


the community to be? The community must feel like what they say matters. They need
to feel that the school is a safe, non-threatening entity. Parents too often see the school
as a fortress, "some of whom have greater difficulty than do others penetrating the
educational system, as that system currently is structured ... This approach [CIS] to
community and control aims to widen the circle [of individuals] who can exercise
options. It supposes that no place of education should be so daunting that only a few
members of the public should dare cross its portals" (Clune & Witte, 1990, p. 238).
The full-services school movement and the CIS model offer two critical elements of
success: delivery of services to families in schools and collaboration of systems in an
integrated fashion.
Summary
The 1990s have been marked by tremendous efforts towards innovations in
school reform. One strategy that has attempted to strengthen the school-family
relationship and the school-community relationship is service integration (coordination
of education, family assistance, mental health and counseling services, and various
social service supports). While service integration at the school building is not a new
movement, it is enjoying renewed attention partially due to a perceived crisis in
childrens deteriorating condition of life in the United States in this decade. This
particular aspect of school reform is also influenced by recognition that schools and
communities work better together rather than as opponents, and also acknowledges the
importance of societal support for the education of Americas youth. Recent work on
69


resiliency of children from distressed environments examines the concept of self-esteem
and how this complicated construct best responds to and is developed from many
factors in a community. Finally, prevention researchers have made great stride in
increasing awareness of the benefits of prevention programming rather than programs
of remediation and crisis-response.
A plethora of barriers to implementation of integrated service programs
confronts program developers, including financial constraints, bureaucratic
sluggishness, professional turf issues, histoiy of failed programs and limited time and
personnel resources. Despite these obstacles, the literature is replete with descriptions
of integrated service ventures, from single case study programs to broad-scale national
programs. Emerging criteria of successful programs allows others to capitalize on
established programs strengths. In this discussion, successful integrated services
programs are reporting various program variables that emerge as critical components: a
unifying mission, planning time before program implementation as well as intentional
periods of planning during the programs, responsiveness to staff needs of authority and
cross-disciplinary training, parental involvement, and a mechanism for conflict
resolution. Community support is necessary, and the program needs a goal of targeting
specific problem behaviors or pandemic prevention. Financial soundness is an
extremely complicated objective, but one that needs adherence, as findings are that
programs do not increase budget coffers but require coordinated budgets. An
evaluation plan reminds participants to be ever-mindful of a client-centered approach,
rather than the agency/institutional agenda.
Finally, after examination of the theoretical perspective from the literature, this
review included a national example of an integrated service program, Communities in


Schools, specifically the Academy of the Rockies in Adams County, Colorado. This
program was examined because it is representative of an integrated service program
currently in operation that was observed and evaluated by this researcher.


CHAPTER 3
METHODOLOGY
The major purpose of this investigation was to study the characteristics of
integrated service programs in the United States. In addition, one integrated service
program was studied in depth, the Academy of the Rockies (a Communities in Schools
program in operation in Colorado), and compared with other integrated service
programs previously examined.
Research Questions
Major research questions used in this study were:
1. What are the components of integrated services programs?
2. How are integrated services programs evaluated?
3. How does the Communities in Schools model serve as a case study of an integrated
services model?
Because of complicating factors associated with integrated services programs, a
mixed-methodological design was used in this study. By using a qualitative and
73


quantitative approach in a single study, often called triangulation, the researcher
attempted to neutralize a bias often inherent in a particular data source, investigator, or
method by using varied data sources and mixed methods (Creswell, 1994). Creswell
states that the advantage of this approach is that it presents a consistent paradigm picture
in the study (a review of components of other national programs) and still gathers
limited targeted information to probe in detail one aspect of the study (the qualitative
case study and the quantitative self-esteem component). This approach adds
complexity, but perhaps better mirrors the research process of working back and forth
between inductive and deductive models of thinking (Creswell, 1994).
This approach also seeks to satisfy recent criticisms of integrated service
evaluations: Evaluations need to reflect a collaborative relationship between those
conducting the research and those studied (Knapp, 1995). People involved in social
and educational programs are more likely to trust the investigator and give more honest
responses when they know the person conducting the research. Of course, this
familiarity compromises evaluator objectivity to a degree. However, in a study such as
this, the objectivity lost is acceptable because some of the respondents (the children)
may have presented special problems in gaining rapport (Creswell, 1994, p. 150).
The researchers background and experiences were useful in building rapport
with the respondents. The researcher formerly served as a middle school teacher, and
at the time of the initial interview and survey administration was working as a family
intervention specialist (family/school counselor) with the Academy being studied. The
researchers training in attending and observing skills, child development, children with
special needs, as well as training in professional school counseling ethics and


confidentiality, offered a relaxed climate for the interviews, especially critical due to the
sensitive nature of some of the program features.
Yin (1989) stated that the .. distinctive need for a case study arises out of
the desire to understand complex social phenomena (p. 14). Studies of social
programs and educational situations have a broader scope in both the time period
covered and the range of questions asked than do traditional quantitative studies which
typically seek to test a single hypothesis (Adler, 1992).
The focus in this approach is on in-depth, long-term
interaction with the people or events to be studied. This
approach assumes that events in social settings are complex
and require attention to the context of the people or events to
be studied .. .Thus, qualitative approaches cut across the
boundaries between various institutions and the social and
cultural contexts in which they exist to tell a story of why
things happen as they do. p. 1
Procedures Used for Study and Instrumentation
The study is framed from: (a) a review of the integrated services literature; (b)
extensive qualitative interviews with participants in the Communities in Schools project;
and (c) data from a formal, standardized instrument (Culture-Free Self-Esteem
Inventory 2).
Review of Integrated Services Literature
Specifically, in order to address the first research question, "What are the
components of integrated services programs?", a review of the relevant literature of


scholarly education journals as well as unpublished reports was undertaken using ERIC
(Educational Resources Information Center): CUE (Current Index to Journals in
Education) and RIE (Resources in Education). Key descriptive words used included:
integrated services, schools, and collaboration. Dissertation Abstracts International
provided information on related dissertation research. In addition, the Communities in
Schools national headquarters provided all evaluation materials compiled to-date to add
to this research base. Programs examined were in operation from 1989 1995.
A synthesis of effective practice and program perspectives were incorporated
into a schema (a comprehensive charting system) that offers clarity for the several major
components. Yin (1989) suggests that for case study research, one mode of data
analysis is to search for patterns by comparing results with patterns predicted from the
literature. A preliminary review of the literature revealed the following potential
categories of program comparison:
governance structures including collaborative personnel
number of children and families served
agencies/service providers included
funding sources/sharing of resources
type and length of program services (e.g., education, health, social
services, mental health programs, counseling features, etc.)
other program features as suggested by Morrill, Reisner, Chimerine, and
Marks (1991) including location of services, commitment of participating
service organizations, parental and community participation, and composition of
target groups
enhanced communication and information sharing


Program implementation was a studied category. Attention was directed to how
models addressed socioemotional needs of students.
Categories emerged from a preliminary reading of case studies. As Tesch
(1990) suggested, a list of all possible topics was made. Similar topics were clustered
and formed columns. The above categories or components provided for a preliminary
organizing scheme. Programs from 1989-1995 described in the literature and other
reports were coded, using the columns as broad categories for program components.
This schema provided the framework for the data analysis.
The researcher examined a voluminous amount of information and reduced it
to patterns. This information was interpreted, based upon literature findings and on the
researcher's experience in the CIS program. The categories stated above provided the
schema for a matrix. Miles and Huberman (1984) support this display model of
information, a spatial format or chart, for systematic representation of various patterns.
The displays are seen as tables of information. Relationships among categories of
information can then be demonstrated from tabled information (Creswell, 1994,
P-154).
The second question, "How are integrated services programs evaluated?" was
the result of a synthesis of the literature. Categories of information included: at what
point programs were being evaluated (developmental), specific evaluation questions,
standardized instruments used, interview questions used, reported program success,
focus of program evaluation, and other related program evaluation data.
For the third question, "How does the Communities in School model serve as
a case study of an integrated service model?" the researcher used the same coding
scheme used to answer dissertation questions 1 and 2. Again, the synthesis of the
77


literature helped to frame this case approach, analyzing components of the CIS program
as well as program evaluation questions. The researcher's own experience working in
a year-long internship at the CIS Academy in Adams County, Colorado, in 1993-1994
support the data, as well as information from interviews, program documents, and
feedback from parents and the community.
Interviews
The researcher used multiple sources within the same school and same
program since it is difficult to generalize from single response data. Responses from
children also differ from adult responses. Also, professional responsibilities and
training offer differences in responses. Accordingly, the researcher specifically asked
questions that allowed for comparison of multiple answers to the similar questions.
The primaiy sources for the case study were in-depth interviews with
program participants. However, archival records, school district policies, program
brochures, district press releases and personal notes and memos were also used as
primary sources. The documents, in conjunction with the interviews, presented a more
complete picture of the implementation of an integrated service program. This data
allowed the researcher to triangulate the information obtained from in-depth interviews.
Comparison of information obtained from interviews with information gleaned from
documents supported conclusions made about the perceptions of the implementation of
the Academy of the Rockies. For example, district information revealed that counseling
is a component of the CIS program, and no other information was provided.
However, responses from the interviewees, who were asked about counseling as a
78


programmatic feature, offered a practical description about that particular component.
The triangulated data is therefore enriched in this manner.
The interviews followed a similar format for each interviewee. Questions
were developed to examine concepts embodied in the general research questions listed
previously. The interview questions focused on personal experiences of program
participants in the Academy of the Rockies during its first year of implementation
(1992-1993) and its fourth year of implementation (1995-1996).
Eighteen extensive face-to-face interviews were conducted with participants in
key positions of the Communities in Schools model: teachers in the school-within-a-
school Communities in Schools program (the Academy of the Rockies) as well as
teachers in the mainstream school, students, parents, administrators, social worker,
counselor, child advocate, secretaiy/receptionist, and district personnel. The
participants in these interviews were guaranteed anonymity. All 18 interviews were
conducted at the school site during the month of April in 1993 (n = 8) and 1996 (n =
10). Individuals were interviewed in order to obtain participants perspectives on
elements of an integrated service program.
The researcher asked participants survey questions developed in advance.
Appendix C contains a complete list of the questions asked. Interviews followed a
random order, and interviewees were not identified, except by position held at the
school. All responses were recorded verbatim either by hand or transcribed
simultaneously on a laptop computer.
Standardized Instrument
Use of the Culture-Free Self-Esteem Inventory 2 added another component
of quantitative evaluation in this study. As treatments are so individualized ... the
79


individual units behavior over time will be its own best control... such designs call
for some baseline of repeated measures over time (Knapp, 1995, p. 13). Select
variables related to self-esteem, as measured by the Culture-Free Self-Esteem Inventory
- 2 were studied. Attempts were made to identify variables, including participation in
the Communities in Schools model, that would predict scores on components of
healthy self-esteem. It was noted that many programs for at-risk youth claimed to
increase self-esteem. This study examined predictors of self-esteem with three student
cohorts involved in Communities in Schools programs in 1993,1994, and 1996.
The Culture-Free Self-Esteem Inventory 2 (Battle, 1992) is a 60 item
forced-choice pencil/paper inventory which purports to assess the following self-
concept subdomains: general, social/peers related, academic/school related,
parents/home related, and a lie scale. The data for this study used the CFSEI total
scores only.
The CFSEI Form A (grades 7-9) reports a Total test-retest reliability of .88 to
.96. Salvia and Ysseldyke (1988) advise .90 minimal for total test reliability and .70 or
better for minimally acceptable subdomain scores for the purpose of hypothesis
generation and screening purposes. The manual reports evidence supporting content
and concurrent validity. Types of scores produced are both percentile ranks and T
scores.
Specific Scales on the Culture-Free Self-Esteem Inventory are:
General self-esteem is the aspect of self-esteem that refers to individuals'
overall perceptions of their worth.
Social self-esteem is the aspect of self-esteem that refers to individuals'
perceptions of the quality of their relationships with peers.
80


Academic self-esteem (i.e., school-related self-esteem) is the aspect of self-
esteem that refers to individuals' perceptions of their ability to succeed
academically.
Parent-related self-esteem is the aspect of self-esteem that refers to individuals'
perceptions of their status at home including their subjective perceptions of
how their parents or parent-surrogates view them.
Lie subtest indicates defensiveness.
The CFSEI-2 for children was standardized on boys and girls in the United
States and Canada in grades 2 through 9. The mean total scorefor the standardization
group (n=873) in Junior High is 37.98 with a standard deviation of 8.33. It can be
administered to individuals or groups of students in 15 to 20 minutes, and each
protocol can be scored under 5 minutes. The items in the instrument are divided into
two groups: those that indicate high self-esteem, and those that indicate low self-
esteem. Responses are forced choice: The individual checks each item either yes or
no.
This mixed method is based on data from a review of the literature as well as
from information resulting from an in-depth case analysis which includes interviews
and a standardized inventory. This design is described pictorially on the following
page.
8 1


Pictorial Protocol
Creswell (1994) pictorially describes this schema (p. 188), and it has been
adapted to fit this particular study:
A Quantitative and Qualitative Inquiry
I
Introduction
1
Problem
I
Research Objectives
National Programs
J
Literature Review (Quant)
. /
Comparison (Quant)
Local Program
I
Interviews (Qual)
I
I
ew
I
ase
I
Description (Qual)
1
Case study (Qual)
I
Standardized Instrument (Quant)
Summary of Summary of
Quant. Results Qual. Results
Summary of
Themes in Literature
I l
Qual: Textual Table
Summary of
Case study
82


This diagram is a picture of the study which is a mixed methodological design
(as indicated in the first phrase, A Quantitative and Qualitative Inquiry). Both
quantitative and qualitative aspects of this study share the same introduction, the same
statement of the problem, and the same research objectives. From here, however, the
study diverges. National programs are described from a quantitative review of the
literature and compared for like characteristics. The researcher works backward from
instances of presumably effective or average practice to explanations for the apparent
success (Knapp, 1995, p. 13). This review and comparison of national programs in
operation are summarized both in themes in the literature, in a summary of the effective
components of integrated service programs, and recorded in the textual table.
The other side of the pictorial scheme takes a qualitative approach to a local
program. This ethnographic case study uses interviews of participants, results from a
standardized instrument, and a review of program components to support findings that
then are recorded in the textual table.
Knapp (1995) suggested several promising kinds of studies of integrated
service approaches. Meta-analysis of service integration studies are tempting, but as
the individual variable remains vaguely or ill-defined, then meta-analysis is difficult to
apply to qualitative studies and premature. Two of Knapps suggestions are
incorporated in this study: an investigation of exemplaiy and typical practice, and a
single-subject (and single-system) time series research to demonstrate impact on
individuals or service systems.
83


The mixed design thus responds to criticisms of meta-analyses and of
evaluators being far from the programs which they study (the evaluator worked for one
year in the local program described in the case study).
Identification and Description of Sample for Case Study
The participants in this study were eighteen adults working in and 84 students
enrolled in the school-within-a-school, the Academy of the Rockies at Adams City
Middle School (ACMS) in Adams County School District #14, located in Commerce
City, Colorado. Adams County School District 14 (ACSD 14) is located in Commerce
City. Two high schools, two middle schools, and five elementary schools serve the
population of 6200. ACSD 14 serves a transient population which is a lower level
socioeconomic group in the Denver metro area (average household income is about
$20,000) (Denver Post. 3/3/96, p. IB). The Rocky Mountain Arsenal is located
within ACSD 14, taking up one-half of the district's land. Because of the arsenal,
ACSD 14 loses as much as 80 percent of the normal revenue that could be expected
from the land if it were residential or commercial /Adams Countv School District 14
Comprehensive Plan and Procedures Manual for Special Education Programs. 1989-
1992).
Of the Commerce City residents over the age of 18, 41 percent have a high
school diploma. During each school year, approximately 50 percent of the students in
ACSD 14 change schools. Almost 20 percent of Commerce City residents live below
the poverty level and 45 percent of the students are eligible for free and reduced
lunches. Ethnically, Commerce City's population is 47 percent Caucasian, 47 percent
84


Hispanic, 2.6 percent African-American, 1.8 percent American Indian, and 2 percent
Asian.
The 1994-1995 senior high class of ACSD 14 had the lowest graduation rate of
any school district in Colorado, where only 35% of the seniors earned regular diplomas
(Colorado's overall graduation rate is 77.4%) fDenver Post. March 3, 1996, p. IB).
The Academy of the Rockies is an alternative school program, part of the
Communities in Schools model, which is completely voluntary for students and their
families. The population studied included all students enrolled the first year of
operation, 1992-1993 (Cohort 1=17 students), the second year of operation, 1993-
1994 (Cohort 2 = 29 students) and the fourth year of operation, 1995-1996 (Cohort 3 =
38). All 84 students were enrolled in the middle school and aged 12-15 years.
All participants in the study, and their parent or guardian, were required to sign
an informed consent statement as an admissions procedure to the Academy. This
consent was obtained by ACSD and is held by the district. Additionally, during the
year 1995-1996, the researcher obtained consent to analyze data and to administer the
CFSEI to students no longer enrolled in the Academy, included in Appendix A. The
University of Colorado at Denver Office of Institutional Research approved the
parent/student consent as well as the standardized instrument. The Culture-Free Self-
Esteem Inventory 2 (CFSEI) was administered in social sciences classes every year.
All students completed the inventory within twenty minutes during the spring of their
first year of attendance, with the exception of the first cohort, which completed the
CFSEI during the fall of the first year of program operation. A second administration
of CFSEI of Cohort 1 & 2 students took place in March 1996 at Adams City High
School and the Lester Arnold Alternative High School. Students were contacted at the
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high school level because they had originally been enrolled at the Academy of the
Rockies. They were contacted by their high school counselor who asked if: (a) They
would participate in the reevaluation and (b) if they would obtain their parents
permission to do so. All students who were contacted and enrolled participated with
the exception of one individual.
Collection of the Data
Data were collected on the Communities in Schools model by the investigator.
Interventions, activities, collaborative efforts, and community involvement were
examined and documented. Descriptive information was obtained on the integrated
services model in order for other schools to replicate either all or certain components of
the model.
Data were collected on the following prediction variables: age, birth date,
socioeconomic status, ethnicity, and gender. Data were also collected on the following
dependent variables: school attendance, school referrals (discipline record), and grade
point average. Data were supplied by the ACSD 14 administrative office of information
and evaluation. Students were identified only by the last digits of their student number.
Treatment of the Data
Descriptive data were reported describing all aspects of the Communities in
Schools integrated model. Components of the model were reviewed in detail.
Quantitative data were tabulated, using the Statistical Package for the Social Sciences
(SPSS). Both /-tests (t) and multiple regression analysis were used.
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r-tests were used to compare the mean scores of the three cohort groups (I, II,
and HI) on the CFSEI (independent means /-test). A second /-test, for repeat measures,
called the correlated /-test, was used to compare the mean scores of the same cohort
groups (I and II) on the same measure (CFSEI) three (Cohort I) and two years later
(Cohort II), or before and after Communities in School program intervention in order to
determine if a significant gain occurred (Borg, 1987) in a matched pre/post fashion.
CFSEI Administration
1992-93 1993-94 1995-96
Cohort 1 n=17 T-test n=13
Correlated T-test
Cohort 2 n=29 T-test
Cohort 3 n=38 T-test
Multiple regression analysis predicts an unknown performance (such as the
score on the CFSEI) using a known performance (such as gender, age, ethnicity, SES,
attendance in the CIS program, experience with individual counseling) and the
correlation between the two. Multiple regression is employed to predict performance
on one criterion variable from the individual's performance on several predictor
variables. The advantage of multiple regression is that it permits the researcher to
explore simultaneously the relationships of several independent (predictor) variables to
a dependent (criterion) variable (Borg, 1987; Creswell, 1994). Both methods of
analysis were utilized in this investigation.
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Summary
Researchers of integrated service programs are struggling to keep up with the
increasing numbers of programs in operation. The literature is replete with case studies
and reviews of large-scale programs. In order to understand components of programs,
a case is made to undertake a mixed method (both qualitative and quantitative design)
approach to studying integrated service programs. The review of programs from the
literature (quantitative review) is supported additionally by a case study (qualitative) of
the integrated service program in which the researcher spent a year-long internship
working with program partcipants and collecting data.


CHAPTER 4
ANALYSIS OF DATA
An analysis of the data collected is presented based on the research questions
discussed in Chapter 3. This study examined the integrated services programs in
operation in the United States from 1989 1995 in order to determine significant
components that were found in 24 documented programs. In addition, a case study of
the Communities in Schools (CIS) program located in Adams County, Colorado, was
studied for additional data to use to support findings from the literature. The case study
incorporates data obtained from multiple sources, including 18 interviews conducted
with personnel at the CIS Academy and from scores on a standardized self-esteem
inventory administered to 84 students in 1993, 1994, and 1996.
Chapter 4 is divided into four sections. The first section presents an overview
of the findings from the integrated service programs in operation from a review of the
literature, and includes a chart of the 24 programs and their components. The next
section examines the responses from the interviews of people working at the integrated
services program in Colorado. The third section presents statistical findings from data
collected from the self-esteem inventory. The final section discusses the findings in
relation to the research questions.
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Integrated Service Program Findings
Research Question One
In order to answer research question one, What are the components of
integrated service programs? the researcher conducted a literature review of integrated
service programs, finding twenty-four programs in operation from 1989 to the present
which fit the criteria of: (a) being located at school sites; (b) offering more than
physical health services (e.g. no school-based health clinics were examined); and (c)
being designed as collaborations of service providers.
The 24 programs are described below in tabular form and detailed in a narrative
that follows the chart:
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