Tuesday, December 23, 2008

Perspective

A few social workers who work with children were discussing funding for special education. It is a chronic problem for them, as their charges often need very specialised, expensive services that school districts are reluctant to provide. Parents who are attempting to obtain services for their children are familiar with how quickly it can become adversarial with the people in the district controlling the money. It all makes sense, of course. Budget-watchers are supposed to be cautious with the money. Parents are supposed to help their children get educated.

The curious part of the conversation was how quickly everyone at the table agreed that it was better in Europe. I asked for examples, data. All were puzzled that I didn't just know this. Everyone knows that Europe has more widely available health care, that fewer people in Europe are poor, etc. It only stands to reason that they would provide better SPED services as well.

I said I doubted it. Then I went to research what happens in Europe for special ed and specialised mental health services and found I was just about right. There is a lot of variation in services among European countries. Comparisons are exceedingly difficult for the usual apples-and-oranges reasons. Different countries define special needs, emotional disturbance, and psychiatric illness differently, and have different approaches how they want to attack the problems.

Where comparisons can be made however, The US doesn't look so bad on special ed. Nor on mental health services (sidebar links). Nor on overall neurological , mental health, and substance abuse services. In general, you can find 1-3 countries in each small category that does better than the US - the other forty or so are behind us, and the overall average for Europe is behind the US. And it's not the same 1-3 countries each time, either, though Finland is up there most of the time.

We have people out there we can learn from. We can do better. But there is not some mythical area or country where everything is much better. We do well.

It is worth noting that most countries have the same problems of funding. Lots of expensive solutions don't provide much in the way of outcomes. Even excellent, state-of-the-art treatments can often only ameliorate, not solve, brain problems. And the most money goes into those children and youth with multiple problems, where the rate of return is even lower.

It's a good thing to do. Relieving suffering is good. Helping people improve is good. I don't resent the cost. But I also don't feel crushed with guilt about this. I see enormous resources poured into bad-risk patients every day. I don't see our society as hateful simply because people wish they could do more.

6 comments:

Teri said...

I have a severely disabled son. I think a lot of the problem with both the expense and the lack of success is because "special" students/people aren't just different from typical students, they are all mostly different from each other.

Very limited economies of scale, and you get the school trying to shoehorn several special kids into a single solution that isn't optimal for any of them. Parents who hold out for truly "individualized" education plans are stigmatized and stymied every step of the way.

You can have it cheap, good quality or fast (i.e. amount of progress to goal) but you're never going to get all three . . . and the school's much more interested in cheap than in quality or progress.

I'm on a list that includes parents from all over the world. No place is paradise for special needs. We just have to muddle through and do the best we can, and be glad that at least society's answer is no longer to bash their brains out on the back fence.

Assistant Village Idiot said...

Teri, you touch on an important historical point. We also have a fantasy that people with problems were more easily absorbed into older agricultural or village societies. Because we can imagine such idylls, we think it must have been so. It wasn't so long ago that we didn't make much provision for them, and most starved or abandoned. Not quite bashing their heads on the back fence, but darn close.

Gringo said...

Teri:
You can have it cheap, good quality or fast (i.e. amount of progress to goal) but you're never going to get all three..

Excellent point about the issue. There is no simple solution, no magic bullet, but an issue of juggling priorities.

Before I completed my engineering degree, I worked for two years at a psychiatric hospital and an institution for the mentally retarded. From that time I came out with several perspectives: 1) while it is necessary to devote time and funding for helping people with these problems, one should not assume that the treatment program being funded will be successful. IOW, there are some problems that are a) intractable or b) while they are not intractable, we still have a ways to go in successfully treating them. Funding a program is no guarantee whatsoever that the program will be successful.
2) There will always be an issue of priorities, of limited funds.

Neither of these perspectives supported the traditional liberal “more government is better” point of view that inundated my childhood.


AVI: Your response to the “Everything is better in Europe” crowd is well taken. Look at the data first. For example, while there is more income inequality in the US than in Europe, by some measures a poor person in the US is better off than the average person in Europe. (page 24)

Adjusting for size of household, one finds that poor households in the USA have slightly more dwelling space than the average European. The average American household has a home that is 80 per cent larger than its average European counterpart. Europeans, in other words, are more crowded in an American perspective.

Test assumptions with reality.

Anonymous said...

I just read an article in Die Zeit about Germany's recent ratification of the UN convention on rights of the handicapped (both physically and mentally).. Apparently under this convention all children have a right to be educated in normal schools. The article discussed the problem Germany will have in meeting the goal because it has three different school types in addition to special schools.

This illustrates the problem of defining rights from above. It certainly seems to me that some kids might profit from special schools. In addition things like available money and population density (NYC vs a small town in Wyoming) could affect the decisions about how best to provide services. But the UN seems to have embraced mainstreaming for all despite the differences among the handicapped.

Another article that I haven't read yet deals with special medical needs of the handicapped and talks about things like vision tests for children with severe mental handicaps. The author seems to be calling for specifically traing some doctors in diagnosing these children.

What I have read supports Teri's statement that no place is paradise for special needs.

Retriever said...

Good piece. No easy answers. There was a famous study that measured the relative stress on a family of being toldtheir kid had terminal leukemia, I believe, or had serious special ed issues. The families with the special ed kid were twice as depressed and did FAR worse.

I was a chaplain in a child welfare agency when young and have a lot of respect for the religious institutions which (at least then) managed to keep tight budgets, offer compassionate care,and get state and federal funding to help them provide the needed services.

These days, raising my own kids,one of them with high functioning autistic and other issues, I am grateful I live in a school district that can afford to educate him reasonably well. Our family's entire life for the last 16 years has revolved around assuring his care: one parent could no longer work in their field because of needing to have secure health insurance, another laid off because the insurance rates for the firm would have doubled with the types of claims made for kid's treatment.

In that time we have never been able to afford a family vacation, we do not go out to eat, nor have household help, and we live in a crumbling ranch with vintage kitchen, everything. No HGTV remodels when one has thousands of dollars in uncovered consultation fees with experts who might be able to help one's kid. Half my salary goes to the uncovered health expenses.

IMHO, education in "typical" schools is not always the best option for special ed kids. In very early years, when the other kids are more accepting and the disabled kids themselves are less daunting physically to teachers (most of whom never signed on to teach special ed and who resent having to devote such a percentage of their time to inclusion) it can work. But we found that eventually a therapeutic school worked better (no more bullying or warehousing in coatrooms with ignorant aides). It's a conundrum.

My two "typical" kids got zip for extra attention,but because they got straight As, etc. didn't need it as much.

Any time someone snarks to me about how expensive special ed kids are, I smile sweetly and say "Yes, I chose to have a disabled son. I went down and drank a crate of whisky, smoked a carton of cigs every week and guzzled my way to 300 pounds to get this kid....NOT!"

I was also a chaplain in an inner city hospital where we treated drug addicts, alcoholic suburbanites, chain smoking lung cancer patients, and kids with leukemia with equal devotion and lack of judgment. Just tried to bring healing. It seems to me that if a civilized society like ours can compassionately care for and fund the treatment of many people with self-inflicted health conditions, the least we can do is care for God's innocent children.

I am deeply grateful to my community for educating my kid, and I do what I can to repay that by volunteering , by teaching Sunday school every week, helping support other parents of disabled kids, and volunteering in the regular schools with regular kids when my kids were still there. On top of working full time and paying taxes.

But of course one can't fully repay the debt.

Anonymous said...

"...how quickly it can become adversarial..."

This says it all. It is not their money. Parents, nay the whole community, pays their salary and ensures their pension is fully funded, and pays for the education services. Period. They hold the purse string but refuse to allow any look or transparency into their spending.

If the school administration or teachers were interested in students above what they can skim off the education budget, they would look to the whole needs of their students and provide accordingly and not seek to limit services based on an individual. Employment at will should follow education a must.