That emotional distress and behavioral problems are prevalent, especially in high schools, is well known. The lack of consensus as to who should be classified as "at risk" has been reviewed in Part I of this series. It has been found that students in distress are more likely to approach family, friends, and school personnel for assistance rather than mental health professionals. This article reviews the school- and community-based programs advocated in educational, psychological, and psychiatric journals over the past five years. It excludes studies conducted in traditional mental health settings (for example, outcome studies of inpatient programs and residential treatment facilities).
Classification of the Programs and Studies Reviewed
The programs evaluated in this review are classified by location, focus, and format as shown in Figure 1. Table 1 gives the main characteristics of the larger studies and those which utilized expression of emotions and social bonding and support as intervention modalities.
Proposals to Overhaul the Educational System
DeRidder (1991) advocated changes in the school system to assist at-risk students in a nonpunitive way "since additional punishment for students who are already alienated simply creates hostility and does not adequately address the students' real problems." It was hoped that the proposed changes would "help each student by identifying and remedying the factors that contributed to the discipline and academic [TABULAR DATA FOR TABLE 1 OMITTED] problems. They would then provide personalized and caring assistance at a level appropriate to the student's academic and psychological functioning." Preferably, parents would be involved in developing and carrying out each student's individualized program. The specific proposed changes included: (1) separating potential dropouts or "pushouts" (i.e., at-risk students who are encouraged by their teachers to leave school) from other students and placing them in special programs; (2) a strong vocational component, including practical job-related skills; (3) out-of-class learning connected with paid employment; (4) individualized instruction; and (5) more individual and group counseling.
Cuban (1989) recommended separate programs for at-risk students in urban areas, and reducing the school size (between 50 and a few hundred students) and smaller class size (15-20 students per teacher). Cuban proposed housing these programs as schools-within-a-school or completely separate from the main building. Other recommendations included: (1) employing dedicated and accepting teachers and administrators who choose to work with the "at-risk" population; (2) flexibility of the teachers, administrators, and school board members; (3) program flexibility using nontraditional approaches to nontraditional problems (e.g., increasing the population's homogeneity - avoiding "ability grouping" so that the less able do not feel stigmatized), and providing access to a variety of social services; (4) avoiding the conventional school model, where the teacher's primary concern is academic achievement.
Unfortunately, several factors made these two approaches impractical: the magnitude of the problem, high student-to-teacher ratio, limited school budgets, and poor support available to students at home. The societal inclination to integrate rather than separate at-risk students made implementing these recommendations difficult except for those with severe behavioral problems.
Out-of-School Programs and Those Designed for Students Who Have Dropped Out
Behaviorally and psychoeducationally oriented programs or programs focused on specific behaviors. O'Sullivan and Jacobsen (1992) studied the effectiveness of a special health care program on the repeat pregnancy rate and school re-enrollment of unwed African-American adolescent mothers receiving Medicaid. In addition to routine baby care, the program for the experimental group included rigorous follow-up, discussions with the mother about her plans for return to school and the use of family planning methods, and additional extra health education. …