Drug-resistant TB

Let us think about the school-resistant teenager. 

Initially, he gets the usual combo therapy. Teachers encourage. Parents called. Extra tutoring offered.  Connected with a mentor. Possibly evaluated for a disability.  

Still he struggles. Now what?

a) Try something very different.

b) Try same stuff, but execute better, and tailor the interventions more precisely.  

In this week’s New England Journal of Medicine, they examined a variant of that question–how to treat the drug-resistant tuberculosis pati ent, someone who has been treated several times by a doctor without success? 

A team tried “B”–same stuff, execute better, more precision. Combo therapy of 5 drugs, plus home visits by social workers who made sure the patients actually did their homework, oops, took their medicine. 

They were able to cure about 60% of previously drug-resistant patients. 

Lesson? Right now we put secondary teachers in an untenable position. They write prescriptions (assigning homework, readings, studying), but the school-resistant teen simply never actually takes the medicine. Then we’re never quite clear on who owns that noncompliance: kid, parent, teacher, someone else? 

In the TB experiment, the medical team took on that responsibility. But there was division of labor.  Doctors wrote the prescriptions, but social workers got patients to actually take the medicine. Who is the “someone else”–not teachers–who essentially act as personal trainers to get school-resistant kids to exert effort? 

–Guestblogger Mike Goldstein

7 Replies to “Drug-resistant TB”

  1. My proposal for the school-resistant teen (placed in the comment section to not totally overload the home page):

    a) More schools that try something very different. Unfortunately, many “alternative schools” more-or-less replicate the typical school day, with smaller classes.

    b) Some schools that try better execution, generally expecting an extra 10 to 15 hour per week per teacher to do a million little thing designed to elicit effort from school-resistant teens.

    c) A new option in many traditional schools: allow the school-resistant teen to become a school-willing 20-something. The way to do this is to change the dropout process. The $ allocated to educate a kid would become “protected” just for him.

    The added benefit would be that instead of, say, 10 urban teachers each working with 70% reasonably engaged kids and 30% resistant kids, under the new plan 7 teachers might work with 100% reasonably engaged kids and 3 teachers might work with 100% reasonably engaged people aged 20 to 25. Win-win-win for kids, teachers, and society.

    -Guestblogger Goldstein

  2. The silence in response to this post is deafening, apart from GGW’s comment (which I think is on to something). Classroom-based secondary education — even primary education — is a group endeavor that suffers when the teacher has to make too many adjustments to match individual children’s preferences, level of engagement, previous achievement, etc. (Some adjustment is appropriate and necessary; constant adjustment is not). If what we want is customized education for each child, it’s going to have to happen in a different environment than the traditional classroom.

  3. You should take a look at a new report published by WestEd on the outcomes for students who drop out and then return. The population studied were kids who chose to return on their own, not as part of a “recovery” program. The majority tried multiple times to come back, and just couldn’t catch up on the classes. One of the researchers said they just “lost hope.”
    Following your own metaphor, remember that health research also points to the patient’s support group and personal faith in recovery as critical to recovery from chronic illness. Likewise, students who have received multiple educational “treatments” might need a renewal of faith in the educational system in order for even correctly implemented interventions to be successful.
    I’d love to know how educators address student cynicism or even despair in these situations.

  4. I strongly support your suggestions. Like The Turnaround Challenge said, there are multiple times when students become disengaged and drop out and each need their own rifleshot approaches.

    Take all of my complaints about CYA online “credit recovery” programs that we have tacked on to our neighborhood schools to make our data look better, and ask what would happen if it was 18, 19, and 20 year olds who were utilizing them to come back to school? The same kid who cut classes and then tried to game the system when he was 15 would often come back to the same program with the maturity that comes from the experience of dropping out. A college kid gets services until they are 22 or older, and we pay through Medicaid, jail etc. for dropouts. But society doesn’t help them learn how to make better decisions.

    The biggest and the toughest and the scariest challenge is the young middle school kids. We don’t want to ghettoize them in a separate but equal alternative system, but then we can predict that 85% or more of those kids will drop out, so which is better for the kid? We are proposing in our district that we enforce our code of conduct and attendance policies, but that is impossible unless we:

    a) borrow some ideas from Lynn Canady and design schedules within the schools so that disengaged and hopelessly behind and disruptive students can have hope and opportunity within the same building,
    b) create “Rolls Royce” quality alternative schools to create choice and empower parents and overcome the stigma of alternative schools, and
    c) recognize that politically it will be incredibly difficult to enforce disciplinary consequences, so concentrate first on truancy. It would be much harder to argue that alternative schools might hurt kids more than just hanging out on the corner.

    Then immediately we have to make instruction more engaging. Without the constant disruptions, we can be more rigorous in:
    a) getting rid of the worst teachers,
    b) demand more instructional focus, and
    c) get the kids out of the buildins on field trips and for community learning.

    I also agree that the silence on this issue is deafening. Perhaps the most destructive aspect of the “staus quo” is the nonstop pressure on teachers to not write disciplinary referrals. Every year Kappan has its poll on attitudes of parents, teachers, and the community. They rarely ask about disorder, but the people consistently volunteer their beliefs about the need to create safe and orderly schools. And take a look at the Education Next poll. Unless we find humane ways to help disengaged kids as we address the chronic disorder that they do so much to create, we will either face vigilante type anger from the community or the voters will just disengage from public schools.

    But I like your idea, which is another way to get out of this one size fits all “quick fix” mentality.

  5. You’ll see that I wrote “parents” in the original post — with a question behind it.

    Our small school’s experience (90% Af-Am or Hisp, 70% low-income) is that high school parents are very willing to support a school’s high standards (if they get a weekly phone call from a staff member, so they feel like their kid is known as an individual).

    However, a much smaller cohort of parents really sit a school-resistant teen down at the kitchen table each night to do homework et al.

    1. Why not?

    Variety of reasons. Most you can guess. One which I’ve observed and didn’t realize before: frequently a single mom is spending her “parent capital” on keeping her school resistant kid out of even bigger trouble. Gangs. 26-year-old guys who want to date their 15-year-old daughters. This, one might argue, is a rational response.

    2. Even if we make significant progress is getting parents to become much more involved in the school-resistant kid, let’s also assume many kids will continue to arrive to school each day without that support. What then?

  6. I understand your desire to find a way to excite students in spite of their parents, and I agree it is laudable. I am of the mind that unless we make explicit the claim that parental involvement is required, parents will continue to assume the school is the final arbiter of all things educational. And that is wrong, IMHO.

    I would like to see schools, as institutions, refrain from begging parents to be involved, and start expecting them to be involved. We need alternative paths for kids who are resistant, and for whom parental involvement is absent (for whatever reason). Remember shop? Vocational training? Tracking? These would go a long way towards making school more relevant to the non-college bound kid. And what about this college-bound thing? Are all kids college bound? No! So let’s stop saying they are!

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