Expulsion from school is used to punish children, alert moms and dads, and protect other children and school staff. Unintended consequences of these practices require more attention from health care professionals. Expulsion may exacerbate academic deterioration, and when children are provided with no immediate educational alternative, child alienation, delinquency, crime, and substance abuse may ensue. Social, emotional, and mental health support for children at all times in all schools can decrease the need for expulsion and should be strongly advocated by the health care community. This policy statement, however, highlights aspects of expulsion that jeopardize kid’s health and safety.
Recommendations are targeted at doctors, who can help schools address the root causes of behaviors that lead to expulsion and can advocate for alternative disciplinary policies. Doctors can also share responsibility with schools to provide children with health and social resources.
Expulsion from school is a method used by school administrators to decrease violence, discourage drug abuse, and curtail criminal activities on campus. Expulsion is also used to deal with difficult and challenging behaviors, including truancy.
Between 79% and 94% of schools have policies known as "zero tolerance"—the term given to a school or district policy that mandates predetermined consequences for various child offenses, and almost 90% of Americans support these policies. Despite widespread public support for schools’ zero tolerance disciplinary policies, the American Bar Association (ABA) voted in 2001 to recommend ending them. The ABA argues that it is wrong to mandate automatic expulsion or referral to juvenile court without taking into consideration the specifics of each case. It is understandably important for legal professionals to challenge a "one-punishment-fits-all" approach. It is equally important for doctors and related health care professionals to address potential physical health, mental health, and safety concerns that arise from expulsion from school.
Advocacy from the health care sector can be divided into 3 major categories:
First and foremost, health care professionals need to advocate that the educational system provide, through its own system and through community partnerships, an environment and a range of resources that support children and that decrease the likelihood that children will engage in behaviors requiring disciplinary action. These recommendations are covered in the American Academy of Pediatrics policy statement "The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level." In addition, "Mental Health in Schools: An Overview," developed by the University of California Los Angeles Center for Mental Health in Schools, provides good references. A number of other published documents also exist on this subject, many of which are informative and comprehensive.
The second category of health, mental health, and safety concerns is related to the lack of professional support and adult supervision often associated with expulsion.
The third, discontinuity in education is an important concern, not least because educational success is so strongly linked to health and safety. Forty-nine percent of children in schools disciplined under a zero-tolerance clause are given out-of-school suspensions that last 5 days or more. Thirty-one percent are expelled, and 20% are transferred to an alternative school or program but often have out-of-school suspension periods up to 4 days in duration. Seventy-eight percent of schools in large urban school districts consider out-of-school or at-home suspension an acceptable disciplinary action.
REASONS SCHOOLS EXPEL CHILDREN—
Real and perceived immediate threats to a child’s own safety or to the safety of others are some underlying reasons for out-of-school suspension. The Gun-Free Schools Act (Pub L No. 103-882) of 1994 requires schools to expel, for a period of not less than 1 year, children who have brought a weapon to school. However, this act also specifies that schools are allowed to provide educational services in alternative settings. Threat to safety logically should only apply to those children who have already caused serious injury or damage to school property or are at high risk of causing such injuries (e.g., possession of a gun or explosive). However, studies of expulsion patterns suggest that danger of assault is not a major reason for children having been excluded from any school program. In 1997, of the 3.1 million children suspended from school, most were involved in nonviolent and noncriminal acts. Only approximately 10% of the expulsions or suspensions were for possession of weapons. In the small towns of states such as Oregon and South Carolina, children are expelled at 5 to 6 times the rates of children in cities such as Chicago and San Francisco, yet it is unlikely that crime rates in small towns are 5 times the rates in these large metropolitan areas.
Excluding a child from attending school is sometimes imposed as a disciplinary tactic, intended primarily to punish the offender and secondarily to deter other children. School administrators have reported that removing a youngster from school provides a cooling-off period for the offending child as well as for frustrated educators and administrators. At-home suspensions are also sometimes seen as warnings for moms and dads who may have not previously taken their youngster’s misbehavior seriously and who may have considered problem behaviors to be purely the school’s responsibility. Other school disciplinarians readily admit to using expulsion as tools to eliminate troublesome children from the educational system. In some states, no alternative educational setting is provided to suspended children. For example, in 1996–1997 in Massachusetts, 37% of expelled youth did not receive alternative education in another school or a special education program. In 75% of those cases, alternative education was not provided because the school district chose not to do so.
Many school districts have developed alternative programs for children who are expelled or suspended. Unfortunately, in many of these circumstances, children are required to stay at home during an interim period ranging from days to months until arrangements can be made or a position becomes available in an alternative setting.
RISKS FACTORS FOR EXPELLED CHILDREN—
Kids who are suspended are often from a population that is the least likely to have supervision at home. According to the 2000 US census, kids growing up in homes near or below the poverty level are more likely to be expelled. Kids with single parents are between 2 and 4 times as likely to be suspended or expelled from school as are kids with both moms and dads at home, even when controlling for other social and demographic factors. There may also be racial bias for application of school disciplinary actions, with African American youth suspended at nearly 2 times the rate of white children in some regions.
Kids who use illicit substances, commit crimes, disobey rules, and threaten violence often are victims of abuse, are depressed, or are mentally ill. As such, kids most likely to be suspended or expelled are those most in need of adult supervision and professional help. In one study, 15% of kids who have never been abused but had witnessed domestic violence were suspended from school in the previous year. This was attributed to heightened aggression and delinquency from living in a violent home environment. For children with major home-life stresses, academic suspension in turn provides yet another life stress that, when compounded with what is already occurring in their lives, may predispose them to even higher risks of behavioral problems.
Despite high rates of depression and numerous life stresses that are associated with school-based problem behaviors, children are not routinely referred to a medical or mental health provider on expulsion or suspension. The only exceptions are children requiring rehabilitation or drug testing when the cause of disciplinary action was related to substance abuse. Without the services of trained professionals (e.g., doctors, mental health professionals, and school counselors) and without a parent at home during the day, children with out-of-school suspensions and expulsions are far more likely to commit crimes. A Centers for Diseases Control and Prevention study found that when youth are not in school, they are more likely to become involved in a physical fight and to carry a weapon. Out-of-school adolescents are also more likely to smoke; use alcohol, marijuana, and cocaine; and engage in sexual intercourse. Suicidal ideation and behavior may be expected to occur more often at these times of isolation among susceptible youth. The lack of professional assistance at the time of exclusion from school, a time when a child most needs it, increases the risk of permanent school drop-out.
ALTERNATIVES—
Many school districts have been innovative with alternatives to expulsion. Children are immediately transferred to supervised suspension classrooms run by the district until they are moved to an alternative setting or readmitted to their regular school site. In some districts, moms and dads are required to accompany children to school for a portion of the school day. Some districts have children provide community service on school grounds during nonschool hours.
Although far from perfect, the statute for disciplinary action taken against children who are served by the Individuals With Disabilities Education Act (Pub L No. 101-476 [1990]; i.e., those who qualify for special education) presents a promising model for managing all young offenders in the educational setting. The law requires that children with disabilities, even if expelled, continue to receive educational services. The school must perform a pre-expulsion assessment and demonstrate that it has made reasonable efforts to minimize the risk of harm in a child’s educational placement. These children’ individualized education programs are often specifically modified to address and prevent recurrence of inappropriate behavior.
RECOMMENDATIONS FOR SCHOOLS—
1. A full assessment for social, medical, and mental health problems by a pediatrician (or other providers of care for kids and youth) is recommended for all school-referred children who have been suspended or expelled. The evaluation should be designed to ascertain factors that may underlie the child’s behaviors and health risks and to provide a recommendation on how a youngster may better adapt to his or her school environment. A full history should be derived from the child, family members, and school staff members once consent to exchange information is attained. Management options to consider include appropriate referrals to drug rehabilitation programs, social agencies, mental health professionals, and other specialists who may assist with underlying problems. Doctors should routinely consider including school staff members as partners in the management of kids and youth with school behavior problems, providing that privacy issues are respected as outlined in Health Insurance Portability and Accountability Act of 1996 (HIPAA [Pub L No. 104-191]) regulations.
2. As part of the school’s or district’s written policy on disciplinary action, schools should routinely refer a child to his or her primary health care professional for an assessment if there is a disciplinary action or a child is at risk of such action. Assistance with obtaining a medical home should occur in circumstances in which a child facing disciplinary action does not yet have one.
3. Matters related to safety and supervision should be explored with moms and dads whenever their youngster is barred from attending school. This includes but is not limited to screening moms and dads by history for presence of household guns.
4. Out-of-school placement for expulsion should be limited to the most egregious circumstances. For in-home expulsion, the school must be able to demonstrate how attendance at a school site, even in an alternative setting with a low ratio of highly trained staff to children, would be inadequate to prevent a child from causing harm to himself or herself or to others.
5. Doctors are encouraged to provide input to, or participate as members of, school- or district-based multidisciplinary child support teams that can provide disciplined children with a comprehensive assessment and intervention strategies. Schools should help support the participation of doctors on multidisciplinary teams by arranging for participation at times and in formats (e.g., telephone) that are conducive to practicing healthcare professionals, by financially supporting time for school physicians, or through other logistic considerations.
6. Doctors should advocate for practices and policies at the level of the local school, the school district, and the state department of education to protect the safety and promote the health and mental health of kids and youth who have committed serious school offenses.
7. Doctors should advocate to the local school district on behalf of the youngster so that he or she is reintroduced into a supportive and supervised school environment.
8. Schools need to establish relationships with various health and social agencies in their communities so children with disciplinary problems who require assistance are readily referred and communication lines between these agencies and schools are established.
9. Children and their families should be encouraged by school staff members to access health care and social services, which can be accomplished if these important topics are included in health education and life skills curricula. It is also recommended that health care professionals provide information to kids, youth, and families on access to health care and social services.
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