The Role of Cost-Benefit Analysis in Achieving Results in Special Education
When they encounter the term, cost-benefit analysis, many people take this to imply an objective to achieve the lowest possible cost and the very highest benefits. In practice, however, cost-benefit analysis is much more complex than this simple description would imply. Consider, for example, that the evaluation of cost and benefit in education is complicated by the fact that education is asked to incur the cost of preparing students for adulthood, yet receives very little in the way of benefits, which accrue to the community at large. Thus, something that might appear to be cost-beneficial for a school district might not be good for society as a whole in the long-run. Alternatively, something that is not cost-beneficial for a school as a singular entity might in fact have significant long-term benefits. The lesson is that we must not look at education expenses in isolation; rather, we must consider them within the context of investments, which ultimately should be repaid.
For hard evidence, we can call upon the powerful industrialist who gave us the assembly line and helped propel the country and the world from an agrarian to an industrial economic base, Henry Ford. Picture the situation: Ford invented the assembly line, which he was about to put to work to deliver his Model T. Before long, every second car on any American Road would be a Model T. As he set about staffing his assembly lines, Ford faced a labor market with an abundance of workers who would have been glad to sign on for 15 to 20 cents an hour.
But Ford had a bigger picture in mind. With a view that encompassed all of the consequences of his actions, he opted to set the pay scale on his lines at $5 a day. His reasoning: At that rate, he could get the best quality people who would be loyal and relatively immune to the intensive labor organizing that was going on all around Detroit. Beyond that, Ford had another, overriding reason: At $5 a day, his workers would be able to afford to buy and drive Ford cars. And he did take strong measures to make them customers.
In the early 1900s the nation had not yet seen the creation of a sizable middle class. By adopting his strategy to expand the potential market for his product, Mr. Ford was effectively making an investment in the future of his company and, in the process, impacting the entire national economy. In hindsight it is clear that Mr. Ford's vision was absolutely correct. Indeed, the story of twentieth century America has been one of a nation that generated unprecedented levels of new wealth, but also managed to disperse that wealth more broadly than any other society in history. Opportunities for well-paid work became available for even those with minimal education. Even a person without a high school education could find factory work that paid a living wage.
This is not to suggest that, with Mr. Ford's help, Americans have built an economic paradise. No way! A rising tide may indeed raise all boats, but some boats are clearly raised more than others. Dispersing of the nation's wealth has not encompassed the entire populace. Nonetheless, in the aggregate we have accomplished much, even if there remains progress to be made.
What we have learned in the course of experiencing a century of unprecedented wealth creation is that increases in the aggregate standard of living are directly proportional to increases in the productivity of the populace. That is, by utilizing people's efforts more efficiently, we free resources to address higher-level needs, thus theoretically increasing the general welfare of the public at large. The ability to utilize people's efforts more efficiently results from innovations in either process (we do the same task, but we do it better) or from advances in technology. Ford's assembly line, in its day, achieved advances on both fronts. By using a more efficient process coupled with the technological concept of moving cars to workers rather than requiring workers to move to the vehicles, Ford reduced costs and made cars more affordable. In the process, he established methodologies that ultimately revolutionized American life, including a basis for improving the overall standard of living.
Productivity Changes the Nature of Employment
Technological innovation has accelerated since Ford's day and is playing an increasingly important role in our world and presents education with its greatest challenge to date. Again the Ford precedent applies: Today, a significant portion of automobile production is performed by machines with minimal human intervention. In other words, the number of human hands needed to build a single automobile has dropped dramatically. Thus, workers have been displaced by technology. Those who have not been displaced have needed to upgrade their skills to remain employed in factory jobs. Today's production worker knows volumes more about the overall manufacturing process, statistical measurement, and quality control than his counterpart of 40 or 50 years ago. Correspondingly, the same worker is also much more empowered to make decisions about the process. Manufacturing is no longer a place for people with only minimal skills.
Farming offers a similar example. For the last hundred years or so, the farm worker productivity has increased at the rate of roughly 1.5 percent per year. This may not seem like a lot, but cumulatively it is hugely significant. A hundred years ago, roughly 30 percent of the populace was engaged in farming. Today, that figure hovers around 3 percent. Yet as a nation we produce a greater amount of food. Again, the results derive from a combination of process innovation and technological progress.
For the past 40 to 50 years, manufacturing has been charting a parallel course with essentially equivalent increases in productivity. Thus, today the percentage of the populace engaged in manufacturing is around 14 or 15 percent and falling! Some project that, in the next 10 to 20 years, manufacturing will account for no more than 3 percent of all employment. The good news, from an economist's perspective, is that the economy will continually require fewer people to do unskilled work, thereby freeing people to pursue higher-level employment. The bad news, from a pragmatist's perspective, is that a significant portion of the population may not be prepared to succeed in a world where the key to success will depend on the application of high-level knowledge for the creative solution of complex problems. The role of education is pivotal in addressing this most pressing societal issue.
Note the classification of the issue above as societal rather than economic. We are a nation that is largely shaped by our value of equity, though that value admittedly means different things to different people. At a minimum, though, it could be safely posited that we predominantly agree that equity encompasses equal access to opportunity. That is, if we wish to improve our lot in life through personal effort, we should have the same opportunity to pursue our goals as anyone else. Indeed, this is a strength of the nation - hard work and good ideas have historically had stature that transcends birthright. This has been somewhat unique within the international community.
Equity in opportunity is so valued in this the nation that the majority of civil strife over the past 40 years has had at its foundation the interests of groups of citizens who did not have such equity. Educational parity, which held the opportunity of economic and societal gains for minority students, was the fundamental issue underlying Brown vs. Board of Education, the 1954 Supreme Court decision that mandated integration of public schools. The ensuing Civil Rights Movement of the 1960s broadened that interest to many, many more facets of everyday life, particularly in the areas of employment and community access. Public Law 94-142 - the Individuals with Disabilities Education Act of 1975 - was itself founded on the belief that access to education for people with disabilities gave them enhanced opportunities to succeed in life, opportunities to which it was decided they had a legal right.
Will Lack of Equity Lead to Strife?
If inequitable opportunity indeed underlies social conflict, we may very well be headed for a contentious era of American history. Since the early 1970s, the gap between the most highly compensated and the lowest paid workers has been growing at an accelerating pace. The differentiating factor is clearly the level of skills an individual brings to the work place. As noted previously, opportunities for people with low or marginal skills have been disappearing. Unfortunately, the overall skill level of graduates has essentially remained the same. Thus, the simple economics of supply and demand accurately predicted low wage growth for this portion of the labor market. At the same time, demand for highly skilled workers has increased - recall that the information-based economy creates jobs that require the use of high-level knowledge in the creative solving of complex problems. If the overall skill level of graduates remains constant, however, compensation levels for the people who fill such jobs rise dramatically while many positions simply go unfilled. The result is the increasing wage gap.
Indeed, this is the scenario that is playing out in today's economy.
Displaced workers with low skill levels either cannot find work or they settle for work that is compensated far below what such workers had previously been paid. At the same time, there is such a shortage of candidates qualified to work in the field of information technology that technology companies are pushing legislators for liberalized immigration policies. Though some probably are, most such companies are not looking for a source of cheap labor, which is evidenced by the fact that qualified immigrants in the field generally earn at levels commensurate with their American counterparts. Rather, these companies truly face an issue of not being able to find qualified human resources that are needed for these companies to grow and prosper.
The key to successfully addressing the growing earnings disparity - which will find its way into societal conflict if not countered - is to improve the overall skill level of graduates. Yet, despite being almost two decades into the most recent wave of education reform, we have achieved very little in this regard. If it is true that "human history becomes more and more a race between education and catastrophe," as H.G. Wells once observed, we may indeed be on a collision course with disaster.
Special Education as Bellwether
Special education probably offers a reasonably accurate preview of what challenges face not only regular education, but society as a whole, over the next couple of decades. Research indicates that the results of special education are disappointing, especially in light of the enormous financial resources that have been dedicated to it, particularly since passage of 94-142. People with disabilities are still far more likely than their non-disabled counterparts to be indigent, unemployed, underemployed, homeless, and incarcerated. They are far less likely to live independently. From the perspective of the policy-maker or the taxpayer, the result is increased dependence on costly adult human services. From another, more important, perspective, though, the issue is lost potential and wasted possibilities. Failure to increase the overall quality of graduating students portends these types of lifestyle results for an increasing portion of the population, many of whom could not be considered as disabled.
Twenty years ago, American enterprise faced a situation not unlike that confronting education today. American products were simply not competitive with foreign offerings. As compared with Japanese products of the day, for example, they were of very poor quality and unattractively priced. Today, the situation is very different. The American economy is the envy of the world and our enterprises consistently demonstrate an ability to manufacture products that achieve world-class levels of quality. Advances in technology and medicine are emanating from American research and development facilities and universities. While there are many elements that have contributed to this dramatic turnaround, one of the most important has been that American enterprise got very serious about improving quality. Ford was serious in the early 1980s when it said, "Quality is Job 1." Having dramatically turned around its quality record, Ford finds itself today on a trajectory that could make it the world's largest automobile producer in the early part of the next century.
Defining and Identifying Quality
But what is quality and have not there been numerous initiatives in education to improve the effectiveness of the institution? The answer to the latter part of the question is, of course, yes, though many of the efforts have been tepid and most have been ineffective. The problem may be that we have made the first part of the question far too complex. Schools have worked with concepts such as Total Quality Management and the whole standards movement currently in vogue has roots in the notion of using rigorous measurements as a critical tool to facilitate systemic improvement. There is, of course, nothing inherently wrong with Total Quality Management or the raising of standards - achieving high quality and having high standards are hallmarks of excellence. Perhaps, though, we jumped too far too quickly and failed to truly answer the first part of our rhetorical question, "What is quality?"
There are numerous approaches to quality management and many concepts are associated with such initiatives. Total Quality Management, or TQM, has already been mentioned. Similarly, many large manufacturers, General Electric being the most noteworthy, have adopted the principles of Six Sigma, a program that aims to reduce the defect rate of any process to less than 3.4 per every million opportunities. Statistical quality control, Kaizen, a Japanese term for "continuous improvement," and competitive benchmarking are tools a quality manager keeps in his or her arsenal. Before even considering implementation of such measures or using such tools, managers must establish a clear understanding that quality is founded on the principle that it can only be measured from the perspective of the customer.
That quality can only be measured through the perspective of the consumer is not only an interesting concept - it is the single most critical concept required for delivering quality results. Quality in the mind of the producer is unimportant, perhaps even irrelevant; quality in the mind of the consumer, however, is the ultimate measure of success.
The Quality Movement in Education
Let us again consider the history of education reform. Assuming that the release of A Nation at Risk in 1983 marked the starting point of the last wave of education reform, we have basically been at the task of changing education to meet the challenges of a new world for over 15 years. In that time, we have seen efforts aimed at top-down reform, bottom-up reform, and, most recently, at raising standards for the purpose of improving our schools. While the jury is still out on standards, it is clear that efforts in the other approaches have basically floundered. Despite huge investments of time, effort, and money, 15 years of initiatives have produced minimal positive results.
The issue, in our opinion, is that we have been looking to improve education from within. That is, we are attempting to define quality in education from the perspective of the institution rather than from that of the consumers of our efforts: students, parents, business, and the community at large. Even standards, which have been advanced and advocated primarily by the business community, have largely degraded into an internally focused activity. Who has decided what the standards will be? The answer: primarily educators. Thus, the standards naturally reflect the interests of educators, which are not necessarily aligned with the interests of education's consumers.
Recent research conducted by Dr. Willard Daggett and the International Center for Leadership in Education tends to bear out this conclusion. The International Center has compiled a set of education standards that are highly reflective of those used in our various states. They have asked a wide variety of people, educators and non-educators alike, to rank the standards in terms of importance. Overwhelmingly, those participating have ranked skills-focused standards above those that are content-based. Yet, a review of what is taught in school and what is measured on tests reveals that content is still emphasized, especially at the secondary level. Granted, content can be a valuable conduit for teaching a skill. Nonetheless, in promoting learning, it is necessary to adapt content to the true goal of helping students to build the skills to apply that knowledge practically. In education today, acquisition of the skill is more often than not assumed to be a natural derivative of the learning process; for the majority of students, it is not a given. We need to be much more proactive in setting acquisition of the skill as the desired result and working backward into appropriate content so as to build toward achieving our goal.
A Framework for Achieving Results and Facilitating Change
The Wildwood Institute's Framework for the Evaluation of Cost and Benefit in Special Education is a model that can be used for focusing decision-makers on achieving long-term results for students with disabilities, as opposed to just attempting to meet standards that may or may not be relevant. Additionally, the model is intended to provide decision-makers with reliable information about program effectiveness through accumulation of data that yield objective information. Evaluation of these data can, in turn, help to identify demonstrably successful practices. The targeted result, then, can provide the foundation for productive change processes and initiatives.
The Framework has been developed over the past couple of years under the guidance of a national panel of distinguished experts. This panel, which was co-chaired by the aforementioned Dr. Daggett and Laurence Gloeckler of the New York State Education Department, consisted of representatives from education, academia, business, and disability advocacy groups. The panel also included practicing professionals and family members. By having diverse interests in the group's membership from the outset, it was very easy to maintain a focus on the end results the public expects from special education. These desired results essentially center around the public's desire for special education to prepare students for an adulthood that maximizes their vocational productivity and residential independence. Incidentally, people with disabilities have the same basic desires for education as the general population. This demonstrates that, when special education is meeting its true mission, it is achieving a unique win-win scenario. That is, when people with disabilities can lead relatively independent and meaningful lives, the general community benefits by having people who are less dependent on formal and expensive public support systems.
The basic model of the Framework is perhaps best understood by using the illustration below. Note that any Framework-based analysis is conducted for a single program for a single student. Systemic reviews require the compilation of a set of analyses to gain insight into how a system is functioning as a whole.
On the left side of the illustration is the Total Education Cost, which is broken into two components: the Average Regular Education Cost per Student and the Additional Cost for Special Program. On the right side is the measurement of benefit which has three distinct components: the level of Vocational Achievement; the amount of Support Required to maintain that achieved level of employment; and Residential Achievement, which is expressed in terms of support required to maintain the achieved level of residential independence.
When education is meeting its mission of preparing students for life, the resources applied to it are not really costs but investments. Therefore, the Framework model measures the incremental improvements in adult productivity and independence that derive from the investment made in a special program. That investment is illustrated above as the Additional Cost for Special Program box.
The special investment is then correlated to the benefits, which are illustrated as the half-arrows A, B, and C in the illustration. In each case, the left-most part of the arrow represents the life result expected when only a regular education program is provided a student. The right-most part of the arrow represents the result expected subsequent to the implementation of a special program. Each expected result is quantified in line with data derived from public sources; the difference between the right point and the left point is the expected incremental improvement, which is then quantified to represent the financial benefit accruing to the public. The three benefits are finally combined to derive the total benefit of implementing a special program.
Once the results are quantified, the resultant data can be charted on the Cost-Benefit Matrix, which is shown below. This graphical model can be used to ascertain quickly the cost-benefit results of a program.
Region I programs are described as Low Benefit, High Cost and are the least desirable programs a district can run as they are expensive but provide little benefit to the individual.
Region II programs are High Benefit, High Cost. Their high benefit characteristic makes them desirable, but the high cost factor prevents their widespread use. Districts should reserve such programs for students with the most severe and/or complex disabilities.
Region III programs are described as Low Benefit, Low Cost. We describe these as "dangerous" programs, since they are attractive because they are inexpensive to operate. Despite their low cost, they do not produce a desirable level of benefits and thus should be examined to see if there are better alternatives or opportunities for program improvement.
High Benefit, Low Cost programs are found in Region IV and represent the ideal. Districts can operate such programs without a huge impact on the budget. Yet, students are well served by their implementation. Districts should look for these types of programs and seek to replicate their successful practices on a widespread basis.
Finally, as cost-benefit analysis is truly an inexact science, there will be some programs that fall near the intersection of all the regions. For such programs, cost-benefit analysis alone is inconclusive for determination of implied action. We therefore recommend that decision-makers examine non-financial factors in making decisions about the ultimate value of such programs, a requirement that's always there but is more strongly present in cases like these.
Evaluators using the Framework to evaluate a program make extensive use of a tool called the Triangle of Holism, which is shown below.
The Triangle concept was developed to help evaluators identify the broad factors that predominantly influence a program's ability to achieve life success. The realms of requisite competency are academic, interpersonal, and physical. Balance among the realms is necessary for an individual to maximize his or her adult levels of productivity and independence. For example, while a student could be academically very capable, a seriously deficient ability to demonstrate self-control, which is an interpersonal skill, will most likely serve to prevent successful employment. Additionally, to the extent that violent criminal behavior may result from this inability, independent living may be jeopardized by the potential for incarceration.
The evaluator therefore uses the Triangle first to identify a student's defining factors. This term is essentially defined to identify those aspects of a person's character and competencies, or lack thereof, that have significant potential for restricting the ability to succeed in life. Again, from the example above, the strong academic program that fails to address an individual's propensity for violence would not be ideal, since violence has a long-term negative consequence. The evaluator subsequently examines a program to see not only if it is addressing the defining factors, but also to measure the progress that is being made with the chosen approach. Programs that cannot demonstrate progress evaluate poorly.
Note that the Triangle uses terminology that is relatively generic and easily understandable by informed persons who are not necessarily educators. This approach was intentionally taken to address the previously noted issue of perceiving quality from the point of view of the consumer. Furthermore, the use of such terminology keeps the Framework agnostic with regard to program or practice. That is, the Framework is designed to be indifferent to the approach that is used to achieve desired results. Consequently, it is more open to creativity and innovation than education decision-making processes generally are.
Lessons from Individual Framework Case Studies
To illustrate the benefit of using the Framework as a decision-making tool, consider the following stories of George and Greg, both of whom have participated in programs evaluated using the model.
George: Marginal Skills, Abundant Drive
George is a seventeen year old high school student living in a rural community. Neither of his parents were good students and subsequently neither completed high school. The people at George's school observed that his mother would today probably be considered educably mentally retarded. Nonetheless, the family is stable, George's father is gainfully employed as a factory worker, and both parents strongly support George and value what hard work and education can do for him. George himself is an affable young man, but like his parents, is an individual who clearly faces limitations in his intellectual potential and finds schoolwork very difficult. George also has a strong sense of self and a willingness to work hard.
Nonetheless, his final year of middle school found George considering dropping out as he was achieving little success academically or socially. Furthermore, he did not feel that his educational experience was offering him anything of long-term value - "Middle school was not teaching me what I needed to know." The Institute's program evaluators identified the following as George's "defining factors:"
- academic performance combined with other weaknesses that suggest one or more learning disabilities;
- a strong sense of worth deriving from a supportive family environment;
- a willingness to work hard; and,
- an ability to succeed when participating in activities that are meaningful to him.
The most important of these factors is the last one. Without an ability to attach meaning to what he is learning by putting new knowledge to immediate use, George does not succeed in academic pursuits. Without such success, school becomes meaningless for George and he contemplates exiting the system.
Recognizing the loss of potential that would likely be realized by dropping out, the school looked for an alternative program that would entice George to continue his schooling and also facilitate the development of enhanced math and language skills. The school found a good match in a program they had already developed. That program was essentially a small craft business operated within the school. In addition to working with the business, George participates in traditional math and language arts classes. However, the math skills taught in the classroom are reinforced in the business through "real world" activities such as projecting, budgeting, taking inventory, reconciling cash, and performing precise measurements. Written language skills are reinforced through the preparation of reports and marketing materials while verbal skills are strengthened by interactions with customers, production teams, and suppliers. Tight and formal coordination takes place between the academic instructors and the small business personnel.
The combination produces exceptional results for a student like George. He not only remains in school, but now claims to enjoy it immensely. His academic progress is proceeding at a rate he has not experienced since elementary school. And, not only is he learning vocational skills that will make him more competitive upon leaving school, he is involved in an environment that actively supports the growth of social skills he will need to be vocationally successful. Despite appearing to be an expensive program, this program was moderately below the Cost Threshold shown on the Cost-Benefit Matrix. The level of benefits easily exceeded the Benefit Threshold, making this an ideal High Benefit, Low Cost program. This conclusion was further supported by a relatively short four and a half year payback period.
Greg: Strong Cognitive Ability, Poor Behavior, Little Ambition
Now consider Greg, a student of roughly the same age, but of a somewhat different background. Greg lives in a suburban area and is the son of divorced parents. He lives with his father, who has substance abuse problems and is in and out of work. Whereas George appeared to have limited academic potential, but unlimited drive, Greg appears to have, at a minimum, relatively strong cognitive capabilities. He displays little ambition, however. In fact, when asked to demonstrate initiative, Greg often responds with a behavioral outburst or an outright refusal to work. Apparently, this aspect of his character combined with a minor amount of physical disability resulted in Greg's referral to special education. Greg's "defining factor" is that he is a bright student who is nonetheless happy doing nothing more than that which is required for basic survival. Put another way, despite definite ability to be gainfully employed, Greg will likely choose to portray himself as disabled enough to access benefits which would support, for him, a satisfactory existence. His character is such that he is likely to succeed in this effort if he pursues it.
Greg was essentially "kicked out" of his regular education high school program for behavioral reasons and placed in a program within a vocational education center, though his program is primarily focused on academic instruction. While having an academic focus, the class sizes are roughly half the size that would be ordinarily found in a regular education classroom. While some may have legitimate questions about Greg's referral to a special program, the program itself is of a high quality and the primary educator working with Greg appears to be exceptional. Additionally, there are behavioral and vocational components to the program as well, the former being relatively strong while the latter is less so.
Despite the program's high quality, we wondered whether or not it represented the best approach for Greg. As stated, the "defining factor" in this case is Greg's refusal to do anything more that he must to get by. Greg will certainly pass his academic courses, yet he will not excel and their impact on his life is likely to be absolutely minimal. Thus, this program evaluates as Low Benefit, Low Cost on the Cost-Benefit Matrix.
These examples demonstrate the value of the Framework. Though there are differences between the stories of George and Greg, for both there is a core issue of making education meaningful to them personally. The craft shop made education relevant for George. With its creative interface to core regular education curriculum it produced student results that most people would not have expected. Greg, on the other hand, is likely to achieve moderate academic success, including meeting the state standards, yet the program is not considered cost-effective since it does not sufficiently address his "defining factor." The Institute has seen innovative vocational programs that would have been far more likely to engage Greg and enhance his potential for life success. For example, perhaps an apprenticeship program in a field of interest for two days a week would make school more meaningful to him. As a prerequisite, he would have to maintain strong performance in related, core academic areas, which could in turn support his development of skills. The point is to find a way to really engage him and unleash the potential he has but rarely demonstrates.
For many special education students, Greg included, one must think very creatively about the best approach for programming. The level of willingness on the part of decision-makers to pursue non-traditional approaches appears to be the factor that most clearly separates exceptional programs from those that are in need of improvement. The Framework can be an invaluable tool for identifying relevant opportunities for and supporting this type of creative, "out of the box" thinking.
While the Framework was designed for evaluating special programs, it has, with some minor modifications, application for all education. As the Institute gains more experience with the Framework in real world situations, we become more convinced that its lessons are universal in nature. These lessons basically fall into three distinct categories.
- Be clear on what you wish to achieve. The primary focus of this lesson is to know what your consumers expect, as described above. For special education students, this means taking into account the extra difficulties that impede people with disabilities in adulthood. It means working closely with families, who are the parties generally most invested in their child's education. It means being open to the community to learn what it expects so that a real partnership can be established. If you fail to know where you want to go, you will almost never get there.
- Build an infrastructure that supports success. There is no stronger driver of human behavior than culture. Schools that focus on building a strong, student-focused culture are always more successful than their counterparts that do not, regardless of the obstacles a school may face. Also, ensure that staff pursue opportunities for professional growth and that these opportunities are used to truly improve the practices in place at your school. Finally, ensure that staff have the opportunity to work together so that the school's efforts as a whole facilitate student success. Content may be learnable in isolation, but rarely are skills, which are what students really need.
- Establish accountability and empower those who are responsible. Accountability is an area where the standards movement has had great value. Somebody must be accountable for student success, and it cannot be only the student. Perhaps we need a mindset that students do not fail at school, but rather that schools fail students. This is not universally true, of course, but there is much more than a hint of truth to it. Finally, whoever is accountable must also be empowered to achieve results. Let us resolve ourselves to not overburden our teachers and principals with tasks that do not enhance student learning and development, but rather give them the tools and flexibility needed to get this most important of jobs done.
There is truly no more important social institution than education. The general welfare and prosperity of our children, and someday their children, is dependent on our ability to prepare them for the world in which they will live. The Framework for the Evaluation of Cost and Benefit in Special Education was designed for use with special programs. But its basic tenets, with only minor modifications, and its resultant lessons are applicable for all of education. Education has historically been the foundation upon which human development and advances have been built. Our education system today has its problems, but it has as assets many, many wonderful practitioners who are more than up to the challenges presented to the institution if they were given the focus, tools and leadership to make great things happen once again. We have seen those excellent programs - they are possible everywhere.
Copyright 1998 Wildwood Programs, Inc.