Johns Hopkins Magazine - November 1996 Issue

Public Policy and International Affairs:
In Short

One man's campaign to "improve America"... solving behavioral problems in school... a tepic vaccine initiative...

On the stump with a "real" Democrat

In a few days, perhaps as you're reading this, voters on Maryland's Eastern Shore will go to the polls to elect a new representative from the 1st Congressional District. Challenging Republican incumbent Wayne T. Gilchrest is Democrat Steven R. Eastaugh (PhD '78).

"I think we need to improve America," Eastaugh says. "We have too many people who are self-serving, pompous time-servers in Congress, and we need people who will get things done. I'm an action person, which is why I want to replace the Newt Gingrich fan currently occupying that office."

Eastaugh, who has never held elected office, bested seven other contenders for the Democratic nomination last June after an unsuccessful try in 1994. In Gilchrest, he faces an opponent who has been elected three times in a district that has three registered Democrats for every two registered Republicans.

"My big issue is affordable health care," says Eastaugh, who is a professor of public health at George Washington University and a lecturer at Hopkins. "We have 10 million children in this country without health insurance coverage. I would introduce in the first session of the 105th Congress a bill called 'Children-First Health Insurance,' requiring that all insurance companies that do business with the federal and state government must offer health insurance. I would have the government put up half the money in terms of tax credits, and the parents put up the other half. A joint-cost program to get 100 percent of our children covered. At Eastern Shore prices, according to Maryland Blue Cross, that works out to $600 per year per child--in other words, $25 a month from tax credits from Uncle Sam and $25 a month from the parents."

Both candidates spent the summer campaigning on health, environmental, and economic issues. Eastaugh missed few opportunities to remind Eastern Shore voters that his father was a waterman on the Chesapeake Bay. He favors increases in the minimum wage, and tax credits for small businesses that add jobs or upgrade their plants and equipment. He also supports government measures to help families afford college tuition for their children; in response the Maryland State Teachers Association endorsed him.

Eastaugh likes to refer to himself as a "real" Democrat--"someone who believes in our principles of social justice and social equity, but isn't so out-of-date as to think that we should have a welfare-preservation bill that keeps welfare as it is." He adds, "A 'real' Democrat wants welfare reform, but doesn't want welfare destruction."

A model for school discipline

Maryland's Hammond Middle School is overflowing. It has nearly 300 more students today than it was designed to handle. Two years ago, that overflow began causing serious disciplinary problems, resulting in large numbers of students being sent to the principal's office. "We had literally thousands of referrals to our offices," says vice-principal Woody Rhoades.

The school also experienced a large influx of new faculty and administrators. "We couldn't come to a philosophical agreement on how to handle the disciplinary situations we were seeing," Rhoades says. "The children didn't know what was expected of them. Every time they spoke to someone, they got a different message."

So Hammond Middle School turned for help to Michael Rosenberg, chairman of the department of special education in Hopkins's School of Continuing Studies. Rosenberg brought to the school a model for discipline management that is based on years of research he's done on inefficient learners. The model is known as PAR, because it teaches schools how to "prevent, act upon, and resolve" troubling behaviors.

While most students use mental checklists to help them organize tasks, explains Rosenberg, inefficient learners get easily sidetracked. For example, two students may be asked to write an essay. One will read the assigned material, decide on a thesis, then write down sequential points to support that thesis. The other, the inefficient learner, will begin reading, find a sentence that reminds him of something else, go off on a mental tangent, come back to reading, meander again, and by the time the assignment is due have only half of it completed. "Then, instead of admitting trouble," says Rosenberg, "these students act out, to hide the fact that they haven't accomplished a task."

In workshops that last three to five days, he and his team instruct teachers and administrators on ways to find the root of these problems and deal with them. He stresses that he does not supply answers. Rather, he teaches problem solving."We ask the school, 'What do you want?' and we go from there," he says.

During their five-day workshop, Hammond teachers and administrators wrote a mission statement for the school, now prominently displayed upon entrance to the building. They developed explicit consequences for both rule compliance and non-compliance, and committed to positive reinforcement. They created a checklist, called a "Time-Out Self-Evaluation." Now when a student misbehaves, instead of a referral to the principal's office, he or she fills out the checklist, marking whatever applies: I understood the directions, or I really do not understand the work in class, or I need to talk with you. The list is designed to help a child get organized and better express whatever might be causing problems.

The Hammond team also wrote out a thorough crisis plan, so that no teacher has to guess as to how to handle a situation, and each teacher's actions will be consistent with those of everyone else on the faculty. Now, says Rhoades, "every action has a consequence, and that consequence is consistent everywhere in the school." It's not a revolutionary program, he admits. "Everyone, knows what's expected of them now, that's all. But it works."

Hope and entreaty for a malaria vaccine

Though malaria is all but eliminated in the United States, throughout the world half a billion people get sick and an estimated 2.7 million people die from the disease each year.

A national panel headed by a Hopkins vaccine expert concludes that although advances in molecular biology and immunology now make a malaria vaccine feasible, efforts toward a vaccine are tepid. "The pace of vaccine development appears to be slowing, mainly because of diminished public funding, fragmented government efforts, and limited interest within the vaccine development industry," according to a recent report issued by the Institute of Medicine, the health policy advisory arm of the National Academy of Sciences. Philip Russell, professor of international health at the School of Public Health, chaired the Institute's Committee on Malaria Vaccines.

Pharmaceutical companies are not willing to invest resources in a risky economic venture such as an experimental malaria vaccine, says Russell. "The perception is that the market in the Western world is limited to travelers and the military, and that there is limited money to pay for a vaccine in the developing world. That has put a damper on the industry to forge ahead."

The public sector supports such research, but the groups involved--the Army, the Navy, the National Institutes of Health, and the Agency for International Development--are not as coordinated as they should be, says Russell.

In its report, the committee recommends that a federal Malaria Vaccine Development Board be created, to coordinate, plan, and help underwrite malaria vaccine research. The board would include members of the government agencies involved in vaccine research, representatives of pharmaceutical and biotechnology companies, and university investigators. Russell says he also believes the public sector should take the lead in vaccine research. If it shows proof of principle that an experimental vaccine can work, the vaccine industry will follow. The World Bank is also considering taking on a leadership role, notes Russell.

One function of the board would be to decide which lines of research to pursue. Several experimental vaccines are especially promising, notes Russell.

If there is good news behind the report, it is that a malaria vaccine can be done, he says. "I don't think a 10-year period is an unrealistic hope."

Who's in charge here?

Sociologist Patricia Fernandez Kelly has been studying some of the unintended--and unfortunate--side-effects of social legislation and programs meant to combat child abuse. She has concluded that all too often what constitutes these abuses is ill-defined in the law. This permits a multiplying of meanings, until, to use an actual example from her research, tickling can be construed as abuse. And this proliferation of meanings ends up undercutting parental control of children, especially in poor neighborhoods.

"It's not the philosophy that's at fault here. But almost everything these programs do works against the authority of poor parents," says Fernandez Kelly, research scientist at Hopkins's Institute for Policy Studies.

She cites one city school program that's intended to teach children that some things that adults may do to them are wrong and illegal, and that they can take action to protect themselves. Few would argue with the concept. But in this particular school, Fernandez Kelly notes, the children were given lists of "touches we like" and "touches we do not like." Under the latter was listed "tickling." Granted, she says, lots of kids hate to be tickled. But how, she asks, can tickling constitute child abuse-- conflated with genuine offenses against children like punching or sexual fondling?

What happens next, she has found, is that when children in poor neighborhoods realize that by dialing 911 they can initiate a child abuse investigation (and for something as absurd as tickling), they often hold that as a threat over the parent. Spank me, or make me stay inside, they say, and I'll call the authorities and report you for child abuse.

"Children are taught that 'if it doesn't feel right, it probably isn't right,'" she says. "It's very much left to the interpretation of children, and children are not stupid. They absorb, process, and use information. They learn how to use that information to give themselves leverage and autonomy vis-a-vis adults."

Fernandez Kelly, who has been researching these issues in poor African-American and Hispanic and Haitian immigrant neighborhoods in Baltimore and Miami, points out that the authority of adults in these neighborhoods is much eroded anyway. Often they must work at jobs that any teenager could do, if they can find work at all. They must constantly interact with case workers and the social services bureaucracy in ways that clearly mark them as powerless, dependent, and subordinate. Their children rarely see them in situations that bespeak adult authority.

Fernandez Kelly advocates much more specific, detailed legal definitions of abuse. At the least, she says, programs that instruct children on what constitutes abuse should also tell them what constitutes acceptable forms of discipline. If society intends to empower children to resist fear, anxiety, and abuse, she says, it must also empower parents to maintain authority.

Written by Melissa Hendricks , student intern Keri Hicks '97, and Dale Keiger.

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