Social Assessment in Health Promotion Planning

Within the context of health promotion, social assessment refers to a process in which objective and subjective information are used to identify high-priority problems, or assets, that affect the common good. Ideally, this process will use a variety of social, economic, and quality-of-life indicators, including the perceptions and concerns of representatives from the area or community being assessed.

There are strong connections between major health problems (e.g., violence, chronic disease, teen pregnancy) and their social determinants (e.g., cultural differences, variability in levels of income, social support, housing, and education). While these factors tend to cluster within neighborhoods or communities, they vary considerably between communities. Any social assessment should be designed to take these realities into account. Armed with the information generated from a social assessment, planners will be in a better position to tailor interventions to meet the unique needs of a given community.

Multiple Indicators

There are different ways of knowing, and different interpretations of reality. An epidemiologist, an anthropologist, a health educator, and a layperson are all likely to view a given problem through different lenses. More importantly, each is quite likely to detect a glimpse of reality that the others may miss. The social assessment process will be productive to the extent that: (1) it serves as a first step in a planning process, (2) it reflects a spirit of inclusion, (3) time is dedicated to allow all stakeholders to discuss and interpret information gained in the process, and (4) those discussions are carried out in an atmosphere of mutual respect and trust.

The literature describing methods and instruments to assess quality-of-life and social indicators is extensive and growing. Included among the objective and subjective indicators that may be used as a part of social assessment include perceptions of quality of life; sense of community; perceived functional capacity; employment rates; differences in levels of income; access to transportation and transportation services; alcohol-related auto crashes; housing density; crime; trust or distrust in government; air and water quality; access to health, mental health, and social services; and education.

A wide range of methods have been used to collect data for social assessments. These include, but are not limited to, interviewing those who have a stake in the outcomes of a relevant program or project, community town meetings, focus groups, community polls and surveys, archival research, reviews of income, housing status, access to health services and other relevant social indicators, and synthetic estimates from national data interpolated to the local level. As a means to save limited resources, some planners retrieve existing information whenever possible, rather than generate new data. Federal, state, and local offices of housing and urban planning keep reasonably up-to-date summary records. Most of these data are in the public domain and are easily accessible, though a meaningful social assessment will inevitably require the allocation of resources to gather new information perceived as relevant to the population being studied.

Assets

As implied in the definition, a social assessment in health promotion should involve an accounting of community and individual assets as well as identification of problems or concerns. John McKnight and John Kretzmann describe a process of community asset mapping, wherein relevant skills and capacities of individuals, as well as other assets that may exist in a given community, are documented. These assets are classified into three tiers of primary, secondary, and potential building blocks. Primary building blocks are those that exist and are controlled within a given community (e.g., a local health agency, or a local teacher); they are also the assets that are most accessible. Secondary building blocks are those that exist within a community but are controlled from outside the community (e.g., a health clinic which is a satellite of a regional or corporate medical system). Potential building blocks are those located and controlled outside of the community (e.g., federal grant programs or national campaigns). An analysis of this kind will help planners keep a realistic perspective on the comparative difficulty of accessing the assets they have identified.

Another example of using positive indicators is found in Peter Benson's work on the developmental assets that influence children and adolescents. Benson describes forty developmental assets, which are classified equally into two categories:(1) internal assets related to the personal qualities of children (e.g., self esteem, achievement motivation) and (2) external assets (e.g., family and adult support, safety, programs and services). Analysis of developmental assets reveals a consistent pattern where, among youth, developmental assets are inversely related to high-risk health behaviors— the more developmental assets children have, the less likely they are to engage in behavior that puts them at health risk. High levels of developmental assets are associated with success in school and valuing diversity.

Respect

Lawrence Green and others have made the point that health is an instrumental value, that is, a value that facilitates the striving for, or attainment of, higher order, or ultimate values. For example, a company may value a commitment to physical fitness and nutrition to the extent that it influences employee performance and satisfaction. The implication is that health has value to the extent that it either supports or enables higher order values, which may include social benefits, overall quality of life, the capacity to function, or even an organization's bottom line. This point is relevant to social assessment because information gleaned from the process can be used to illustrate how the effective application of health-promotion programs contributes to the improvement of social benefits beyond improvements in health.

In a study designed to improve the immunization rates among children 0 to 2 years of age and born to low-income mothers in an urban setting, researchers found that marked increases in immunization coverage were attributable to tailored messages created from assessments that took into account the family characteristics, social and environmental conditions, and selected cultural factors unique to the participants. Irrespective of the methods, indicators, or instruments used in the social assessment process, a commitment to engaging the people of a community in identifying and assessing their own perceived problems and aspirations is essential. Not only does such a commitment assure that a critical view of reality will not be left out of the health-promotion program planning process, it signals a tangible sign of respect toward the members of a community.

(SEE ALSO: Assessment of Health Status; Community Health; Community Organization; Health Promotion and Education; Healthy Communities; Mobilizing for Action through Planning; Sociology in Public Health)

Bibliography

Bauer, R. A., ed. (1966). Social Indicators. Cambridge, MA: MIT Press.

Benson, P. L. (1997). All Our Kids Are Our Kids. San Francisco, CA: Jossey Bass Publishers.

Green, L. W, and Kreuter, M. W. (1999). Health Promotion Planning: An Educational and Ecological Approach. Mountain View, CA: Mayfield Publishing Company.

Kreuter, M. W.; Vehige, E.; and McGuire, A. G. (1996). "Using Computer-Tailored Calendars to Promote Childhood Immunization: A Pilot Study." Public Health Reports 111:176–178.

McKnight, J. L., and Kretzmann, J. P. (1977). "Mapping Community Capacity." In Community Organizing and Community Building for Health., ed. M. Minkler. New Brunswick, NJ: Rutgers University Press.

Mootz, M. (1988). "Health (Promotion) Indicators: Realistic and Unrealistic Expectations." Health Promotion 3:79–84.

Noack, H., and McQueen, D. (1988). "Towards Health Promotion Indicators." Health Promotion 3:73–78:

Patrick, D., and Erickson, P. (1987). Assessing Health-Related Quality of Life in General Population Surveys: Issues and Recommendations. Washington, DC: National Center for Health Statistics.

Wilson, R. (1981). "Do Health Indicators Indicate Health." American Journal of Public Health 71:461.

— MARSHALL KREUTER; BRICK LANCASTER

Social promotion is the most common name for the policy of promoting students to the next grade level despite poor achievement at their current grade level. It is motivated by a desire to protect the social adjustment and school motivation of struggling students, as well as a belief that these students will get more from exposure to new content at the next grade than they would from repeating their current grade.

In Comparison to Grade Retention

Social promotion is usually studied and discussed in comparison to its opposite: grade retention. A grade retention policy calls for requiring students who have failed to achieve satisfactorily to repeat their current grade the following year, instead of moving on to the next grade. This policy is motivated by the belief that an extra year in the grade will give struggling students an opportunity to master content that they failed to master the first year, and consequently leave them better prepared to succeed in higher grades in the future. Those who favor grade retention policies also tend to believe that it is important for schools to maintain high standards, and that social promotion policies fail to do this and instead send students the message that little is expected of them.

Grade retention and social promotion occur because many students fail to achieve at desired levels. If assessed using norm-referenced tests that yield grade-level equivalence scores, almost half of all students necessarily will score "below grade level" (although with considerable variation across schools and districts). More students will pass the criterion-referenced minimum competency tests used by many states, but even here, significant percentages of students will fail to meet standards. This forces schools to choose between socially promoting these students and retaining them in the grade for another year.

Retention in grade is common, with about a third of all students retained at least once before high school. Students retained in a grade are more likely than other students to be small in stature or youngest in the grade, to be from lower socioeconomic status or minority backgrounds, to have parents with lower educational attainment, to be boys rather than girls, and to have moved or been absent frequently. Presumably these same generalizations also would be true of socially promoted students, simply because these categories of students are represented more heavily among low achievers. It is not possible to collect social promotion statistics the way it is possible to collect grade retention statistics because school districts usually do not distinguish in their records between regular promotions and social promotions.

At any given time, both grade retention and social promotion have their adherents, probably because each policy is based on an appealing rationale. Attitudes toward the two policies tend to flow in cycles, with first one and then the other gaining ascendancy for a decade or so, and the same essential arguments repeated on both sides. Grade retention was ascendant in the 1990s and early 2000s, with U.S. Presidents Bill Clinton and George W. Bush, many state governors, and many state-and district-level policymakers calling for eliminating social promotion as part of their plan for reforming schools. These policymakers tend to believe that unless poorly achieving students are faced with the prospect of flunking and being forced to repeat the grade, they will have little incentive to apply themselves to their studies. Most teachers also favor grade retention as a potential option for occasional use, especially in the early grades. Teachers tend to view it less as a motivational stick with which to threaten underachieving students, however, than as a way to enable them to catch up and begin to achieve more successfully. Barring information to the contrary, it is reasonable to believe that the threat of grade retention might motivate students who do not apply themselves to invest more effort in their studies, and that an extra year to catch up might benefit students whose low achievement is due to limited maturity or readiness.

However, a great deal of information to the contrary exists. Research comparing retained students with similar students who were socially promoted repeatedly shows that most students do not catch up when held back; that even if they do better at first, they fall behind again in later grades; that they are more likely to become alienated from school and eventually drop out; and that these findings hold just as much for kindergarten and first-grade students held back because they were presumed to lack maturity or readiness as they do for older students. By itself, retention provides either no achievement advantage or only short-lived advantages relative to social promotion, and it imposes costs on the retained students, their teachers, and the school system.

What typically happens is that administrators announce a "no social promotions" policy with a great deal of fanfare, then over the next couple of years call attention to any data that appear to suggest that the policy is working. Later, however, when it becomes clear that too many students are being retained (some repeatedly) and the administrators are confronted with angry parents, frustrated teachers, upset students, and rising costs, they quietly begin to back off by lowering standards (i.e., the test scores that will be required to earn promotion to the next grade) and by exempting certain categories of students from the policy (e.g., those who are learning English as their second language or have been assigned a special education diagnosis). Eventually they or the administrators who succeed them quietly drop the policy (without, of course, admitting that all of the problems that it created could have been foreseen if attention had been paid to the relevant research literature).

Advantages and Disadvantages

Costs to the retained students include the shame and embarrassment of being held back and the separation from age mates in the short run, as well as alienation from schooling as an institution and a much greater propensity to drop out prior to graduation in the longer run. Costs to teachers include increases in the student motivation and classroom management challenges that are involved in teaching classes that include a significant number of retained students, as well as the problems that ensue in junior high and high school when physically more mature older students are in the same classes with less developed younger students. For school districts, there are costs in both expense (grade retentions translate into higher class sizes and related logistical problems) and effort (increased administrative responsibilities for establishing and maintaining mechanisms to implement grade retention policies and for defending them when students or their families challenge them).

Occasionally, research, such as that of C. Thomas Holmes in 1989, appears to suggest that grade retention is helpful, at least to some students. Usually these data are confined to short-term findings that the retained students showed higher achievement during the year that they repeated the grade than they had the year before. Longitudinal data, however, typically show that grade retention is not helpful. For example, in 1995 Karl Alexander and colleagues reported findings from Baltimore indicating that retainees did somewhat better after retention than they had before (although with diminishing advantage over time) and even displayed positive attitudes toward self and school. This study was frequently cited by proponents of grade retention as evidence that newer studies were beginning to show a different pattern of findings from the conventional wisdom. However, an update six years later indicated that the earlier reported advantages to grade retention had washed out and that the retained students proved to be much more likely to drop out of school than the socially promoted students. Reports from Chicago, another district that had made a high-profile commitment to grade retention policies, also indicated that initially mixed findings had turned negative within three years, according to Melissa Roderick and colleagues in 2000. More generally, a meta-analysis that focused on studies published between 1990 and 1999 once again proved unfavorable to grade retention, refuting the claim that newer studies were showing a different pattern of findings.

In 1989 Holmes completed a meta-analyses of sixty-three comparisons of grade retention with social promotion. He reported that fifty-four of the sixty-three studies yielded overall negative effects for grade retention but nine showed positive effects. The latter studies involved suburban settings and middle-class families, and usually not retention alone but also efforts by the school to identify struggling students early, involve the parents, and provide special assistance such as placement in classes with low student-teacher ratios. Even so, the advances made by the retained students during their repetition year tended to diminish over time.

Different Perspectives

In 1998 Richard Rothstein put social promotion, grade retention, and related issues into perspective by noting that the dilemma of what to do with students who don't progress "normally" is endemic to compulsory education. As long as all students are required to stay in school until they reach a certain age (e.g., sixteen), the decision on what to do with those who are less advanced will remain. Research throughout the twentieth century repeatedly indicated that, on the whole, age is a better grouping principle than academic achievement.

Researchers and reviewers who have focused on grade retention and social promotion typically conclude that neither policy is an effective treatment for unsatisfactory achievement, but if one must choose between them, social promotion is preferable. This is because grade retention imposes too many social and motivational costs, and students appear to get more out of a year spent in the next grade than they do out of a year spent repeating a grade, even though they are likely to continue to achieve less successfully than their classmates. However, social promotion does not help low achievers to begin to catch up with their age peers. Therefore, better than either social promotion or grade retention are policies that mobilize schools to identify struggling students early and provide them with special forms of assistance that might allow them to achieve more satisfactorily (placement in smaller classes, provision of tutoring or other special assistance, enrollment in after-school or summer school programs, and so on). Organizations such as the International Reading Association and the National Association of School Psychologists have published policy statements advocating this approach to students who are not achieving satisfactorily. Some ideas about intervention alternatives to both grade retention and social promotion mentioned by McCay (2001) and U.S. Department of Education (1999) include setting clear performance standards at key grades, emphasizing early childhood literacy, providing high-quality curriculum and instruction and professional development, reducing class sizes in the primary grades, keeping students and teachers together for more than one year, and using effective student grouping practices.

Bibliography

Alexander, Karl; Entwisle, Doris; and Dauber, Susan. 1995. On the Success of Failure: A Reassessment of the Effects of Retention in the Primary Grades. New York: Cambridge University Press.

Alexander, Karl; Entwisle, Doris; Dauber, Susan; and Kabbani, Nader. 2001. "Drop Out in Relation to Grade Retention: An Accounting from the Beginning School Study." CEIC Review 10 (5):3 - 4, 12, 21.

Holmes, C. Thomas. 1989. "Grade Level Retention Effects: A Meta-Analysis of Research Studies." In Flunking Grades: Research and Policies on Retention, ed. Lorrie Shepard and Mary Lee Smith. London: Falmer.

Jimerson, Shane. 2001. "Meta-Analysis of the Effects of Grade Retention: 1990 - 1999." CEIC Review 10 (5):7 - 8, 21.

Mantzicopoulos, Panayota, and Morrison, Delmont. 1992. "Kindergarten Retention: Academic and Behavioral Outcomes through the End of Second Grade." American Educational Research Journal 29:192 - 198.

McCay, Elizabeth, ed. 2001. Moving beyond Retention and Social Promotion. Bloomington, IN: Phi Delta Kappa International.

Owings, William, and Magliaro, Susan. 1998. "Grade Retention: A History of Failure." Educational Leadership 56 (1):86 - 88.

Reynolds, Arthur. 1992. "Grade Retention and School Adjustment: An Exploratory Analysis." Educational Evaluation and Policy Analysis 14:101 - 121.

Reynolds, Arthur, and Wolfe, Barbara. 1999. "Special Education and School Achievement: An Exploratory Analysis with a Center-City Sample." Educational Evaluation and Policy Analysis 21:249 - 269.

Roderick, Melissa. 1994. "Grade Retention and School Drop Out: Investigating the Association." American Educational Research Journal 31:729 - 759.

Roderick, Melissa; Nagaoka, Jenny; Bacon, Jen; and Easton, John. 2000. Update: Ending Social Promotion: Passing, Retention, and Achievement Trends among Promoted and Retained Students: 1995 - 1999. Chicago: Consortium on Chicago School Research.

Rothstein, Richard. 1998. "Where Is Lake Woebegone, Anyway? The Controversy surrounding Social Promotion." Phi Delta Kappan 80:195 - 198.

Shepard, Lorrie, and Smith, Mary Lee, eds. 1989. Flunking Grades: Research and Policies on Retention. London: Falmer.

Tanner, C. Kenneth, and Combs, F. Edward. 1993. "Student Retention Policy: The Gap between Research and Practice." Journal of Research in Childhood Education 8:69 - 75.

Thompson, Charles, and Cunningham, Elizabeth. 2000. Retention and Social Promotion: Research and Implications for Policy. New York: ERIC Clearinghouse on Urban Education, Teachers College, Columbia University.

Tomchin, Ellen, and Impara, James. 1992. "Unraveling Teachers' Beliefs about Grade Retention." American Educational Research Journal 29:199 - 223.

U.S. Department of Education. 1999. Taking Responsibility for Ending Social Promotion. Washington, DC: U.S. Department of Education.

— JERE BROPHY