Tuesday, September 27, 2011


Triage and Profiling

Last week I had a discussion that’s still echoing in my head.

It was with some people who work at four-year colleges in the area. We were discussing various measures we had taken to improve student success and retention rates: different approaches to academic advising, tweaks to new student orientation, early warning systems, that sort of thing. At which point one of them, from a tuition-driven college, said:

“And of course, you have to identify upfront the students who no amount of help will save. Target the resources where they’ll actually make a difference.”


In a strictly numerical sense, she’s right. If “bang for the buck” is the relevant measure, then yes, some students will not repay the investment.

But the logic leads to some very ugly places.

Anyone with passing familiarity with the sociology of education can rattle off the demographics of the students most at risk: young men of color from shaky school districts. Their rates of academic success are dispiriting at best.

But how you choose to respond to that reveals a lot.

Yes, resources are limited, and yes, college is supposed to be hard. But there’s also a basic moral obligation to make opportunity real, and to try to avoid simply piling on. Profiling the least likely to succeed, and then writing them off, winds up looking a hell of a lot like racism.

Rather than looking at which students are likeliest to succeed, I’d much rather look at which interventions are likeliest to succeed. National data suggests that Upward Bound, for instance, accomplishes very little. But streamlining developmental course sequences accomplishes a lot. (The CCRC studies on this over the last year or so have been revelatory.) To the extent that vulnerable populations are overrepresented in the developmental sequences, they’ll benefit disproportionately from any improvements in it.

The work that needs to be done, and that really has only started, is deliberate experimentation to allow for evidence-based decisions about what works. My image of a really great college is one that incorporates experimentation -- documented, deliberate, scalable experimentation -- into the course of doing business. A college that teaches itself about its students over time -- and that faces the reality of unexpected results when they happen -- is the kind of college that will make real headway in both quality and fairness. Evidence has a way of defeating stereotypes.

The whole idea of writing off entire sections of the student population misses the point of realism. Yes, some students face more challenges than others. But the point of public higher education is not to dignify class divides with a patina of merit. It’s to give everyone a real shot. The place for realism is in evaluating the success of various measures to help those who need it. If one measure doesn’t work, try another. But don’t give up trying. The right place for idealism is in affirming the mission; the right place for realism is in evaluating the methods. When the methods displace the mission, something is fundamentally wrong.

So no, thanks. I won’t triage students when they walk in. The world does too much of that already. If that means I wind up wasting some second chances on some folks who were doomed to fail anyway, well, there are worse crimes. I’ll take that one.

It's really too bad that the starting point can't be wherever each student is at and the goal can't just be someplace better than that. I don't understand why the goals have to be standardized across groups.
Where did you get this statement, "National data suggests that Upward Bound, for instance, accomplishes very little." ?

I was just talking with an expert in this area and he said that nobody knows whether or not Upward Bound has any effect. No randomized controlled study of Upward Bound has been done. No natural experiments have been exploited. The data are not available even for attempts at matching or modeling.

(Also, should be data suggest, not suggests.)
Very interesting, to someone outside the education field. Following up on N&M above, how would your deliberate experimentation work? What would be the control group? Do the participants understand they are part of an education experiment? Does that knowledge, if they have it, affect the outcome, and the conclusions?

"Target the resources where they'll actually make a difference" does sound cold, unfeeling, and unpleasant. But your alternative seems to imply that resources aren't really constrained. We wish that they weren't, but they are.

No one will argue against giving someone a second chance. But someone else, someone not present, lost something when resources were diverted to create that chance. What are the consequences of that?
I wish I could print out the paragraph that begins "The work that needs to be done..." and tape it to every faculty member's door with a sticky-note that says, "this is what assessment is FOR."
(a different Anonymous): it's not necessarily about triage in the medical sense (withholding treatment from those who will die anyway). It's about a) creating pathways that work for students who enter at different levels of prior education; and b) being realistic about the fact that there are many young people enrolling in CC's (and 4-year colleges too) who are there because they have been told they must attend college or be considered a failure. For them, the obligatory one semester or one year functions as a gesture in that direction, and then they proceed to do what they really wanted to do all along (or, frequently, embark on a period of floundering, as we all know). I'm not saying that this failure to engage some of our students is a good thing; I'm only saying that for some, engagement in school at this time in their lives, is not in the cards.
A different take on "triaging": Isn't the greatest bang for the buck achieved by investing where each additional dollar has the greatest chance of increasing success, or that will increase success the greatest? (Details of the appropriate metric can be figure out later.)

Spending money on the right subset of African-American males from a weak school district who have some other marker for drive or ambition may produce much higher results than pouring more money into a program for traditionally successful students. At this point, it's not profiling, but figuring out who benefits most from certain programs, which is triage, I suppose, but based on more individual circumstances?
I agree with nicoleandmaggie; I'd like data/citations for the Upward Bound statement. We have an Upward Bound on our campus and I've long wondered about the impact as they haven't produced any assessment - they just point to vague claims about studies elsewhere. So if there's real analysis of the impact of Upward Bound, I'd love to see it.
That you should have to consider having a triage system labeled racist (with the consequent sturm und drang) seems to doom what could be real innovation to a semi-strangled incrementalism. That is, if despite best efforts, your profile group is "harmed", you will be punished just as though you presented your freshman orientation in white sheets.
The first hit on a google search on "upward bound evaluate impact" leads to a 2004 report by Mathematica Policy Research that is available on the Dept of Ed web site. I can't vouch for the report and I don't know if it's what DD had in mind, but it could start a literature search.

@maggie - thanks for correcting data (plural)!
I work in the library at an open admissions university. We regularly see students who are functionally illiterate, and entirely unfamiliar with how to use a computer, come in and ask us for help. I feel very badly for these students, who so clearly want to improve their lot in life, through a college education, but who are still unable to spell two-syllable words, or write a simple, cogent sentence, or fill out a financial aid form on their own.

These are the students who come to my mind when I think of "triage". Yes, they do often fall into socially disadvantaged groups. But how does it help an individual like this if we take a semester's worth of tuition from him when he's at a level where he's truly unable to take advantage of even the most rudimentary remedial coursework?

And it does not benefit other students when I work with students like this for fifteen minutes or more, helping them to send a simple email. "No, don't put your login name in the browser's URL box. Put yahoo.com there. Now click there. See, the link that says 'login'? No, the other link. Click there. Now put in your login name. Are you sure that's how you spell your last name?" And so on.

How is it fair to give students like this false hope? Wouldn't their time and money be better served by finding a way to get them into more relevant training where they have a prayer of success?
O.C.: Read the post again. DD's colleague at the "tuition-driven college" isn't proposing triage to keep the high-risk students from being admitted altogether. She's proposing that those students be admitted and their tuition dollars accepted, but then that they be given no resources to help them succeed. Which, I agree, is a despicable and cynical practice.
There's two types of triage.

There's triage as practiced at most emergency rooms where the neediest patients get care first so and their less needy compatriots wait (ever taken a kid to the ER with an ear infection and sat their all night? Your kid got bumped by the guy with chest pain and the little old lady with shortness of breath.)

There’s battlefield triage where those with grave injuries are ignored in favor of those with fewer and more treatable problems.

The type of triage you practice is driven by the resources you have. When you have plenty to go around, you make sure everyone gets they care they need by putting a priority on the neediest – the others can muddle through until their turn comes. When resources are tight or when your resources are overwhelmed, you try to keep as many people alive as you possibly can. You cut loose those that require a lot because at the end of the day, boots on the ground are what wins the day.

I can see reasonable people arguing for either type of triage in education. Do you implement the changes that help the greatest number (but don’t require as much investment per capita)? Do you invest heavily in those few that because of circumstances have benefited little from a broken K-12 educational system? I suspect that most schools would do a little of both and if I were holding the purse strings, I’d invest tax money in the interventions that served the greatest number while writing as many grants as possible to get funding for intensive programs that impact those with the greatest need. This strikes me as the most politically palatable balance between the two and the most fundable from a grantsmanship perspective.

I’d also try to be as clear as possible with students about what skills were needed for success and where they fell in the spectrum. I’ve seen students take Intro to Bio three times and fail – at some point, we had to direct them elsewhere. Investing heavily in those with the most need works from a social justice perspective but it does mean that tax resources are being heavily concentrated on the select few we deem unfortunate enough to help. It’s politically difficult to justify and one could argue that serving a greater number of students is a better use of the resources that we are all throwing in the pot. As resources become more scarce, battlefield thinking is likely to become more common.
How about a) identifying those at the most serious risk b) targeting them for immediate help and c) evaluating if the help is working within a short time. If not. . .

IEHO the major issue is not pouring resources at those folk, but continuing to do so after it is clear that it is not working
Good point, EliRabett. Subjecting struggling students to semester after semester of various interventions that don't work is almost like performing experiments on them. It seems unethical to continue, unless there are clear signs of progress that the "treatment" is working.
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