Students disciplined with suspension and expulsion are at increased risk for dropping out of high school and involvement with the juvenile justice system. Both experiences can stunt lifetime earning potential and increase the risk of chronic health conditions, such as asthma, cardiac disease, mood disorders and substance use disorders.
Suspension (temporary removal from the usual educational setting) and expulsion (permanent removal) traditionally were used for student behaviors that caused harm to oneself or others, such as bringing a weapon to school. Currently, the most common indications for suspension and expulsion are for behaviors that are neither violent nor criminal, such as truancy, according to a systematic review of interdisciplinary literature.
An updated AAP policy statement draws from over 20 years of research in the fields of education, juvenile justice, psychology and public health to describe how exclusionary school discipline practices harm students and disproportionately affect those with marginalized identities. The policy also offers a multidisciplinary, trauma-informed approach to reduce school suspensions and expulsions and provides recommendations for pediatricians and educators.
The policy statement School Suspension and Expulsion, from the AAP Council on School Health, is available at https://doi.org/10.1542/peds.2024-068466 and will be published in the October issue of Pediatrics.
Disparities in school discipline practices
Students who are American Indian/Alaska Native, Black, male or LGBTQ+ are disciplined with suspension and expulsion at much higher rates than their peers. In addition, students with disabilities, a history of childhood trauma and in families with low-socioeconomic status are disciplined disproportionately.
Disparities in student discipline practices are evident even in the early education period. According to recent data, Black toddlers receive one-third of all preschool suspensions and one-quarter of all preschool expulsions despite representing only 17% of total preschool enrollment.
School-to-prison pipeline
School suspension and expulsion greatly increase a child’s likelihood of being involved in the juvenile justice system, even as early as the same month the child is disciplined. This is known in the literature as the “school-to-prison pipeline.”
About 40% of children with a history of juvenile incarceration will be re-incarcerated in an adult prison by age 25. The cycle of incarceration, release and re-incarceration leaves little time for education and markedly increases the risk of a student dropping out of high school.
Impact of pediatric health care providers
The toxic stress framework explains how prolonged or significant childhood adversity has the potential to create a wide array of biological changes associated with negative adult health trajectories. School suspension and expulsion, particularly when used repeatedly and in the absence of relational buffers, can be a source of prolonged or significant adversity for children and adolescents.
Pediatric health care providers can help reduce the risks and harms of suspension and expulsion by using surveillance/screening practices, partnering with caregivers to promote relational health, making referrals for trauma-informed therapies and participating in advocacy work.
Role of local education agencies
The policy recommends universal anti-bias training for school staff, given the disparities in discipline practices.
Local education agencies also should collect and analyze disaggregated data and generate publicly available discipline reports based on the data. These reports can determine areas for improving school personnel professional development and promoting positive school climates. Continued school district funding for programs that offer alternatives to suspension and expulsion is necessary, particularly for under-resourced schools.
Recommendations for pediatric health care providers
- Screen all children and adolescents for developmental delays and disabilities that may lead to school difficulty, and refer to developmental-behavioral pediatricians, early intervention services and/or special education services (individual education program/Section 504 plan) in a timely manner.
- Refer families to government and community resources, including trauma-informed care systems, that address the social determinants of health associated with school difficulty, including food insecurity, unsafe and unstable housing, maltreatment and witnessed interpersonal violence.
- Support legislation that requires schools to provide educational services to all children and adolescents who are suspended or expelled, either through remote learning or homework assignments.
- Advocate for expansion and sustainable funding of school-based mental health services with appropriate professional-to-student ratios.
Recommendations for local education agencies
- Collect and analyze internal disaggregated data regarding exclusionary school discipline practices.
- Offer anti-bias training for administrators, teachers, school resource officers and other school staff to decrease bias related to race, ethnicity, gender, sexual orientation, family socioeconomic status and ability.
- Promote positive school climates by partnering with families and utilizing interventions such as trauma-informed school frameworks, Multi-Tiered System of Supports, including positive behavior interventions, and restorative practices, such as conflict resolution.
Dr. Jain is a lead author of the policy statement.
Resource
“Eliminating Suspension, Expulsion, and Other Harsh Discipline Practices in Schools and Early Education,” (S5207) will be presented at the 2024 AAP National Conference & Exhibition on Tuesday, Oct. 1, and will be livestreamed, https://aapexperience24.eventscribe.net/.
