Schools increasingly are ineffective institutions for a growing number of children and youth. Problems of the schools are connected with other institutional problems within the family and the health care system. As a society, Americans have tended to wait until children's needs and problems have reached epidemic proportions and then have provided categorical funding support for remediation aimed at identifiable individuals and groups. Social, economic, and indirect costs of these problems are noted. The journey toward new insights into these problems is examined, leading to a conceptual shift from framing the problem as a school restructuring need to a systems change perspective. A "Healthy Learners, Schools, and Communities Model" is being developed, which integrates schools, social services, and health care systems. The paper sketches an example of the ways in which the addition of community development and family support-empowerment agendas to school restructuring adds new dimensions to schools. Tables list: (1) sources of variation in school-linked family and health services; (2) a comparison of two approaches to networking; (3) 16 primary assumptions for healthy learners, schools, and communities; and (4) 27 exemplary characteristics of healthy schools. (Contains 21 references.) (JDD)