Basic Issues in Coordinating Family and Child Welfare Programs [Reprint 2016 ed.] 9781512801095

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Basic Issues in Coordinating Family and Child Welfare Programs

Government Studies

FELS INSTITUTE SERIES

University of Pennsylvania Press

This volume is one of a series devoted to problems of current and long-range significance which are of particular interest to students of local and state government. Stephen B. Sweeney and Thomas J . Davy (Eds.) , Education for Administrative Careers in Government Service Stephen B. Sweeney and George S. Blair (Eds.), Metropolitan Analysis: Important Elements of Study and Action W. H. Brown, Jr. and С. E. Gilbert, Planning Investment: A Case Study of Philadelphia

Municipal

Reed M. Smith, State Government in Transition: of the Leader Administration, 1955-1959 Harold Herman, New York State and the Problem

Reforms

Metropolitan

Oliver P. Williams and Charles R. Adrian, Four A Study in Comparative Policy Making

Cities:

Charles P. Cella, Jr. and Rodney P. Lane (Eds.), Basic Issues in Coordinating Family and Child Welfare Programs

Basic Issues in Coordinating Family and Child Welfare Programs Edited By

Charles P. Cella, Jr. and Rodney P. Lane Government Consulting Service Fels Institute of Local and State Government University of Pennsylvania

Philadelphia

University of Pennsylvania Press

© 1964 by the Trustees of the University of Pennsylvania Published in Great Britain, India, and Pakistan by the Oxford University Press London, Bombay, and Karachi

Library of Congress Catalog Card Number: 63-21719

7434 Printed in the United States of America

Foreword The papers in this volume were presented in a pair of seminars sponsored by the Government Consulting Service, Fels Institute of Local and State Government, University of Pennsylvania, and financed by a special grant from the Samuel S. Fels Fund. The theme of the seminars was "Basic Issues Involved In Achieving A Coordinated Pattern of Family and Child Welfare Services and Resources In A Metropolitan Community." The seminars were held on May 18 and May 25, 1962, at the Fels Center in Philadelphia. Over the past ten years the Government Consulting Service has engaged in a wide range of studies and consultation in the field of social welfare administration. These projects have focussed on a variety of issues of policy, program, and structure in various functional areas of social welfare at the community, state, and national levels. Whatever the problem or the focus, all of them have involved in some form and in some degree, the common challenge of coordinated planning and utilization of the resources of multiple authorities, agencies, programs, and disciplines in coping effectively with the human and social problems associated with ill health, economic dependency, and social maladjustment. From a general administrative standpoint, few other fields of endeavor require the clarity of goals and priorities, the diversity and flexible combinations of skills, the nice articulation of programs and serv-

ices, and the careful definition of public and private responsibilities that characterize the field of social welfare. The mission of the Fels Institute and the Government Consulting Service is the improvement of local and state government administration. Our interest and work in social welfare are concerned with developing and improving the program planning and operational machinery through which medical, social work, educational, and related skills in public and private agencies can be brought to bear most effectively and constructively on social welfare problems. The seminars for which the papers in this volume were prepared were conceived, therefore, to explore in the broadest possible perspective the basic issues involved in achieving a coordinated pattern of services in the family and child welfare component of social welfare. The six topics selected were designed to cover the issues as we see them. Persons of recognized competence were invited to prepare and present papers on the six topics. The seminars were limited to approximately thirty-five participants representing both theory and practice in social welfare and governmental administration. The central objective in both the papers and the seminar discussions was to help establish guidelines for courses of action and research designed to maximize the impact of available resources and knowledge on the problems of children and families in trouble. Mr. Norman V. Lourie, Deputy Secretary, Pennsylvania Department of Public Welfare, served as special advisor to the Government Consulting Service in planning the seminars. His long experience and sound judgment in social welfare were of inestimable value in this undertaking. The project was conducted under the direction of Mr. Charles P. Cella, Jr., Supervisor of the Government Consulting Service. Mr. Rodney P. Lane of the Government

Consulting Service staff was principally responsible for formulating the concepts and issues around which the seminar program was organized. GOVERNMENT CONSULTING Philadelphia June 1963

SERVICE

Contents Page Foreword I. The problem of Social Welfare Coordination— A Public Administration Viewpoint Rodney P. Lane II. "A Coordinated Pattern of boleth or Feasible Goal? Alfred J. Kahn

1

Services"—Shib-

III. Do Our Program and Administrative Instruments for Serving Family and Child Welfare Needs Reflect and Implement the Highest Level of Knowledge for Solving the Problems Presented? Verl Lewis IV. How Adequate and Flexible Are the Legal Base and Social Policy Which Underlie Family and Child Welfare Services and Resources? Wayne Vasey V. How Efficiently Are We Spending Public and Private Funds to Meet Total Family and Child Welfare Needs? James R. Dumpson

6

25

44

60

VI. How Should Public and Private Agencies Relate in the Development of a Coordinated Pattern of Services? Fred

Delliquadri

VII. How Effectively Are We Utilizing Professional Staff Resources in Meeting Family and Child Welfare Needs? Mary R. Baker

About the Authors

1

Basic Issues in Coordinating Family and Child Welfare Programs

I The Problem of Welfare Coordination— A Public Administration Viewpoint by RODNEY P. LANE Government Consulting Service Fels Institute of Local and State Government University of Pennsylvania

Perhaps the most challenging problem facing the entire field of social welfare administration at the present time is the need to achieve a more effective utilization of available knowledge and resources to meet the full range of human needs. This problem has become critical in the family and child welfare component of the social welfare field for several reasons: 1. Unmet needs exist in all family and child welfare program areas and the "gap" will increase as the child population grows and social policy changes and develops. 1

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2. Professional staff services for meeting these needs are in short supply, with no major relief in sight. 3. A multiplicity of public and voluntary agencies provide services for children and youth, but there is much confusion, conflict, and duplication; and we cannot measure the adequacy of the total effort, nor can we make fully reasoned decisions about the ways in which structure might be improved and functions realigned. 4. More and more public and private funds are being channeled into various kinds of family and child welfare programs and agencies with little assurance that funds are being used effectively or that expenditures are directed toward priority needs. These problems exist and are recognized at every level of government and by public and private agencies alike. There is a general consensus that what is needed to improve the critical situation is a "coordinated pattern" of services at state, county, and community levels. However, there is little or no agreement—and even less research— on any organized plan or series of actions directed toward achieving that goal. The problem, in many respects, is most critical in our metropolitan areas where the incidence of dependency, delinquency, and emotional disturbance and maladjustment is greatest, where we have the greatest proliferation of agencies and programs, and where region-wide concerted planning and cooperation by the state, city, suburban counties, and voluntary agencies are indispensable elements in any realistic attack on social welfare problems. A number of propositions or premises can be stated in connection with the current state of family and child welfare services in Pennsylvania and elsewhere. These are in the form of observed phenomena of the social welfare

The Problem of Social Welfare Coordination

3

field and have wide recognition, if not full acceptance. These phenomena have particular relevance to the public administration field as it contributes to the development of the structural framework and operational machinery through which legislative mandates can be translated into effective action programs. 1. There exists in Pennsylvania and in other states, a plethora of agencies and programs providing family and child welfare services. These agencies collectively represent the mechanism through which society offers an increasing number and variety of services. From the point of view of the social architect, as well as from the point of view of the client, this pattern of agencies and programs represents, for the most part, a maze of independent and self-operating parts rather than an integrated structure with related and interdependent functional members. It is a fair extension of the analogy to characterize the interrelationships of existing agencies and programs as thin guy wires of communication and a rather indiscriminate rigging of financial support. It follows that improvements are possible in the alignment of these services, in the area and scope of their program responsibilities, and in the nature and extent of their operational and program interrelationships. It is probable that such improvements will substantially increase the effectiveness of the services involved. 2. There has developed over the years a tendency to develop and sustain categorized social welfare programs and services oriented toward providing specific, often piecemeal, services rather than toward solving problems. This may be due to a variety of cultural, legal, and professional forces and factors* one product of which seems to be an unwillingness or, more kindly, an inability, to develop the responsive and flexible administrative ma-

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chinery necessary to deal with all of the component parts of a given problem. There are some indications of change in this respect but the goal remains distant. 3. It is well documented that the human problems involving children and their families which face our social welfare agencies and programs are highly inter-related and inextricably combined. The case of the multi-problem family which, collectively, uses vast amounts of available social welfare resources has been clearly described. To a limited extent, we have been able to develop special diagnostic and classification tools and machinery for more effectively coping with the problem, but we have not developed community patterns which weld together in stable form the many agencies and programs required to deal with the multi-faceted needs of problem children and families. 4. The shaky partnership between public and voluntary agencies in providing family and child welfare services must be sustained and strengthened, but it must be flexible and responsive enough to meet changing needs and conditions. Broad responsibility for services required to meet the needs of children and their families has been assigned to the public authority; it must be prepared to define this responsibility in meaningful terms to meet needs and social problems which affect children and their families. Public agencies can implement this responsibility either by establishing and maintaining direct programs and services, or by utilizing the services provided by private agencies. It is desirable that the interest reflected by private agencies be stimulated, and that the services which such agencies provide be utilized to the fullest extent possible in providing needed services. However, direction and controls are required to achieve a strategic utilization of all available resources.

The Problem

of Social Welfare Coordination

5

These are descriptive characteristics, in basic terms, of the field of social welfare administration. The challenge at this point in time is to develop a more effective ordering of existing programs and services which will maximize their impact in solving or alleviating human problems. Is a fully coordinated pattern of services a realizable goal, or can we only verbalize the problem? Do we have sufficient knowledge to solve the social problems and dislocations with which we are confronted, and are we implementing fully what we do know? Do existing legal and social policy bases provide adequate mandates under which existing programs can be more effectively combined or interrelated? How can the present pattern of allocating and distributing public and private funds be made to produce a more efficient expenditure of total funds available? How can public and private agencies provide a more effective partnership in meeting total needs? What are the directions for achieving a more effective deployment and utilization of professional staff in meeting family and child welfare needs? These are the hard questions underlying the challenge, and they are questions posed for seminar discussion. The aim of these discussions is to develop guidelines and directions for new courses of action and new research efforts needed to achieve a truly coordinated pattern of existing social resources.

и "A Coordinated Pattern of Services"—Shibboleth or Feasible Goal? —To what extent is the community's failure to achieve a greater measure of success in solving problems affecting children attributable to deficiencies in the structural framework and operational patterns through which family and child welfare services are implemented? What is the priority ranking of child welfare problems and deficiencies in terms of (1) social need, and (2) general feasibility of solution? by ALFRED J. KAHN New York School of Social Work Columbia University

One very seldom has an opportunity to talk for a half hour to the executives of the Council on Social Work Education, the Child Welfare League of America, the Family Service Association of America and to the President of the National Association of Social Workers all at 6

Shibboleth

or Feasible Goal ?

7

the same time. I regard this seminar as a valuable opportunity. The question is posed as to whether coordinated services represents a shibboleth or a feasible goal. I assume that we are not here for a public relations undertaking and that this is honest, plain talk between and among informed people. In responding to the question posed, I am going to draw on a variety of pieces of work in progress—work in which I am currently involved. At the outset, I must say that I cannot assure anybody that it is feasible to have a coordinated pattern of services, feasible in the sense that all political and organizational obstacles will be overcome. There is no overwhelming conceptual roadblock, however, and I do know that the need for coordination is urgent. The solution of the political and organizational problems is another matter, and that is why I am not positive as to how feasible it is. Coordination of services and programs is urgent because the United States is experiencing an urban child care crisis of very considerable size. Its exact form varies from city to city, but it is characterized by long-term and very often unnecessary institutionalization of children, by long-term waiting in temporary shelter for children who need stable care, and by very frequent replacement of children from foster home to foster home. The model of foster care is one child in one home for a limited period; the practice of foster care is one child in many homes for endless periods. The crisis is characterized by interim arrangements which become semi-permanent or permanent in nature, by a shortage of vital facilities, and by a lack of rehabilitative and therapeutic services in the ADC caseloads which contain a very substantial portion of the problems. These problems—and others—have been described in

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the findings which are reported by Maas and Engler, and others. One should call special attention to the unevenness of provisions from place to place and the obvious relationships between the kind of provisions and community factors other than needs of the children involved. Among the most startling findings is that of Maas and Engler demonstrating that for those children in care over 1 Vi years, the likelihood of return to their natural parents, or their eventual adoption, is discouragingly low. Natural parents do not visit large numbers of children in long-term foster care; agencies do not maintain adequate contacts with them; and parents avoid paying for child support. You are aware, I am sure, of the lack of long-term care facilities, adoptive facilities, and other facilities for children in certain minority groups in urban areas. These well-known problems could be elaborated upon, but I think perhaps our exploration of coordination might be furthered by looking a little more at the consequences for the client of what we now do. There are a number of generalizations which grow out of studies of delinquent and neglected children, not all of them in child care. I would like to point out some things which are known to "insiders," but not to everybody. A very large portion of the caseload in courts, the portion that poses basic child welfare problems, i.e., problems of planning child welfare services, are those which relate to dependent and neglected children. The juvenile courts are so much associated in the public mind with delinquency that it is not recognized that dependent and neglected children are a very large part of the juvenile court load. In many ways these children represent the most difficult part of the planning aspect of the caseload. Here, then, is a series of generalizations which characterize and describe some major difficulties in planning and

Shibboleth

or Feasible

Goal ?

9

organizing child welfare services. I have used slogans to dramatize the central theme.1 Cases are found, but opportunities are lost.

A large proportion of the neglected families or families of delinquent children who are of major community concern, actually come to community attention years before the final breakdown which leads to court or institutional placement. Sometimes the family as a whole needs help; at times it is one or the other parent or one of the children. In spite of all the talk about organizing for early identification of those who may need help, the problem in early identification is not one of inability to establish contact with most families and children who will at some time be in serious trouble. Cases are really found and make themselves known, and all the talk about early identification is unnecessary and distorts the real issue in child welfare planning. Why, then, are opportunities lost? The reason is that agencies which deal with these families in the first instance do not act—in fact they are not expected to act— as agents or representatives of any kind of integrated community system. In most instances, there is a lack of recognition that the one who finds the case is in a strategic position, with a potentially valuable opportunity before him. In most instances, there is a minimum of service available, as defined by the agency's function. There is only a handful of instances involving agency initiative, that is, going beyond the specified and defined functions— broad family diagnosis, preventive planning, concern 'Alfred J. Kahn, Planning Community Service for Children in Trouble (New York: Columbia University Press, 1963), Chapter I.

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for those children in the family who are not the ones referred. These are far outnumbered by the cases in which relief checks are authorized regularly and no action is initiated despite obvious parental neglect of children; cases in which medical service is arranged but a subsequent handicap isn't dealt with; cases in which one child in the family may be placed in a foster care facility, while other children in the very same family, remain in a home recognized as unsuitable. The extent of lost opportunity varies with the charge of the agency, its place in the process, and so on.

Case plans are not made in accord with the best professional practice. Professional experience attests to the fact that we cannot choose wisely between probation and institutionalization, foster homes and institutions, one institution or another, probation and out-patient clinic, and so on, without a systematic analysis and evaluation of the child's characteristics, his strengths, his relationships to parent figures and their strengths and weaknesses, his relationships to peers, his community contacts, likely response to various courses of action, etc. Such formulation is more helpful to planning if it includes a variety of things about the background and dynamic elements behind the problem situation. Current thinking stresses family diagnosis. I invite you to examine the records of the agencies and courts which dispose of situations of this sort. You will find that in a very substantial proportion of the cases, and it does vary from place to place, no adequate evaluations have been made and no disposition planning in any true diagnostic sense has intervened between the process and

Shibboleth

or Feasible

Goal ?

11

the decision. What then is the result? The agencies—here is another slogan—drift into dispositions. Habit, realistic appraisal of resource limitations, sometimes the desire to be harsh with some offenders, and sometimes a series of community attitudes dictates disposition patterns. If a child is on probation and acts up, there is a response. A neglectful mother is in court once: she doesn't do what the judge says, and so the judge responds. A client in a very disorganized family fails to keep χ number of appointments: the agency makes a decision and acts, and so forth. Sometimes the reverse occurs. For example, on the first offense, the prevailing practice may be to refrain from taking any significant action, rather than to make an evaluation which leads to a decision as to what to do. Some of these patterns reflect community sentiment; sometimes they reflect realistic assessment of what the resources are; sometimes they are simply very elaborate rationalizations of these drifts into disposition. Sometimes they involve what might be called "self-deception." For example, a well-intentioned staff may request the guidance of a psychiatric hospital, court clinic, or other facility. They review the analyses and reports. The clinicians who have made the studies often name the agency to which the child should go. Yet all of them know that it is a kind of make-believe game. A recommendation is made that the child needs an institution for normal children with facilities for psychotherapy and vocational guidance. The child goes to institution X . None of the facilities required are really there, but everybody plays the game. Or, a voluntary foster care agency is selected because it will provide foster care and psychotherapy in its institution, and everybody knows the institution doesn't really have any psychotherapy. Then there is an organizational problem that sometimes

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creates disposition by self-deception, this is what you might call "locating resources by shopping," or structuring community resources in such a way that there is no systematic decision on the basis of priorities. Each probation officer tries to find a foster home. Each of many agencies competes for foster care. Each of many organizations competes for spaces in the same institutions. This amounts to "shopping" involving, not rational decisions, but personal influence, intervention of judges, individual skill, and astuteness, timing—all sorts of things which are not relevant to community priority requirements for the allocation of resources. Agency definition of function, procedures and philosophies are not always consistent with the requirements of a community system of services. Successful work with children and families in trouble obviously requires more than occasional cooperation between various agencies. Case finding, evaluation, and disposition can hardly be effective unless the different agencies are part of a truly integrated effort. Yet, such integration is seldom found and can be achieved only on the basis of substantial reconsideration of philosophies, objectives, sanctions, and interrelationships of numerous agencies. When a case is referred from agency to agency and from place to place, often the point gets lost along the way. A judge sends a child to temporary shelter while a foster care plan is made. The child is low in priority in foster care resources because of racial, ethnic group, age or handicap. While in temporary shelter the child acts up, and the court is called to intervene. The court shops for resources. The child acts up some more. Thus, a child

Shibboleth

or Feasible Goal ?

13

who begins by being dependent or neglected is, in these circumstances, categorized as delinquent. He may be delinquent in a category in which there aren't resources, so he becomes more delinquent. Too often the point of the procedure seems to be forgotten while the decision about institutionalization of foster care is made, and the machinery begins to function. If I had to make any generalization I'd make this one again and again. We start the machinery going and we forget the point. We take children into temporary care and then we forget the point. The family that should be reunited isn't worked with, and so the children never get back to the family. We establish a relationship with the family in the helping process, and we forget the point. Before we know it, a variety of referrals are made that have nothing to do with the original relationship. I am talking about the pathology of the system, not about the successes, but that is the point of today's conference, I gather. We are not here to tell each other how good we are, but to talk about what it is that does not work and how to improve our machinery and our philosophy. I would like to suggest a deep and basic deficiency that causes us to lose the point, to make diagnoses that do not lead anywhere, to make plans that are not followed through, and to fail to put the pieces together. The basic deficiency in community programs, of which all this is a reflection, is a lack of responsibility and accountability for the system. This lack is a central one and transcends practice in individual agencies and institutions. For example, a dependent child awaiting placement is referred by a temporary shelter to a psychiatric hospital for observation and is found to be disturbed but not committable. The child is returned home without further action. An

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institution returns a child to his home after a period of care and makes no provision for needed outpatient care. An agency does not pick up a big-sister referral made by the court and does not report back to the court. The court feels that something is happening which isn't happening. A clinic receives a case on referral but doesn't tell the referring sources that the client will not cooperate, so the case is closed. In each instance, somebody thinks that somebody else has taken responsibility and is rendering a service which it is not. Nothing happens until all this comes to community attention. No one agency is at fault all the time. No one agency is unusual in its failures. We simply have not established the principle that a child or a family found to be in trouble must not be lost, because the community loses at the same time. We have not established the notion that an agency which has rendered incomplete or unsuccessful service has some obligations for assuring continuity of community concern. In a climate of responsibility and accountability, strategically located agencies, such as the public welfare department, school and health agencies, would inevitably define their obligations more broadly in instances where they detected deviation while rendering their primary services. Agencies would think twice about transferring a too aggressive child, and so forth. Social service departments in hospitals would view the consequences of hospitalization more broadly. There would be more uneasiness about the endless waiting lists which may eventually get a child to a needed clinic or institution, but often only after the problem has been aggravated by a long stay in a temporary shelter. In a responsible community pattern of services, one would not meet so often this situation which I found: the father had a prison record; the mother spent two months in a mental hospital; and all the children had

Shibboleth

or Feasible Goal ?

15

been in foster care. Yet, no one agency looked systematically at this family, to pull together all facets of the problem and offer help beyond what was called for, beyond the immediate urgency of the moment which brought client and agency into contact. Nor would agencies readily close cases for failure to establish contact, or where a variety of other avenues might yield results. These are universal problems. They are identified in this country and England by workers in child welfare, mental health and family welfare. The implications of these problems would seem to be that we ought to think a little bit about organizing our services so that agencies arc not so hard to reach; so that the right clients are served in the right places; so that clients are not lost in gaps between agencies or in the inadequacies of agencies; so that agencies would work together more efficiently—putting people before functions; so that necessary technical knowledge will be developed and taught to adequate numbers of personnel; and so that sufficient resources will be available in a pattern of service which will yield more effective and lasting results. I have suggested a case for more adequate planning and coordination. Perhaps this is the time to say a few more things about what I mean by coordination. It is probably already clear that I really need two words to describe what I am talking about, coordination and integration, service integration. The mental health field makes this distinction quite clearly, but family and child welfare is only beginning to do so. I am suggesting that some of the weaknesses in community services may be met through improved handling of individual cases within a given service or through integration of the services of two or more agencies in relationship to the individual case. Other soft spots in the system may be eliminated

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through the development of what I am calling "accountability machinery". However, the problems of specialization, large scale organizations, and professionalization also require something more—adequate coordination and planning on several levels. Planning—as I am employing the word—is the process concerned with evaluating alternatives, developing proposals and timetables for the future, and indicating methods and stages for implementing proposals. It involves formulation of criteria for goals relevant to the choices which must be made. It requires research and fact finding as well as decisions about goals, values, and priorities. Coordination, on the other hand, deals with the meshing of agencies, programs, services, and activities in order to accomplish basic objectives. Each agency or unit requires information about the activities, areas of responsibilities and policies of the others. Adequate coordination is based on communication, interpretation, and interchange. It also provides for negotiation, settling differences and arriving at agreements relating to policies and procedures. At times, where differences of opinion exist about objectives or methods and involve mutually contradictory courses, coordination may require some devices to assure that some common course is adopted by all concerned. For present purposes, it is helpful to differentiate between coordination relating to agency programs, policy, objectives, scope and plans on the one hand, and work at the level of the individual case on the other. The latter phenomenon I am calling service integration or case integration. Where there are many planning activities carried on there is also a need for coordination of planning, but that is a slightly different subject. The coordination problem may be seen in more detail, not so much from the angle of the individual case, but

Shibboleth or Feasible Goal?

17

more from the point of view of the organization. Part of the problem is an organizational one—very basically organizational. To return for a moment to Maas and Engler, they were able to show in their important study that one cannot and should not consider child care problems outside a total community context. Different conceptions of dependency and different social service resources, which are related in turn to community culture broadly defined, produce quite different rates of parent-child separation, placement in foster homes, use of institutions, return of children to their own homes, adoption and so forth. One might comment in fact that there are no real dependency rates, but that such rates are a matter of community and cultural definition broadly conceived and applied. True, professional knowledge has some generic components and some professional values are universal, but strong local community forces affect local populations and agencies and may be overriding. The Maas-Engler research included a nine community study, and while it was only an exploratory study, they have more data than we have ever had before. It seems to me they show that ethnic and class loyalties, the strength of primary group ties, degree of urbanization, industrialization, heterogeneity, and related values and practices are particularly important in shaping child care practices. These may be more influential in fact than staff or staff training, for example. While all this may suggest the complexity of the problem of initiating changes as needed and the desirability of continuing diversity and flexibility in organizational patterns, it also encourages one to ask whether all the existing patterns could possibly make sense. Some must be more functional than others, some less damaging to children and family life. Yet, we are able to designate only

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the most grossly damaging of the alternatives. The rest may or may not be undesirable. Periods of crisis do, however, give us a chance to ask questions and explore alternatives. From the point of view of child care, this is a period of crisis. Although it was proclaimed over fifty years ago at a White House Conference that no child should be separated from his family for reasons of poverty alone, and while ADC has in many places restored a measure of economic underpinning, the goals implied in the White House Conference, of course, have not been achieved. The fact is, that while we don't separate children from families for economic reasons as a matter of public policy, we tolerate a very predictable chain of events which leads to this as an inevitable consequence. Between two and one-half and three million children are receiving ADC, while several hundred thousand more are getting help in public assistance and general assistance categories. We know that these categories are made up of large categories of cases reflecting social and health concomitants of poverty. Federal law and many state statutes proclaim the policy of helping these children and mothers, and occasionally the fathers, to overcome their handicaps; but legal provision varies, implementation varies, and the appropriation of funds and the budgets vary. Some states do not vote general assistance; others do not vote adequate budgets in many of the categories. More than a quarter of our counties have no full time public health units. Few public welfare departments have counseling or guidance staff services competent to help families toward rehabilitation. What does all this suggest? Simply that it means very little to develop qualified foster homes, placement, or residential treatment centers in communities which lack

Shibboleth

or Feasible

Goal?

19

basic assistance programs and related family case work or child welfare services to children in their own homes. Evaluation of the need for institutionalization or specialized community-based treatment is truncated unless the community provides financial assistance, medical help as needed, counseling service, and so forth. Otherwise, poverty does lead to placement through a well-marked pathway, and by the time the child reaches foster care, he is often disturbed. Child care planning, in short, cannot be carried on in a health and social services vacuum. It is proper to deal with it as a family and child welfare problem, or better, a family, health, and child welfare problem. To pretend any more that the health and social services vacuum can be ignored is to practice self-deception, community deception, or both. Let us begin by facing it—the goals of the 1909 White House conference have not been achieved. Another aspect of the Maas-Engler report deserves some attention. There is in the more urbanized communities a higher degree of specialization and professionalization, including a greater willingness to assume a diagnostic attitude towards children in trouble. Associated with this is a readiness to attempt to meet needs independently of ethnic and religious labels or agency limitations. However, this self-same professionalization, which in so many ways is admirable, creates new problems as the consequence of segmentation and fragmentation. This subject has far too many ramifications to cover adequately here, but there are some dimensions that are immediately relevant to the planning discussion. Child care in a large urban area is performed by specialist workers, sometimes located in agencies with very narrowly conceived function, sometimes located in bureaus of multi-function agencies. One agency supervises

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the child in foster care, while another agency works with the family. Family agencies are often unrelated to child care agencies. Child guidance clinics treat individuals, but they have no systematic relationship with child care services. Thus, while specialization apparently contributes to the development, knowledge, and skill relevant to practice, certain degrees or forms of specialization may have undesirable consequences for the total system. The possible implications of this would seem to deserve attention. For example, Wolins has found that specialized home finders and child placement workers operate with different criteria. In a related finding, Scott Briar found that when experienced social workers are presented with a case abstract and asked to make a case disposition for tthe child, they make decisions which reflect their agemcy background. In other words, residential treatment workers tend to feel that the child needs residential treatment aind foster home workers tend to feel that the child needs foster home care. Etzioni, the author of an importaint book on organization, has stated that one of the mcost important observations of students of organization is thiat often the tools in part determine the goals to which thiey are applied. I am reminded of the story of the intoxicated alcohoilic who looks for the quarter he lost under the light, mot because he lost it there, but because he can best see therre. We all recognize as unsatisfactory those institutions in which the children's program is secondary to protecting the lawn. Now we worry about staff-oriented considerations which complicate program priorities. If you haive visited any children's institutions recently you know juust what I mean. Not long ago, the head of the childrem's program of the London County Council toured Amerieca and saw the best of our child care facilities. When askeed

Shibboleth

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for his opinion and reaction, he said: "You have many good things, but who stays with the children?" This is part of what I mean by organizational problems. There are also organizational problems which affect collaboration between agencies. Maas and Engler use the phrase "non-collaborative networks". It appears that if a child is in the care of an agency offering one particular service, and that agency is relatively isolated—not physically but in communications—long term care is the likely result. Let me just suggest another topic. One of the results of organizational structuring and lack of collaborative networks is that a very small number of ideological slogans can dominate child care for much too long. The Child Welfare League is now giving leadership in re-examining some of these slogans. For example, the point of view that institutional and congregate care are generally inferior to foster homes needs re-examination. The original research on which some of the present generalizations are based is forgotten and put aside in favor of a series of slogans which are easily communicated in relatively non-collaborative networks. The original Goldfarb research comparing foster care and institutional care was based on conditions not at all like those of today. Present-day foster homes and institutions are not like those he studied. Yet people still accept as gospel that foster homes are better for all children than institutions. Rene Spitze's very limited sampling of certain kinds of pathology related to the isolation of children in a very peculiar kind of facility has been translated into a series of generalizations which block our attempts to be flexible and inventive in the use of group care. It may be that under certain conditions, group care is superior to foster homes, and, under other conditions, as good as foster homes. Certainly, such care may be

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superior to long term stays in temporary shelter because the ideal foster home is not available. I think organizationally induced problems can be solved through professional ethics, but they also require organizational solutions. I would like to suggest one or two. In connection with planning family and children's services, I suggest the possibility of a broader definition of our social service problem, at least of the child welfare component, than even the notion of a collaborative network including family welfare, child welfare, courts, mental health, etc. I suggest that perhaps one part of the box that we are in has to be looked at from the point of view of social philosophy, values, and conceptions of social welfare in America today. If you examine social trends and data—the numbers of women who work, the numbers of young people on the job market at the age of 16, 17, and 18, the unique characteristics of families in urban areas, etc.—and then examine what we offer, it occurs to you that social work has participated in defining large parts of American social welfare provisions in terms of therapeutic or residual services. We define what we do as services to people who fail to make the grade, fail to get along, and fail to fit in. We say these are the victims of industrialism, the victims of urbanism. I suggest that perhaps if we understood urbanism and industrialism, we would recognize that a lot of our programs really ought to be defined as programs for the normal people in this system. If, in child welfare planning, we could begin to talk a little bit about what normal people need in the age in which we are living and recognize that some of the things which we define as problems are normal situations, we might be better off. I use the Wilensky and Lebeaux vocabulary of institutional and residual definitions of so-

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cial welfare. Residual means those things which you need to provide for people because the primary group which should take care of them has broken down. Institutional means those things which are normal services in urbanism. The assumption is that competent, normal, and, I think, moral people manage alone, or obtain family help and do not need assistance while others do need help. This affects attitudes toward those who need service, and it affects the way in which we organize service. It seems to me that the institutional view ought to have serious consideration here. We learned that you can have structural unemployment, and therefore we need unemployment insurance. Now we have unemployment insurance for localities called aid to depressed areas. Just as we have developed these programs, perhaps we may need a variety of other "institutional" provisions. In our area of concern, I would suggest, by way of illustration, that we could begin to think of day care as something every mother has a right to when her children are three, just as she now has a right to kindergarten when they are five. With this kind of change perhaps we might remove a large number of mothers from the arena of child welfare therapeutic services. If we could accept the fact that educational programs ought to be made available to a variety of kinds of people through a variety of channels and tracks, depending upon predilections and skills and so on, perhaps we could have vocational guidance, counseling, retraining, and work corps for young people in America without defining and structuring such programs under a delinquency model. Perhaps if we recognized the isolation of urbanism and the problems of transition from school to family, we might accept the fact that we need family life education and group counseling for all adolescents.

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Participation in such programs should not mean that a personal problem exists. Maybe if we did this we would have a somewhat different point of view about resources and about the way in which we look at the people who get the services. Maybe we could decrease that portion of the American population which is defined as the object of rehabilitative or therapeutic programs. It seems to me that when we talk about planning, we not only have to deal with organizational factors, not only with conceptual factors relating to treatment, and, not only with the problem of service integration, which I just hinted at here, but we must also deal with the question of how much of what we do is going to be therapeutic and how much is going to be developmental. We shall also need administrative machinery to put all this together—but that must be the subject of another discussion.

III Do Our Program and Administrative Instruments for Serving Family and Child Welfare Needs Reflect and Implement the Highest Level of Knowledge for Solving the Problems Presented? —Are we able to implement and administer what we know about the solution of family and child welfare problems? What are the barriers? What general organizational devices and what operational and procedural techniques at the client level, as well as at higher hierarchical levels, might be developed or utilized to more fully exploit and implement the highest level of knowledge in the solution of problems affecting the health and well-being of children?

by VERL LEWIS School of Social Work University of Maryland 25

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The question posed as the title for this paper is not difficult to answer; in this company only a devil's advocate would respond with less than a resounding "no." You do not expect less of me, but my presence here appears to require at least some documentation of that position. The question turns, then, to: what particular difficulties do we encounter in translating our knowledge of the needs of children and families into more effective program and administrative instruments, and why? These, I think you will agree, are far different questions. To answer them in truly satisfactory fashion would necessitate the eloquence of Churchill and the time that Castro can command, as well as a quality of wisdom that, as soon will be evident to you, I no more possess than I do the two other attributes. Even so, I welcome this opportunity to explore with you three aspects of the problem. First, I will attempt some examination of the nature of the problem. That is, I will suggest something of the reasons for our failures to develop and carry out as effective solutions as we might, and I will try to indicate the nature of the problems with which we should be concerned. Next, I should like to review with you some of the limitations of the knowledge that is available to us; for, despite our failure to use effectively much of what we do know, it well may be that limitations inhere in the form of our knowledge of the needs of people and of how these may be met. Finally, I will comment upon critical discrepancies in the utilization of what we do know. You will not expect me to cover this ground exhaustively, but I will try to illustrate the range of the difficulties in which we find ourselves entangled. If we proceed upon the assumption that we do, in fact, fail to make full use of the knowledge we do command to

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solve the problems that confront us, the dilemma poses, in turn, other problems of great complexity. In part, the reasons appear to lie within ourselves and to reflect a conflict that, as humanists in a society that values acquisition and the symbols of material success as highly as does ours, we really cannot expect to escape. In part, however, the reasons must be sought also outside ourselves in this valuation the larger society places upon the uses it makes of people and by the ambivalence it expresses about their worth. To an extent we are trapped by the views the community at large holds about the nature of the problems involved in meeting the needs of families and children, and our perspective is blurred by the inclination of the community to associate us invidiously with our clientele. It is not enough to have one foot caught in these defeating community attitudes; we ensnare the other in our own conflicted feelings about these same relationships. Caught so, is it surprising that our accomplishments reflect something less than we might otherwise achieve? A perceptive analysis of the way in which conflicting community views stand athwart our way to progress is to be inferred from a discussion in Galbraith's The Affluent Society.1 His second chapter, titled "The Concept of the Conventional Wisdom," illuminates the ideological milieu that influences our efforts to meliorate social conditions and to develop appropriate, effective solutions to community problems. In passing we note the irony that Galbraith should have beguiled some of our contemporaries with that tenet of the conventional wisdom that poverty has so far vanished from the United States as to become the proper concern of historians rather than of social welfare admin'John K. Galbraith, The Affluent Society (Boston: Houghton Mifflin Co., 1958), p. 20

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istrators and social scientists; and that the ills of society, though perhaps not those of all its individual members, can be cured if the political economists—or perhaps it is the economic politicians—will but arrange to devote a larger proportion of our affluence to the public sector of the economy. Our debt to Galbraith lies, rather, in the clarity with which he does express the need for more adequate public services, and in the clarity with which he reminds us that the march of events ultimately does dislodge obsolete notions no matter how dearly held. It is Galbraith's view that ideas are essentially conservative, yielding only to the onslaught of circumstances with which they cannot contend. The principal characteristic of the conventional wisdom, he points out, is acceptability rather than objective credibility, and the challenge he poses for us is to scrutinize with as much discernment as we can muster the ideas that we find most acceptable as well as those which have the widest currency in the larger society. Possibly the conventional wisdom which most impedes our progress is less the resurgence within the radical right of the credos of Malthus and Thomas Chalmers than that expressed in such concepts as "means test"—made respectable by the euphemism "budgeted need"—"waiting period," "less eligibility," "relative responsibility," and "suitable home," deeply imbedded in our social welfare programs. Implicit in these concepts are conceptions of the nature of need, the reasons for need, and the nature of needy people. The origins of these conceptions can be traced to pre-depression—and in turn to Nineteenth Century—circumstances. Their present form largely was shaped in the social trauma from which depression-born programs emerged. A quarter-century has elapsed since the basic programs

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and administrative instruments available to us as public services to meet family and child welfare needs took shape: the social insurance structure laid down in the Social Security Act and the locally or state administered means-test assistance programs. Deeply, apparently inextricably, imbedded in these programs are conceptions that were of doubtful validity in the 1930s and well may be dysfunctional today. However, the limits of acceptability that define the conventional wisdom that belongs particularly to social welfare are so narrow that these obsolete concepts—rather than the fulminations of the Mitchells and the Goldwaters, nostalgic for a past that never did exist outside of fantasy—stand as a barrier to the development of programs and administrative instruments appropriate to our time and its problems. If, as Galbraith asserts, the enemy of the conventional wisdom is the march of events, we will do well to examine, at least briefly, the "massive onslaught of circumstances" which renders obsolete not only the conventional wisdom so widely held, and which we find so frustrating in our contemporaries in the general public, but also that to which, at least by our inaction, we, too, pay allegiance. This circumstance which threatens to overwhelm both of these conventional wisdoms is the massive persistence of poverty and its relationship to a concentration of other aspects of social pathology. Keyserling has documented trends that must concern us. Pointing out that in 1960 two-fifths—some 77 million—of the people in the United States were living in conditions of "poverty or deprivation," he has shown that in 1960 more than half as many people were living in poverty as during the depression years 1935-36. He demonstrates, also, that the rapid reduction in those numbers which characterized the years of World War II slowed to a virtual standstill after 1953.2

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It is commonplace for us to acknowledge the role of poverty in the sweep of revolution throughout Asia and Africa, and we are blind indeed if we cannot see into Latin America through the window which Castro holds open for us. No one really disputes that we are affected by these stirrings in the "under-developed" and "emerging" nations. The idea of "one world" also has acquired its place in the conventional wisdom. But we are placed in peril by an insufficient recognition that we cannot be merely spectators at this arena. We are more than affected by—we are involved inexorably in—the world-wide social changes that are sweeping like a firestorm around the globe. While it is true that we are involved at a different level than the Congo or South Africa, than Portugal or India or Indonesia, than Cuba or Argentina, we have no immunity to the march of these events. Here in the United States we are caught in the cross fire of what are truly massive revolutionary economic transformations, and there is reason to fear that the conventional wisdom in which we place our faith blinds us to the implications of what is happening. One facet of this transformation is the mechanization that is revolutionizing American agriculture. In doing so, it is undermining the economic support that has provided a reasonably stable, if desperately impoverished, culture "Keyserling uses Department of Commerce data showing 13.8 million families with incomes less than $4000 and 3.6 million unattached individuals with incomes less than $2000 (both in 1960 dollars) in 1947. By 1960, the number of such families had decreased to 10.4 million, but the number of unattached persons had increased to 3.9 million. The data for families with incomes less than $2000 shows a decrease of .5 million f r o m 2.8 million between 1947 and 1960, and for unattached individuals with incomes less than $1000 an increase during the same period from 1.7 million to 1.8 million. Conference on Economic Proggress, Poverty and Deprivation in the U. S. (Wash., D. C., 1962), pp. 24-25.

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for millions of American families—the small owners, the tenant farmers, and the field hands who have subsisted on the land. This is happening throughout rural America, but its consequences for people are most evident in such areas as northern New England, the midwestern prairies, the Appalachian Plateau where the obsolescence of coal complicates matters, and in the South; especially in the South, where the rural population is caught in the grip of an enclosure movement dwarfing that which eroded the feudal holdings of medieval England. The comparison falters, for the transformation of the English countryside from small peasant holdings to landed estates required centuries, and the numbers of families affected at any given time could be counted in thousands—perhaps no more than hundreds at times. The face of the South—and the lives of its people—is being changed in a single generation, and the uprooted and displaced people number hundreds of thousands. Simultaneously with this drastic change in rural America—lagging somewhat, perhaps, but accelerating under the impact of competition for survival with the countries beyond the Iron Curtain and for trade with those of the Common Market—our industrial economy is caught up in changes no less far reaching. The contemporary revolution in manufacturing, popularly known as automation, necessitates adapting to an electronic era fantastic in its potential. We can only conjecture about the eventual consequences of dimly discerned forces already in motion. What has happened to the coal industry and to people in the mining communities forecasts massive changes whose beginnings already are being widely felt. The Bureau of Labor Statistics has estimated that the jobs of at least five million workers will be made obsolete by automation during the decade ahead, and we can have confidence in the

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conservatism of this estimate. Among the certain victims will be the least skilled and those least able to acquire new skills and adapt to changed circumstances. The convergence of these two simultaneous revolutionary trends—the automation of industry and the mechanization of agriculture with shattering consequences for families and communities—is causing an explosive acceleration of urbanization both South and North. The people uprooted from the land and those more or less permanently shunted aside by industry are congregating in the central areas of our large cities. Whether driven or drifting, whether seeking refuge or opportunity, millions of people are collecting in these slums and near-slums and slums-to-be. In an alien environment, they live in poverty and deprivation—many of them in hopeless, grinding penury—and they are chronically exploited by the slumlords, the vicelords, the loan sharks, the glib-talking, fast-buck installment sellers and insurance "salesmen." The hazard to our social order and the challenge to all of us who have responsibilities for community services has been formulated dramatically by the eminent scientisteducator, Dr. James B. Conant. Exploring the problems of education for our youth, he glimpsed—then took a closer look at—the home and community environment of the children attending the inner city schools. He concluded that the central areas of our large cities are packed with "social dynamite." Hemmed in by barriers of discrimination that block the way to educational and employment opportunities and so to legitimate avenues of economic self-support, unassimilated and alienated people generate a concentration of social pathology that erodes the lives of those enmeshed in it and endangers the safety and health of the whole community. Social disorders are not peculiar to the central areas of

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our large cities. Disability, delinquency, desertion, child neglect, illegitimacy and chronic joblessness are to be found throughout the social strata in every community, but in the inner city—and perhaps in chronically economically depressed areas elsewhere—this concentration of social distress and dysfunction becomes a way of life. This adds up to a very different complex of problems than our social welfare programs were designed to alleviate. Neither the conventional wisdom of the public at large nor that which we peculiarly possess as professionals in the social welfare field prescribes adequate solutions. I have attempted to indicate something of the nature of the problems which the march of events presents to us. Having alluded to barriers which make it difficult to comprehend and to solve these problems, I propose now to comment briefly upon some of the limitations of our knowledge about the needs of people and how these might be met. Realistic appraisal yields the conclusion that there is unevenness in the knowledge we possess, and that even that in which we find the greatest consensus tends to be deficient on two counts. (1) Available data either concern gross phenomena that are likely to be associated in uncertain ways with the behavior we seek to understand, or they are primarily impressionistic, based upon limited, usually grossly distorted empirical evidence, often taking the form of case illustrations that encourage the logical fallacy of generalizing from a single case. Seldom have these data been subjected to rigorous experimental verification. Indeed, often we cannot now even conceive of experimental design that would permit such verification. (2) Our knowledge is insufficiently systematized—conceptualized—to use a term currently favored in professional circles. We suffer from a paucity of theory of a field

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where, as in the natural sciences, "nothing is more practical than a good theory." My purpose in identifying these limitations of our knowledge is not to deprecate the state of what we know. All of us recognize the defeating consequences of failures to act because of imperfections in our data, and that many times what we need is more vigorous applications of what we think we know coupled with far more ambitious scholarship than we have yet contemplated in an effort to verify what now passes for knowledge and open new frontiers to understanding. It is impossible to overstate the urgency for research that will organize and examine and thus permit the extension of what we know. For the long run there could be no more productive expenditure in our field than that which would encourage the systematic formulation of theory to explain the complex phenomena with which we are concerned and to underwrite the search for experimental verification of that theory. In this connection I do wish to pay my respects to the few agencies and foundations that have supported the beginning of such efforts and to the social and behavioral scientists and social work scholars who have contributed much to what we do know. Illustrative of work which has particular relevance is the creative theoretical formulation in Cloward and Ohlin's Delinquency and Opportunity, and the plans for testing aspects of that theory as set out in the "Proposal for Preventing Delinquency by Expanding Opportunity," developed by Mobilization for Youth of New York City. I propose to turn now crepancies between what made by our programs of ices. Later I will identify

to an examination of two diswe know and the provision family and child welfare servwhat appear to me to be two

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lags in the development of appropriate administrative instruments for their application. The first issue I call to your attention is the serious discrepancy between what we know about common human needs and the provision we make for meeting them—the benefit standards—in both social insurance and public assistance programs. Originally designed to meet subsistence needs at a minimum level, established in an era when the nation's productive capacity was both impaired and limited, the benefit levels of the social insurance programs directly administered by the federal government generally have fallen behind living costs; and on the whole they fail to reflect either the enormous increase in our absolute and relative productive capacity or the substantial rise in community living standards and expectations in the years between 1936 and 1962. All of this would be irrelevant if a decent level of benefits was beyond the country's productivity capacity, but the fact appears to be that much productive capacity actually lies idle because of insufficient consumer demand. The benefit levels of our social insurance programs have been maintained at levels that condemn the great majority of more than 17 million OASDI beneficiaries— virtually all of those who lack substantial supplemental resources—to a precarious submarginal subsistence standard. This includes more than 13 million aged persons, 1 million disabled workers and their dependents, and 2.5 million widowed mothers and children, virtually all of whom subsist below the poverty line by acceptable 1962 standards. When we turn to our public assistance programs, we find that virtually nowhere do they assure more than the most meager subsistence; and in many jurisdictions, socalled standards of assistance are a disgraceful commen-

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tary upon man's inhumanity to man. We really cannot escape the conclusion that public assistance standards generally are no more than devices for sharing the most abject poverty more or less equally. It should be clear to us that an adequate level of economic assistance is fundamental to a family's efforts to maintain its social functioning at a satisfactory level. To the injury of assistance grants that everywhere are insufficient to maintain even consistent levels of malnutrition and which, throughout most of the country, constitute a guarantee of slow starvation we add the insult of a means test that humiliates and demeans the applicant. I will return to this later. Incomplete though our knowledge may be, the science of nutrition, and the mass of biological research supporting it, provides a substantial body of experimentally verified data about basic human needs. In a manner of speaking we acknowledge this in basing food allowances upon intricately calculated data which we term a "minimum adequate food budget," I know of no clearer illustration of the conventional wisdom than the fiction embodied in this minimum adequate budget. Only in a laboratory where custom and preference can be ignored, and where the exigencies of time and opportunity have no meaning, can this calculation yield even hypothetically adequate nutrition. In a more important sense, also, it is fiction. Its ostensible function is to provide a measure of uniformity of treatment—and this I have no doubt it does—but a far more important latent function is to lend the aura of scientific respectability to the delusion that public assistance standards do assure at least an acceptable minimum subsistence standard. In summary, our basic income maintenance programs, social insurance, and public assistance, provide benefits substantially below the known needs of beneficiaries. These

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standards conflict directly with our knowledge of the adverse consequences for physical and mental health of the chronic deprivation to which they consign large numbers of beneficiaries. During the late 1930s, as old age assistance programs were inaugurated, it quickly became evident that our estimates of longevity for recipients became obsolete even as the first large number of applicants qualified. The conjecture then was that the old people lived longer because they received Old Age Assistance. Before this could be verified, the "miracle drugs" came along to vanquish pneumonia, "the old people's friend" of former days, and to contaminate the crude evidence that was accumulating. However, in this impression is an idea worth exploration: that the inadequacy of benefit levels may bear a causal relationship to the prevalence of somatic, psychological and social disorders among recipients. In relation to the adequacy of benefit standards, we know far better than we do. The means test, referred to earlier, requires more decisive commentary. Contrary to popular impression, this means test is a comparatively new device in the age-long effort to cope with problems of human need. An innovation during the Reformation, it was refined under the tutelage of Malthus and Chalmers. It was the core of Charity Organization teaching, and because it was close to the heart of the teaching of such revered social work pioneers as Josephine Shaw Lowell, Mary Richmond, and Edward T. Devine, we defer to the concept as if it were the first article of the Holy Writ. On the other hand, the left hand not knowing what the right hand doeth, there is no student in any school of social work who, by the end of his first week in class, does not recite that the basic assumption—the fundamen-

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tal value orientation—of the profession is "the worth and dignity of the individual." Such knowledge as we have of how people can be helped to cope more effectively with their problems assumes that a basic ingredient is the person's self-respect and directs attention to the importance of enhancing or repairing weak or damaged self-esteem. Most of what we teach as social-work method best can be comprehended in these terms. We are concerned in our public assistance programs with great numbers of people who are experiencing economic distress, most of whom show objective evidence of deprivation when they request aid. In our society, this request in itself reflects an acknowledgment of inability to cope with one of the key roles of social functioning. Very many such families experience, additionally, one or more other such obviously serious social disorders as desertion, delinquency, neglect, illegitimacy, mental illness or retardation—each of these a massive trauma assaulting the family's conception of its adequacy. If an objective of our family and child welfare programs is to prevent further deterioration of social functioning or to set in motion processes which hold some hope for rehabilitation, it is difficult to conceive of a more self-defeating policy than the abnegation that is an inherent aspect of the ritual of pauperization we euphemistically term "establishing eligibility." Delafield Smith reminds us that "we cannot rehabilitate people any more than we can rehabilitate plants. All we can do is to stimulate the normal processes within the organism itself."3 The means test provides a noxious environment for the nurture of self-esteem. 'The Right to Life (Chapel Hill, University of North Carolina Press, 1955), p. 3.

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At least the beneficiary of social insurance has been spared the degradation of the means test. Spared, that is, until illness or enfeeblement overtakes him. Then, in this extremity, we strip him of his last resources and require that he abjure his self-respect. Our predecessors in this business, the overseers of the poor of a generation or two ago, conducted this rite of pauperization hardly more cruelly—certainly more honestly, for they acted consistently with the knowledge available to them—when in town meetings they asked the electorate to authorize inscription of the indigent person's name upon the official role. From these two issues in which available knowledge is reflected insufficiently in programs for families and children, I wish now to turn to the matter of the adequacy of our administrative instruments. To highlight the different levels at which this problem arises, I have chosen to present briefly only two issues. The first is technological—the use of processes and equipment in the interest of more efficient administration. We need to devise ways in which the automation of business and industrial processes can be used to streamline agency operations. At the very least, we should seek ways to turn to our use, in the interest of providing basic maintenance and rehabilitative services for our clientele, some of the technological advances which, in their industrial uses, have dislodged and disadvantaged them. I particularly have in mind what is known as the "programming of data" which adapts it for storage and retrieval, but I am somewhat aware that there are a myriad of devices and processes with which I am unfamiliar which might hold open possibilities for major improvements in our operations. Certainly there are relatively few people in social welfare leadership positions who understand and can evaluate the possibilities which use of com-

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puter and related electronic processes may open for us. At least a few state and large city welfare departments have ventured into some use of this technology; and, if we were to pool the experience within the field, we might find that we are further advanced than we know. One thing is certain, the literature of our field portrays little of either understanding or interest in these possibilities. A glimpse of the potentialities of harnessing these electronic technologies to the service of people's needs is available in the operation of OASDI in Baltimore. There a most ingenious application of modern technologies will establish a prospective beneficiary's eligibility and benefit status at a speed that defies human imagination. I was told that were an application to be filed by a retiring worker in the afternoon in a district office a continent away from Baltimore, the following morning eligibility will have been confirmed, wage records scanned, benefits computed, and payment authorized. If that applicant will return to that district office in California when it opens in the morning, he can be handed confirmation of his eligibility status. Between his application one afternoon and his recipient status the following morning will have intervened watts and volts, cathode tubes, reels of magnetic tape and countless transistors, but hardly a human hand or eye. I cannot resist reminding you that while these ingenious applications of electronic technology will establish a recipient's eligibility at a speed that dazzles our imagination, the award he receives almost certainly will be insufficient to meet his economic needs on more than the most meager basis. It is beyond my purpose to predict the possibilities that may open to us as we turn electronic technologies to our advantage. For so much of the future as I am able to anticipate, I presume that these uses will lie principally in

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the direction of improved administrative procedures and in more effective executive controls. A second problem respecting the adequacy of administrative instruments is one of organizational arrangements in communities rather than within agencies. It will be dealt with more comprehensively in other papers, and I only will identify and briefly comment upon it. The problem to which I allude has to do with the fragmentation of community social welfare services and the inability of community agencies to coordinate—often even to relate—efforts directed to the community control of social disorders. Some of the basic requirements for solutions of these problems have been identified for us by Bradley Buell, and Community Research Associates, demonstrations of methods of community control of disorders have illuminated practical adaptations of relationships in the interest of more effective services to families and children. How permanent these rearrangements, achieved by a combination of cooperative good will and the adroit application of strategic power, have been is less clear. The fundamental issue here lies in long established patterns of relationships among such official agencies of community control as the public schools, the courts, the public welfare, and public health services. What is involved here is far deeper than attitudes of isolation or cooperation, of good-will or ill-will. It seems to me that the problem here is entrenched at the very core of our system of government. The founding fathers, apprehensive of dynastic power and distrustful of the unlettered and unpropertied masses, came up with a solution which has come to be known as the principle of the "separation of powers." In this way basic conflicts were intentionally built into the structure of government and means were

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introduced to hold these within the limits of an often uneasy equilibrium. As our social welfare programs have developed, conflicts emerged not simply between agencies with differing mandates, but more fundamentally between the executive function of administering social services and the exercise of the judicial function of social control. Generally, we have found it possible to compromise these problems, and between our ability to compromise them and to ignore them the issues involved have tended to be blurred. As long as our agencies—official and voluntary—limit themselves to providing services—tangible or intangible—there are available to us methods of communication and cooperation that usually keep the problem within manageable bounds. When our health and welfare agencies undertake to control such disorders as desertion, delinquency, and illegitimacy—the whole gamut of what Buell terms "official disorders"—it is difficult to see how the conflict with the judicial function can be avoided. I know that it can be ignored, but I doubt that it can be avoided. I ask your indulgence to illustrate this by a specific illustration from the front pages of the Baltimore papers. Α Miss X, the mother of nine children out of wedlock, was placed on probation for a year when she was unable to post a $500 bond to assure the community that she would have no more illegitimate children. At the same time, the putative father of five of the nine children was sentenced to a two-year term in the House of Correction on a charge of non-support. I happened to know a good deal about Miss X and her problems because I am advisor to one of our students placed for field instruction in the Baltimore City Welfare Department. This student had devoted months of patient

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effort to untangling the web of fact and fantasy in which Miss X and her nine children were enmeshed. For the first time in the years that this family had received ADC, and the putative fathers of the children had been under support, somewhat irregularly it is true, for four of these ing the father in something more than a support or go-tojail way. Miss X got to the court because the agency requires an official support decree to qualify the latest baby for ADC. Actually, the putative father—though intermittently jobless and at the time of the hearing out-of-work—has paid support, somewhat irregularly it is true, for four of these children over a term of years. I make no claim to knowing all of what happened. Neither the student nor a representative of the welfare department was present or consulted. I do know that my student's patient work over a period of_ months convincing Miss X that she really could venture a little trust, was smashed during that stormy session in court. Whatever progress had been made in involving the father of the children was lost, and such support as could reasonably have been expected from him no longer was available to the family. Doubtless there were many reasons why this happened, but basic to them all, it seems to me, is the fact that neither welfare agency nor court can yield its prerogatives to the other.

IV How Adequate and Flexible Are the Legal Base and Social Policy Which Underlie Family and Child Welfare Services and Resources? —What are the deficiencies in terms of concept, clarity, and flexibility of (1) the statutory base which underlies and supports public family and child welfare programs and services, and (2) generally accepted principles, objectives, policies and priorities which, collectively, underpin private family and child welfare programs and services? To what extent do these deficiencies represent barriers to the establishment and implementation of structural improvements conducive to coordination? by WAYNE VASEY Graduate School of Social Rutgers University

Work

These times call for a consistent, comprehensive welfare policy, unequivocally stated, and clear in intent. Such a 44

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policy would be one in which respect for the individual and belief in human dignity would be more than high-sounding phrases, and one which would serve to guide us toward a program of welfare services based upon a genuine belief in human rights. As I use the phrase "human rights" I am guided by the following statement, which expresses the concept with vigor and deep meaning: Human rights are universal rights or enabling qualities of human beings as human beings or as individuals of the human race, attaching to the individual wherever he appears, without regard to time, place, colour, sex, parentage, or environment. They are really the keystone of the dignity of man. In their quintessence they consist basically of the one all-inclusive right or enabling quality of complete freedom to develop to their fullest possible extent every potential quality and talent of the individual for his most effective selfmanagement, security, and satisfaction.1 The mixture of compassion and contempt reflected in our public assistance policies, our uneasy veering between helpful and punitive approaches to the public welfare programs, especially ADC and general assistance, and the pittances which pass for assistance payments in many parts of the country are scarcely conclusive evidence of respect for the essential human qualities of those who need and receive the aid. Many of these inconsistencies are rooted in fears which are deeply imbedded in social consciousness. Our fear of dependency, our worship of self-reliance, and our resistance to organized effort by government, all contribute to our resistance to what we have come to term the welfare state. It is perhaps this fear, compounded by our inability to accept the reality of problems beyond the scope of 'Arnold J. Lien, "Fragment of Thoughts Concerning the Nature and Fulfillment of Human Rights," Human Rights (New York: Columbia University Press, 1949).

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self-management in a complex world, which leads to recurring attacks on welfare and the unfortunate commitment of administrative energies to warding off such attacks. Obviously while welfare measures have increased in extent and coverage, many people have continued to view with alarm our further development as a welfare state. We can't halt its progress, but we seem as a people to be bent on forestalling our enjoyment of it, or to prevent its complete success, as if we were afraid that such success would create an irresistible momentum. Charles Frankel reminds us that, contrary to popular belief, the welfare state is not a recent phenomenon. He notes: From a longer point of view, the Welfare State is not simply the product of the immediate emergencies of the past thirty years. It is the product of the chronic emergency that has been with us since the moment, whenever it was, that Western society cast its fate irreversibly with machinery, cities, productivity, and economic growth.2 Such perspective is perhaps too much to expect generally. But it should help to remind us that welfare programs are consequences, not causes, of the problems with which they are designed to deal. Perhaps such a perspective will help those in the programs who need to strengthen their personal convictions that welfare should be a strong helping force in our society. What We Mean by Policy We have been employing the word "policy" without defining its meaning. Obviously, in the foregoing paragraphs we have been alluding to very fundamental values, which would serve as a basis for laws, administrative "From address delivered at the University of Buffalo, Fourth Annual Social Work Day, May 3, 1961.

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formulations of purpose, scope, and method, and for the informal commitments that grow out of the daily operation of organizations. We have been talking of "the aims and ends of social action." Such policy, however, must be implemented by these other forms of policies. Otherwise they become pious expressions of intent, without meaning in terms of action and program. We need laws and administrative policies which clearly reflect a consistent, basic pattern of service based on respect for the individual and his rights. Some may argue that we are really confusing the problem by stressing policy and that we have not begun to operate within the full scope or latitude now possible in the administration of welfare. It may be argued with some justification that organizational behavior is the real determinant of the nature and quality of administration of the programs, and that the law is what people say it is. It is true that we have many examples of failure to take full advantage of the laws. Sometimes, as in the case of the public assistance amendments of 1946, it is a question of lack of resources. Sometimes, as in the case of income of working members of the family receiving public assistance, it may be due to a narrow interpretation by state administrators of legislation. Perhaps, as in the case of organizational and community behavior with respect to children in need of protection, limitations may be based on conflicts in attitudes toward parental rights vis-a-vis the needs of the children. It may be in the public welfare services that frustrations, arising out of years of inability to meet the myriads of acute human needs, have forced the beleaguered welfare administrators and their staffs to develop the habit of concentrating on the manageable rather than the difficult problems.

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We also must acknowledge the possibilities of multiple interpretations of statutory and other policy meanings. Such interpretations represent in their extremes two distinct patterns. One is that of viewing the law strictly and exclusively as a device for curbing the enthusiasms of administrative personnel. The other is the pattern of thinking of the law as a means of conferring unlimited license to those engaged in administration. As usual, we find little help in extremes, and we seek in the statute and in administrative formulations positive guidelines to policy consistent with the apparent intent reflected in the law. A clear statutory or legal base for a program is highly essential. At its best it can be an expression of the posture of government's relation to the individual. It can enunciate and signalize an approach to human needs which, frankly, I prefer to see come from duly constituted legislative representatives rather than from cleverly contrived administrative interpretations, however beneficent the latter may be. While not able to supply detail sufficient for a program of action, such statutory enactment should set the tone and provide the limits for the services. It is only when interpretations of statutes result in a rigid approach—incapable of adaptation to changing circumstances which confront the programs—that we become acutely aware of the problems of the legal base. The ponderous processes of amending the statutes frequently do not provide sufficient flexibility, and one may ask that the statute reflect a purpose and intent to guide the administration but that it not try to legislate in detail on the structure and method of administration. The balance between legal base and administrative authority is too complex a topic to be treated in detail here. Actually, to round out the picture, one would need to add

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the factor of judicial determination of constitutionality and the further factor of administrative or organizational patterns of service which become so fixed as to have the force of law. For the present, let us say that a balance is needed between the legal base and administrative latitude which will permit flexibility without surrendering all public control and authority. Such a clearly formulated fundamental policy may actually permit more, rather than less, flexibility of action, and should certainly free the agency from the restraints of excessively detailed rules and regulations. To quote Charles Frankel again: "For detailed and direct intervention is more necessary when general policies are missing and when there are no regular facilities for dealing systematically and in advance with the normal dangers of life in a highly developed economy. In the summer of 1961, while working with the Ad Hoc Committee of Public Welfare, I was struck by an interesting phenomenon which I shall characterize as using the law to dislodge administration from solidly entrenched positions which it had dug for itself. There were some points in the administration of public welfare services in which it seemed quite clear that the administrative agencies could have interpreted the law more liberally than they had. The particular area in which this phenomenon was most strikingly evident was in the consideration of income for assistance recipients. So habitual had certain restrictive interpretations become, however, that nothing short of a law seemed likely to have any effect. To ignore the pragmatic importance of the legal or statutory base in this instance would be to deny reality. Policy is important. It can provide authorization for a positive, well conceived program. It can impart a quality of consistency to welfare services. It can reflect a level of

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aspiration for a society, and can express the finest ideals. In this way it can free those responsible for the administration of services to make the program work in the best interests of the people. On the other hand, policy can also provide obstacles. It can reflect the narrowest and most restrictive of views. It can express the inconsistencies of attitude which have characterized our welfare provisions. It can manifest negative as well as positive views of people and their circumstances. Generally speaking, our welfare policies are a mixture of both. But the obstacles are formidable, and certainly pose a threat to any large scale move toward a consistently positive program. Let us now look at some of the more tawdry patches in our curious garment of welfare policies. Some Policy Obstacles In Public Welfare—Time for a Change—the report of the Project on Public Services to Families and Children, sponsored by the New York School of Social Work— Elizabeth Wickenden and Winifred Bell noted several particulars in which present provisions fall short. They noted that help was not equally and universally available to all who need it, that it was not in many instances extended in such a way as to serve the best interests either of the helped or of the social organization as a whole, and that organizational and jurisdictional arrangements did not lend themselves to the most effective and adaptive policy development. 3 The authors also noted limitations on eligibility, on program, and on organization. Many have noted the vestigial influences of the old л

Public

Welfare—Time

for a Change,

p. 23.

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poor law in such measures as relatives' responsibility and continuing emphasis on settlement and residence. Such groups as the Advisory Council on Public Assistance have called attention to the restrictions which seem to be inherent in the categorical approach. Particular notice has been taken of the exclusion of general assistance, which Joanna Colcord once described as being composed of "the residual legatees of disesteem." Wickenden and Bell include in their catalog of limitations other restrictions, including questions of morality, which lead to such measures as denial of aid to children of illegitimate birth, restrictions based on living arrangements, which require the child to be living in the home of relatives of specified degree, requirements that the disabled person be "totally and permanently" in that condition, and various other measures which have the effect of defeating the purpose of restoring people to self-support and self-care. The details are familiar, I am sure, to those present here. One ironic aspect of these limitations is the extent to which some of them represent measures which were benevolently conceived, but which have had quite the contrary effect. In child welfare services, too, the whole picture is far from clear in its policy content. The role of the state in protective services, the lack of strength in many of our licensing measures, the uncertain relationships between the administrative agencies and the courts, and the tendency today to build services for children and youth around rather than through established children's programs and agencies all contribute to the uncertainty. What are some of the basic social policies which underlie these obstacles to affirmative measures in public welfare? One of these is the persistent theme of local responsibility which runs through much of our thinking with respect to welfare. This is a time-hallowed concept. It has

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its roots in our colonial past and is a part of our whole system of political and social values. It has survived with stubborn tenacity the onslaught of a national economy, or an interdependent society, and of a growth in efficiency and rapidity of communication which have made local boundaries all but obsolete except in the minds and the hearts of the people. Welfare, like public education, is one of the bastions of localism. This theme of local responsibility has persisted even in the face of inability to finance services with local and even state funds. By an exercise in logic, some local authorities now contend that there is no such thing as federal money; it is just local money coming back home, they contend. It has had some unfortunate and even evil consequences. By being related to the principle of settlement it has had the effect of denying aid to desperately needy people who have sought general assistance. In the categorical aid programs, it has influenced the continuance of residence laws which have limited the availability of assistance. In some instances, localism has provided a pious mask for prejudice against newcomers, especially those of racial or ethnic background dissimilar to that of the inhabitants of local communities. We have seen instances in which the only protection against a conscienceless, harsh treatment of needy people has been provided by the intervention of state authorities using state and federal policies. Many here will shudder, I am sure, at any prospect of wholesale turning back of welfare policy and administration to local authorities without state and federal control of any sort. The pressures that build in the local community are intense. We have rather convincing evidence in many of our general assistance programs of how progres-

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sive our locally controlled measures are likely to be. And I for one do not subscribe to the belief that the behavior would be so strikingly different if this complete local authority were operative with state and federal funds. I believe in the standards with the funds. Before we leave this subject, however, we should examine the opposite possibility—complete centralization. This would have unfortunate consequences also. Decentralization of authority within established policies is a must in welfare administration. As a local administrator, I was often thankful for a program locally controlled which gave me the option of meeting directly an acute community need, without the fear of violating some formalistic state standard. And I have seen instances of depression of local standards by state control. This leads me to a basic policy question that I should like to pose to this group: Is there any way to combine the blessings of federal and state resources and influence on standards with a considerable degree of local autonomy and how can there be decentralization without loss of control? A second major area of policy is found in the relations between public and private agencies. Time has taken care of the traditional differentiation in role and function between the two. No longer do we treat the private agency as the sole innovator, helping by force of example and by awakening the public conscience to pull its laggard governmental counterpart to higher levels of service and aspiration. Yet there is in our thinking a continuing problem that has much to do with decisions on the role of public agencies in providing services. This is the question of whether the role of the public agency is a residual or an institutional one. The former would assign to the public

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agencies only those services that cannot be performed adequately by the private agency. An example of this policy is embodied in a New Jersey statute that assigns to its child welfare services only those functions which are not covered by voluntary services. The latter, the institutional concept, would make no such universal distinction, but would confer on the public agency the authority to render those services which the people, through their elected representatives, deem necessary or appropriate. We are, as has been noted, a pluralistic society, meeting our needs through a variety of institutions. But the concept of residual role of the public agency does not fit modern conditions and needs. If ever the times called for flexibility between the two, they do now. Artificial distinctions of functions, based on source of support, will not solve the social problems of these times. Do we, however, need to rethink the dictum of requiring the use of public funds through public instrumentalities? In some states, including, I believe, Pennsylvania, there is considerable flexibility in this regard in child welfare services. On the other hand, do we want to incur all of the dangers which many believe would inevitably result from large scale purchase of services by public agencies? The furor created by the legislation introduced by the Administration in this session of Congress provides an example of how strong this feeling is. In this measure, the public agencies under the expanded concept of family services, would have been free to exercise the option of purchase of services from voluntary agencies, provided the public agencies themselves could not provide the services as well. This brings me then to another basic question. Should we rethink the whole question of the use of public funds to secure services from private agencies or are there dan-

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gers which outweigh whatever temporary benefits might accrue? We could consider all of the many other questions that arise in connection with welfare policy. Has the extent and quality of services been impaired by the categorical approach? Or is it possible that in an age of specialization of problems the solutions are to be found in diversity rather than in integration of agencies and programs? How far should our public welfare policy take us in the direction of a basic family and children's service? Should public welfare be freed from the restrictions inherent in its charge to serve needy individuals in public assistance? Should we move toward incorporation of our growing delinquency control measures into our basic child welfare programs? The list of possible questions could be multiplied. But a clearly enunciated, yet flexible approach, which stresses responsiveness to the changing character of social problems rather than adherence to fixed traditional patterns of policy and program is clearly indicated. Some Thoughts on Private Agency Programs Thus far we have considered the private agency only in relation to the public programs. At the same time we must realize that the private agency also has policy problems today, and that these are of the utmost importance in the welfare scene. One of the first considerations is the changing character of the private agency's accountability. The classic definition of the private or "voluntary" organization is expressed in such terms as these: A voluntary association develops when a small group of people, finding that they have an interest or purpose in common, agree to meet and to act together in order to try to

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satisfy that interest or achieve that purpose. Frequently, their action requires that they urge other like-minded persons to join them, so that some associations may become very large and extend throughout the whole country.4 While I do not quarrel with that description, which is essentially accurate, I must call attention to a point it failed to cover—the importance of legal and other forms of community authorization. The private agency must serve an acceptable social purpose. It must have a policy which is in the community's interest, if it is to survive. In an earlier day, a high degree of individualization and freedom of choice of program was permitted the private agency. In many ways we might sigh for those good old days when the agency's individual policy respecting clientele and nature of service was subject only to the test of whether the purpose was laudable. In today's society, however, developments have occurred that demand a different kind of accountability. With the increasing strain on community resources, and with the widening scope of financial support of voluntary services, priorities of program are demanded. The rate of demographic change is placing severe strains on agencies geared to another kind of population. Changes in ethnic and racial character, in income levels of the central city area, altering relationships between suburbs and urban centers, the growth of urban renewal measures, and many other factors are compelling some thorough scrutiny of policies as well as of structure of agencies. Another development, which is having a profound effect, is the discovery of new knowledge of social phenomena and the development of measures for treat'Arnold M. Rose, "The Impact of Aging on Voluntary Associations," in Handbook of Social Gerontology, Clark Tibbits, ed., (Chicago: University of Chicago Press, 1960), p. 666.

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and Social

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ment of social pathologies. Inevitably, such discovery requires the collaboration of the helping disciplines, and this in turn may demand more and more interagency cooperation, as the resources are not to be found within a single organization. As a Rutgers University colleague has stated: "At some point or other, all welfare communities must deal with the question of the fit between patterns of service and population needs. . . When this is done, it is unlikely that consensus will rapidly be reached, and may be never reached. Advocacies are multiple and complex, shown in determination to maintain existing patterns without change, in proposals for complete reorganization, and the more frequent attachment to that which is immediately attainable, or which reflects patterns of power rather than patterns of efficiency."'' The urgency and complexity of social needs and the growing difficulty in securing sufficient support for welfare services would seem to deny the voluntary agency complete freedom of choice in its determination of priorities in its program. The work of the Community Research Associates and others in identifying pathologies in communities stresses the need for mobilization on a community-wide basis for both treatment and prevention. This raises another question, however, which I suggest for discussion purposes. In acceding to the need for community-wide action patterns, must the private agency surrender all freedom of choice and how can individual initiative and freedom to experiment and to initiate be retained for the private agency? Possibilities for social invention are far from exhausted. In seeking to correct the situation in which an agency is permitted to cling rigid"Ludwig Geismar, "Family Diagnosis, Similarity and Variance in Different Settings" (Unpublished manuscript).

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ly to outmoded policies and programs, we must guard against the inflexible control of central planning bodies. Toward a Sound Rationale for Policy

Through the dust and debris of attack on welfare by extremists, it is not too difficult to discern some major changes. Legislation presently before Congress for substantial amendments in public assistance and child welfare are sure to have some decisive effects on these welfare programs. They are certain to reach into all phases of welfare. While they may not be startlingly new in concept, these proposals are more impressive in scope than any in recent years. They are a mixture of good and bad. They represent both constructive and potentially harsh measures, with the accent predominantly on the former. In connection with these proposed policy changes, I wish to make two observations which may serve as cautionary notes. The first relates to the risks inherent in passing the right measures for the wrong reasons. When we comment that the Newburgh incident was a good thing because it focused popular attention on welfare, we may be deluding ourselves by hoping too much that this attention has brought enlightenment. Rehabilitation motivated by a belief that this is the way to save money may lead to an accounting if the savings are not continuous and substantial. In a society in which the members are all too prone to seek simple solutions to involved problems, welfare leaders must avoid being maneuvered into a position in which they seem to be offering such solutions. I cannot greet with any elation an alliance with forces consistently critical of welfare and its purposes who suddenly discover the economics of rehabilitation.

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I must also note with concern a tendency to assume that a policy of comprehensive training of personnel would in itself bring solutions. The best of personnel will be frustrated by bad policy. Certainly professional, enlightened personnel can do much to mitigate the harshness of punitive and restrictive provisions, but they cannot change their basic character. The rationale for welfare policy must be found in something other than an alternative to punishment or to an emphasis upon uplift resting upon the assumption that we are dealing with inferior people. It must be based upon the assumption that our society's fellow members, whatever their present status, have within themselves a capacity to better their lot and the right to the best possible opportunity.

ν How Efficiently Are W e Spending Public and Private Funds to Meet Total Family and Child Welfare Needs? —What are the deficiencies in the allocation and distribution of public and private funds for family and child welfare services among the various needs and programs? To what extent does this distribution reflect desirable priorities and emphases? Does the distribution stimulate the development of an integrated, mutually supporting pattern of services? Can it? Are there deficiencies in the mechanisms through which allocation and distribution of funds are accomplished? by J A M E S R. D U M P S O N Department of Welfare The City of New York

Within the philosophical f r a m e w o r k of A m e r i c a n democracy and its value system, social welfare is a pivotal insti60

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61

tution for implementing and preserving significant aspects of our value system. We have created a government for the good of all. We have committed ourselves, as a government to promoting, safeguarding, and guaranteeing rights that we believe are inherent in our conviction about the dignity and worth of every individual. We are committed to the pursuit of the general welfare, and experience has demonstrated that the general welfare is best achieved by assuring the welfare of each individual and the groups of which he is a part. Public welfare is one of the instrumentalities for government's assurance of the well-being of its people. It is the agency which is assigned the function of care through financial assistance as well as protective and rehabilitative services. To the extent that individuals and families cannot themselves provide the basic necessities of living in accordance with the requirements of present-day experience and the benefits of modern knowledge about man and his world, governmental or other social measures must assure their availability.1 "Democracy has a special obligation to assure to all the nation's children full and equitable opportunity for family life, health, growth and maximum utilization of their potentialities."2 Complementary to this proposition is that which advocates the obligation of private citizen initiative and enterprise in assuring the well-being of children and families. Citizens, individually and in groups, we believe, have a right and indeed an obligation to provide welfare services that are in accord with their particular interests. But it must be remembered that private agencies exist by choice; they cannot be a substitute for government-sponsored services for all the people. Private philanthropy, then, as a partner with government, has established and supports a 1 Legislative Objectives—American "Ibid.

Public Welfare

Association—1961.

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broad spectrum of welfare services to meet the welfare needs of people under both sectarian and non-sectarian auspices. This structural pattern of private and public welfare services to meet the needs of people, I believe, is sound and must be strengthened and supported provided there is a clearly defined pattern of basic welfare services, related to the unique characteristics of each community and the needs of its people and reflecting sound social policy in welfare administration. This pattern should be designed to provide the quality and quantity of help and care that children and families need—when they need it. Such a complementary partnership between public and private welfare agencies is in the best tradition of our democratic heritage. At this point in the progress of this seminar, I am certain that no elaboration of a definition of child and family welfare services is needed. I shall assume that we subscribe to the definition of child welfare services enunciated by the 1959 Advisory Council on Child Welfare Services: Those services that supplement, or substitute for, parental care and supervision for the purpose of: protecting and promoting the welfare of children and youth; preventing neglect, abuse and exploitation; helping overcome problems that result in dependency, neglect or delinquency; and when needed, providing adequate care for children and youth away from their own homes, such care to be given in foster family homes, adoptive homes, children-caring institutions or other facilities.3 Our acceptance of this definition, I believe, renders functionally inseparable child and family welfare and for the 'Report of Advisory cember 28, 1959.

Council on Child Welfare Services; H.E.W., De-

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purposes of this paper, I shall treat them as such in my formulations. I suggest that while there may be no disagreement about the mission or goals of these services, there must be recognition of the changing character and expression of need for the services. A variety of changing social, economic, and political factors influence the kinds and varieties of welfare services required at a given time. These factors influence shifts in priority needs in structuring a community's social service complex and, indeed, do dictate periodic review and realignment of financing patterns. These changes in turn affect the relationship between public and private agencies in fulfilling their obligations to people in need. Population movement from rural to urban to suburban areas, with accompanying shifts in the power structure, leadership, and financial resources; intergroup tensions reflecting economic as well as cultural conflicts; and increased birth rates among the socially and economically disadvantaged—resulting not only in significant demographic shifts, but substantially affecting the extent and character of social service need— are but a few of these factors. To them may be added the increase in technological unemployment; increased social pathology in American family life; the availability of new knowledge about human growth and development and tools and skills for effecting the process; and the impact of global imperatives on America's domestic social policy and practice. Patterns of organizations and practice in social welfare in our nations are substantially affected by a variety of social, economic, and political factors; and the goals of public and voluntary social welfare and the necessary shift in emphasis will not be realized if social planning at the national, state, and local level fail to take them into account.

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Against this brief sketch of the warrant for our complementary pattern of public and private organizations in family and child welfare and the fact that the social welfare needs of a community are not static and therefore its attempts to achieve a coordinated pattern cannot be static, let me address my comments to the question posed for me by the Institute: How efficiently are we spending public and private funds to meet total family and child welfare needs? I submit that we are not spending efficiently the funds we have available; and when additional funds are made available, as they must be, we shall have to effect changes in at least two areas if we are to achieve the maximum utilization of our material and human resources in the fulfillment of our obligation to children and families in need. The remainder of my material, therefore, will deal with those areas where change is indicated: 1) the manner in which we now spend and should spend our money in family and child welfare; 2) the function of and financial relationship between public and private agencies in the field of family and child welfare. While there are marked variations among the states in expenditures for all welfare services, the available data establish that nationally they represent a pitifully small portion of our national product. Lack of uniformity in definitions of welfare services and the unavailability of information about income and expenditures of private welfare agencies on a national basis make reliable comparisons between public and private expenditures impossible. In the public sector in family and child welfare, in fiscal 1960, $4 billion was spent for public assistance programs which have large components of service to families, and $1.2 billion for other welfare service such as institutional care, school lunch, vocational rehabilitation

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and child welfare services. If one reviews per capita expenditures for child welfare alone in the states, we find it ranges from a low of $0.39 in Texas to a high of $10.56 in New York, with the national per capita expenditure for child welfare at $3.06. Surely one must question how much and of what quality these per capita expenditures for child welfare will purchase. And one may ask whether inadequate, insufficient expenditures are not wasteful if they fail to produce meaningful results. Present annual expenditures approximate $1.35 billion. However, the monthly grant per child ranges from $46.90 in Connecticut to $8.90 per child in Mississippi. The per recipient grant in Puerto Rico is $3.77. In the private agency sector one finds that of $5.1 billion contributed for philanthropic and religious purposes in 1955, $3.1 billion went to religious organizations, of which $290 million was spent for church-financed welfare programs. Non-religious welfare agencies spent about $480 million in the same year. $275 million of this amount was spent for family services and specialized care of children. The combined public expenditure for public assistance and other welfare purposes of $5.2 billion was nearly five times as much as the $1.1 billion estimated to have been contributed in 1960 for comparable voluntary welfare agencies supported by church and non-religious organizations.4 However inadequate or inconclusive the data, these are considerable sums of money. Yet one must question whether their expenditure represents the most efficient use of the money in the protection and conservation of our human resources. This is not to say that funds are being 'Testimony of Secretary Ribicoff on H.R. 10032. Proceedings of Hearings before House Ways and Means Committee, February, 1962, pp. 177-185.

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wasted, although there may be isolated instances where this is the fact. But as long as the greater proportion of our expenditures in child welfare are for foster care of children or for services to children outside their own homes, we cannot claim to be making the most efficient use of funds in terms of the primary goal of all family and child welfare services. The first line of defense for the welfare of children is security within their own homes with parents capable of providing the understanding, love, and guidance all children need. To do their job well, parents must have access to a wide variety of community services: health, education, welfare, housing, employment, rehabilitation, recreation.5 Yet of 388,506 children reported as served by public and voluntary child welfare programs in 1960, 288,701 or 74 per cent were outside their own homes or those of relatives. 63,391 or 17 per cent were in institutions for dependent or neglected children and residential treatment centers for emotionally disturbed children. 115,168 or 30 per cent were in foster family care. Only 35 per cent were in the homes of parents or relatives.6 I do not cite these data in this context to question the validity of the placement of the children although we know that many placements should never have occurred and still many others should have ended long ago. I cite them to indicate that we are spending the greater share of our money and frequently effort for types of services that should have secondary priority in terms of the goals of family and child welfare. More children should be receiving suppor'Report of Advisory Council on Child Welfare Services—H.E.W. 1959, pp. 38-39. "Helen R. Jeter, Services in Public and Voluntary Child Welfare Program, (H.E.W., 1962), pp. 6-14. Ibid.

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tive services in their own homes, and more of our expenditures should go to support such services. Close to 2.6 million children are living in 800,000 families supported by Aid to Dependent Children. Yet only seven states are reported as having approved plans for child welfare casework services to children in their own homes or those of relatives. These were services appropriate either to the public assistance or child welfare programs.7 Every evaluation of the ADC family has revealed it to be almost by definition a family in double, and sometimes triple jeopardy. The raison d'etre for classifying the great majority of the families in financial need in the ADC category indicates the absence or disability of the father. These are socially and emotionally broken families. A constellation of social and emotional problems are present and the mere provision alone of financial assistance is not sufficient to satisfy the aims and objectives of the ADC program. These are high priority families insofar as social service needs are concerned. The data indicate that they are not receiving high priority consideration in the expenditure of money. Administratively in many agencies child welfare services are as separate from public assistance as day is from night. Workers in child welfare often reject assignment in public assistance with the ADC program. Casework services for families and children receiving ADC and general assistance is the exception rather than the rule. There is a higher status assigned to child welfare than to ADC in both public welfare staffs and appropriating bodies. In my own city, practically all private child welfare agencies provide services in or to foster care programs; virtually none to ADC, which is in the public assistance program. A review of the average monthly payments in the ADC

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program presents additional evidence of the conflict between our values, as they pertain to the child in his own family, and expenditures made to support that child if he is dependent. Average monthly payments in ADC have increased in the past twenty-five year period from $11.23 per child to $30.06 per child. Yet O.A.A. average monthly payments increased from $18.79 to $69.15 per person. 8 In our low income states, the monthly payment per child is $9 in Mississippi, $10 in Alabama, $15 in South Carolina, and $16 in Arkansas. In New York City our average monthly payment per child in the ADC program is $44.75; yet we pay from $83 up per month per child in foster family care and as high as $ 13 per day per child in institutions for dependent and neglected children. Undoubtedly the spectrum of child and family welfare services being provided in public agencies is broadening. Indeed, many public welfare agencies provide a broad spectrum of protective and rehabilitative services for children and families. But the national picture is spotty. In some states a means test is the criterion of eligibility for the services. In others, the services are concentrated in the large urban centers. Generally, we must say that financial assistance to families is not accompanied by services and is not seen as but one tool in strengthening family life and assuring care and protection of children. One final illustration of our failure to spend efficiently in child and family welfare is the fact that in spite of the billions of dollars we are spending in the public sector for child and family welfare, we have not produced the requisite understanding and skill in public welfare personnel to assure the maximum use of the expenditures now being made. It has been estimated that at least 20 per cent of all "Trends, (H.E.W., 1961), p. 83.

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recipients of public assistance have a disability problem, physical or psychological, that requires identification and treatment. If the ADC grant is to be more than a dole—if it is to be one of a number of tools in the protection and care of children and the strengthening of family life—the current record of untrained personnel in public welfare must be erased. Only 10.5 per cent of all caseworkers in public assistance, where the bulk of families are served, have any graduate training in social work and only 3.2 per cent have one or more years of graduate study. 89.5 per cent therefore are without any graduate study in social work. In child welfare, the picture is better but not sufficiently to assure the quality of service that the expenditure of funds warrants. 30 per cent of all child welfare personnel in public agencies have one or more years of graduate training in social work. 57.2 per cent, therefore, are not trained to provide protective and supportive services to children and families. In no other program involving the health and welfare of children and families with which I am familiar is tax money spent in such a situation tolerated. Certainly it is not true in public health nor in public education. Until federal, state, and local governments provide the financial resources and assist in providing the facilities for training personnel in public welfare, we can be assured that the funds presently being spent, or to be spent, will not yield maximum effective help to people. In the private sector, comparable data is not as readily available as that found in governmental publications for public agencies. Private agencies by their very nature are selective in the activities they engage in. Many restrict their services on the basis of race and color; still others restrict their services on the basis of religious identification. Both restrictions, particularly in metropolitan areas, tend to eliminate from service a large group of families

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and children who represent a high priority client group. The services available in private welfare agencies are those sorely needed by large groups of families in receipt of ADC, and those that come before the courts on petitions of neglect. They are the protective services and the parent-child counselling services required by so-called "hard core" or "multi-problem" families. Whether because of selective intake policies, sectarian auspices, financial limitations, or basic philosophy, private child care and family welfare agencies are at best touching but a tiny part of the high priority client group in most communities. It must be remembered that more than half of the people in the United States live in areas where there are no private family welfare agencies. The question must be raised as to whether the client groups chosen at any given time by many private family welfare agencies represent the most efficient use of private philanthropy. Certainly, it can be argued that many of the families now served by these private agencies would become dependent, broken, and multi-problemed if private services were not available. As will be indicated later in this material, however, the question of priority determination must relate itself to this claim. In concluding this discussion of how we are spending our funds, reference must be paid to the point made by Dr. Alfred Kahn. He pointed out that the services that the so-called supportive or protective services usually employed on a diagnostic basis for families already known to a child or family agency should be available for the adequate socialization, development, and protection of all families. It is clear, he pointed out, that the social scene does not permit a normal family to manage alone. This suggests to me that day care, homemaker services, childparent counselling, should become central services avail-

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able to the entire community, as are other services now considered essential for the health, welfare and protection of the entire community. If there is validity to this proposition, use of available funds should include attention to strengthening and supporting family life where pathology has not already been identified. It could suggest the conversion of some agency services from a preoccupation with "treatment" and pathology and the use of funds to preserve and support the health and well-being of families and children not presently considered as a client group. Indeed, families that are functioning well might be considered a high priority group in a community that decides to use part of its financial resources for prevention. My final statement on the manner in which we are spending money inefficiently in family and child welfare relates to the absence of a sound priority determination procedure in most of our communities about the country. Bigness seems to beget bigness in the allocation of funds of both the philanthropic dollar and the tax dollar. In my own city, allocations of the philanthropic dollar are made not on the basis of any soundly established priority of service needs basis, but chiefly on the basis of "eligible expenses" versus certain defined income. The grant to the agency then attempts to meet the philanthropic deficit between the two. In the public sector, provision of welfare services except those usually mandated in law, such as public assistance grants, have low priority among the claimants for allocation of tax funds at budget-making time. Frequently, political values, rather than human welfare values, determine the fate of public budgetary appropriations. Services that have a high degree of visibility to the public, or that are supported by powerful, influential individuals or groups have first claim on available tax

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resources. Unmistakably, the public image of a service or its client group becomes a determinant in the process. Family and child welfare services do not have high visibility, and the current image of public welfare has not made it popular with appropriating officials. Allocating funds for family and child welfare on any of these bases is not only unsound but lessens the efficiency of use of those funds that are made available. Generally, in the entire field, the rule is: Who asks for what? instead of determining service needs, the quality of the available services and their readiness, and the ability of an agency to satisfy those needs. The most efficient allocation of funds would begin, I believe, with a definition of the problem of need, a decision as to which service complex is best equipped to meet the need, and agreement as to the source of the funds to support the agency providing the required service. Emphasis then moves from agency support to service provision and priority planning and financing. Such an approach will substitute rationality for vested interest and emotional attachment to agencies that either have long outserved their usefulness or whose services have a low priority in the light of changing needs and requirements. It will tend to eliminate what Robert Walther of United Community Funds and Council calls "crisis planning" in which a community addresses its efforts to crisis after crisis, situation after situation, solving neither the crisis nor attacking the causative factors in the crisis. It will tend to eliminate what Mr. Walther describes as "drift planning" characterized by doing what others do without specific reference to local needs and conditions because it is reported at a conference or in a professional journal. To assure the most efficient use of money requires definition of objectives and procedures for reaching the objectives, moving always in a deliberate, calculating

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fashion from year to year with financing appropriate to the priority assigned to the problem and the required complex of services. Until we adopt such an approach, I do not believe that we can claim the most efficient use of funds in child and family welfare. I come now to a consideration of public and private agency relationship, insofar as making the most efficient and productive use of the money we spend in family and child welfare. In my judgment, unless the relationship between these two sectors in a community's organization are rational and sound, gaps in services exist, duplication and overlapping of function is assured, and waste of the funds of both is the result. I believe that effective partnership results when there has been an intelligent assessment by all agencies—including particularly the lay and governmental officials responsible for the allocation and appropriation of funds—of the total job to be done. There must be a clear, frank, and honest determination of who has developed or who can best develop the services and facilities to meet the need. Effective partnership between public and private agencies is possible when there exists a broad spectrum of services for people under a variety of auspices, all related in quantity and quality to demonstrated need. Until this assignment is completed in a community, and provision is made for periodic review and evaluation both of the validity of the assignment of responsibility for service coverage and the source of the funds to support the service, we cannot assure that families and children will be adequately served, nor can we assure that the most efficient use of money is being made. While I am persuaded by the proposition that the public agency should carry full and complete service responsibility for all children and families in need of care and protection at public expense, and the

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private agencies assure service coverage for all families and children in need of service but not at public expense, I accept that this must be a decision for each community to make. Of one thing I am certain, and that is of the essential importance of a clear-cut division of responsibility for services to families and children if families and children are not to get lost between agency functions and in a haphazard, unpatterned aggregation of public and private agencies in a community. In my judgment, such a pattern is the first step in assuring accountability in total service for a child and his family. I refer to the kind of accountability that assures assumption of responsibility for provision of continued, comprehensive service to a family, irrespective of the number of agencies involved. This really contributes to avoiding "lost children and families" in a community as well as insuring efficiency in agency expenditures. In public-private agency relationship it is important to repeat that families and children are neither public nor private. The public agency, however, by definition, and in a real sense, belongs to all the people; and its services should be designed for all the people who, by their own choice, elect to use them. It is supported by tax funds which come from all the people. The nature of tax support implies universal acceptance of services to meet universally accepted need. I believe we can begin by determining the established "clear record" of public responsibility. This clear record is comprised of the statutory provisions dealing with the welfare of people. However statutes may differ from state to state, there is in each a clear mandate for government "to do for a community of people whatever they need to have done, but cannot do at all, or cannot do so well for themselves, in their several and

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9

individual capacities." For me, it follows that the public agency has as its responsibility the assurance of total coverage of service for children and families who need it at public expense. This principle, in my considered judgment, should be the cornerstone of any sound division of responsibility between public and private family and child welfare agencies. Assurance of coverage does not imply that the public agency itself must establish a network of direct-care services. It would not be in the public interest, for example, for a public agency to expend large capital outlays to construct an institution for children if there are already available in the community institutions under private auspices with acceptable facilities and standards from whom services may be purchased. But the public agency does have the inescapable responsibility for guaranteeing that every child and family receives the kind of service and care they need when they need it. If purchase of service and care seems to be the best way to guarantee total coverage, then the purchase must be on an equitable, and an economically and professionally sound basis; and it must be available to all children who need the service. This would dictate, I believe, that the services purchased can be demonstrated to meet the needs of the family and child; that the services meet acceptable standards of family and child care; and that the reimbursement rate or purchase price covers the full cost of care. However, when the public agency is unable to purchase the service and care according to these criteria, then it must, itself, create and administer the facilities and services required by families and children in "John G. Nicolay and John Hay (eds.), Complete Works of Abraham Lincoln, (12 vols., 2nd printing from plates of Gettysburg edition; New York: Francis D. Tandy Co., 1905), Π, 182.

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its community. It seems to me that it has no alternative to fulfilling its statutory responsibility. Beyond any doubt, the problem of reimbursement for services purchased from private agencies has been and continues to be a most complex and vexing feature of public-private agency relationship. I submit that there are some basic principles to serve as guidelines in publicprivate agency financial relationship. While their present formulation is the speaker's, they had their origin in reports developed by the Welfare and Health Council of this City some time ago. I would summarize these principles as follows: 1. The purchase of service by a public agency is not an acceptable substitute for provision of that service by the public agency. It is but one way to widen the service spectrum of a community. 2. The reimbursement or purchase rate should be the full cost of the service less the contribution that the private agency can justifiably provide from funds it has secured in behalf of children and families. 3. Responsibility for the decision to purchase the service and concerning the appropriateness of the service must remain with the public agency. The public agency cannot be merely an agent for remitting tax monies to private agencies. 4. As the purchaser of services, the public agency must establish the standards and conditions under which it will make the purchase and must be prepared to evaluate the appropriateness and effectiveness of the service. 5. The private agency holds in trust funds contributed to it for care and protection of children and families. In a real sense, funds given to private agencies are diverted tax funds, because of the tax deductible privilege enjoyed by the donor to welfare agencies. The agencies

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are morally bound to expend these funds to complement service provided by the public agency and for those described in its charter as the recipients of its help and described in the agency's appeal for citizen support. These are rather simple statements, but their implementation requires the best thinking and most skillful administration by private and public agency administrators. They require acceptance that neither the public nor the private agency may abdicate responsibility for the use of funds entrusted to it. Failure to use funds allocated or contributed for families and children is to be neglectful of the intended recipients, and to violate a public trust. Purchase of service when employed must be within the context of the community's priority determination procedure. It may be one of the answers as to the source of financing a community's program of services. Within an established plan of community priorities it is one way of assuring provision of services that are needed rather than assuring the perpetuation of an agency.

VI H o w Should Public and Private Agencies Relate in the Development of a Coordinated Pattern of Services? —What are the bases and guide lines for achieving a more effective partnership of public and private agencies serving the needs of families and children? What spheres of interest and areas of primary operational responsibility should be delimited for public and private agencies to achieve maximum impact on presenting needs and problems? What structural framework and continuing operational relationships are needed to coalesce the efforts of public and private agencies in this field? by F R E D D E L L I Q U A D R I New York School of Social Work Columbia University

The provision of services essential to the well-being of the nation's citizens falls within the responsibility of the pub78

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lie sphere. The definition of this sphere is continuously broadening as the concept of what constitutes well-being deepens and expands. Public responsibility is the broad base from which the field of welfare emanates, and it must be clearly established without regard to the presence or absence of other resources. The public agency has a legal mandate and is established through legislation, or executive order, and operates within the framework prescribed by statute. The origin of public welfare stems from all the people through the democratic process, and it is supported by all the people through public taxes. It has the opportunity to serve all who are eligible. Administrative authority resides in persons or groups elected by the people or appointed by officials so elected. A clear distinction between public and private bodies concerned with and operating within the welfare field is that private bodies, while being instrumental in setting the tone for such welfare services, by nature, are identified with particular elements or interests in the community which, in itself, prevents them from meeting the final requirement of "classless justice." A. Delafield Smith has expressed it this way: "There is only one proved method of avoiding the growth of the sense of dependency in company with any increased reliance upon proffered services. That method is to make him who is dependent the legal master of that on which he depends." This demand for impartial and impersonal service finds its ultimate fulfillment in a democratic society through the public services. The term "voluntary" applies generally either to actions performed by choice, impulse, or free will, or to organizations established under the auspices of, and maintained or supported wholly or in part by the contributions and/or subscriptions of members of particular segments of socie-

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ty. Any group of people may organize for the purpose of providing welfare services in accordance with its particular interest. Its services exist by choice of the sponsoring body, and there is no legal responsibility to establish or continue such services. The only limitations are financial resources and the meeting of governmental requirements for incorporation, licensing, and maintaining acceptable standards of performance. Voluntary agencies have the legal freedom to select their areas of activity, to limit their scope in the interest of quality, to experiment, demonstrate, or adapt programs to meet specific demands, and to serve whom they choose. Recent testimony on H.R. 10032 given by Robert E. Bondy is as follows: "The purposes of democracy are best served when social welfare programs function under both voluntary and governmental auspices. Programs supported by voluntary contribution and effort have the freedom to emphasize variety, flexibility and experimentation, they can develop limited programs for particular need or particular groups, new approaches to needs, and varied approaches to needs of long standing. But this freedom depends, in turn, upon the existence of a governmental program adequate in coverage and resources to meet those welfare needs that lie beyond the capacity of voluntary effort. Only government can meet widespread social needs which require programs based on a rule of law, tax based financing, or principles of universal availability."

It is this freedom from universality of obligation that is the great asset of voluntary welfare, because with it goes the freedom to experiment, to diversify, to explore new frontiers, and to specialize to meet specific needs. Because it is voluntary, this type of effort will always resist conditions which limit its freedom such as widespread financial destitution, unemployment, and other mass pressures

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which have brought governmental social security programs into existence. In fact, it is in these areas that voluntary welfare agencies have served to bring pressure on government to expand its responsibility. In this connection, Elizabeth Wickenden, in an article entitled "Social Security and Voluntary Social Welfare," says: One reason for the increasing acceptance of governmental programs by voluntary agencies is the awareness that today's highly organized society creates new welfare needs far faster than our combined resources can meet them. Voluntary agencies not only have wide and challenging range of needs to meet within their own area of functioning but are more confidently conscious of their potential role for leadership in the entire welfare development At the present time however, the most direct impact of voluntary welfare on the governmental program is through the growing interest in public social policy. As voluntary welfare has increasingly recognized its essential and organic role in the larger social organization, it has come likewise to see the relationship of its particular functions to larger questions of social policy. There is really no need for the power struggle between public and voluntary welfare to continue, but the great debate continues. The hearing on H.R. 10032 contains the following exchange between Msgr. Raymond J. Gallagher and Representative Bruce Alger. Msgr. Gallagher: It seems to me that this proposal takes in considerable new ground beyond that which has customarily been considered the area of public welfare programs. It would seem to bring public welfare programs into areas of service where private agencies with adequate staffs could work with a great degree of success. We in private agencies are concerned about the growth of the responsibility of public welfare. We have serious question as to this trend, even as other professional groups question the degree of governmental participation in their areas of professional service.

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Traditionally, it has been the attitude of this democratic society that government should stimulate and facilitate the growth and development of individual activity and of the activity of primary citizen groups. We feel that this proposal sets up an unnatural competition, one in which the private agency is financially disadvantaged. If we reduce this concept of competition to its ultimate conclusion it would seem to stifle the opportunity of primary citizen groups to be engaged in assistance to their own members or to others who qualify for service. The implication is that public welfare must do this job alone. Any inference that private effort has failed and therefore public welfare alone is equal to the task is basically incorrect. The only ingredient in which there is any superiority is in the availability of money. This superiority is available through tax dollars which ultimately must come from the same source as that which supports voluntary agency programs. In motivation and in interest in the welfare of their fellow citizens, voluntary agencies are at least equal to public welfare groups. The level of training and competence at this moment favors the voluntary private agency. The propriety of the voluntary agency receiving not mere recognition, but clear acknowledgement of its opportunty to continue, not by benign tolerance of government, but by right, is really an issue here. Although this bill seeks to improve public welfare, we believe it should be evaluated as part of the total welfare picture—government, private, sectarian, and nonsectarian. Mr. Alger: Do you see any danger in the drying up of private money for the support of the church by the expansion of Federal programs? Msgr. Gallagher: Yes, Sir; we do consider it one of the elements in the problem of voluntary effort. Again quoting from the Wickenden article: Voluntary welfare serves many functions in our pluralistic social system, but when all is said and done its principal

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contribution lies in its own programs and services. The fact that it has consistently served as a dynamic force in the development and expansion of the governmental programs of social security has in no way served to limit the horizons of its own challenge or to dry up the well-springs of its own ingenuity. This contribution is essentially qualitative in character, but quantitative measures of its persistence offer reassuring refutation to the predictions of early Cassandras who believed governmental programs would cut off the sources of voluntary giving. According to the figures reported by Karter (Thomas Karter, Voluntary Agency Expenditures for Health and. Welfare from Philanthropic Contributions, 1930-1955) voluntary welfare expenditures rose from $247,000,000 in 1930 to $1,150,000,000 in 1955. This is nearly a sixfold increase as contrasted with a fourfold increase in personal income during the same period. To all concerned it should be clear that the welfare task today demands all of the combined resources of both public and private endeavor. While in the interest of clarity it is essential to point out the distinctions and differences in public and voluntary welfare functions, the areas in which they can coalesce, combine, supplement, and complement one another should also be pointed out. The real distinction of the two appears to lie in the motivation and authority of each rather than in their functions. It is my contention that basic recognition should be given by a community for an effective department of public welfare; one which performs its functions in an atmosphere of confidence, respectability and acceptance. This can only come with strong leadership at state and local levels, dynamic citizen participation, emphasis on services with special emphasis on prevention, and, above all, personnel practices that are equal to, or better than, those found in voluntary agencies. It would seem to me that regardless of the number and

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quality of the voluntary agencies rendering service to families and children, its real contribution to meet the needs of these groups is negated if the public welfare department is weak by reason of constant staff turnover, inadequate and low quality staff, inability to perform services, inability to recruit and retain staff, and lack of esprit de corps for its operation and purpose. To help accomplish a healthy, well-respected array of social welfare agencies in a given community, both public and voluntary, the following suggestions are presented for discussion. Budget Preparation and

Presentation

One of the most important elements in any agency's operation is the preparation and presentation of its budget. The budget is not merely an accounting of expenditures and income. If developed and presented properly, it becomes a most significant statement in portraying the program of the agency. It relates the purpose and objectives of the agency, the implementation of these objectives in types of activities, personnel requirements, service costs, management outlays, training activities, public relations, research, etc. In all such presentations, adequate justification is given for changes which may increase and in some instances decrease certain operations. The budget statement should reflect the problem areas, purported solutions and should be a realistic attempt to anticipate future needs or changing needs to carry out the broad purposes of the agency. The initial development of the budget should be an ideal one reflecting the total needs of the agency. It is well that the public know what the true costs are to carry out

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the agency objectives, despite the fact that priorities may need to be made at later stages to meet limited financial resources. Because the budget is strategic this is one important area in which public and voluntary agencies can and should develop a closer relationship. The knowledge gained, the interpretation, consultation needs, problems faced, and the long-range projection can be made in a mutually benefiting atmosphere. To accomplish this end the following actions might take place: 1. During the preparation stage involve lay and agency board members as well as agency personnel in development of the public welfare budget. This may be done through use of advisory committees or specially designated ad hoc committees. 2. The above process could be effectively used in the involvement of public agency representatives in voluntary agency budget preparation. 3. Attending and testifying at budget hearing whether before governor, mayor, budgeting committees, or community chests. 4. At national level similar arrangements should be developed. Board and Advisory

Committees

There should be more representation of voluntary personnel and Board members on public welfare committees. Too often local and state welfare departments have not utilized this avenue for advice, understanding, interpretation and mutual aid in planning. The welfare departments operate in so many areas that numerous advisory committees could be created and effectively used—aged, handicapped, children, youth, administration, research, legislation,

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training, volunteers, public relations, housing, financing, equipment, etc. Many state laws permit utilization of advisory committees, but implementation depends on strong and effective leadership. A word also must be said about representation of public welfare employees on strategic voluntary agency committees and boards as well as community councils, councils of social agencies, and other planning and operating groups that function in the total welfare field. 1. Adequate staffing of advisory committees. 2. Agenda preparation should reflect serious planning of meetings. 3. Continuous appraisal of advisory committee membership in order to involve more people and representation from a variety of community interests. 4. Concerted effort to utilize members of committees in as many activities pertaining to agency function as possible; for example, in annual meetings, conferences, radio and television, and other means of interpretation. 5. Special efforts and preparation to utilize committee representatives in interpretation and support of agency that might involve legislation, budget, policies and rules, and recruitment of personnel. Training and

Manpower

The field of training personnel is one of the key areas in social welfare planning and operation. Training, of course, envisages many areas of activities including: fully trained social workers with Master's degrees in social work; the partially trained social workers; workers with no graduate training but extensive exposure to in-service training courses; workers with courses in allied fields;

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workers with no adequate preparation. The manpower situation in all these categories is acute and serious in the public welfare field. Some public welfare departments have progressed rapidly and enjoy a prestige and working competence as good or better than voluntary agencies. However, many have not achieved such status. К public welfare departments are to achieve the status that is projected for them—services that emphasize prevention and rehabilitation—then immediate action is demanded for the most creative and imaginative thinking from both public and voluntary groups. Planning and action in this area must be done not only at the national level but also at the state, local and regional levels. The following would need attention: 1. Training to encompass all levels of employees in voluntary and public welfare fields. 2. Agencies must delineate and classify positions, skills required and knowledge necessary. 3. Schools of social work to be attuned to levels of training and exert a direct influence in preparation of these employees to evaluate continually the training needs in the field and respond positively in curriculum planning for these needs. 4. Development of a blueprint for long range planning, expansion of schools of social work, establishment of new schools with serious attention given to field placement, research, teaching personnel, overall financing comparable to federal efforts now found in medical, dental and physical sciences. Fellowships and scholarships for students at the M.A. and Ph.D levels of training. 5. Recruitment for the field must be greatly accelerated throughout the country by wider use of summer work experience, undergraduate work experience, utilization and training of mature men and women.

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6. Personnel practices in both public and private agencies must be comparable. In most instances public agencies lag behind for a variety of causes, but such can be alleviated with effective participation of lay and voluntary agency groups. Salaries, working conditions, and employee benefits must be attractive to potential employees. 7. Utilization of part-time employees. Volunteers The effective use of volunteers becomes more and more prominent in the manpower picture today. The supply of workers who meet the job qualifications of an agency are limited and will continue in short supply for some time to come. Use of volunteers in private agency fields has been effective and extremely useful. Public welfare agencies must avail themselves of this type of manpower which can have a very positive influence in the work of the agency as well as an excellent means of public understanding and acceptance of the welfare programs. To seriously undertake such a task, careful and realistic planning should take place on the national, state, and local levels. One effective device might be the creation of a national committee on volunteers in public welfare, sponsored by the Department of Health, Education and Welfare, and whose membership would include members of voluntary agencies that have had successful experience in this area. Local areas such as Philadelphia and the State of Pennsylvania could move immediately into such planning to serve as an example for national committees and to other areas of the nation. In development of this area of manpower, some of the questions to be addressed are: 1.

Potential volunteer supply—sources for recruitment.

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2. Level of experience. 3. Types of existing training programs. 4. Areas of potential use of volunteers. 5. Training programs in agency and/or schools of social work. 6. Compensation for services. 7. Evaluation of activities performed. National Institute for Public Welfare

During the past several years many persons have advocated the establishment of a National Institute on Public Welfare, such an Institute to be devoted to study and research on many of the problem areas in public welfare. Others, such as Msgr. Gallagher, contend that such an institute should also embrace the total social welfare field encompassing also the problems of the voluntary agency field. Such a point, I feel, is well taken and can do much to combine and utilize the efforts and thinking of the two fields. From such a vital institute many benefits would emanate: 1. Areas of prime concern. 2. Guide lines of operation. 3. Management. 4. Effective utilization of manpower. 5. Coordinating device for federal and national voluntary agency research and evaluation projects. 6. Effective utilization of schools of social work in initiating and conducting research. 7. More effective reporting to Congress on legislative committees.

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Programs

Planning at the Local Level (A Super Planning Council) Councils of Social Agencies in one form or another have existed for many years in many communites. Their primary object has been the direct planning with voluntary agencies in meeting the social welfare needs of a given community. To a degree public agencies, through their representatives, might be involved in such planning. The pattern is more superficial than it is real involvement and decision-making. If we are serious in our beliefs to consider the total welfare needs of the community—to determine which should be the province of the voluntary or the public agency, or how to achieve a better utilization of each other's personnel, services and management—then some super-planning welfare council is needed. Such a council must have policy making powers in programming, assessment of needs, development of priorities, and adherence to decisions rendered. To have recognition and respect by all community groups such a body should be: 1. Appointed by the local governing bodies (mayor, manager, commissioners, etc.). 2. Represented by persons who are thoroughly familiar, by experience, training, and interest, with the social welfare needs of the community. 3. Limited to small membership (three to five members). 4. In large cities, members might be full-time and paid for their service. In smaller cities, council members would be paid on a part-time basis or operate on a volunteer basis. 5. Make wide use of advisory committees. 6. Be given sufficient funds from public and voluntary agency funds to carry out its activities.

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Licensing Powers Many representatives of voluntary agencies often refer to the licensing powers of the state as a means of influencing the activities of the voluntary agency. This is especially true in the area of activities regarding children and youth. As one who has had considerable experience with state licensing activities, I would say that many direct uses and influence can result if the state exercised strong leadership in the use of its licensing powers. A licensing law should give wide and general authority in the development of policies, regulations and standards. Enforcement of licensing laws does not need to be punitive but one that stresses education, development and assessment. To be operationally effective the following should be considered: 1. Wide use of voluntary agency personnel, board members and lay persons in the development of standards in all areas of concern—foster homes, institutions, day care, homemaker service, and agency operations. 2. Extend licensing laws to more than child welfare agencies—family, mental health, correctional, etc. 3. Provide for periodic review of standards under the same conditions as in item 1, above. 4. Employment by the licensing division of the state department of public welfare of highly competent personnel that command the respect of the professional community, and employment of sufficient personnel to do the job. 5. Periodic evaluation of each agency licensed which should include an honest appraisal of the agency's program, personnel practices, financing, etc. 6. State should be in a position to deny, revoke, or refuse to re-issue a license in situations warranting such.

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Such action must, of course, be on the basis of standards and properly stipulated. Social Policy Historically, there is no doubt that the voluntary aigencies have played a major role in activities relating to social policy. One could relate at length the moveiments, social reforms, legislation, services on public ag?ency boards, etc. However, in the past fifteen or twenty ytrears, public welfare officials have criticized voluntary ag^ency officials, board members, and others for lack of suppport and understanding of public welfare services and facilities. Since the inception of the social security prograims in 1935, long before Newburgh, there have been attaclus on public welfare programs in almost all the states. I know from my personal experience over the past twenty-three years in several states the same accusaltions concerning chiselers, perpetual reliefers, loafers, weblfare mess, fraud and corruption, illegitimacy, etc. were prevalent. It has been very encouraging, however, to wittness the growing concern and action programs developedd by voluntary agencies at all levels of operation includingg national, state, and local. The work of the following; are notable examples: APWA, NASW, NSW A, Counciil on Social Work Education, Council of Churches, Parentss for Children, AFL-CIO, and others. The actions of thesee organizations have been noted in publications, testiirnony before legislatures, investigative bodies, and in reports. All this points to the fact that one of the most imnportant functions developing for the voluntary agency iss social policy and action. An effective, dynamic progranm of this type can well insure the development of adeqquate

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public welfare services. Some specific suggestions that might be considered are the following: 1. All voluntary agencies establish committees on public affairs to include not only representative groups in the community but the power interests. 2. Proper staff assignments to keep the agency and its membership abreast of current developments in all aspects of social policy. 3. National agencies make available immediately to local agencies information, policies, issues, and decisions. 4. At the national level make a study and assessment of the various agencies that are involved in social policy issues. Such a study may lead to the consideration of a combined and integrated agency on social policy and action for social welfare. In other words, are we utilizing our resources as effectively as we might? Is there too much duplication of effort, cost, and use of personnel? 5. Necessity for schools of social work to embody in the curriculum more courses or course content that would enable all students to develop an attitude and a conscience about social policy. Some schools should develop a comprehensive program for students in administration and social policy. 6. Schools of social work might be encouraged to develop courses and seminars on a periodic and continuing basis for agency executives and other personnel, as well as board members in these areas. 7. Social policy and action should operate on all three levels—national, state, and local. It should involve such activities as membership in political parties, committees, development of legislation, supporting legislation, making reports on social issues, conducting meetings, public relations programs on social policy issues, etc.

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International Social Welfare A word must be said concerning social welfare activities on the international level. Public and private welfare agencies in this country can have more of an impact on this development than is the situation today. The international agencies, United Nations and HEW continually face serious recruitment problems in securing experienced as well as trained personnel. In addition, combined efforts must be made to have an effective impact on the State Department and its various agencies in the utilization of social workers in social and economic development programs in foreign countries. The establishment of social worker attaches in major embassies throughout the world will advance this cause immeasurably. Some of the basic considerations should encompass the following: 1. Consideration of a national pool of available social work personnel that might be utilized on the international front. Such a pool might be maintained by NASW or in HEW, or a combination of both, and would include practitioners, consultants, administrators, etc. 2. Agencies, both public and private, might consider a liberal personnel policy which would grant one to two year leaves of absence for foreign service without loss of job status, increments, or other benefits. 3. Specific training and orientation programs can be established in already existing university schools of foreign affairs and schools of social work such as exists at Columbia University. 4. Council on Social Work Education should tap all the faculty who are on leaves from schools of social work for use in aiding social work training programs in foreign countries.

VII How Effectively Are W e Utilizing Professional Staff Resources in Meeting Family and Child Welfare Needs? —What are the major defects and deficiencies in the deployment of available numbers and kinds of professional skills among the various family and child welfare programs in relation to priorities reflecting need, potential solutions, and optimum combinations of available skills? What are the directions for achieving a more effective utilization of the required skills? by M A R Y R. B A K E R Council on Social Work Education

The plan for this seminar reflects an intent to find a pattern for the array of social services to families and children that have "growed" like Topsy, a pattern that will permit planning for a whole range of interrelated 95

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needs of families and children—physical and emotional, social and economic. The goal is to overcome the present fragmentation of services in the typical community structure which tends to prevent an attack on a total problem, for the satisfaction and benefit of either the family concerned or the community as a whole. The demand such a goal imposes upon the services of a relatively small, developing profession will require heroic measures in differentiating and realigning the tasks involved, and in training various levels of personnel to accomplish them. The full resources of the profession and the strong backing of the citizens who support it will be required. A realistic view of the facts about the extent of need and the supply of social work manpower makes the position so clear that no time will be spent on presenting this familiar material in any detail. That only one-fifth of the persons in social work positions in 1960 had two years of graduate social work education is of even less significance than their disproportionate distribution in the various fields of practice and in voluntary and public services. In view of our focus here, however, it should be pointed out that analysis of figures in the manpower survey of 1960 reveals that 52 per cent of this trained, professional manpower is employed in services to families and children.1 In planning for more even distribution of the scarce supply and for training additional numbers, it must be remembered that in this country it is not a matter of allotting them to services where they are needed. It is also a matter of attracting them to fields of service that appear at present to be relatively unattractive. 1 Salaries and Working Conditions of Social Welfare Manpower in 1960. (New York: National Social Welfare Assembly), especially Tables 18 and 19.

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Possibility of Different Tasks within a Profession Public demand that tasks be differentiated and staff be trained for less than full professional social work has met with such delayed response partly because of the nature of professional practice. A profession is not really practiced in a task-centered way. It is the social worker's business to bring to the analysis of each situation presented to him the full range of his professional knowledge and skill, and to see to it that all the tasks involved are performed in a related pattern dictated by the individual situation. The doctor, and not the technician to whom he delegates some tasks, is responsible for deciding whether the complex set of symptoms presented by the patient simply as severe headaches is caused by eye strain, sinus trouble, migraine, brain tumor, intrapsychic disturbance. Only the doctor will plan the treatment—however many lesser trained personnel, or other specialists, he may employ in carrying it out. It is hard to settle for less than this in social work. Nothing that is done by using personnel with less training to provide the services that must be made available can be allowed to obscure this obligation of the profession, or to make us less aware of the difference in kind of responsibility assumed. On the other hand, it is impossible to deny that social work has been slow in facing necessity. We have known that college graduates without professional education could not have the body of professional knowledge and skills. They could not identify the different causative factors in the problems of families and children, whose external situations may look deceptively alike. They could not assign relative importance to multiple causes of difficulty and select appropriately with the client the aspect to

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be placed in immediate focus—what Helen Harris Perlman calls the "problem-to-be-worked." Knowing these basic elements of true rehabilitative and preventative service to be outside their scope, we have perhaps underestimated what they could do. And in the public services, where we have used them extensively, we have instituted such a multiplicity of external controls that we have defeated our purpose of enabling these workers to perform to their fullest capacity with people, not paper. Service Goals Determine Use of Personnel Facing the logic of necessity, and meeting public demand for defining separate tasks, has come with a rush. An uncomfortable number and variety of experiments and proposals have been made and have to be reviewed in any attempt to survey the subject as a whole. The confines of this paper make a thorough account of them all impossible. Generalizations about them require an assumption that all the programs directed to the needs of families and children will have service goals in common. This assumption is open to some question. At a fairly high level of abstraction it is easy to define common goals. Few will quarrel with an intent to improve social functioning. But this intent might be assumed to be accomplished, in some public welfare departments for instance, by reemployment of a parent and removal from the relief rolls, without extending the service goal to insure adequacy of child care in the family or to estimate probable recurrence of the factors that caused the original dependence on relief. Another department might have broader goals, covered by the same general statement of intent. Many professionally staffed, voluntary family and chil-

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dren's services may be presumed to assess and treat the entire range of factors that contribute to family breakdown and to its possible restoration. Even so, service goals may vary, depending upon definition of agency function, selectivity of caseload, length of waiting list. Or differences may appear not in the agencies' statements of function but in their actual levels of practice, qualifications of staff, coordination with other agencies, and support and understanding by the citizen board under whose auspices the agency operates. For all these reasons, it seems hardly possible to discuss more effective use of personnel without making at least two separate approaches to the subject. The first would consider steps taken by or open to the family and children's services traditionally concerned with diagnosis and treatment of psychosocial problems that have interfered with social functioning or prevented adequate care for children in their parental family. These agencies have for the most part been staffed by professional social workers, or have utilized additional selected personnel under professional supervision, in tasks that are indistinguishable in kind, if not in quality of performance, from those carried by professional workers. These agencies have been commonly, though not exclusively, under voluntary auspices. The second approach would discuss the most effective use of personnel in service programs traditionally directed toward external, tangible goals such as financial assistance unaccompanied by a full range of rehabilitative service, or physical and protective care of children. A major proportion, in many cases an overwhelming proportion, of the staff in such agencies has been without any professional education. By far the largest number have operated under public auspices. Probably a good many agencies serving families and

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children fall in a middle range between these two extremes, but the separate approach is dictated by the facts of the manpower shortage. The best family and children's services, with the highest personnel qualifications and standards of service, feel the pinch in their way as severely as the public assistance department, for instance, that is trying to increase rehabilitative services and raise the level of staff qualifications. Proposals for optimum use of professional staff and differential assignment of less qualified staff mean as much to one as to the other. But since they begin at very different levels of professionalization of staff and service, proposals often cannot be similarly applied. It will be necessary to assume, however, that the same set of values distinguishes all social work operations and governs the service programs of all the agencies concerned, public and voluntary, professionally administered or staffed by untrained personnel. These values derive equally from the humanitarian motive of serving people in need and the selfish requirements of society as a whole, which cannot afford to ignore the social problems of poverty, delinquency, illness, and disability. These social problems are reflected in the needs of people and are themselves intensified when a community is unable to serve these needs in such a way as to restore the person to his best level of functioning and prevent his further breakdown. It must be the task of the agency to enlist public understanding and support of those service goals, and the responsibility of the public to insist that they be demonstrated in any service program provided by the community, whether through taxes or voluntary funds. Only the carrying out of this mutual responsibility, by agency and public, will make effective a

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plan for maximum use and training of social workers at several professional levels. The critical nature of the shortage of manpower in social work is obscured for the public by the use of unqualified personnel to perform the same work as that done by professional workers. So long as the job appears to be accomplished somehow in this way, it is hard to convince the public that it is important for the self-interest of society as a whole that the job be done better. This gives added urgency to the proposal of methods for task differentiation. I cannot leave the subject without referring briefly also to the advantage it will bring in helping social work to explain its different levels of personnel in terms that are understandable to civil service administrators, who do not differentiate people by how they do things, but by what they do. Differentiation of Tasks in Agencies Traditionally Staffed by Professional Social Workers We begin from the premise, now generally accepted, that the manpower demands of neither voluntary nor public welfare services can be met in the near enough future by professional education at the Master's level. In the agencies whose service program depends upon professional social work staff, what we are being asked to do, in effect, is to define the social work equivalent of the dentist's "not below the gum line." In such agencies, attempts to use staff with less than professional education have generally fallen into the following types: 1. The first kind of experiment involves allocating certain kinds of cases to workers with lesser qualifications. In these situations the case aide carries responsibility,

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under supervision, for certain cases which the agency would normally consider a professional responsibility and for which a professional caseworker would be employed if possible. The assignment has included cases believed to be "less complex," or to require "tangible" services. This kind of attempt is exemplified by the experiment with an in-service training course for a group of children's agencies in New York City reported upon by Verne Weed and William Denham. 2 They take the position that selected young people can be trained through such a course to carry with relative success, under close supervision, services which would preferably be given by a professional caseworker. Further, they believe that many of the persons thus trained and assigned as substitutes for the caseworker who is lacking may be encouraged to complete professional education as they discover in a work situation their inadequate knowledge and skill, and their limitations for career advancement. These authors do not believe that cases can be honestly selected as suitable for less than full professional service. Such assignment would, in their view, always be made in default of adequate professional staffing. Young people would be recruited for employment by a group of agencies—or perhaps a single agency—with time released for one day a week of concurrent study during at least their first year of work. They should have constant professional supervision on the job related to the course of study, and the expectation would be that a large number of them "Verne Weed and William H. Denham, "Toward More Effective Use of the Non-Professional Worker: A Recent Experiment," Social Work, Vol. VI, No. 4 (October, 1961). For full reports on the experiment, see An Approach to the Shortage of Social Service Personnel in New York City Child Care Agencies (New York: Community Council of Greater New York, 1961).

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would choose to go on through education for a Master's degree and swell the ranks of professional social workers. 2. The second kind of experiment involves allocating to the case aide certain types of service, either with full responsibility for the case if no other service is deemed to be required, or to work with the caseworker who carries full responsibility for the case. This kind of attempt is exemplified by the experiences of such agencies as the Brooklyn Bureau of Social Service, and the Chicago Travelers Aid Society,8 where case aides have been used to perform designated services believed to be within their competence and not necessarily to require the service of a professional caseworker. Tasks assigned to case aides or assistants have covered a wide range—school visits on children in the family who are not the immediate focus of treatment, play contacts with children, doing escort duty, friendly visiting, camp and institutional placements, telephone and other courtesy contacts—and they are all time-consuming and important tasks whose performance releases a caseworker to carry a larger number of counseling interviews. A significant point here, well stated by the account of the Chicago Travelers Aid Society experiment, is that "it is the character of the service to be performed, rather than the degree of psychopathology," which distinguishes the assignments to caseworkers or case aides. Under such a plan an agency would recruit persons with prescribed qualifications, who could be trained on the job to perform specific duties without concurrent study of theory and without expectation that they need "The Use of Case Aides in Casework Agencies (New York, National Social Welfare Assembly, 1958), pp. 12-20, and Laura Epstein, Differential Use of Staff—a Method to Expand Social Services (New York: National Travelers Aid Association, 1961). Mimeographed.

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advance to other professional levels, although a desire for professional education would not be discouraged. In either of these two kinds of assignment to less qualified personnel, the diagnostic process, the assignment of partial or complete case responsibility, and the recurring evaluation of progress and revision of the treatment plan are the responsibility of a professional caseworker. The usefulness of the aide is based upon the activity of a large proportion of professional caseworkers. A third kind of experiment has allocated to a case aide certain groups of tasks required by the whole service function of the agency but not assigned on a case-by-case basis.4 These have included telephoned applications screening interviews, agency reports on closed cases, maintaining contacts and building resource files on collateral agency resources, and so forth. Agencies have reported varying degrees of success in this attempt, but all their experiences are based on the administrative pattern of the particular agency and do not lend themselves readily to generalization. The most that can be said is that an agency can do as much of this as it wishes, within its own function and structure. Questions Arising from Various

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Some kinds of problems that have arisen typically in the course of these experiments can be grouped by the nature of the questions they raise: 1. How can clients and their situations be classified into categories so as to determine which cases are the kind suitable for assignment to the less well qualified worker? 'For one example, see Use of Case Aides cit., pp. 4-11.

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People do not stay the same. The "less complex" case often changes character unexpectedly, develops exceedingly difficult problems, and demands services beyond the capacity of a case aide. 2. Who is to see the client originally and assess the situation as one for assignment to either caseworker or case aide? Unless a professional assessment has been made, the assignment may be based on data that would be perceived quite differently by a worker who brought to it a wider range of knowledge, experience, and skill. 3. Can caseworker and case aide share responsibility successfully for treating a single family or child? Although several agencies have believed their experience with this kind of plan to be highly successful, it does not appear to have been widely adopted. Little appears in writing to account for this. It is said to be more appropriate to multifunction agencies than to programs which provide principally a highly skilled counseling service in such problems as marital conflict or faulty parent-child relationships. Perhaps the tasks that have typically been delegated to a case aide have not been part of the usual tasks in a counseling service and do not exist to be delegated. Another possibility is suggested by Margaret Heyman's report of an experiment in a hospital social service department.5 Transfers of cases from caseworkers to case aides were initiated less often, even when indicated by developments in the case, than were transfers from case aides to caseworkers. Speculation arose whether caseworkers were too reluctant to transfer an active and productive relationship with a client to a person whose serv'Margaret M. Heyman, "A Study of Effective Use of Social Workers in a Hospital: Selected Findings and Conclusions," Social Service Review, XXXV, No. 4 (December, 1961), 428.

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ices they believed of lesser quality, and also whether they disliked to keep all the hard tasks and release some of the more satisfying and less demanding ones. 4. The whole question of the professionally controlled client-worker relationship, upon which all services are based if they are to result in the participation of the client and his motivation to change, will demand much closer analysis. Space prevents any discussion here but it must not be overlooked either in the assignment of two workers to a single case or in the shared responsibility of supervisor and worker." 5. What amount and kind of supervision of case aides is necessary, after they have been trained to do their jobs? If it is so extensive as to take up an equivalent amount of professional staff time, it will not reduce the caseworker's load as intended. 6. Will use of case aides help not only to insure a quantity of service to meet demands on the agency but also to increase the quality of counseling services to those receiving help? A high quality of service requires a professional staff equipped by education and experience to give it. In this regard there is no way to equate any number of case aides with one caseworker, any more than three or thirteen or thirty medical technicians would equal one doctor. 7. Almost all attempts to use case aides in professionally staffed agencies have been devised to suit the particular situation. When written up at all, they tend to be reported descriptively, without regard for critical comparison with other experiments. The major exception to this, where a research design O f particular interest in this connection is the paper by Ruth Fizdale, "The Challenge of the Middle Class—Casework Off the Beaten Path," Journal of Jewish Communal Service, Vol. XXXVII, No. 1 (Fall, 1960).

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has been carried out and could be replicated, is in the work already referred to by Margaret Heyman at the Albert Einstein Medical Center. It is to be hoped this experiment will be carried further and tested in family and children's services as well. It measures results both qualitatively and quantitatively, and it succeeds in clearly differentiating the tasks of different levels of staff, providing for professional control of assessment and assignment, and setting a pattern for reassignment as indicated. Differentiation of Tasks in Agencies not Traditionally Staffed by Professional Social Workers Among agencies where services have been provided through a largely "untrained"—or, more precisely, jobtrained—staff, the problems of public welfare stand out sharply because of their scope and their urgency. The service goals are rooted in the same values as those of agencies with full professional staff, but they sometimes appear to have been lost in a plan of operation that gives the worker an infinite series of explicit instructions to perform tasks at a minimum level, and does not encourage the use at any level of professional knowledge and judgment. The first problem is how to give some training to a large number of workers, in order to improve the quality of all the social work services, and second, how to attract a larger number of professional social workers to help families and children with the most serious and complex problems and to guide the services given by the larger group of workers. Simultaneously, an acceptable system for classifying families and their problems must be found

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in order to assign different workers appropriately to different kinds of cases. In devising an approach to these problems, the most comprehensive model is a report on social workers in the British health and welfare services. It has the advantage of having been developed in a locality and in relation to a range of services sufficiently remote from our own to enable us to view it objectively. Also it grows out of an educational system sufficiently different from ours to prevent any temptation to take it over lock, stock, and barrel. It is based on exhaustive data about the nature of client needs and the services presently provided. From these the report derives three different levels of need for help in the total client group. These are defined in terms of the degree of skill they require of the worker who gives the help. They are presented with great clarity and simplicity, accompanied by brief and pertinent illustrations. The whole section headed "Degree of Skill Required" should be read in this connection.7 After explaining that not everyone applying for service will need a highly trained and experienced social worker, and stressing the range of people's ability to help themselves if simple services are supplied, the report points out that "as much depends on the personality and strength of the person or family concerned as on the nature of the crisis, or disability, which afflicts them." 8 The following categories are then presented into which the content of the caseloads of social workers through all the British health and welfare services can be divided: 9 a. People with straightforward or obvious needs, who 7

Report of the Working Party on Social Workers in the Local Authority Health and Welfare Services (Ministry of Health, London: H.M. Stationery Office, 1959), paragraphs 558-602. ''Ibid., paragraph 560. "Ibid., paragraph 562.

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require material help of various kinds, some simple service, or a periodic visit to see whether any change has taken place or to provide evidence of the continuing support and interest of the authority. b. People with more complex problems, who require systematic help from a trained social worker. c. People with problems of special difficulty requiring skilled help by professionally trained and experienced social workers. What appears to be lacking for complete validity in the British categories is a system for classifying families and their problems. The three categories of cases are not clearly differentiated in that way, and tend to be defined simply by somebody's determination that a situation calls for one or another degree of skill in the worker. After pointing out that any given person or family might, at different times, be in any one of the three categories, the caution is given that people are not to be "passed like parcels . . . on a conveyor belt from one type of worker to another . . . arrangements [are called for] to ensure that the needs of each new case are fully assessed, that it is allocated to an appropriately qualified worker and that progress is periodically reviewed."10 Experiments Current or Proposed Quotation from the report to this extent emphasizes the familiar ring it may have to one who knows the Family Classification System developed by Community Research Associates. In that system, the magic number three is applied to levels of service,11 to which cases are to be assigned after being classified by a more systematic plan m

Ibid., paragraph 566.

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than is proposed in the British report. In the process the classification takes into account a definition of the population at risk, with a view to prevention. (This idea, differently expressed, recurs in the British report as well.) The present experimentation with the CRA system in at least four state welfare departments, including Pennsylvania, will supply experience that should help to provide tools for categorizing the kinds of cases to which differently trained social workers can be assigned. Their newly published formulation of family types may prove significant for classification.12 The CRA system, however, does not help in the equally important aspects of defining the kind of training and skill needed by the worker, and the ways in which a sufficient number of social workers thus trained can be attained. Administrators who adopt the CRA system of classifying the caseload and who attempt the differential assignment this makes possible will need to develop rapidly a plan to secure and train social workers with a degree of skill appropriate to the level of treatment ascribed. Differential assignment is meaningless without equal planning for an appropriately qualified worker. Preliminary work on another kind of plan has now been completed in the Bureau of Family Services, Department of Health, Education, and Welfare, resulting in recommendations that propose the training of two levels " F o r a summarized discussion of the C R A concepts of family classification and differential assignment to levels of service, see Memorandum on Implications for Social Work Curriculum of Community Research Associates' Materials, prepared by the Council on Social Work Education for the Louis W. and Maud Hill Family Foundation (St. Paul, Minn.: The Foundation, 1960), p. 10 ff. For detailed information on the family classification schedule, write Community Research Associates, New York, N.Y. "Alice Voiland and Associates, Family Casework Diagnosis (New York: Columbia University Press, 1962).

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of social work personnel below the Master's degree. In function, these levels correspond roughly with the "welfare assistant" and the "general purpose social worker" envisaged for the (a) and (b) categories of service in the British report. As presently proposed, they differ from the British plan by requiring college graduation as a minimum qualification for both the new levels. The first would receive three months specific training to equip the person for performance in a particular agency job. The second category of worker would have one year of education, half of it identical with the first half year in the two-year Master's program. In the second half of the year, the study would include academic content and work experience, both of them related directly to social work in public welfare. The work on which these recommendations are based was stimulated by response to a letter circulated in her private capacity by Phyllis Osborn, Regional Representative of the Bureau of Family Services. The letter communicated to a large number of leaders in social work her grave concern about the inability of public welfare staff to give service of the quality required for rehabilitation and prevention, unless immediate measures could be adopted to increase their professional training. The replies reflected equal concern and a variety of reactions regarding steps that could be taken. Mayo Newhouse was employed to analyze them and formulate his proposals.13 Alongside this development has been a second piece of research in the Bureau of Family Services, The Educational Standards Project. The eventual results will, it is "Reported in an unpublished document Considerations in Meeting the Educational Needs of Public Assistance Personnel, prepared by Mayo Newhouse for the Department of Health, Education, and Welfare, Social Security Administration, Bureau of Family Service, Division of Technical Training (April, 1962).

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hoped, provide precise definition of the functions of public assistance workers that can be performed acceptably by persons with a bachelor's degree plus experience, and by persons with a Master's degree in social work. Agreement on this subject, based upon analysis of actual agency operations, will be necessary underpinning for the design of any programs of training such as the Newhouse proposals. Especially in the urgent matter of training public welfare personnel, all the separate experiments need soon to be viewed in relation to each other, to see how each bears upon the others. The hypotheses stated in the Educational Standards Project about functions to be performed by persons with different levels of training will need to be tested in operating agencies. I hope some testing of them will take place in operations where the CRA Family Classification System is being installed and operated. The effects of this system in reorganization of caseload and services are so far-reaching that special examination may be needed to see whether they alter the original hypotheses or produce radically different results in the testing. Perhaps this process will also provide one test for the validity and usefulness of the CRA classification. As Mr. Lourie has pointed out elsewhere, one of the first salutary effects of the installation process in the Family Classification System was the shift in the workers' perceptions of what is expected of them by the administration. It focuses their observations and efforts on helping to solve the problems of families and children, not simply on eligibility and financial assistance. In addition, it spotlights the problems having particular urgency from the point of view of prevention and helps to select the cases needing particular kinds of service. Frank classification of the caseload in this way does away with the fiction

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that all can receive equal service—an illusion that simply results in unsystematic choices, according to the pressures on the individual worker, as to what families or problems get the worker's time. Theoretical Formulations about Differential Use of Personnel A necessarily brief mention must be made of the theoretical approaches that have been made to the problem and have resulted in tools applicable to work done in a range of different agencies and fields of practice. Using a set of principles for analysis of functions, California's Advisory Committee on Social Welfare Education proposed two classes of personnel, designated X and Y, and having two kinds of professional training to carry out functions on two different levels. The less highly trained worker, X, is thought of as performing standardized services involving the gathering of facts, the application of explicit criteria to the facts, planning action patterns where the application yields unambiguous results and no special risk is apparent, and carrying out the planned action. The X worker may also perform standardized subtasks as part of direct service designed and controlled by the Y worker. The Y worker refers to a person with special social work education beyond the baccalaureate degree, perhaps equivalent to the M.S.W., although the educational pattern for the M.S.W. might be considerably different from what it now is. The Y worker also gathers facts, but in situations demanding unique designs based upon his professional judgment. He further makes decisions in situations where application of criteria yields ambiguous results and where risk is involved. He plans action patterns uniquely designed to meet individ-

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ual needs, and carries out the plans involving continuing risk and re-design of the pattern.14 Another theoretical formulation has been developed by the NASW's Subcommittee on Utilization of Personnel as a way to approach systematically, in all kinds of programs, the division of work among professional social workers and other social work personnel. Instead of attempting to isolate the tasks to be performed by differently qualified workers, it provides an instrument to measure the groups of tasks in any agency, applying two dimensions of measurement: client vulnerability and worker autonomy. The rationale for the two dimensions is clearly stated and the variables within the two concepts are defined. The variables define, first, the ways in which clients can be seen as vulnerable to harm from the absence in the worker of the internalized values, knowledge and skills of a professional social worker, and, second, the degree to which the worker is called upon to function autonomously, without explicit guides or direct supervision. 15 With criteria supplied by this formulation, groups of tasks within the agency can be compared and rated as high or low in these two dimensions. In the little testing of it that has been done, it appears to have usefulness and validity as a tool for administrative decisions about differential staff assignments. If it proves valid upon further application, it would have the great merit of providing an instrument applicable to any social work operation. A "Social Workers for California, Report of the Advisory Committee on Social Welfare Education (September, I960), p. 36 f. Available from Milton Chernin, Chairman, University of California, Berkeley, California. Mimeographed. "Utilization of Personnel in Social Work: Those With Full Professional Education and Those Without. Final Report of the Subcommittee on Utilization of Personnel, NASW Commission on Practice (New York: National Association of Social Workers, 1962). Mimeographed. This document also provides a useful Annotated Bibliography.

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comment made by one administrator who tested it may be significant here: The method does not provide any absolute scale for classifying a specific job as requiring a fully trained caseworker or as falling within the competence of a worker with other than full casework training. It does provide effective means of helping an administrator classify jobs or work tasks in relative order of their need for fully trained casework personnel so that available staff may be deployed in positions of greatest usefulness.16

Although it has not yet reached the stage of reduction to an instrument for use in making personnel assignments, reference ought to be made to the probable future significance of the theory being developed by Helen Harris Perlman about the role concept in social casework.17 К it is true that social diagnosis involves indentifying the nature and cause of difficulties in a person's performance of his life roles, and social treatment involves selecting the points at which role functioning can be improved or restored, further theoretical development along the lines Mrs. Perlman is pursuing will make it possible, as she says, to view a person's role performance in an organized regular way. The eventual usefulness of this work for classification and for differential assignment is obvious. Conclusions It is not possible at this time to draw from all these endeavors recommendations that are applicable to all aspects of so complex a problem. Several conclusions can '"Utilization of Personnel in Social Work: Those With Full Professional Education and Those Without, op. cit., p. 23. "Helen Harris Perlman, "The Role Concept and Social Casework: Some Explorations," Social Service Review, Vol. XXXV, No. 4 (December, 1961) and Vol. XXXVI, No. 1 (March, 1962).

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be stated categorically for what they may suggest in looking for answers. 1. Need for action in the public assistance program and in the field of child welfare, public and voluntary, is so urgent that it is likely to be taken soon, somehow, by someone. If social work wants a share in setting the direction such action will take and in the provisions it will make, social work must act fast. 2. The nature of the work, depending as much on the personality and strength of the client as on the nature of his situation, calls for professional social work skill in the worker. The interrelationships between the person and his situation are not reducible to a set of instructions that can be carried out independently of professional judgment. 3. There is no need for and no possibility of postponing the training of staff at levels below the Master's degree, in the hope that an adequate number can be trained at the level of two-year professional education. Demand will continue to outstrip the supply. 4. On-the-job training will not suffice. Workers cannot be trained for a standard of quality in performance simply by working in programs where such a standard is not operative. 5. A systematic method of classifying caseload and assigning cases to different appropriate levels of professional staff must be developed, with attention to identifying those situations most susceptible to preventive measures. Satisfactory definition of functions that can be performed by different levels of professional personnel, and the type of training appropriate for each level, will be held up so long as an agreed upon, acceptable classification of family problems and family strengths is lacking. 6. Much more experimentation is needed with the use

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of more than one worker on a case. It is hard to see how the necessary professional control of diagnosis, assignment, and regular reevaluation can be provided without consistently delegating some responsibilities to others and sharing the relationship with the client in a kind of team assignment. The conclusions suggest the need to pull together the ideas and results from all the experiences reviewed above and to reformulate them into a smaller number of approaches to the problem. It is to be hoped that the resulting proposals will develop a methodical system of differential use of staff, applicable to larger groups of agencies, and productive of comparable results. It appears that we are now at a point where we know a good deal about the professional contribution of social work to solution of problems through provision of service, but do not know how to deliver the product. Social workers, and all who know the importance of these services for society as a whole, will have to work together to develop a plan, convince the public, and find the money for the heavy investment in research and training that will be required.

About The Authors Alfred

J.

Kahn

Alfred J. Kahn is Professor of Social Work at the Columbia University School of Social Work. He received his B.S.S. degree from the College of the City of New York; and his M.S. and D.S.W. from Columbia University. He also serves as consultant to the Citizens' Committee for Children of New York City, Inc. He is the author of Planning Community Services for Children in Trouble, A Court for Children, and is the editor of Issues in American Social Work, published by the Columbia University Press. He has published numerous articles in various professional journals. Among his monographs are: For Children in Trouble, Police and Children, Children Absent from School, and Protecting New York City's Children.

Verl S.

Lewis

Verl S. Lewis is Professor and Dean of the School of Social Work, University of Maryland. He received his A.B. degree from Huron College, Huron, South Dakota; his M.A. from the School of Social Service Administration, University of Chicago; and his D.S.W. from Western Reserve University. He has served as a public welfare administrator in various capacities and taught at the University of California, University of Oregon, and the University of Connecticut before assuming his present position. He is the author of Connecticut Town Relief: The Administration and Financing of us

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General Assistance by Connecticut Towns, 1957-1959, and has contributed articles to many journals including Mental Hygiene, Social Work, Federal Probation, and Social Service Review.

Wayne

Vasey

Wayne Vasey is Dean of the School of Social Work, Washington University, St. Louis, Missouri. He received his A.B. degree from William Penn College, Oskalousa, Iowa; and his A.M. in Social Work from the University of Denver. Immediately before assuming his present position he served as Dean of the Graduate School of Social Work at Rutgers. He has also served as Director, School of Social Work, State University of Iowa; as Research Associate, Russell Sage Foundation; Consultant, Ad Hoc Committee on Social Welfare; and as a public welfare administrator in various capacities. He is the author of Government and Social Welfare, and has contributed numerous articles to various professional journals in the social welfare field.

James R.

Dumpson

James R. Dumpson is the Commissioner of Welfare of the City of New York. He received his B.S. degree at the Pennsylvania State Teachers College; and his A.B. and M.A. from the New School for Social Research, New York City. He also received an L.H.D. from Howard University and an LL.D. from Tuskegee Institute. He has served as public welfare administrator in various capacities and as consultant to a number of private social welfare agencies. He has served on many national and international boards and committees. He is a member of the President's Commission on Narcotics

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and Drug Abuse; and has served as Chief of the United States Delegation to the United Nations Economic and Social Commission for Asia and the Far East Seminar in Bangkok, Thailand. He is co-author of Working with Teen-Age Gangs; Narcotics — U.S.A.; and has written monographs and contributed articles to many professional journals including Journal of Psychotherapy, Journal of Social Work; Public Welfare; and other similar publications.

Fred

Delliquadri

Fred Delliquadri is Dean of the Columbia University School of Social Work. He received his B.A. degree from the University of Colorado; and his M.S. in Social Work from the University of Nebraska. He has served as a Lecturer at the School of Social Work, University of Wisconsin, and as a public welfare administrator in various capacities including that of Director, Division for Children and Youth, Wisconsin Department of Public Welfare. He is the U.S. representative to the Executive Board of UNICEF. He has served as U.S. Delegate and Vice President of the Inter-American Children's Institute and as a participant in many other national professional committees. He is editor of Helping the Family in Urban Society, Columbia University Press, and is the author of other monographs and articles in the social work field.

Mary

R.

Baker

Mary R. Baker is Consultant on Careers in Social Work for the Council on Social Work Education, 345 East 46th Street, New York 17, New York. She received her B.A. degree from Western College, Oxford, Ohio; and her M.S.

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degree from the New York School of Social Work, Columbia University. Miss Baker has served as Administrative Consultant to the National Travelers Aid Association and as Executive Secretary of the Brooklyn Council for Social Planning. She is co-author of Education for Social Workers in the Public Social Services (Vol. VII of the Social Work Curriculum Study, Council on Social Work Education). Her other research and writing activities include Implications for Social Work Curriculum of Community Research Associates Materials.

ERRATUM

The first paragraph, top of page 43, should be correctly read as follows:

effort to untangling the web of fact and fantasy in which Miss X and her nine children were enmeshed. For the first time in the years that this family had received ADC, and the putative fathers of the children had been under support orders, there seemed to be some hope of involving the father in something more than a support or go-tojail way.