Prevention : Toward a Multidisciplinary Approach 9781317736011, 9780866566759

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Jason et al.

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Prevention: Toward a Multidisciplinary Approach

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Prevention: Toward a Multidisciplinary Approach

Leonard A. Jason • Robert E. Hess Robert D. Felner • John N. Moritsugu

Prevention: Toward a Multidisciplinary Approach

The Prevention in Human Services series: • Evaluation & Prevention in Human Services, edited by Jared A. Hermalin and Jonathan A. Morell • Helping People to Help Themselves: Self-Help and Prevention, edited by Leonard D. Borman, Leslie Borck, Robert E. Hess, and Frank L. Pasquale • Early Intervention Programs for Infants, edited by Howard A. Moss, Robert E. Hess, and Carolyn Swift • ~ Television: Enhancing the Preventive Impact of TV, edited by Joyce Sprafkin, Carolyn Swift, and Robert E. Hess • Innovations in Prevention, edited by Robert E. Hess and Jared A. Hermalin • Strategies for Needs Assessment in Prevention, edited by Alex Zautra, Kenneth Bachrach, and Robert E. Hess • Aging and Prevention: New Approaches for Preventing Health and Mental Health Problems in Older Adults, edited by Sharon Simson, Laura B. Wilson, Jared A. Hermalin, and Robert E. Hess • Studies in Empowerment: Steps Toward Understanding and Action, edited by Julian Rappaport, Carolyn Swift, and Robert E. Hess • Prevention: The Michigan Experience, edited by Betty Tableman and Robert E. Hess • Beyond the Individual: Environmental Approaches and Prevention, edited by Abraham Wandersman and Robert E. Hess • The Ecology of Prevention: Illustrating Mental Health Consultation, edited by James G. Kelly and Robert E. Hess • Prevention and Health: Directions for Policy and Practice, edited by Alfred H. Katz, Jared A. Hermalin, and Robert E. Hess • Prevention: Toward a Multidisciplinary Approach, edited by Leonard A. Jason, Robert E. Hess, Robert D. Feiner, and John N. Moritsugu

Prevention: Toward a Multidisciplinary Approach Leonard A. Jason Robert E. Hess Robert D. Feiner John N. Moritsugu Editors

I~ ~~o~;~~n~~~up LONDON AND NEW YORK

First published 1987 by The Haworth Press, Inc. Published 2014 by Routledge 711 Third Avenue, New York, NY 10017, USA 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business ISBN: 978-1-315-79160-9 (eISBN)

Prevention: Toward a Multidisciplinary Approach Prevention in Human Services Volume 5, Number 2

CONTENTS Chapter 1: Toward a Multidisciplinary Approach to Prevention

1

Leonard A. Jason Roberl E. Hess Roberl D. Feiner John N. Moritsugu

Teaching Research Intervention Volume Purpose

Chapter 2: Synergy, Prevention and the Chicago School of Sociology

3 5 6 9

11

Christopher B. Keys

Conceptual Framework: Individual, Social Context, and Community Research: Life Histories and Epidemiological Surveys Intervention: The Chicago Area Project Commentary: Contributions and Criticism Conclusion

Chapter 3: Anthropology, the Meaning of Community, and Prevention C. Timothy McKeown

12 17 21 25 32

35

Robert A. Rubinstein James G. Kelly

Community Restudies by the Book Kinds of Community

37 40

Community: A Multifaceted Construct Community and the High School Study Conclusion Chapter 4: Understanding the Policy Process: Preventing and Coping with Community Problems Tom Seekins Steven Maynard-Moody Stephen B. Fawcett

Common Structural Elements in Policymaking Models Differences Between Policymaking Models Case Study of Local Policymaking: Lifeline Utility Rates Discussion Chapter 5: Economic Development and Community Mental Health David Dooley Ralph Catalano Seth Serxner

Recent Economic Policies and Their Implications for Regional Economies Hypothetical Links of the Economy to the Incidence of Psychological Disorder Los Angeles Community Sutvey, 1978-1982 Implications of the Research Findings

48 52 61 65

66 70 77 84 91

94 97 101 109

Chapter 6: Prosocial Television for Community Problems: Framework, Effective Methods, and Regulatory Barriers 117 Richard A. Winett

Principles and Framework Effective and Ineffective Variables Presentation Format Prosocial Programming: Brief Examples Prosocial Television: Extended Examples Prosocial Television: Positive and Negative Conclusions New Media Communication Regulation: Historical Perspective

120 125 126 128 138 144 146 148

Centralization of Power and Resources: Problems of Access Future Alternatives Chapter 7: The Roles of Religion in Prevention and Promotion Kenneth I. Maton Kenneth I. Pargament

Religious Influences: Explanatory Factors Inreach: Pathways of Religious Influence on the Individual Congregation Member Outreach: Pathways of Religious Influence in the Community and Society Some Illustrations of Religious Inreach and Outreach The Unique Roks of Religion in Prevention and Promotion The Interface Between Religion and Allied Disciplines: Directions for Multidisciplinary Collaboration in Prevention and Promotion Chapter 8: Public Health and Community Wellness Judith E. Albino Usa A. Tedesco

Public Health as Community Prevention: An Historical Perspective Child Health in the Late Nineteenth Century Acquired Immune Deficiency Syndrome (AIDS) A Final Comment Chapter 9: The Use of Law for Prevention in the Public Interest Murray Levine Charles P. Ewing David /. Levine

The Legal System The Individual Lawsuit Institutional Reform Litigation Wuori v. Zitnay: Successful Implementation of a Consent Decree

149 155 161

163 167 176 183 194 199 207

208 212 221 235 241

242 252 262 265

Influencing Legislation Summary Chapter 10: Preventive Interventions in the Environment: Examples and Issues Joseph A. Durlak Jill N. Reich

Solid Waste The Judicial System Changing the Environment Afterword

272

274 279

281 287 294

299 J. R. Newbrough

Interdisciplinary Community Prevention

299 301 307

PREVENTION IN HUMAN SERVICES Editorial Board EDITOR ROBERT E. HESS, Riverwood Community Mental Health Center, Saint Joseph, Ml SPECIAL ISSUE EDITORS LEONARD A. JASON, DePaul University, Chicago, IL ROBERT E. HESS, Riverwood Community Mental Health Center, Saint Joseph Ml ROBERT D. FELNER, University of Illinois, Urbana, IL JOHN N. MORITSUGU, Pacific Lutheran University, Tacoma, WA ASSOCIATE EDITORS JARED A. HERMALIN, Cherry Hill, NJ CAROLYN SWIFT, Wellesley College, Wellesley, MA EDITORIAL BOARD BILL CLAFLIM, Clear Brook Manor, Wilkes Barre, PA LEONARD DUHL, University of California, Berkeley, CA STEPHEN FAWCETT, University of Kansas, Lawrence, KS RONALD FRIEND, State University of New York, Stony Brook, NY LEONARD D. GOODSTEIN, American Psychological Association, Washington, DC ALFRED H. KATZ, University of California, Los Angeles, CA JAMES G. KELLY, University of Illinois at Chicago Circle, Chicago, IL BERYCE W. MacLENNAN, General Accounting Office, Rockville, MD FORTUNE MANNINO, National Institute of Mental Health, Adelphi, MD RUDOLF H. MOOS, Stanford University, Stanford, CA JONATHAN A. MORELL, Hahnemann Medical College and Hospital, Philadelphia, PA ANNE PENNEY, East Alabama Mental Health-Mental Retardation Center, Opelika, AL JULIAN RAPPAPORT, University of Illinois, Champaign, IL SEYMOUR B. SARASON, Yale Universitv, New Haven, CT ARTHUR L. SCHWARTZ, Sound View- Throgs Neck Community Mental Health Center, Bronx, NY FRED SPANER, National Institute of Mental Health, Rockville, MD CLIFFORD H. SWENSEN, Purdue University, West Lafayette, IN BETTY TABLEMAN, Michigan Department of Mental Health, Lansing, Ml ALAN J. TUCKMAN, Rockland County Community Mental Health Center, New City, NY GARY WOOD, Northside Community Mental Health Center, Tampa, FL ALEX ZAUTRA, Arizona State University, Tempe, AZ

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Chapter 1

Toward a Multidisciplinary Approach to Prevention Leonard A. Jason DePaul University

Robert E. Hess Riverwood Community Mental Health Center

Robert D. Feiner University of lllinois

John N. Moritsugu Pacific Lutheran University

The message of this volume is clear- if we are to be sufficient in our preventive interventions, we must expand our view beyond our own singular disciplines to include the disciplines of others. It is not sufficient to enact laws requiring the use of seat belts if a large portion of the population refuses to wear them despite the law. The discipline of law needs to be joined by other disciplines, such as psychology, sociology, and anthropology, in a united effort to further raise the probability that seat belts will be worn. It is not sufficient to teach children new ways of learning if gains are diminished by poor nutrition and ill health. The efforts of educators need to be linked with those of health professionals and others so that children can better realize their capacity. © 1987 by The Haworth Press, Inc. All rights reserved.

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PREVENTION: TOWARD A MULTIDISCIPLINARY APPROACH

It is not sufficient to grandiloquently call for equity in housing for the poor when equity takes the form of indefensible environments such as Pruitt-Igoe. Improvements in housing and responses to other societal problems require the analysis and integration of many complex factors beyond the understanding of one or even two disciplines. Without this understanding, many of our efforts may simply not be sufficient. As it is not sufficient for only one discipline to address problems lending themselves to prevention, it is also not sufficient for multiple disciplines to address the same problem within disciplinary confines. One discipline does not exist separately from another; disciplines form a system, the components of which subtly intermingle with one another to produce a synergistic multidisciplinary effect. The focal point of the system is not the components but the "sphere of between" (Buber, 1965), the complex interaction of the components .. Similar thoughts have been expressed as early as the 1920s with a movement called general systems theory. According to Bertalanffy, a major proponent of general systems theory, a general theory might be developed to explain complex behavior. Such a theory might help to integrate multiple disciplines, thus approaching the goal of unity in science (Laszlo, 1975). Theorists in many disciplines have echoed Bertalanffy. For example, Dresselhaus (1984), a physicist, has stated that social and physical scientists need to work together to help people cope with constant massive change. In psychology, Cowen (1984) has argued that knowledge from sociology, social ecology, architecture, political science, and economics is needed for effective "primary" prevention programming. Despite these repeated calls, multidisciplinary approaches to prevention appear to be the exception rather than the rule. At first glance, this is surprising as multidisciplinary approaches to both theoretical and applied science are recognized as basic in many fields of endeavor. For example, present theories of evolution draw upon information from a broad range of sciences such as climatology, anthropology, geology, and physics. Many modern products could not exist in their present form without the contributions of diverse disciplines. For example, designing, manufacturing, and selling automobiles requires the involvement of engi-

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neers, designers, physicists, economists, and professionals in numerous other disciplines. Multidisciplinary efforts are required in response to the multitude of complex variables confronting modern scientists. Upon closer examination and comparison to other fields, it is not really surprising that prevention has not wholeheartedly embraced multidisciplinary approaches. Compared to the areas mentioned in the above examples, it is in its infancy and is lacking some key unifying elements, the primary one of which is an agreed upon definition. Prevention has been defined in terms of "primary," "secondary," and "tertiary" prevention. It has been defined as "primary" prevention only. It has been left undefined. New definitions have continued to be put forth on a regular basis (e.g., Prevention Work Group, 1986). Without a readily understandable definition, prevention cannot really lay claim to being a field at this time, making it difficult to effect a rallying point for various disciplines. As has been the case with many other fields, a consensual definition of prevention will slowly emerge over time. The process cannot be forced by one person or one discipline stating that this or that is the definition of prevention; it is a process requiring continuous discussion and debate for the purpose of building understanding and consensus. It involves a quest to identify that which is unique to various disciplines and that which is common among them. Above all, it calls for disciplines to interact with each other in areas such as teaching, research, and interventions so that the process may unfold. TEACHING

A multidisciplinary approach to teaching students implies that there is no prior reason to believe that any discipline has any more claim to producing useful methods or theories than any other scientific tradition. This is a potentially threatening notion for many academicians. While advocates might argue that such an approach might help avoid the biases of one discipline, critics might counter by stating that this orientation would produce generalists lacking depth in any one particular field. As an alterna-

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PREVENTION: TOWARD A MULTIDISCIPLINARY APPROACH

tive approach, one which might be more acceptable to the present scientific community, students could first be trained to understand their own traditions, then knowledge of other areas could be provided from either outside minors or interdisciplinary seminars (Heller, Price, Reinharz, Riger, Wandersman & D' Aunno, 1984). Such an approach would leave students with a clear professional identity as well as the capacity to learn new methods from other disciplines. Multidisciplinary training opportunities have been provided to students. For example, Wolman (1977) described a broad-based interdisciplinary graduate program within a Department of Geography and Environmental Engineering. Cross-fertilization between disciplines proved effective in solving real world problems. Over the nine year history of the program, a variety of unique problems were encountered. Since the problems being addressed were not exclusively in one discipline, a persistent problem involved defining the core of study for students. Along with this issue was the conflict in training students in breadth or depth. This tension was most adequately resolved with those students who were well trained in specialized areas but also had a broad background with respect to the environmental problems being studied. Students learning material across disciplines needed to master new languages and were faced with the challenging task of staying current in multiple fields which were experiencing geometric expansions of information. According to Wolman, the faculty in the interdisciplinary program confronted a different set of problems. In order to promote interaction, an effort was made to limit the size of the faculty to about 15 members. While this proved effective in facilitating collaboration and communication, there were only a few or, in some cases, only one faculty member representing a particular discipline. This situation could have led to some faculty members feeling somewhat estranged from their discipline and separated from their colleagues who had once been a crucial part of their social support system. In addition, for junior faculty with concerns about tenure and promotions, some anxiety was experienced since university boards and faculty might not understand or value scientific contributions not specifically linked to one academic discipline.

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The problems articulated by Wolman were not insurmountable, and the program and its achievements were considered successful. What is clear from this description of a multidisciplinary program is that language, values, and goals of different participants are likely to differ; therefore, a high degree of tolerance and flexibility will be needed for those venturing into these types of settings. Kelly (1977) further states that those participating in multidisciplinary programs will need a strong sense of self-assurance, purpose, and self-realization in order to cope with the uncertainties of group goals, anxieties in achieving a common purpose, and ambiguities in crossing over disciplinary topics. RESEARCH

Although there have been a number of multidisciplinary research efforts, such efforts are generally limited to two disciplines and are not standard practice. This volume provides a step, albeit a small one, in that direction by making us aware of aspects of other disciplines which require attention in our research. The implication is that, to advance our understanding, we need to examine and report on a large number of apparently relevant variables in our research, not just the ones that seem to be germane to the intended purpose of the study or our area of expertise, so that we can begin to establish a data base interpretation. Even though such data may be of no immediate use to the investigator, they may be useful, especially when aggregated across studies, to suggest relationships and to generate hypotheses for future research. They may be especially important to a discipline other than that of the investigator, thus contributing to the development of a systems approach to research in the area of prevention. This approach to research would yield much richer data than that normally reported in journals and would breathe life into the participants and the settings that are being examined. For example, "subjects" in a research study of learning abilities in a classroom setting would be described in more detail than the usual dry demographic data presented in such studies. Relevant information such as the state of their nutrition and health would also be presented. Information about their home environments and as-

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PREVENTION: TOWARD A MULTIDISCIPLINARY APPROACH

pects of the classroom environment such as sociometries, noise level, and options in space would also be presented. Photographs and diagrams of the environment would be provided to assist us in beginning to understand the system in which the research is taking place (see Twardosz, Cataldo & Risley, 1974, for an approximation). Ideally, the data would be collected and reported by a multidisciplinary research team. This approach might be anathema for some because it is a move away from the orderly and systematic method of investigation generally used by modern science. However, it is an appropriate approach when the end is known but understanding of how to reach that end is limited. It harks back to the approach that Edison used when he tried more than 6,000 variations of vegetable fiber in his search for a suitable carbon filament for the lightbulb. Goodyear, who spent years treating rubber with a multitude of different chemicals before discovering vulcanization, captured the essence of the approach when he stated, While I admit that these discoveries of mine were not the result of scientific chemical investigation, I am not willing to admit that they were the result of what is commonly called luck. I claim them to be the result of the closest application and observation. (Wilson, 1954, p. 128) Of special note is that Goodyear was not alone when he discovered vulcanization but was the only one who found the charring of the rubber to be "worthy of notice" (Wilson, 1954, p. 128). So too must we observe.

INTERVENTION

Perhaps the most promising area for a multidisciplinary approach is in actual preventive interventions. An example using an important social problem illustrates the benefits which can be gained from a more integrated and comprehensive approachbenefits which would not be possible with reliance on the theories and concepts from only one discipline.

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The problem to be addressed concerns the alarming number of children killed each year on American highways. Each year, about 1,000 youngsters under age 5 are killed in automobile crashes, and more than 60,000 are injured, many sustaining permanent damage. If an infant or child is not placed in a car seat or infant seat, the unrestrained youngster is like a missile if there is a car crash. In a crash at only 20 miles per hour, a 15 pound infant would be thrown with the force of 300 pounds (equivalent to a fall from a three-story building). Eighty to 90% of these deaths and 65% of these injuries could be prevented if parents properly placed their children in car safety seats (Evans, 1981). A multidisciplinary team composed of individuals from psychology, art, environmental design, public health, biology, political science, law, anthropology, sociology, and economics could be convened to seek solutions to this serious social problem. While a particular individual might convene the group, all members would participate as equals with decisions made through consensus. The psychologist might provide reliable and valid means for observing the number of youngsters in various sites who are appropriately restrained while in a motor vehicle. In addition, this person might assess ways to instruct parents on how to use restraints and how to gain the cooperation of their children when passenger restraints are employed. The representative from art might suggest that, in communitywide programs, more visual aids should be used (e.g., posters, bumper stickers, buttons; videos, and films). Parents could be asked to rate different visual aids to assess which are most helpful in conveying information. The environmental designer might suggest that parents often do not use car seats because they are too difficult to operate. Some parents are found to be afraid that their children will be trapped in safety seats during an accident and suffer more severe injuries. Parents could be involved in rating different car seats in terms of their convenience to use and their perceived safety. Educational programs could be designed to take these concerns into account. The public health official might suggest that an epidemiological study is needed to provide the team with a comprehensive

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PREVENTION: TOWARD A MULTIDISCIPLINARY APPROACH

overview of current patterns of automobile safety practice in the community. Questions to be answered could include: Are there different rates of use of childhood restraints for individuals from different income levels? Does adult use of seat belts influence levels of childhood restraint? Do certain settings have higher levels of use than others? The biologist might examine the possible impact of passive restraints and air bags, either of which might be required in American automobiles. This research would find that passive restraints are only employed in the front seats and are not appropriate for children weighing less than 40 pounds. In addition, air bags provide adequate protection only in frontal impact collisions; they are not employed in side or rear impacts. Even if the bags are employed under nonfrontal angles of impact, occupants without infant or car seats will be thrown around in the vehicle or possibly ejected from it. The political scientist might be interested in analyzing the process by which community groups work together as lobbyists in influencing legislative change. This person might assist them by showing them effective lobbying techniques. The representative from law might examine laws in different states and assist in writing effective legislation. An anthropologist might suggest that participant observation procedures be used in order to better understand the problem. By going to local health clinics, day care centers, schools, and homes, parents and children could be observed and interviewed to assess current safety practices to determine which factors facilitate or hinder appropriate automobile safety. The sociologist would support this initiative since it might provide a more qualitative depiction of the problem. In addition, social network variables might also be employed since it is possible that those parents whose support systems favor appropriate restraints are the families where highest levels of compliance are obtained. The presence of these two disciplines would also ensure that interventions are culturally appropriate. Finally, an economist might investigate what economic procedures might motivate parents to use safety seats. After the birth of a child, a hospital-based loaner program might be the most effective way of inducing parents to begin the habit of using restraints when driving with their infants. In addition, an economic

Jason eta/.

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analysis of the costs to society for deaths and injuries resulting from the lack of use of restraints could be performed. Perhaps insurance companies could be motivated to offer incentives to those families who purchase and use appropriate automobile restraints. This type of collaboration could provide a balance between the richness of qualitive analyses and the precision of more quantitative methods. Such an approach would also provide a better understanding of person-and-environment transactions since personal dispositions as well as environmental supports for safety practices are both critical to a more comprehensive analysis. The collaboration among individuals from different disciplines would produce stimulating exchanges and synergistic solutions to intransigent problems. Multidisciplinary interventions, such as the one described in the example, would begin to provide sufficiency to our responses to the pressing problems confronting society. VOLUME PURPOSE

The purpose of this volume is a limited one- it is to provide a taste of different disciplines as they relate to prevention. The particular disciplines chosen for inclusion were selected because they appeared to be among those with the most relevance to prevention. The volume is far from being all inclusive; missing are significant disciplines such as psychology, product design, architecture, and management. The intent of the volume, however, is to be suggestive rather than definitive, a beginning rather than the end. It is hoped that readers' appetites will be whetted to the point where they will make efforts to learn more about disciplines other than their own and will, perhaps, participate in joint ventures with other disciplines. We encourage such collaboration because we believe that only through the attendant discussion and debate can a multidisciplinary field of prevention be defined. And, as prevention becomes more defined, more disciplines can discover their niche, further refining the field and increasing the comprehensiveness and impact of our efforts. Analogous to what we foresee in the development of prevention as a field is the development of the automobile. In its early

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PREVENTION: TOWARD A MULTJDJSCIPLINARY APPROACH

days the automobile was produced through the efforts of a limited number of disciplines. As it became more defined over the years, more disciplines saw areas in which they could contribute to its further development. Ergonomics found a niche in instrument design and placement. Physics found several niches, recently in efforts to reduce drag coefficients. As a result of the increase in disciplines focusing on the automobile, it has developed into a sophisticated product better able to respond to the needs of both consumers and the environment. We strongly believe that a multidisciplinary approach to prevention is needed given the complexity of the problems facing society. It is clear that one discipline acting alone cannot yield sufficient interventions. It is also clear that multiple disciplines are not sufficient unless they act in concert; sufficient interventions can only occur when the thoughts and efforts of disciplines are merged. We hope that readers will perceive this need with the same clarity so that interventions may gain in sufficiency and definition may be brought to prevention.

REFERENCES Suber, M. (1965). What is man? In Between man and man. New York: Macmillan. Cowen, E. L. (1984). Training for primary prevention in mental health. American Journal of Community Psychology, 12, 253-259. Drcssclhaus, M.S. (1984). A physicist's perspective on the complementary roles of the physical and behavioral sciences. American Psychologist, 39, 333-340. Evans, P. (1981 ). Car scat safety: It's a life and death issue. American Baby, 43, 44-47. Heller, K., Price, R. H., Rein harz, S., Rigcr, S., Wandersman, A. & D' Aunno, T. A. (1984). Psychology and community change (2nd cd.). Homewood, IL: Dorsey. Kelly, J. G. (1977). Varied educational settings for community psychology. In I. lscoc, B. L. Bloom & C. D. Spielberger (cds.), Community psychology in transition: Proceedings of the national conference on training in community psychology. New York: Wiley. Laszlo, E. (1975). The meaning and significance of general system theory. Behal'iora/ Science, 20, 9-24. Prevention Work Group (1986). Mental disability prel'ention in Michigan. (Available from Mental Health Association in Michigan, 15920 West Twelve Mile Road, Southfield, Ml 48076). Twardosz, S., Cataldo, M. F. & Risley, T. R. (1 974). An open environment design for infant and toddler day care. Journal of Applied Behavior Analysis, 7, 529-546. Wilson, M. (1954). American science and inl'ention. New York: Bonanza. Wolman, M.G. (1977). Interdisciplinary education: A continuing experiment. Science, 198, 800-804.

Chapter 2

Synergy, Prevention and the Chicago School of Sociology Christopher B. Keys University of Illinois at Chicago

SUMMARY. The Chicago School of Sociology and the Chicago Area Project pioneered the development of theory, research, and practice concerning juvenile delinquency and its prevention. The theories of Thomas, Burgess, and Park emphasized the continuity and similarity between deviant and normal individuals, the potent influence of the social context in shaping behavior, and the community as the primary cause, preventive agent, and cure of deviance. Shaw and McKay's quantitative research supported the zonal theory of urban development that predicted high delinquency rates in socially disorganized communities near the central city. Their qualitative life histories of delinquents supported their continuity view of delinquents and explicated the social influences that promoted delinquency. The Chicago Area Project has a 50-year history of preventing delinquency by developing indigenous talent to work with local youth and improve community conditions. This Chicago example demonstrates the value of prevention programs that emphasize the synergy of theory, research, and practice, the importance of social and community levels of analysis, the combination of quantitative and qualitative research methods, and the use of citizen participation. This article is dedicated to the late Joseph Puntil and to Emil Peluso. They devoted themselves to delinquency prevention and introduced the author to the work of the Chicago School of Sociology and the Chicago Area Project. The authors appreciate the support of Len Jason, Steve Stelzner, Jim Bennett, Robert Hess, Jim Kelly and Jerry Haisten and the secretarial talent of Pat Simpson in preparing this article. Copies may be obtained from the author at: Psychology Department, University of Illinois at Chicago, Box 4348, Chicago, IL 60680. © 1987 by The Haworth Press, Inc. All rights reserved.

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One of the primary sources of the history of prevention in sociology is the Chicago School of Sociology. In the late 1800s and early 1900s, sociology was a nascent discipline trying to define its identity. Between the First and Second World Wars, the Sociology Department at the University of Chicago emerged as a leading force in the development of the field (Blumer, 1984). First, William I. Thomas, and then in the 1920s, Robert Park and Ernest Burgess, were leading theorists who helped to develop the concept of the city as a sociological laboratory in which a wide variety of social behavior could be examined (Bennett, 1981). Their orientation emphasized gathering a "mosaic" of both qualitative and quantitative data concerning the topic of interest. Clifford Shaw and Henry McKay studied sociology at the University of Chicago and then in the mid-1920s began research on juvenile delinquency at the Institute for Juvenile Research. Thus, the members of the Chicago School emphasized neither the physical topics that interested early ethologists nor the theoretical abstractions of some nineteenth century sociologists who were given to advocating doctrine rather than looking for evidence directly (Faris, 1967). The primary goals of the members of the Chicago School were, first, to develop sociology as an empirical ·science, and second, to encourage social reform. Their focus was the city of Chicago and its myriad strengths and weaknesses. Studies of community life, urban ecology, ethnicity and race, public opinion, crime, deviance, and delinquency broke new ground to establish a sociological research tradition. In this paper, the topic of the prevention of juvenile delinquency is considered as an exemplar of the work of the Chicago School of Sociology. The conceptual framework, the research base, and the intervention methods of the Chicago School of Sociology work are all examined. CONCEPTUAL FRAMEWORK: INDIVIDUAL, SOCIAL CONTEXT, AND COMMUNI1Y

To suggest the multi-level conceptual analyses of the Chicago School of Sociology, key concepts representing individual,

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group or social context, and community levels of analysis are presented. On an individual level, one tenet that Thomas, an early intellectual leader of the Chicago School, espoused and his successors supported was a continuity view of deviance. That is, the person or group of individuals being studied were, first and foremost, human beings, with thoughts, behavior, feelings, aspirations, and attitudes like those of other human beings. Their distinctive and often socially deviant behavior was salient but of secondary importance to their similarity to others who were not deviant. This position had much in common with that of Harry Stack Sullivan, the founder of interpersonal psychiatry and a contemporary of Thomas, who believed, "We are all much more human than otherwise." One implication of this continuity view is that the delinquent and other deviants needed to be understood in the context of their other non-deviant actions, thoughts, and feelings. Understanding these other aspects of individual functioning helped make clear the internal consistency and integrity of an individual's personal world and its similarity to that of others. For example, Shaw and McKay (1972), leaders of the Chicago School's delinquency research and prevention programs, considered juvenile delinquents to have aspirations for success similar to those of other adolescents. This understanding increased their ability to empathize with troubled youth and treat them with respect. Thus, sociologists of the Chicago School approached those they studied with humanitarian respect. Clifford Shaw's early work as a probation and parole officer convinced him that many of the young men he supervised were fundamentally worthwhile individuals who could improve given some help from adults. For Shaw the continuity perspective also implied an optimism about the strengths of deviant individuals. People had the potential to improve themselves and their communities and to prevent delinquency, as well as other social problems. Neither genetic endowment nor early experience were critical impediments to improved future behavior. A second major tenet of the Chicago School of Sociology was to emphasize the importance of the social context in understanding deviance. Thus, Shaw and McKay emphasized that delinquent behavior was rarely a purely individual act, but rather something two or more youths did together. To understand delin-

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PREVENTION: TOWARD A MULTIDISCIPLINARY APPROACH

quency, one needed to understand the social world of the delinquent, the ties to family, school, and especially peers. Shaw and McKay believed that these typical social settings had a strong influence on how individuals reacted to the expectations of other youth and adults who were important to them. Individuals sought to establish a role with some prestige or status in the social settings they frequented. Often, individual behavior could be understood as an effort to create, maintain, or change one's particular role or identity in a group (Kobrin, 1959). This emphasis on the social was in contrast to a strong emphasis on the individual which historically has been primary in most scientific investigations, mental health professions, and American society (cf., Keys, 1983; Sampson, 1978). With their continuity view of deviance, Shaw and McKay applied these social principles to delinquent as well as to socially acceptable behavior. They did not consider delinquents to be antisocial, but rather to be striving to find satisfying roles in their social milieu (Kobrin, 1959). The most important social setting for the delinquent was the peer group organization or gang. Gang members interacted frequently, taught each other and new members methods for particular criminal acts, and gave one another support for their illicit activities (Shaw & McKay, 1972). Members' prestige in the gang often depended on their ability to fight and to steal. Shaw and McKay (1972) emphasized that the social context was essential for supporting delinquency and that this context included underlying values as well as overt behavior: The existence of a system of values supporting criminal behavior becomes important . . . in shaping individual life patterns, since only where such a system exists [may] the person through criminal activity acquire the material goods so essential to status in our society and at the same time increase, rather than lose, his prestige in the smaller group system of which he has become an integral part. (p. 183) In addition, Shaw and McKay considered the lack of positive adult contact important to delinquency. They maintained the relative isolation of male adolescents from adults fostered delinquent behavior. This isolation resulted from the distancing of

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each group from the other (i.e., both youths dropping out of contact with adults and adults pushing youths out of contact with them). Without the positive influence of adults, delinquent behavior became more likely. Thus, the social context was important both for its support and transmission of criminal behavior and values and for its lack of support for conventional norms and values. However, the social context is embedded in the social structure of the community. Perhaps the most important principle of the Chicago School for us to understand is Shaw and McKay's view that the community is the cause, the preventive agent, and the cure for juvenile delinquency. Although Shaw and McKay did not define them precisely, they typically used the terms "community" and "neighborhood" interchangeably to refer to the world of a youth outside his (their studies were primarily of male adolescents) own family exclusive of contact with the mass media. Shaw and McKay concurred with Thomas on the importance of social organization and disorganization for community functioning. Social organization essentially referred to the capacity of adults to communicate conventional values and norms to youth. Socially disorganized communities were not unorganized, but were ineffective in providing support and sanction for conventional values and behavior. While social disorganization provided opportunities for social reorganization, it also was associated with negative living conditions. The characteristic growth pattern of American cities typically created certain types of areas, according to the ground-breaking theory of Park and Burgess in urban ecology (Bennett, 1981). The socially disorganized community was usually found in a "transitional area" characterized by physical deterioration, low socioeconomic status, numerous social welfare agencies, and a high prevalence of other social problems like adult crime, poverty, and disease. Also, these communities lacked capable indigenous political leadership, viable local economic institutions, effective voluntary associations, stable family patterns, and even unconventional institutional structures that supported local community and conventional values. In these disorganized communities, a broad range of norms and standards of behavior were often tolerated, including criminal behavior by elected officials and

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police officers. Crime organizations made delinquency "a powerful competing way of life" (Shaw & McKay, 1972, p. 170) .. Shaw and McKay believed that social disorganization was caused by rapid social change, primarily in the forms of immigration and industrial expansion. In the early twentieth century, waves of immigrants arriving primarily from Europe sought the cheapest housing available and settled in high density slums. There the youths would see the difficulty their parents faced in succeeding in the new world and would turn away from them and be more attracted to peers who knew quicker, if less legitimate, paths to material success. Anticipated industrial expansion in these transitional areas meant that landlords and banks invested little in maintaining residential properties soon to be demolished. More recently, urban renewal and now gentrification have continued to create changes in these transitional zones which are typically close to the central city and/or industry. Disorganization in these areas can be prolonged if there are few opportunities available for individual improvement and community development. Fundamentally, Shaw and McKay also maintained that the basic problem that produced and perpetuated social disorganization was the relative powerlessness of community members. Community members, therefore, found it difficult to achieve their goals. For example, they often did nothing to organize to improve the welfare of youth in the community and thereby seek to prevent delinquency. In sum, to oversimplify greatly, three of the central principles of the Chicago School of Sociology relevant to the prevention of juvenile delinquency were: 1. the deviant individual is more similar to than different from the normal individual; 2. the social context is a crucial factor in learning, maintaining, and transmitting delinquent behavior, and 3. the community is a primary cause, preventive agent, and cure for delinquency. Combining these three principles reveals the enriched picture provided by a multi-level conceptual framework. Social disorganization at the community level is most. important in under-

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standing the causes of delinquency. This disorganization creates an environment in which there are more social contexts that promote delinquent behavior and fewer social forces that prevent it. The individual youth is a social animal and acquires knowledge and behavior according to the general principles of social learning that apply to both normal and deviant behavior. In the social contexts of a disorganized community, that learning often concerns the values, norms, and behavior of delinquency. RESEARCH: LIFE HISTORIES AND EPIDEMIOLOGICAL SURVEYS

Shaw and McKay's research followed the tradition of other sociologists of the Chicago School by using both qualitative and quantitative methods to develop sociology as an empirical science and to provide a basis for reform. Thomas and Znaniecki's classic study, The Polish Peasant in Europe and America (1918), relied in part on the personal letters of Polish immigrants in Chicago to describe their life dilemmas and coping strategies. These personal documents vividly captured the perspective of the Poles, and the use of a variety of personal documents became more popular among sociologists between the World Wars. The use of personal documents and oral history involved the researcher with the research subject to a greater degree than was common then or now in scientific investigations. Madge (1962) commented on the value of such qualitative work: "By taking subjects into your confidence, Thomas and Znaniecki rightly claim not only that you are respecting their human dignity, but also that the resulting investigations will be more fruitful" (p. 100). Also, such qualitative research communicated the conditions of the delinquent or other subject in an immediate, direct manner and, thus, provided a basis for informing the public and initiating social reform. Shaw became interested in the life stories of delinquents during his tenure as a probation and parole officer and encouraged the boys to write. From these efforts resulted three life histories of book length: The Jack Roller (Shaw, 1930, 1966), The Natural History of a Delinquent Career (Shaw, 1931), and Brothers in Crime (Shaw, McKay & McDonald, 1938), as well as hun-

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dreds of other briefer life histories. In a number of cases, Shaw also went to some length to verify the accuracy of the factual information in the boy's story. These histories were an ideal vehicle for communicating a continuity view of deviance by demonstrating the common humanity of delinquent boys in their thoughts, feelings, non-criminal behavior, aspirations, and attitudes. The life stories also provided insight into the social context of delinquent behavior. For example, this excerpt indicates how one boy in a high delinquency area came into contact with delinquent norms and was influenced to adopt them: One day when I was about nine, we were caught by the gang that beat me up my first day home from the orphanage. They wanted us to join their gang. I saw we would get the worst of it, so I made a bargain with them. I told them to let James (my brother) alone, and if they did, I would join their gang. They wanted both of us and I pleaded and begged. Finally the leader, the fellow that gave me a beating agreed. I made James promise he would say nothing to Ma. The gang was about thirty strong. They would steal milk off porches, bread from bread boxes, steal from peddlers and take kids' lunch money from them. At first I just watched for them. (Shaw & McKay, 1972, p. 178) Shaw and McKay (1972) used quantitative data from official court records to support the importance of the social context in understanding delinquency. For example, to make the point that delinquency is primarily group behavior, they noted that over 80% of juvenile court cases in 1928 concerned criminal acts done by boys acting as members of groups. They documented the contact of older boys with younger boys in joint criminal activity. They found evidence that in certain neighborhoods boys specialized in particular types of crimes (e.g., jack-rolling) that required specific knowledge and skills. Presumably older boys taught their delinquent specialty to younger ones in the same neighborhood. These findings were consistent with Shaw and McKay's view of delinquency as socially learned and transmitted. They also used truancy rate studies to demonstrate the relative isolation

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of youths from adult teachers. In neighborhoods where delinquency rates were high, truancy rates were also high (Shaw & McKay, 1972). These quantitative findings complemented other qualitative results from life histories concerning the social context of delinquency. These histories documented the theorized importance of the peer group as a source of support and pressure for criminal activity. They pointed out that in delinquency areas, the weakened status of the family as supporter for conventional social standards was in part due to the direct or indirect ties of many families to illicit activities. The life histories also indicated the many new problems of living in a disorganized community in a new country. Consequently, the isolation of youth from adults could occur, in part, simply because of the many other problems with which adults were coping. Research at the community level of analysis was predominantly quantitative, with life history information and other qualitative information used to help develop major points. Interestingly, Park developed the zonal model of urban ecology based on his extensive visits to cities around the world as a journalist before he became a sociologist (Bennett, 1981). According to Park, urban areas developed a series of essentially concentric circles radiating outward from the central downtown and industrial areas. Closest to the central city was the transitional zone and, as one moved to the periphery of the city, in each of the four successive zones living conditions improved and problems declined. Focusing on the city of Chicago and juvenile delinquency, Shaw and McKay (1972) and their colleagues (Shaw, Zorbaugh, McKay & Cottrell, 1929) systematically examined official juvenile court records to ascertain the distribution of delinquents throughout the city. Their evidence supported the zonal model of Park and Burgess with delinquency rates usually declining as one moved further from the central city. Interestingly, Shaw and McKay (1972) found this same general pattern for the time periods 1900-1906, 1917-1923, 1927-1933, and 1934-1949. They also found similar zonal distributions for the rates of police arrest of alleged delinquents and for the rates of delinquents committed by the juvenile court for recidivism. In addition, they found that the rates of other community problems followed a similar zonal

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pattern including truancy, infant mortality, young adult crime, and hospitalization for mental disorder. In short, Shaw and McKay presented comprehensive epidemiological evidence concerning the prevalence of delinquency as a community characteristic that varied consistently with other community problems. These findings and concurring results from a number of other American cities (e.g., Philadelphia, Cincinnati, Boston, Cleveland, and Richmond) supported the fact that delinquency serious enough to receive the attention of police arrests and the juvenile court seemed to be more common in communities in transition zones. Shaw and McKay (1972) also identified the other characteristics these communities in transition zones had in common. In addition to the above factors, they included population decrease, low percentage of home owners, and a high rate of foreign-born or Black heads of households. These communities also had high concentrations of social welfare organizations administered and staffed by individuals outside the local community. Later data on rates of male delinquency (1945-1951, 1954-1957, 1958-1961, and 1962-1965) and female delinquency (1958-1962) revealed somewhat similar patterns to earlier male data. Shaw and McKay maintained that areas demonstrating the greatest increases in delinquency had experienced new migrations and in those with decreases in delinquency rates, community institutions had achieved greater stability. Shaw and McKay interpreted these rate variations among communities as reflecting important difficulties in the "dynamic life of communities." They argued that concentrations of problems in the same areas decade after decade, immigrant group after immigrant group, could not be attributed to individuals or ethnic group characteristics. When ethnic group members became successful enough to move farther from the center city, their rates of delinquency and other community problems fell. Following Thomas, Shaw and McKay saw social disorganization as the common element in these communities across time, problem, and location. The higher rate of delinquency and crime also promoted further social disorganization by increasing the likelihood of the social transmission of delinquent values. High rates of delinquency indicated the inability of conventional institutions to

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respond to the needs of community members, usually due to rapid social change. As community institutions became more effective, delinquency rates dropped. Thus, a longitudinal perspective suggested that social reorganization could emerge from social disorganization. In conclusion, the Chicago School of Sociology studies of juvenile delinquency reflected a commitment both to use multiple, complementary methods and to study the problem at different levels of analysis. The major conceptual principles guided both the selection of method and content of the research. The epidemiological research of Shaw and McKay provided a sound quantitative base for determining in which natural areas delinquency problems were the most serious. The life history research complemented by some of the studies of juvenile court records suggested the importance of the social context for delinquent behavior and how that social context worked to foster and maintain delinquent behavior. The life history method reflected the continuity view of deviance both in content by revealing a human picture of the delinquent and in procedure by demonstrating respect for him and his perspective. INTERVENTION: THE CHICAGO AREA PROJECT

About 1930, with Burgess' help Clifford Shaw began the Chicago Area Project in order to prevent, and to a lesser extent, to treat delinquency in disorganized communities. He began programs in three high delinquency areas: the near north side, the near west side, and near the steel mills on the south side. Based on the principle of the continuity between the deviant and the socially acceptable, Shaw believed that an intervention that respected the youths and other citizens of the community would be effective. Neither individual differences in genetics nor in early experience were substantial enough to render ineffective interventions that focused on the social conditions youths faced in disorganized communities. These interventions needed to acknowledge and encourage the positive strengths of the youths and adults in the local community. Local adults who became involved were to have respect for youths and not see them as a

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social menace (for a somewhat contrary view on citizen participation see Ventriss, 1985). Particularly important was the preventive emphasis. As Burgess said, "prevention ... is so much easier, cheaper, and more effective than cure and begins with the home, the playgroup, the local school, the church and the neighborhood" (quoted in Short, 1972, p. xxvi). Shaw's knowledge of the social context of delinquency influenced the design of the Area Project. The primary goal was to discourage delinquent behavior by changing the social ecology of the lives of local youths. For Shaw, such a change meant involving local adults who knew the youths and were familiar with their ethnic background. Youth workers and interested adults worked to increase positive adult contact with youth and to strengthen expectations for non-criminal behavior. They sought to provide legitimate avenues of opportunity for youths to use in their striving for prestige and status. They worked to create social groups for boys to encourage and maintain positive behavior. Shaw and his colleagues at the Institute for Juvenile Research were open to a wide variety of activities and methods, but the principle of local participation and involvement was inviolable. The Area Project also reflected the Chicago School of Sociology principle of communities as cause, preventive agent, and cure for delinquency and other social problems. Following the view of community as cause, Shaw targeted the most socially disorganized communities. If the powerlessness and social disorganization of these communities were root causes of delinquency, then the preventive interventions had to address these problems as well as those of the youths themselves. In contrast to most, but not all (cf., Sarason, 1974), mental health professionals of their era, Shaw and his colleagues believed that community forces could be mobilized to address social problems effectively. In fact, applying the continuity principle to communities as well as individuals, Shaw believed even in the most disorganized community, there were strengths. There was a critical, if latent, mass of community members available to make delinquency prevention programs work. These people not only were concerned about youth but also were likely to be upwardly mobile, interested in recognition (especially those for whom relatively few other avenues for recognition were available), and/or interested

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in being less isolated from other community members (Kobrin, 1959). To enable these communities to begin preventing delinquency, Shaw and his colleagues encouraged community members to form community youth committees to identify and change local conditions engendering delinquency. These volunteer committees included concerned citizens and local leaders from the neighborhood with informal ties to a variety of local business, fraternal, kinship, and friendship groupings. In the relatively less disorganized communities, these committees usually developed as an outgrowth of and had strong connections to major institutions such as local churches or political groups. In the most disorganized neighborhoods, the committees' ties to informal local groups and institutions were fewer and less stable, as were those groups and institutions themselves. The community committees nominated an indigenous executive staff member to enable them to work more effectively. The indigenous member was hired as part of Shaw's staff for the Chicago Area Project. The indigenous staff leader was selected for his {I believe they were all male) knowledge of the local community, his access to youth, and his interpersonal ability in working with boys and adults. Shaw strongly valued the use of indigenous staff because he believed that a local community member was more credible than an outsider from a social service agency. Shaw and his colleagues favored hiring indigenous workers as a way of developing local competence to enable the community to organize to prevent social problems. Indigenous staff also made visible the belief of the Area Project in the strength of local communities. Shaw and his staff sought to provide training, technical assistance, and other support needed by the community youth committees and their staff workers. He respected the local community by maintaining the independence of these youth committees. The community youth committees usually nominated and always had veto power over the selection of the executive staff member. These executive staff maintained an identification with their neighborhood. They were expected to represent and advocate for their community committee at the Institute for Juvenile Research and the Chicago Area Project (CAP) offices. CAP staff honored committee decisions with which they disagreed and defended the

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membership of the committees to critics. The community committee took credit for its success and accomplishments, fostering not only independence but also a sense of efficacy and pride (Kobrin, 1959). Community youth committees established programs and activities responsive to the particular needs of their neighborhoods. Across the community committees in the first 25 years of the Chicago Area Project, there were three primary program components. First, prevention programs involved youth in recreational activities in a local setting during the school year and then at a summer camp. These efforts used available space in a nearby church or school and were usually staffed by local volunteers. Because of the concentration of YMCAs and other recreational facilities in some communities, the recreational programs of the committees varied widely from nonexistent to substantial. The second component of community committee work was activities to improve the neighborhood. These efforts involved identifying a community problem like the quality of schools, sanitation, community development planning, or law enforcement. Adults, and often youths, worked together on the problem to strengthen the community. The direction and scope of these improvement efforts varied widely as a function of community interest in a topic. For example, the Near West Side Community Committee worked for eight years on a complex community planning project with local merchants, citizen leaders, and politicians (Sorrentino, 1977). It also sponsored a weekend program of graffiti removal in which interested adults and youths used sandblasting equipment loaned by a local businessman (Keys, 1981). The third component of the Area Project's community committee activity was working with troubled youth directly to prevent the transmission of delinquency and to reduce the likelihood of more severe delinquent acts, thereby preventing incarceration. Indigenous youth workers met and passed time with groups of boys, encouraging them to get involved in positive activities like visiting new places in the city, fishing, and developing their own clubhouse. The workers and committee members counseled troubled youth and their families and, when necessary, linked them with social service agencies for additional assistance. The worker

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and community committee also joined with the police and juvenile court to prepare an effective supervision plan designed to keep a troubled youth out of prison. They visited local boys serving time in detention facilities and helped adult parolees make the transition to community life. These last two activities- with convicted criminals- were intended not only to reduce the likelihood of recidivism, but also to prevent delinquency by making it less likely that former convicts would transmit the norms, skills, and values of delinquency to neighborhood youth. Virtually all of the community committees were active in working directly with gangs and troubled youth. COMMENTARY: CONTRIBUTIONS AND CRITICISM

The Chicago School of Sociology and the Chicago Area Project that developed to prevent juvenile delinquency have made significant contributions to their twin goals of establishing sociology as an empirical science and promoting social reform. Their primary theoretical contribution has been to develop a "bold, imaginative" (Sarason, 1974, p. 127) theory to understand how social problems are consequences of the way communities function, including individual, social, neighborhood, and citywide levels of analysis. This theory does not blame individual deviants for their problems but examines the development of the city and the accompanying social conditions over time. It recognizes that large cities can be alienating for youth and that a sense of community and belonging is a powerful antidote to that potential alienation. Consequently, one implication of the perspective of the Chicago School of Sociology has been to encourage mental health professionals to broaden their theoretical perspectives of cause, risk, and prevention to include social and community factors as well as individual ones. Unfortunately, it can still be argued that while psychology and other mental health professions attend to social and community factors now more than they did in the 1920s and 1930s, they still have a long way to go. To a significant extent, recent preventive theory, research, and interventions continue to focus on individual factors (Cowen, 1982; Elias, 1987).

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In terms of criticism, the conceptual framework of the Chicago School has been faulted for overemphasizing the physical location of urban zones and for not accounting for delinquency in the black community (Bennett, 1981; Short, 1972). While their position doubtlessly evolved over time, Shaw and McKay (1972) were clear that they regarded the zonal model of Park and Burgess as a useful, if somewhat arbitrary, heuristic device to summarize a complex variety of findings, not as a rigid framework that implied great homogeneity within zones. In fact, they favored examination of variations between and within neighborhoods within zones. Interestingly, some sociological research continues to support the usefulness of the zonal model to describe urban development and the distribution of delinquency (cf., Webb, 1980). The delinquency patterns of Shaw and McKay (1972) reported for the black neighborhoods indicated a high rate of delinquency. Shaw and McKay noted that the impact of migration, urban renewal, and other social changes may be more pronounced in the black community. Due to racial discrimination, relatively fewer resources and avenues of opportunity were available to Blacks. Consequently, social disorganization and resulting social problems like delinquency could be more serious. For example, the Cabrini-Green area in the zone of transition just north of downtown Chicago had been a port of entry for many waves of immigrants in the early part of this century. However, since the Second World War and the advent of a large public housing complex there, this succession of ethnic groups has stopped and its inhabitants have continued to be virtually all black and poor. On the other hand, Shaw and McKay also point to data from the 1950s and 1960s that reveal declining (if still high) rates in some older black communities on Chicago's south side. These communities have made progress in establishing more stable social institutions. In short, Shaw and McKay have been able to account for delinquency rates among Blacks the same way they have accounted for delinquency rates among Irish, Swedes, Poles, and Italians- by identifying the social changes and the resulting disorganization that each ethnic group confronted in its communities.

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Concerning research, Shaw and McKay's work is a model for blending qualitative and quantitative methods to complement one another. The quantitative studies of the distribution of delinquency in urban areas give a breadth of perspective and the life histories of delinquents offer a depth of insight. Such illuminating combinations of methods are all too infrequent. Shaw and McKay's (1972) work is also noteworthy for its longitudinal quality; it began in 1900 and sampled each of the next six decades. This time series permitted examination of community patterns of delinquency over time to suggest the impact of successive social disorganization and reorganization. Also, Shaw and McKay established a strong, theoretically grounded, empirical analysis of delinquency prevalence and transmission prior to planning a prevention program. Goldston (1983) has noted that establishing an adequate research base for the planning of effective preventive interventions continues to be a challenge for mental health researchers and practitioners. In terms of limitations, the most unfortunate shortcoming is the lack of thorough outcome evaluations of the Chicago Area Project and its community committees. Kobrin (1959) maintained that the complexities of evaluation research and the possible denial of service involved made such studies ethically questionable, if not scientifically unfeasible. Also, evaluation research did not begin to attract attention as a major area of study until the early 1970s- nearly 15 years after Shaw's death in 1957 and not long before McKay's in 1980. For example, Bailey's (1966) review only included 22 "systematic empirical" studies of correctional outcomes conducted outside of correctional settings (e.g., private agency, private practice, and community setting), and many of them did not include control groups. Nonetheless, there was significant information that reflected the impact of the Chicago Area Project. Kobrin (1959) reported that about a dozen community committees were established in the first 20 years of the prevention program. Bennett (1977) noted that in the mid-1970s there were 18 community committees in Chicago and over 100 similar groups in Illinois based on the model of the Area Project. Keys (1977, 1981) reviewed the recent archival records of two programs of the Near West Side Community Committee, one of

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the first committees established in the 1930s. Its records revealed continued attention to the three central components of the Area Project programs initiated over 40 years earlier. There was an active athletic program, including baseball, flag football, basketball, boxing, and hockey. There were adults and youth working together to improve community conditions- identifying and removing graffiti and repairing related property damage. Effective working relationships with juvenile court, local police, and city social service programs were evident. Community members worked with troubled youth of black, Hispanic, and ItalianAmerican descent who subsequently stopped their anti-social behavior. At least two of the leaders in the Near West Side Community Committee had been on the brink of delinquent careers when their participation with this committee and the Area Project directed their lives in a different way. Now senior citizens, both these men have devoted their entire adult lives to delinquency prevention in their neighborhood and throughout Illinois. While the Chicago Area Project has not been rigorously evaluated, the direct impact of its work continues to be very evident over 50 years after its inception. It currently is established as a United Way agency with a $2 million dollar annual budget and active community committees in 25 Chicago neighborhoods (Jeter, 1986). One other research criticism has been common: the use of official statistics to identify delinquents, critics argue, may reflect police and court attention to an area more than the actual prevalence of delinquency (Bennett, 1981; Short, 1972). Shaw and McKay were aware of the limitations of official records; they maintained strongly that official records were not grossly inaccurate because police "looked the other way" with some regularity in all neighborhoods. Also, the offenders did not appear in juvenile court until their criminal behavior was considered serious, no matter what their home neighborhood. It should also be noted that the era of victimization surveys had not yet begun; consequently, few viable options to official records existed for Shaw and McKay to study the prevalence of delinquency city-wide. Concerning practice, advocates have praised the Chicago Area Project as a social reform movement to save American cities from their self-destructive tendencies (Sorrentino, 1977). The

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Area Project demonstrated that citizens can become involved and work together constructively to address and, in some cases, prevent a social problem. Saul Alinsky, who worked with Shaw from 1931 to 1941 on the Area Project staff, appreciated those principles of community organizing (Bennett, 1981). For example, including a cross section of local leaders, establishing a community committee, and building the community committee's sense of efficacy are all principles he articulated and applied in his later work in community organizing and training of community organizers (Alinsky, 1945). Alinsky's primary difference with Shaw was his use of conflict and confrontational tactics rather than persuasion and cooperation when dealing with those in power and authority. Nonetheless, in a real sense, Alinsky's disciples, from Caesar Chavez with the United Farm Workers in California to Gail Cincotta who made banks' disinvestment in changing communities a national issue, continue in the tradition of community improvement begun by Shaw and the Chicago Area Project. In addition, the Area Project's community-based model of citizen participation serves as an exemplar for the delinquency prevention programs in the 1960s. The Area Project was a forerunner of many social programs of that era that required citizen involvement and that helped develop greater indigenous leadership in economically disadvantaged communities throughout the United States (cf. Moynihan, 1969). Presently, the issue of citizen empowerment through participation continues to be important (Ventriss, 1985). Rappaport (1981), in fact, argued that current conceptions of prevention are too limited because their focus on individual needs excludes consideration of individual rights which derive from the social, community, and legal contexts. He called for an empowerment perspective that considers both needs and rights in conducting research and designing intervention programs. His rationale for empowerment is very similar to Shaw and McKay's emphasis on citizen participation and self-determination by communities. Another significant contribution of the Area Project was its outreach through gang work. While gang work began in the nineteenth century, in all likelihood the first sustained, organized program of gang work was that of the Area Project (Kobrin,

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1959; Short, 1972). Having an indigenous staff member interact informally with juveniles in their local gathering places was intended to prevent delinquent behavior, more serious criminal offenses, and incarceration. By the 1950s, many programs throughout the country used street workers to make contact with disenfranchised youths. Such outreach became a more accepted practice in social work (Short, 1972). Currently, innovators are proposing that staff go into the neighborhoods to work with the homeless who are too alienated from society to seek help in traditional ways (McNamara, 1986). Street work continues as a community-based prevention strategy, although its potential remains partly realized and little studied. A final significant contribution of the Area Project has been its implicit testimony to the limitations of viewing preventive interventions within an inoculation framework. Levine (1983) cogently noted that an inoculation framework derives from ~ physical health perspective that does not take differences in social and community contexts and their interactions with the individual into account. According to this perspective, the person can be quickly inoculated and can retain the preventive benefit of the inoculation across many, if not all, situations over time. Similarly, environmental interventions focus simply on affecting the physical environment (e.g., keeping the water supply clean) and do not attend to the interaction of individual and social settings. However, Levine argued that in contrast to physical health, behavior is more setting-specific and limited in its generalizability to other contexts over time. Behavior is complexly determined, involving individual, social, and community factors such that no one variable causes or prevents a particular behavior across all individuals, settings, and times. Therefore, interventions for the prevention of deviant behavior need to be sensitive to the possible impact of different social contexts across time and the interaction of persons with social and community contexts. A social ecological approach to prevention is sensitive to these issues (cf., Kelly & Hess, 1986). While Shaw did not conceptualize the operations of the community committees in those terms, their activities were very supportive of a more social ecological perspective for preventive interventions. Their direct involvement of indigenous boys in

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their peer groups, in recreation and camp programs, and in community improvement activities took into account the relevant social and community contexts and the boys' interaction with them. These interventions in the youngsters' community with friends, neighbors, families, and local institutions meant that generalization across settings was unlikely to be a significant problem. The community committees intervened in many of the behavior settings important to neighborhood youth. Because these local volunteers comprised these committees, the committees became part of the fabric of the local community and, in' some cases, have continued for decades. Thus, the problem of generalizability across time became moot. Finally, the multiple interventions of the Area Project committees addressed the concerns of individual youth, both those in trouble and those not in trouble, the social contexts of youth, and conditions in the community. This multi-faceted approach is appropriate for changing behavior caused by many interacting individual, social, and community factors whose relative contribution is difficult to specify. A variety of activities provide a variety of opportunities for reaching youths and involving adults, thereby strengthening the community's capacity for self-improvement. In short, given the difference between physical disease and socially deviant behavior, the preventive interventions for delinquency should follow a social ecological approach rather than an inoculation approach. The Chicago Area Project has demonstrated how a preventive intervention based on a social ecological approach can be put into practice. The most common criticism of the Chicago Area Project ironically reflects its distinctive strength- the emphasis on the local community. Critics of Shaw, and later Alinsky, have maintained that they focused too much on local neighborhoods to the exclusion of the entire city (Bennett, 1981). Consequently, they were less effective in addressing local problems caused by citywide factors beyond the control of the neighborhood. For example, the Near West Side Community Committee spent eight years in neighborhood planning, but it was unable to prevent Mayor Daley's decision to locate the new Chicago campus of the University of Illinois in the east end of their neighborhood. On the other hand, Plato and Aristotle believed that "polis" could only exi.st

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in a small community. Citizen participation may not be possible if too many are involved. Given Shaw's model of the idealized small Midwestern town from his own youth, the community was certainly a most appropriate focus for an urban intervention. More problematic is the role of the community today. Hunter and Riger (1986) indicated that currently neighborhoods are less central to individuals' lives than previously. Relationships are likely to be determined by profession, place of work, and other common interests instead of primarily by residential proximity. People may belong to many networks in which they have a limited investment. It is unclear to what extent this pattern applies to juveniles, but it does suggest that it may become somewhat more difficult to involve local adults in neighborhood-based delinquency prevention. Conversely, modern technology, media, and mobility have enabled those with common interests to establish a cornucopia of mutual aid or self-help groups. In the future, such groups may be the successors to community committees. They may be less locally based but more connected with one another and with delinquency prevention issues on metropolitan, state, and national levels. CONCLUSION

In conclusion, the Chicago School of Sociology and the Chicago Area Project exemplify some guidelines for the prevention of deviant behavior. There can be synergy among theory, research, and practice in which the strength of the whole prevention project is greater than the sum of the parts. For example, prevention projects should attend both to theory development and empirical research that increase understanding of the phenomenon as well as to interventions that prevent it. There can also be synergy in theory, in research, and in intervention considered separately. Theory that addresses individual, group, and community levels of analysis can do more justice to complex social behavior, like delinquency, than theory that focuses only on one level. The use of multiple methods focused by theory can indeed create a mosaic of data. Different kinds of data complement one another to provide a fuller understanding of the

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phenomena of interest. The preventive intervention can be impactful when it focuses on an entire neighborhood. Indigenous leadership, citizen participation, adequate training and support, and linkages to other local institutions are important. Multiple activities should address those most at risk for delinquent careers (e.g., gang work, counseling), those possibly at risk (e.g., recreation programs), and negative community conditions that could increase the risk for all (e.g., poor schools, influence of adult criminals). Overall, the activities of the Chicago School were characteristic of a broader social ecological model of preventive interventions rather than an inoculation model. The work of the Chicago School in juvenile delinquency helped initiate sociology as an empirical science and provided a basis for reform. That work continues to have influence in urban ecology, community organizing, social work, and criminology (Short, 1972). Hopefully, the field of the prevention of mental illness will find ways to draw on this historical resource. REFERENCES Alinsky, S. ( 1945). Reville for radicals. Chicago: University of Chicago Press. Bailey, W. (1966). Correctional outcome: An evaluation of 100 reports. Journal of Criminal Law, Criminology and Police Science, 57, 153-160. Bennett, J. (1977). Introduction. In A. Sorrentino (cd.), Organizing against crime: Redeveloping the neighborhood. New York: Human Sciences Press. Bennett, J. ( 1981 ). Oral history and criminology: The rhetoric of criminology. Chicago: University of Chicago Press. Blumer, M. ( 1984 ). The Chicago school of sociology: Institutionalization, diversity and the rise of sociological research. Chicago: University of Chicago Press. Cowen, E. (ed.). (1982). Research in primary prevention in mental health. American Journal of Community Psychology, 100, whole number 3. Elias, M. (1987). Establishing enduring prevention progress: Advanc:ing the legacy of Swampscott. American Journal of Community Psychology. In press. Faris, R. (1967). Chicago Sociology 1920-1932. San Francisco: Chandler. Goldston, S. (1983). Reactions. In H. Marlowe & R. Weinberg (eds.), Primary prevention: Fact or fallacy? Tampa: University of South Florida. Hunter, A. & Riger, S. (1985). The meaning of community in community mental health. Journal of Community Psychology, 14, 55-71. Jeter, J. (October 27, 1986). Chicago Area Project offers kids help, hope. Chicago Sun Times, p. 30. Kelly, J. & Hess, R. (eds.). (1986). The process ofpreventive consultation: An ecological approach. New York: Haworth. Keys, C. (1977). Near west side community committee youth project: Evaluation report. Chicago: University of Illinois at Chicago.

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Keys, C. (1981 ). Operation clean up: External evaluation for 1980-81. Chicago: University of Illinois at Chicago. Keys, C. (1983). Graduate training in organizational consultation: Three dilemmas. In J. Meyers & J. Alpert (eds.), Training in consultation. Springfield, IL: Charles C. Thomas. Kobrin, S. (1959). The Chicago Area Project: A 25-year assessment. Annals of the American Academy of Political Science, 322, 19-29. Levine, M. (1983). A comment on the debate on primary prevention. In H. Marlowe & R. Weinberg (eds.), Primary prevention: Fact or fallacy? Tampa: University of South Florida. Madge, J. (1962). Origins of scientific sociology. New York: Free Press. McNamara, B. (1986). Mental health policy in Illinois: The perspective of the mental health association of greater Chicago. Lecture at University of Illinois at Chicago. Moynihan, D. (1969). Maximum feasible misunderstanding. New York: Free Press. Rappaport, J. (1981). In praise of paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9, 1-25. Sampson, E. (1977). Psychology and the American ideal. Journal of Personality and Social Psychology, 35, 767-782. Sarason, S. (1974). The psychological sense of community: Prospects for a community psychology. San Francisco: Jossey Bass. Shaw, C. (1930, 1966). The jack-roller: A delinquent boy's own story. Chicago: University of Chicago Press. Shaw, C. (1983). The natural history of a delinquent career. Chicago: University of Chicago Press. Shaw, C. & McKay, H. (1972). Juvenile delinquency and urban areas, rev. ed.; Chicago: University of Chicago Press. Shaw, C., McKay, H. & McDonald, J. (1938). Brothers in crime. Chicago: University of Chicago Press. Shaw, C., Zorbaugh, F., McKay, H. & Cottrell, L. (1929). Delinquency areas. Chicago: University of Chicago. Short, J. (1972). Introduction to the revised edition. In C. Shaw & H. McKay (eds.), Juvenile delinquency and urban areas. rev. ed.; Chicago: University of Chicago Press. Sorrentino, A. (1977). Organizing against crime: Redeveloping the neighborhood. New York: Human Sciences Press. Thomas, W. & Znaniecki, F. (1918). The Polish peasant in Europe and America, Vols. 1 & 2. Chicago: University of Chicago Press. Ventriss, C. (1985). Emerging perspectives on citizen participation. Public Administration Review, 45, 433-440. Webb, J. (1980). Tracing the geographic distributions of delinquency (1940-1970) in Chicago: A time series analysis. Paper presented at the American Society of Criminology, San Francisco.

Chapter 3

Anthropology, the Meaning of Community, and Prevention C. Timothy McKeown Northwestern University

Robert A. Rubinstein Northwestern University

James G. Kelly University of lllinois at Chicago

SUMMARY. Successful health promotion and disease prevention efforts must be designed with a thorough knowledge of the community in which they are to be used. Unfortunately, our understanding of the term "community" is currently in a muddle. In this paper we clarify the nature of communities by examining how the concept has been treated in four classic community studies. Three important points emerge: (1) that community is a multifaceted conce'pt, (2) that communities are best viewed as assortments of social processes, and (3) that each community has within it many different communities. We then illustrate these findings with a commentary on Kelly's often cited longitudinal community psychology study of adolescent boys attending two high schools.

Successful health promotion and disease prevention efforts must be designed with a thorough knowledge of the community This paper has profited from critical review from Steven Cobb, Robert Hess, Leonard Jason, Chris Peebles, Helen Schwartzman, Dave Todd, Jeff Ward, and Oswald Werner. Reprints may be obtained from C. Timothy McKeown, Department of Anthropology, Northwestern University, Evanston, IL 60201. © 1987 by The Haworth Press, Inc. All rights reserved.

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in which they are to be used. Public health professionals, community psychologists, and other practitioners recognize this basic premise but differ in how they operationalize it. To some it simply means being sure that they know the "demographic facts" about an area. To others it may mean that a telephone survey or other kind of "needs assessment" should be carried out before a program is designed. To still others it means recognizing that the success of any health promotion or disease prevention effort will be effected by the cultural and social meanings given it by the people it seeks to reach. We agree with this last group- how a program develops, and how successful it will be, depends upon how it is integrated into people's daily lives. In this sense, project success depends upon a deep understanding of the "community" (see Rubinstein et al., 1985). It is thus necessary to pay careful attention to what is meant by "community" when we talk about community-oriented or community-based projects. The term community is currently in a muddle. It is used to describe everything from plural organisms to the entire human population of the planet. This stands in the way of effective health promotion and disease prevention activities. Sociologists and anthropologists have had a good deal of experience with a genre of work called community studies. In this paper we seek in that work a clarification of the nature of communities. We do this by using the analytic techniques of ethnoscience to examine closely how the concept of community is treated in four classic community studies. Although none of these four studies is directly related to health promotion or disease prevention work, they provide empirical and conceptual materials concerning the nature of communities upon which practitioners interested in developing more effective programs can draw. Three important points emerge: (1) that community is a multifaceted concept; (2) that communities are best viewed as assortments of social processes; and (3) as our understanding of communities matures we see that each community has within it many different communities. We illustrate these findings with a review and commentary on an often cited community psychology research project, the longitudinal study of adolescent boys attending two high schools by

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James G. Kelly and his colleagues (Edwards & Kelly, 1980; Kelly, 1971, 1979). In developing effective health promotion and disease prevention programs, how a program is integrated in daily life, and what community resources are mobilized to insure its success varies depending upon the perspective from which the group is viewed. Effective prevention efforts will be those that successfully mediate the competing interests of various communities within a community, thus enabling the program to tap rich social and cultural resources in community life.

COMMUNITY RESTUDIES BY THE BOOK Community is used as an over-arching concept in a wide variety of situations and it is given many meanings. Hillery (1955, 1982) reports on the basis of surveys he did of the professional literature that "there is no agreement over the object that the term 'community' is supposed to describe, except perhaps that community refers to something living. Certainly, however, a diligent search would destroy even that apparent unanimity" (Hillery, 1982, pp. 12-13). Indeed, there are many settings in which to seek the meaning of community: in the private conversations of lay people, in textbooks, at professional meetings, in the popular press, in journals, and in ethnographies. The four examples we use in this paper- each a "classic" in the anthropological literature- meet three criteria. They are: (1) from the professional literature of anthropology, thus expressing its "expert knowledge" (Werner & Schoepfle, 1987); (2) studies with an explicit focus on the community as a unit of analysis; and, (3) examples of community restudies, places which have been studied at two or more points in time. We focus on two sets of community restudies, one of Chan Kom, Mexico by Robert Redfield (1934, 1950), the other in Wangala and Dalena, India by T. Scarlett Epstein (1962, 1973). These studies are widely considered classics of the community study literature, and collectively they span research from the 1920s to the 1970s. We use these studies to look at the actual use

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of the concept of community by investigating the contextual meanings of the term. The detailed analysis of printed sources has a long history. Perhaps the greatest tradition of this type of textual research is biblical scholarship. This method of research, called exegesis"the interpretation of and commentary on a book" (Williams, 1983, pp. 92-102)-has also been used in anthropology, where ethnographers routinely include the review of documents in their work. Exegesis has more recently been used by anthropologists to understand native knowledge systems. The contextual exegesis of key concepts is a major way of structuring ethnographic analysis in several recent texts (e.g., Rosaldo, 1980; Schieffelin, 1981). Contextual exegesis of native concepts is to interpretive ethnography as kinship and social structure were to functional ethnography ••• (Marcus & Cushman, 1982, p. 36) The "native" concept under study in this paper is community in the restudies of Redfield and Epstein. The analytical techniques we use for this exegesis are the methods of ethnosemantics (Spradley, 1979, 1980; Werner & Schoepfle, 1987). This approach emphasizes the importance of the environment within which a concept occurs. Textual environment is defined by the semantic relationship of the term with other concepts. The related concepts describe the semantic content of the term. In this chapter we investigate the relationship between the genus community and its differentiae. The concepts, semantic intention and extension, are particularly useful for this analys~s (Lyons, 1968). The most general type of community, that is the one with the fewest and most general attributes, has the most extension. Inclusion of additional attributes creates a new subtype of community with less extension, or applicability, but greater intention, or specificity. Data for this study were gathered in two phases. First, every use of the terms community and communities was located in the four texts and the sentence containing the term was recorded. Some occurrences were ambiguous and failed to make the refer-

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ent explicit. This included such phrases as their community and the community. These ambiguous sentences were only included in the analysis if the specific referent could be identified from the preceding text. A total of 173 explicit uses of community were identified. These sentences provide the source of the relationships which define the semantic content and context of the term community. Throughout this paper. these "native terms" have been underlined to set them apart from the text. The second phase of analysis consisted of reviewing all sentences in order to identify the various "kinds of" communities. From this analysis, we constructed a taxonomy of community types for each of the four volumes. After the construction of these taxonomies, each sentence was reviewed again for attributes related to each individual taxon. For example, the following sentence from Redfield's first study of Chan Kom was treated as described. If Chan Kom differs from the typical tribal community in that it is tied into wide economic and political systems by the institutions that have just been described, on the other hand it is like all such preliterate communities in the imminence and importance of gods and spirits. (Redfield, 1934, p. 107)

Redfield identifies two different kinds of communities. These are the tribal community and the pre/iterate community. These can in turn be seen as hierarchically related with tribal community being a kind of pre/iterate community. Chan Kom is identified in the sentence as being a pre/iterate community and different from the typical tribal community. Lastly, the pre/iterate community is characterized by the ''imminence and importance of gods and spirits." This technique was used to abstract all semantic relationships of community from each of the 173 sentences, in order to establish a semantic field. These minimal semantic specifications, for example "Chan Kom differs from the typical tribal community," were next paraphrased to fit grammatical constraints and incorporated into the taxonomies. We follow convention by

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marking the taxonomic relationships in each figure with an arrow pointing from the more general to the more specific term. KINDS OF COMMUNI1Y Redfield!1 1934

The peasant village of Chan Kom is located in the Mexican state of Yucatan. Redfield did fieldwork at Chan Kom from 1930 to 1933, together with Alfonso Villa Rojas, a Yucatan-born teacher. The study, Chan Kom: A Maya Village, was published in 1934 (Redfield & Villa Rojas, 1934). Redfield was interested and theoretically involved in developing the concept of community. Fieldwork at Chan Kom is Redfield's second community study in Mexico, the first being his 1920s study of Tepoztlan (Redfield, 1930). Redfield's primary interest in Chan Kom study was the comparison of village communities with more "civilized" town and city communities. Toward this end Redfield developed the concept of the folk-urban continuum to distinguish among rural and urban communities. This became a widely used way of organizing community studies (see, e.g., Wirth, 1956; Reissman, 1970). Redfield's primary focus was on the village community. In discussing village communities he states: They differ from the communities of the preliterate tribesman in that they are politically and economically dependent upon the towns and cities of modern literate civilization and that the villagers are well aware of the townsmen and city dwellers and in part define their position in the world in terms of these. Besides the primitive tribal settlement, the peasant village and the city, one may distinguish the town, intermediate between the city and the village on this rough scale of community types. (Redfield, 1934, p. 1) This statement provides insight into Red{ield's conception of the community. Several different kinds of communities can be identified from it. He stratifies communities into preliterate and liter-

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ate categories. Similarly, he identifies four kinds of communities: the primitive tribal settlement, the Peasant village, the town, and the city. Of these four types, the primitive tribal settlement and peasant village can be classified as preliterate communities with the town and the city being literate communities. These basic distinctions can be used to organize the rest of the communities Redfield identifies. From the total of 37 sentences in which he uses the term, Redfield names 18 different kinds of communities. These are distinguished from each other by the use of various modifiers such as the indefinite article (a community), pluralization (the communities), or by the identification of particular constituent populations (Indian communities), relationships with other communities (daughter communities), and other attributes like the transitional character of the Chan Kom community. Major stratifications (such as the preliterate/literate dichotomy) can be placed on the same level of abstraction in a taxonomy of community. Redfield is concerned with both the description of Chan Kom and with the position of this village within the milieu of other communities (see Figure 1). At the bottom level of the taxonomy Chan Kom is the community described according to its character, membership, relationships to the outside, and dynamics. By working upward through Redfield's taxonomy various other attributes of the Chan Kom community become apparent. Chan Kom is described as a daughter community to its parent community of Ebtun. It is also related to various other communities outside of this parent/daughter relationship. Chan Kom is considered a local community in contrast to its neighboring communities. Chan Kom is a village community, or more precisely a peasant village community, and differs from the primitive tribal settlement, the town, and the city. Chan Kom is an Indian community as well as a pre/iterate community. At the top of the taxonomy Chan Kom can be identified simply as a community with its own folk culture. Taken as a whole, this taxonomy shows that the concept of community is used by Redfield to categorize a great many varied types of phenomena. These categories are related to each other both horizontally, in terms of contrasting attributes, and vertically, in an additive fashion.

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community

the communities

Indian the town prtmtttve tribal

vtllage community community

dt~ughter

community

Chtln Kom/the community

parent communities

other communities

disordered communities

FIGURE 1. Taxonomy of "community" in Redfield (1934).

Redfield, 1950

Redfield (1950) returned to Chan Kom in 1948 to study the changes in the village since his original research. Chan Kom had changed much since the early 1930s. The results of this restudy were presented in A Village that Chose Progress: Chan Kom Revisited. This volume has 98 sentences containing the term community. Twenty-three different kinds of community were identified from these sentences. A taxonomy of the community concept in the Chan Kom restudy is presented in Figure 2. Starting at the top of the taxonomy, the first two nodes (a community and the community) are

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identical to those identified in 1934. From this point on, however, major divergences are evident between the two publications. In the restudy Redfield proceeds by identifying Yucatecan communities as kinds of communities. Further division of Yucatecan communities is problematic. Redfield specifically identifies Maya communities but does not explicitly name any nonMaya communities. He next identifies a split between rnral communities and significant, civilized and cultivated, progressive, and sophisticated communities. Villages and settlements of tribally organized Indians are identified as rural communities. Two kinds of village communities are recognized; attached coma community

communities

Vucatecan communities progressive community significant community sophisticated community civilized 11nd cultlv11ted community the city

home community C11thollc community

store's community

FIGURE 2. Taxonomy of "community" in Redfield (1950).

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munities and pueblos. On the side of the significant communities, two kinds are further delineated; the city and pueblos. At this point, the two branches of the taxonomy that initially were separated after Yucatecan communities are rejoined. Following the left branch of the taxonomy upward, the pueblo is identified as a kind of village community, rural community, and Maya community. The pueblo can also be seen as a kind of significant, civilized, progressive, and sophisticated community. This somewhat unconventional taxonomic representation mirrors the status of the pueblo as visualized by Redfield. The pueblo is viewed by Redfield as being in a transitionary position which, while still a village, also has the form and practical advantages of civilized life, with its own lands to exploit for the benefit of those who worked them and with the freedom and right to make its own government and administer its laws through its own citizens. (Redfield, 1950, p. 163) Two different kinds of pueblos are recognized by Redfield. Parent communities or home communities are kinds of pueblos which are related to the previously mentioned attached village communities. The other type of pueblo is the pioneer community. The pioneer community has little dependence on or obligation to any other community. Furthermore, pioneer communities are defined in two contrasting ways: "first of pioneers in a wilderness and then of pioneers in adopting many of the ways of city people" (Redfield, 1950, p. 17). The next lower taxonomic node is the frontier community, which emphasizes the wilderness aspect of pioneer communities. Finally, we arrive at Chan Kom or the community, which is defined by the attributes of all the preceding taxonomic nodes as well as a specific set of spatial and temporal attributes. Unlike his earlier analysis, Redfield later identifies several new types of community which are kinds of, or within, the Chan Kom community. The two examples given are the Catholic community to which some, but not all, of the Chan Kom residents belong and the store's community, with an unknown member-

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ship. Both of these sub-Chan Kom communities are associated with identifiable institutions. There are two major differences between the use of the term community by Redfield in the 1934 and 1950 volumes. In the initial study, he emphasizes the importance of literacy in stratifying the kinds of communities. This criterion is not mentioned at all in the second study. Second, the restudy concentrates on several new types of community which were not mentioned in the original study. These new types include the significant, civilized, cultivated, progressive, sophisticated, pueblo, pioneer, frontier, Catholic, and the store's communities. The inclusion of some of these terms is obviously, though not entirely, due to actual changes in the Chan Kom community as it developed from a dependent daughter community into a pueblo. Other changes reflect a difference in the way Redfield was using the concept of community. Although the restudy is a much slimmer volume, Redfield uses the term over twice as many times. Further, he uses the term to identify a broader range of groupings, including communities within the Chan Kom community. Epstein, 1962

T. Scarlett Epstein studied two villages in South India: Dalena and Wangala. She conducted fieldwork for her original study from 1954 to 1956 and published it in 1962 as Economic Development and Social Change in South India. This volume has a total of 13 sentences containing the term community. Figure 3 presents the taxonomy of the nine kinds of community identified from Epstein's use of the term in these sentences. Starting at the top of the taxonomy, the most extensive type of community is indicated by the definite article. The term "the community" designates a concept defined in terms of obligation, making life possible and defining a person's position within it. Only one type of the community is explicitly named. This is the Community (with a capital C). The Community is a much more intensive concept which denotes the target of a large development project. Village community is one such target of the Community Development Project. Working down the left side of the taxonomy, the first node under the community is not explicitly

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(coste community)

village communities

Adlkl!rl!tko Untouchl!ble community

pel!sont community

Wong!! II! Untouchable community

Wl!ngl!ll! Pel!sl!nt community

the Untouchable community

the pel!sl!nt community

FIGURE 3. Taxonomy of "community" in Epstein (1962).

named but postulated from other parts of the text. This is the caste community. Two kinds of caste communities are explicitly identified by Epstein. There are the Adikamatka Untouchable community and the Peasant community. Both of these terms denote national level populations, with the Peasant community being the largest in the nation. The next more specific kinds of caste communities are the Wangala representatives of the nationwide Untouchables and Peasants. These local examples of caste communities are also designated as the Untouchable community and the Peasant community. It should be noted that the term the Peasant community is used twice in the taxonomy, once to designate the national Peasant community and once to designate the local Peasant community. However, in these contexts the terms refer to two quite different sets of people. Epstein, 1973

Epstein returned to Dalena and Wangela in 1970. This restudy was published in 1973 as South India Yesterday, Today and To-

McKeown, Rubinstein, and Kelly

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morrow: Mysore Villages Revisited. Twenty-four sentences containing the term co·mmunity were collected from this volume. Figure 4 presents the taxonomy of community from these sentences. In her second volume, Epstein explicitly identifies 14 different kinds of communities. The most general kind of community is a community. Two different kinds of community are named: the Community (again with a capital C) and local communities. The Community again identifies a development project, with a specific example being the Mandya Community Development Project. Village communities and caste/jati communities are identified as kinds of local communities. Some village communities are identified as modernized communities. A kind of modernized village community is the community. Two kinds of caste/jati communities are Peasant communities and "Backward Com11

community

local

Mandya Community

peasant community the community

other "backward" communities

Mana's community

FIGURE 4. Taxonomy of "community" in Epstein (1973).

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munities." Kinds of "Backward communities" are "scheduled

communities" and "other backward communities/castes." The most precise kind of community mentioned by Epstein is that of a single individual named Mana. Mana's community consists of himself and other individual members of the community and the scheduled community. Differences between Epstein's use of community in her original study and the restudy include changes in terminology and the explicit mention of community types in the latter study which were only implied earlier. The primary change in terminology concerns the designation of the Untouchable caste. In the original study, the local population of this caste was designated as the Untouchable community. In the second volume, the Untouchable community was never explicitly mentioned but was included as a scheduled community within a larger class of Backward communities. This change in terminology is directly due to changes in the policy of the Indian government concerning this caste which, while initially enacted before her 1950s research, are not manifest in that volume. Epstein's inclusion of designations which were previously only implied includes the local community and Mana's community. Both village and caste communities are identified as local communities. Epstein's placement of the individual within community context clarifies her earlier use of the term. COMMUNI1Y: A MULTIFACETED CONSTRUCT

Redfield's and Epstein's uses of the community concept differ from each other due to the particular study, populations, the diachronic development of the community concept itself, and the contrasts between the two ethnographers. Differences between the two study populations are obvious. Yucatan and Wangala are separated by a considerable distance and exemplify vastly different cultures. Discussion of caste or jati communities would be out of place in Redfield's work, while Epstein was not faced with the Indian-Ladino ethnic differentiation evident at Chan Kom. However, changes in each ethnographer's use of the concept through time are of interest. The taxonomy of the community

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concept in Redfield's first volume depicts a series of categories which are horizontally mutually exclusive. For example, a person is a member of a daughter community, a parent community, or another community (see Figure 1). One can only be a member of one of these communities and not share membership in several. In his restudy, Redfield uses the community concept differently. Categories are no longer mutually exclusive. Thus, a pueblo is both a rural community (like a settlement of tribally organized Indians) and a significant community (like a city). Redfield also recognized that even the most specific types of communities identified in his first study (the community and the Chan Kom community) were composed of more narrowly defined communities. The store's community and the Catholic community were recognized as specific kinds of Chan Kom communities. Between the two publications Redfield made clearer his use of the concept; he could account for more specific groupmgs. Epstein's use of the concept underwent the same sort of development as did Redfield's. Her initial study focused upon the interrelationship between the village community and various kinds of caste communities. An individual's membership in more than one kind of community at the same level is implied, but not explicitly stated. In her 1973 work, she makes this relationship explicit with the inclusion of an individual's community which is a specific kind of Wangala community. It is clear that community is a fluid concept and must be fitted to the requirements of particular study populations and changing theoretical positions. The development of a usable concept of community requires not only a thorough knowledge of the potential differences between usages but, more importantly, of the areas of agreement: Among sociologists who focus their study on community, concepts have attained such a degree of heterogeneity that it is difficult to determine whether any one of the resulting definitions, or even any one group of definitions, affords an adequate description. To the extent that the degree of consensus is in doubt, to that extent must one remain uncertain whether different things are being described or whether the

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same thing is merely being viewed from different vantage points. (Hillery, 1955, p. 111) At the most general level, both authors agree on what the community is. Using the designation a community or the community, both present a similar portrait of the concept. Both use a variety of attributes, including culture, spirit, common purpose, common rights, common obligation, determination, enterprise, making life possible, and the like. Redfield and Epstein indicate that they are looking for the sameness within their study populations. This use is quite similar to Tonnies (1963 [1887]) concept of Gemeinschaft (a close translation equivalent of the English term community), which can be characterized by "a high degree of personal intimacy, emotional depth, moral commitment, social cohesion, and continuity in time" (Nesbit, 1967, p. 47). Culture, spirit, purpose, rights, obligations, determination, and enterprise are all concepts which can easily be subsumed under the rubric knowledge. At its most abstract then, the community can be identified as the common, shared knowledge of a population. Community is the intersection of a group's knowledge. There are also areas of agreement concerning the types of attributes of various communities. They use four major attributes to define communities- biological membership, social membership, common institutions, and shared actions. These four types concern locality, membership, institutions, and actions. Attributes denoting locality were widely used by both authors. Attributes of locality designate the population of a particular location as members of a given community. Beginning with a large area (such as a state), the locality of a series of hierarchically organized communities was defined in an increasingly narrowing fashion from the top of the taxonomy to the bottom. Membership is likewise made more explicit at the lowest terminal nodes of the taxonomy than at the high-level, general ones. Redfield and Epstein use two types of membership criteria. The first of these concerns biological membership which denotes communities into which one is born and includes the various caste communities and the Maya community. The second attribute concerns individuals considered by others to be members of a given community. The most specific sort of mutually recognized membership is Epstein's example of Mana's community, where

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a single individual represents the authority of recognition for inclusion. The third attribute used to define community is that of institutions. A variety of institutions are recognized by the two authors. These include the Community Development Project, the store's community, the Catholic community, and the village community. Association with any of these institutions is a sufficient criterion for membership in the affiliated community. Some of these institutions, especially the store and the village, can also be considered, at least indirectly, locational in nature. The final attribute used by Redfield and Epstein to define community is that of actions. Various types of shared actions can be carried out toward or within a community. Thus, The life cycle of the maize plant, that every year sees repeated, fixes the annual rhythm of life for all the individuals of Chan Kom and for the community itself. (Redfield, 1934, p. 82) Lack of economic competition among Untouchables has strengthened the unity of the Untouchable community. (Epstein, 1962, p. 182, emphasis added) Conversely, the community itself can be portrayed in an active fashion. This kind of action attribute includes, for instance a community recognizing individuals and trying to enforce obligations. The type of community which can act on its own accord is known in the anthropological literature as a corporate community (Wolf, 1955, 1957).

Redfield and Epstein's uses of community provide for a rich understanding of the concept. Each of the 64 communities they identify has the attribute of common knowledge. This common knowledge is increasingly restricted at lower taxonomic levels by an overlapping matrix of attributes. Locality, membership, institution, and action attributes can be used in almost any combination to define the community. The most specific taxons of any community taxonomy would be expected to have examples of each of these attribute types. As a generalization, both action attributes and institutional attributes are restricted to the most

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specific types of communities, while attributes of membership and locality occur at all but the highest level. The concept of community has been many things to many people. Reviews of definitions of the term reveal little in the way of agreement. For a practitioner in search of a larger context within which to base social policy research, the concept of community provides an ambiguous beginning. Our investigation of the actual use of the concept reveals a much less muddled situation. Community is a hierarchically organized concept with the genus of the term designating the shared knowledge of a group. The specific group is defined by various differentiae according to locality, membership, institutions, and activities. An individual is simultaneously a member of several communities. As such, the individual must understand the shared knowledge of each of these communities. It is this shared knowledge which provides the contrast against which "abnormal" groups are judged. There are four general points about the meaning of community and prevention that we draw from this work; (1) prevention efforts must be presented in the "community•s" terms, in order to facilitate communication; (2) we should be especially careful that the effectiveness of the intervention program and its staff is not restricted because their means of entry into a community results in their being given an overly narrow social role; (3) we should pay attention to the importance of fitting prevention activities to the community cycle of daily life; and (4) we should realize that prevention efforts are never simply two-way transactions between "a community" and "a program," but always necessarily involve other "communities of interest": whether funding sources, professional communities, or political groups.

COMMUNITY AND THE HIGH SCHOOL STUDY

The following discussion offers reflections about the meaning of community, stimulated by an intensive research experience in designing and carrying out a longitudinal study of high school students. This discussion draws implications for the concept of

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community- the meaning of shared knowledge of a groupfrom different aspects of this research. From 1968 to 1972, the third author (Kelly) directed a longitudinal study of groups of high school boys attending two high schools in southeastern Michigan (Edwards & Kelly, 1980; Kelly, 1971, 1979). The study was conceived to assess the impact of social environment factors within the high school upon the coping styles of high school boys. The major psychological concept of interest was the boys' level of exploratory preference. Eighth grade boys were selected from two schools according to whether they had a low, middle, or high level of exploratory preference, and they were followed with multiple methods during the rest of their high school careers. The two high schools were matched as closely as possible for social and economic variables. Final school selections were based on the turnover rates of students. During the research, it was determined that the high school with the highest turnover rate, Wayne, also generated a quality of more informal social interaction among students and faculty than South Redford High School. South Redford High School, with the lower turnover rate, had a consistently more formal style of interaction and there was less interaction between students and between students and faculty. The major finding of the research was that, over time, fewer high explorer boys at Wayne dropped in their level of exploration than those at South Redford. The research staff concluded that the quality of informal social interaction had an effect on the boys' engagement in the social life of the school. The research staff of the High School Research Project worked hard to break new ground in conceptualizing and measuring qualities of persons and social settings- specifically the relationship between qualities of the boys' exploratory preferences and the quality of informal social interaction within the high school. However, we did not record, or note many of the qualities of the total culture of the two schools or the surrounding community. Yet, today Kelly has still a very vivid memory of the "total culture" of the two high schools. The following four topics illustrate features of the research settings, not considered as primary data at the time, but which,

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nevertheless, suggest compelling characteristics of the total research setting. These topics will be reviewed to suggest the benefits of taking an anthropological outlook and of thinking anew about community-based research. Each of these four topics is presented, following the framework presented earlier in this chapter, as an important facet of phenomena related to the contexts of the high schools, even though these phenomena were not examined directly at the time. The Multifaceted Nature of Community: The Ledge

One of the high schools was constructed on a one floor plan with a series of interconnecting courtyards. The outside walls of the school had waist-high ledges, large and comfortable enough for students to sit on. Before school, between classes, during the lunch hour, and after school, the ledges were points of assembly for peer groups. Some groups always used specific ledges. The ledge locations of peer groups were so regular and predictable that a high school faculty member could easily locate a specific student. Since there were enough ledges for a large number of groups there were not many occasions, as far as can be recollected, where there was a conflict over ledges. When the research was being carried out, the phenomenon was noted with interest. Today, the significance of the ledge seems much larger. Certainly the social structure of the high school that contained the ledges was not similarly expressed at the other school. There was confirming evidence at the high school with ledges that the students believed that the high school was not a supportive, congenial, or attractive social setting. It seems today that the ledges were not only a critical part of the social environment of the high school but that in using the ledges, students were creating an explicit social structure as a response to being a member of an undifferentiated and unstimulating environment. Students may have been taking the initiative to, in fact, "explore" ways to use the physical properties of the environment to create a meaningful social space when the overall school environment was not providing much of a supportive structure.

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In retrospect, the culture of the school could have been tapped to enrich the meaning of the psychological construct of exploration that the research team was assessing. One hypothesis is that the students, by sitting in a predictable place, could be seen and at the same time see the life of the school and, by doing so, they could create a conception for themselves of structure and identity. The ledges may have defined social membership in terms of special locales. Who was occupying which ledge with whom gave an opportunity for students to express their social roles and status. At the time, the research staff did not understand the precise ways in which the activities of the subgroups of boys defined how ledges were selected, how ledge partners were selected, and how ledge ownership was expressed and redefined. Now what seems to be an apt question is to clarify to what extent the knowledge and use of the ledge provided cultural and psychological meaning for the individual students and the social structures of the adolescent boys. Ledges could be excellent sites to examine how individual boys related to the social structure of the high school. Given that one of the distinguishing variables of the two high schools was that the schools differed in terms of patterns of informal social interaction, the study of the ledge could have elaborated how the informal social structure, as expressed via the ledges, could serve a pivotal role in the particular high school where the larger social environment was characterized by little informality and a small sense of connectedness. In retrospect, this phenomenon of the ledge suggests that in social structures where there is a low amount of informality, the participants can use their ingenuity to create a visible way to define themselves through their use of space. The importance of the concept of geographical space is that by being a participant in a self-defined space, participants can visibly express their special, shared knowledge and their position in the social structure. Elaborating the concept of the ledge emphasizes how indeed the concept of community is multifaceted and how the community interventionist is aided when the concept of community can be elaborated. In this instance, the role of the ledge gave a richer meaning to the concept of the high school.

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The Community as Social Process: Differences in Ownership

The concept of ownership of the research illustrates the stages and social processes members of the high school community went through to define and give meaning to their concept of community. Each high school had a contrasting response to the research when they were providing research data and when they were considering the potential benefits of the research data. As mentioned previously, the school in Wayne, Michigan was a more attractive site for students and faculty. The longitudinal research pointed out that students were able to maintain or increase their preferences for exploratory behavior at Wayne Memorial High School more than at South Redford High School. The two high schools also differed in the type of working relationship they developed with the research staff. When we approached Wayne High School to collect data we found a very efficient research enterprise. Data was easily collected and there was no major difficulty in obtaining maximum cooperation from the faculty, students, and administration. When we approached the faculty to discuss the implications of the research findings, the research staff was greeted at Wayne with polite, perfunctory courtesies. It did not seem as if they were receptive to the information generated by the research project. The principal and faculty were glad to listen to us present our findings but it did not seem as if the research results were really heard. At South Redford High School, the response was reversed. Going to this high school to collect data created anxieties. Frequently, there were last minute hitches. Often, there were understandable and unavoidable last minute requests for us to change procedures. On occasion these last minute changes were prompted by the consensus of a group of faculty or administrative staff who felt they needed to review the research instruments. What we found out over time was that such requests were not always stimulated by only the personal concerns of the faculty. Reasonable delays and extra surveillance were designed, in fact, to protect us from unnecessary or unexpected complaints from parents. Over time, we realized that the Principal, Assistant Superintendent, or Field Coordinator were being helpful in their

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anxiety-provoking actions. In reviewing the research instruments they were better prepared to interpret the research to a concerned citizen or school board member. The additional review process helped them to help us. It took the research staff some time to see requests for additional reviews not just as guardedness, anxiety, or opposition, but as expressions of commitment to us and our work. The two schools' contrasting response to the research team's roles as researchers and as resources for useful information were apparent and consistent over time. As mentioned, the high school in Wayne was most efficient in responding to the needs of the research team. Students were easily assembled for data collection. The principal and field coordinator were cooperative and industrious in their efforts to help us meet our research objectives. As a research staff we looked forward to going to Wayne Memorial High School to conduct our research. When we reported research results, we found that at Wayne the time allotted for our report was brief. There was usually a full agenda covering the primary business of the high school. The report session usually followed a business meeting and served as an important ceremonial occasion in which the research staff were simply complying with terms of an agreement to report results on a semi-annual basis. Going to South Redford as a research group created anxieties within the research team. But when we reported the results to the faculty at this school, there was genuine attentiveness and interest about how the research findings and our research instruments could be used as feedback. Feedback sessions were arranged so that our report was the only topic to be discussed. Towards the end of the research relationship, the faculty at South Redford created a work group and took the initiative to form plans to study the quality of the high school environment. This faculty group took seriously the task of looking at the quality of life within the high school environment. Using our research instruments and staff as resources, they developed plans to assess such topics as morale of the faculty, satisfactions of students with teaching innovations, and plans for revising the curriculum. While the restlessness within the faculty and students at South Redford High School contributed some

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definite unpredictability in research efficiency, this same unpredictability, in retrospect, also seems correlated with a readiness for faculty to benefit from insights from the research group. This phenomena of the contrasting responses to the research relationship is tantalizing for what it says and does not say about these two high school communities- their styles of life, their definitions of membership, their boundaries for relating to outside groups, and their values for primary activities. Somehow, the apparent pain, confusion, and anxiety in South Redford turned out over time to be an opportunity to provide a genuine basis to build a relationship with the research staff. In our efforts to succeed in the difficult tasks of creating a longitudinal study in the field, the research staff often did not see any latent benefits of inefficiency. Likewise, we were under the illusion of thinking that the school which helped us carry out our research role in such a superb way would be equally cooperative and responsive in doing something about improving or evolving their school as a result of our findings. In this sense we experienced the meaning of community as a social process, where the definition of community varied depending upon the processes- the activities we were engaged in. The social process of relating to the schools as research investigator appeared to be different than the social process of relating to the schools as research interpreter. Considering the concept of community as a social process enhances an understanding of these quite different responses of the two schools. It appears that South Redford assumed the role of ownership seriously and, thereby, was more invested in seeing to it that the research procedures did in fact go well without parental complaint. There certainly were more opportunities to test out the meaning of the research data. At Wayne, with less investment in the social process of owning the research relationship, there was more attention to protecting the cosmetics of the research relationship by doing a good job of fulfilling the contract to supply data. The Community Changing Over Time: The Role of the Field Coordinator

To enhance the efficiency of data collection and to reduce any negative impact of the research relationship with the collaborating high schools, a faculty member at each school was selected to

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setve as a field coordinator. This role was created to help facilitate data collection and to setve as a resource to the research staff in understanding the social environments of the two schools. An important criteria in the selection of the field coordinator involved recruiting a high school faculty member who had the respect of administration, faculty, and students, and who could communicate with these different subgroups in the high school. We seem to have intuitively identified an essential concept of the field coordinator: boundary spanner. The field coordinator was the person who had access and acceptance within the multiple strata of the social structure of the school. We were fortunate to have had the cooperation of persons in the role of field coordinator, who during the course of the study were able to achieve these key roles. In this way, the study was more connected with the social life of the two schools. The research, then, was coupled with the social fabric of the school. Over time, the research staff members were perceived as resources to the school and in several instances the research staff setved as informal advisors and consultants on topics of school guidance and curriculum development or research. The field coordinators helped us interpret the locality, and they helped us understand the different criteria for membership in various clique formations within faculty and student groups. The subtle differences in the styles of interactions of habits or traditions of the two high schools were illuminated by the field coordinators' insights and perspectives. We were better able to ascertain how the various informal activities of students and faculty could be understood within the traditions and activities of the social life of the high school. The role of the field coordinator in itself could have been a major topic of investigation. Of particular interest would be an analysis of the equity that the field coordinators themselves gained or lost as they carried out their roles and were perceived as the "go betweens" for the research investigation. Today, we know very little of the bartering or influence processes they used to request cooperation and compliance with the research procedures. Did the role of field coordinator help or hinder their own integration within their own communities? At the time, our view of the field coordinator was to make it easier for this complex research to be carried out and for the

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research staff to have a comfortable working relationship with the school staff. While we were curious about the significance of the concept of the role of field coordinator, we did not take full advantage of the fact that the concept and role of the field coordinator was in itself, in its own right, a topic of substantive value. The very operation of the role of field coordinator reflected how the communities of the two schools did work. How the field coordinator did their work was, no doubt, diagnostic of the social norms and values of their high school environments and of their way of defining their role in the context of their other faculty roles within their own communities. As the research team became more familiar with the high school, and the high school faculty became more knowledgeable about the research team, the relationship became more developed. The field coordinator's role in each school enlarged. At South Redfield the field coordinator became more of a resource for the faculty and administration as they became more invested in using the data. The field coordinator used the research staff as a resource to discuss topics of faculty morale, quality of the school environment or organizational change in secondary education. The field coordinator at Wayne Memorial High School, on the other hand, became more invested in thinking about the role of social science and psychology in the high school curriculum and became a resource for other faculty who were interested in curriculum reform in the high school. As both field coordinators became more established in the role, they articulated ways in which the research staff could be a resource for the high school in keeping with the social norms and values of each school. The changes in the role of the field coordinator illustrated the changing meaning of the research for that community. Summary

Each of the three topics- the multifaceted nature of community, the social processes of community, and the meaning of community in tenns of changes over time are compelling themes for the field of prevention. Drawing upon the experience of the high school study, the third author has suggested how these different concepts can be illustrated. In describing the ledge as a facet of one high school, the social process of ownership of the research,

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and the evolving role of the field coordinator, varied meanings of the concept of community have been presented. These examples illustrate the range of phenomena that can reflect the richness of a community research relationship. With a broader community lens, important and new insights and understandings can emerge. These three examples suggest the types of community research that can help unravel the intricacies of a community study within the field of prevention. For the field of prevention, these concepts of community are generic issues, for they illuminate the behavior of individuals and social settings. The meaning of psychological concepts are expanded. Strictly psychological interpretations of community phenomena can only serve as an unintended affirmation of a null hypothesis- and miss the chance to understand the rich subject matter of prevention: the study of community processes and functions as these processes effect individuals and social structures. Elaborating the concept of community is essential for the field of prevention because such elaboration, specifies precisely how social processes can be understood beyond focusing on the qualities of the individual. The field of prevention needs to create concepts to account for how social, organizational, and cultural processes impact the individual and vice versa. Focusing on the various meanings of the concept of "community" helps to create essential defining qualities for the uniqueness of the field. CONCLUSION

Review of work in community studies makes it clear that, whatever else they may be, communities are complex and dynamic collections of social processes. The task of studying these and of designing mental health interventions based on them requires hard work and a sensitivity to social process. We began by noting that community development work recently has been much in vogue in sociology and anthropology. While formal definitions of community are still in flux, this work has resulted in some common understandings about how to carry out community-based interventions. Goodenough (1962, pp. 22-33), for instance, sums these up:

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1. Development proposals and procedures should be mutually consistent. 2. Development agents must have a thorough knowledge of .the main values and principal features of the client community's culture. 3. Development must take the whole community into account. 4. The goals of development must be stated in terms that have positive value to the community's members. They must be something they, as well as the agent, want. 5. The community must be an active partner in the development process. 6. Agents should start with what the community has in the way of material, organizational, and leadership resources. 7. Development procedures must make sense to the community's membership at each step. 8. The agent must earn the respect of the community's members for himself as a person. 9. The agent should try to avoid making himself the indispensable man in the development situation. 10. Where there are several agents at work, good communication and coordination between them and their respective agencies is essential. As the High School study reveals, these are not sterile scientific principles. Rather, they are dynamic imperatives that should serve as a prospective guide to developing community based prevention research. Those efforts will need to accommodate social and cultural factors if they are to be truly collaborative. To this end, the anthropological literature suggests that (1) efforts must be presented in the "community's" terms, (2) the effectiveness of the intervention program and of its staff may be restricted because the community assigns them an overly narrow social role, (3) prevention activities should be fitted to the community cycle of daily life, and (4) prevention efforts are never simply two-way transactions between "a community" and "a program," but always necessarily involve other "communities of interest," be those funding sources, professional communities, or political groups.

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REFERENCES Caplow, T., Bahr, H. M., Chadwick, B. A., Hill, R. & Williamson, M. H. (1982). Middletown families: Fifty years of change and continuity. Minneapolis: University of Minnesota Press. Edwards, D. W. & Kelly, J. G. (1980). Coping and adaptation: A longitudinal study. American Journal of Community Psychology, 8, 203-216. Epstein, T. S. (1962). Economic and social change in South India. London: J. K. Publishers. Epstein, T. S. (1973). South India yesterday, today and tomorrow: Mysore villages revisited. New York: Macmillan. Goodenough, W. H. (1963). Cooperation in change. New York: Russell Sage. Hillery, G. A., Jr. (1955). Definition of community: Areas of agreement. Rural Sociology, 20, 111-123. Hillery, G. A., Jr. (1982). A research odyssey: Developing and testing a community theory. New York: Transaction Books. Kelly, J. G. (1971). The coping process in varied high school environments. In M.S. Feldman (ed.), Buffalo studies in psychotherapy and behavioral change (No. 2). Buffalo: SUNY. Kelly, J. G. (1979). Adolescent boys in high school: A psychological study of coping and adaptation. Hillsdale: Laurence Erlbaum Association. Lewis, 0. (1951). Life in a Mexican village: Tepoztlan restudied. Urbana: University of Illinois Press. Lynd, R. S. & Lynd, H. M. (1929). Middletown: A study in American culture. New York: Harcourt and Brace. Lynd, R. S. & Lynd, H. M. (1929). Middletown in transition: A study in cultural conflicts. New York: Harcourt and Brace. Lyons, J. (1968).lntroduction to theoretical linguistics. London: Cambridge University Press. Marcus, G. E. & Cushman, D. (1982). Ethnographies as texts. Annual Review of Anthropology, I, 25-69. Redfield, R. (1930). Tepoztlan: A Mexican village, a study of folk life. Chicago: University of Chicago Press. Redfield, R. (1950). A village that chose progress: Chan kom revisited. Chicago: University of Chicago Press. Redfield, R. & Villa Rojas, A. (1934). Chan Kom: A Mayan village. Washington: Carnegie Institution of Washington. Reisman, D. (1970). The urban process. New York: Free Press. Rubinstein, R. A., Kelly, J. G. & Maines, D. R. (1985). The interdisciplinary background of community psychology: The early roots of an ecological perspective. APA Division of Community Psychology Newsletter, 18, 10-14. Spradley, J. P. (1979). The ethnographic interview. New York: Holt, Rinehart and Winston. Spradley, J. P. (1980). Participant observation. New York: Holt, Rinehart and Winston. Tonnies, F. (1963). Community and society: Gemeinschaft und gesellschaft. New York: Harper and Row. Werner, 0. & Schoepfle, G. M. et al. (1987). Systematic fieldwork. Beverly Hills: Sage. Williams, R. C. (1983). Scientific creationism: An exegesis for religious doctrine. American Anthropologist, 85(1), 92-102.

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Wirth, L. (1956). Rural urban differences. In A. J. Reiss (ed.), On cities and social life. Chicago: University of Chicago Press. Wolf, E. R. (1955). Types of Latin American peasantry: A preliminary discussion. American Anthropologist, 57, 452-470. Wolf, E. R. (1957). Closed corporate peasant communities in Mesoamerica and Central Java. Southwestern Journal of Anthropology, 13, 1-18.

Chapter 4

Understanding the Policy Process: Preventing and Coping with Community Problems Tom Seekins Steven Maynard-Moody Stephen B. Fawcett The University of Kansas

SUMMARY. The resolution of many community problems is linked to political processes. Public policies may both create the context for community problems and offer a strategy for solving them. Two frameworks for viewing community policymaking, the Rational and the Dynamic Interest Group Models, are discussed. A case study involving utility rates illustrates the policymaking process and its relationship to community functioning. Particular attention is paid to the behavior of policy actors, factors that may influence their actions, and the consequences of their behavior. The role of public policymaking in prevention is discussed.

Public policies influence the quality of community life with political behavior central to building and maintaining the consensual thread of social organization. Politics involves resolving conflicts over social arrangements and allocating community resources and may be as fundamentally human as speech. Moreover, policymaking defines, in part, the contexts that influence who is poor, unemployed, uneducated, and in ill health. Many problems of individuals, families, and communities are political Reprints may be obtained from Thomas Seekins, Research and Training Center on Independent Living, University of Kansas, BCR/348 Haworth, Lawrence, KS 66045. © 1987 by The Haworth Press, Inc. All rights reserved.

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in origin. Such problems are often either the result of specific decisions of elected and unelected government officials or their willingness to leave unchanged current circumstances. Many of the problems in living addressed by professionals interested in prevention and community change are linked, therefore, to political processes. Population control, housing costs and availability, crime and delinquency, race relations, public health, poverty, child abuse, employment, and environmental preservation are just a few examples of individual and group problems that are largely shaped by government action or inaction (Levine, 1981). Once the political dimensions of community problems are identified, many community change agents have attempted to influence public policy as an element in prevention and treatment. Unfortunately, the policymaking process is complex, and advocating or examining policies requires understanding alternative explanations for community decisionmaking. This paper will describe two frameworks for viewing community policymaking: the Rational and Dynamic Interest Group Models. These models differ in their interpretation of policy making, but they share common elements. Common to the two are the components of the policymaking environment: the presence of institutions, actors, and consequences to actors. In addition, the models agree that the policy process involves three clusters of decision events: agenda setting or issue emergence, policy deliberation and adoption, and policy implementation. The models differ in how they describe the interaction of these common elements in the formation of specific policy responses, including non-decisions. After these models are outlined, they are applied to a case study of one community's response to the inability of its poor to pay increased utility bills. The paper closes with a discussion of behavior analysis as a framework for describing the processes underlying the two models and illustrated by the case example. COMMON STRUCTURAL ELEMENTS IN POLJCYMAKING MODELS

Policymaking takes place within the broader context of the routine events of daily life and involves the interaction of institu-

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tions, actors, and consequences to those involved and those choosing to remain on the sidelines.

Institutions In the United States, governmental institutions are the primary means for formulating and implementing public policy (Gerston, 1983). Policy making occurs in five major arenas, including legislative, executive, judicial, bureaucratic.and regulatory agencies, and occasionally by public referendum. The governmental structure of the United States may be described as a partially disjointed hierarchy of city, county, state, and federal governments. These levels have generally defined areas of responsibility and authority that subsume those below it. The federal government has the broadest area of responsibility but does not have direct control over most local policies. For example, the Department of Education can influence local school boards by providing grants for certain programs, but except in areas of equal opportunity and the separation of church and state, federal government has little direct control over local schools. In addition, the interaction of policies across levels of government is rarely simple. Policies are often modified beyond recognition as they move from one institutional arena to another. For example, numerous state legislatures have passed laws requiring car safety seats for young children, and state police may begin enforcing such a law on its effective date. In states with homerule provisions, however, city police cannot enforce the state law until it is adopted as an ordinance by the city government. With most of the population doing most of its driving within cities, city governments can functionally veto the state law. In this manner, a policy created at a higher level may not appear at a lower level. The interaction of policies of different units of government at the same level is not always direct, either. To use the example of child passenger safety law, the state police must develop guidelines or regulations prior to enforcing the law; is a seat belt or a safety seat required? These guidelines may enhance or blunt the impact of the law on child safety. For example, Tennessee State Police have emphasized enforcement of child passenger safety law while many other states have not (Seekins, Fawcett, Cohen,

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Elder, Jason, Schnelle & Winett, 1986). In addition, policies emerge from any level or unit of government and need not be initiated at the broadest level. For example, policies designed to prevent violence by reducing access to handguns have been repeatedly blocked at the national level. Meanwhile, a number of cities have adopted various forms of handgun control. The numerous levels and institutions of government do not form a neatly ordered system, and disputes across levels and between units of government reflect conflict in our society (Schattschnieder, 1960). The ongoing policy debates over racial segregation exemplify these conflicts. Discretionary decisions by a local school board to maintain neighborhood schools may reinforce discriminatory arrangements. Dissatisfied parents of affected children may file complaints and law suits to remedy the situation. In support of the law suit, the state's school board may threaten to withhold funds. The U.S. Department of Justice may ignore the case, thereby supporting the school board. A federal judge, in turn, may impose a court-ordered solution, such as busing. Parents dissatisfied with this new arrangement may protest in the streets. Local police may or may not attempt to prevent and control protesters' disruptions, property destruction, or violence. Other families may enroll their children in private schools or abandon the neighborhood. Thus, policymaking responds to and creates changes in social arrangements, although connections between policymaking and the events created by other relevant actors may be difficult to draw. Actors

A decision that produces a policy or non-policy response rarely occurs between all policy actors on an issue instantaneously. Rather, each actor makes many decisions over time. The consequences of these individual decisions influence the future decisions of other actors and those of the individual actor. Thus, policymaking may be described as involving a series of events taking place over time that set the occasion for other events by other individuals. A number of important actors, both individuals and groups, are involved in policymaking. These actors engage in influence and decisionmaking behavior in a number of contexts that in-

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elude private and public discussions and formal and informal settings. The actors in policymaking can be usefully categorized into three groups: (1) individuals, (2) interest groups, and, (3) the audience. Individuals. Individual policy actors involve a wide range of elected and unelected public officials and other community members who personally participate in policy discussions. As a result of their position and authority, these individuals have considerable influence over policy outcomes. They may be visible opinion leaders, such as an activist minister, or more obscure influentials, such as the director of an important agency (for a rich description, see Caro, 1977). Interest groups. Although individuals have considerable influence over policy, groups forming around specific interests, from mothers against drunk driving to dairy farmers for increased prices, are major actors in the policy community. These groups raise money, seek to expand public involvement in their causes, support and challenge selected elected officials, and lobby for specific policies. At times their efforts are highly visible, but often interest groups bind a small number of elected officials, administrative specialists, and individuals who are directly affected by the policies into policy networks or "iron triangles" (Fritschler, 1975). Established interest groups and entrenched policy networks defend the status quo by keeping issues off the public agenda, whereas emergent interest groups arouse public attention to get their issue on the policy agenda. Audience. The influence of individuals and groups in the policy environment depends, in large part, on the cycles of interest and disinterest of the broader public, or the policy audience. Even the most active members of the policy community cannot influence all of the issues of interest to them. Most citizens devote little, if any, attention to policy concerns. Therefore, the particular audience that momentarily attends to a policy debate has considerable influence over the outcome of a particular issue. A small number of parents attending a school board meeting or the presentation of a petition with numerous signatures changes the nature of the debate and probable policy outcome. If only a group of realtors attends a hearing on zoning the outcome will likely differ from a hearing with neighborhood groups present. One of the primary acts of political influence is for groups to

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rally an audience to their cause. Of course, representatives of the print and broadcast media, and those who decide what information is and is not communicated, contribute significantly to the cycle of interest and disinterest for a given policy issue. Consequences for Actors

Actors taking part in policymaking experience a variety of consequences depending on their placement and involvement. They get and retain jobs and positions of influence. They address issues of concern to them and promote their personal interests. They collect and spend money. They build roads, preserve old houses, and sign an arms treaty. Sometimes the rewards are tangible, as in financial support for political campaigns or in securing an appointed position. Other times the rewards are more symbolic, as when political actors provide legitimacy to groups by supporting their views. These consequences shape the decisionmaking behavior of each actor, individually and collectively, and how these consequences are communicated to each actor alters policy choices. For example, an elected official who meets with a constituent group is more likely to make statements of support for their policy proposal. If statements of support produce positive consequences, votes and other actions in correspondence with this verbal behavior may be more likely. Thus, tangible and symbolic consequences shape successive approximations of support from decisionmakers.

DIFFERENCES BETWEEN POLICYMAKING MODELS

These elements of policymaking- institutions, actors, and consequences to actors- are common to the two models discussed below. These elements do not, however, explain how instHutions, actors, and consequences interact to produce a policy response or non-response to an issue. The Rational and Dynamic Interest Group Models employ these three elements but provide alternative explanations of how they interact to produce policy results.

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When considering public policymaking, most observers will use a Rational or Stage Model of the policymaking process in the United States (Mann, 1978, p. 110). Their conception will parallel a problem-solving model in which significant policy actors process issues in a decision context to reach some outcome. The process is often described as occurring in stages, including agenda formation, policy adoption, and policy implementation (Cochran, Mayer, Carr & Cayer, 1982: Palumbo, Fawcett & Wright, 1981; Seekins & Fawcett, 1986). Much about policymaking confirms rational assumptions. The policymaking process involves formal institutions, such as city councils; formalized procedures, such as voting; and deference to law, due process, and precedent. In addition, hearings are held, experts consulted, and numerous options studied. Moreover, as Edelman (1977, p. 4) observed, "[P]eople typically think of government as a rational device for achieving their wants and see their own opinions and actions as the epitome of reasoned behavior." The Rational Model views policymaking institutions and procedures as artifacts of careful design, rather than as contexts for complex, often chaotic, behavior. To fully appreciate the role of policymaking in communities, neighborhoods, or the nation, we must examine common assumptions of the Rational Model of policymaking. These assumptions and the counter-assumptions . of the Dynamic Interest Group Model are best described in relationship to major policymaking events. Policymaking Events

There are three particularly salient policymaking events: agenda-setting, policy deliberation and adoption, and policy implementation. One difference to note from the start is that the Rational Model views these events in stages, whereas the Dynamic Interest Group Model sees them as continuous, ongoing events that can occur in any order. · Agenda setting. Out of the pool of potential issues, only a small number receive attention within any policy arena at any one time. In some fashion, a policy agenda forms and dissolves. Setting the agenda may be the single most powerful political act

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(Lukes, 1974). The agenda determines whose claims on what resources will be considered by the government. The rational view of agenda formation suggests that the occasion for policymaking is set when a large number of citizens experience a common problem, such as a lack of adequate and affordable health care (Gerston, 1983). As a problem is discussed, various goals and alternatives for its resolution emerge. These alternatives constitute potential issues for the public agenda. Elected officials, the media, interests groups, judges, bureaucrats, and individual citizens use information and publicity to develop issues. As the scope and intensity of an issue develops, the likelihood of its being formally considered by a policymaking institution increases (Schattschnieder, 1960; Cobb & Elder, 1972). Levine (1981) describes how publicity about the prevalence of neuropsychiatric disorders experienced by military recruits for World War II, deteriorating conditions in psychiatric facilities, and research findings about promising social and pharmacological treatments helped propel mental health reforms onto the national agenda in the 1950s and 1960s. This rational view of agenda formation assumes that legislatures and administrative agencies identify and address the more salient or important social problems. We have come to view our government as the Problem-Solving State. As social problems emerge, we expect government's careful attention. Needs assessments, long-range planning, special commissions, and public hearings serve to articulate problems that warrant the attention of policymakers. Although not every concern elicits action, we generally assume that the more important concerns will find their way onto the policy agenda. The Dynamic Interest Group Model suggests that the agenda setting process is, however, far more chaotic. Issues come to the attention of policymakers in near-random fashion. Many are ignored for years and then become the source of bitter controversy. These controversies often dissipate without resolution and then reappear again several years later (Maynard-Moody, 1984). Other issues receive considerable attention but have little objective importance. For example, the Missing Children Program was a major thrust of the Reagan Administration. Ads appeared

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on milk cartons, special school programs were presented, and toddlers were fingerprinted. There was, however, little evidence that an epidemic of abductions existed (American Academy of Pediatricians, 1986). The national hunt also occurred at a time when nearly one-third of the nation's children were slipping into poverty. Yet, the impoverishment of children was, and probably is at the time of this reading, a nonissue. It is rarely discussed in the press and is ignored by the government. Clearly the substance and prevalence of a social problem does not necessarily determine its relevance to policymaking. An alternative description of agenda setting corresponds more closely to naturally occurring, rather than consciously planned, events. The Dynamic Interest Group Model suggests that by chance (Kaufman, 1985) and intentional actions (Corning, 1983; Maynard-Moody & McClintock, in press) an issue or problem is temporarily identified. At this point, it either attracts additional attention and enters the agenda or remains ignored. The current policy agenda is a threshold that separates the vast array of nonissues, such as genetic engineering (a new issue) and the homeless (an old issue), from a small number of issues that temporarily preoccupy government. Issues cross this threshold in various ways (Kingdon, 1984). Sometimes highly visible events, such as a national disaster or actions of other nations, force attention to ignored problems. Most often, issues are carried across the policy threshold by individuals and interest groups. Issues define the context within which groups vie for political power. Groups attach themselves to certain issues and spend considerable effort in attracting attention. Or, individuals in government pull issues across the threshold to serve other goals. Tax reform as a way of cutting spending is an example. Much policymaking is, therefore, determined by the access structure. Policymakers consider some individuals, problems, and solutions more legitimate than others. The access structure is largely determined by existent authority, interests, and distribution of consequences to actors rather than objective characteristics of a problem. Rather than an orderly, predictable process, the policy arena more closely resembles a decision "garbage can." Here "problems, solutions, decision makers, and choice

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opportunities are exogenous streams flowing through a system" (March & Olsen, 1984, p. 746). Policies are determined by who and what are tossed into the can. Thus, a proposal to organize neighborhood health clinics may not gain agenda status if its supporters cannot deliver salient consequences, while a proposal to build a new roadway may gain quick access and action if its supporters have and can deliver such consequences as campaign funds and votes (Seekins & Fawcett, 1986). Policy deliberation and adoption. Once a problem has emerged on the agenda, the rational model suggests that either a substantive or a symbolic decision will result (Gerston, 1983). Substantive decisions involve allocating a significant amount of resources, usually in the form of taxes and expenditures. By contrast, symbolic decisions involve recognizing a need without allocating sufficient resources to solve the problem. A decision by a Medicaid administrator to channel funding for personal attendant care services for physically disabled adults through private health providers rather than individual consumers is both a substantive and symbolic decision (Sullinger, 1986). The rational view of policy adoption assumes that laws and policies are designed to address identified problems. An important corollary to the Rational Model is the assumption that policymaking would be improved by soliciting and then following research evidence on the nature of problems and the effectiveness of government solutions. This assumption is strongly held by policy analysts and program evaluators (e.g., Nagel, 1983). As a prerequisite to applying social research methods to policy problems, many social scientists assume that laws and policies are causal arguments. They see laws and programs as designed to change the contingencies that shape individual and collective actions. This view was first articulated in Campbell (1969) in "Reforms as Experiments" and was recently restated by Cook (1985): "Every social program is implicitly or explicitly undergirded by theoretical postulates about factors that will ameliorate a social problem, whether it is poor academic achievement, underemployment, or prison recidivism" (p. 30). Although often frustrated by an apparent disregard for research-based information, most researchers believe research can be useful to decisionmakers in policy adoption (Takanishi, 1981;

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Wallis & Roberts, 1956; Weiss, 1977). Seekins and Fawcett (1986) suggest that research that focuses on controlling variables, offers program alternatives, and validates a policy's social acceptability may be particularly useful during the policy adoption stage. Like the previous assumptions about agenda formation, this assumption de-emphasizes important aspects of the policy-making process. The Dynamic Interest Group Model sees laws and policies as largely determined by precedent, tradition, and the established interests of actors and groups in the policy community. Policies, in this view, express social values as well as causal arguments (Maynard-Moody & Stull, 1986). The Missing Children Program's example underscores the value of the family and the alarm felt by some about its presumed disintegration. At the same time, children slipping into poverty are viewed as the unfortunate result of necessary economic adjustments. In addition, the Dynamic Interest Group Model emphasizes the stochastic relationships between problems and policies. Rather than proceeding in orderly stages, many laws follow rather than precede local actions. They are often effects rather than causes. Local communities commonly develop programs in response to local needs. These local innovations are then attempted in other communities. After the program becomes widespread, legislators write enabling legislation to institutionalize those existing programs (Palumbo, Maynard-Moody & Wright, 1984). Program evaluators who take the passage of law as the intervention point often overlook the preceding 10 years of program implementation. Finally, numerous studies of the impact of applied social science on the policymaking process have produced discouraging results. Careful and valid analyses of problems and evaluations of programs have had little visible impact on the policymaking process. Clearly, effectiveness, as measured by social scientists, holds little sway in political decisions. Policy implementation. The third idealized assumption of the Stage Model views administrators and street-level bureaucrats as servants of elected officials. Once laws are passed or policies determined, the rational view limits the role of administration to faithful implementation. This assumption has roots in democratic

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theory. Modern states are largely governed by administrative agencies. The routine decisions of who is arrested, what snowbound streets are plowed, or who is eligible for income maintenance are made by unelected civil servants. The authority of this "shadow government" is legitimated by the thread of accountability that ties the police officer, street cleaner, and social worker to elected officials. Elected officials make laws, determine budgets, and appoint and impeach upperlevel bureaucrats. This view of policymaking maintains a sharp distinction between policymaking and implementing. Here, implementation is defined as the faithful carrying out of mandates. Like the previous assumptions, defining implementation in terms of faithful adoption of statutory goals and implied practices is central to traditional views of program evaluation. The Dynamic Interest Group Model describes a very different, a more continuous and fluid, process. This model emphasizes change. Implementation often involves developing rules and regulations to adapt policies to local situations (Lipsky, 1981; Palumbo, Maynard-Moody & Wright, 1984). Street-level bureaucrats, such as police officers and social workers, reinterpret policy as they deliver services to clients. They select who is arrested or eligible and determine the subjective quality of the services delivered. When discretion and adaptation is considered counterproductive, it is denounced as goal displacement. When discretion produces positive results, it is applauded as innovation. But, regardless of the outcome, implementation is best understood as a continuation of the policymaking process by other individuals and institutions (Majone & Wildavsky, 1977, p. 189). Rather than being reproduced at the local level, policies are altered, sometimes beyond recognition, during the implementation process through the discretion of the implementors. These changes are based upon the interests of the different actors involved. For example, police officers may, out of concern for their own safety, ignore stiffer anti-drug laws and avoid making arrests. Thus, laws and policies may be considered abstractions that are given meaning only when put into practice.

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CASE STUDY OF LOCAL POLICYMAKING: LIFELINE UTILITY RATES

A city government case study illustrates the policymaking process and its relationship to community functioning. It highlights the interplay of institutions, actors, and consequences in the important decision events of agenda setting, policy deliberation and adoption, and policy implementation. In the fall and winter of 1982-3, the City Commission of Lawrence, Kansas considered providing affordable natural gas to low-income families. One option, known as lifeline utility rates, would provide a subsidy for residents of lowest income. This subsidy would require slightly higher rates for nonqualifying ratepayers. This case study examines: lifeline rates and alternative proposals, the actors and action contexts in the policymaking community, the stages of local policymaking, and the consequences of competition for resources between diverse and changing actors. The Issue of Poverty and Utility Rates

Between 1980 and 1982, natural gas prices rose more than 200%. These increases in home heating costs resulted, in part, from government decisions to deregulate the industry. Many families with low, fixed incomes- the elderly, parents without adequate means of support, and persons with permanent physical disabilities- were required to use 30% or more of approximately $400 monthly incomes on heat. Many low-income families faced the monthly dilemma: "Should I not pay the gas bill, not pay the rent, or buy less food for the family?" The Policy Alternative of Lifeline Utility Rates

The policy process began as community activists and applied researchers from the University of Kansas prepared the Lawrence Lifeline Plan (Fawcett, Seekins, Whang, Muiu & Suareq de Balcazar, 1984; Lewis, Hackney, Fawcett & Seekins, 1982). This plan was based on a review of similar rate subsidy plans in other states and consultation with poverty families, community

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advocates, elected and appointed officials, and representatives of the local gas service company. The plan, as modified by city commissioners in study sessions, involved creating a new customer class. It would consist of those low-income households that met federal poverty standards for energy assistance. Census data suggested that approximately 1,600 families would be eligible. According to the plan, beneficiaries would receive a 50% reduction in rate for the first 15 mcfs (15,000 cubic feet) of gas for the months of January and February. Based on an average consumption of 25 mcfs (25,000 cubic feet) per month, an eligible family's bill would be reduced from $131 per month without Lifeline to $91 with Lifeline. The total cost of the program for the estimated 1,600 beneficiaries could be recovered by an average monthly charge of $.62 per month for 12 months for the city's 16,300 ratepayers. This plan represented an estimated public investment of $121,000 in winter utility assistance for lowincome families. Institutions and Actors in the Policy-Shaping Community

There were a number of participants and decision contexts involved in the process of promoting consideration of the Lifeline proposal, formulating the policy options, and considering its adoption. These might be loosely characterized as proponents, opponents, and public officials who appeared to be neutral with respect to the Lifeline Plan. Proponents included a core group who articulated and promoted the policy alternative and a small group of human service providers and consumers who generated public support. The core group consisted of the first and third authors, a director of a local poverty agency, and a part-time state lobbyist for utility assistance for low-income families. With the assistance of the second author, they prepared and supervised a telephone survey to assess public support for a change in utility rate design. In addition, several administrators, staff, and members of the boards of directors of local human service agencies offered advice and encouragement to the Lifeline core group. Consumer advocates for the physically disabled rounded out the small group of proponents.

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I

A core opposition group included the editors of the city's only local newspaper, a state representative from the district, the head of a local industrial plant who had opposed Lifeline in other states, a local minister, the head of the city-regulated natural gas company, several members of the human service community, business leaders, and citizens concerned about their own rates. The five city commissioners who were the elected officials in the city, the city manager and assistant city manager with main executive responsibility, and arbiters chosen to review the rate structure change were the other main actors. The public forums for communication between these groups were study sessions and public meetings of the City Commission. Policymaldng Regarding Utility Assistance

We shall examine the actions of participants in this policymaking community in the context of the decision events of agenda setting, policy deliberation, and policy implementation. This section reports prominent actions involved in propelling the issue of utility assistance onto the local agenda. It also considers the policy option known as Lifeline and the Warm Hearts alternative and discusses implementing a utility assistance policy alternative. Agenda setting. The Lifeline core group approached the utility problem from a rational perspective. A loose alliance of community activists designed the Lifeline Plan in consultation with city commissioners. They communicated the plan to policymakers, city management staff, and the media in study sessions and public meetings of the City Commission. They provided survey research data on the apparent public acceptance of a rate subsidy plan and technical assistance in formulating specific elements of the plan. They arranged for publicity on the issue and helped organize attempts to build public support for the proposal. These technical reports and initially noncritical media coverage of them helped propel the issue and the alternative onto the public agenda. Letters to the editor in support of the plan were drafted, and personal testimony on the consequences of skyrocketing gas rates and the expected benefits of Lifeline were presented.

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The Lifeline proposal engendered controversy. A core opposition group was formed the weekend after the first City Commission vote on the Lifeline Plan. Opponents did not deny that gas rates were creating a major community problem. They opposed the nonvoluntary and redistributive aspects of the plan and conceived of a charitable alternative, called Warm Hearts. Following the first private meeting of the core opposition group, the newspaper expressed its criticism of the plan in a series of editorials, reports, and letters to the editor. The paper questioned the general need for utility assistance, expressed a suspicion that many of those who do not pay their utility bills are unworthy of public support, and advocated charity, rather than rate reform, as the socially appropriate option. The president of the local natural gas company would not disclose the number of utility shut-offs, an index of the problem. He down played the need for utility assistance in the community. Several human service providers argued that if citizens were required to provide subsidies, voluntary support for the needy might decrease. Also opposed were several business leaders who disliked the no-growth policies of city commissioners who supported the Lifeline Plan. As with many political issues, opposition on one issue infects other, unrelated issues. This segment of the business community provided financial resources for a petition drive to garner opposition to the Lifeline Plan. In creating the charitable alternative of Warm Hearts, and publicizing its availability in free newspaper advertisements during the policy debate, the opposition forced a second policy alternative onto the public agenda. In a classic opposition strategy (see Banfield, 1961 ), by putting this private, charitable program into immediate operation, opponents eviscerated the Lifeline alternative. The opposition group's ready access to the local authority structures altered the context of policy adoption. Policy deliberation and adoption. Consideration of the Lifeline Plan took place over several months in the contexts of study sessions and public meetings to discuss a proposed city ordinance to change the rate structure. Initial public meetings featured presentations of the plan by the Lifeline core group, personal testimony from members of a consumer advocacy organization and human service providers, technical information from engineering

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consultants hired to analyze the plan, objections and questions about the city's authority in the matter from the city manager, and questions about the feasibility of the plan from the president of the natural gas company. Later meetings included presentations of a petition against the plan that contained 2,000 signatures. They also included testimony against the plan and the idea of public support for those on welfare, and threats were made to recall commissioners who supported the rate reform plan. The city commissioners supported the plan 5-0 on the first reading. The initial meetings of the opposition group occurred following publicity about this first vote. A second vote, one week later, supported the plan 4-1. Normally, two majority votes are sufficient to establish an ordinance. But the dissenting commissioner questioned the validity of the first vote, and a third vote was scheduled. Between the second and third votes, Warm Hearts received extensive publicity. Several thousand dollars in donations were collected. Plans for distributing these funds through existing human service agencies were described publicly. Despite the emergence of the opposition and the Warm Hearts alternative, there appeared to be a 3-2 majority in favor of Lifeline at a final study session just 24 hours before the scheduled third vote. The Lifeline Plan was defeated in that vote, however, and a motion to appoint a task force to study the issue was substituted and passed. This symbolic action was possible, since the low-income persons who represented the natural constituency were not well-organized. Further, the highly-organized Warm Hearts program could be pointed to as a more acceptable and already operating, private-sector policy alternative. Policy implementation. In this case study, the proper focus for examining policy implementation is the operation and evolution of the Warm Hearts program, since it was created and adopted as a policy alternative to the Lifeline Plan. The state representative from the core opposition group served as the spokesperson for the charitable fundraising campaign. The newspaper publisher contributed larg~. front-page, advertisements at no cost to the campaign. The campaign raised approximately $70,000 in the first year, approximately $50,000 short of the target for the Lifeline Plan.

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The goals of Warm Hearts were multiple: to provide a charitable contribution to citizens whose exceptional circumstances of poverty require it and to exclude those "welfare cheaters" who might take advantage of such a program. Initially, the program featured somewhat restrictive eligibility guidelines, modest benefits, and more intrusive needs tests relative to the Lifeline proposal. In subsequent years, Warm Hearts reduced its goal to approximately $25,000, less than one half the amount obtained in the first year and $100,000 less than the projected revenue from the Lifeline Plan. The reduced targets were justified on the basis of "surpluses" derived by gradual restrictions in eligibility and tangible benefits. Such restrictions may have been prompted by occasional newspaper editorials criticizing the review panel's liberal policies and raising the question of the unworthiness of some of the beneficiaries. In this sense, implementation was faithful to the multiple goals of proponents of Warm Hearts, if not to those who supported the Lifeline alternative. Evaluation and Stocktaking

Judgments of the value of these utility assistance policies for the local community rest on an analysis of its consequences for low-income families who were targets of utility assistance policies, for proponents and opponents in the policy-shaping community, and for the broader community. An obvious consequence for targets is the collection and eventual distribution of approximately $120,000 over the first 3 years of the Warm Hearts campaign. The average benefit of $135 per year for each of the approximately 342 households served reduced some of the burden of winter utility bills. As eligibility guidelines were restricted, needs tests made more intrusive, and the size of benefits reduced, the number of people benefiting and the level of assistance have decreased, however. Proponents for the Lifeline Plan included a city commissioner whose defeat in a reelection bid was attributed, in part, to his support of Lifeline. The unfavorable newspaper publicity regarding Lifeline, including negative characterizations as a "social experiment" and as anti-American, resulted in reduced opportunities for researchers in the Lifeline core group to work in city

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government for the next several years. By contrast, the state representative enjoyed extended favorable coverage by the newspaper in her successful reelection bid. Bitter controversy was the initial consequence of the Lifeline policy debate for the broader community. The editorial page and its letters to the editor section provided a forum for angry characterizations of proponents as "coercive," opponents as "uncaring," and targets as "lazy and shiftless." The rejection of the Lifeline policy alternative eliminated the bitter public conflict. A long-range consequence of the charitable giving alternative was renewed public consensus about the causes of poverty and the acceptable policy options for addressing welfare concerns (Ryan, 1971). A strategy of charitable giving presumes that undesired consequences of the economic system, such as the inability to afford heat, are exceptional. Poverty is seen as the result of unfortunate circumstances for a relatively few unlucky individuals. By contrast, a strategy of system change, such as utility rate reform, presumes that the inability to afford heat and other consequences of the economic system are universal. They are a result of systemic variables such as chronic unemployment and underemployment on large numbers of people who are poor. Adoption of Lifeline would have provided a precedent for tinkering with the basic system to reduce its consequences for a small percentage of its consumers. In a domestic version of the domino theory, it was argued that changing the rate structure for residential customers to benefit the poor might result in proposals to change the rate for commercial users to benefit all ratepayers. It could also lead to other proposals to extend a rate subsidy to additional utilities such as electricity and telephone, and so on. By contrast, support for the charitable giving option helped preserve the belief that poverty is experienced by a few unfortunate ones and by a larger number of people unwilling to work. By restricting eligibility requirements and, accordingly, the number of people served, it appeared that the scope of the problem was limited. Similarly, the reported surpluses in the Warm Hearts fund helped create the impression that the system's abundance permitted charitable aid more than sufficient to provide for the few truly needy.

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DISCUSSION

The Rational and Dynamic Interest Group Models and the Lifeline case stress the complexity of policymaking. The Rational Model identifies orderly stages, studies responses, and assumes faithful implementation, whereas the Dynamic Interest Group Model highlights fluidity, recursiveness, and competition. Although the Dynamic Interest Group Model more accurately describes the events in the case example, it is limited in its explanation of why individuals and groups choose to enter the policy arena and why they adopt specific policy options. Behavioral theory (Skinner, 1953) provides a useful framework for understanding the actions of policymakers as suggested by the Dynamic Interest Group model of decisionmaking. Behavior-analytic explanations of policymaking (Seekins & Fawcett, 1986) point to consequences of a decisionmaker's behavior, and information suggesting the availability of consequences for an action, as the most important variables. Consequences, such as votes, support, and financial contributions, are delivered contingent on decisionmakers' actions by a variety of key actors, including representatives of interest groups and the media. Similarly, information, such as polling results showing constituent support for a particular action, may also exert control over a vote or decision since that information may suggest the high likelihood of maintaining or gaining public support if a particular decision is made and followed. Behavioral theory might explain the apparently chaotic actions of decisionmakers during agenda setting, policy deliberation and adoption, and policy implementation. The decision to place an issue on the agenda, to admit it for further consideration, might be expected to be influenced by its consequences. Individuals and interest groups lobby for consideration of their issues by presenting information that refers to positive consequences for adoption, such as campaign contributions or constituent votes, or the threat of loss of consequences for failing to attend to the issue. Thus, a decisionmaker's favorable or unfavorable response to a request for considering an issue might be explained by the balance of consequences controlled by various interest groups and

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the decisionmaker's past history of reinforcement for making similar decisions with issues of this type. The Dynamic Interest Group model for policy deliberation and adoption notes the apparent lack of function of research information about effectiveness on decisionmakers' behavior. A behavior-analytic explanation would suggest that such research information may not discriminate for consequences of importance to decisionmakers. For example, data suggesting the positive consequences for parents and children of a voucher system in education might not prompt adoption of the system if voting for the measure is likely to lose campaign contributions from interest groups representing teachers. Finally, the Dynamic Interest Group model highlighted the fact that policies are often altered during implementation. Behavioral theory would suggest that the consequences of actions that constitute implementation, including positive consequences for ignoring the policy and negative consequences for implementing it faithfully, would shape the behaviors that we call implementation. For example, a patrol officer who enforces a law requiring use of seat belts by writing a ticket may be subjected to verbal abuse by local citizens and criticism from local officials. Such consequences may help explain why behavior consistent with faithful implementation, such as regular ticketing, is abandoned in favor of modified implementation, such as oral warnings, that help avoid or reduce the aversive consequences associated with implementation. The Dynamic Interest Group Model and the behavior-analytic explanation suggest that agenda setting, policymaking, and implementation lack the order often presumed by both citizens and most applied social scientists. When reasoned arguments and careful research appear to be ignored, cynics may denounce the "chaos" of policymaking as "politics." This model does, however, find order in the policymaking process, but it is the order of an untended field rather than a formal garden. As the case study of Lifeline illustrates, communities and policymaking are best understood as the products of the competition of a diverse and changing set of institutions, values, and actors. They are what Long (1958) has defined as an ecology of games in which independent actors pursue their own goals.

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Any particular policy outcome- including ignoring the problem- results from a complex interaction of players, institutions, rules, and consequences. Nonetheless, the outcomes are predictable, although not determined, by traditions and the socialization of actors into definable roles. "Bankers will play like a banker and newspapermen like a newspaperman" (Long, 1958, p. 253). Each role is, in turn, shaped by the consequences of acting in correspondence with the role. Thus, banker activities that produce bank revenues and personal advancement are more likely to occur than those that have a negative impact on these and other valued consequences for those in the role of banker. The consequences for actors in the Lifeline case might be expected to increase the likelihood of similar actions for those in the roles of opposing city commissioners, state representatives, newspaper editors, or utility company executives. Social scientists and community change agents are merely among the many sets of actors within this policy-shaping community. Although their advice often appears value-free and disinterested, they are another interest group vying for influence, legitimacy, and resources within the political arena. The data gathering, statistical reports, and claims of objectivity made up the policy analyst role for the researchers in the Lifeline case, just as valuing the preservation of the rate structure was part of the utility executive's role. The apparent chaos of policymaking limits the impact of individual interests, whether community groups, local economic elites, or policy researchers. It is important to recognize, however, that not all groups have equal influence on policymaking. Often, a small number of individuals and groups, policy elites, retain disproportionate control over the information received by and consequences for elected officials. Thus, opponents of the Lifeline plan- all powerful members of the community- obtained swift and easy access for the Warm Hearts policy alternative. Nevertheless, the diffusion of sovereignty that characterizes the American political system provides a voice to a large array of actors. In this regard, the small group of proponents for the Lifeline Plan achieved a surprising success in prompting attention to this issue and alternative. The diffusion of sovereignty also pro-

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vides a role for local implementors in policymaking. The multiple avenues of influence reduce the probability that any single group of actors will determine policy outcomes, and they set the stage for the competition we call "politics." Politics is the arena in which social goals are set and in which the rules to govern behavior that we call laws are made (Skinner, 1981; Seekins & Fawcett, 1986). These rules are often followed by interventions that government agencies use to enforce compliance with the rules or achieve the goals, although they may be used erratically or not at all. Those interventions that produce community conditions providing a more just distribution of resources are particularly consistent with empowerment and prevention efforts (Albee, 1986; Fawcett et al., 1984). Those interested in prevention might examine public policymaking with the goals of gaining a greater understanding of communities and those decisions that improve the well-being of its members. Local policymaking settings, such as city commissions, are important contexts in which to develop the resources for community change. The public policies created in these settings influence the quality of community life and the likelihood that community residents will experience various problems. Studying the functions of the policy-shaping community and how it effects decisions will enhance our general understanding of communities and our competence in promoting beneficial change. REFERENCES Albee, G. W. (1986). Toward a just society: Lessons from observations on the primary prevention of psychopathology. American Psychologist, 41, 891-898. Banfield, E. C. (1961). Political influence. New York: The Free Press. Campbell, D. (1969). Reforms as experiments. American Psychologist, 24, 409-429. Caro, R. (1977). The power broker: Robert Moses and the fall of New York City. New York: Random House. Cobb, R. & Elder, C. (1972). Participation in American politics: The dynamics of agenda-building. Boston: Allyn and Bacon. Cochran, G. E., Mayer, L. C., Carr, T. R. & Cayer, N. J. (1982). American public policy: An introduction. New York: St. Martin's Press. Cook, T. (1985). Postpositivist critical multiplism. In R. L. Shotland & M. Mark (eds.), Social science and social policy. Beverly Hills, CA: Sage Publications. Corning, P. (1983). The synergism hypothesis: A theory of progressive evolution. New York: McGraw-Hill.

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Edelman, M. (1977). Political language: Words that succeed and policies that fail. New York: Academic Press. Fawcett, S., Seekins, T., Whang, P., Muiu, C. & Suarez de Balcazar, Y. (1984). Creating and using social technologies for community empowerment. Prevention in Human Services, 3, 145-171. Frederickson, H. G. & Hart, D. (1985). The public service and the patriotism of benevolence. Public Administration Review, 45, 547-554. Fritschler, A. L. (1975). Smoking and politics, 2nd ed. Englewood Cliffs, NJ: Prentice Hall. Gerston, N. L. (1983). Making public policy: From conflict to resolution. Glenview, IL: Scott, Foresman, and Company. Greenwald, C. S. (1977). Group power: Lobbying and public policy. New York: Praeger. Jason, L. A. & Rose, T. (1984). Influencing the passage of child passenger restraint legislation. Journal of Community Psychology, I 2, 485-495. Kaufman, H. (1985). Time, chance, and organizations: Natural selection in a perilous environment. Chatham, NJ: Chatham House. Kingdon, J. (1984). Agendas, alternatives, and public policies. Boston: Little, Brown and Company. Levine, M. (1981). The history and politics of community mental health. New York: Oxford University Press. Lewis, T., Hackney, P., Fawcett, S. B. & Seekins, T. (1982). Lawrence (Kansas) Lifeline Plan. (Available from the Community Development Program, University of Kansas). Lipsky, M. (1981 ). Street-level bureaucracy: Dilemmas of the individual in public services. New York: Russell Sage. Long, N. (1958). The local community as an ecology of games. American Journal of Sociology, 64, 251-261. Lukes, S. (1974). Power: A radical view. New York: Macmillan. Majone, G. & Wildavsky, A. (1977). Implementation as evolution. In J. Pressman & A. Wildavsky, (eds.), Implementation. 2nd ed. Berkeley, CA: University of California. March, J. & Olsen, J. (1984). The new institutionalism: Organizational factors in political life. American Political Science Review, 87, 734-749. Maynard-Moody, S. (1984). The fetal research dispute. In D. Nelkin (ed.), Controversy: Politics of technical decisions, 2nd ed. Beverly Hills, CA: Sage Publications. Maynard-Moody, S. & McClintock, C. (forthcoming). Weeding an old garden: Toward a new understanding of organizational goals. Administration and Society. Maynard-Moody, S. & Stull, D. (forthcoming). The symbolic side of policy analysis: Interpreting policy change in a health department. In F. Fischer & J. Forrester (eds.), The politics of criteria: Social values in policy analysis. Beverly Hills, CA: Sage Publications. Nagel, S. (1983). Policy evaluation methods. In W. Eddy (ed.), Handbook of organizational management. New York: Marcel Dekker. Palumbo, D., Fawcett, S. & Wright, P. (1981). Evaluating and optimizing public policy. Lexington, MA: Lexington Books. Palumbo, D., Maynard-Moody, S. & Wright, P. (1984 ). Measuring degrees of successful implementation. Evaluation Review, 8, 45-74. Schattschneider, E. E. (1960). The semisovereign people: A realist's view of democracy in America. Hindsdale, IL: The Dryden Press. Seekins, T. & Fawcett, S. (1986). Public policymaking and research information. The Behavior Analyst, 9, 35-45.

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Seekins, T., Fawcett, S. B., Cohen, S. H., Elder, J.P., Jason, L.A., Schnelle, J. F. & Winett, R. A. (1986). Experimental evaluation of public policy: The case of state legislation for child passenger safety. Manuscript submitted for publication. Skinner, B. F. (1953). Science and human behavior. New York: Macmillan. Skinner, B. F. (1981). Selection by consequences. Science, 213, 501-504. Sullinger, J. (1986, March). Policy change may end quadraplcgic's independence. Kansas City Times, p. 27A. Takanishi, R. (1981 ). Preparing a policy-relevant reporl: Guidelines for authors. Los Alamitos, CA: SWRL Educational Research and Development. Waldman, S. R. (1972). Foundations of political action: An exchange theory of politics. Boston: Little, Brown and Company. Wallis, W. A. & Roberts, H. V. (1956). Statistics: A new approach. Glencoe, IL: The Free Press. Weiss, C. H. (1977). Introduction. In C. H. Weiss (ed.), Using social research in p11blic policymaking. Lexington, MA: Lexington Books.

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Chapter 5

Economic Development and Community Mental Health David Dooley Ralph Catalano Seth Serxner University of California, Irvine

SUMMARY. This chapter describes the processes believed to affect the performance of regional economies and the mechanisms that might connect these processes to the etiology of behavioral disorder. The initial findings of a major study of these linkages will also be summarized (based on Catalano & Dooley, 1983; Dooley & Catalano, 1984a, 1984b). The implications of this literature for economic policy and for the provision of mental health services are also surveyed.

The study of regional economies has a long and rigorous tradition and has, like all organized inquiry, had its paradigm shifts and controversies. A brief overview of such a field inevitably fails to convey the subtleties of these controversies and typically draws on the most widely held, but not necessarily most recent or parsimonious, theories. The reader is therefore advised to consult Catalano (1979), Isard (1976), Oppenheim (1980), and Perloff, (Perloff, Dunn, Lampard & Muth, 1961) for introductions to the field and journals such as Economic Geography and Regional Science for a sampling of current issues. Reprints may be obtained from David Dooley, Program in Social Ecology, University of California, Irvine, CA 92717. © 1987 by The Haworth Press, Inc. All rights reserved.

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Understanding why some regions grow while others decline can be furthered by an appreciation of several basic concepts from economiC geography. Most western economic thought assumes that individuals will strive to use their labor and savings in a way that maximizes their economic security. They will invest in institutions that promise the highest return at an acceptable level of risk and seek the highest paid employment that offers acceptable work conditions. Capital and labor, therefore, are assumed to be mobile in both the institutional and geographic sense. Investors and workers will assess sectors of an economy, and firms within each sector, looking for the best "payoff." When a better return per unit of capital or labor is promised by other than an existing commitment, investors or workers move their assets. The spatial implications of this assumed mobility are crucial for understanding regional growth and decline. Each productive activity, or firrri, is assumed to have one location at which its costs of assembling raw materials and labor and of making and marketing a product are lowest. This location has "situs" for that firm. Managers of firms are constantly reviewing costs to insure that they are at locations that have situs. Investors favor firms that find situs because minimizing the cost of production makes an enterprise very competitive in the marketplace. Such firms also tend to be good employers because their success implies security of employment. Workers, therefore, exercise their mobility and move to regions where firms have found situs. Firms can find situs through trial and error or by a priori calculations. The latter, of course, is highly desirable given the cost of the former. Economic geographers have historically attempted to reduce the risk of location decisions by identifying classes of costs affected by geographic distance (Weber, 1968). This has proven a difficult task because the relative contribution of each class of such costs to the total cost of production changes quickly with new technologies as well as with changes in other costs such as taxes and pollution control. While general models for location decisions do exist (Berry, 1967), their practical implementation remains an art that firms cultivate at great expense. The practice of this art results in a spatial distribution of productive activity in which some regions attract considerable capi-

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tal investment and labor while others remain relatively undeveloped. The firms that are attracted to a region because it is believed to have situs for them are called the "economic base" of that region. Classic examples are that the automobile industry is the base for the Detroit region, steel for Pittsburgh, entertainment for Los Angeles, and government for Washington, DC. These are simplifications but they convey the concept that each populated region has an economic base of industries that connect the region to the national and international system of collection, production, and distribution of goods and services (Berry, 1972). If the basic industries of a region are growing, they are assumed to trigger the growth of "dependent industries" which are those activities that provide the basic industries and employees with goods and services (Thiebout, 1962). The number of retailers, accountants, physicians, butchers, bakers, and candlestick makers who are purveyors to the basic sector is related to the size of the basic industries by a "multiplier." If the ratio of dependent to basic employees is, for example, two to one, the expansion of the basic industries by 100 employees will yield demand for 200 dependent employees. These may come from new entrants to the labor market, from the indigenous population, or from migration of mobile labor from regions whose economic bases are stagnant or contracting. Industries go through cycles of growth and decline. Regions whose bases are dominated by a single industry will expand during that industry's growth periods and contract during that industry's decline. This expansion and contraction can be measured in capital investment, employment opportunities, and population. The concepts of situs, economic base, dependent industries, multipliers, and industrial cycles have led to considerable debate over which are prudent strategies for communities in attempting to protect thell)selves against economic decline. One line of thought argues that communities should solicit or entice a wide mix of basic industries so that declining industries can· be balanced by those that are expanding. The problem with this strategy is that it assumes a region can attract a wide array of industries. A community must offer considerable incentives to attract industries that would not otherwise locate there. This strategy is believed to distort location patterns based on market costs and is

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known to require subsidies to keep the enticed industries. These subsidies and distortions may reduce the overall efficiency of the national economy (Blumenfeld, 1955). Another strategy, the "pick a winner" approach, has been pursued in recent years in the case of "high tech" industry. Under this strategy, regions compete for investment by firms that are associated with sustained growth. The problem with this strategy is that it leaves the successful region dependent on one industry that will inevitably have cycles. The effects of the energy boom and bust of recent years on the economic status of communities based on oil and coal operations is a classic example of the potential for the picking a winner strategy to fail. A third strategy is to foster and maintain as complete a set of dependent industries and amenities as possible in the hope that basic industries will always desire services (Blumenfeld, 1955). This strategy implies that the key to success is focusing on dependent services and "infrastructure" (e.g., roads, schools, public services) rather than on basic industries. The latter are assumed to come and go depending on the vagaries of economic cycles and on new technologies. Growth industries, it is believed, will define situs to include dependent industries and infrastructure and be attracted to regions that maintain these assets. The problem with this strategy is that it implies that communities that have established dependent industries, infrastructure, and amenities will be most attractive regardless of other cost factors. Recent experience, however, suggests that many industrial activities will locate away from established areas to take advantage of low labor and land costs (Sternlieb & Hughes, 1977).

RECENT ECONOMIC POLICIES AND THEIR IMPLICATIO NS FOR REGIONAL ECONOMIE S A perception of economic crisis emerged among political leaders in many of the western democracies in the first half of this decade. The perception was that the high inflation of the late 1970s and deep recession of the early 1980s were a result of long standing government policies that increased public spending

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faster than productivity. An increasing proportion of private capital was diverted, through taxation and borrowing, to public programs that did not yield goods and services. The money was supposedly drawn from taxpayers and lenders and given to those who were old, very young, or infirm, and, therefore, relatively unproductive, or who produced goods and services not available for general consumption (e.g., defense hardware). The results supposedly were, first, a reduction in capital available for private investment in new, highly productive technologies; and second, a surge in inflation caused by governments' redistribution of resources to participants in consumer markets who did not contribute goods and services to those markets. This inflationary spiral was assumed to further constrain investment in new productive facilities because investment in tangibles (e.g., precious metals, art) and government securities was more lucrative than commitment to industry. Shrinking investment meant fewer new jobs and less secure older jobs and, therefore, drove unemployment up as the labor force grew through population growth. There has been remarkable agreement among liberals and conservatives on the remedy for this perceived crisis (Simon, 1978; Thurow, 1980). The remedy is believed to be increased productivity of the private sector. More product per unit of labor would supposedly allow higher returns to investors, increased, or at least stable, employment, and more goods and services. This combination would supposedly yield improvement in real living standards without spurring inflation. There is, of course, considerable disagreement on how to increase productivity. Elections, however, have tended to support the conservative alternative which is based on four principal policies. The first is to reduce the growth of the proportion of private capital that is diverted to support public programs. The second is to reduce public programs that redistribute wealth from the middle and upper classes to the chronically or transiently less productive. The third is to reduce environmental and other public regulation that is assumed to lessen productivity. And the fourth is to encourage the investment of private capital in technologically advanced industries that are markedly more productive than older, labor-intensive industries.

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While all these policies have had implications for the economic and social conditions of the western democracies, the last policy has had particular effect in the United States. The policy of encouraging investment in capital-intensive industries has been implemented in several ways. Perhaps the most effective of these has been reduced corporate and individual tax rates and accelerated depreciation schedules for investment in new facilities. Together these strategies have increased the funds available for private investment and encouraged commitment of these funds to new capital facilities. These programs, combined with the high heating, labor, and tax costs typical of the Northeast and Upper Midwest, have considerably influenced location decisions in recent years. The trend toward rapid growth in the South and Southwest that began in the late 1960s markedly accelerated (Sternlieb & Hughes, 1977). Communities with economic bases dominated by older, labor-intensive industries began to stagnate while regions with bases typified by "high-tech" operations, especially those connected to defense contractors, began to grow (Bendick & Ledebur, 1981). Agriculturally-based regions began to stagnate as the strength of the U.S. dollar raised prices for American food products on a world market already softened by the global recession of the early 1980s. Farm- and energy-related loans with high interest rates typical of the late 1970s and early 1980s, moreover, could not be repaid, forcing defaults and foreclosures. These disruptions of normal commerce further depressed the agricultural and energy industries, making "busts" of many of the boom towns of the 1970s. The recovery from the recession of the early 1980s has been geographically very uneven. Metropolitan areas whose economic bases are typified by defense-related and other capital-intensive activities have done well. Communities connected to the national and world economies by older, labor-intensive industries have fared badly. The multiplier effects of contracting or expanding bases have reverberated throughout these communities, making some centers of opportunity and receptors of considerable migration while others stagnate and export their young and entrepreneurial.

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HYPOTHETICAL LINKS OF THE ECONOMY TO THE INCIDENCE OF PSYCHOLOGICAL DISORDER Shifts in the temporal and spatial distribution of economic expansion and contraction have been hypothetically linked to temporal and spatial variation in the incidence of treated and untreated psychological disorder (Catalano, 1979). These links are based on the assumption that disordered behavior is inconsistent with the expectations of the exhibitors' "audience," including family, friends, fellow workers, and neighbors (Scheff, 1966, 1975). These expectations are formed from explicit or implicit beliefs concerning which behaviors are appropriate responses to environmental cues and on the interest members of an audience have in the functioning of the exhibitor (Sarbin, 1969). It is further assumed that the cues most likely to evoke audience scrutiny of responses are those often characterized as "stressful life events." These events have been empirically identified as those which representative samples of the population believe require cognitive and behavioral adaptations (Dohrenwend & Dohrenwend, 1974). Failure to make the adaptations judged normal or acceptable is considered symptomatic of disorder. Psychologists have identified, or speculated about, many biological, psychodynamic, or conditioning factors that make individuals good, bad, or average adapters to environmental cues or stressors. Assuming that any population will be normally distributed in adaptation skills, differences in the prevalence of disorder across populations will be a function, in part, of differences in the mean level of adaptation skills and of differences in the number of stressors to which the populations are adapting. Two populations with identical distributions of adaptation skills will yield different incidences of failures to adapt if they are coping with different frequencies and intensities of adaptation demands. Put more generally, two populations with equal probabilities of failing a test would be expected to yield different incidences of failure in a given time period if they are tested a different number of times. A corollary to this axiom is that the yield of failed tests by

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a population with a fixed distribution of testing skills will vary over time with the number of tests encountered. The above propositions are connected with the dynamics of regional economics by the likelihood that the number and intensity of stressors experienced by a community will be affected by the status of its economic base (Catalano & Dooley, 1979b). All empirically derived lists of stressors include job and financial events that are more or less likely to occur among employees of an industry, depending on that industry's position in the cycle of expansion and contraction. The multiplier effect alluded to above further implies that persons throughout a community, based on expanding or contracting industries, will eventually experience the stressors first faced by those in the basic industries. A further intrafamily multiplier effect is suspected to the extent that the principal wage earner's economic life events distress his or her dependents. A synthesis of these constructs yields the general hypothesis that communities will vary cross-sectionally in the incidence of disordered behavior with differences in the distribution of adaptation skills as well as with the incidence of adaptation demands, including those tied to the performance _of economic bases. A second hypothesis is that longitudinal variation in the incidence of disordered behavior in a community will be related to the performance of the community's economic base. The interest an audience has in judging a response to a stressor as unexpected or abnormal may also vary with the economy. It has long been suspected that tolerance for deviance is affected by the competition for jobs and resources (Thomas & Znaniecki, 1920). In recent years this suspicion has been reflected in, for example, the work of ecological psychologists (Wicker, 1979) and other social scientists (e.g., Easterlin, 1980) who report that overstaffed organizations (i.e., those with a surplus of labor) are less tolerant of individual peculiarities than are understaffed organizations. It is, therefore, possible that longitudinal variation in diagnosed or treated disorder in a community will vary with the status of the economic base. A contracting base may make an audience more likely to scrutinize responses to stressors because a response diagnosed as deviant makes its exhibitor less competitive for scarce resources.

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Previous Research The hypothesis that economic change affects social and psychological processes has been studied scientifically at least since Durkheim (1897). Researchers have construed this hypothesis in different ways and have taken quite different methodological tacks in testing it. The resulting literature is too extensive to review in detail here (see Dooley & Catalano, 1986). Suffice it to recognize that two principal strategies have been used to address this problem: the aggregate-only and the individual-only methods. The aggregate-only approach has its origin in Durkheim's study of suicide (1897). He related variations over time in the aggregate suicide rate to variations in the economy, also measured in the aggregate (hence the label "aggregate-only" for this time-series approach). This approach has continued to the present day with increasing statistical sophistication. Ogburn and Thomas (1922) calculated a Pearson correlation coefficient for the time-series relationship which improved on the earlier visual estimation of the relationship. Pierce (1967) added a degree of econometric sophistication by testing for autocorrelation of residuals using the Durbin-Watson test. The aggregate-only time series approach recently has enjoyed its greatest popularity due in large part to Brenner's (1973) study of the relationship of mental hospitalizations to the economy in New York State. The individual-level approach, in contrast, relates personal economic setbacks such as job loss to subsequent personal psychological and health consequences. This approach, which requires close clinical monitoring of a panel over time to be done convincingly, reached a peak of popularity during the Great Depression (e.g., Bakke, 1940; Cavan & Ranck, 1938; Jahoda, Lazarsfeld & Zeisel, 1971; Komarovsky, 1940). Such 1930s vintage studies were essentially qualitative. The recent (1981-82) recession has spawned a new generation of quantitative individual research. Anticipating this new literature is the model plant-closure study by Cobb and Kasl (1977). As discussed in more detail elsewhere (Dooley & Catalano, 1986) these two approaches have not converged on an answer to

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the question of whether the economy affects individual health and psychology. The individual-only approach fails to test the possibility that the economy can affect individuals in ways other that through personally experienced events such as job loss. The aggregate-only approach captures aggregate influences but is subject to the criticism that aggregate relationships cannot be generalized confidently to the individual level (i.e., ecological fallacy). Cross-Level Approach

Even if results from the aggregate-level and individual-level approaches converged, we would be left in some doubt about the implications of the results for our question regarding the relationship between the economy and individual psychological and physical costs. We elsewhere have proposed to resolve this dilemma by employing a cross-level approach in the study of the economy-social costs relationships (Dooley & Catalano, 1984a). In the cross-level approach, aggregate economic indicators are combined with individual measures of life change (both economic and noneconomic) and of health and psychological outcomes. The cross-level approach has rarely been used to address the economy-social cost question, and few such studies have appeared previous to our work (Brown, 1982; Cohn, 1978; Korper, 1976). The promise of the approach is that individual symptom variance can be divided simultaneously among control variables (e.g., sex, age, status, and even prior symptoms if panel data are available), recent individual stressors (both economic and noneconomic), and recent economic conditions measured in the aggregate. Further, the cross-level approach uniquely permits the measurement of interactions between individual and aggregate variables. Our first cross-level studies (Dooley, Catalano & Brownell, 1986) were conducted on existing survey data sets collected by other investigators in Kansas City, Missouri, and Washington County, Maryland (for details of these surveys see Markush & Favero, 1974; Radloff, 1977). One component of these surveys was a two-interview panel with the second interviews distributed

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over six or nine months and with an interim period between interviews of from three to twelve months. We assigned respondents to different levels of economic conditions based on the economic indicators of the months during and just preceding their second interviews (the aggregate variables). Individual measures of life events, and psychological symptoms were drawn from the second interview, and social support measures were drawn from the initial interview. The second interview measure of symptoms was statistically adjusted by the first interview symptom measure in order to provide an estimate of net symptom change (using analysis of covariance). The failure to find any main or interaction effect of economic condition on adjusted symptoms may have been due to the small range of second interview months. Brown (1982) reanalyzed the first interview data from Kansas City (extending 16 months but without controls for prior symptoms) and found both main and interaction effects. LOSANGELESCOMMUNITYSURVE~

1978-1982

We subsequently have conducted a survey designed specifically for cross-level analysis. This "Economy as Stressor Project" was conducted in Los Arigeles County, California. The political jurisdiction of Los Angeles County is coterminous with the economic unit, the Los Angeles-Long Beach Standard Metropolitan Statistical Area (SMSA). The main purpose of the survey was to test hypotheses that variations in the aggregate economy have psychological and physical costs felt by .individuals. The survey measured life events and efforts to seek help for mental problems, as well as psychological symptoms and physical health status. This survey was designed to provide a test of the direct and indirect relationships between aggregate economic measures and various health and behavioral outcomes. The primary intervening variable of interest involves economic and noneconomic life events. The Los Angeles Community Survey improves, for present purposes, on the earlier surveys in several respects. The greater time length (54 months) allows for more economic variability.

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The greater number of respondents (approximately 500 per wave for a total of over 8,000) provides more representative sampling of demographic subgroups. The survey instrument itself was designed to include a large number of economic life events to represent better the universe of possible personal economic changes. The analyses summarized in this chapter are based primarily on the main (first interview) component of the Los Angeles Community Survey, i.e., the single interviews (as opposed to the smaller panel component which entailed additional interviews with some respondents). Though this portion of the survey design sacrifices possibility of statistical control for existing symptoms available in the panel component, this defect should lead only to an overestimation of the relationship among the individual-level variables (due to the variance· shared with baseline symptoms) but should not affect the estimation of the effect of the aggregate economic environment that is the central focus here. Sampling

Data were collected through 16 quarterly telephone surveys of fresh samples of approximately 500 randomly selected residents of Los Angeles County. The analyses were based on 12 and 16 waves of the survey. The first 15 surveys were conducted each quarter from the spring of 1978 through fall of 1981. The 16th survey was conducted in June of 1982 (delay due to federal budget cuts in 1981-82). Interviews were conducted in either Spanish or English with a respondent 18 years of age or older selected randomly from members of households reached through random-digit dialing. Up to 12 calls were made to complete an interview: four calls to reach a household and designate a respondent, four calls to speak with the designated respondent, and four calls to complete an interview following an initial refusal or premature termination. While the survey effort yielded a 76 percent cooperation rate (number of completed. interviews/completed interviews + refusals to cooperate), the sampling underrepresented blacks and males when compared to the 1980 census. Possible bias in our sample of blacks and the small size of the Asian sample led us to

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focus on Anglos and Hispanics in these analyses (although an investigation of ethnicity effects including blacks is reported elsewhere by Dooley & Catalano, 1985). Survey Measures

Respondents were asked a battery of questions that included an inventory of life events. This inventory included events drawn from existing scales as well as several original items. Respondents were asked whether an event had occurred in the last six months and, if it had, the month of the occurrence. Life events were divided into three variables, "undesirable job and financial life events," "positive and indifferent job events," and "noneconomic and nonhealth life events." The job and financial event inventory (Catalano & Dooley, 1983) included 36 items; some were drawn from the PERI Life Event Scale (Dohrenwend & Dohrenwend, 1974), Holmes and Rahe Scale (1967), and the Theorell "workload" scale (Theorell & Floderus-Myrhed, 1977), and others were original items. Recent (three-month recall) events were studied in their raw count rather than adaptation weight form (Brown & Harris, 1978; Horowitz, Schaefer, Hiroto, Wilner & Levin, 1977; Rahe, 1974; Ross & Mirowsky, 1979; Uhlenhuth, Haberman, Baler & Lipman, 1977). The psychological symptom measure consisted of 25 questions about recent psychosomatic problems adapted from the PERI (Psychiatric Epidemiology Research Instrument) Demoralization Scales (Dohrenwend, Shrout, Egri & Mendelsohn, 1980). Of these, 16 were similar to those on the commonly used Langner 22 (Langner, 1962). The help-seeking measure consisted of a single item asking whether the respondent had sought help for an emotional problem in the past three months. The health outcome measure consisted of two items asking whether the respondent had had an illness or injury in the past three months and was scored dichotomously- either ill or injured vs. neither. Demographic (sex and age) and socioeconomic measures were also obtained as control variables. Respondents were divided into four age groups (18-28, 29-39, 40-55, 56+) and three socioeconomic status (SES) levels (by thirds).

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Economic Measures

The aggregate economic measures were all obtained archivally for the Los Angeles-Long Beach SMSA. There were two economic dimensions employed in order to represent different aspects of the economy. The first type of economic change is directional, and reflects contraction of employment opportunities in the community. The traditional but problematic unemployment rate was one such indicator of employment opportunities. Another measure of opportunity consisted of change in total number of persons employed and is called "economic contraction." A second dimension of the economy is change per se and is measured by the sum of the absolute monthly differences in the number of persons employed in each sector of the 89-sector recording system. Called "absolute change," this measure reflects total change, whether directionally desirable or undesirable. Analysis

The hypotheses to be tested imply a multivariate analysis that will measure the main and interaction effects of the economy on life events, symptoms, and help-seeking, while statistically accounting (controlling) for demographic or socioeconomic (SES) characteristics. There are two issues involved in selecting the analysis. The first involves applying an appropriate statistical procedure, given the nature of the dependent variable (i.e., continuous or dichotomous). Second, since the hypotheses to be tested involve variables which may be dependent variables in one test (symptoms as a function of life events), and independent variables in another (symptoms influence on help-seeking), a hierarchical modeling approach is required. Multiple regression was used when relationships were assumed to be linear and the dependent variable was not dichotomous. Given the dichotomous nature of the principal dependent variable in some tests (Hanushek & Jackson, 1977), interpretive benefits of dichotomizing the other dependent variables (e.g., high/low symptoms) and large sample size, logit analysis was chosen for other analyses (Fienberg, 1978). Logit analysis is interpretively similar to multiple regression (Swafford, 1980) and

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has been used for analyzing surveys (Goodman, 1978) and a short-time-trend model (Clogg, 1979). Both methods of analysis involve hierarchical modeling. Models of association are tested by starting with the final dependent variable in the hypothesized causal sequence and determining the degree to which it is associated with all the prior causal variables. The analysis continues by treating each intervening variable as the dependent variable modeled as a function of those variables hypothesized to be causally prior. Through an iterative process of model building the most parsimonious and explanatory model is empirically derived. The analyses published to date with these data are too extensive for detailed presentation here (for details see the original reports by Dooley & Catalano, 1984a, 1984b, and Catalano & Dooley, 1983). However, to illustrate these results, we will summarize the findings for the effect of the economy on mental health and illness/injury outcomes. The following presentation of findings will be organized by four dependent variables: life events, psychological symptoms, physical symptoms, and helpseeking behavior. All these analyses controlled for demographic and socioeconomic characteristics of age, sex, and SES, as summarized below. Due to sample constraints, privacy analyses were conducted on Anglos and primary wage earners. Figure 1 depicts the variables and their significant associations. Life Events Life events with desirable or uncertain valence were found to be positively associated with economic change per se when analyzed for the first 12 waves of the survey. The odds of experiencing a positive or indifferent life event are elevated in times of highest economic change per se. Periods of high economic change per se increase the odds of one or more such events by 25 percent over the low and 30 percent over the medium periods. Undesirable job and financial life events were positively associated with economic contraction, including unemployment, in 12 and 16 wave analyses, but the finding held only for middle status respondents. For such respondents, high unemployment

§;

....

I •

Positive & Indifferent Job and Financial Lila Events

I

Undesirable Job & Financial Lila Events

Physical Illness & Injury

Figure 1.

Economy As Stressor

High values represent increasing unemployment or contraction Middle status respondents only Respondents in the work force only U-shaped relationship

Significant Association

(a) (b) (c) (d)

b

>---------------,

Helpseaklng

~----~d~-------------------------------------------------J

Aggregate Economy Change Par Sa

Aggregate Economy Directional Change (a)

...----------{ c

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quarters were associated with a 39 percent increase in the likelihood of events over low unemployment quarters. The above relationships of life events to the economy are to be expected since these indicators reflect intersectoral job shifts, which should be connected to total economic life events in representative samples of the population. The importance of this finding is that it is the best evidence to date for a systematic environmental (rather than stochastic) patterning in self-reported life events. Psychological Symptoms

Psychological symptoms at the individual level seem to be related to economic contraction through the intervening variable of undesirable life events, as well as being directly related to the unemployment rate. Unemployment was positively associated with psychological symptoms in the 16 wave analysis, controlling for life events. Although the unemployment effect on symptoms was statistically significant and positive in the full sample, this result was due entirely to the subsample of people who were in the work force. That is, unemployment rate had a negligible effect on those retired people, housewives, and students who did not regard themselves as being in the work force. Economic contraction was indirectly related to psychological symptoms via undesirable job and financial life events. Undesirable job and financial life events were positively associated with symptoms, while controlling for aggregate unemployment rate, noneconomic life events, being in or out of the work force, and the previously noted demographic and SES characteristics. For example, the experience of one or more events increased the odds of higher-than-median symptoms by 148 percent. Physical Symptoms (lllness/lnjury)

Recent physical health changes for the worse move positively with undesirable job and financial economic life events, which are related to the measure of directional economic change (contraction). This finding was based on the first 12 waves of data (Figure 1). For example, experiencing one or more undesirable

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job or financial events would nearly double the odds of illness or injury for an individual in the 18-28 year old age group (Catalano & Dooley, 1983). In contrast to psychological symptoms, physical symptoms were not directly related to the aggregate economy. Help-seeking

Help-seeking is connected to the economy in three waysdirectly from economic change per se, indirectly from contraction via undesirable job and financial life events, and via symptoms. Symptoms and events both have direct effects on help-seeking behavior. The experience of one or more events raises the odds of help-seeking by 133 percent, and having greater-than-median symptoms raises the odds of help-seeking by 159 percent. Economic change per se is directly related to help-seeking behavior controlling for symptoms and events. Although the effect is highly significant, the magnitude is modest. However, this direct effect for change per se is curvilinear with both low and high change quarters associated with increased help-seeking. Control Variables (Age, Gender, SES, and Ethnicity)

The control variables of age, gender, and SES generally were associated with the dependent variables. Females reported both more symptoms and more help-seeking. The elderly reported fewer life events, fewer symptoms, and less help-seeking. Higher status respondents reported fewer symptoms but more help-seeking. In another study focusing on ethnicity (Dooley & Catalano, 1985), there were no main effect differences among ethnic groups on symptoms, controlling for variable such as education and life events. However, blacks reported more life events, and since events are positively related to increased symptoms, this may translate into an elevated risk for blacks. Blacks also reported less likelihood of help-seeking. Of special relevance here, there were no interactions of ethnicity with aggregate economic variables on events, psychological symptoms, or help-seeking.

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The main purpose of these analyses was to test the hypotheses that variations in the aggregate economy produce psychological and physical costs felt by individuals. Apparently contraction influences psychological symptoms directly (controlling for events) and indirectly via events (at least in middle status respondents). Since the reverse causation explanation of the observed association (e.g., that symptoms or help-seeking by individuals causes fluctuations in the economy) is highly improbable on theoretical grounds, we are inclined to accept the hypotheses. Undesirable life events, psychological symptoms, and help-seeking all are positively interrelated. While these data (cross-sectional within wave) cannot determine causal direction among these survey variables, these results are consistent with a life event-tosymptom-to-help-seeking causal sequence which we have labeled "provocation" (from the provocation of help-seeking by increased symptoms). There are two other ways in which the economy is related to help-seeking. Help-seeking is related directly to economic change per se, controlling for symptoms and events. This relationship is U-shaped and may be attributed to anomie which can lead to help-seeking without the intervening variable of disorder. Economic change supposedly reduces the predictability of the social and physical environments and can lead individuals to anticipate difficulties in coping. An additional process to anomie may involve this anticipation response which is assumed to motivate individuals to seek help. A second way the economy is related to help-seeking is via events controlling for symptoms. This relationship may be understood as the prophylactic use of facilities. This mechanism assumes that prophylaxis is initiated by the experience of undesirable job or financial events. Help is sought when the economy contracts because people want to preclude the disorder intuitively associated with the undesirable life events they have experienced. IMPLICATIONS OF THE RESEARCH FINDINGS

We believe that these research results can be combined with political and economic facts as well as with what we know about

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service provision to yield general guidance for interventions. These interventions can be separated into preventive and remedial, and the former can be further divided into proactive and reactive prevention. Proactive prevention is the control of the external stressor that is a risk factor for disorder (Catalano & Dooley, 1980). In the case of economic stressors, proactive prevention would require reducing the number of undesirable job and financial events experienced by the population. This is a laudable goal and few public officials would argue for more rather than less economic contraction. Few national recessions are intentional. Regional decline, however, often is the expected and accepted outcome of public policy. The current national policy of encouraging investment to shift away from labor-intensive to capital-intensive industries has caused some communities to decline. Growing awareness of the mental health costs of these shifts could lead to attempts to avoid disorder through community stabilization policies. The mechanisms by which economic policies would be assessed for their potential impact on psychological well-being include social impact assessment and cost/benefit analyses. The former is a data collection and forecasting procedure mandated by federal legislation in the case of projects covered by the National Environmental Policy Act (Finsterbusch & Wolf, 1977). These procedures could be extended to policies that have the potential to adversely affect the economic bases of communities (Hartsough & Savitsky, 1984). Research such as that described above could soon allow estimation of the risk of increases in various behavioral problems given anticipated economic dislocations. This information could be added to social impact assessments. The information gathered through social impact assessment could be used to better inform cost/benefit analyses. All policymaking is preceded by formal or informal estimates of the costs and benefits that will be realized by various constituencies whose interests are represented among legislators. The theoretical and empirical bases of these analyses have been the subject of considerable work in recent decades (Mishan, 1976). Methods are now available that allow comparison, at a conceptual level, of various classes of outcomes, including health and behavioral problems. A crucial ingredient in these methods is the relative weight as-

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signed to one class or type of effects vis-a-vis others. These weights are, of necessity, derived from political processes. It is certainly possible that the making of federal economic policies could be preceded by formal cost/benefit analyses, open to public scrutiny, that include alternative analyses based on different weighting schemes. Such formal, open analyses could sharpen the debate over policy and make the value systems of various legislators and institutions more obvious to voters. We are not very sanguine about proactive prevention at the federal level because the current political environment favors accelerating rather than arresting the movement of capital and labor. The specter of controversy over such proposals as taxing growing regions to help declining areas also appears to keep our political institutions from meaningful proactive prevention. Moreover, the nature of these findings, modest in magnitude and sometimes complex or curvilinear, limits their impact in political debate that prefers simple slogans over complex analyses. State and local governments have considerable power to influence the amount and type of capital investment in their jurisdictions. States have been reluctant to use this power until recent years and have used it principally to attract investment in "high tech" firms. Local government, on the other hand, has freely used its land use controls, real estate taxes, and ability to provide infrastructure at public expense to encourage or discourage economic development. The objective of this activity has typically fallen into one or another of the three categories described above. These are to broaden an economic base, to build an economic base consisting of expected growth industries, or to enhance dependent industries and infrastructure to ensure a region is attractive to whichever industries are in growth phases. These strategies were rarely informed of likely behavioral outcomes but tended to be proactive by nature in that the objective was to avoid economic contraction. The improvements in epidemiologic knowledge and in decision methods alluded to above should make these efforts more effective in the future. This should not, however, be viewed as necessarily a desirable development because these locally devised strategies can succeed at the expense of other localities. To the degree that the larger economy is not growing, the expansion of one region can imply contraction of another. It is, therefore,

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prudent that the federal government monitor the spatial distribution of economic activity and exercise its charge to protect the general welfare, as vague as that concept may be. Another mechanism for proactive prevention is to press corporations to take their social responsibilities seriously (Catalano & Dooley, 1980). There is considerable literature arguing that the economic justification for the free market system implies a social accounting for firms (e.g., Dilley & Wergandt, 1975; Estes, 1976; Nadel, 1976). Indeed several firms have actually attempted social audits of their behavior (e.g., Eastern Gas and Fuel Associates, 1974; Scovil Corporation, 1972). Such audits can reveal the health and behavioral costs of shifts in capital investment and motivate stockholders to support policies that reduce the health and behavioral costs of mobile capital. Our belief is that the probabilities of this happening are small unless federal legislation forces all corporations to perform social audits and provides tax advantages for internalizing the health and behavioral costs of corporate decisions. Reactive prevention is that which increases the ability of individuals to cope with stressors that cannot be cost-effectively avoided. "Stress inoculation" programs have appeared in recent years (Michenbaum & Jaremko, 1983) but little is known with confidence about what kinds of individual-level interventions will help people cope with economic stressors. Although there have been various displaced-worker counseling programs stimulated by the recent recession, surprisingly few formal evaluations of them have appeared in the literature. More research on such interventions is urgently needed. Assuming that even excellent prevention programs will not preclude psychological disorder from economic contraction, we must think about providing and paying for remedial services in "hard-hit" communities. We believe that paying for services for displaced workers should be a national responsibility. Our overall economy is, once again, growing, although several communities and regions are declining. Basic fairness, as well as sound economic theory, suggests that those who are benefiting from the current economic policies should help pay the costs of those policies. No state includes the same proportion of "winner" and "loser" communities as does the nation. State tax systems, therefore, cannot provide for an equitable flow· of resources from

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growing to declining regions. Only the federal income tax can "close the system" to ensure that our much-cited national sense of fairness is honored.

REFERENCES Bakke, E. W. (1940). A study of the effects of unemployment upon the workers' social relations and practices. New Haven: Yale University Press. Bendick, M. & Ledebur, L. (1981). National industrial policy and economically distressed communities. Policy Studies Journal, 10, 220-234. Berry, B. J. (1972). City classification handbook. New York: Wiley. Berry, B. J. (1967). Geography of market centers and retail distribution. Englewood Cliffs: Prentice Hall. Blumenfeld, H. (1955). The economic base of the metropolis. Journal of the American Institute of Planners, 21, 114-42. Brenner, H. M. (1973). Mental illness and the economy. Cambridge: Harvard University Press. Brown, R. L. (1982). Mental health and economy: A disaggregated analysis. Doctoral Dissertation, University of Michigan. Brown, G. W. & Harris, T. (1978). Social origins of depression: A study ofpsychiatric disorder in women. New York: Free Press. Catalano, R. & Dooley, D. (1980). Economic change in primary prevention. In R. H. Price, R. F. Ketterer, B. C. Bader & J. Monahan (eds.), Prevention in community mental health: Research, policy and practice. Beverly Hills: Sage. Catalano, R. (1979). Health, behavior, and the community. New York: Pergamon Press. Catalano, R. & Dooley, D. (1983). The health effects of economic instability: A test of the economic stress hypothesis. Journal of Health and Social Behavior, 24, 46-60. Cavan, R. & Ranck, K. (1938). The family and depression: A study of one hundred Chicago families. Chicago: University of Chicago Press. Clogg, C. C. (1979). Measuring underemployment: Demographic indicators for the United States. New York: Academic Press. Cobb, S. & Kasl, S. V. (1977). Tennination: The consequences ofjob loss (Report No. 76-1261). Cincinnati, Ohio: National Institute for Occupational Safety and Health, Behavioral and Motivational Factors Research. Cohn, R. M. (1978). The effect of employment status change on self attitudes. Social Psychology, 41,81-93. Dilley, S.C. & Wergandt, J. (1973). Measuring social responsibility: An empirical test. Journal of Accountancy, 136, 62-70. Dohrenwend, B. S. & Dohrenwend, B. P. (1974). Stressful life events: Their nature and effects. New York: Wiley. Dohrenwend, B. P., Shrout, P. E., Egri, G. & Mendelsohn, F. S. (1980). Non-specific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry, 37, 1229-236. Dooley, D. & Catalano, R. (1985). Economic change and primary prevention: ethnicity effects. In R. L. Hough, P. A. Gongla, V. B. Brown & S. E. Goldston (eds.), Psychiatric epidemiology and prel'ention: The possibilities. Los Angeles: University of California. Dooley, D. & Catalano, R. (1984a). The epidemiology of economic stress. American Journal of Community Psychology, 12, 387-409.

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Dooley, D. & Catalano, R. (1984b). Why the economy predicts help seeking: A test of competing explanations. Journal of Health and Social Behavior, 25, 160-75. Dooley, D. & Catalano, R. (1986). Do economic variables generate psychological problems? Different methods, different answers. In A. J. Macfadyen & H. W. Macfadyen (eds.), Economic psychology: Interactions in theory and application. New York: North-Holland. Dooley, D., Catalano, R. & Brownell, A. (1986). The relation of economic conditions, social support, and life events to depression. Journal of Community Psychology, 14(2), 103-119. Durkheim, E. (1897). Suicide: A study in sociology. Paris: Alcan. Easterlin, R. (1980). Bitth and forlune: The impact of numbers on personal welfare. New York: Basic Books. Eastern Gas and Fuel Associates. (1974). Annual reporl. Boston: Eastern Gas and Fuel Associates. Estes, R. (1976). Corporate social accounting. New York: John Wiley and Sons. Ficnbcrg, S. E. (1978). The analysis of cross-classified categorical data. Cambridge, MA: MIT Press. Finstcrbusch, K. & Wolf, C. P. (1977). Methodology of social impact assessment. New York: McGraw-Hill. Goodman, L. A. (1978). A general model for the analysis of surveys. In A. Goodman & J. Magcdson (cds.), Analyzing qrtalitatiw/categorica/ data: Log-linear models and latent-stmcture analysis. Cambridge, MA: Adt. Hanushck, E. A. & Jackson, J. E. (1977). Statistical methods for social scientists. New York: Academic Press. Hartsough, D. & Savitsky, J. (1984). Three Mile Island: Psychology and environmental policy at a crossroad. American Psychologist, 39, 1113-22. Holmes, T. H. & Rahc, R. E. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 2, 213-18. Horowitz, M., Schaefer, C., Hirota, D., Wilner, M. & Levin, B. (1977). Life event questionnaire for measuring presumptive stress. Psychosomatic Medicine, 39, 41331.

lsard, W. (1976). Introduction to regional science. Englewood Cliffs, NJ: PrenticeHall. Jahoda, M., Lazarsfcld, P. F. & Zciscl, H. (1971 ). Marienthal: The sociography of an unemployed community. Chicago: Aldinc-Athcrton. Komarovsky, M. (1940). The unemployed man and his family: The effect of rmemployment upon the status of the man in 59 families. New York: Dryden Press. Korpcr, S. P. (1976). Utilization of community mental health services: Further consideration of the implications of socio-economic class and related variables. Doctoral dissertation, Yale University. Langner, T. S. (1962). A twenty-two item screening score of psychiatric symptoms, indicating impairment. Journal of Health and Human Behm•ior, 3, 269-76. Markush, R. E. & Favero, R. V. (1974). Epidemiologic assessment of stressful life events, depressed mood, and psychophysiological symptoms: A preliminary report. In B. S. Dohrenwcnd & B. P. Dohrcnwcnd (cds. ), Stressful life et·ents: Their nature and effects. New York: Wiley. Michenbaum, D. & Jarcmko, M. (1983). Stress reduction and prevention. New York: Plenum Press. Mishan, E. (1976). Cost benefit analyses. New York: Praegcr. Nadel, M. (1976). Corporations and public accountability. Lexington, MA: D. C. Heath. Ogburn, W. F. & Thomas, D. S. (1922). The influence of the business cycle on certain social conditions. Journal of the American Statistical Association, 18, 324-40.

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Oppenheim, N. (1980). Applied models in urban and regional analysis. Englewood Cliffs, NJ: Prentice-Hall. Perloff, H., Dunn, E. S., Lampard, E. E. & Muth, R. F. (1960). Regions, resources and economic growth. Baltimore: Johns Hopkins Press. Pierce, A. L. (1967). The economic cycle and the social suicide rate. American Sociological Review, 32, 457-62. Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. Rahe, R. H. (1974). The pathway between subjects' recent life changes and their ncarfuture illness reports: Representative results and methodological issues. In B. S. Dohrcnwend & B. P. Dohrcnwcnd (eds.), Stressful life events: Their nature and effects. New York: Wiley. Ross, C. E. & Mirowsky, J. (1979). A comparison of life-event-weighing-schemes: Changes, undesirability, and effect-proportional indices. Journal of Health and Social Behavior, 20, 166-77. Sarbin, T. (1969). Schizophrenic thinking: A role theoretical analysis. Journal of Personality, 37, 190-206. Scheff, T. (1964). Being mentally ill. Chicago: Aldinc. Scheff, T. (1975). Labeling madness. Englewood Cliffs: Prentice-Hall. Scovil Corporation. (1972). Annual report. Waterbury, CT: Scovil Corporation. Simon, W. (1978). A time for tmth. New York: Readers Digest Press. Stcrnlicb, G. & Hughes, J. (1977). New regional and metropolitan realities of America. Journal of the American Institute of Planners, 43, 226-41. Swafford, M. (1980). Three parametric techniques for contingency tables analysis: A nontechnical commentary. American Sociological Review, 45, 664-90. Thicbout, C. (1962). The community economic base study. New York: Committee for Economic Development. Thomas, W. & Znaniccki, F. (1920). The Polish peasant in Europe and America. New York: A. Knopf. Thurow, L. (1980). The zero sum society. New York: Basic Books. Uhlcnhuth, E. H., Haberman, S. J., Baler, M. B. & Lipman, R. S. (1977). Remembering life events. In J. S. Strauss, H. M. Babigan & M. Roff (cds.), The origins and course of psychopathology. New York: Plenum. Wicker, A. (1979). An introduction to ecological psychology. Belmont: Wadsworth.

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Chapter 6

Prosocial Television for Community Problems: Framework, Effective Methods, and Regulatory Barriers Richard A. Winett Virginia Polytechnic Institute and State University

SUMMARY. Prevention professionals have often steered away from using media because of the mistaken notion that media cannot be effective for behavior change. This chapter presents one integrative framework, "behavioral systems," useful for conceptualizing, designing, implementing, and evaluating media-based, particularly televised, preventive efforts. Effective elements and variables for such behavior change efforts are gleaned from the framework and related literatures and are shown to be operative in a number of successful prosocial and health promotion television spots and programs, as well as being applicable to various "news media" efforts. However, a major problem is gaining access to the media. Typically, in the U.S., extensive resources are required to deliver televised messages, even at a local level. This central problem is discussed in relationship to regulatory policy and ways to work within the current broadcast system, as well as Reprint requests should be sent to Richard Winett, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061. All of the author's research reported in this chapter was supported by the National Science Foundation. The opinions expressed in this chapter are, however, the author's and not the agency's. Some of the work presented in this chapter has appeared in extended form in the author's book, lnfonnation and Behavior: Systems of Influence, Hillsdale, NJ: Erlbaum Associates, 1986. © 1987 by The Haworth Press, Inc. All rights reserved.

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ways to bypass the system, so as to deliver specialized content to specific target audiences.

Prevention efforts have often been dedicated to large-scale methods of intervention. Approaches have been diverse, but with some few exceptions (e.g., Jason, Gruder, Martino, Flay, Warnecke & Thomas, in press), prevention professionals have not sought to use media as a major strategy. There are a number of possible conceptual and practical reasons for this omission.

1. Until recently, many papers, and, indeed, books appeared to have the primary goal of delivering the message that "media (information) cannot affect behavior change." A newcomer to the literature would quickly reach the conclusion to move on to another approach. 2. Should a preventive interventionist not be thoroughly dissuaded by this first review, it will next become apparent that developing effective media and gaining access to delivery systems may be complicated and expensive endeavors. 3. If resource and access problems can be overcome, it is unclear what conceptual and action frameworks are actually effective for developing media-based, behavior change efforts. These barriers to using media approaches will now be addressed. The objective at this point is not to convince the reader that using media is actually simple, but rather that conceptual and practical barriers may be creatively overcome. The author (Winett, 1986) has recently reviewed hundreds of media-based studies conducted during the last 50 years. It became apparent that, with a few exceptions, conclusions about the nonefficacy of media were often based on studies conducted prior to modern visual technologies, i.e., television, with these studies often not imp len 1ented in ways conducive to effect and measure behavior changes. Ironically, for many years, behavioral scientists have been warning about the power and dangers of television. For example, though the debate continues, most behavioral scientists would agree that violence depicted on television increases aggressive

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behaviors in some viewers (Liebert, Davidson & Sprafkin, 1982). If this media effect is evident, how can other media not also affect behavior? The answer appears to lie in the more proper use of communication, psychological, and marketing principles. An interventionist also is typically interested in influencing large, nonselected audiences. In order for such influence to be achieved, the interventionist faces the next major barrier. Access must be gained to the "public airways." If it is assumed that more than simple announcements or news items, e.g., a series of spots or an intact program, are desired, then it will be quickly discovered that the public airways are actually the commercial airways. Programs on television are sponsored by corporations which pay to have their vJmmercials broadcast with a program. Larger and/or more affluent audiences, such as during prime time, entail higher fees assessed by networks, affiliates, or cable stations. Public service announcements (PSAs) are broadcast at the discretion of the station, generally at nonprime times where not all commercial time has been sold. Guidelines and regulations requiring community responsiveness and access have been relaxed by the Federal Communication Commission (FCC). In many communities, though, access may still be gained through cable companies with special openaccess channels. This is not the same as appearing on network TV, but it does allow for low-cost local "narrowcasting." However, resources will be needed to develop quality programs that viewers will attend to, learn from, and adopt and adapt the recommendations that are made. It would be a mistake to assume that any format and quality will do, even for local programs. For example, a "talking head" format is simple and inexpensive, but does not appear effective for behavior change (Winett, Hatcher, Fort, Leckliter, Riley, Fishback & Love, 1982). The preventive interventionist interested in television (and other media) will find it necessary as an individual and as part of a team to develop at least some expertise in these fields: -Social learning theory and other theories of social influence -Behavior Analysis -Communication principles

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-Media development and production - Social marketing -Research and evaluation -Regulatory policies These fields now will be discussed as they can be used to form a coherent framework for media-based efforts, particularly television. After this framework is developed, a number of specific examples of its use will be given. Most of these examples are from limited PBS and other experimental applications; therefore, regulatory policy as it relates to broader access will be discussed. Media access is the overriding issue in the discussion of any present and future media and behavior change. Thus, a final section will discuss potential applications of new media, but within the context of regulatory policy. Finally, the last sections of the chapter will discuss some strategies countering current TV fare by gaining some limited access to commercial TV and bypassing the commercial system. Another strategy for gaining access, "working within the system," will also be described. PRINCIPLES AND FRAMEWORK

From several complimentary fields, a number of principles can be drawn that, in turn, can be fit within one overall framework, referred to as "behavioral systems." Its components and key principles are as follows: Social Learning Theory (SLT)

SLT has evolved as a kind of meta-theory, and its present scope encompasses and incorporates such diverse fields as information processing, operant conditioning, and the diffusion of innovation (Bandura, 1986). The concern is always with the reciprocal determinism of the environment, behavior, and cognition. SLT's more recent emphasis on cognition and information processing within social contexts has led Bandura to suggest that SLT be renamed social-cognitive theory (SCT).

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SLT, and now SCf, provide perspectives and some definitive principles of behavior change. The potency of modeling is certainly well-known by psychologists and, indeed, is often used in commercial marketing. Unfortunately, modeling has been infrequently used in PSAs (Winett, 1986). For example, people may be urged to stop smoking, but never shown how to deal with withdrawal symptoms or tense social situations (but see Jason et al., in press). It can be convincingly argued that prosocial media efforts that do not use modeling (e.g., simply use fear or exhortation) have a very high probability of failure (Leventhal, Safer & Panagis, 1983). Behavior Analysis (BA)

BA focuses on microanalyses of target behaviors within their environmental context. For example, exactly where, when, and how often does a particular target behavior occur? What are the immediate and long-term personal, social, physical, and economic consequences of engaging in the target behavior?_ Thus, analyses of environmental settings and contingencies are critical for properly presenting a planned behavior change and for providing strategies to overcome barriers and constraints to reinforcement. For example, attempts to change food-buying and nutritional practices must be developed with cognizance of cultural, social, and psychological determinants of food choice and consumption. Shopping behaviors must be analyzed in relationship to complex supermarket environments and time constraints on shoppers. Media-based nutritional messages must show shoppers simple ways to make quick and appropriate food purchases within hectic, stimulus-laden supermarkets (Winett, Kramer, Walker, Malone & Lane, 1985). Communication

Of particular relevance to prosocial media efforts is a growing literature on the formal features of the media that can be used to increase attention, comprehension, and memory (Wright & Huston, 1983). The formal features can be considered the syntax and grammar of a medium. For television, such elements as the speed

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of pacing, the use of zooms and close-ups, voice-overs, music, and particular sound effects appear to have predictable cognitive effects. While some (e.g., Singer & Singer, 1981) have criticized television for these elements, often such critics have not appropriately differentiated the content and context of the usual television fare. Thus, some television programs may have negative effects (e.g., increase aggressive behavior) because of their content (violence), and not the context of the program (e.g., rapid pacing). The major point here is that the consideration of formal features, with some notable exceptions (e.g., Sesame Street), has often been lacking in prosocial programs. Media Development, Design, and Production

A number of activities can be placed under this term including picking particular media, script and message development, setting locations, proper lighting and voice levels, the convergence of colors, rehearsing and directing actors, various shooting angles and perspectives, continuity of shooting, integration of voice and music tracks, and a host of critical activities listed under the term "editing." Unless there are special circumstances and interest, it is unlikely that a prevention professional will master any of these activities, let alone all of them. Reliance on media professionals is usually the rule. However, attached to this last statement is a major caveat. The job of a prevention professional is to assure that all the proper conceptual elements are applied to the production. For example, no matter how visually attractive, dramatic, or funny a prosocial spot is, it will probably fail to achieve any behavior change without vivid and realistic depiction of the target behavior. Social Marketing

SM can be considered the key to the overall enterprise. SM is a framework that focuses on the product, its promotion, place, price, and positioning, with these five variables interrelated. SM insists upon a systematic program of formative research that carefully develops products in tune with the knowledge, beliefs,

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and lifestyle of particular population segments (Fine, 1981; Kotler, 1982; Manoff, 1985). Audience segmentation is at the heart of SM. Less clearly developed are the exact methods of doing formative research and collecting data. Indeed, SM methods run the gamut from surveys to focus groups, to situational and pilot tests, often depending on the conceptual orientation and resources of the social marketer. Unfortunately, the relative hodgepodge of techniques must be seen as a present weakness. A major strength, however, is forcing attention in the development process to all major marketing variables (Fox & Kotler, 1980). For example, planners of brief programs on nutrition for poorer people living in cities with young children must devise programs that fit current audience knowledge, beliefs, and lifestyle; are interesting and attractive to them; depict food purchase and nutritional changes that are doable without great (or any) personal, social, or economic costs; are shown on channels and at times of high viewership by the audience segment; show places for food purchase and preparation that exist in those communities and homes; are differentiated from the steady bombardment of commercials; and occupy a niche appropriate to the target audience. Reviewers of prosocial media campaigns indicate that most often an SM framework was not followed, and often, at best, minimal formative research was done (Manoff, 1985). Most of these campaigns have failed. Such rudimentary formative research as deciphering what most members of the target audience need- information, different attitudes, or skills and practices, or all of these (i.e., a simple hierarchy of effects model; Maccoby & Solomon, 1981)- has also not often been done. Fortunately, there is evidence which shows that following an SM framework can result in messages and programs that are relatively effective (Manoff, 1985). Although the basic mission of social marketing, i.e., fitting and developing specific programs for specific audiences, is highly consistent with the therapeutic mission of mental health (Paul, 1967), many preventionists and mental health professionals appear either repelled by their preconceived beliefs about the evils of "marketing," or, at best, have a cursory knowledge of

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marketing. Frequently, SM is confused with "social advertising.'' Simply developing spots or PSAs is not an example of SM. It is instead only one type of promotion that may or may not be appropriate for the task at hand. A project only uses an SM approach when all variables in the framework are used in planning, development, and implementation (Fox & Kotler, 1980). Coupled with the misconception of SM as social advertising, are unrealistic attempts to emulate commercials as a means to affect behavior change. There is a lack of understanding that a commercial is simply one part of a well-orchestrated marketing mix. For example, McDonald's® hamburgers are readily available in almost every community; at a reasonable price; with a certain image differentiating them from other similar fast food; and are obtained at relatively clean and friendly places, where the reliably acceptable product is offered. The commercials would be ineffective without the other marketing variables in place (Solomon, 1982). Then too, the objective of most commercials- to change choices within the same product class- is also relatively "simple" to obtain. A campaign that shifted the market share several percent between Pepsi® and Coke® would be a startling success. But, note that no major change in consumer behaviors ("lifestyle") is required by such brand shift. Compare brand shifting to changes in health behaviors such as dietary and activity practices. The typical task of SM is more difficult than commercial marketing and requires more potent efforts. This is again why media access and regulatory policy is of critical concern for prosocial efforts. Research and Evaluation

One of the unique skills of prevention professionals, such as community psychologists, that can be contributed to media efforts is research skills (Rappaport, 1977). Further, a frequent criticism of information/media campaigns is that from start to finish there has been no serious evaluation (Wallack, 1981). While there is an overriding need to systematize formative research, there is also the need to perform sophisticated outcome

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studies which address impact and cost effectiveness (Levin, 1983). Clearly, in the development stage, evaluation serves a feedback function resulting in new iterations of the product and further testing. This stage requires considerable time and resources for product development. A series of pilots (following other formative research) must be performed to refine the product prior to larger outcome studies. However, few good, controlled-outcome studies have been done on media campaigns and television programs (Wallack, 1980). When realistic and obtainable measures are used and care is taken for exposure by "experimental" viewers and nonexposure by controls, true experiments of media effects are quite possible (Winett, Leckliter, Chinn & Stahl, 1985). However, it would be a mistake for an interventionist to only be involved as an evaluator in such campaigns. Many concepts and principles from the behavioral systems framework have been missing from campaigns that have not been effective. If the design and "creative" people insist that spots have a certain pacing and integration of music and colors, the prevention professional must also insist that the processes and barriers involved in changing specific health behaviors are carefully modeled. Well-conceived research on information campaigns shouV:J also be used to address more basic discipline and paradigmatic concerns and issues which override various large-scale efforts, e.g., the interrelationships of media and social networks and the adoption of innovations (e.g., Rogers & Kincaid, 1981). The interventionist needs to make the case that the concerns of science and application can mesh in these endeavors to the long-run benefit of all concerned parties. EFFECTIV E AND INEFFEC TIVE VARIABLE S

Table 1 summarizes elements and variable related to ineffective and effective information campaigns. This table uses communication independent variables, and is based on the framework presented in the prior section and summaries of the literature by Atkin (1980) and McGuire (1981). It also serves as a

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~ (format and content)

Ineffective

Effective

Poor quality decreases attention

High quality to enhance attention (e.g., comparable to conmercial ad)

Overemphasize quantity vs. quality Vague or overly 1ong messages; drab, e.g., "talking head" Limited exposure (e.g., 1ate night PSAs) Inappropriate media (e.g., detailed print for behavior change)

High qua 1 i ty may overcome some problems in limited exposure Highly specific messages; vivid, e.g., behavioral modeling Targeted exposure Appropriate media (e.g., TV for behavior change)

Not well attended to

Trustworthy, expert or competent; may also be dynamic and attractive

Little formative research to understand audience characteristics

Much formative research to target message to audience

Destination

Difficult or complex behaviors resistant to change

Simple behaviors, or behaviors in a sequence, changeable and where lung-term change can be supported by the environment

Conceptua 1 i zati on

Inappropriate causal chain (e.g., early events as predictors of later ones)

More appropriate causal chain and emphasize behavior change

Little analysis of competing information and environmental constraints Unrealistic, i.e., expect too much change

Analysis of competing information and environmental constraints used to design messages Realistic, specific, limited

bridge to the next sections which describe appropriate goals and formats of programs, and then details a number of prosocial TV efforts. It appears that a successful prosocial TV program, i.e., yields some behavior change, must follow all the guidelines noted in the table (Mendelsohn, 1973). PRESENTATION FORMAT

Lovelace and Huston (1982) have stressed that considerable research is needed to find optimal presentation formats for proso-

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cial content, particularly if a program will compete with commercial fare. A program designed for PBS may have less concern with commercial competition. The program still needs to be enjoyable, but probably can focus more on the message. Programs may also be used in situations where there is a captive audience, such as classrooms. Here the program may most explicitly focus on the message and key behaviors and be supplemented by interpersonal activities (e.g., Evans et al., 1981). Thus, as a first step, prosocial programs must be clear on the delivery mode. Table 2 describes three different presentation options, and their advantages and disadvantages, for prosocial programming derived from Lovelace and Houston (1982). The formats are primarily based on research with children. Table 2 Presentation Fonnats for Prosocial Proqrams: Advantages and Disadvantages* Presentation format

Advantages

Disadvantages

1. One model or several models only display prosoci a 1 behavior and no portrayals of antisocial or conflicting behaviors.

- Very clear - Most support from soc•al learning theory - Can be very effective in classroom and theraPY and easily supplement with interpersonal activities

- Not very dramatic - Few commercial programs in this fonnat - May not hold attention - Most of research on captive audience and assessment in artificial settings -May have generalization prob 1em when vi ewer encounters negative situations

2. One or more models exhibit prosocial behaviors while the same people or others display antisocial or inappropri ate behaviors which receive negative ~quences.

- Provides drama - Most similar to usual TV fare - "Sesame Street" and "Mr. Rogers" appear to successfully use

- Antisocial and inappropriate behaviors may be modeled - May need interpersonal supplement to sort out positive and negative behaviors

3. One or more models exhibit prosocial behaviors while the same people or others display antisocial or inappropriate behaviors, but no final resolution presentecr:-

- Provides drama - May provoke postviewing problem solving to solve conflict -May be effective when coupled with post-viewing interpersonal activities

- Antisocial and inappropriate behaviors may be modeled - Vi ewer not generate postviewing problem solvinq

*Based on Lovelace and Huston, 1982.

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Lovelace and Huston also addressed the critical problem of generalization and maintenance of behavior change. That is, specifically targeted behavior change strategies are, not surprisingly, most effective in changing specific behaviors in specific circumstances (Wilson & O'Leary, 1980). As somewhat different behaviors are needed in somewhat different settings across time, highly specific training will be less efficacious. If the television program is the singular intervention, then generalization and maintenance may be enhanced by showing multiple models in an appropriate range of situations showing diverse and appropriate responses. This approach will likely be effective with children and adults. In addition, using a model who is similar to the target audience but somewhat more competent, and showing the model being reinforced for the appropriate social behavior, will respectively facilitate viewer identification with the model and actual performance (Wilson & O'Leary, 1980). Finally, a dramatic story, and where possible, post-viewing role play, may further enhance attention, memory, and behavior change. Based on Table 2 and these additional comments, it is possible to describe the preferred format of a prosocial TV program with no interpersonal component:

1. Have one model or several models similar to the target audience, but a bit more competent, display prosocial behaviors. 2. Show multiple models in diverse settings display variations of the desired behavior. 3. Show the models being reinforced for performing appropriate behaviors. 4. Accurately depict constraints and obstacles to performing prosocial behaviors and show how to overcome them. 5. Provide an interesting or dramatic story to maintain attention and increase comprehension and memory. PROSOCIAL PROGRAMM ING: BRIEF EXAMPLES

The purpose of this extended section is to review a number of well-known prosocial television efforts (see also Rushton, 1982), and ferret out their effective and ineffective elements. How well

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do effective programs fit within a "behavioral systems" perspective, and prior analyses of key media variables, and presentation formats? This section will briefly review five of these efforts and then spend more time on two of them-the "Feeling Good" series and a recent project by the author. Freestyle

This program, funded by the National Institute of Education, was developed in response to concerns in the 1970s that boys and girls had rigid stereotypes of appropriate behavior (Johnston, 1982). The goal of "Freestyle," designed for children 9-12, was to alter the children's stereotypes and enhance the possibility of girls pursuing more traditionally "masculine" interests and, later, occupations. The series, which included 13 one-half-hour dramas, and took $3.7 million and two and a half years to produce, could be used for home and school use, and data are available on comparative effectiveness. The program made its PBS debut in the Fall of 1978, accompanied by teachers' guides and other print material. The basic scenario and format of the programs entailed teenage actors choosing nonstereotypical activities and being rewarded for their choice. Thus, preoccupational activities (mechanics for girls), behavior skills (e.g., assertiveness for girls), and nonsex-typed work and family roles were depicted. However, usually the characters had to overcome adversity to succeed and the programs were done in a dramatic fashion. An evaluation study included 7000 children in seven cities who saw the programs under three conditions: classroom viewing with discussion, classroom viewing alone, and home viewing (with presumably no discussion). From this chapter's perspective, an assessment of "stereotyped" and "nonstereotyped" behaviors prior to, during, and after the program sequence would have been the most straightforward evaluation consistent with the program goals. Long-term follow-up could focus on job choice, college major, and family status. Obviously, expecting the latter type of follow-up outcomes would be overly optimistic. Unfortunately, the evaluation primarily focused on attitudes toward those engaging in activities and occupations which are

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stereotyped as inappropriate (e.g., policewoman), beliefs regarding the competence of boys and girls and men and women in nontraditional pursuits, and a viewer's interests in pursuing nonstereotypical activities. A pretest/post-test (four months apart) design was used with adequate attention given to the representatives of the sample children's background. A nine-month followup was also done in one of the cities. Generally, the detailed evaluation showed some expected changes on attitude and belief measures in the direction of the programs' content which, however, tended to diminish over time. The more intensive format, classroom and discussion, provided better outcomes than classroom viewing alone. The heaviest home viewers showed some modest changes, although less than the classroom viewing only condition. "Freestyles" can be described as a good idea with poor execution. Some of the content and format, e.g., behavioral modeling in a drama, seem consistent with the points for effective TV programming made earlier. The goals, however, appear too vague and poorly timed (e.g., occupational choices). An evaluation with, perhaps, only 100 children, not 7000, with a focus on actual behaviors, could have told us much more about the impact of "Freestyles." Television Spots and Seat Belt Use

The study by Robertson, Kelley, O'Neill, Wixom, Eiswirth, and Haddon (1974) using television spots to increase the use of seat belts is extremely pivotal in any discussion of the potential of television for prosocial behavior change. This is because: (1) the study was an excellently controlled field experiment; (2) the television spots received wide exposure, including during prime time, thus eliminating a common problem of other prosocial programs; (3) the target behavior was simple and easy to perform; and, (4) the inability of the effort to show any evidence for increased seat belt use has been widely reported (seat belt use remained only 9%) and generalized to mean that "television is ineffective for behavior change." Thus, it is important to critically examine this study.

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In this field experiment, messages were only shown on one cable of a dual cable system that had been purposely designed for marketing studies. Actual seat belt use was unobtrusively observed in standard community settings one month prior to the study and for the nine consecutive months during the airing of the spots. Recording license plates allowed matching of driver and vehicle to the appropriate cable outlet. Thus, the design and data system were excellent. However, a critical problem appears to revolve around the messages' theme and content. Through survey research, it was decided to emphasize in the messages that use of safety belts will decrease the probability of disfigurement and disability. The use of physician endorsements and a theme of family responsibility were also used. But, the major approach was based on fear tactics. Behavioral modeling and discussion was not used to demonstrate the ease and protection of seat belt use. Thus, fear was seen as an antecedent and mediator of behavior change, a faulty supposition (Leventhal et al., 1983). The following is one such spot: A woman whose face cannot be seen is shown in front of a mirror applying makeup. A full face picture on her dressing table shows her as a beautiful woman. Her husband enters the scene and suggests that they go to a party. She asks him not to look at her without makeup as she turns to reveal a scarred face. An off-camera announcer describes a crash in which the wife was driving slowly and carefully. The announcer continues, as the picture on the table is showing, "Terry would still look like this if she had been wearing safety belts." Announcer: "It's much easier to wear safety belts than to hear your husband say ... " Husband: "Honey, I love you anyway." (Robertson et al., 1984, p. 1073)

The spots were written and produced in collaboration with an advertising agency, and six spots were developed. They were strategically placed on or adjacent to an appropriate program, such as a soap opera.

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One other crucial mistake was made. The only apparent pretesting and evaluation consisted of ("excellent") ratings by panels of "advertising experts." However, the acid test is piloting with a representative sample and monitoring behavior change. This was not done. Robertson et al.'s conclusion about the ineffectiveness of television needs to be questioned. Clearly, not any type of message and format will promote behavior change. A more warranted conclusion is that some types of messages are ineffective. Further, where there is little public interest or support for particular behavior changes, as was the case for seat belt use when this study was done over 15 years ago, it is unlikely that any behavioral strategy will be effective. Behavioral technology needs a supportive context (Winkler & Winett, 1982). Over Easy

This program was developed in 1977 and originally funded by the Department of Health, Education, and Welfare's Administration on Aging and the Corporation for Public Broadcasting (Keegan, 1982). The program was aimed at a target audience of persons 55 years and older and had cognitive, affective, and behavioral objectives. The basic philosophy of the program involved seriously questioning the cultural preoccupation with being, looking, and acting young. The specific goals of the program entailed reversing the negative images of aging (affective), informing viewers of specific services and self-help activities (cognitive), and having viewers initiate a number of these self-help behaviors. The program's format mixed information and entertainment. An older person hosted the program, serving as a positive role model, and providing information and entertainment through interviews with celebrities and experts. Self-help behaviors in a wide range of areas- medical, nutritional, legal, interpersonal, financialwere discussed and evaluated in the programs. In addition, the program tried to increase viewers' use of existing private and public community and social services by emphasizing that viewers were entitled to use them.

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This last behavioral objective is well worth describing in detail. At the end of many "Over Easy" programs, local information would be listed. Rather than simply advising viewers to "contact local agencies," agency or community information and referral numbers were listed. Thus, the program attempted to embed itself in existing networks of related social programs and services, and the behavior requested of the viewer was simple and specific-i.e., call this number. The project's evaluation indicated that additional funding was needed for promotional and scheduling efforts since only about 7% of people over 55 had seen the show at least once. However, viewers liked and appreciated the different approach to aging, and about 75% of the viewers retained at least one pro-aging message. Significant information gain was shown in such areas as medical needs and employee rights, and how to use such information. Agency directors actively promoted the program with more than a third documenting an increase in their information and referral services, transportation, in-home services, and senior centers. The most frequent new behavior was requests for information. The "Over Easy" program also provided important guidelines for future preventive TV efforts: 1. Use an "upbeat" program to focus on preventive behav-

iors, and not have an individual crisis intervention approach. 2. Use a program to link viewers and existing services; do not create a new set of services (see McAlister et al., 1982, for a similar approach). 3. Focus on simple behaviors to forge the linkage. Parental Beliefs and Behaviors

Ratcliffe and Wittman (1983) reported on a unique attempt to influence the beliefs and behaviors of parents of young children. A pilot study was first conducted in Ontario, Canada, under the auspices of the Ministry of Community and Social Services. Four animated 30-second television commercials were designed with the general goals of fostering a more positive emotional family

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environment and providing parents with behavioral skills needed for dealing with typical parent-child problems. It is important to note that these were paid commercials, not PSAs, and thus, there was the ability to properly target the messages. Although the commercials were targeted to all parents with young children, they were developed in light of psychological factors related to child abuse. These factors included: (1) regarding physical punishment as natural and appropriate; (2) treating children as little adults, and thus having unrealistic expectations and making very high performance demands; and (3) attributing malevolent intentions to their child, leading to an antagonistic, frustrating relationship. The messages were designed around the theme (copy line) of "You're Not Alone," i.e., other parents have similar feelings and problems and you can obtain helpful information. It was postulated that this theme would both alleviate anxiety and reduce anger and frustration. · The first three messages portrayed the child-rearing problems of sibling rivalry, toilet training, and night walking. The specific goals of the messages were to: ( 1) increase understanding of the child-rearing problems; (2) develop more appropriate performance expectations; and (3) decrease attributions of malevolent intentions. The fourth commercial was not described in detail, but evidently its purpose was to remind parents that showing affection was important for optimal child development. Note that in the first three commercials, a major assumption was made that observing a parent with similar problems and high expectations would reduce negative emotions and unrealistic expectations. Except for obtaining specific information (i.e., "write to ... "), behavioral strategies were apparently not recommended in the commercials. The commercials were aired twice- during an 11-week period, followed by six weeks without commercials, then eight more weeks of commercials- on one television station with the commercials shown at a weight of 70% prime-time viewing and 30% daytime viewing. The target audience was all mothers under 35 years of age with one or more children under five. The authors estimated that 54% of the target audience would see one or more

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of the campaign messages 30 to 35 times. A pamphlet, freely available by call-in, was also distributed in doctors' offices, hospitals, and supermarkets. The evaluation primarily consisted of 20- to 30-minute telephone interviews using telephone numbers randomly chosen from a directory. An unusually high percentage, 97%, completed the interview. Interviews were done on separate samples of 300 mothers before the commercials were broadcast, after the first 11 weeks, and then after the final eight weeks of commercials. The interview data yielded the following findings: 1. Awareness (unaided plus aided) of the commercials increased from 39% at the time of the second interview series to 55% by the end of the third. 2. Pamphlet awareness was about 35% at interviews two and three. 3. Shifts in appropriate opinions/beliefs of about a mean of 10% were found in the second interview, and were at about the same level at interview three (i.e., no additional increase). 4. For those "aware" of the commercials, about 85% on both the second and third interviews rated the commercials as "very" or "somewhat" helpful for parents of young children. 5. For those aware of the campaign, about 22% on the second and third interview reported that the commercials had changed the way they dealt with their child(ren). 6. Prior to the self-reported behavior change interview question, parents were asked if in the past week compared to a few months ago, they behaved differently on a number of key dimensions. The best comparison here was between "unaware" parents (N = 313) and "aware" parents (N = 59) reporting change. In regard to their children, aware changed parents, when compared to unaware parents, reported feeling more relaxed (42% vs. 16% ), less angry (12% vs. 8% ); more patient (29% vs. 8% ), more aware of their children's needs (49% vs. 22%); less frustrated (19% vs. 6% ), more confident (42% vs. 23% ), more emotionally close (56% vs. 29%), and more happy (58% vs. 30%).

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Mother reported they praised their children more (41% vs. 21% ), were more affectionate with them (37% vs. 12% ), played with them more (44% vs. 20% ), and talked with them more (53% vs. 28% ). 7. Separate analyses suggested that the pamphlets had little influence on parental beliefs or reported behaviors. However, 453 requests for information were received by the Ministry during the combined 19 weeks of the campaign. Following this extensive and laudatory pilot work, a large province-wide campaign, running for four weeks with a media weight estimated to reach 75% of the audience five to six times, was conducted. A new positive discipline commercial was developed, but only the affection commercial from the pilot study was also used in this campaign. A post-only survey of 306 mothers showed fairly similar results to the pilot study in awareness of the campaign, belief change, and reported behavior change. Interestingly, a subsample of fathers showed similar, though less, change than mothers. It was also found that lower income and education groups were more affected by the campaign. In the province-wide campaign, there were 1,323 requests for information. Clearly, the project reported by Ratcliffe and Wittman is commendable in scope and execution. Several key questions concern some method to verify reported changes, maintenance of reported changes, effects on at-risk segments (i.e., potential or actual child abusers), and some fine-grain approach to cost effectiveness evaluation. Toward the last concern, Ratcliffe and Wittman reported that it cost only about $2.25 per person to positively influence an estimated 64,500 mothers and 25,000 fathers in the province. In addition, it is conceivable that this campaign could have been more successful by emphasizing two key points from this chapter: (1) more formative research prior to the pilot study to determine existing parent-child problems and current beliefs and behaviors regarding those problems- and less assumptions (i.e., the child abuse model), and (2) depictions (modeling) of appropriate parental strategies in the commercials. However, note that, as with "Over Easy," linking a viewer to existing

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sources of (more) information seems to be a realistic goal of a commercial or program. Improving Social Behavior

Sprafkin and Rubinstein (1982) reported on an experiment with 132 institutionalized, behaviorally-disordered children (mean age = 14 years) that demonstrated the potential of prosocial, available, commercial programs. During an initial assessment, it was found that the usual television "diet" of these children consisted of many action and violent programs. The children apparently modeled many of these behaviors, making their behavioral problems worse. The study compared the usual TV diet with commercial programs picked from an extensive videotape library following the criteria of prosocial programs containing at least 29 prosocial acts and less than three aggressive acts per hour. The themes of these programs included compromising when there is a conflict, considering others' feelings, cooperating with teachers, and refraining from stealing and practical jokes. The control programs consisted of the ten mostwatched programs during the initial assessment period. In addition to the different television diets, half the children also received a ten-minute discussion period following exposure to the programs. The prosocial discussion highlighted those behaviors, while the discussion with the usual diet pointed out the inappropriate behaviors in the programs. The main part of the study was conducted over a two-week period with ten half-hour programs shown each weeknight. This study is also noteworthy for conducting actual behavioral observations on the children's wards following a time-sampling system. lnterobserver reliability was somewhat low (about 70% ), but acceptable. Observational categories for prosocial behaviors included altruism (e.g., acts of sharing); affection (e.g., displays of fondness); and appropriate interaction (e.g., conversing). Aggressive behaviors included physical (e.g., kicking); verbal (e.g., threats); and object (e.g., damage to any part of ward). Other measures included attention during television viewing of the programs and comprehension of program content. Both attention (77%) and comprehension (61%) were reasonably high.

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The results of the study showed that children viewing the prosocial programs showed an increase in altruism relative to their baseline mean, while the control children showed a decrease in altruism. For the prosocial viewers, those high in physical aggression showed the increases in altruism, while those low in aggression showed no change. Symbolic aggression (e.g., gestures) also decreased for highly aggressive, prosocial viewers. The results for the additive discussion were less clear-cut. For prosocial viewers, verbal and object aggression decreased if there was no discussion. However, control viewers showed a decrease in verbal aggression with the discussion and an increase in verbal aggression without the discussion. Sprafkin and Rubinstein explained these results by noting that the prosocial discussion may have undermined the programs by being too moralistic, while the control discussion seemed effective in concretely giving pragmatic reasons to behave or not behave in certain ways. This point strongly indicates that an interpersonal supplement to a television (or other media) intervention must be well conceptualized, fit with the media, and also be pretested. The study's use of available, previously taped television programs has obvious cost savings and it appears possible that other selected, commercial programs would be suitable for interventions with additional, special populations. PROSOCIAL TELEVISION: EXTENDED EXAMPLES

In this next section, two other prosocial television efforts are discussed in detail. "Feeling Good" illustrates potential health behavior outcomes of a television series. The author's work in residential energy conservation shows some of the benefits of programs that are closely tailored to a population, "narrowcast" to them, and explicitly focus on only several key behaviors. Feeling Good

This was an experimental series aired during prime time on 250 Public Broadcasting Service stations in 1974 and 1975. It first began with an hour-long weekly format covering many topics and later was changed to a half-hour focusing on one specific

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health topic. The programs were designed for adults, and the series' explicit objective was not just information gain, but also motivational- to change health behaviors. These programs were designed specifically for young parents and low-income families, and combined serious content with entertainment and a story line. Formative research efforts were substantial and were conducted over a two-year period. These efforts included extensive interviews, pilot testing, entailing actual observation of viewers, and development of community aspects of the program effort. After six one-hour programs, it was apparent that audience share was declining and the mix of serious content and entertainment directed at a variety of health behaviors was not viable. This format was discontinued after 11 weeks, and was replaced with a half-hour format stressing more serious content, generally one health practice, and more emphasis on information and attitudes. This format change appears consistent with a more focused behavior change effort. The evaluation plan entailed gathering different kinds of evidence, from different kinds of studies conducted by different agencies (Mielke & Swinehart, 1976a, 1976b). A myriad of problems existed in each evaluation study, e.g., reliance on selfreport and sample selection problems, yet the sheer effort and the strategy of multiple evaluation methods remain laudatory even more than a decade later. The evaluations of "Feeling Good" are highlighted here: 1. Between 1-2% of the (then) 68.5 million TV households in the U.S. on the average viewed each program, figures that are big~ for PBS programs. 2. About 5% of the adult U.S. population reported seeing at least one program during a two-month period; however, it appeared that viewers tended to be young, well-educated, and higher SES. The last two demographic characteristics are in line with typical PBS viewers but not with the program's prime intended audience (lower SES). 3. The programs had a number of behavioral goals, and the convergence of data from the different studies was used to indicate "strong," "partial," or "no evidence" for these

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goals (Mielke & Swinehart, 1976a, 1976b). It is reasonably clear that the program had some success in changing simple but important behaviors, i.e., seeking information, talking to another person, obtaining screening examinations, minimal dietary changes. More complex dietary, exercise, and other involved or, perhaps, fear-provoking behaviors showed no change. 4. The program's goals included providing correct information, and data were collected on knowledge and opinions. Favorable gains were shown in such areas as alcoholism, diet, high blood pressure, and self-care. However, one important aspect was missing. It was unclear how change in information related to reported change in behavior. Although some (e.g., Wallack, 1981) have considered "Feeling Good" a failure because of format changes, limited reach, and less than clear outcomes, it is viewed here as a success. Changing simple but strategic health behaviors is a realistic goal for television programs. These additional and supporting points were emphasized by Mielke and Swinehart: 1. The series was particularly effective in motivating viewers to seek additional information about health concerns and to encourage friends and relatives to take appropriate preventive health actions. 2. Approximately one million viewers watched each week despite a variety of topics and formats and a change in the length of the program. The cost per viewer was minimal (about the same cost as a health pamphlet), and cost effectiveness can be great if preventive health measures are taken which reduce later clinic or office visits and hospitalization. 3. The fact that there was a small but receptive audience suggested experimentation with less expensive, perhaps more local, productions. 4. Even though the absolute number of viewers was low, it still was large enough to suggest that purposive programming for health and related topics is worthwhile. 5. It is difficult to combine entertainment, information, and motivation into one program. These are usually seen as separate types of programs by viewers. It may be possible to

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exclude involved drama or entertainment if information is highly salient and effective formative features are used. 6. There are many factors besides the program format and content that need to be considered for audience acceptance. These entail promotion, competitive programming, and signal clarity. 7. The difficult goal of behavior change warrants extensive pilot testing and refinement of programs. However, such pilot tests should not just emphasize viewer liking or attitude change but actual behavior change. From this chapter's perspective, "Feeling good" was a qualified success. In particular, its second, more focused format can serve as a model for other programs, and its delineation of simple behaviors, not global health messages, was also quite appropriate.

Conservation Studies by the author (Winett, Leckliter, Chinn & Stahl, 1985) on the use of special television programs to properly inform and motivate consumers to conserve home energy exemplify many of the key points noted in this chapter's prior sections. There are also a number of points about the development of those projects which are noteworthy. These points include: following the lead of one other successful use of television for prosocial behavior change (Evans et al., 1981); carefully developing the media approach and the "energy conservation product" in a series of studies (i.e., we knew what low-cost, no-cost strategies were acceptable and how well they worked); learning how to tailor a program to a particular audience, and explicitly narrowcasting the program to that audience. In this field experiment, participants were recruited from one central area (neighborhood) that best represented the audience characteristics most appropriate for the program, i.e., in this case, middle-class homeowners. Using a door-to-door recruitment approach, about 55% of the households in a neighborhood were enlisted, thus reducing the problem of volunteer bias that has plagued much other media research.

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During a baseline period of about a month, readings were taken three times per week on outdoor energy meters (requiring no contact with participants). Some other measures (e.g., measures of perceived comfort) that required contact with participants, and were pertinent to other aspects of the project (developing new comfort standards), were taken in 60% of ("contact") participant households. Persons hired to collect these measures (forms) on a weekly basis were unaware of the participants' treatment conditions. After the baseline period, and just prior to the first airing of the program, households were randomly assigned to one of five conditions:

1. No-contact Control (n = 30): Households were simply informed that they were in a control condition for an energy conservation study. Only outdoor energy meters continued to be read, and these households were not involved in other measurements in the study. That is, contact ceased. 2. Contact Control (n = 30): This condition was the same as the prior condition except other measures which required contact were continued. 3. No-Contact Media (n = 30): This condition was the same as the no-contact control except that mail and phone prompts were used to inform participants about the time of the program. 4. Contact Media (n = 30): This condition was the same as no-contact media except the other measures requiring contact continued to be taken. 5. Contact Media-Visit (n = 30): This condition was the same as the contact media condition except that a few days after the program a home visit lasting about 30 minutes was conducted. The purpose of the visit was to further explain procedures, adopt them to the participants' situation, and develop more interest and commitment. This approach had been used before with some success (Winett, Love & Kidd, 1982).

The television program, "Summer Breeze," was about 20 minutes long and was shown on the public access station of the cable system at 7 p.m. on Monday, Tuesday, and Friday, and 9

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p.m. on Thursday. This schedule provided excellent reach; 98% of the participant households viewed the program at least once. Viewing was verified by a special insert at the end of the program which required participants to mark a form with an "X" if they had watched the program. The procedure and mark were only noted in the television program. Only 2% of the control households watched the program, meaning that the integrity of the experimental design was maintained. The most significant features of the program were: (1) a theme song, "Summer Breeze," was used for audience recognition (it was a popular song), to tie program parts together, and to represent the main point of the program- the use of natural ventilation and fans could replace much air conditioning; (2) in the beginning, a two-sided visual and auditory format was used to counter beliefs that energy conservation was no longer important, and only resulted in discomfort; (3) characters and locations closely fit the audience; (4) fairly rapid pacing was used to hold attention; (5) voice-overs and captions were used to emphasize main points and strategies; (6) strategies were depicted (modeled) a minimum of three times, and summaries at different points were used; and (7) a coherent story line which emphasized modeling and reinforcement was used. The results of the study showed that households viewing the program (regardless of contact or home visit) reduced their overall electricity use by about 11% (compared to control conditions) for a period of two months (end of the summer) after the program. The study's design strongly indicated that simply seeing the program once was the crucial factor. Six months later a similar winter program was delivered over the cable access station following the No-Contact Media condition for all experimental households. For this program, the results showed about a 10% reduction in energy use (electricity or natural gas). Finally, with no program shown, the following summer outdoor meters were again read. There was still some evidence for savings (about 5.5%) one year later for experimental households. The results of this study were seen as quite positive. One program showing (i.e., very low "dose" and duration) was sufficient to produce change. The outcomes, 10%-11% reductions, are quite meaningful for energy conservation (on an aggregate

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level), and also represented savings of 20%-25% on the major targets for the program, cooling or heating. Despite these changes, there were no reported changes in comfort level, which remained quite acceptable. This is because the programs offered viewers a set of simple strategies which could offset reduced air conditioning or heating. To balance these positive results, it may be noted that participants only tended to adopt the simplest no-cost strategies; more effortful or costly procedures (e.g., insulate the hot water heater) tended not to be adopted. In addition, the simplicity of the procedures and lack of strong barriers to behavior change may not be general conditions for other problems (e.g., health). The estimated cost of the summer program, which had over 20 locations and numerous short scenes, and hence required extensive editing, was $40,000 for a commercial production. However, the intervention lends itself to being able to be used in many locations at only the additional cost of prompting viewers (i.e., $1 per home, with no additional cost for air time if public access channels are used). Based on the savings in the project, if one million homes viewed the program, then over the course of a summer $15 million for energy could be saved at an initial cost of slightly over $1 million, a Benefits/Costs ratio of about 15 to 1. Also, in the winter, since energy use is much higher, the B/C ratio would be 30 to 40 to 1. Obviously, this B/C analysis does not take into account the complex political, economic, and social issues of the distribution of benefits and costs (Levin, 1983). These are B/C questions which become particularly relevant as information interventions become more developed, and if such programs find delivery modes to reach wide audiences. PROSOCIAL TELEVISION : POSITIVE AND NEGATIVE CONCLUSIO NS

This section must conclude on a mixed note. On the positive side, it appears that the qualities of effective, prosocial programming can be identified. A number of projects support the common effectiveness of several key strategies and elements including:

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1. Considerable fonnative research about the target audience pertinent to program objectives and considerable pilot testing of programs, with preferably a focus on behavioral measures. 2. The strategic use of a range of fonnal features to maintain interest and attention and to underscore key points. 3. The development of some story line and drama in which multiple models in multiple settings depict the prescribed behaviors and are reinforced. If a story line and drama is not possible, direct information and modeling can be effective. 4. The depiction of relatively simple behaviors which nevertheless yield significant beneficial outcomes or represent important first steps in a chain of behaviors. 5. The development of realistic, reachable goals based on the type of behavior change needed, barriers to change, program exposure, and effects that can be expected from simple behavior changes. Of particular interest in the future are studies on the relationships of formal features to attention, comprehension, and behavior change. In addition, it is unclear how the same processes are affected by program length, number of program exposures, and duration of exposure (e.g., massed versus spaced viewing of a series). Research can also be directed to attempts to change seemingly more complex behaviors, such as nutritional practices (Winett et al., 1985). However, as the B/C analysis for the energy conservation television program showed, most prosocial television programs, particularly those with some story line and/or diverse locations, require a large audience to justify the production costs. Thus, the question is how can such programs gain access to a wide audience? The answer requires some brief discussion of the nature of television in this country, and it is here that the other negative side is presented. Prior to the discussion of networks and regulatory policy, there will be a brief section on "new media." This section is not only important to show the future directions and capabilities of media, but also to make the case that new media is not a panacea which will eliminate the need for regulatory change.

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NEW MEDIA

Comprehensive (Rice, 1984) and critical (Winett, 1986) reviews of "new media" exist, and it is not the purpose of this section to either present an overall review, a framework (Schramm, 1977), or critique of particular technological or behavioral claims. This section will only apprise the reader of some commonalities and capabilities of new media. According to Rice (1984), the new media primarily have changed the channel of communication, rather than specific content or purposes. However, if the "medium is the message," then it is apparent that a change in medium almost inevitably alters content and purpose. The new media include PCs, VCRs, videotext, teletext, interactive systems, various computer games, videodiscs, electronic mail, computer conferencing, communication satellites, and office information systems. Major overriding dimensions of the new media are: speed of access; interactivity; the linking of communication and computer systems, i.e., "compunications," as well as the linkage of different media systems; variability in the time and place of communication; incredible capabilities for storing and arranging information, and blurring of distinctions between different media and technical and artistic endeavors. The key dimension of new media is interactivity between users of a system or between a user and the information in a system. For many new media (e.g., computer-mediated communication), the roles of sender and receiver become interchangeable. However, the exact definition of interactive is a bit fuzzy at this point. For example, interactivity can be between individuals on a system, but is also represented by the user's interactions with system designers and programmers who developed the system. Videodiscs exemplify the key dimensions. A videodisc can contain a tremendous amount of information. For educational and training purposes, videodiscs can be combined with a TV monitor, computer, and other control devices. The user can access a great volume of information in seconds that can be displayed in print, graphic, and pictorial form. For instructional purposes, content, questions, and learning branches can be completely individualized. Of course, all user responses can be automatically recorded.

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Thus, there is interactivity, individualization, speed of access, the combination of systems, and different representations of information. However, bear in mind that creating videodisc programs is very expensive (John Moore, personal communications, May, 1985); they are usable by only one person at a time, and it is unclear how learning and training generalize to nonmedia settings (Kiesler et a!., 1984), despite early hyperbolic claims (Broderick, 1982). This underscores a general point made by Rice and Williams (1984). It is necessary with any media, but, perhaps, in particular with new media, to differentiate between its usual content and its specific attributes. Presently, on videodiscs, there may be considerable training content, but this does not mean that this current use reflects the medium's best attributes and uses. Two other aspects are important for understanding the uses and impacts of new media. Media can vary on the dimension of "social presence" felt by the user. Data is limited at this point on "social presence," but it appears to be an important aspect of any media system. A second aspect that is often overlooked is that most people, most of the time, use media for entertainment. For example, Rice and Williams (1984) noted that in 1982 video arcade users in the U.S. spent seven billion dollars on this pursuit; this figure was greater than the combined revenues of the movie and record industry. Videogames involve symbolic, mythic, social, and entertainment functions. The arcade situation also can make videogame playing a public, even interpersonal and participatory, entertainment situation that may substitute for other social activities. Thus, videogames uniquely combine interactivity, social presence, social interaction, and entertainment. However, at this point, it is not clear what effects a large amount of time spent on playing videogames (or the use of other new media) has on learning and socialization outside the context of the game situation. Claims for spontaneity, increased eyehand coordination, or preparation for computer use must be met with calls for evaluative data and concern on other fronts. For example, the learning and interactivity is restricted to what has been preprogrammed by others. Also, the content of the games often centers on violent action, with the games designed by males for the use of males. Obviously, many of these points are

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similar to those raised about the effects of violent TV programs (Rubinstein, 1983). Other new media described at length by Rice (1984) include electronic newspapers, computer-mediated group interaction, advanced word processing, multimedia teleconferencing, new library systems, and the large-scale introduction of PCs into schools and homes. For all these innovations, it is unclear if their present form and content is optimal, and what their behavioral, social, economic, and cultural impacts will be. There is also concern that new technology will become the province of the elite, creating more distance between the "haves" and "have nots" (see discussion in Winett, 1986), and that technological innovation (i.e., more outlets for information) will be confused with the issues of diversity of content and access to media, thus forestalling regulatory changes. It is to that issue we now turn. COMMUNICATION REGULATION: HISTORICAL PERSPECTWE

Current concern about media content, access, and influence must be seen within an historical context (Manoff, 1985). From the very beginning, radio and later television were not treated the same as other public utilities. While the public interest was to be served, the standards for assuring public interest priorities were not specified. The Federal Communication Commission (FCC) from the outset was generally denied the rate-making and standard-setting authority given to other regulatory agencies. There have been periods during the last 50 years when the FCC has pressed for fairness, rights of reply, ethical standards in advertising, and more local programming. These efforts have typically been stymied by the industry, political forces, and the agency's own lack of will (Manoff, 1985). The FCC has most often simply been given the responsibility of assuring a "free-market" (e.g., competition between networks). The result of this approach, quite unique to the U.S., has been predictable: A free-market system is the de facto communication objective of U.S. policy. What one would expect has come to pass: extraordinary expansion of the consumer market place

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through TV advertising, the fortune of Croesus for its network and station licensees, and the loss of a great educational opportunity for the public. (Manoff, 1985, pp. 81-82) It is important to reiterate that public policies which have bridled market forces and protected the public interest in other areas (e.g., land use) have been minimal in communication. Nothing will be proposed here that does not have precedent and tradition in how we protect and allocate other resources for the public good. It is also clear that Supreme Court opinions and decisions since the 1930s have emphasized that:

1. the licensee does not have absolute right (a monopoly) to the air and control over content; 2. the FCC should not just promote competition but can also help determine content; 3. controversial issues and opposing viewpoints need to be represented; 4. there is nothing in the First Amendment preventing government from requiring licensees to share their access with others (e.g., representative voices of the community); 5. the rights of viewers and listeners is the first priority, not those of the broadcasters. While these opinions have been clear (if not refuted by the TV and radio industries), they often have not been followed by a set of principles and concrete actions. A later section will propose such principles and actions. The next section will further discuss the problems and manifestations of the "no-holds barred" free market system. CENTRALIZATION OF POWER AND RESOURCES: PROBLEMS OF ACCESS

A number of writers (e.g., Bittner, 1980) have shown how in the U.S. the development of any new media (e.g., newspapers, radio) has moved toward centralization. And, despite the proliferation of cable stations (most owned by large conglomerates), the networks still hold about 70% of the prime time audience

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(Newsweek, April 1, 1985). A network owns the hardware of

communication (e.g., satellites and downlinks) and controls the software (e.g., paying companies to produce specific shows) and outlets (affiliates). Networks have been described as gigantic profit-making systems (from charges to advertisers) which deliver hegemonic ideology via "free entertainment" to viewers (Kellner, 1982). The entire system revolves around ratings done by Arbitron and Nielsen which determine audience size and demographics. Larger and more favorable audience demographics result in higher charges assessed to advertisers. The real customers of the networks are the advertisers whose dollars are essential. A program watched by too few people, or a lot of people of the wrong type- no matter whatever other redeeming characterist-ics- is not likely to stay on the air. To this writer, the ratings system does not represent "consumer sovereignty" and democracy. It is simply a tool for increased control and myths about democratic processes. Thus, networks develop and launch programs, and advertisers decide which ones to sponsor. Hence, certain types of fare, e.g., programs showing consumers how to resist commercials, are not a part of (commercial) U.S. television. Likewise on television, the most expensive media, usually only large corporations whose products yield large profit margins can afford to advertise. Thus, there is the bevy of fast-food, beer, and automobile commercials, and a dearth of commercials on fruits and vegetables, or bicycles. Quite simply, without abundant resources and sponsorship, programs and spots will not be shown on television. One result of this system has been homogenization of the product and the inability of diverse groups and interests to be represented on network media in a sustained and serious way. Further, as recently noted by Bagdikian (1985), the development of the action-oriented, 30-second commercial changed TV content. This type of commercial did not fit with some of the more serious dramatic shows of the 1950s and 1960s, but they do fit with action shows and light comedy. By changing TV content, Bagdikian argued, the commercial has thus changed our perceptions of reality. Federal regulations demand that a certain amount of broadcast media time be devoted to PSAs and that affiliates run a regular

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schedule of PSAs. Various groups, government, and nonprofit organizations compete for PSA time. However, many affiliates can approve, disapprove, or modify PSAs; and they are only bound to put PSAs in spots that have not been sold to commercial interests. TV is run as a free-market institution and affiliates must make a profit to survive. Hence, most PSAs appear at odd times, and almost certainly out of prime time. Poorly targeted PSAs are, indeed, worthless. Likewise, the "Fairness Doctrine" deemed that radio and TV were bound to present all sides of a controversial issue. This has been more recently (1974) watered down . . . . a station is not required to provide "equal" opportunity for opposing views ... (it) does not require balance in individual programs or a series of programs, but only in a station's overall programming (and) there is no assurance that a listener who hears an initial presentation will also hear a rebuttal. (Bittner, 1980, p. 333) One bright spot in the decentralization of media was the FCC's requirement that cable TV systems permit access to at least one of their channels for local organizations. However, this regulation has also been watered down. In deference to the deregulation position, it should be noted that cable systems are also subject to a sometimes complex web of state and local regulations. But, except for rate issues, many cable systems now seem to have bypassed the local access issue (Don Le Due, personal communication, February 1985). There is a need for some balance on regulation of media. Mass media are supposed to have freedom from government control as guaranteed by the constitution. However, particularly the broadcast media use limited resources and thus require some regulatory control. One critical question is whether the apparent diversity provided by new media (especially VCRs) will obviate the need for regulation to provide access and diversity. A brief history of other new media and current trends can help answer that question. Le Due (1982) noted in his article "Deregulation and the Dream of Diversity'' that:

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In the world of Washington, "the trend" seems mightier than the truth. New approaches to old issues are in constant demand so that yesterday's policies can be blamed for today's problem. Thus, for example, it is no longer fashionable to view regulation as the remedy for all inequities in the marketplace. Instead, it is now considered proper to view the marketplace as the remedy for all inequities in regulation. (Le Due, 1982, p. 164) Thus, it should not be assumed that current inequities will be solved by the free-market approach, but it should not be assumed either that a return to prior regulation is the answer. The key questions are: (1) whether new technologies provide a degree of access and diversity so that true competition exists, and (2) what past implementation of new technology may tell us about diversity, serving the public interest, and centralization of power. The second question will be addressed now by examining the development of radio and TV. According toLe Due, radio flourished in the 1920s and 1930s with over 700 stations in operation. However, more than half soon affiliated with the major networks and the networks only accepted the most powerful stations. Thus, many local stations soon became outlets for network programs. Radio survived the introduction of TV by offering more specialized stations and programming. However, many of these stations actually offer mostly prepackaged programs and syndicated news and feature programs. The number of stations may have proliferated, but it is deceiving to think of this as meaning diversity. The diversity in recent programming, according to Le Due, may be similar to the "choice" provided between McDonald's® and Burger King®. TV was originally conceived to be a local medium and in the 1940s over 2000 TV broadcast channels were assigned to different communities. Evidently one objective was not to repeat the network experience of radio. However, TV stations primarily developed in large markets where affiliation with a network seemed probable. Local and independent stations gradually developed, but then (1950s) and now, these stations mainly offer reruns of network fare. Thus, the history of radio and TV suggests a ten-

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dency toward centralization and decreasing diversity (see a similar account of newspapers, in Bagdikian, 1985). At this point, there are now a growing number of domestic satellites for TV and radio service on a nationwide basis, numerous cable systems, linkages between satellite and cable systems, superstations, and many stations equipped to receive and distribute different program channels. In addition, VCRs are selling at a phenomenal rate (New York Times, March 3, 1985, p. 1); teletext services are increasing; direct broadcast satellites (DBSs) can bypass local affiliates and directly deliver programs; low-power TV stations allow for coverage of local events; pay TV stations are available; and microwave systems can be used in areas without cable TV. Will these innovations not create diversity and competitiveness? The answer appears "possibly not" if attention is given to what actually is seen and who owns what. Licensing regulations, rather than the marketplace, " ... compels broadcasters and the copyright owners of film and syndicated features to allow cable use of this material. In return for a fee, the cable system must pay into a reimbursement pool" (Le Due, 1982, p. 166). However, this regulation does not increase the number of different programs, but rather allows their showing at a time different from that of the affiliate station. Likewise, with pay stations, it is possible to see a feature film after its run in movie houses, but before being shown on networks. This may generate more money for the film industry, perhaps creating more diversity. However, for the most part, pay stations may simply provide another opportunity to see existing material. Cable systems now offer a number of advertising supported programming (e.g., ESPN) and some programming not yet selfsupporting. While this may be a pro~ising area for diversity and competition, it is possible that networks will start to use these special stations as a way to bypass local affiliates. For example, ABC and Getty Oil produce ESPN. It is also unclear if microwave systems and DBSs will truly offer original programming. Thus, the broadcast networks have moved into cable system ownership, cable networks, videodisc marketing, and DBS operation. The main problem according to Le Due is that the focus of regulation has been on individual broadcast stations as if more stations or outlets could provide more diversity. Regulatory pol-

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icy has failed to address the problem of control of broadcasting, film, music, and "mass entertainment" by the three networks, five feature film distributors, and seven record distributors. They stand between the program, music, and film producers and the distribution channels. Cross-media ownership and cross-licensing agreements also keep various information, entertainment, and art forms within the control of a limited number of corporations. By limiting itself to the program outlet and not the program supplier, the FCC has failed to create a competitive marketplace for ideas. The FCC has not regulated program offerings under the guise of ''free speech.'' However, Le Due concluded that this has been contrary to a 1969 Supreme Court ruling in which Justice White declared that: It is the purpose of the First Amendment to preserve an

uninhibited marketplace of ideas in which truth will ultimately prevail, rather than to countenance monopolization of that market whether it be by the Government itself or a private licensee .... It is the right of the viewers and listeners, not the right of the broadcasters, which is paramount. (cited in Le Due, 1982, p. 177) Apparently, legal and regulatory principles must be developed to create diversity. Some guidelines include: 1. The FCC should restore aspects of the Fairness Doctrine and maintain reasonable access requirements. 2. Regulations requiring cable systems to allow local access, but since rescinded, should be reinstated. 3. The source of competition must be seen as program content not merely in channels of delivery. 4. The rights of artists and the public and those of the merchandisers must be differentiated. Currently, the emphasis has shifted to the rights of the merchandisers. 5. A comprehensive set of policies needs to be developed to ensure a marketplace of ideas.

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FUTURE ALTERNATIVES

Regulatory Reform and Access

The final sections focus on several different proposals and ways to increase access and provide diversity of content on television, as well as possible ways "to work within the system." At the outset, it must be emphasized that simply gaining access is not enough. The prevention professional must know what to do when access is gained. Thus, the framework developed at the beginning of this chapter, and the elements and formats of effective programming (Tables 1 and 2), should also be carefully studied. The major focus of regulatory reform needs to be placed on making the "public airways" serve the public interest. Manoff (1985) has (idealistically) recommended a time-bank procedure in which 10% of commercial TV time is devoted to information campaigns and local access. The time bank would be overseen by a nonpartisan congressional committee. Ten percent of air time could provide considerable clout for consumer and health concerns. At present, $8 billion is spent on TV advertising with spending and the number of commercials increasing (Manoff, 1985). It does not appear that the profits of the networks will be greatly endangered by a time bank, although objections by executives as well as stockholders would surely arise. In addition, the likelihood of such a "radical" step being taken in this conservative political era is doubtful. In the immediate future, prevention professionals can focus on the following strategies which should be enacted in ways which seriously consider audience wants and needs: 1. PSAs -It may be possible to have impact with a series of short PSAs that follow the important elements identified in this chapter. Likewise, much of the content of the prosocial programs described in this chapter can fit the PSA format (e.g., self-help behaviors for the elderly). However, in the absence of regulations requiring PSAs in specific times for specific audiences, PSAs now typically appear at times an

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affiliate could not sell, e.g., 2 a.m. Solomon (1982) noted that PSAs may be better fit to the target audience through the development of personal relationships with affiliate staff. 2. Narrowcasting- It is still possible to reach a select target audience by gaining access to local cable systems. However, if a program is aimed for a limited audience, its production qualities usually must be very inexpensive. The inexpensive format may not appeal to viewers. But, it may be that most of the key format points needed for behavior change will fit within inexpensive productions. 3. Cassettes-As VCRs make even further inroads in the home market, prosocial programs can be widely distributed on cassettes. While the cost of cassettes should decrease via increased distribution, one problem is likely- the approach would make programs available to those who need them the least, e.g., the wealthier elderly. 4. Reciprocal Benefits- There should be some programs beyond sheer entertainment that can be beneficial to networks and viewers. Certainly health programs appear to be one candidate. Given the great interest in fitness, nutrition, and other personal health habits, it is possible that a revised "Feeling Good" program could find a wider audience. With more money for production and promotion and a better delineated behavioral technology, such a national program may be commercially and behaviorally effective. Working Within the System It must be noted that a shortcoming of most of the proposed strategies in this chapter is that they require the development of new programming (but see above, Sprafkin & Rubenstein), a costly endeavor, and a fight for access, a difficult fight, indeed. A martial arts metaphor quickly informs us that we cannot overcome superior force with force, but must work in the direction of that force. Some examples of working with current network fare and affiliates illustrate this principle. Shows with high ratings, e.g., currently "Cagney and Lacey" and "Miami Vice," have huge audiences. The depiction of the

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dilemmas of abortion on "Cagney and Lacey" may well have had significant impacts on that audience. Such risky efforts could be supported by letter writing campaigns to the network instigated by preventive interventionists in concert with various organizations. An incredible public health opportunity was lost when the leading character, Sonny Crockett, on "Miami Vice" stopped smoking, but his cessation efforts and methods were not depicted on the program. Since part of the character's persona involved chainsmoking, showing how he stopped smoking, and hopefully, got over a relapse, could have been quite instructive and motivational. These two examples indicate that with some redirection and external pressures and, hopefully, reinforcement, at least some current TV fare has considerable but largely untapped health promotion potential. The "Miami Vice" and "Cagney and Lacey" examples also indicate that health behavior change strategies and controversial health matters can be woven into a story line or become the central story of an episode or even series of episodes. These two programs, as well as a recent made-for- TV movie on a family's attempts to deal with AIDS, also illustrate commercial TV's ability to use virtually every effective element in Table 1, and format in Table 2 (positive behavior modeled and reinforced, negative behavior modeled but punished), while retaining dramatic appeal and reaching huge audiences. Such possibilities may also be magnified if a star (e.g., Bill Cosby) who has production control over a series becomes particularly interested in health promotion or other issues and can present information and strategies repeatedly within the program series. Interventionists can attempt to exploit these seemingly "winwin" situations. For example, we can gather what is currently known about health behaviors and change strategies and have ideas on how these key points can be presented using effective elements and formats with potential program scenarios. The next step would require active collaboration with affiliate and/or network personnel. Jason et al. (in press) have recently shown the viability of this approach. They worked with a local affiliate and community groups in Chicago on a smoking cessation media-based series.

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Apparently, the affiliate also benefitted from increased audience ratings and improved public relations. The Jason et al. project was able to involve over 40 worksites in this collaborative effort. It would be incorrect to interpret this last section as suggesting that we drop our efforts at access and regulatory change. Commercial TV will not be radically transformed overnight, nor is it likely to ever reach the full potential suggested by this last section. However, the exciting possibilities of reaching large mass audiences certainly means that we would be wise to invest some of our energy in the direction of the superior force. REFERENCES Atkin, C. K. (1981). Mass media campaign effectiveness. In R. E. Rice & W. J. Paisley (cds.), Public communication campaigns. Beverly Hills: Sage. Bagdikian, B. H. (1985). The U.S. media: Supermarket or assembly line? Joumal of Communication, Summer, 97-109. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Review, 84, 191-215. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. New York: Prentice Hall. Bittner, J. R. (1980). Mass communication: An introduction, 2nd cd. Englewood Cliffs, NJ: Prentice Hall. Broderick, R. (1982, November). Interactive video: Why trainers arc tuning in. Training!HRD, pp. 46-53. Evans, R. 1., Rozelle, R. M., Maywell, S. E., Raines, B. E., Dill, C. A., Guthrie, T. J., Henderson, A. H. & Hill, P. C. (1981). Social modeling films to deter smoking in adolescents: Results of a three-year field investigation. Joumal of Applied Psychology, 66, 399-414. Fine, S. H. (1981). The marketing of ideas and social issues. New York: Praegcr. Fox, K. F. A. & Kotler, P. (1980). The marketing of social causes: The first 10 years. Joumal of Marketing, 48 (Fall), 24-33. Jason, L.A., Gruder, C. L., Martino, S., Flay, B. R., Warnecke, R. & Thomas, N. (in press). A media-based smoking cessation intervention involving self-help and worksite locations. American Joumal of Community Psychology. Johnston, J. (1982). Using television to change stereotypes. Pre1•ention in Human Services, 2, 67-81. Keegan, C. A. V. (1982). Using television to reach older people with prevention messages: The Over Easy experiment. Prevention in Human Services, 2, 83-91. Kellner, D. (1982). Network television and American society: Introduction to a critical theory of television. In D. C. Whitney & E. Wartclla (eds.), Mass communication review yearbook, Vol. 3. Beverly Hills: Sage. Kiesler, S., Siegel, J. & McGuire, T. W. (1984). Social psychological aspects of computer-mediated communication. American Psychologist, 39, 1123-1134. Kotler, P. (1982). Marketing for nonprofit organizations. Englewood Cliffs, NJ: Prentice Hall, Inc.

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Leventhal, H., Safer, M., Clearly, P. & Gutmann, M. (1980). Cardiovascular risk modification by community-based programs for lifc·stylc change. Comments on the Stanford Study. Journal of Consulting and Clinical Psychology, 48, 150-158. Levin, H. M. (1983). Cost·effectiveness: A primer. Beverly Hills: Sage. Liebert, R. M., Sprafkin, I. N. & Davidson, E. S. (1982). The early window: Effects of tele1•ision on children and yowh, 2nd cd. Elmsford, NY: Pergamon Press. Lovelace, V. 0. & Huston, A. C. (1982). The writing on the wall. In R. Haugh (cd.), Communications in the 21st century. New York: Wiley. Maccoby, N. & Solomon, D. S. (1981). Heart disease prevention: Community studies. In R. E. Rice & W. J. Paisley (eds.), Public communication campaigns. Beverly Hills: Sage. Manoff, R. K. (1985). Social marketing: An imperative for public health. New York: Pracgcr. McGuire, W. J. (1981). Theoretical foundations of campaigns. In R. E. Rice & W. J. Paisley (eds.), Public communication campaigns. Beverly Hills: Sage. Mendelsohn, H. (1973). Some reasons why information campaigns can succeed. Public Opinion Quarterly, 37, 50-60. Mielke, K. W. & Swinehart, J. W. (1976). Evaluation of the "Feeling Good" televi· sion series. New York: Children's Television Workshop. Paul, G. L. (1967). Strategy of outcome research in psychotherapy. Journal of Consult· ing Psychology, 31, 109-118. Rappaport, J. (1977). Community psychology: Values, research, action. New York: Holt, Rinehart, and Winston. Ratcliffe, W. D. & Wittman, W. P. (1983). Parent education: Test market evaluation of a media campaign. In R. E. Hess & J. Hcrmalin (cds.), Innovations in Prevention. New York: Haworth, 1983. Rice, R. E. (1984). The new media: Communication, research, and technology. Beverly Hills: Sage. Rice, R. E. & Williams, F. (1984). Theories old and new: The study of new media. In R. E. Rice (cd.), The new media: Communication, research, and technology. Beverly Hills: Sage. Robertson, L. S., Kelley, A. B., O'Neill, B., Wixom, C. W., Eirwirth, R. S. & Haddon, W., Jr. (1974). A controlled study on the effect of television messages on safety belt use. American Journal of Public Health, 64, 1071-1080. Rubenstein, E. A. (1983). Television and behavior: Research conclusions of the 1982 NIMH report and their policy implications. American Psychologist, 38, 820-825. Rushton, J.P. (1982). Television and prosocial behavior. In D. Pearl, J. Bouthilet & J. Lazar (cds.), Television and behavior: Ten years of scientific progress and implica· tions for the eighties, Vol. 2. Washington, DC: U.S. Government Printing Office. Singer, J. L. & Singer, D. G. (1983). Psychologists look at television. Cognitive, developmental, personality, and social policy implications. American Psychologist, 38, 826-834. Solomon, D. S. (1982). Mass media campaigns for health promotion. Prevention in Human Services, 2, 115-123. Sprafkin, J. & Rubinstein, E. A. (1982). Using television to improve the social behavior of institutionalized children. Prevention in Human Services, 2, 107-114. Wallack, L. M. (1981 ). Mass-media campaigns: The odds against finding behavior change. Health Education Quarterly, 8, 209-260. Wellman, B. (1981). Applying network analysis to the study of support. In B. H. Gottlieb (ed.), Social networks and social support. Beverly Hills: Sage.

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Wigand, R. T. (1982). Direct satellite broadcasting: Selected social implications. In M. Bugoon (ed.), Communication yearbook-6. Beverly Hills: Sage. Wilson, G. T. & O'Leary, K. D. (1980). Principles of behavior therapy. Englewood Cliffs, NJ: Prentice Hall. Winctt, R. A. (1986). lnfonnation and behavior: Systems of influence. Hillsdale, NJ: Erlbaum Associates. Winctt, R. A., Hatcher, J. W., Lcckliter, I. N., Fort, T. R., Fishback, J. R., Love, S. Q. & Riley, A. W. (1982). The effects of videotape modeling and feedback on residential thermal conditions, electricity consumption, and perceptions of comfort: Summer and winter studies. Journal of Applied Behavior Analysis, 15, 381-402. Winctt, R. A., Kramer, K. D., Walker, W. B., Malone, S. W. & Lane, M. K. (1985). Effective consumer information intervention: Concepts, design, and impacts using field experiments. Paper presented at the Bell Labs Conference on Telecommunications and (Consumer) Demand. New Orleans, October. Winctt, R. A., Leckliter, I. N., Chinn, D. E. & Stahl, B. N. (1984). The effects of special, brief cable TV programming on residential energy conservation. Journal of Communication, Summer, 37-51. Winett, R. A., Leckliter, I. N., Chinn, D. E., Stahl, B. N. & Love, S. Q. (1985). Effects of TV modeling on residential energy conservation. Journal of Applied Behavior Analysis, 18, 43-53. Winkler, R. C. & Winett, R. A. (1982). Behavioral interventions in resource conservation: A systems approach based on behavioral economics. American Psychologist, 37, 421-435.

Chapter 7

The Roles of Religion in Prevention and Promotion Kenneth I. Maton University of Maryland Baltimore County

Kenneth I. Pargament Bowling Green State University

SUMMARY. Religion represents an important resource for efforts to prevent significant personal and social problems. Yet, far from a unitary phenomena, religions embody fundamentally different world v1ews, interpersonal communities, and practices. This chapter describes the diverse pathways through which religions attempt to influence both the mdividual congregation member and the larger community and society. The varied implications of these pathways for the well-being of the individual and the social system are considered. Drawing from case studies, several distinctive roles of religion are distilled, roles which raise general questions and challenges for preventive and promotive workers in diverse disciplines. Finally, directions for more effective collaboration between religion and allied disciplines are discussed.

As an individual and institutional force, religion represents an important resource for efforts to prevent significant personal and The authors are grateful for the feedback of Robert Hess, editor of this journal, for indepth feedback on an earlier version of the paper. The order of authorship was determined alphabetically. Requests for reprints can be sent to either author. Address correspondence to Kenneth I. Maton at: Department of Psychology, University of Maryland Baltimore County, Catonsville, MD 21229. Address correspondence to Kenneth I. Pargament at: Department of Psychology, Bowling Green State University, Bowling Green, OH 43403. © 1987 by The Haworth Press, Inc. All rights reserved.

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social problems. After all, American society is in many respects highly religious. For example, as of 1982 there were approximately 341,000 religious congregations in the United States made up of approximately 140 million members. In response to a national survey, forty-one percent of the population reported attending a religious service within the last week. Fifty-six percent of the population stated that religion is very important in their own lives. Fifty-eight percent reported that religion is an answer to all or most of today's problems. Eighty-one percent indicated that they would like to see a revival of religious faith (Jacquet, 1984). As important as the sheer level of religiousness is for preventive work, so is the long helping tradition of religious systems. For thousands of years, religious institutions have tried to help people come to grips with ultimate questions- the purpose of life, the reason for suffering in the world and the best response to it, the key to the "good life," how people should relate to one another, the proper relationship between the individual and society. Moreover, the solutions to these questions have had critical significance for the shape of social life. Clearly, many disciplines share with religion a deep concern and interest in many of these questions and a commitment to helping people come to terms with them. More generally, they share with religion the desire to enhance the well-being of individuals and the viability of their social systems. Yet it would be a mistake to view religious systems as "prevention centers." Religious institutions have traditions, perspectives, and practices which set them apart from other systems and disciplines. For example, the language of prevention is not commonly spoken in religious systems. This is not to say that these systems are not involved in related work. However, a different language is likely to be spoken. Multidisciplinary efforts to prevent significant problems should rest on a clear understanding of religious systems and their unique yet diverse approaches to human problems. In this chapter we will describe and illustrate the ways in which religious institutions have attempted to influence the wellbeing of their members, the local community, and society more generally. From these efforts, we will try to glean those ques-

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tions, challenges, and lessons particularly relevant to preventive and promotive actions. Avenues for collaboration between religious settings and other disciplines will then be discussed. RELIGIOUS INFLUENCES: EXPLANATORY FACTORS

Religion is far from a unitary phenomenon. Religious systems attempt to influence their members and the social world in a variety of ways. Before considering them, it is important to understand some of the external and internal forces which shape the direction taken by particular religious settings. The external forces include a number of socio-contextual factors such as the social class and ethnicity of the members, and the geographical 'location of the congregation (Roberts, 1984 ). The internal forces are tied to the basic mission of the congregation and practices directed towards this mission. Greeley (1972) has stated that all religious systems attempt to respond to two basic human needs: the need for meaning and the need for belonging. In this direction, congregations attempt to provide their members with a religious world view, an interpersonal community, and a set of related religious practices. Religious World View

Many theorists have pointed to the human need for some understanding of the world and some way of grappling with one's specific position in life and one's ultimate mortality (Allport, 1950; Berger, 1967; Spilka, Shaver & Kirkpatrick, 1984; Yinger, 1970). Religious world views represent a response to this need for meaning. At the most general level, religions address questions of "ultimate meaning": how and why the world was created, why suffering and evil exist, the purpose of life, and what happens after death. A religious world view also has more immediate implications for how to relate to God, others, and oneself in day-to-day living. Finally, a religious world view embodies concerns about the goals and ideals for human and social development.

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Different aspects of religious world views may have preventive or promotive impacts in different ways. For example, a religious world view may directly influence an individual's appraisal of the nature and meaning of stressful life events. Thus, a religious belief system which views a recently deceased child as residing in heaven may facilitate hope and self-sustaining behavior in the midst of tremendous grief. Or, a religious world view may strengthen self-esteem- e.g., by enabling individuals to believe that God fully loves them and views them as unique and invaluable, whatever their personal shortcomings. Alternately, a religious world view may promote confidence and optimism about the future. For example, the belief that God is personally arranging events and opportunities for one's future may help individuals to overcome fears, maintain hope, and actively pursue competencies in preparation for the opportunities to come. Religious world views vary dramatically in their responses to questions of life, death, and meaning, as well as in their scope, specificity, salience, and rules of evidence. Clearly, they can have both positive and negative, promotive and preventive, major and inconsequential influence on individual lives. Finally, as we shall see, the diversity in religious world views has important consequences for both the congregational member and the larger society. Interpersonal Community

Congregations also provide their members with the opportunity to be part of an ongoing network of relationships with those who share a similar religious world view. The sense of shared identification with God and a religious tradition can contribute to the experience of community, affirmation, and continuity. A religious interpersonal community may have a preventive or promotive influence in a variety of ways. One important way is through providing social support to individuals, whether as a buffer to life stress or as an integral aspect of daily living. A second important mechanism is by providing opportunities to participate in meaningful and potentially competency-enhancing congregational activities, including organizational task and social

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functions. A third is by providing social norms and personal role models of adaptive, health-enhancing lifestyles and behaviors. Religious settings vary greatly in their form of organization, including their size, level of resources, relation to the larger denomination, abilities of the leadership, decision-making structures, climate, and the traditions and resource personnel of the larger denomination. These features, as well as differences in religious world view will influence the nature of social support, organizational activities, role models, and norms available to members. For example, social support may occur regularly in the context of intimate prayer groups in one congregation, in social action groups in a second, and in informal social activities among members of a third. Or, church activities and role models may emphasize the development of individualistic, active, problemsolving competencies in one congregation, passive coping in a second, and collaborative problem-solving in a third. Or, social norms may support the development of health-promotive lifestyles in one congregation, high stress lifestyles in a second, and a lifestyle based on serving others in a third. In addition, religious communities can have a negative effect on members. They may, for example, encourage conformity to dysfunctional norms. In short, congregations establish diverse kinds of interpersonal communities with the potential to impact on their members and society in diverse ways. Practices

Congregations prescribe particular religious practices as means of promoting their religious world views and interpersonal community. These include practices which are part of one's lifestyle such as prayer, reading the Bible, dietary habits, not working on the Sabbath, and participation in education classes and weekly religious services. They also include major life transition rituals such as baptisms, bar mitzvahs, weddings, and funerals. Congregations also involve themselves in more specialized methods for reaching their members. Increasing numbers of clergy and lay leaders are receiving explicit training in pastoral counseling as part of their preparation for work in the ministry (Clinebell, 1984). This represents a significant resource since

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church-based staff are a first source of help sought by most Americans for a variety of problems and stressful life situations (Veroff, Cohen & Douvan, 1981). Many congregations are also implementing group-based helping activities which include marriage or family life "enrichment" programs. The focus of these programs varies from explicit training in couple's communication or child-rearing techniques to a more general focus on relationship quality and family spiritual life (Kahn & Kammerman, 1983). Other congregations are involved in self-help groups composed of individuals who share common life situations such as widowhood (e.g., Catholic Widowers) or being gay (e.g., Dignity). Prayer or fellowship groups are also offered in some congregations (Maton, 1985a). Such groups are composed of members who meet regularly to share their personal concerns and support. Some congregations offer financial or material aid programs for members in need. Finally, many congregations are involved in outreach activities designed to meet the spiritual, psychological, and social needs of the larger society. The general and specialized practices of congregations have significant preventive and promotive potential. General religious practices such as prayer may contribute to prevention by providing structure, meaning, and hope both on a day-to-day basis as well as during times of acute life crisis (Gay, 1978). Life transition rituals such as baptisms, weddings, and funerals may contribute to cognitive and emotional mastery of both positive and negative events. Specialized practices such as counseling, marital enrichment, self-help groups, and economic support programs have the potential for preventive impact through reducing stress, providing support, building competencies, and increasing selfesteem. It is also important to note that religious practices may induce as well as reduce stress. For instance, certain practices may reinforce maladaptive cognitive or behavioral coping mechanisms. The type and mix of practices and the nature of their impact on members and the larger society vary widely across religious settings. In sum, the world views, interpersonal community, and practices of religions represent three distinctive yet interrelated channels of influence on their members and the social world. Religions and religious settings vary widely in these features, as well

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as in contextual variables such as the SES and ethnicity of members, and their geographic locale. As a result, there is great diversity in the particular pathways and forms religious systems take to reach in to their members and to reach out to society. Each pathway, in turn, has distinctive implications for the nature, extent, and specific mechanisms of preventive and promotive activities. In the next section, the diversity of inreach and outreach pathways are explored and the varied implications for prevention and promotion are highlighted. INREACH: PATHWAYS OF RELIGIOUS INFLUENCE ON THE INDIVIDUAL CONGREGATION MEMBER

Religion may influence the individual congregation member through many pathways. These pathways may be described in terms of two dimensions: the level of involvement of religion in the life of the individual and the orientation or function of religion in the life of the individual. Thus, in studying personal religion, psychologists have been careful to distinguish among those individuals highly committed to a religion which represents a central unifying force in their lives and those individuals less involved in a religion which serves more limited purposes (Allport, 1950; Spilka, Hood & Gorsuch, 1984). Psychologists have also distinguished between at least two types of orientation of religion to the individual: a conserving orientation, one which helps people maintain themselves psychologically, and a challenging orientation, one which encourages people to confront themselves and expand their perspectives on living (Fromm, 1950; Batson & Ventis, 1982). In Figure 1 the two dimensions are presented as a framework for describing several pathways of religious influence on the individual. As the figure suggests, a congregation may provide different pathways to different individuals. Furthermore, it is likely that subgroups of people within a given congregation will be influenced by different pathways, and that individuals may be simultaneously involved in more than one pathway. These pathways are presented to underscore the diverse multifaceted nature

.... g;

Challenge

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-+-Conserve

FIGURE I. Pathways of religious influence on the individual.

Low

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High

Involvement of Religion in Individual Ufe

Orientation to Individual

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of religious influence in general and the preventive and promotive channels of religious influence in particular. Personal Defense

For many people religion serves a limited function, meeting a relatively narrow subset of psychological or utilitarian needs (Allport, 1950). For these individuals, religion is not a unifying, internalized truth; rather, it is a circumscribed external resource to be tapped in specific ways. Thus, individuals may use religious or congregational involvement primarily as a defense against feelings of anxiety or loneliness, as a moral justification for certain values or lifestyles, as a means to foster continuity with childhood upbringing, or as an opportunity to develop and maintain social or business contacts. In congregations in which many individuals are externally oriented to religion, there will likely be difficulty in establishing and maintaining congregational activities and a sense of community among members. Involvement in the Personal Defense pathway is not likely to serve fundamental preventive or promotive functions in an individual's life. It may in fact prevent a more basic resolution of an individual's problems. Indeed, in their review of the literature Batson and Ventis (1982) located ten studies in which a negative relationship was found between external religion and various indices of mental health. On the other hand, in three additional studies neither a positive nor negative relationship was found. Thus, for some individuals the Personal Defense pathway may serve a positive, albeit limited, conserving function. Personal Stress ButTer

Like its Personal Defense counterpart, the Personal Stress Buffer pathway rests on a limited involvement of religion in the life of the individual. However, the limit of involvement is defined by a specific period of stress, rather than by a stable characteristic of the person. Times of personal stress or major life transitions are, for some people, the only periods in which they have significant contact with religion or congregational life. In this vein, several studies have shown that people pray or seek help

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from God more frequently during times of frustration, threat, or major change (Welford, 1947; Pargament & Hahn, 1984), and that many individuals who undergo conversion experiences are seeking relief from psychological distress and/or life crises (Galanter, Rabkin, Rabkin & Deutsch, 1979; Spilka, Hood & Gorsuch, 1985). During times of crisis and transition, religion and congregations may contribute to prevention and promotion by providing psychological comfort and/or challenging individuals to make basic life changes. Three specific sources of religious influence during times of life transition are congregation-based rituals, congregation-based specialized helping activities, and religious world views. Bereavement-related religious traditions such as sitting shiva (Jewish) or communal outpourings of grief during funerals (diverse traditions) represent rituals which may initiate an effective grieving process and thus serve a preventive function (Kaplan, 1976). Pastoral counseling represents a specialized helping resource of significant potential since clergy have immediate access and sanction to work with people, many of whom are unlikely to seek help from mental health professionals. Finally, the religious belief that God is nearby and deeply cares about one's life and well-being may prove adaptive during times of life stress or crisis. In this vein, Maton (1986a) found "spiritual support" to be an important correlate of well-being and selfesteem in several populations of individuals confronted with serious life stressors. Similarly, Zuckerman, Kasl, and Ostfeld (1984) reported that religiousness predicted reduced mortality rates for infirm and poor elderly. Of course, other practices and beliefs designed to assist members through crisis periods may prove less functional. For example, Pargament and Hahn (1986) found that some people were more likely to blame themselves or others for misfortune such as accident or disease, assuming that a just God would not allow misfortune to strike a truly innocent victim. Personal Marginality

Religion may offer a challenge for some individuals who are not an integral part of the system; for these people religion repre-

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sents a system to examine and react against. Thus, marginal status and involvement in a religious system can provide a challenge to construct alternative sources of personal meaning and belonging. Congregations and religions of all types present members with the opportunity for marginality. Generally, psychologists have viewed marginality as a potential threat to the well-being of the individual. Individuals who are different in opinion, age, or marital or ethnic status, or who are newcomers, may feel unwelcome and set apart in congregations, generating stress in a setting in which affirmation and support was expected. In this vein, several studies have found relationships between lack of individual-systems fit and dissatisfaction with the system (Pervin, 1968; French, Rodgers & Cobb, 1974). However, reconsidered as a potential challenge, marginality may also spur personal development and health promotion. Rubin (1982), for example, has noted that marginality helps the individual develop a sense of uniqueness. Similarly, Pargament, Tyler, and Steele (1979) found that peripheral status in churches and synagogues, while associated with lower congregational satisfaction, was also related to greater self-efficacy and more active coping skills. Of course, the implications of marginality for the well-being of the member may also depend on the nature of the system the member is reacting against (Pargament, in press). In this regard, marginality within less benevolent congregations is apparently more helpful and might have greater promotive potential for members than marginality within more benevolent religious systems (Pargament, Johnson, Echemendia & Silverman, 1985). Persona/Identity

Religion may provide the individual with a system to identify with as well as a system to react against. Religious belief systems, religious rituals during times of significant life transitions, structured religious practices and traditions, and religious symbols and imagery offer a foundation for the development of personal identity. As Herman (1977) has noted, an identity with a religious group can serve several purposes. It defines the ways an individual differs from many other people and, in this sense, may

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enhance a sense of uniqueness, pride, and self-esteem. It also defines ways in which individuals are alike, for members of the religious group share a set of beliefs and traditions which draw them closer together. Finally, an identity with a religious group provides the individual with a sense of continuity with the past and a sense of direction for the future. Thus, involvement in the Personal Identity pathway may help promote the development of a meaningful view of oneself, of one's relationship to the world, and of one's links to the past and future. This involvement may be particularly valuable to people in times of uncertainty and transition, and to groups of minority or marginal social status. However, it is important to note that the Personal Identity pathway may, in itself, be a source of problems when it becomes particularist, that is, based on the belief in the unique truth and superiority of a particular set of teachings and practices. In this vein, direct relationships have been reported between measures of religious particularism and anti-Semitism (Glock & Stark, 1966). Personal Structure

For many individuals who are highly active in religion, religious and congregational involvement provides a structure of explicit restraints and definitive guidelines for living. Thus, a number of studies have found churchgoers as a group to be more socially conforming and conservative than non-churchgoers (Spilka, Hood & Gorsuch, 1985). Moreover, religious involvement has been significantly related to lower rates of drug abuse, alcohol abuse, and nonmarital sexual activity (Gorsuch, 1980; Benson, Wood, Johnson, Elkin & Mills, 1983). These results underscore the positive impact religion may have on people through structuring potentially maladaptive behavior into acceptable channels. A frequent hallmark of the Personal Structure pathway is an authoritarian world view which stresses unquestioning adherence to religious dogma and a threatening vindicative God who punishes those who err or disbelieve (Benson & Williams, 1982; Moberg, 1977). This perspective is often supported by an interpersonal community which strictly defines

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rules for membership and standards of behavior and demands high levels of involvement in religious life. Kelly (1977) has found that over the past 25 years congregations that endorse strict religious thinking are growing more rapidly than mainline congregations. He ties this growth to the ability of these congregations to provide members with a clearer and more compelling religious world view. Certainly, the Personal Structure pathway may be helpful to members in important respects. For example, a commitment to an "upright" life style may have a direct preventive impact on members who are lacking in impulse control or enmeshed in a maladaptive subculture (Spilka, Hood & Gorsuch, 1985). Furthermore, firm beliefs in God's ultimate control and activity, and involvement in a tightknit religious community may provide personal support to individuals- reduced insecurity, guidelines for dealing with problems, and a sense of hope -which serves a preventive function by helping individuals maintain themselves in relation to the world (Pargament, Echemendia, Johnson, Myers, Cook, Brannick & McGath, in press). However, the restrictiveness of this pathway may limit personal functioning in other ways. Thus, several studies have shown that world views involving a view of God as angry and vindictive, and absolutist religious beliefs are associated with lower self-esteem and greater personal maladjustment, closemindedness, and prejudice (Benson & Spilka, 1973; Batson & Ventis, 1982). Furthermore, a problem-solving style in which the individual passively awaits solutions imposed by God has been related to poor mental health (Pargament, Kennell, Grevengoed, Newman & Hathaway, 1985). Finally, authoritarian or absolutist religious world views and congregational settings may limit independent thought and action and interpersonal dissent and run the risk of defining a set of dysfunctional social norms to guide members' behavior. Personal Quest

Often overlooked by psychology is the potentially challenging role of religion. Many people are highly committed to a religion which provides an opportunity for personal change and growth rather than stability (Benson & Williams, 1982). From this per-

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spective religion establishes a set of ideals and goals for human development and encourages independence of thought and action in pursuing these ideals (Meadow & Kahoe, 1984). Indeed, traditional institutional structures may be seen as impediments rather than aides to personal development. The Personal Quest pathway is expressed through flexible interpersonal communities which sanction different types of religious practice, encourage a variety of forms of personal expression, and allow members to challenge each other as well. The religious world view of this pathway does not offer absolute, definitive answers to ultimate questions. Rather, it stresses the freedom God gives people to shape their own lives and world in the fashion they choose and emphasizes the responsibility this freedom places on each individual. Thus, the pathway is highly involving of the individual in a process of search, change, and potential growth. The Personal Quest pathway has both potential advantages and disadvantages in terms of prevention and promotion. On the positive side, this pathway may enhance a personal sense of control and efficacy in life, encourage self-examination and change, and stimulate a greater tolerance and respect for individual differences. For example, Pargament, Tyler, and Steele (1979) found congregations which encouraged individuality had members with a lower sense of control by powerful others, a higher level of self-criticism, and greater trust in others than congregations which discouraged individuality. Similarly, Batson and Ventis (1982) have reported significant correlations between a religious orientation which stresses the process of personal search for answers in a complex world and measures of openmindedness, creativity, compassion, and racial tolerance. These outcomes may be considered health promotive and may have observable preventive effects as well. On the negative side, however, Batson and Ventis (1982) note that the complexity, skepticism, and tentativeness of the Personal Quest pathway may, at times, lead to higher levels of anxiety and insecurity. In addition, Maton (1981) found that individuals high on a measure of "religious cognitive complexity" were less likely to develop consensually valued personal attributes than individuals with less cognitively complex religious views.

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Personal Empowerment

Central to the Personal Empowerment pathway is a personal relationship with a loving God who is perceived by the individual as actively providing aid both in coping with life's difficulties and in achieving important life goals. Ideally, for such individuals God empowers by simultaneously conserving, supporting, and challenging the individual. In contrast to the Personal Structure pathway, "correct" religious beliefs and practices are secondary in importance to developing and maintaining a vital, personal relationship with God. In contrast to the Personal Quest orientation, there is a firm faith that God is actively and beneficially involved in the life of the individual and the society. Consistent with the Personal Structure and Personal Quest pathways, the individual is likely to be involved in a community of likeminded members committed to caring for each other and to be a regular participant in ongoing prayer, fellowship, and/or Bible study groups. Several studies point to the potential promotive and preventive implications of the Personal Empowerment pathway for the member. Loving, caring images of God have been found to relate positively to measures of self-esteem (Benson & Spilka, 1973). Committed, supportive religion has also been associated with more positive attitudes to death (Spilka, Stout, Minton & Sizemore, 1977) and a variety of measures of mental health (Batson & Ventis, 1982). Maton and Rappaport (1984) found that in a congregation with strong norms towards personal transformation and personal outreach, members who reported strong expectancies that God would protect their future, high levels of affirmation from other members, and a constant experience of God's love and caring were more likely to develop positive personal attributes over time. Religious lnreach, Prevention and Promotion

As this review has indicated, the religious inreach pathways have varying implications for member psychological well-being, prevention, and promotion. Religious inreach may increase emotional and physical well-being, prevent psychological and medi-

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cal problems, and enable individuals to achieve goals they define as important. On the other hand, it may actively contribute to emotional and physical distress. Furthermore, religion and religious settings may have only minimal influence on psychological well-being. While some pathways may be more promising than others for certain types of preventive and promotive influence, it is important to realize that any given pathway is likely associated with both psychological advantages and disadvantages. The potential preventive and promotive impact of religious inreach can be understood from diverse psychological paradigms (e.g., Maton & Rappaport, 1984). For instance, to the extent religion and congregations are viewed as helping to instill psychologically adaptive life values and lifestyles in individuals, motivational or social influence paradigms are relevant. If perceived love and support from God and congregational members are viewed as central to preventive outcomes, self-esteem or social support theories are useful. If preventive outcomes are seen as the consequences of learning new skills and competencies, social learning or coping skills perspectives will have relevance. Finally, to the extent adaptive outcomes are viewed as stemming from increased faith in God and in religious activity, attributional or expectancy theories may be brought to bear. Further research is necessary to establish the extent of religious preventive and promotive influence and the types of psychological mechanisms involved. OUTREACH: RELIGIOUS INFLUENCE OF PATHWAYS IN THE COMMUNITY AND SOCIETY

Religion takes many different stances towards the social world as well as to the individual congregation member. These stances vary in terms of at least two important dimensions which parallel the previously discussed individually-oriented dimensions: the level of involvement of the religious system in society and the type of orientation of the religious system to society. Sociologists have long noted distinctions among religious systems in their involvement in the social order. Indeed, the level of social integra-

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tion has been described as one of the crucial features which sets institutionalized churches apart from religious sects (Troeltsch, 1964; Wilson, 1959). Religious systems have also been distinguished by their orientation to society- in particular, their relative support for the larger social system. Berger (1967), for instance, has noted that religion may act to maintain the world or to shake the world. Similarly, Glock, Ringer, and Babbie (1967) have pointed to the potentially comforting and challenging roles of religious institutions. Together, both dimensions -level of involvement in society and orientation to society- provide a framework for describing several paths of religious influence in the community and society (see Figure 2). As the figure indicates, these pathways are not necessarily independent of each other; religious settings may be involved in more than one pathway. They do, however, illustrate the varied approaches of religion to society. While empirical data documenting the impact on the larger society of each of these outreach pathways do not exist, comments on the possible preventive and promotive impacts of each of these outreach pathways will be made below. Social Conservatism

Yinger (1970) has argued that since religious institutions are heavily supported by this society, they are not likely to seek change in the system which supports them. Rather they are "more likely to be a conserver of old values than a creator of new ones" (p. 513). Consistent with Yinger's perspective are several studies which point to efforts by religious institutions to resist social change and conserve the social order (Campbell & Pettigrew, 1959; Glock & Stark, 1965; Johnson, 1965). Campbell and Pettigrew (1959), for example, document the lack of active support for integration by the majority of ministers in Little Rock during the desegregation crisis in the 1950s. Well-established middle- to upper-class churches may tend to be most supportive of existing values and practices. This support is often expressed through the visible conservative involvement of church leaders and members in community decision-making processes (e.g., boards, committees, governmental bodies). In short, many religious systems adopt a stance of Social Conservatism, supporting

~

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Challenge

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I L

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FIGURE 2. Pathways of religious influence in the community and society.

\

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Involvement of Religion in Society

Orientation to Society

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the status quo in society through active involvement in the community. The preventive or promotive impact of these systems on society likely depends on the nature of the society. For example, Social Conservatism systems may try to maintain societal structures and processes which protect personal freedoms. However, they may also try to perpetuate an inequitable status quo. Social Service

The Social Service pathway is based on the less sanguine social view that a portion of the population is not adequately served by the current social system. The response to this viewpoint involves an effort to resolve individual (rather than systemic) problems. Thus, the Social Service orientation reflects a moderate level of support for society and a desire to redress its limitations through active involvemept with individuals. This pathway rests on a religious world view which emphasizes serving God through constructive activities and deeds in this world (Roberts, 1984). Social Service congregations are often located in urban areas where social problems are likely to be more immediate and widespread. In response to these problems, Social Service oriented religious systems have attempted to respond to the full range of community psychological, social, and physical needs through a variety of formal and informal programs. These programs may be directed by congregational staff and members, or undertaken collaboratively with human service agencies. Haugk (1976) and Pargament (1982) cite the work of several religious institutions in the areas of marital enrichment, parental effectiveness training, crisis intervention, grief counseling, divorce recovery, coping with aging, services for the retarded, blind, and poor, and social support for deinstitutionalized individuals facing serious problems in living. Considerable resources can be amassed for these programs. For instance, 16.4 billion dollars were generated by religious institutions for health, social, and public services in 1982 (Jacquet, 1984). While social service programs for troubled or disabled individuals are primarily rehabilitative or curative in focus, those dealing with basically healthy individuals (e.g., those facing a significant life stress) may prove preventive or

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promotive in their impact, especially if they have significant impact on individual's social support, competencies, self-esteem, and material resources. Social Action

In contrast to the Social Conservatism and Social Service perspectives, many religious systems hold that there is something fundamentally wrong with the world today. They point to the problems of racism, sexism, poverty, violence, and social injustice as violations of basic religious values. Moreover, they hold to a religious world view which defines the obligation of religious institutions to "solve" rather than "salve" the problem of human misery (Berger, 1961; Berton, 1965; Neal, 1983; Winter, 1962). Social problems are seen as stemming primarily from the corporate sins of society rather than the sins of individuals (Moberg, 1977). Thus, the Social Action pathway involves active attempts to change not individuals but the social order. These attempts may occur at the community, societal, or international level through collaboration with secular bodies or through independent efforts. Community organization, political involvement, active participation in social policy formation and decision-making, social protest, and civil disobedience represent social action methods implemented by these systems. Some groups have moved further, providing theological justification for the use of conflict (Marty, 1964) and, in some instances, aggression (Guttierrez, 1973) to resolve inequitable situations. While typically directed towards liberal causes, social action stances have also been adopted to challenge societal practices which conflict with more conservative religious views (e.g., abortion, pornography, homosexuality, drug abuse). Many religious institutions have invested considerable resources in social action efforts. For example, the U.S. Catholic church sponsored the Campaign for Human Development (CHD) as a national effort to fight domestic poverty and socio-economic injustice through educational and self-help programs designed to create "substantive changes within the social, economic or political systems at all levels of our society" (Evans, 1979, p. 268).

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Over the past 15 years, the CHD has allocated over 100 million dollars to over 2,000 social justice programs. Social action religious systems may have systemic, proactive, preventive, and promotive effects. For instance, church-based community organizing efforts (see below) may both empower involved individuals and reduce stress by altering the social environment. Local, national, and international efforts to influence social policies which contribute to racial discrimination, economic injustice, and political oppression similarly have the potential to reduce environmental stress and enhance psychological well-being. Unfortunately, the actual preventive or promotive impact of religious social action has not been formally evaluated.

Social Conversion Like its Social Action counterpart, the Social Conversion approach views the world in negative terms- a troubled place lacking religious value. However, it takes issue with the notion that society is perfectible through the worldly actions of people. Social problems are seen as a result of individual sin, and the resolution of sin involves spiritual rather than psychological or social change (Roberts, 1984). From -this perspective, dedication to God through prayer, strengthened personal faith, and attempts to evangelize others represent the most effective solutions to social and personal problems. However, in its work to convert others, Social Conversion systems often maintain a basically conservative involvement in society. Although the number of systems involved in social conversion is not known, Jacquet (1984) reports that fifty-three percent of the population in the U.S. indicate they have engaged in an evangelical activity. Evangelization efforts take a variety of forms: distribution of religious literature, personal witnessing in public places, healing crusades, or invitations to newcomers to join a Bible study group. Other attempts at evangelization involve a more gradual introduction of the individual to religion. Visitation of the sick, religiously-related media events (e.g., television, music, drama), and community programs sponsored by the church are offered as means of encouraging greater individual religious involvement and, ultimately, religious conversion.

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To the extent that religion provides individuals a sense of meaning, community, and structure (see Inreach section above), then evangelization of individuals may have a promotive or preventive impact on the previously nonreligious. On the other hand, evangelization may increase stress and conflict by pressuring individuals to abandon former beliefs and/or lifestyles. Social A voidance

Social Action and Social Conversion represent two responses to perceived evil in society. Social Avoidance represents another pathway. Rather than seek change in a sinful world, many religious systems have chosen to withdraw from it. Wilson (1959) notes that there are a variety of reasons why religious sects choose to live apart from society. These include a mistrust of modernism and science, a belief that separation from the world is essential for moral rectitude and personal inspiration, and the desire to practice a special body of teaching (e.g., healing within Christian Science, communal sharing of property among Hutterites). While Social Avoidance systems may occasionally take part in societal structures, this pathway emphasizes the goal of living a more faithful life among those who share a commitment to common religious values. Social solidarity, clear expectations and rules for living, and firm social control mechanisms help these systems maintain themselves apart from the world (Hostetler, 1974; Nichol, 1966). Such systems are unlikely to have much of a promotive or preventive impact on the external society. However, through the isolation of their members from the larger social system significant social stressors may be eliminated from members' lives. Social Sanctuary

Other religious settings maintain a low level of involvement in society, not because they view it negatively, but because they seek a sanctuary from it. Central to the Social Sanctuary pathway is the comfort the system provides the member in response to the stresses and uncertainties of life (Glock, Ringer & Babbie, 1967). This comfort may come in the form of reassuring religious messages, a sense of community among fellow believers, a

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supportive relationship with God, and relief from daily anxieties. Rather than actively support or attempt to change the social order, these systems help members adjust to it. In this direction, Social Sanctuary settings provide their own members with a variety of opportunities for supportive interaction (e.g., discussion groups, retreats, social events). However, only to the extent that members influence others in their external social networks can a promotive or preventive influence of Social Sanctuary systems on the larger society be expected. Religious Outreach, Prevention and Promotion

The different religious outreach pathways, like their inreach counterparts, have different implications for the well-being of the member and for prevention and promotion. Many of the outreach approaches taken by religious systems to influence society represent proactive primary prevention-attempts to modify dysfunctional social conditions (Catalano & Dooley, 1980). However, other approaches by religious systems may depart from and, at times, conflict with proactive primary preventive activities. SOME ILLUSTRATIONS OF RELIGIOUS INREACH AND OUTREACH

In this section, the diversity of approaches taken by religious systems to influence their members and the larger society is illustrated. The examples were not selected as a representative sample of religious involvements. Rather they were chosen to highlight the varied pathways of religious influence on the individual and the community, to underscore the promotive and preventive potential of religious activity, and to raise important questions and possible new pathways for disciplines concerned with personal and social change. Personal Empowerment Pathway: Spiritual/Personal Growth Congregation

New Covenant Fellowship is a non-denominational, Christian congregation of 175 members located in a medium-sized midwestern city. Most members are committed to a personal rela-

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tionship with Jesus in which they report experiencing love, forgiveness, and healing. In addition, members appear committed to and challenged by the religious ideal of becoming the type of individual they perceive Jesus to have been: compassionate, selfsacrificing, and empowering of self and others. Empirical research using multiple data sources has indicated that the congregation has a significant promotive inreach influence on individuals, resulting in increased interpersonal competencies and sense of well-being (Maton, 1981; Maton & Rappaport, 1984). The congregation also has a moderate social service outreach influence in the community, including church operation of a food pantry for the hungry, initiation and maintenance of a shelter for the homeless, and participation in a housing repair program for low-income residents. Extensive empirical and participant-observation research suggest several factors which may account for the setting's preventive and promotive impacts: (1) many members regularly reported the experience of God's love, forgiveness, and expectancies of positive outcomes for future life events- in the context of private and group prayer, worship, and Bible study; (2) reports and observation of personal affirmation from one member to another were common; (3) meaningful responsibilities were offered to most members in the setting; (4) explicit and implicit group expectations to develop interpersonal attributes like Jesus' were frequent; (5) emotional and material support was offered during times of stress in dyadic, small group and large group contexts; (6) exposure to models of appropriate interpersonal behavior was frequent; and (7) opportunities for self-disclosure, guidance, and emotional insight about personal problems or limitations occurred regularly- in counseling, "prayer partner," small group, and teaching (i.e., "sermons") contexts. The empowering and promotive influence of religious world view, interpersonal community, and practices on congregational members can be understood in the context of several psychological theories (Maton & Rappaport, 1984). At the setting or organizational level, many factors help to explain the setting's influence on members. One primary feature is the leadership qualities of the four elders (i.e., lay ministers). The elders manifest high levels of vision, commitment, and en-

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thusiasm for the development of a unique religious community fostering the spiritual and personal growth of members. They are widely respected by members for having an authentic God-serving orientation. Special areas of talent possessed by one or more of the elders (as well as others in leadership positions in the setting) include interpersonal sensitivity, pastoral guidance, music and worship, and organizational development. A second salient feature is the decentralized network of structures which facilitate personal involvement and commitment in the setting. Members are involved in one of five "housechurches" which meet on weekday evenings to carry out worship, bible study, and discussion. An integral part of housechurch participation is ongoing involvement in a small (six to ten person) prayer group. Finally, in most of the small groups, members pair up with a "prayer partner," with whom they share personal concerns and provide mutual support for spiritual and personal development. The housechurch, small group, and prayer partner arrangements, as well as pastoral counseling with an elder, provide an extensive array of structured contexts in which both religious and psychological helping and development occur. A third salient feature of the setting is widespread lay involvement in organizational decision-making. While the four elders share overall authority, congregation-wide participation in decision-making is carefully orchestrated on major decisions. To enhance this process, most activities and issues are discussed in the small groups and housechurches, and advisory committees of lay persons representing the range of congregational perspectives are formed when special consideration of controversial issues is necessary. Sense of community and levels of commitment are strengthened by this sharing of decision-making responsibility in the setting. Personal Quest Pathway: Social Action Congregation

Church of the Savior, an ecumenical church of 125 members in an east -coast city, is in many ways the Social Action counterpart of New Covenant. Like New Covenant, the vision and passion of a talented, widely respected leadership, combined with a decentralized, small-group structure, draws and maintains a core

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of highly committed members. However, unlike New Covenant, Savior is explicitly structured to facilitate outreach, and while personal spiritual development is a priority, there is less emphasis on an intimate personal relationship with God. The vision of the leaders is focused on interpersonal community and social transformation (Hug, 1983). Participant-observation (Maton, 1985b) suggests that the central facets of the setting's influence on members are interpersonal community and shared outreach activity. Each member is part of a small mission group which undertakes a corporate ministry based in the city. Examples of ministry groups include: FLOC (For Love of Children), a ministry in which members give aid to abandoned and abused children; Jubilee Housing, in which members purchase and renovate deteriorated housing for the poor and see that such housing is wellmanaged after it is refurbished; World Peacemakers, the church's ministry for peace which presently coordinates regional pledges for civil ministry for peace should the U.S. invade Central America; Media Ministry, which aims to influence the media ,to "rethink and re-fashion" the American Dream; and Ministry of Money, which educates affluent Christians about the Biblical imperatives regarding money. These examples reflect the combination of social service and social action ministries in which the church is involved. Each ministry group is initiated by members of the congregation who perceive a personal religious "call" to that work. This emphasis on "call" reflects the church's belief that each individual's "outward journey" (i.e., ministry of service) must emanate from and develop as an integral part of their "inward journey" (i.e., their spiritual reflection). Consistent with a personal quest orientation, member's religious world views are generally complex, non-absolute, and focused on personal growth as well as social outreach. To facilitate their personal and spiritual quest, the church expects members to spend time each day in prayer, Bible reflection, and personal journal writing. Ministry group discussion of outreach efforts, adult education classes which include dialogue on diverse religious and social issues, and periodic retreats .also contribute to members' "inward journey." Taken together, the personal quest, interpersonal support, and

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shared outreach activity of members result in a lifestyle with distinctive promotive and preventive potential both for congregational members and for those to whom outreach is directed. Personal Defense Pathway: Pentecostal Congregation

Zion Holiness Church is a Pentecostal congregation of approximately 100 members which provides life structure and primary community for low-income, inner city blacks. Most members participate daily in the life of the congregation, avoiding any sustained contact with surrounding inner city subcultures. That the congregation serves to help isolate and defend members from the perceived "evils" (e.g., drugs, alcohol, sex, greed) of the surrounding society was documented in a three-year participant observation study (Williams, 1974). There is little emphasis on outreach activities. The congregation's inreach effectiveness is facilitated by its religious world view and practices. Members view God as a defense against the devil, who is always present. They also view God as a source of strength, support, and hope, a view which helps to buffer individuals from the impact of endemically stressful life circumstances. In addition, specific Pentecostal religious practices focus on the "quickening powers" of God, including speaking in tongues, prophesying, and other expressions of spirit possession. The deviation of their religious beliefs and expression from the mainstream solidifies the importance of the church in the lives of members, further enabling it to isolate and defend them from alternative inner city lifestyles. A second important feature is the extensive network of religious, instrumental, and social activities which are central to congregational life and provide extensive personal structure in members' lives. Sunday religious activities take up most of the day and include active member involvement in bible study, personal testimony, group prayer, and worship. Weekday evening religious services and special religious events (e.g., funerals) are also central to the community's religious life. Ongoing instrumental activities focus on fundraising activities and church maintenance tasks. Social activities include day-long picnics, trips to other churches, and rehearsals and church plays. Finally, daily

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in-person and phone conversations about church events and members are an integral part of the structure of individuals' lives. The church contains, relative to membership size, a large number of formal positions of responsibility. These positions represent arenas of influence through which members and subgroups vie for power and status. Major positions include pastor's aide, choir president, choir member, church secretary, deacon board chairman, deacon (in charge of church operations), trustee board chairman, trustees (in charge of church business), Sunday school superintendent and teachers, ministers and "missionaries" (men and women, respectively, empowered to perform various religious functions), and financial captains (in charge of fund raising). The ongoing activities and responsibilities represent multiple ecological niches for member involvement and psychological investment in the church community. Central to the viability of the Zion community is the position of pastor. He is a paternal symbol of authority and the active dispenser of rewards and status, both formally, through administrative appointments and delegation of responsibility, and informally, through verbal recognition or criticism. Especially important at Zion is the pastor's ability to maintain an overall sense of community in a setting in which various subgroups compete for status and influence. A final important feature of the setting is the extensive tangible aid provided to all members for daily and crisis-oriented needs. Members band together to help each other move, to raise money for any emergency, and to take care of daily family needs during times of sickness and death in a household. Such caregiving, combined with the elements of religious belief and church organization described above, help reduce members vulnerability to influence from the surrounding subculture- all in the context of a cohesive religious subculture which sees itself as "in the world but not of the world." Stress Buffer Program: Stephen Series The Stephen Series was developed in 1974 by Kenneth Haugk, an ordained minister and clinical psychologist, as a system for training and organizing lay ministers in congregations for caring

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one-to-one interactions with members in need of help (Haugk, 1985). Leaders from local congregations, often including the minister, receive two weeks of training by Stephen Series personnel. They, in turn, provide 50 hours of training to volunteer lay "Stephen ministers" in their congregation. The Stephen ministers then provide assistance to fellow members, who commonly are identified and referred by the minister. The Stephen ministers continue to receive supervision, education, and support bimonthly. While the Series has not been formally evaluated, it is a program with strong potential for preventive influence for a large number of individuals facing diverse life stresses. The Stephen Series is explicitly rooted in Christian theology, particularly the belief in the "priesthood of all believers" (1 Peter 2:5-9). In the training, psychological theory and methods are woven together with concepts of Christian caring. Training topics include listening skills, dealing with feelings, crisis intervention, assertiveness, the use of community resources, confidentiality, termination, work with special populations, and the distinctive nature of Christian caring (e.g., the use of prayer in ministry, helping people with spiritual concerns). Stephen ministers have worked with people experiencing difficult life transitions, such as divorce, grieving, and unemployment, and also those suffering from more long-term problems, including depression and chronic illness. The Series is seen as helpful not only to those receiving care, but to the care providers themselves and to the congregation as a sharing community. The series has worked with 1100 congregations from 40 denominations which vary in size and sociodemographic characteristics. Approximately 30,000 to 40,000 Stephen ministers have been trained. One church reported that its 25 Stephen ministers made 736 direct contacts and 648 phone contacts with members in 18 months. The Series estimates that over 90 percent of members agree to accept help from Stephen ministers after contact and encouragement by the minister. Systematic empirical evaluation is necessary to reveal the extent to which the provision of social and religious support by congregational peers to those facing serious life stress reduces the incidence of psychological disorder.

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Personal Social Identity Pathway: Jewish Congregation

Through observation, surveys, and interviews, Roozen, McKinney, and Carroll (1984) studied River Plain Jewish Congregation, a Reform temple of 400 families located in a suburban community outside of Hartford. Since the synagogue is the only congregation in the area, it attracts a population diverse in its religious beliefs and practices. In an effort to accommodate the different needs of the members, the congregation has blended various religious traditions and practices. Similarly, the rabbi has adopted a low-key democratic leadership style, one in which controversial topics are avoided and one which places responsibility on the congregation itself for major decisions. The congregation has also steered away from potentially divisive social action efforts, taking a Social Service stance instead (e.g., aid to tornado victims, assistance to resettlement of Asian refugees, anti-racism projects). Binding the diverse membership together is a strong sense of Jewish social identity. "Joining the synagogue ... is tantamount to a statement of solidarity with the area Jewish community. To this extent the fact of belonging is both self-definitional ('I am a Jew') and supportive ('I want to do my share to see that a synagogue in this area can exist')" (p. 120). This sense of personal social identity is expressed in several ways: a variety of social and instrumental activities with fellow members and area Jewish congregations, support for the State of Israel, celebration of traditional Jewish holidays which enhance the sense of continuity with previous generations, and educational programs for members and the larger community. Education for members is viewed as a means of fostering a greater understanding, appreciation, and commitment to Judaism. For the larger community, educational programs represent a means of combatting the ignorance which underlies anti-Semitism. More broadly, River Plain Jewish Congregation is described as a "buffer between Jews and the non-Jewish community . . . an advocate on behalf of Jews . . . (and a source of) security in a largely Christian environment" (p. 126). Thus, both interpersonal community and educationally-based social action contribute to the psychologically

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conseiVing (and possibly preventive) inreach and environmental influence of the congregation. Social Service Program: Social Support and Jobs for the Unemployed

Genesis Jobs is a church-sponsored program to help hard-core unemployed Baltimore residents find and retain employment. The program is sponsored by Episcopal Social Ministries (ESM) and operates out of an inner city Episcopal church. The goals of the program are to: provide social support to unskilled, chronically unemployed individuals looking for a job; enhance jobseeking competencies; help arrange job inteiViews; and continue to provide support in the first few months after a job has been found. Given the combined financial and psychological stresses of unemployment, job-seeking, and entering (or reentering) the work force, the program has the potential for a significant preventive impact (Maton, 1986b). In contrast to most volunteer programs, the vast majority of Genesis Jobs volunteer staff are male, many with years of experience in the work world. They are recruited from congregations and denominations in the Baltimore area. The highly selective recruitment procedure emphasizes the importance of some element of religious "call" to working with the inner city unemployed. Each Genesis Jobs volunteer is trained in basic unemployment counseling skills. In addition, training emphasizes the basic (God-given) rights to employment, dignity, and social support for each individual. Most of the volunteers meet individually with 3 to 5 unemployed individuals each week. The volunteer's commitment to "walking alongside" the unemployed person (i.e., providing emotional and instrumental support) while they are looking for a job, and afterwards, is emphasized. The first two or three meetings are structured in part to allow the unemployed individual to demonstrate some level of personal responsibility and seriousness about seeking a job. Once this is established, a paid "Jobs Developer" begins working intensively with the individual, drawing upon public information and personal networks to uncover appropriate job openings, arrange inteiViews, provide instrumental help (i.e., help ensure the individual arrives on time to inteiViews), and advocate for the indi-

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vidual with potential employers. One distinctive resource network of contacts is the membership of the Episcopal and other congregations in the area. ESM staff and selected volunteers attempt to cultivate contacts with those members of their own congregation or denomination known to have some influence on hiring decisions at their place of work. In addition, unemployed individuals may find out about or be referred to Genesis Jobs from their own church. The social support, competency-enhancing, and religious social network components of the program combine to help a hard to reach segment of the unemployed population find and retain employment, with potentially preventive consequences. Social Action Program: Community and Parish Renewal

Communities Organized for Public Service (COPS) is a community action organization based in the Mexican-American community in San Antonio, Texas (Boyte, 1984). Due to the neighborhood and parish organizing activities of COPS, low-income Mexican-American neighborhoods have received hundreds of millions of dollars worth of improvements in streets and drainage and have become the site for the extensive development of new housing projects, new public facilities (e.g., five new libraries), and new businesses. In its ten years of existence, COPS has developed significant organizational "clout" and become a major actor in San Antonio civic affairs. Concurrently, citizens note an enormous increase in self-respect and pride among residents of the Mexican-American community (Boyte, 1984). As a result of environmental changes in living conditions and resources, and the psychological benefits of participation, COPS has the poten· tial for a significant preventive and promotive influence on lower-income Mexican Americans. The Roman Catholic Church is a primary institution in the Mexican-American community in San Antonio, and the church has both significantly influenced, and been influenced by, COPS. From the start COPS received explicit, strong support from the church leadership, beginning at the level of the bishop

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of the archdiocese and including priests and sisters at the parish level. For the church, support of COPS was not only a question of religious values- equally important, church leaders perceived that the long-term viability of the church depended on the longterm viability of the community. Many of the workers and leaders in the COPS organization are active members of and leaders in the 35 parishes presently involved. The support of the Church was essential for COPS' success, providing the organization with both legitimacy in and access to the Mexican-American community. In its organizing efforts, COPS and parish leaders have drawn heavily upon religious beliefs and imagery to influence citizens. For instance, in training new members, biblical examples of the action-oriented tactics of Christ are used in an empowering fashion to link together the traditions and heritage of the church with the legitimacy and potency of community action. Similarly, some parishes have incorporated in their religious education programs the current issues COPS is working on, interweaving these issues with biblical and Mexican historical and cultural themes. Finally, COPS has been instrumental in facilitating parish renewal. The process of renewal often begins with a program of value discussion and training for the leadership of a parish, led by COPS members. Next, the parish leaders are trained in community action interviewing techniques, focused on eliciting residents' neighborhood concerns. Then the parish leaders interview residents, whether active members of the church or not. This stage of the renewal process culminates in a parish convention in which the various groups and organizations in the area are recognized and celebrated, and action priorities for the coming year are generated, often in a festive spirit. Apparent consequences of parish involvement in COPS with possible promotive or inreach implications include enhanced interpersonal community in the parish, increased leadership competencies, greater self-respect, a revitalization of faith in the linkage between the church and justice-based action, reduced personal externality (see inreach section), and increased congregational participation.

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THE UNIQUE ROLES OF RELIGION IN PREVENTION AND PROMOTION

The case studies illustrate the potentially adaptive influence of religion on individuals and society. They also underscore the unique resources, traditions, and perspectives religion is able to bring to bear in its efforts to serve others. Drawing from these case studies, five distinctive religious roles in prevention and promotion can be distilled. These roles have broad implications and raise general questions and challenges for preventive and promotive workers in diverse disciplines. Special Access

One of the striking aspects of religion in America is its special access to large numbers of people. As noted above, a formidable number of Americans consider themselves religious, attend religious settings on a regular basis, and turn to their religion and religious personnel during times of life difficulty and crisis. While there is a great variance in levels of member involvement and commitment, congregational based activities and personnel have the potential to influence literally millions of people. Religious settings have access to human and financial resources for carrying out preventive and promotive programs and to citizens who can benefit from preventive and promotive programs. As resources, congregations are a source of personpower for social change (e.g., COPS) and personal change (e.g., Stephens Series) efforts and a source of financial resources for local and national programs (e.g., Campaign for Human Development). In addition, a congregation and its members represent connecting points to bases of organization and power in a community (e.g., Genesis Jobs). In terms of potential beneficiaries of service, congregations are distinctive in their multiple channels of special access to individuals across the lifespan. For instance, during a time of crisis, such as the death of a spouse, individuals may be influenced by what happens at the funeral, in subsequent visits by the pastor, by material presented in sermons, through congregational social

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networks, and by ongoing involvement in regular prayer, bible study, or fellowship groups. Furthermore, some religious settings have a history of legitimacy in the local community which provides them with special outreach access to nonmembers as well. These often include hard to reach community residents, especially in low income and minority neighborhoods. Noting the special access of religion to a large number and cross-section of Americans raises several questions and challenges for other professionals involved in prevention. Who are our natural "congregants"- those with whom we have a special access and legitimacy in our community work? Is it possible or desirable to regularly meet some defined subset of needs of community constituents, as religion has done, thus enhancing our legitimacy and community access? Can we find ways to increase our access to religious settings, thus expanding the types and numbers of individuals we reach as preventive and promotive professionals? In our work with religious systems, can we enhance the preventive and promotive potential of natural religious functions such as sermons, prayer groups, and funerals without violating the members' experience? Leadership: Vision and Calling

Effective religious leadership is central to efforts to mobilize and sustain member involvement in helping activities. Two dimensions of effective religious leadership are particularly noteworthy- "vision" and "calling." Vision involves projecting an ideal image or goal of what the congregation can become or can do. Thus, Church of the Savior leaders generate a vision of a congregation knit together in a shared social justice ministry to the inner city. New Covenant Fellowship leaders evoke a vision of a special congregation where God is actively present, stimulating growth and building community. To take another example, Martin Luther King shared a vision of a country in which "all God's children" were holding hands, together singing "free at last." Effective religious leaders also are able to communicate that God "calls" each member to utilize their talents and time in

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contributing to the congregation and/or community. Each individual has a part to play; each one's "calling" is important. Biblically and historically-based ethical traditions of a religion help to legitimize leaders in their generation of vision and of call. The ability to generate a vision rich in imagery and hope and to mobilize a sense of purposeful individual contribution to a larger effort helps religious leaders generate a level of passion and commitment which makes effective long-term projects possible. The nature of effective religious leadership suggests that other preventive professionals examine the role of vision and calling in their work. Do the visions for prevention and promotion we espouse generate the desired levels of passion and commitmenti.e., is the imagery right and effective (Rappaport, 1981)? What are the legitimate sources we can turn to- i.e., our "biblical" sources- in looking for effective new imagery and perspectives in our work? Finally, are extant empirical data and faith in science sufficient to generate a sense of "calling" for prevention or promotion work in our students, colleagues, and the community at large? In the 1960s and 1970s professionals were able to find sources of vision and call in social movements in the larger culture. These movements are now largely quiescent, generating a need for new sources of passion and commitment. Building Community

Religion contains distinctive assets, and is faced with distinctive challenges, in attempting to build interpersonal community. One asset of religion is the potential for a holistic approach to the person- spiritual, psychological, interpersonal, and economic needs can all be legitimately addressed in religious settings. Zion Holiness Church is one example of a religious congregation able to meet a wide spectrum of members' needs in building community. A second distinctive asset is a rich heritage of tradition and symbols which facilitate the sense of continuity and shared history integral to community. Both Zion Holiness Church and Riverdale Jewish exemplify congregations which draw upon rich historical symbols and traditions in providing a community identity for members.

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One major challenge faced by many religious settings in building community is how to overcome the impersonality due to large numbers and a traditional centralized organizational structure. One effective organizational response to this problem is to base ongoing activities in small, decentralized structures, such as the "House Church" and prayer groups in New Covenant and the ministry outreach groups in Church of the Savior. Such ongoing, smaller units can enhance personal intimacy, commitment, and community. The discussion of the community building activities of religion raises questions and challenges for other disciplines involved in prevention. To what extent is building community integrated into our preventive theories and programs? Can we adapt the idea of "base communities" of ongoing support and/or outreach to help restructure settings such as schools, neighborhoods, and places of work? Focusing on our discipline's sense of community, what are the traditions and symbols (i.e., our Passover seder, shared communion cup), and the organizational structures we have adapted, or need to creat~, to generate continuity, personal contact, and shared commitment with our colleagues and collaborators? Outreach Roles and Priorities: Servant and Witness

Outreach by religious participants and settings encompasses a diverse array of roles and content. Perhaps most distinctive are the religious concepts of "servant" and "witness." The concept of servant (or servant-leader) emphasizes that in helping others the focus should be placed on the needs of the other, at possible cost to oneself. The concept of witness refers to the concern that one's help reflect in a positive manner upon God's nature and what one has received from God. Two religious individuals who exemplify the ideas of servantleader and witness are Mother Teresa and Pastor Andre Tocme. Mother Teresa is well known for her lifetime of self-giving work with the most destitute, ill, and rejected of Calcutta. Perhaps less known is Tocme, the French Huguenot priest, who daily risked his life during World War II, hiding large numbers of Jews in his

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parish in occupied France and then helping them escape to neighboring Switzerland (Hallie, 1979). In both cases, full emphasis was placed on meeting the needs of others and thus witnessing God's concern for all individuals, especially those most in need. These examples and concepts raise questions for other preventive and promotive professionals. Is the idea of "servant" a viable one for other disciplines involved in prevention? If so, is it adequately reflected in our professional roles or does it require a rethinking of how and why we perform our work? Concerning the concept of witness, what values or truths are our fields a "witness" to, and how do we establish whether the process and content of our work is consistent with the values we espouse? And finally, do our models and priorities encompass the array of content areas of need addressed by religion- such as the prevention of destitution, homelessness, and political oppression? Incorporation of such roles and priorities for outreach requires the development of new theories and models in preventive work. Religious World View

One of the most striking features of religion is its provision of "ultimately hopeful" beliefs and perspectives on life, life crisis, and death to billions of people. Prevalent throughout the world are religious beliefs which provide assurance that there will be a positive ending to history and a life after death, and that there is a good reason why one's life is as it is. The widespread presence of religious world views points to a deep "need" in humans to find and create "ultimately hopeful" meaning (Spilka, Hood & Gorsuch, 1985). And in settings where belief, community, and practice combine to challenge and uphold individuals, the influence can be preventive, promotive, and empowering. A second distinctive feature of religious world view is its simultaneous potential for building elements both of external and internal loci of control in individuals. On the one hand, the emphasis that God is in control of events can lead to a passive approach to coping. On the other hand, the emphasis that God and the individual are partners working together may enhance a sense of personal efficacy. Furthermore, the sense of control by a benevolent God may be particularly helpful in situations or crises

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where there are real limits to what an individual can accomplish (Barbarin, 1983). In short, some elements of external control, when integrated appropriately with an internal locus of control, may serve important preventive and promotive functions (Pargament, Grevengoed, Kennell, Newman, Hathaway & Jones, 1985). The potential adaptiveness of religious world views raises questions and challenges for prevention. Can and should other disciplines try to create interventions which attempt to empower individuals through enhancing their world view and sense of personal and historical "meaning?" Are there life situations or contexts for which our traditional sole endorsement of an internal locus of control is limiting for prevention and well-being? Can empirical research on the preventive, promotive, and/or maladaptive impact of specific elements of members' religious world views (e.g., varieties of internal/external locus of control, "ultimate hopefulness") provide information which could lead to proactive modification of religious, psychological, and health practices?

THE INTERFACE BETWEEN RELIGION AND ALLIED DISCIPLINES: DIRECTIONS FOR MULTIDISCIPLINARY COLLABORATION IN PREVENTION AND PROMOTION

This chapter has been guided by the theme that allied disciplines involved in prevention have something to learn about and from religion: about religion because of the central role many religious institutions play in individual and social life and from religion because of the rich tradition and experiences of many religious systems in promoting personal and social change. Yet many disciplines have something to offer religious systems as well. For example, the concepts, theories, research methods, applied skills, and systematically-derived body of knowledge from the social sciences could be useful to religious communities in their efforts to influence their own membership and reach out to the

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larger community. In short, religious systems and allied disciplines have something to offer each other. Multidisciplinary interaction between systems should be carefully considered. Particular attention should be paid to the values and goals of the religious organization, those of other disciplines, and to their degree of compatibility. In some instances, the world views of these groups will differ. For example, empowerment programs developed by psychologists are based on the value of personal control in life. It is questionable whether an effort to increase personal control could be implemented successfully in a congregation which stresses the importance of placing sole control of personal problems in God's hands. In a similar vein, some professionals would not feel comfortable responding to a request from a church for help in improving its evangelism program. At times then, the process of defining and acknowledging one's own values and goals and those of the religious system may lead to appropriate decisions not to work together. However, there will be other instances in which there is greater overlap between the world views of religious systems and other disciplines. These instances offer important opportunities for collaboration and exchange. What form should collaboration take? Typically, the interactions between religious communities and other disciplines have been one-sided. For example, in relationship to the mental health system, Carson (1976) has found that clergy receive training from and make referrals to mental health professionals, yet they receive very few referrals from mental health professionals in return. Implicitly, religious institutions seem to have often been narrowly defined as quasi-mental health centers (Rappaport, 1981). Collaboration should be based on a recognition of and respect for the unique resources and limitations of religion and other disciplines as well (Tyler, Pargament & Gatz, 1983). In this direction, several promising collaborative efforts have been initiated which suggest that, when carefully conceived and implemented, exchanges between religious communities and allied disciplines hold considerable potential for the promotion of individual and social development. Roberts and Thorsheim (1982), for example, have implemented a drug abuse prevention program with over 10,000 members of 24 Lutheran congrega-

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tions. Underlying their program is the recognition of the distinctive power of the community of religious congregation members. Central to their intervention is the use of existing social support networks in the church as a tool for discouraging drug use and encouraging a greater sense of personal efficacy. Pargament and his colleagues have worked with over 40 churches and synagogues through the Congregation Development Program, a databased assessment and feedback program designed to help congregations identify their strengths and weaknesses and plan for change (Pargament, Silverman, Johnson, Echemendia & Snyder, 1982, 1983). In their work they have encouraged congregations to generate their "vision" of what they should be about and how they can move closer to their goals. Identifying black churches as "units of problem solution," Eng, Hatch and Callan (1985) designed a series of health prevention programs with particular sensitivity to "the functions, structure, and rhythm of existing decision-making and social support patterns within the Church" (p. 66). For example, through involvement in the church they identified natural helpers and trained them as lay health advisors. These advisors in turn established and facilitated health-related self-help groups for hard to reach high risk members. In this way they built upon the unique and special access of religious systems to the community. Finally, Maton (1985a) collaborated with congregational members to develop an economic barter and sharing service, a program which has since spread to other congregations. This program grew out of the special world view and vision of the church, one which involves a commitment to helping and sharing with others. What these diverse collaborative efforts have in common is a recognition of the unique resources of religious systems and an attempt to draw on these resources carefully and thoughtfully. Early collaborative work between religion and other disciplines has focused on efforts to influence the members of congregations. Given that 60% of the American population belongs to a congregation, these activities are quite significant (Jacquet, 1985). However, collaborative activities to promote community and social change also hold considerable potential. For example, many disciplines (e.g., psychological, religious, legal, and health) could pool their resources in an attempt to empower par-

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ticularly disadvantaged groups (e.g., the poor, the deinstitutionalized). Further, they could work together towards change in the social and economic conditions which lie at the root of many psychological and social problems. Thus, joint efforts to foster equitable social policies, address institutional bias, and advocate social systemic change represent additional promising directions for further collaboration between religion and allied disciplines. REFERENCES Allport, G. (1950). The individual and his religion: A psychological interpretation. New York: Macmillan. Barbarin, 0. A. (1983). Coping with ecological transitions by black families: A psychosocial model. Journal of Community Psychology, II, 308-322. Batson, C. D. & Ventis, W. L. (1982). The religious experience: A social psychological perspective. New York: Oxford University Press. Benson, P. & Spilka, B. (1973). God image as a function of self-esteem and locus of control. Journal for the Scientific Study of Religion, 12, 297-310. Benson, P. L. & Williams, D. L. (1982). Religion on Capitol Hill: Myths and realities. New York: Harper & Row. Benson, P. L., Wood, P. K., Johnson, A. L., Eklin, C. H. & Mills, J. E. (1983). Report on 1983 Minnesota sun•ey on drng use and drng-related attitudes. Minneapolis: Search Institute. Berger, P. (1961 ). The precarious vision. Garden City: Doubleday. Berger, P. L. (1967). The sacred canopy: Elements of a sociological theory of religion. New York: Doubleday. Berton, P. (1965). The comfortable pew. Toronto: McClelland & Stewart. Boyle, H. C. (1984). Community is possible: Repairing America's roots. New York: Harper & Row. Campbell, E. Q. & Pettigrew, T. F. (1959). Racial and moral crisis: The role of Little Rock ministers. American Journal of Sociology, 64, 509-516. Carson, R. J. (1976). Mental health centers and local clergy: A source book of sample projects. Washington, DC: Community Mental Health Institute. Catalano, R. & Dooley, D. (1980). Economic change in primary prevention. In R. Price, R. Ketterer, B. Bader & J. Monahan (eds.), Prevention in mental health: Research, policy and practice. Beverly Hills: Sage. Clincbcll, J. (1984). Basic types of pastoral care and counseling. Nashville, TN: Abingdon. Cohen, S. & Wills, T. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98(2), 310-357. Dittes, J. E. (1971). Two issues in measuring religion. In M. Strommen (cd.), Research on religious del'elopment. New York: Basic Books. Eng, E., Hatch, J. & Callan, A. (1985). Institutionalizing social support through the church and into the community. Health Education Quarterly, 12(1), 81-92. Evans, B. F. ( 1979). Campaign for human development: Church involvement in social change. Rel'iew of Religious Research, 20, 264-278. French, J.P., Rodgers, W. & Cobb, S. (1974). Adjustment as person-environment fit. In G. Coelho (cd.), Coping and adaptation. New York: Basic Books.

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Fromm, E. (1950). Psychoanalysis and religion. New Haven, Cf: Yale University Press. Galanter, M., Rabkin, R., Rabka, J. & Deutsch, A. (1979). The Moonies: A psychological study of conversion and membership in a contemporary religious sect. American Journal of Psychiatry, 136, 165-169, Glock, C. Y., Ringer, B. B. & Babbie, R. (1967). To comforl and to challenge: A dilemma of the contemporary church. Berkeley: University of California Press. Glock, C. Y. & Stark, R. (1965). Religion and society in tension. Chicago: Rand McNally. Glock, C. Y. & Stark, R. (1966). Christian beliefs and anti-semitism. New York: Harper & Row. Gorsuch, R. (1984). Measurement: The boon and bane of investigating religion. American Psychologist, 39, 228-236. Greeley, A. M. (1972). The denominational society. Glenview, IL: Scott, Foresman. Gutierrez, G. (1973). A theology of liberation. Mary Knoll: Orbis Books. Hallie, P. (1979). Lest innocent blood be shed. New York: Harper & Row. Haugk, K. (1976). Unique contributions of churches and clergy to community mental health. Community Mental Health Journal, 12(1), 21-27. Haugk, K. C. (1985). Christian caregiving-a way of life. Minneapolis: Augsburg Publishing. Herbert, S. N. (1977). Jewish identity: A social psychological perspective. Beverly Hills: Sage Publications. Hostetler, J. A. (1974). Hutterite society. Baltimore: Johns Hopkins University Press. Hug, J. E. (1983). Tracing the spirit: Communities, social action, and theological reflection. New York: Paulist Press. Jacquet, C. H. (ed. ). (1984). Yearbook of American and Canadian churches. Nashville: Abingdon Press. Johnson, P. A. (1965). Call me neighbor, call me friend: The case history of a neighborhood on Chicago's south side. Garden City: Doubleday. Kahn, A. G. & Kamerman, S. B. (1982). Helping America's families. Philadelphia: Temple University Press. Kaplan, B. H. (1976). A note on religious beliefs and coronary heart disease. Journal of the South Carolina Medical Association, XV(5), Supplement, 60-69. Kelley, D. M. (1977). Why consen•ative churches are growing. New York: Harper & Row. Marty, M. E. (1964). Religion and social conflict. New York: Oxford University Press. Maton, K. I. (1981). Empowerment in a religious setting: An exploratory study. Master's Thesis, University of Illinois at Urbana-Champaign. Maton, K. I. (1985a). Economic sharing among members of a religious setting: Patterns and psychological correlates. Doctoral Dissertation, University of Illinois at UrbanaChampaign. Maton, K. I. (1985b). Church of the Savior: Congregation with an inner city and world mission. Manuscript. Maton, K. (1986a ). The stress-buffering role of spiritual support: Cross-sectional and longitudinal investigations. Manuscript submitted for publication. Maton, K. I. (1986b). Unemployment and the church network: Genesis jobs. Division 36 Newsletter, 11(3), 4. Maton, K. I. ( 1987). Patterns and psychological correlates of material support: The bidirectional support hypothesis. American Journal of Community Psychology, 15, 185-207.

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Malon, K. & Rappaport, J. (1984). Empowerment in a religious setting: A multivariate investigation. Prevention in Human Sen•ices, 3, 37-72. Mcadow, M. J. & Kahoe, R. D. (1984). Psychology of religion: Religion in individual lives. New York: Harper & Row. Moberg, D. 0. (1977). The great re1•ersal: Evangelism and social concern. Philadel· phia: J. B. Lippincott. Neal, M. A. (1984). Social justice: The right to use power. Journal for the Scientific Study of Religion, 23, 329-370. Nichol, J. T. (1966). Pentecostalism. New York: Harper & Row. Pargament, K. I. (1982). The interface among religion, religious support systems and mental health. In D. Biegel & A. Napcrstak (cds.), Community supporl systems and mental health. New York: Springer Press. Pargament, K. I. (in press). Refining fit: Conceptual and methodological challenges. American Journal of Community Psychology. Pargament, K., Echemendia, R., Johnson, S., Myers, J., Cook, P., Brannick, M. & McGath, C. (in press). The conservative church: Psychosocial advantages and disad· vantages. American Journal of Community Psychology. Pargament, K., Grevengoed, N., Kennell, J., Newman, J., Hathaway, W. & Jones, W. (1985, October). Religion and the problem solving process: Three styles of coping. Presented at Society for the Scientific Study of Religion, Savannah. Pargament, K. I. & Hahn, J. (1986). God and the just world: Causal and coping attribu· tions to God in health situations. Journal for the Scientific Study of Religion, 25, 193-207.

Pargamcnt, K., Johnson, S., Echemendia, R., Myers, J., Cook, P., McGath, C., Silverman, W. & Wallrabenstein, L. (1984). The congregation development pro· gram: A data-based change approach. Division 36 Newsletter, 8(3), 4-5. Pargament, K., Johnson, S., Echemendia, R. & Silverman, W. (1985). The limits of fit: Examining the implications of person-environment congruence within different religious settings. Journal of Community Psychology, I 3, 20-30. Pargament, K., Silverman, W., Johnson, S., Echemendia, R. & Snyder, S. (1983). The psychosocial climate of religious congregations. American Journal of Community Psychology, JJ(4), 351-381. Pargament, K., Tyler, F. & Steele, R. (1979). Is fit it? The relationship between church/synagogue-member fit and the psychosocial competence of the member. Journal of Community Psychology, 7, 243-252. Pervin, L. (1968). Performance and satisfaction as a function of individual environmental fit. Psychological Bulletin, 69, 56-68. Rappaport, J. (1981 ). In praise of paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9( 1), 1-25. Roberts, B. B. & Thorsheim, H. I. (1982). The approach of social ecology: A partner· ship of support and empowerment. Joumal of Primary Pre1•ention, 3(2), 139-143. Roberts, K. A. (1984). Religion in sociological perspectil·e. Homewood: Dorsey Press. Rohrbaugh, J. & Jessor, R. (1975). Religiosity in youth: A personal control against deviant behavior. Journal of Personality, 43, 136-155. Roozen, D., McKinney, W. & Carroll, J. (1984). Varieties of religious presence. New York: Pilgrim Press. Rubin, J. Z. (1982, August). Being a positively marginal Jew. Paper presented at the American Psychological Association, Washington, DC. Spilka, B., Hood, R. W. & Gorsuch, R. L. ( 1985). The psychology of religion: An empirical approach. Englewood Cliffs: Prentice-Hall.

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Spilka, B., Shaver, P. & Kirkpatrick, L. (1985). General attribution theory for the psychology of religion. Journal for the Scientific Study of Religion, 24, 1-20. Spilka, B., Stout, L., Minton, B. & Sizemore, D. (1977). Death and personal faith: A psychometric investigation. Journal for the Scientific Study of Religion, 16, 169178. Spivack, G., Platt, J. & Shure, M. (1976). The problem solving approach to adjustment. San Francisco: Jossey-Bass. Thayer, E. (1985). Genesis jobs: Program goals, values and description. Manuscript. Troeltsch, E. (1964). Sect-type and church-type contrasted. In L. Schneider (ed.), Religion, culture and society, New York: Wiley. Tyler, F. & Gatz, M. (1977). The development of individual psychosocial competence in a high school setting. Journal of Consulting and Clinical Psychology, 45(3), 441449. Tyler, F., Pargament, K. & Gatz, M. (1983). The resource collaborator role: A model for interactions involving psychologists. American Psychologist, 38(4), 388-398. Vcroff, J., Kulka, R. A. & Douvan, E. (1981 ). Mental Health in America: Patterns of help-seeking from 1957-1976. New York: Basic books. Watzlawick, P., Weakland, J. H. & Fisch, R. (1974). Change: Principles of problem fonnation and problem resolution. New York: Norton. Welford, A. T. (1947). Is religious behavior dependent upon affect or frustration? Journal of Abnonnal and Social Psychology, 42, 310-319. Williams, M. D. (1974). Community in a black Pentecostal church. Pittsburgh, PA: University of Pittsburgh Press. Wilson, B. R. (1959). An analysis of sect development. American Sociological Review, 24, 3-15. Winter, G. (1962). The suburban captivity of the churches. New York: Macmillan. Yinger, J. M. (1970). The scientific study of religion. New York: Macmillan. Zuckerman, D. M., Kasl, S. V. & Ostfeld, A. M. (1984). Psychological predictors of mortality among the elderly poor: The role of religion, well-being, and social contacts. American Journal of Epidemiology, 119, 710-723.

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Chapter 8

Public Health and Community Wellness Judith E. Albino Lisa A. Tedesco State University of New York at Buffalo

SUMMARY. Since its inception, the discipline of public health has been distinguished by a concern for the environmental and social contexts of disease and the importance of behavior in disease control, as well as by leadership in using data-based approaches for the solution of health and community problems. These characteristics are explicated in the description of two major community health problems that have threatened special segments of the population, albeit nearly a century apart: child health at the turn of the century and the current AIDS epidemic. In both cases, the continuing public health focus on natural support systems and empowerment of clients is richly evident.

In several very important ways, the discipline known as public health, and its practice, presaged by fifty to one-hundred years the focus and the concerns of such contemporary disciplines as health psychology and medical sociology. With respect to the prevention of illness and the promotion of wellness- in its broadest sense of physical, psychological, and social well-being- public health can be said to have spawned the first practitioners of primary prevention. While the early public health theoThe authors wish to thank Jerome Freeman of the Western New York AIDS Program, Mary C. Murphy, Teresa M. Schuster, Cheryl L. Shenkle, Anthony D' Augelli, and Michael T. Werden for their helpful comments and suggestions as this chapter was developed. Reprints may be obtained from the senior author at the Department of Be· havioral Sciences, Squire Hall, State University of New York, School of Dental Medi· cine, Buffalo, NY 14214. © 1987 by The Haworth Press, Inc. All rights reserved.

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rists and practitioners were focused on specific diseases and were motivated primarily by their desire to eradicate these health problems, their efforts and investigations led inevitably to a concern for the environmental and social context of disease and the importance of behavior in disease control. In the development and use of epidemiological techniques, moreover, public health can claim a key role in .pioneering data-based approaches to the solution of health and community problems. In this chapter we will provide a brief description of the evolution of the community prevention movement in public health, including major theoretical assumptions and methods of inquiry. The rest of the chapter will be devoted to illustrations of two major community health problems, approaches used to address them, and descriptions of the solutions to these problems that have been achieved, or are being achieved, through the public health movement. We have chosen to address health problems that have threatened special segments of the population, and in each case we have explored the social meanings of the population subgroup in question. First, we will discuss issues of infant mortality and child health in the late nineteenth and early twentieth century. Then we will turn to a more current problem, that of today's epidemic of acquired immune deficiency syndrome (AIDS), which has affected disproportionately the gay population. In each case, we will describe the health problems in question and characterize their effects on both individuals and the community at large. We will describe efforts to solve these problems and the health care context within which these efforts have taken place. Finally, we will attempt to show that public health efforts focused on each of these problems- although separated in time by nearly a century- have played a similarly critical role in forging a proper balance among competing economic, social, and humanitarian concerns, as well as in improving the health of individuals. PUBLIC HEALTH AS COMMVNIJY PREVENTION: AN HISTORICAL PERSPECTIVE It is difficult to pinpoint exactly when public health became recognizable as a distinct profession or discipline, although ef-

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forts to control disease within communities- primarily through sanitation efforts- are clearly recognizable in historical records of the public planning, engineering, and health and safety regulations of the Roman Empire. Even some 3,000 years earlier, the Minoans, and later the Mycenean and Egyptian societies, constructed public drainage systems. The Romans probably elevated public health to the highest levels prior to colonial times, however, as evidenced by their public bath houses, elaborate water and sewer systems, and the development of hospitals, as well as procedures for cremation of the dead, ventilation of houses, masks for protection from occupational hazards, and other hygienic advances. Their achievements clearly reflected an awareness of environmental hazards and social factors in disease, as well as a high level of social responsibility. Public hygiene practices declined in many respects during the Dark Ages, however, when this period was witness to recurring pandemics of bubonic plague that eventually killed one-fourth of the European population. The first quarantine laws were developed during this era, suggesting some knowledge of the communicability of diseases, but the greatest health efforts were those expended in caring for the ill. By the sixteenth century, the prevalent theory guiding public health efforts was based on a belief that it was foul air, or "miasmas," that caused disease. Interest in public health practices began to revive. Rules and regulations regarding public water and sewage, and the quarantining of households where there was illness were methods aimed at controlling the odors associated with corrupt air. Although it provided little comfort to a world where contagious diseases yielded a life expectancy of less than 35 years, the theory of "miasma" did not die easily (Burton & Smith, 1970; Rosen, 1958). The development in the seventeenth century of the microscope enabled the identification of organisms thought to cause infectious diseases, but it was not until after Jenner's development of a smallpox vaccination in 1796 that physicians and the "sanitationists" began to question the theory of miasma. It was at about this time also that the professions of medicine and public health became distinct. The latter group intensified their efforts to achieve minimal sanitation in the slums of the teeming British and European cities, while physicians turned their attention to the birth of the germ theory, through the study of specific microorga-

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nisms responsible for disease. The work of Henle, Koch, and Pasteur exemplified this new model. On the North American continent as well, public health efforts were focused primarily on general sanitation and quarantining of the ill. The Boards of Public Health that were established in the larger cities on both sides of the Atlantic continued to be concerned with water supplies, sanitary sewers, and other public works related to hygiene until the end of the nineteenth century. By that time, the specific organisms responsible for the most dreaded contagious diseases of the times had been identified, and vaccinations for their prevention had been developed. The health care field had been revolutionized, and the role of the public health profession in this new field was not immediately clear. The new directions indicated by establishment of the germ theory of disease, however, eventually demanded the full attention of the public health profession, and it held that attention for most of the first half of this century. During those years, public health efforts continued to emphasize the importance of sanitation, but from the perspective of a more accurate understanding of disease etiology and contagion. Public health as a profession emerged from the eventual substantiation of the germ theory of disease with a clearer mission and an even stronger focus on social factors and the importance of public education in the control of disease. Public health departments were established, and full-time staff became involved in the personal aspects of prevention and treatment of disease, as well as in public aspects of hygiene and disease control. The first state health departments were also established in the late nineteenth century, and these have played a major role in the development of systematic information about disease and prevention practices. The role of the federal government in public health was stimulated by the formation of the American Public Health Association in 1872. From its inception, the APHA included members with such varied interests and expertise as health administration, food sanitation, education, and sanitary engineering, as well as medicine. That organization spearheaded the movement to empower a National Board of Health in 1879 and promoted establishment of the U.S. Public Health Service in 1902. At all of these levels, major emphasis was placed on the eradication of communicable diseases. The results have been enormously successful, not only in terms of

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disease control, but also in the general improvement of living and working conditions for the majority of people in this country. More recently, public health has faced another challenge that has begun once more to reshape and redirect the efforts of the profession. Today, most deaths in the general population are caused not by contagious diseases, but by cardiovascular disease and other chronic or acute conditions which are associated with behavioral and lifestyle variables, and economic and environmental conditions. The "stress theory" of disease, articulated by Hans Selye in the 1950s, has led to an increasingly sophisticated understanding of the role of host response in susceptibility to disease. For the first time, scientists are beginning to explain what the germ theory could not- the reasons that some individuals are more susceptible to disease than others. Today's concept of prevention, consequently, goes far beyond that practiced by the public health professionals who sought to promote sanitation and inoculation against disease. Promoting health requires an understanding of the sources of stress, as well as the causes of disease, and the ability to manage both internally and externally imposed assaults on health and well-being. In retrospect, however, it has been the profession of public health, more than any other of the social sciences, that has viewed understanding and management of the environment as a key factor in health promotion. Ralph Catalano (1979) has suggested that the current perspective in public health reflects a paradigm that recapitulates some of the assumptions of the ancient ecological paradigm that structured public health efforts of the Roman Empire. He pointed out that in both the ancient and the modern paradigms, attention is given to balance among internal and external factors related to health, lifestyle factors, and environmental and economic predictors. We would maintain, moreover, that even during the reign of the germ paradigm- with its focus on laboratory research and specific bacterial causes- the practice of public health has always acknowledged the environmental and community contexts of health and disease. At any rate, it appears that public health has won its greatest battles when it has approached the health problems of individuals not as isolated phenomena, but as problems that are inextricably related to life conditions and stresses, to the physical environment, and to the goals and behaviors of

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individuals and those around them. The following sections of this chapter will illustrate this premise. CHILD HEALTH IN THE LATE NINETEENTH CENTURY

The fifty years surrounding the turn of the century saw enormous positive changes in health and decreases in mortality of children in this country. Prior to 1900, the death rate approached 20 percent for infants in the first year of life, and one in ten of those remaining did not survive three more years. The infant mortality rate was cut in half by 1940, and that for older children reduced to 3 in 1,000- dramatic declines, indeed. While obviously related to scientific discoveries concerning bacterial causes and control of disease, the contributions of public health workers to these achievements cannot be overestimated. In an address at Yale University in 1922, Professor of Public Health C.-E. A. Winslow (1923) described the new emphasis on education as the "keynote of the modern campaign for public health" (p. 55). He enumerated the preventable causes of death and disease which required educating "the mothers who bring up the babies and the men who pay rent in the tenements and work in the stores and factories" (p. 55). He described the public health nurse as central to this educational effort, "a sort of community mother but armed with the expert knowledge which few mothers can possess" (p. 56). Indeed, the nurses and other public health workers of the late nineteenth and early twentieth century made their greatest contributions when they went out among the poor and uneducated, learned their lifestyles, and helped them adapt their behavior to accommodate new information about infant health. The problems these early health workers faced were complicated by the economic and social development of that period of American history. During the fifty years prior to 1910, the proportion of the U.S. population living in urban areas had increased from less than twenty percent to almost half of the total U.S. population. By 1890, the population density in some Manhattan wards was as high as 500 persons per acre (Riis, 1957). Most of the new city

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dwellers, moreover, were poor, uneducated, and unskilled immigrants from the villages and rural areas of southern and eastern European countries. Many had never learned to speak English. They were joined in the northeastern cities by hundreds of thousands of southern rural blacks, equally poor and unprepared for city life and who, like the European immigrants, flocked to the cities in pursuit of factory jobs and the promise of a better life. And with these new urban dwellers came hundreds of thousands of children, most of whom were destined to live out their frequently very short lives in crowded tenement flats with inadequate washing facilities, unsanitary food and drinking water, little medical care, air polluted by industrial and residential wastes, and harsh working conditions tolerated in only the most economically depressed and undeveloped countries today. By the turn of the century, the low standards of living, crowded and unsanitary working conditions, poor health practices, and general degradation of the new urban masses could no longer be ignored by American political and social leaders (Rosen, 1958). The abject poverty and the squalor of the tenements stood in stark contrast to the extravagant lifestyles of the new American upper classes with their unprecedented wealth. The fact that it was unrestrained industrial expansion fueled by the labor and suffering of the new American immigrants that had created these economic extremes could not be denied. A reform movement was underway, and public health professionals were at the front of this movement as they worked to gain entry to the tenement communities and acceptance of their recommendations by the new urban immigrants who inhabited them. In many of these efforts they focused primarily on the children- since it was they who were most vulnerable to the environmental stressors of poverty and most likely to eventually rise above these conditions. Infant Mortality and Clean Milk

Infant mortality is a particularly sensitive index of health in a society; based on this index, the urban communities of the late nineteenth century could be considered very ill, indeed. In 1879, Dr. Abraham Jacobi, who had long advocated the breastfeeding

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of infants, published data showing that nearly 50 percent of those infants fed cow's milk died during their first year-41 percent from intestinal illnesses and 21 percent from respiratory problems- and that more than half of those dying in the first year did so during their first two months (Smillie, 1955). Dr. Jacobi's recommendation of breastfeeding was followed by the strong advice that cow's milk should be boiled before it was given to infants. In 1889, Dr. Henry Koplik opened the first milk distribution center in New York City to make available boiled milk for infants during the hot summer months. It was not until 1893, however, when the philanthropist Nathan Straus began opening a series of milk stations, that convincing evidence was provided that public health reforms could offer solutions to major health problems of the new urban communities. Between 1880 and 1907, more than 500 major incidents of disease traceable to contaminated milk were reported. During the summer months, the problem was particularly acute, and infant deaths from intestinal disorders were especially common. By 1902, however, the Straus dispensaries were distributing 250,000 sterilized nursing bottles of milk monthly, and they were soon followed by other milk stations. The stations, established by the Division of Child Hygiene, sold pasteurized milk for less than it could be purchased in the stores. Public health workers at these stations also provided instruction in how to prepare milk in the home. The effects of these efforts were immediate, and in spite of relatively unsophisticated and incomplete data collection, the mortality figures began to reflect these changes. Dr. S. Josephine Baker, a physician appointed as the first head of the Division of Child Hygiene in 1908, saw in the milk stations an opportunity for more extensive outreach to the community. She used the milk stations as a contact point to provide education about infant care and feeding. Baker also began registering the births of infants on New York's lower East Side and sending public health nurses to the homes of each newborn to provide child care instruction. Baker kept the first records of both births and deaths by residential area so that the effectiveness of the Division's efforts could be evaluated more accurately. In the first year of her home visits program the number of infant deaths

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in a particularly crowded area of the lower East Side was down by 1,200. Still another of Dr. Baker's innovations in child health was the establishment of a Little Mother's League. Recognizing that in many homes the oldest daughters assumed responsibility for younger children while their mothers worked, Baker went into the schools to organize groups of these girls for the purpose of instructing them in child health and infant care. The girls were praised for assuming important responsibilities and given badges that conferred a special status. They also were encouraged to teach others in their own and neighboring families as a part of their special responsibilities. This use of natural family and community structures to facilitate enhanced health care for children was not prescribed by a medical model. Rather, it was based on an understanding of the social structures of families, the functions of individuals within them, and the relationships among family members within a specific community. In this way, the natural teaching and helping mechanisms most appropriate for addressing a particular problem were mobilized to enhance child health. Child Labor and Public Health

The development and distribution of clean milk supplies were not the only activities spurred by concern for the health of children during the late nineteenth century. Lesser (1985) has pointed out that much of the emerging focus on child health originated as a response to the exploitation of child labor brought about by rapid industrialization following the Civil War. By 1900, one in six children between 10 and 15 was employed, and in the South, one-third of the millworkers were children- some younger than ten years. Although minimum ages for child labor were established by state laws enacted as early as the mid-1800s, these regulations were virtually ignored until well after 1900, and children as young as six and eight years worked in absolutely deplorable conditions. Volume II of the Harvard University Press series on children and youth provides numerous detailed accounts of the working conditions of children at that time (Bremner, 1971 ). In the spin-

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ning, textile, and garment factories of northeastern cities, and in the southern cotton mills as well, children worked alongside adults six days a week for ten to twelve hours daily, and longer in some cases. Often worse than the fatigue and boredom of the long hours, however, were the insufferable physical conditions in which they worked. In some mills, the air was white with lint and fibers that clogged their lungs and burned their throats. Most of the factories were not adequately heated in winter and not even ventilated in the summer. For some, too, there were the constant dangers of lost limbs or other injuries related to operating manufacturing machinery. Children also were put to work in a variety of other settings which exposed them, in great quantities and for long periods of time, to such toxic substances as dust, tobacco, dyes, glue, toxic metals, glass, coal, and varnish. Some sat hunched over footpowered sewing machines, or coal chutes where they sorted out slate, for up to six hours without a break. Others fed hot furnaces or pushed and hauled goods. Some worked at home, where all members of the family toiled in tenement sweatshops making cigars, toys, trinkets, or other small items for which payment was notoriously poor. In these cases, the contamination of the work setting pervaded all of the child's hours, both waking and sleeping (Lumpkin & Douglas, 1937; Zelizer, 1985). Some children's skin was permanently stained by toxic dyes, and others actually slept on piles of tobacco. Respiratory and intestinal disorders were understandably common among the urban child workers, as were skeletal abnormalities. Children who worked in match factories sometimes developed phosphorous necrosis, particularly of the lower jaw, and those exposed to naphtha fumes in rubber manufacturing plants developed paralytic disorders. Children exposed to lead in a variety of industries suffered for the rest of their lives from the poisoning of heavy lead exposure. In rural areas, too, children could be found spending long hours at hard labor in the fields, and in coastal areas in the canning factories. In virtually every community, children could be found in the streets selling newspapers or other goods or services. And regardless of their work, their wages were minimal and their education neglected, if not completely ignored.

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The effects on children of these miserable working conditions did not go completely unnoticed, of course, but in retrospect one must wonder how such inhumane practices could have come about. The answer to that question appears to have lain in the economic and social context of the times, in the opportunism and greed of some and the desperation of others. Zelizer (1985) has pointed out, however, that the situation was actually far more complex than this explanation would allow. At the base of the controversy, she suggests, was "a profound cultural uncertainty and dissent over the proper economic roles of children" (p. 66). Children were not generally perceived as a group with special needs that precluded significant participation in the labor force. Instead, they were more commonly viewed as "miniature adults." Proponents of child labor included parents, religious leaders, and even educators, who argued that child labor was an appropriate method of teaching family and social responsibility or simply a proper expression of the child's obligation to parents and to society. John Spargo (1906) enumerated the reasons given for child labor, based on his investigations of 213 children in four northeastern states at the turn of the century. He attributed half of the cases to primary poverty, as indicated by low income, deceased, ill, or unemployed parents, and abandonment or drunkenness of the father. Among the other half, difficulties at school, friends who were working, or the desire for more material goods were the most frequent reasons that young children gave for working. On the other side, parents sought to increase family financial status, and employers benefited from the cheaper labor source. After the passage of minimum work age legislation, unscrupulous lawyers and priests sold false certificates testifying that children were old enough to work, and some physicians even falsely certified the health of child laborers. Clearly, many profited from the system. As Spargo so succinctly described the situation, "Poverty began the ruin of the child by denying it proper nourishment, and ignorance and greed combine to complete the ruin by sending the child in its weakness forth to labor" (p. 637). Although a number of states had passed minimum age laws, and had even required young working children to attend school at least three months a year, federal legislation regulating child la-

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bor repeatedly failed or was struck down by the courts after passage. Although the first federal child labor law was passed by Congress in 1916, it was not until passage of the Fair Labor Standards Act in 1938 that major strides were made in restricting child labor. During the early decades of this century public health practitioners continued to work against the deleterious effects of child labor. The Children's Bureau, established in 1912, offered the first federally funded public health services and provided a new mechanism through which the concerns of public health professionals could be heard and their goals realized. Under the direction of Julia Lathrop, the Bureau gathered much of the data used as evidence by the citizens' National Child Labor Committee, which lobbied effectively for federal legislation. When the tide of public opinion finally began to turn against child labor, it occurred on many fronts. Some decried wasted childhood and the loss of prime years for learning. The new science of psychology provided support for this position, emphasizing the importance of both play and instruction to normal physiological and intellectual development, and describing adolescence as a vulnerable time when adult values, identifications, and goals are being shaped. Others made purely economic arguments, asserting that cheap child labor retards technological progress, lowers the standards of efficiency, and uses up the labor source, since unskilled child laborers generally do not develop increased skill. The labor unions argued that child labor drove wages down in general, and that child laborers simply displaced adult laborers who could easily support their children were those children not driving down the scale. The public health sector, of course, had long opposed both the physical and mental insults to children, as well as the damage done to family structure and long-term potential of the poor to better their lot. While considerable credit for regulating child labor practices must be given both to the labor unions and to the government itself, the role played by epidemiologists and other public health specialists, working alongside social workers, educators, and psychologists, was critical and significant. Some would argue that changes in practices related to child labor in this country ultimately came about only because the economy was ready for them- that the passage of child labor

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legislation was, in fact, simply a capitalist solution. While it is undeniable that changes in manufacturing technology, union pressures, and other economic factors began to make it appear more profitable not to employ children in many settings, cultural factors certainly played a mediating role. The American people were being forced to confront and struggle with their values and to make a final statement about the proper role of children in society. Clearly, the most important contributions of public health in this evolution were to document the occurrence of disputed labor practices and their effects on children and their families. In doing this, they focused on the relationship of work conditions to health. By collecting and publishing such information, the public health profession was able to bring to the child labor controversy an objective base to which society could turn once the more emotional issues were fully aired. In addition, as public health workers moved about the community providing health care, they were able to influence some who did not fully understand the consequences of child labor for children and their families. Although the discipline's role in solving the child labor problems was far less visible than that in dealing with the issue of contaminated milk as a major factor in infant mortality, it was no less important. Other Issues of Child Health

The public health profession was instrumental in other areas of child health at the turn of the century. The initiation of school nurse programs and mass inoculations for childhood diseases represent two well-known efforts. It was public health professionals, too, who first promoted the idea that maternal and child health are inextricably related, that attention to the health care of women who are mothers, or of childbearing age, is essential to improved child health. The maternity and infancy division within the Children's Bureau pioneered support for dependent children and for mothers' pensions, an unprecedented linking of health to social welfare measures. A National Children's Year campaign in 1918 mobilized more than 11 million American women into 17,000 committees in 16,500 cities, towns, and rural communities. These groups planned and carried out activities related to

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four major goals: protection of infant and maternal health; care of older children; enforcement of child labor laws, along with insuring education for all school-age children; and recreation. This was, no doubt, the most successful health campaign the country had seen until that time. While the Children's Bureau over the years was forced to rebut accusations that it overstepped its bounds, there was no denying the fact that the Bureau's combination of medical and social science approaches, along with a strong emphasis on statistical documentation, had advanced the status of child health and increased public awareness of all the problems of childhood. Indeed, this was the conclusion reached in the 1930 White House Conference on Child Health and Protection. Consequently, the Children's Bureau continued its efforts through the depression, working as a separate agency with comprehensive child welfare responsibilities until it was joined to the Department of Health, Education, and Welfare in 1963. In a recent paper exploring the historical position of the client in public health, Charlotte Muller (1985) pointed out that, "The public health movement has always been embedded in the social milieu when defining its obligations and selecting its means" (p. 470). Issues of child health seem to reflect these influences with a particular clarity. In responding to the challenge of reducing infant mortality related to gastrointestinal and feeding problems in the late nineteenth century, public health was caught in a paradigm shift, and professionals struggled to make sense of new scientific knowledge about bacterial causes of disease in light of the social practices of the day. In the case of child labor, public health faced a different type of dilemma precipitated by conflicting social and economic needs. In both cases, however, public health problems could be solved only by understanding and working with the social, cultural, and economic context within which change would occur. A more recent challenge to public health efforts, the AIDS epidemic, represents another striking example of the influence of social values on health care and on the acceptance of scientific knowledge related to a health problem. While intravenous drug users and hemophiliacs are other groups that have been significantly affected by AIDS, and other women and children also

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have contracted the virus, the fact that nearly three-quarters of AIDS patients are gay or bisexual men tends to encourage definition of the syndrome in terms of sexual practices. This creates a situation in which value judgments about real or presumed lifestyles or about sexual practices are overly generalized to issues concerning treatment and even scientific research related to AIDS. Public health clearly is playing a major role in sorting out those social and cultural values, as well as in clarifying the etiology of the syndrome and the communicability patterns of the virus. ACQUIRED IMMUNE DEFICIENC Y SYNDROME (AIDS)

While the first cases of Acquired Immune Deficiency Syndrome appeared in the United States in 1979, it was not until 1981 that AIDS was first described and reported in the medical literature (Council on Scientific Affairs, 1984). In 1983, the Public Health Service declared AIDS its top priority (Brandt, 1985). AIDS is believed to be caused by a rare retrovirus that takes over the machinery of T-cells, or lymphocytes, which are needed to fight infection (Rothenberg, 1985). Cells affected by AIDS work in its service, quickly and efficiently growing more virus. Norman (1985) recently described the virus as operating through Tcell DNA. Once the virus is integrated into the DNA it has the capacity to lie dormant for an indefinite time. When the virus is activated, new virus forms and infects new T-cells. In the virus reproduction cycle, the infected T-cells are killed. With a depleted supply of T-cells, the body is no longer able to defend itself against ordinary environmental insults and becomes a ready host to a myriad of infections. The seriousness of this clinical picture is intensified by the two-to-one ratio of diagnosed AIDS cases to AIDS deaths. The most life threatening infection for those afflicted with AIDS is Pneumocystis carinii pneumonia (PCP) and the most common malignant condition has been Kaposi's sarcoma (KS). Public health monitoring of their occurrence has provided the most reliable measure of AIDS incidence.

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Through public health efforts of tracing, counting, and crossreferencing disease patterns in population subgroups, highly accurate descriptions of disease occurrence, clinical course, and necessary prevention activities have been developed. The epidemiological puzzle of AIDS began with the reporting of unusual case occurrences of pneumonia and other opportunistic infections in young men with no other illnesses. With the isolation of and serologic tests for HTLV-111 virus indicative of AIDS, public health and medical scientists have furthered the identification and prevention process. In June of 1981, five cases of pneumonia, caused by the parasite Pneumocystis carinii (PCP), among young gay men in Los Angeles were reported to the Centers for Disease Control (Centers for Disease Control, 1981a). None of these men had any underlying disease or any history of drug therapy that suppresses the immune system, factors that are characteristic of those with PCP. They also had clinical manifestations and laboratory evidence of an immune function disturbance. Other reports from New York and California to the Centers for Disease Control revealed that for the 30-month period ending with July of 1981, 26 cases of Kaposi's Sarcoma (KS), a rare form of cancer, were diagnosed among young gay men (Centers for Disease Control, 1981b). Prior to this 1981 reporting, KS was rare in the United States, mainly affecting elderly men. However, since many of the young gay men with KS also had opportunistic infections, it seemed probable that the occurrences of KS and PCP in gay men were related and could be explained by a disturbance in immune function. This explanation became more widely accepted by the public health community as detailed reports of KS, PCP, and other opportunistic infections appeared among people who also had immune system deficiencies. Based on this recurring clinical picture- that is, the existence of either KS or an opportunistic infection such as PCP, or both, along with unexplained immune system dysfunction- acquired immune deficiency syndrome (AIDS) became recognized as a new disease category (Curran, Gold & Jaffe, 1984). Defining what AIDS is and who is at risk has presented a major challenge for public health epidemiologists, physicians, and

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basic scientists. At the end of the fourth week in September, 1986, there were 25,650 known cases of AIDS ·and 14,345 deaths due to the disease (Centers for Disease Control, 1986) in the United States. Seventy-three percent of those with AIDS are gay or bisexual men; 17 percent are intravenous drug users; one percent are female sexual partners of bisexual men; and three percent are hemophiliacs and other persons receiving blood transfusions. Approximately six percent of the current cases cannot be traced to known means of disease communicability. At least one or more cases have been reported in all 50 states, with New York, California, and Florida, in that order, reporting the highest numbers. The World Health Organization has received reports of AIDS cases from 40 countries (World Health Organization, 1985a). Approximately 90 percent of persons diagnosed with AIDS are between 20 and 49 years old (Centers for Disease Control, 1983). While the virus has been isolated in blood, semen, saliva, and tears (Centers for Disease Control, 1985), studies of twoparent AIDS families with children indicate that close household contact does not transmit the virus, but that repeated heterosexual contact does (Redfield, Markham, Salahuddin, Sarngadharan, Bodner, Folks, Ballou, Wright & Gallo, 1985). In case occurrences, males outnumber females by a ratio of approximately 15 to 1 (Council on Scientific Affairs, 1984). The mortality rate for AIDS is very high. The three year mortality figure is about 70 percent; of cases diagnosed more than three years ago, 85 percent are now dead (AIDS Surveillance Monthly Update, 1985). This high mortality rate does not present the same pattern in all patient subgroups, however. Blacks and Hispanics have a lower survival rate than whites, and females have a higher mortality rate than males. Researchers studying disease co-factors have suggested that behavior may be part of the disease acquisition process; frequent use of recreational drugs, numerous sexual partners, and poor diet and sleep habits can increase exposure or susceptibility to colds, flus, and infections, thereby challenging the immune system. In such cases, the immune deficiency syndrome virus appears to proliferate (Martin & Vance, 1984). But, even though the epidemiological patterns for AIDS were quickly determined,

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the origin of the disease remained unknown. This contributed to what the World Health Organization has described as a "confused and piecemeal response from the medical profession" (WHO, 1985d, p. 98). The role of behavior, then, in disease transmission makes AIDS both a public health and a psychological emergency (Batchelor, 1984). Because there is no cure or vaccine for AIDS and because it is primarily a sexually transmitted disease, social awareness and preventive behavior for disease control are the only known deterrents to transmission. The majority of society, who do not fall into the identified major risk groups, are calling on medical and public health experts for guarantees that no one can give. Value judgments, fear, and misinformation are creating a volatile social climate within which public health must function. In this section, we outline the responses to AIDS and the challenge this presents to public health and wellness. Social Effects and Responses

Consequences of AIDS and the persistent unknowns related to cure appear to be fueling public fear and negative emotional responses to the disease. Dismissal from work, eviction from homes, and refusal of health services are occasional consequences of the disease and reflect the social stigma experienced by individuals afflicted with AIDS (Batchelor, 1984; Green & Miller, 1985; Kelly, St. Lawrence, Smith, Hood & Cook, 1987; Morin, Charles & Malyon, 1984). The insurance industry is even considering screening applicants for AIDS exposure (Saltzman, 1985). An NBC television poll of a randomly selected sample of 1,198 Americans in November of 1985 reported that 58 percent of those surveyed believed there should be government restrictions on AIDS patients. Poll reporters noted that some survey respondents suggested that the general population might be screened and required to carry "clean cards," a wallet-size health record indicating whether you are free from disease, afflicted, or a virus carrier. This practice, when coupled with the public opinion poll findings that one in five Americans believe

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that persons with AIDS should be fired from their jobs suggests profound issues of civil rights. Some religious groups have suggested that AIDS is a punishment for immoral behavior and that the cure lies in eliminating those behaviors and individuals from the population. The Moral Majority, a political group with a religious fundamentalist ideology, vociferously opposed the federal funding allotted to AIDS research (Brandt, 1985). The leadership of this group publicly stated that gay people should be held accountable for the problem. Brandt (1985) summarized their misunderstanding, "In this view, it is homosexuality that causes AIDS, not a virus" (p. 183). The Personal Response

The public and social response to AIDS is only part of the anguish and despair, however. A recently chronicled experience with AIDS touched on social support themes in relation to the terminally ill (Ferrara, 1984). Anthony Ferrara, who died from AIDS in 1984, described his experience in terms of two worlds, his own and his lover's. Too busy protecting and caring for his lover's feelings, Anthony contained most of his own emotion. While it appeared as though Anthony had support and caring, he was actually alone in his suffering. As time passed, they were able to express their sadness to each other. As the illness progressed, Anthony's needs for emotional support increased. Even though that support was forthcoming, friends' feelings of pity were also present. In a physically debilitated state, an individual cannot fully utilize an available social support system for coping, either. Anthony reminds us that the "out of sight, out of mind" philosophy is a profound hardship faced by a friend "too ill to participate in your life as they did before" (Ferrara, 1984, p. 1285). These personal themes and experiences represent only a few of the specific needs that are being addressed by health and mental health agencies dealing with AIDS. Individuals in the 15 to 20 percent group who have three year survivability status and those who have AIDS related complex (ARC), or symptoms and signs without life-threatening disease,

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experience a marginal existence in the "gray zone." Morin and his colleagues (Morin & Batchelor, 1984; Morin, Charles & Malyon, 1984) describe the isolation and fatigue associated with gray zone coping. They experience the same harsh reality as diagnosed AIDS patients. In addition, being in the age group for career strides, their goals are frustrated by illness episodes that draw social stigma. Asymptomatic gay men comprise yet another group of individuals affected by AIDS; their response has been characterized by panic and generalized anxiety (Green & Miller, 1985; Morin & Batchelor, 1984). Particularly in urban areas where the incidence of AIDS is highest, many persist in believing that they are ill or about to become ill from AIDS. Obsessional thoughts and fears of the ''worried well'' sometimes interfere with occupational and social functioning (Morin & Batchelor, 1984; Morin, Charles & Malyon, 1984). It is understandable that some who feel threatened will avoid educational information because it is too frightening to face, and this behavior, of course, may only increase their vulnerability. It has been these personal, social, political, and economic responses to AIDS, as well as the objectively defined effects of AIDS on health and life, that have shaped and directed public health work with respect to this disease. While persons at risk for sexually transmitted diseases (STDs) could once feel secure in the knowledge that antibiotics or other drugs were available and could solve any potential problems, AIDS has changed that. While the epidemiology and risk factors are known and have been described in this chapter, there are still no cures. As suggested by Kassler (1983), "AIDS has raised the ante of STDs, removing the sense of security ... " (p. x). The Public Health Response

Public health institutions have responded to the challenge of AIDS with several types and levels of activity. The examples of the surveillance activities described above, and the monitoring of the cases of AIDS, provide the epidemiological data to clinicians, researchers, counselors, and program directors. Other efforts have been more uneven in the provision of activities to dis-

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seminate prevention and treatment information. The formation of the Centers for Disease Control AIDS Task Force occurred at about the same time as AIDS was formally identified in 1981. This task force was comprised of more than 100 investigators whose mission was to define the epidemiology of AIDS, determine risk factors, and find a cure (Kassler, 1983). Along with playing a major role in defining the epidemiology of AIDS, the public health response has included dissemination of accurate information to multiple segments of society. At least twice in 1985 the World Health Organization met and published recommendations for public health and medical personnel involved in research and patient care (WHO, 1985b, 1985c). Along with the U.S. Department of Health and Human Services, the WHO has recommended the establishment of collaboration centers for research and training, global surveillance with standardized disease definitions, vaccine development, public education for disease prevention, and safety procedures for health care workers treating AIDS patients and handling body fluids and tissues. At an April 1985 meeting, medical and scientific consultants for the WHO noted that information on transmission was sufficient to allow public health officials to design and implement activities to reduce the incidence of AIDS among certain risk groups. Public Health,s Prevention Response

One of the most important responses offered through the American public health movement has been education for the prevention of AIDS. Since drug-related behaviors and sexual practices suggest that AIDS is caused by a transmitted agent, there is a great deal that individuals can do to prevent their exposure. For example, guidelines for safe sex have been disseminated widely through all forms of media presentation. The AIDS Assessment, Education and Surveillance Project (Helgergen, 1984) in Seattle is an example of a community effort that combines surveillance, education, assessment, and research activities for prevention. County and city funds were allocated to the Department of Public Health for this work. Physicians are asked to report illness fitting the AIDS definitions and to identify

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themselves and other health care workers who are likely to provide care for AIDS-like problems. Information via a hotline, brochures and pamphlets, presentations to groups for educational inservice purposes, and consultation with news media are all educational activities organized by this group. The Seattle clinic is staffed by a nurse practitioner with physician and service support to determine personal risk profiles and to identify and recommend ways to decrease personal risk. If health problems are identified, referrals for further care are given. Research efforts are coordinated through the assessment clinic, and clinic patients may voluntarily give blood and skin samples for research that is not immediately useful for their diagnoses or treatment. The Seattle program appears to reflect the model for service and research suggested by the Division of Sexually Transmitted Diseases of the Centers for Disease Control. This organization provides assistance at the state level for program planning, uniform treatment practices, research, and training for health care professionals (Morton, 1984). One of the major foci of this division, at present, is to establish clinics and train professionals for the diagnosis, treatment, and prevention of sexually transmitted diseases. With the cooperation of medical schools across the country, ten model clinics and training centers were established. The program hopes to train 1000 general nurses a year as nursepractitioner specialists in venereology. At just about the time federal and state monies were released for public health efforts to combat AIDS, community, state, and regional coalitions of concerned individuals were being formed. Around the country these ad hoc groups responded with purposeful speed to calls for proposals for funding of community outreach services. In addition, the National AIDS Research Foundation, American Foundation for AIDS Research, and the AIDS Medical Foundation were organized by prominent media personalities, entrepreneurs, scientists, and physicians to provide private foundation funding for research on transmission, treatments, and cure. One of the immediate goals of these groups was to provide funding quickly and without the issuing constraints common to federal agency grants.

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The Response of the Gay Community

Not since the police raid of the Greenwich Village gay bar Stonewall in 1969, or the Harvey Milk proposition 6 movement in California during the late seventies, has an event like AIDS forced large groups of gay men and women to identify themselves as a community. For many, the gay liberation movement in the late sixties presented as much of a personal and psychological challenge as it did a political and social one. Civil liberties and social freedoms were addressed, as were issues related to selfesteem, identity, and integration into the social mainstream. It is this good spirit, perhaps, that has fostered the responsiveness of prevention groups in public health and in community mental health. A recent report described the nation's gay leaders as ready for social combat against discrimination (Adler, Greenberg, Hager, McKillop & Namuth, 1985). A Boston activist reminded the American press that it was only 15 years ago that homosexuality was considered a sign of mental illness. In some sectors of society gay people are now viewed as a public health threat, turning back their social and political gains 200 percent. Yet, in many other ways the reverse is true. According to D' Augelli (1986), the AIDS crisis, "has allowed a caring coalition of people to work together and the numbers of heterosexually defined professionals who are now more aware of gay issues has multiplied probably a thousand times or more." What began and continues to forge the identity of the community of gay individuals with AIDS are the social support systems and networks that have emerged to cope with this disease. Nationally, these support systems, designed to help face illness and death, have developed an added dimension of reaffirming community integrity, personal dignity, and civil rights. Hirsch and Enlow (1984) describe this response to AIDS in terms of the sick and the well. This two-pronged approach provides services for people sick with AIDS and also offers healthy people social activities that enhance positive attitudes, community integrity, and sexual identity. Support is offered on many levels- financial, legal, educational, and psychological. Volun-

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teer and professional counseling is available in most communities along with hotline services for information dissemination and crisis intervention. Even though these activities are more like community mental health programs, their focus on prevention and wellness share the goals of public health. In major cities like New York, San Francisco, and Los Angeles organizations like the Gay Men's Health Crisis have emerged to provide special support for individuals in any way affected by AIDS (Mervis, 1985). Gay and lesbian groups in these cities are establishing hospices for AIDS patients. The Coalition for Sexual Responsibility in New York works with the governor's AIDS Advisory Council to grapple with policy decisions to regulate disease prevention activities. Across the United States we see volunteers and professionals engaged in training "buddies." In Topeka, Kansas and Buffalo, New York, for example, the buddy program provides individual support for sick persons who are without the emotional and physical support usually given by spouse, lover, family, or friends. The buddy program fills in support network gaps as well, relieving the heavy demands placed on those caring for AIDS patients and providing needed contact with physicians, lawyers, clergy, or social workers as well. Individuals involved in these projects have characteristics of what Mitchell and Trickett (1980) describe as the indigenous community worker. Persons with knowledge of resources mobilize networks for assistance in a manner that maintains the sup- ' port ties. The AIDS patient, often too ill to utilize traditional friendships for social support, can rely on the buddy program not only for companionship but also for help in returning contacts or visits to friends and family. The social contingencies for support do not necessarily have to be one-way after illness onset, with the well visiting with or administering to the sick. The buddy program has the potential of creating a work role for AIDS volunteers that can link persons afflicted with AIDS to the other persons in their social network. Since social roles change with illness, the buddy system can mitigate the total dependence and collapse of friendship and caring for others for persons affected with AIDS.

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Practicing Prevention

William (1984) presents some indirect measures of a positive response to educational efforts to enhance risk reduction behaviors among persons who are gay. He reports that gonorrhea cases in gay men have declined by 39 percent from 1982 to 1983 in Denver, Colorado. From 1981 to 1983, there was a 40 percent decrease in reported gonorrhea among 15 to 44 year old males in the Lower Westside Health District of Manhattan, where the highest number of gay men in New York live. An investigation of the reported sexual behavior of gay men in Madison, Wisconsin during 1982 and 1983 showed an increase in the number of men abstaining from sex and a 50 percent increase in single sexual partner relationships (Hirsch & Enlow, 1984; William, 1984). The incidence of gonorrhea in this group also dropped from 6.8 per 100 STD patients to 2.2 (Hirsch & Enlow, 1984). These investigators believe that the data suggest that in New York changes in sexual practices may be reducing the risk of AIDS. McKusick, Horstman and Coates (1985) surveyed 655 gay men in San Francisco in 1983, asking them to report on their sexual practices during the previous month and the same month of the previous year. Participants were sampled at bath houses, bars, and through recruitment advertising for gay men who dtd not utilize bars or baths for sexual contact. Couples in monogamous relationships were also sampled. Except for the bath house group, all groups reported lower frequency of sexual contacts from bars, baths, T-rooms, or parks. Men in nonmonogamous relationships reported a decrease in high-risk sexual activity, but no increase in low-risk sexual behavior. An increase in sexual behavior was related to using sex to resolve tension and for expressing gay identity. A decrease in sexual behavior was associated with remembering someone in the end stages of AIDS. While knowledge of AIDS health guidelines was high across groups, it did not have any significant association with sexual behavior. McKusick and his associates stressed that in terms of health beliefs, 50 percent of the bath house group and 58 percent of the bar group believed they were less susceptible to AIDS than others, with 65 percent in both groups believing they had made

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the necessary changes for safe sexual practices. This is remarkable since the guidelines for disease prevention and safe sexual practices had been disseminated by this time. The authors concluded that educational efforts aimed at changing behavior in these groups should include greater visibility of AIDS patients and suggestions for other methods of tension release. These data were collected in November of 1983, the same year the Public Health service declared AIDS its top priority, and they were not published until May, 1985. A more recent report from McKusick and his colleagues (McKusick, Coates & Horstman, 1985) shows a 55 percent decrease in the number of gay San Francisco men engaged in unprotected anal intercourse, a highrisk sexual practice, with 77 percent not engaging in that behavior during November, 1984. While these data represent progress on the part of public health education and prevention efforts, 100 percent compliance with safe sex recommendations is not yet a reality. This has caused some public health clinicians and educators to express discouragement and suggest risk-reduction guidelines based on very strict interpretation of the epidemiological data (Handsfield, 1985). According to this position, gay men should be advised to engage in sexual activity only in monogamous, permanent, committed relationships. Safe sex guidelines for all other relationships should be presented as clear second choice options. From a personal, psychological perspective, the idea of forced monogamy is perceived as "the simple insensitivity of an outsider approaching the gay world" (McKusick, Coates & Horstman, 1985, p. 1449). Yet, McKusick and his associates report that most of their study participants have expressed a desire for primary partnering aimed at preventing AIDS. However, during the period of their investigations, up to late 1984, no significant increase in monogamous bonds was reported. The investigators suggest that public health education is not an effective vehicle for enhancing the establishment and stability of monogamous relationships. Moreover, they report that reducing the risk for sexual transmission of AIDS is tied more directly to response efficacy, or the personal belief in one's ability to comply with recommended health practices.

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As is the case with most illnesses that have threatened community wellness, public health's most significant contribution has been in the epidemiology of AIDS. Monitoring of illness incidence has led to careful disease definition and identification of population subgroups at greatest risk (WHO, 1985d). At the time of this writing, science observers note that the disease pattern has not changed much at all during the last four years (Norman, 1985). However, both public health experts and scientific researchers express concern about predictability of disease course. Because of the prolonged incubation period for AIDS onset- 29 months average time in adults and 12 months average time in children- tracking the spread of the virus, not necessarily the disease, emerges as the latest challenge (WHO, 1985d; Norman, 1985). In addition, intravenous drug users, the second largest group at risk for AIDS in the U.S., are not organized for advocacy or empowerment. This client group, then, is extremely difficult to reach in terms of prevention and behavior change. In New York State, public health administrators are grappling with policy decisions related to the provision of free syringes which could curb disease spread, but might also encourage drug abuse and addiction (Bird, 1985). If these issues are to be adequately addressed, public health will have to work in concert with other community agenciesnot only to provide accurate testing and individual feedback, but also to safeguard against social stigma and isolation of individuals harboring the virus, which can be dormant for five years before symptoms are experienced. Our growing understanding of disease transmission is due in part to the collaboration of public health epidemiology and basic science research. While public health has played a major role in information dissemination for prevention and disease control, these approaches have not been shown to be highly effective for changing behavior (Albino, 1983). A stronger intervention strategy aimed at changing beliefs, attitudes and behaviors related to sexual health is needed. Here the larger collaboration of public health professionals, community and health psychologists, social workers, counselors, and other health care providers is required not only to change behavior, but also to combat the social sequelae of this disease- fear and scapegoating of a portion of society.

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Politics and Future Directions of AIDS Prevention

Considering that nearly 75 percent of AIDS cases are found among gay individuals and that certain types of sexual expression attributed to gay persons is illegal in many jurisdictions, the initial response for research, prevention education, and social support programs might appear slower than should be expected to a disease of this seriousness. Kassler, a physician, (1983) suggests that the medical profession has neglected sexually transmitted diseases. A 1982 report indicated that only 30 percent of U.S. medical students receive training in venereology, and then with only six hours of instruction on the average. She also points to a demonstration of this neglect in terms of the available funds for research, training, and treatment. From the 1980 federal health care budget of $54 billion, only $90 million was targeted for the control of sexually transmitted diseases. In 1978, gonorrhea cost the American public $770 million. Morton's (1984) medical text on sexually transmitted diseases provides descriptions of U.S. approaches to venereology which reflect these same conditions. It was not until 1970, when 2.2 million cases of gonorrhea and 80,000 cases of syphilis heralded an epidemic, that the federal government, through the Department of Health, Education, and Welfare, organized a National Commission of the Venereal Diseases. With the help of the World Health Organization, their 1972 evaluation report found a failure of public and professional education. Attention was also drawn to the "scarcity and inadequacy of public services." The World Health Organization cited the poor standard of doctoring as contributing to the serious lack of disease control. In addition, the number of clinics could not support the caseload and the quality of facilities was not consistent. It is against this backdrop, less than a decade later, that a public health emergency arises for AIDS, primarily a sexually transmitted disease for which no cure is known. The language used to describe this public health emergency is extraordinarily telling. Brandt (1985) draws our attention to how hemophiliacs, children, and other non-gay persons are described in a July, 1983, New York Times Magazine as "innocent bystanders," implying that the disease is more of a tragedy when contracted by non-gay

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individuals. Brandt goes on to reason that if the highest risk for AIDS exists among gay men, then they become guilty for victimizing other segments of society. By terming this disease the "gay plague" the American public appears to be placing the responsibility for AIDS on people who are gay. Public health writers and researchers have presented clear arguments on the connections between moralistic attitudes and the lack of preventive efforts for sexually transmitted diseases and AIDS (Brandt, 1985; Yankauer, 1986). As long as we design and implement prevention strategies that place the responsibility for behavior change on the individual rather than the culture or society, beliefs and social values will change only very slowly. Yankauer (1986) suggests that public health's prevention efforts should focus on the role social values have played in controlling AIDS and sexually transmitted diseases in our communities. This translates into at least two levels of prevention activities. Along with the design and implementation of behavior-belief change strategy, we must discover and understand the social attitudes, beliefs, and values of individuals in our own environments. Differences may or may not exist along such dimensions as rural and urban settings, ethnic communities, or religious groups. Finally, the lessons of George Albee (1986) for primary prevention of psychopathology might serve us well as we think and act on the primary prevention of AIDS and other sexually transmitted diseases. We must begin to examine social beliefs associated with behaviors that discriminate against individuals for sexual definition. Only then will we be able to facilitate the development of physical, psychological, and social wellness in communities. A FINAL COMMENT

The public health profession has played, and continues to play, a major role in developing solutions to nearly all of the major problems of health and illness that have faced this country since its beginnings. And while the theoretical approaches and the philosophy of public health are focused more on facts related to disease and disease control than on processes related to behavior change, it is apparent that the latter are fundamental tools of

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the profession. In this regard, public health contributions can be seen in terms of major influences on how we live in communities, as well as in terms of improved health indices. The two health issues discussed here provide examples of such public health contributions. The two issues are very different. In the case of child health and infant mortality at the turn of the century, the state of relevant scientific research and medical practice was primitive, compared to the sophisticated scientific work which is being applied to the problem of AIDS today. Yet in both cases, the same basic descriptive epidemiology of public health was necessary to developing an understanding of the causal factors in the health problems addressed. In the first issue, the health problems addressed were affecting infants and children who were both highly vulnerable and helpless in improving their lot. Society, nevertheless, tended to view children as economic assets or liabilities, with little appreciation for their developmental needs. In the case of AIDS, we are dealing with an adult population, and one which- albeit unjustlyis being held accountable for their plight by much of society. Again, while there are differences in the client population, public health efforts have taken into consideration the social milieu and have played a major role in shaping public attitudes and understanding of the clients as well as their health problems. In both cases described here, we find excellent examples of community behavior change strategies which make use of natural support systems and which are aimed at empowering clients, rather than controlling the means for health care and disease prevention. Finally, it seems appropriate to underscore the recognition implicit throughout this chapter that health problems of the type addressed here are social problems- that they reach far beyond the physical well-being of the individuals affected. Within nineteenth century urban communities, problems of child health forced society at large to confront the roles of children and their true value within their families and the community at large. Similarly, the AIDS epidemic has forced a society to confront its attitudes towards the gay population and, in the process, its underlying values related to sexual expression. In each case, public health approaches have helped to balance conflicting economic,

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political, and religious perspectives through promoting views that are based first and foremost on the basic right of every individual to optimal health care and the achievement of his or her greatest possible health and well-being. While the goals of public health are rarely stated in terms of improving communities, there may be no other profession which has so continuously and so profoundly shaped communities and the way we live within them. REFERENCES Adler, J., Greenberg, N. F., Hager, M., McKillop, P. & Namuth, T. (1985, September 23). The AIDS conflict. Newsweek, pp. 18-24. AIDS Surveillance Monthly Update. (1985). New York State Department of Health. Albee, G. (1986). Toward a just society: Lessons from observation on the primary prevention of psychopathology. American Psychologist, 41(8), 891-898. Albino, J. E. (1983). Health psychology and primary prevention: Natural allies. In R. D. Feiner, L.A. Jason, J. N. Moritsugu & S. S. Farber (cds.), Preventive psychology: Theory, research and practice. Elmsford, NY: Pergamon Press. Batchelor, W. F. (1984). AIDS: A public health and psychological emergency. American Psychologist, 39(11), 1279-1284. Bird, D. (1985, December 1). Little success in curbing spread of AIDS by addicts is seen. New York Times, p. 64. Brandt, A.M. (1985). No Magic Bullet. New York: Oxford University Press. Bremner, R. H. (1971). Children and youth in America: A documentary hist01y, Vol. 2. Cambridge: Harvard University Press. Burton, L. E. & Smith, H. H. (1970). Public health and community medicine. Baltimore: Williams & Wilkins. Catalano, R. (1979). Health, behavior and the community: An ecological perspective. In R. Catalano (ed. ), Paradigm succession in the study of public health. New York: Pergamon Press. Centers for Disease Control. (1981a). Pncumocystis pneumonia-Los Angeles. Morbidity and Mortality Weekly Report, 30, 250-251. Centers for Disease Control. (1981b). Kaposi's sarcoma and pncumocystis pneumonia among gay men- New York City and California. Morbidity and Mortality Weekly Report, 30, 305-307. Centers for Disease Control. (1983). AIDS. Morbidity and Mortality Weekly Report, 32, 465-468. Centers for Disease Control. (1985). Weekly surveillance report of AIDS activities. Morbidity and Mortality Weekly Report, 34. Centers for Disease Control. (1986, September 26). Weekly surveillance report for the United States-AIDS. Council on Scientific Affairs. (1984, October 19). The acquired immunodeficiency syndrome. lAMA, 25(15), 2037-2043. Curran, J. W., Gold, J. & Jaffe, H. W. (1984). The acquired immunodeficiency syndrome (AIDS). In K. K. Holmes, P-A. Mardh, P. F. Sparling'& P. J. Weisner (eds.), Sexually transmitted diseases. New York: McGraw-Hill.

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D'Augelli, A. (1986). Personal communication. Egner, D. (1985, November 14). Lawmakers to offer bills banning marriage of AIDS victims. Times Union, p. B-11. Ferrara, A. J. (1984). My personal experience with AIDS. American Psychologist, 39(11), 1285-1287. Getting tougher about AIDS. (1985, November 10). New York Times, p. 26E. Green, J. & Miller, D. (1985). Psychology and AIDS in Britain. American Psychologist, 40(11), 1273-1275. Handsfield, H. H. (1985). AIDS and sexual behavior in gay men (Letter to the Editor). American Journal of Public Health, 75(12), 1449. Helgergen, S. D. (1984). AIDS projects in Seattle, Washington. American Journal of Public Health, 74(12), 1419. Hirsch, D. A. & Enlow, R. W. (1984). The effects of the acquired immune deficiency syndrome on gay lifestyle and the gay individual. Annals of New York Academy of Sciences, 437, 273-282. Kassler, J. (1983). Gay men's health. New York: Harper and Row. Kelly, J. A., St. Lawrence, J. S., Smith, S., Hood, H. V. & Cook, D. J. (1987). Stigmatization of AIDS patients by physicians. American Journal of Public Health, 77(7), 789-791. Lesser, A. J. (1985). The origin and development of maternal and child health programs in the United States. American Journal of Public Health, 75(6), 590-598. Lumpkin, K. D.P. & Douglas, D. W. (1937). Child workers in America. New York: International Publishers. Martin, J. L. & Vance, C. S. (1984). Behavioral and psychosocial factors in AIDS. American Psychologist, 39(11 ), 1303-1308. McKusick, L., Coates, T. J. & Horstman, W. (1985). Response from McKusick et al. (Letter to the Editor). American Journal of Public Health, 75(12), 1449-1450. McKusick, L., Horstman, W. & Coates, T. J. (1985). AIDS and sexual behavior reported by gay men in San Francisco. American Journal of Public Health, 75(5), 493-496. Mervis, J. (1985). Self-blame, lack of support increase stress in AIDS. APA Monitor, /6(11), 10. Mitchell, R. E. & Trickett, E. J. (1980). Social network research and psychosocial adaptation. In P. lnsel (ed.), Environmental variables and the prevention of mental illness. Lexington, MA: Heath. Morin, S. F., Charles, K. A. & Malyon, A. K. (1984). The psychological impact of AIDS on gay men. American Psychologist, 39(11 ), 1288-1293. Morin, S. F. & Batchelor, W. F. (1984). Responding to the psychological crisis of aids. Public Health Reports, 99(1), 4-9. Morton, R. S. (1984). Evolution of venereology as a specialty. InK. K. Holmes, P-A Mardh, P. F. Sparling & P. J. Wiesner (eds.), Sexually transmitted diseases. New York: McGraw-Hill. Muller, C. (1985). A window on the past: The position of the client in twentieth century public health thought and practice. American Journal of Public Health, 75(5), 470476. Norton, C. (1985). A disease in many guises. Science, 230, 1019. Redfield, R. R., Markham, P. D., Salahuddin, S. Z., Sarngadharan, M. G., Bodnei, A. J. & Folks, T. M. (1985, March). Frequent transmission of HTLV-111 among spouses of patients with AIDS-related complex and AIDS. lAMA, 253(11), 15711573. Riis, J. (1957). How the other half lives. New York: Hillard-Wang.

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Rosen, G. (1958). A history of public health. New York: MD Publications. Rothcnburg (1985). Progress on AIDS. AIDS Institute, 2(2). Saltzman, P. (1985, December 1). Usc of AIDS test spreads new fears. Buffalo News, p. A-13. Smillie, W. G. (1955). Public health its promise for the future. New York: Macmillan Company. Spargo, J. (1906). The bitter cry of the children. New York: Macmillan. William, D. C. (1984). The prevention of aids by modifying sexual behavior. Annals of New York Academy of Sciences, 437, 283-285. Winslow, C.-E. A. (1923). The evolution and significance of the modern public health campaign. New Haven: Yale University Press. World Health Organization. (1985a). Meeting of the WHO collaborating centres on AIDS. Weekly Epidemiological Record, 60, 333-335. World Health Organization. (1985b). Acquired immune deficiency syndrome (AIDS). Weekly Epidemiological Record, 60, 129-130. World Health Organization. (1985c). Acquired immune deficiency syndrome (AIDS). Weekly Epidemiological Record, 60, 269-271. World Health Organization. (1985d). AIDS: Where do we go from here. WHO Chronicle, 39, 98-103. Yankaucr, A. (1986). The persistence of public health problems: SF, STD, and AIDS. American Journal of Public Health, 76(5), 494-495. Zclizcr, V. A. (1985). Pricing the priceless child. New York: Basic Books.

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Chapter 9

The Use of Law for Prevention in the Public Interest Murray Levine State University of New York at Buffalo

Charles P. Ewing State University of New York at Buffalo

David I. Levine Hastings College of the Law University of California

SUMMARY. One of the most important functions of law and the legal system is to prevent harm by regulating conduct prospectively. Almost all law- whether in the form of a statute enacted by a legislative body or a judgment decreed by a court- is designed, at least in part, to avoid some socially undesirable future state of affairs. This chapter explores some of the more significant ways in which lawmaking (both legislative and judicial) may be regarded as a form of prevention and the legal system may be used for prevention in the public interest. Although the chapter focuses on litigation and legislation of particular interest to those in the fields of mental health and mental retardation, the legal processes and principles described extend to many other areas of law with implications for promoting health and preventing harm.

Our legal system has many functions and includes not only the courts but the legislative and executive branch of government as well. One of the most important functions is the way in which the Reprints may be obtained from Murray Levine, Department of Psychology, Park Hall, State University of New York, Buffalo, NY 14260. © 1987 by The Haworth Press, Inc. All rights reserved.

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law seeks to prevent harm by regulating conduct prospectively. In this chapter, we will focus on the prevention of harm through the process of adjudicating cases in the courts. We will provide an example of an effort to achieve prevention through legislation as well. Although the chapter will emphasize cases of particular interest to those in the fields of mental health and mental retardation, the processes and the principles described extend to many substantive areas of law with implications for promoting health and well being or preventing harm. THE LEGAL SYSTEM Law and Prevention

The fields of mental health and social problems follow a disease prevention model and to a lesser extent, an accident prevention model. Prevention expressed through law may seek to reduce the prevalence of disease by requiring sanitary practices, or mandating that children be immunized before entering school. Laws regulating automobile traffic are designed to prevent accidents. Laws seek to prevent more than disease and accidents. The law also seeks to preserve or enhance socially accepted values. Using a general definition of prevention to mean actions taken in the present to avoid some undesirable state of affairs in the future, almost all law has prospective application and in that sense fits within a prevention model. Almost all statutory law, law passed by a legislative body, is intended to affect relationships and conduct in the future. The criminal code not only designates those socially undesirable behaviors that will be punished. It also provides notice to everyone of what conduct will be punished in the expectation that individuals will then avoid engaging in such punishable conduct (Hall, 1960). The proponents of the death penalty contend that fewer murders will be committed if potential perpetrators know they will be executed upon conviction. In the field of civil law, the appointment of guardians to manage the property of elderly or retarded persons is designed to prevent the waste of financial assets. The requirements in the laws of some states that minors seeking abortions have the permission of either a parent or a state

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court judge is designed to preseiVe parental authority and to prevent the minor from experiencing the consequences of an unwise decision. State law and regulations governing the application of aversive conditioning procedures in institutions are designed to preseiVe humane values as well as to prevent harm. Federal law and regulations requiring the review of research for ethical propriety is also designed to prevent or to minimize harm and to preseiVe humane values. Sources of Law

There are a number of sources of law in the American legal system. These exist in rough hierarchical order. Each of these sources of law provides the basis for defining legally protected interests. A basic source of law is the United States Constitution as amended, which sets forth the powers of the federal government and restraints on those powers. The restraints on government powers define the rights and freedoms of individuals. The Constitution also allocates power to the legislative, the executive, and the judicial branches of the federal government. Finally, the Constitution provides certain limits on the power of state governments. Statutes that are passed by any state or federal legislative body must be consistent with the provisions of the Constitution. In passing laws, the legislature may delegate authority to executive agencies to promulgate regulations that say in detail how the law will be administered. The executive or the administrative agencies engage in a hearing process to receive the views of concerned constituencies about what the regulations shall be. It is possible to challenge the regulatory process in court. Once the regulations are promulgated, they have the force of law. Disputes about them are first considered through adjudicative processes established within the agency. Thus, someone denied social security disability on initial application may appeal the denial through an administrative law process and, if not successful there, to the federal courts. The judiciary has the function of deciding whether those statutes and regulations are consistent with provisions of the Constitution, if the laws are challenged in court. The judiciary also has the function of interpreting the laws when there is dispute as to

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their meaning or as to whether an action taken by a member of the executive branch is consistent with the meaning or the intended purpose of the law in question. Sometimes a legally protected interest is declared by the courts as in the Tarasoff case, discussed below. Courts may be faced with new problems, such as whether a supplier of asbestos should be found liable for cancer or asbestosis caused by exposure to the product ten or twenty years before. The courts may solve the new problem by declaring new rights, interests, or rules governing relationships. There are parallel processes under state law. Each state has a constitution. Generally, the provisions of the state constitution cannot violate the provisions of the federal constitution. For example, no state can pass an enforceable law imposing slavery, whether or not slavery is forbidden by the state's constitution, because slavery is forbidden by the Thirteenth Amendment to the Constitution of the United States. Although the Bill of Rights, the first ten amendments to the Constitution, was passed originally to limit the powers of the federal government, the courts have held that such limitations apply to state governments as well. The state may legislate in any area not specifically the province of the federal government or that has not been totally preempted by the federal government. There are often parallel state and federal laws. In many instances, state laws will also include authority for state agencies to promulgate regulations. State agencies may also hold hearings or have other administrative methods to adjudicate disputes about the applicability of the regulations in a given case. In general, courts are limited to hearing real "cases and controversies." The courts do not reach out to find cases or to decide issues; rather, they decide cases brought before them by parties to a controversy. In resolving the case at hand, the judges interpret the laws. Many of those interpretations are published, serve as precedent for other courts, and define legally protected interests. Courts are also limited to hearing cases within their jurisdiction. The term jurisdiction means the court (or another agency when the term is applied to it) has authority to act in the matter before it. A court must have subject matter jurisdiction- the case

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must be of a type the court is authorized by law to hear. The court also must have territorial jurisdiction. Trial courts have jurisdiction in the local area in which they sit. Middle level appeals courts have jurisdiction over a wider region, and a high court has jurisdiction over its entire territory. A state high court's decisions on state law are binding precedent throughout that state, and the U.S. Supreme Court's decisions on constitutional or federal law matters are binding precedent throughout the nation. Thus the higher the court that renders the decision, the greater the potential for impact of that decision. Points of Intervention

As this brief description illustrates, advocates seeking to use the law to promote social ends have many possible points of intervention. It is possible, though very difficult, to amend the U.S. Constitution or a state constitution. For instance, those who have been disappointed with Supreme Court interpretations of the United States Constitution regarding abortion, or prayer in the schools, or women's equality have proposed Constitutional amendments. An elaborate political process is involved in achieving change in this fashion. Another more promising avenue for intervention lies in efforts to influence the passage of legislation in both federal and state legislatures. Groups interested in different issues may attempt to influence legislators to pass legislation favoring their interests. They may use persuasion to press their cause by visiting legislators, or by presenting data, or by testifying at legislative hearings. (See Influencing Legislation below.) They may encourage adherents to their cause to write to legislators to inform them of their concerns or interests. For example, a consortium of scientific and scholarly agencies has been modestly successful in fighting off budget cuts affecting research and training in the social sciences and the humanities recently proposed to the Congress by the President. (These efforts are described in memoranda issued by the Research Support Network and the Health and Services Support Network of the Office of National Policy Studies of the American Psychological Association.)

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Once a law is passed by a legislature, interest groups will also attempt to influence the specifics of how the law will be interpreted and administered by participating in the public phase of the process by which regulations are developed by the relevant executive agency. For example, Public Law 94-142, the Education for All Handicapped Children Act, has an extensive set of regulations that define who is eligible for what kind of services and under what conditions. Parents, educators, and advocacy groups presented their viewpoints to the Department of Education which took them into account in writing the regulations. Once a law, regulation, or judicial declaration of rights is in place, it provides the basis for a demand for legal protection. An infringement of a legally recognized right or the breach of a legally mandated duty may be redressed by bringing a claim or a lawsuit in the appropriate forum. Claims may be brought only in a forum which has jurisdiction over the matter. If the specific case is governed by administrative regulations, then the case will be brought initially in an administrative forum and may involve formal litigation. In many instances, there will be published records of the decisions made by administrative agencies and which serve as precedent for subsequent decisions within that agency. Usually, all administrative remedies must be exhausted before an appeal from an adverse decision may be brought in the appropriate court. Advocates may work to establish precedents at the administrative level that will make it easier to win the next case or to prevent the government from acting in certain cases. Cases that come to court may serve a preventive function even though the cases are brought primarily to right wrongs in specific cases based upon events that have already occurred. Not everyone can invoke judicial powers. There must be real disputes, real "cases and controversies," for the judicial power to be exercised. Only a person who has a stake in the outcome or "standing" may bring a lawsuit to a court. It is not enough for a litigant to be concerned about an issue or for the issue to have great importance for society. The other branches of government do not have such restrictions. In theory, the legislative and executive branches of government are receptive to considering issues brought to their attention by people who are not directly affected.

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Courts cannot right all perceived wrongs. Only the invasion of legally protected interests will be recognized by the courts. A potential litigant must be able to point to a legally protected interest that allegedly has been violated before a suit can commence. (We have described these briefly in the section above, Sources of Law.) In some areas, only an agency of government may sue to redress violations of legally protected interests. There may be no private right of action created in the legislation, or it may be ambiguous. Then the courts must decide whether such a private right of action is implied (Cort v. Ash, 1975). For example, in Pennhurst State School and Hospital v. Haldennan (1981), the U.S. Supreme Court held that Congress did not confer a private right of action on individuals to sue to protect any legally protected interest in the Disabled Assistance and Bill of Rights Act of 1975. Advocates seeking to advance a particular cause (such as preventing a perceived harm) may bring cases to test or to shape the law in a given area. Those seeking to influence law through litigation may want to appeal adverse decisions to the highest possible court in order to obtain a judicial opinion that protects the greatest number of people. Whenever there is a published opinion by a court interpreting or making law (see the discussion of the Tarasoff case below), that opinion may serve as a precedent for other courts settling similar disputes. To the degree the written opinion serves to define the law in a particular area, the opinion operates prospectively. It provides a guide to lawyers who advise clients how to act within the law in the future and thus to avoid or prevent problems, or to obtain benefits. In some cases, rights pursued through litigation may influence later legislation. For example, in the 1960s and the 1970s a great many individual cases were brought that defined the rights of individual mental patients when faced with involuntary commitment. Many state legislatures then changed their commitment laws to introduce due process protections the courts had indicated were constitutionally necessary. Public Law 94-142 was strongly influenced by PARC v. Pennsylvania (1972) and Mills v. Board of Education (1972), cases that had previously established that handicapped children could not be denied a public education if

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the state provided education for other children (see Rosenberg & Phillips, 1981-82). In some cases, the litigation and the remedy sought are designed less to compensate for prior unlawful acts than to prevent future harm. When a case ends with either a negative or a positive injunction, that order by the court to defendants to cease doing something (e.g., stop segregating a school system- a "prohibitory" injunction) or to act to do something (e.g., bus to desegregate schools- a "mandatory" injunction) is intended to operate in the future. If the injunction is entered on behalf of a large group, through the class action suit (see below), then it is expressly intended to operate in the future for the benefit of all who may be affected by its terms. If the order is directed toward, for example, an institution for the retarded or an institution for the mentally ill, and directs the institution to improve its services, the order is clearly premised on an intention to prevent injury to others who, in the future, may be patients of the institution. The Courts and Social Change

Courts serve many roles in our society. They serve as forums for the resolution of private disputes, such as whether a contract has been breached or whether an automobile driver has negligently caused an accident. The monetary value of damages may be established by the court. The government also uses courts as forums in which Public laws are enforced against individual citizens. Thus prosecutors use the courts to enforce the criminal laws, and administrative agencies such as the Environmental Protection Agency, the Food and Drug Administration, or the National Labor Relations Board use the courts to enforce a host of regulations including, for example, the Clean Water Act, pure food and drug laws, and laws relating to the terms and conditions of employment (Mayers, 1964). In deciding cases, the courts are implementing policies that are either explicit or implicit in the underlying law. The courts also serve the important function of regulating and serving as a check on the powers of government. Thus, courts frequently are called upon to protect individuals from alleged

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abuses of official authority, which are said to violate fundamental principles of our democracy, such as freedom of speech or the freedom of exercise of religion. It is through this third function that the courts have been used as an important instrument of social change and prevention. In recent years, there has been an expansion of judicial power into areas of public policy, such as the desegregation of the public schools and supervising the operation of prisons or institutions for the mentally retarded or the mentally ill. The preventive role of the courts as a check on fundamental abuse is very old. The seeds, which appear in the Constitution, began to flower with Chief Justice John Marshall's opinion upholding the concept of judicial review (Marbury v. Madison, 1803). The contemporary manifestation of this role is usually traced to the Supreme Court's important school desegregation case Brown v. Board of Education (1954), a decision designed to undo the social, ethical, and personal harms of segregation and to prevent future generations from suffering those harms. Since that case was decided over thirty years ago, the courts have moved into the supervision of many government activities and services (see Horowitz, 1982). This expansion, however, has not taken place without controversy. Some argue that the courts exceed their appropriate role in society when they become involved in matters of policy, which are said to be best left to the more democratic portions of our governmental system, the elected legislature and the executive (Rebell & Block, 1982; Horowitz, 1982). The defenders of the courts counter that the courts are performing their appropriate preventive role by enforcing the guarantees of individual rights provided by state and federal constitutions, statutes, or administrative regulations. Thus, the defenders contend that courts are simply performing the role given to them by the will of the people, as expressed through the adoption of constitutions or statutes allocating broad powers to the courts (Fiss, 1979; Johnson, 1976). This position is not as widely accepted when, as they often must, judges interpret laws in ways that depart from the strict letter of the law. For example, although no right to an abortion is stated explicitly in the Constitution, the U.S. Supreme Court found one there. The Court first found a right to privacy in

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the use of birth control measures in the "penumbras" and "emanations" (but not the text) of several constitutional provisions (Griswold v. Connecticut, 1965), and later extended that privacy right directly to the decision to have an abortion (Roe v. Wade, 1973). The Class Action Suit

When an aggrieved individual has reason to believe that many others have been injured by the same entity in a similar fashion, and that the others may not enforce their own legally protected interests, it may be possible to invoke the class action device. The class action makes it possible for an individual or a small group of people to expand the scope of their lawsuit beyond the traditional confines of a dispute concerning only their grievance. By using this device, individual litigants have been able to prod courts to apply their powers to achieve change in large institutions. Sometimes the goal of broad reform is explicit in the case. The object of the suit may be to make a major change in the operation of an institution, not only for the benefit of people currently being harmed, but to prevent harm to people who may have to deal with the institution in the future. The class action suit makes it possible for a few motivated individuals to represent a large group of people who have stakes in a particular matter, although they may not as yet have asserted- and indeed might never assert- their individual claims. Moreover, if the representative plaintiffs win the suit, the rights of all who are similarly situated are protected without each individual having to bring a lawsuit. The basic initial requirements for a class action suit are: (1) there is an identifiable class (e.g., all those resident in an institution for the mentally ill and all those who will be resident there in the future); (2) those wishing to represent the class are members of it; (3) the class is so large that joinder of parties (having a series of individual cases heard together) by other means is not practicable; (4) there are questions of law or fact common to all of the class members; (5) the claims of the representatives are typical of other class members; and (6) the representatives will adequately represent and protect the interests of

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absent class members. (Rule 23, Federal Rules of Civil Procedure; Friedenthal, Kane & Miller, 1985; Wright, Miller & Kane, 1985). Probably the most important of these is the last, adequate representation. The class action device is favored to achieve goals related to prevention such as in institutional reform litigation because if the plaintiffs win, it is considerably easier to convince the court that system-wide relief is appropriate. The class action suit also has political advantages. It is much more difficult to dismiss as "unimportant" or as an "isolated" event a grievance brought on behalf of a group than the same grievance brought by a single individual (Developments, 1976; Diver, 1979). Political constituencies develop around such litigation (Diver, 1979; Rothman, 1982). The publicity generated by a suit attacking a whole institution may be much greater than that of an individual case. Such publicity may put greater pressure upon an institutional defendant to settle the suit expeditiously rather than continue costly litigation and risk further adverse publicity. The class action suit is not without its problems. Frequently, it is the attorney representing the class who is truly interested in prosecuting the class action. The named representatives of the class actually may be primarily interested in achieving redress only of their individual grievances. The attorneys, who often are in the employ of advocacy organizations, may be motivated by other factors. Ideological differences may arise between lawyer and client. In many of the suits to reform institutions for the retarded, the attorneys for the plaintiffs had strong anti-institutional biases and wished to close down large, isolated institutions (Ferleger & Boyd, 1979). At the same time, other plaintiffs or class members may desire not the closing but the improvement of such institutions (see Frohboese & Sales, 1980; Rothman & Rothman, 1984). In Pennhurst and in other cases, the class proved less than fully unified on the goals of the litigation. Typically, in successful cases, plaintiffs will be awarded attorneys fees, to be paid either by the defendants or deducted from the lump sum awarded to the victorious plaintiffs (Miller, 1979). With respect to money, there comes a point in some class actions where the attorney may have a greater financial incentive to settle a case and be assured of a large fee than does the plaintiff who

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may be willing to risk losing a small sure payment in exchange for a chance to collect a much larger sum at trial (Rhode, 1982). In the institutional reform context, attorneys may sense a point of diminishing returns where further effort is repaid neither by fees nor by rapid, tangible progress in improving the institution. Frequently, the lawyers who are motivated and equipped to handle such cases are employed by an organization that has a long-term strategy in which individual cases are seen as the means to a broader end. Conflicts between the expressed wishes of nominal clients, the named plaintiffs in a class action suit, and their attorneys may never come to light because the plaintiffs typically have very little contact with the attorneys acting on their behalf. Courts attempt to monitor the work of class action attorneys, but the results have been mixed (Garth, 1982; Rhode, 1982). Despite its problems, the class action suit is a useful device for many legal purposes, especially when the goal is social change to prevent harm. However, winning a suit in court and seeing the results of the suit implemented are two different matters (Rothman & Rothman, 1984). We shall offer an example of a successful class action suit later in this chapter and describe the process of implementing the court's order in that case. In sum, law is intended to have prospective effects and, therefore, can be thought of as having preventive functions. There are a number of sources of law. Advocates for a cause may intervene at many points to exercise influence to correct past wrongs and prevent future ones. We turn now to the individual lawsuit to show how the lawsuit can have both "retail" (settle the dispute between plaintiff and defendant) and "wholesale" effects (the effect on other courts and upon the behavior of other potential defendants). THE INDIVIDUAL LAWSUIT

The common denominator in all of the roles allocated to or assumed by the courts (whether resolving private disputes, providing a forum for the enforcement of public laws, or serving as a check on the powers of government) is the lawsuit. To under-

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stand the process by which the courts make law and/or shape public policy, and thus play the preventive role, one needs first to comprehend the basic dynamics of a lawsuit: how it is brought and resolved and how, in some cases, its resolution results in changes in law and public policy. Given the scope of this chapter, an efficient way to explore the dynamics of a typical lawsuit is to examine an actual case, the judicial resolution of which led to significant changes in both law and policy. One such case, now well-known to many mental health professionals, is Tarasoff v. Regents of the University of California (1974, 1976). The facts in the Tarasoff case may be described in a necessarily somewhat oversimplified fashion as follows. Prosenjit Poddar, a graduate student at the University of California at Berkeley, was receiving outpatient psychotherapy from a psychologist, Dr. Lawrence Moore. During a therapy session, Pod dar informed Dr. Moore that he intended to kill another student, a young woman who had earlier rebuffed his romantic advances. While Poddar did not name his intended victim, she was readily identifiable as Tatiana Tarasoff. Dr. Moore decided to have Poddar committed under a 72-hour emergency psychiatric detention. At Dr. Moore's request, the campus police briefly detained Poddar but released him when he appeared rational and agreed to stay away from Ms. Tarasoff. Subsequently, Dr. Moore's superior, Dr. Powelson, a psychiatrist, ordered that all notes and correspondence regarding the incident be destroyed and that no further efforts be made to have Poddar committed. Neither the mental health professionals nor the police made any effort to warn Ms. Tarasoff or her family of Poddar's threat. Poddar terminated treatment and, two months later, killed Ms. Tarasoff. Subsequently, Ms. Tarasoff's parents initiated a lawsuit against the mental health professionals, the campus police officers who had released Pod dar, and their employer, the Regents of the University of California. The Regents were named as defendants on the accepted legal theory that employers are responsible for their employees' tortious acts where those acts occur in the ordinary course of the employees' duties (Prosser & Keaton, 1985).

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The Tarasoffs' lawsuit, like any other, was initiated by a complaint, a written statement specifying the nature of the harm, the legal theory or theories under which the defendant(s) may be held liable for that harm, and the remedy sought by the plaintiff(s). In their complaint, the Tarasoffs (1) set forth the circumstances which led to their daughter's death, (2) argued that the defendants' failure to commit Poddar or warn their daughter of his threat had been negligent and had contributed to the cause of her death, and (3) asked the court to require the defendants to pay them a specified dollar amount in money damages. Once such a complaint is filed with the court and served upon a defendant, he or she is required to tender a response or risk an adverse judgment in the form of the remedy sought by the plaintiff. In the written response, the defendant may admit or deny the factual allegations set forth in the plaintiff's complaint, in full or part. Here, however, the defendants' response did not deny the factual allegations in the Tarasoffs' complaint but argued that the suit against them should be dismissed because, even if all the alleged facts were proven at trial, the plaintiffs had failed to state a legally recognized cause of action. The defendants' response was clearly appropriate under thenexisting California law. In Tarasoff, the defendants claimed that the plaintiffs had no cause of action- and thus no right to suebecause neither the psychologist nor the campus police had, under existing law, a legal duty either to commit Poddar or to warn Ms. Tarasoff or her family of Poddar's threat. Agreeing with the defendants, the trial court dismissed the Tarasoffs' suit for failure to state a cause of action. The Tarasoffs then appealed the dismissal to the California Court of Appeal, which affirmed the trial court's decision on two grounds. First, the appeal court concluded that under state civil commitment law, which used the permissive term "may," the defendants had the authority to commit Poddar but were under no legal duty to do so. Second, the court concluded that, under existing law, the defendants had no legal duty to warn Ms. Tarasoff or anyone else of Poddar's threat or to otherwise attempt to protect Ms. Tarasoff from Poddar. (Tarasoff v. Regents of the University of California, 1973. hereinafter Tarasoff). In reaching this second conclusion, the appeal court relied on a general principle of tort law. In the absence

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of a special relationship between the parties, there is no duty to so control the conduct of a third person that he is prevented from causing harm to another (Tarasoff, 1973). As the court stated, Defendants in the present case had no relationship with plaintiffs or plaintiff's daughter . . . . Plaintiffs' cause of action as asserted in (their complaint] requires as elements an allegation of a special relationship and a reliance by plaintiffs on defendants' conduct. These elements have not been pleaded nor does it appear that they could be pleaded. (Tarasoff, 1973, p. 886) Had the case ended with this first appeal, the function of the courts would have been accomplished without the making of any new law or policy. In fact, however, the Tarasoffs brought a further appeal to the California Supreme Court, whose handling of the matter vividly illustrates how courts make law and shape public policy. In essence, the Tarasoffs argued to the California Supreme Court that the defendants should have a duty to warn their daughter of Poddar's threat. In its first Tarasoff decision (1974), which may be referred to as Tarasoff I, the Court agreed with the Tarasoffs and held that psychotherapists do have an explicit duty to warn potential victims threatened by their patients. Had such a legal reform been proposed in the California state legislature, instead of the state Supreme Court, there undoubtedly would have been staff investigations, considerable debate, and public hearings to which various interested parties (such as psychotherapists and their professional organizations) could have contributed. The function of the California Supreme Court or any other court, however, is not to propose and weigh the merits of legislation but rather to adjudicate specific legal controversies which come before it. Thus, the Court's decision in Tarasoff I was not, indeed could not, be informed by the kind of wide ranging debate, investigations, and public hearings which characterize the legislative process. In keeping with the limits of the judicial function, the issues before the Court were both framed and argued by the litigants, the plaintiffs and defendants, and the Court decided those issues on the basis of judicial reasoning.

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Perhaps not surprisingly, mental health professionals (or at least those in charge of their professional organizations) were not pleased with the Court's holding in Tarasoff I. Once the Court's decision was published, the Northern California Psychiatric Society led a drive, joined by various other organizations of psychotherapists, to convince the Court to reconsider the "duty to warn" (American Psychiatric Association et al., 1974). In response to their petitions, the psychiatric society and other organizations were allowed to enter the case as amici curiae, "friends of the court." In that role, they filed briefs (written arguments) that ultimately persuaded the Court to reconsider its decision in Tarasoff I. In their amicus briefs, these groups argued that the "duty to warn" would (1) undermine the confidentiality needed to conduct effective psychotherapy; (2) complicate the treatment of potentially violent patients, deter many psychotherapists from treating such patients, and thereby not only decrease public safety but also increase the likelihood that such patients would be involuntarily committed; and (3) be unworkable in practice because psychotherapists are unable to predict "dangerousness" with any degree of accuracy (American Psychiatric Association et al., 1974). Eighteen months after its decision in Tarasoff I, the California Supreme Court took the unusual step of withdrawing that ruling and issued a new decision which is commonly referred to as Tarasoff II (1976). In Tarasoff II, the Court held that a psychotherapist has a legal duty to exercise reasonable care to protect the potential victims of his or her patients: When a therapist determines or pursuant to the standards of his profession should determine that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. (p. 334) The exercise of such "reasonable care," the Court concluded, might include but would not necessarily require warning the intended victim. In the words of the Court, what constitutes reasonable care "depends on the circumstances of each case, and should not be governed by any hard and fast rule" (p. 345). Rejecting the reasoning of the Court of Appeal, the state Su-

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preme Court concluded that a special relationship between the psychotherapist and the intended victim was not necessary to trigger the duty to exercise reasonable care: Applying this [special relationship] exception to the present case, we note that a relationship of defendant therapist to either Titiana or Poddar will suffice to establish a duty of care .... "[B]y entering into a doctor-patient relationship the therapist becomes sufficiently involved to assume some responsibility for the safety, not only of the patient himself, but also of any third person whom the doctor knows to be threatened by the patient." (Tarasoff, 1976, p. 343) In explaining why it had reached this conclusion, limiting the confidentiality of the psychotherapist relationship and imposing a duty where none had existed before, the Court emphasized the need to prevent harm to others in the community: Public policy favoring protection of the confidential relationship must yield to the extent to which disclosure is essential to avert danger to others since the protective privilege ends where the public peril begins. (p. 337) As a result of Tarasoff II, the Tarasoffs were again free to pursue their lawsuit against the defendant. Ultimately, however, the suit was settled out of court (Stone, 1984). Thus, while the California courts never did resolve the basic dispute between the parties, whether a duty owed to Ms. Tarasoff had, in fact, been breached, they were able to use that dispute as a vehicle for making a major change in law and public policy for the prevention of future harm. The debate over Tarasoff has continued since the California Supreme Court's final ruling in 1976, both in professional circles and in the courts. Mental health professionals have continued to voice the same kinds of arguments stated by those who successfully sought reconsideration of Tarasotf I (see, e.g., Beck, 1982; Stone, 1976, 1984; Wolsin, Bursztajn & Gutheil, 1983). And the courts, both in California and other states, have grappled with the meaning and limits of the "Tarasoff Rule." Subsequent court

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cases dealing with Tarasoff-type claims illustrate a further aspect of the law and policy making role of the courts: i.e., the application, interpretation, and refinement of judicial precedent in the context of cases presenting new fact situations. Consider, for example, three recent California cases, two in which the courts have limited the Tarasoff Rule and one in which they have extended it. In Bellah v. Greenson (1978), a California appellate court dealt with the claim of the parents of a woman who had committed suicide. The Bellahs, relying on Tarasoff, claimed that Dr. Greenson, their daughter's psychiatrist, was liable for damages in her death because he had failed to warn them of her suicidal propensities. In finding that the Bellahs had no cause of action, the Court concluded that while Dr. Greenson was permitted by law to breach confidentiality in a case such as this, he was under no legal duty to do so. Clearly distinguishing this case from Tarasoff, the Court stated that: Case law requires only that a therapist disclose contents of confidential communication where the risk to be prevented thereby is the danger of violent assault, and not where the risk of harm is self inflicted . . . . (Bellah v. Greenson, 1978, p. 622) In Thompson v. Alameda County (1980), the California Supreme Court affirmed the dismissal of a suit brought by the parents of a young boy, who had been sexually molested and then murdered by another youth, recently released from county custody. The Thompsons alleged, among other things, that agents of the County (1) knew that this youth was dangerous and likely to assault young children, and that he had threatened to kill a young child if released; and (2) had failed to warn or advise the youth's mother, the police, or the parents of young children in the neighborhood to which the youth was released. The trial court dismissed their suit for failure to state a cause of action against the County. In affirming the dismissal, the Supreme Court distinguished this case from Tarasoff, observing that in Tarasoff the threat had been made against a specific, identifiable individual. In Thomp-

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son, the Court noted, the threat had been toward members of the general public. To impose a duty to warn in such a case, the Court concluded, would, at best, result in generalized warnings which "would do little to stimulate increased safety measures" and "would be difficult to give" (p. 736). Moreover, as a practical matter, the Court said, imposition of such a duty would undermine the efficacy of parole and probation programs and "necessitate the diversion of an inordinate expenditure of [police] time and manpower" (p. 736). In both Bellah and Thompson, the courts saw public policy as dictating certain limitations to the Tarasoff Rule. Just three years after Thompson, in Hedlund v. Superior Court (1983), however, the California Supreme Court decided that, as a matter of public policy, the Tarasoff Rule should be extended to cover not only specific intended victims but also other persons who might be injured if a threat against such victims were carried out. In Hedlund, a woman's boyfriend had made threats against her in a psychotherapy session with two psychologists, who made no effort to warn the woman of the threats or otherwise protect her. Subsequently, the boyfriend turned a shotgun on the woman, who threw herself over her two year old son to protect him. While the woman suffered serious physical injuries, her son was physically uninjured. In her suit against the psychologists, the woman sought damages for herself and her son, whom she claimed had suffered serious emotional trauma. The suit was grounded, in part, in a claim that the psychologists should have taken reasonable steps to protect both the woman and her son. In reversing the trial court's dismissal of the suit, the Supreme Court concluded that it was not unreasonable to impose upon psychotherapists a duty to protect "persons in close relationship to the object of a patient's threat" because "the therapist must consider the existence of such persons both in evaluating the seriousness of the danger posed by the patient and in determining the appropriate steps to be taken to protect the named victim" (Hedlund v. Superior Court, 1983, p. 47). Nearly ten years after Tarasoffwas decided, the rule was further modified by the California legislature. As described by Sargent (1986):

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The bill [which took effect in January, 1986] limits liability to situations in which the patient has communicated to the therapist a serious threat of physical violence against reasonably identifiable victims. Even in such a case, the therapist can avoid liability under the new law by making reasonable efforts to warn the victim and inform a law enforcement agency. Further, the law relieves therapists of liability for failing to predict their patients' violent behavior, except in specific cases when patients have voiced threats against an identifiable victim or victims. (p. 12) Although, as is discussed below, Tarasoff appears to have had a major influence on the behavior of psychotherapists throughout the nation, it is legally binding only in California and even there subject to the new statutory modification. The decision of a state's highest court (or, for that matter, any state court) is binding only within the borders of that particular state. A major decision such as Tarasoffmay influence courts in other stati(S because of its persuasive reasoning on policy grounds, but those courts are not required to regard it as binding precedent. In some states, courts have looked to Tarasoff for guidance in shaping their own decisions regarding a psychotherapist's duty to protect, (see, e.g., Mcintosh v. Milano, 1979; Lipari v. Sears Roebuck & Co., 1980) but in others the courts have joined in the effort to limit application of the Tarasoff Rule (see, e.g., Brady v. Hopper, 1983; Shaw v. Glickman, 1980; Matter of Estate of Votteler, 1982). To date the Tarasoff Rule, as enunciated by the California Supreme Court, has been officially accepted by the highest court in only one other state, Vermont (Peck v. Counseling Service of Addison County, 1985). But as a practical matter, the impact of the Tarasoff Rule has been felt well beyond the borders of California. Indeed, it appears fair to say that Tarasoff has influenced the professional functioning of psychotherapists throughout the United States (see Beck, 1985). The nationwide influence of the Tarasoff Rule was demonstrated clearly in a recent survey of 2875 psychiatrists, psychologists, and social workers practicing in Boston, Chicago, Detroit, Los Angeles, New York, Philadelphia, San Francisco, and

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Washington, D.C., the eight largest metropolitan areas in the United States (Givelber, Bowers & Blitch, 1984). Virtually all of these psychotherapists (96 percent) were aware of Tarasoff, the majority having learned of the decision through professional organizations and literature. Nine out of ten of these psychotherapists were not only aware of the Tarasoff Rule but realized that the rule imposes a duty to protect not only when a particular therapist determines that a patient poses a danger to someone, but also when a reasonable therapist would have reached that determination. Yet more than three-quarters of these therapists were not aware that Tarasoff does not require actually warning the intended victim in every case. Perhaps the most important finding of this survey, however, was that while fewer than one in five of the respondents who practiced outside California believed that Tarasoff (or a ruling like it) applied in their own locations, the majority nevertheless believed that they were legally bound by the California decision. As the authors of the study have explained, this inconsistency appears to be the result of a belief on the part of these respondents that Tarasoff somehow applies legally to their professions. This belief is clearly erroneous; the California Supreme Court has no authority to establish law governing anyone, professions included, beyond the borders of California. Yet as the authors of the survey also note, this belief, however erroneous, may well be functional for psychotherapists: Therapists may not have much interest in or understanding of such formalities. Rather, they may want to know what is likely to happen to them if they are sued in a local court. Few lawyers, however, would feel comfortable providing blanket assurances to therapists that a given court would not follow Tarasoff when the case has been neither officially adopted nor rejected outside California. (Givelber, Bowers & Blitch, 1984, p. 474) In sum, Tarasoff is a leading example of an individual lawsuit, the judicial resolution of which has had major preventive implications reaching well beyond the confines of the actual dispute before the court. In resolving the ostensibly narrow issue pre-

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sented by the litigants, i.e., whether these particular defendants owed a duty of care to Ms. Tarasoff, the California Supreme Court developed a policy to prevent injury or death to prospective victims. It may have also intended to create a rule to make it easier for victims to be awarded compensation from someone who, because of insurance coverage, would be able to provide funds when no other source is available. One court in one state developed a rule of law that has shaped the professional behavior of psychotherapists throughout the nation. We have no direct evidence, however, that the new rule of law has actually prevented injury to potential victims, or that it has not created greater harm in the form of false warnings than it has produced benefits. One study has shown that warnings did not actually reduce the incidence of injuries to potential victims (Beck, 1985). We turn next to an example of a class action suit that was successful. It resulted in a court order providing for the extensive reform of the system of care for the mentally retarded in the State of Maine.

INSTITUTIONAL REFORM LITIGATION

In the 1960s and the 1970s, public interest lawyers challenged the conditions of confinement and treatment of prisoners, the mentally ill, the mentally retarded, and children in need of special education in the schools. In the past, the courts had avoided interfering with the operation of state institutions, deferring to the expertise of those charged with providing the services. However, after Brown v. Board of Education, the courts took a greater interest in the state's actions. They became receptive to claims of mistreatment, and they ordered drastic changes in institutional care. One of the best known cases is Wyatt v. Stickney (1972). In Wyatt, United States District Court Judge Frank Johnson declared a right to treatment, a new legal interest not recognized by all courts, and he ordered sweeping changes in Alabama institutions for the mentally ill and mentally retarded. Other courts used

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the Wyatt precedent, if not its reasoning, to order changes in similar institutions around the country (see Rothman & Rothman, 1984). Winning the case in court and getting an order for institutional reform are but early steps in a complex and arduous process. Judge Johnson issued his first order in 1972. When he held a hearing in 1979, he found: "substantial and serious noncompliance with the orders entered in this case over seven years ago, in several critical areas" (Wyatt v. Ireland II, 1979, p. 14). At that time he appointed a special master to oversee the case. Although progress had been made in improving the institution, full compliance was not achieved until 1987 (Levine, 1981; Rodger P. Hildreth, Court Monitor, Bryce Hospital, Tuscaloosa, Alabama, personal communication, 1985). The Political Context for Institutional Reform Litigation

Institutional reform litigation has many difficult and novel features. In fact, it has been called a wholly new form of litigation (e.g., Chayes, 1976). The litigation itself and the process of developing and implementing remedies under court supervision reveal how closely intertwined both law and the human services are with our system of government. The litigation is controversial because it involves issues of federalism (state, federal relationships) and the separation of powers (Frug, 1978; Nagel, 1978). Litigation in institutional reform suits requires a great deal of interdisciplinary cooperation. Marshalling the evidence that standards of care are being violated often requires a great deal of investigation by experts in various fields: treatment, habilitation, nutrition, medical care, physical facilities, and others. After the liability phase of litigation is successfully concluded, which is no easy task, and the defendant institution or the defendant agency (e.g., state department of corrections or human services) is found to have violated standards of care, it is necessary to develop a plan to correct the deficiencies. Depending on the extent of the violation, the process of fashioning the remedy can also be quite complex (Berger, 1978). The courts prefer that the defendant agencies develop the plans to correct the violations of standards of care on the theory that it

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is their responsibility in the first place, and to minimize the court's interference with an independent agency of government. The U.S. Supreme Court has instructed the lower federal courts to be especially deferential when the defendant is a state agency to avoid unnecessarily encroaching on the state's prerogatives (Chayes, 1976; Frug, 1978; Nagel, 1978). If the defendant agencies fail to produce plans satisfactory to the plaintiff's attorneys and to the court, the court may appoint a special master to consult with all parties and experts and to develop a satisfactory plan for institutional change in keeping with the nature of violations that were found (D. Levine, 1984; Nathan, 1979; see also Brazil, 1983). That plan then becomes the court's order and the blueprint for change. Sometimes the defendant agencies agree to settle the suit without a trial to avoid the adverse publicity and the political liabilities that would accrue with a trial. The plaintiffs and the defendants may then arrive at an agreement between them as to how the violations will be corrected. Since there is an out of court settlement, the court will usually ratify the agreement between the parties. The document is called a consent decree. Once the parties accept the agreement and the court formally ratifies it, the settlement is enforceable. Implementation

The defendant agencies may not be willing or able to carry out the order. Some of the orders require additional personnel, new facilities, training, the release of patients to community based facilities and much more (see Wyatt v. Stickney, 1972). Often the defendant agency or institution does not have the resources to implement changes. The agency must seek resources through normal governmental channels. The state legislature, other branches of state government not party to the suit, and the citizens, if a referendum is required for capital construction bonds, must be consulted if resources to implement the court's order are to be obtained. The process under the supervision of the court is equally complex because once the court has issued an order or ratified an agreement, the court has become the change agent. The court can

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preserve its role as a neutral fact finder and decision maker ·by appointing a special master or a monitoring group as a buffer between it and the parties (D. Levine, 1984; Nathan, 1979; National Institute of Corrections, 1983). When the defendants do not comply with the court's order or the agreement, the court's prestige and power is challenged. The situation is highly delicate (Rosenberg & Phillips, 1981-82). When a special master is appointed, that individual becomes an important player in the game. The role requires great skill in management, in negotiation, in understanding leverage that may be exercised, in fact finding, in using expert consultants, in public relations, and in understanding the power of the court order as well as the political and tactical constraints in exercising that power (Kirp & Babcock, 1981). We shall present a case of successful reform resulting from litigation and following a fairly lengthy implementation phase. We shall emphasize the role of the two special masters. However, it should be clearly understood that the case would not have progressed as well without the skillful leadership of two successive Commissioners of Mental Health and Mental Retardation and the general willingness of two successive state governors to improve the system of care. WUORI V. ZITNAY: IMPLEMENTATION OF A CONSENT DECREE

SUCC~SSFUL

Wuori v. Zitnayu (1975) is one of the most successful of the institutional reform cases. The case is unusual because the court gave up active supervision within a relatively few years. The defendants achieved substantial, if not full, compliance with an extensive consent decree which committed the state to improve an institution for the retarded and to create new community facilities as well. The case was brought in 1975 by Neville Woodruff, an attorney who headed the Legal Services Corporation office in Portland, Maine. In the course of visiting the Pineland Center, an institution that at its peak had housed nearly 1500 mentally re-

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tarded individuals, Woodruff received information and documents from some employees who were frustrated by their inability to provide decent care. The institution was overcrowded and in poor condition. The residents had inadequate clothing. Their personal hygiene was poor. Residents were in restraints for unconscionable periods and were overmedicated. There was a lack of both programming and professional services. Dentists were pulling teeth from some residents to prevent self-abuse or harm to others. Moreover, many who had been released to the community as part of an earlier deinstitutionalization thrust were living in inadequate homes and were not receiving adequate habilitation services. The suit, alleging violations of the Eighth Amendment right to be free of cruel and unusual punishment, or to be free from harm at the hands of the state, was brought in 1975 on behalf of a class of all residents in the institution and all residents who had been conditionally discharged but were still under the supervision of Pineland Center. Shortly after the suit was initiated, George Zitnay was hired by the state of Maine to become Director of Pineland Center. Zitnay, an experienced and gifted institutional administrator, immediately recognized the opportunity the suit presented to gain resources and leverage to improve Pineland. When he was deposed (i.e., when he gave testimony under oath and subject to cross examination as part of the pretrial procedure to discover evidence), he told the full truth about the institution. Zitnay's testimony, along with the plaintiffs' fully documented case, convinced the state that it could not win. Moreover, state officials would be subject to highly adverse publicity as long as the case was in court. The state agreed to settle out of court. For the next two years, the plaintiffs' attorney negotiated with the state to develop a satisfactory plan for correcting deficiencies. Meanwhile, Zitnay was promoted from Superintendent of Pineland to State Commissioner of Mental Health and Corrections. The then Governor, the late James B. Longley, under whom Zitnay served, sincerely supported substantial improvement in the care of the mentally retarded. Zitnay was also very able in winning support from parents' groups as well as influential private citizens throughout the state of Maine. Despite such

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support, progress was slow in arriving at a satisfactory plan to remedy Pineland's deficiencies. In 1978, the plaintiff's attorney called for assistance from the Mental Health Law Project, a Washington, DC public interest law firm with a great deal of experience in this type of litigation. The Mental Health Law Project assisted in developing an extensive, highly detailed plan for institutional reform covering both the Pineland Center and especially community residences and programs. The plan called for the appointment of a special master to oversee implementation. Zitnay and Kevin Concannon, then Director of the Bureau of Mental Retardation, recommended that the State of Maine accept the settlement, for both men understood it could be used as a blueprint and as leverage for modernizing and improving the entire system of care for the mentally retarded throughout Maine. The State's Attorney General, Joseph Brennan, who was later to succeed Longley as governor, accepted their recommendation. Implementation Under a Special Master

In July, 1978, United States District Court Judge Edward T. Gignoux, a highly respected jurist, entered the consent decree, based on the plan developed by the parties with the assistance of the Mental Health Law Project, as the judgment of the court. After a search, the judge appointed David Gregory, a University of Maine law professor, as special master for a period of two years. The participants believed the decree would be fully implemented by that time. The special master began with two assumptions. The first was that the state would not have agreed to anything it did not intend to do. The second was that the limit of what he had to know was what was in the court order. He believed at the time that the total job was one of looking at what the decree required, looking at what was going on in the institution, and then reporting on the differences. As he became aware of institutional dynamics and of the organizational and political complexities of introducing change in public agencies, he soon realized that both assumptions were incorrect.

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After the first six months of educating himself about the problems of mental retardation, the culture of the institution, and interagency issues, Gregory took a more active role. He not only gathered information about the state of compliance with the decree, but he began educating the heads of other agencies as to how their actions were affecting implementation of the decree. In effect, he became an advocate for the decree. He worked closely with Zitnay, who was the named defendant, and with Concannon on the task of implementation. He came to understand that although Zitnay was commissioner, he had little direct control over Pineland Center itself and no power over state agencies on the same organizational level as his department (e.g., the state personnel department, the Commissioner of Finance, and the Commissioner of Human Services, basically responsible for Medicaid and other welfare programs). As a consequence of that decision, he tended to confront some department heads vigorously, strongly intimating that he expected their cooperation. For instance, he once had a difficult confrontation with Governor Brennan (Governor Longley's successor) who, as Attorney General, had consented to the decree. Governor Brennan objected strongly to the critical tone of Gregory's reports. Gregory also worked with operators of group homes around the state to encourage them to organize politically to obtain changes in state regulations that limited their ability to program effectively. That activity, too, led to friction between Gregory and some state officials. During this period, Zitnay and Concannon worked through the state's governmental structure to gain resources to modernize services for the retarded. They kept Gregory fully informed about barriers to implementation and other institutional problems. Gregory conducted his own investigations as to the state of compliance with the decree. He continued to receive information from some employees about deficiencies in programming or about abuses. (Other employees viewed his activities less benignly.) His reports to the court depicted the shortcomings and remaining problems in the institutions. Zitnay and Concannon could make bold requests for resources to correct deficiencies and point to the special master's reports to bolster their requests. In effect, the "blame" for the necessary large budget increases

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and other legislative changes could be placed on the special master. (See Rothman & Rothman, 1984, for a description of a similar process in the Willowbrook case.) As the two year period of court supervision ended, Gregory's reports were still highly critical of the limited progress. He recommended extending the period of the court's supervision until compliance had been achieved. The plaintiffs and defendants resumed negotiations arriving at a stipulation (an agreement) as to what further needed to be done to satisfy the terms of the decree. The state defendants agreed to the continuation of the special master's office, but in view of the friction between Gregory and the defendants, they insisted that Gregory be replaced. The change may have been at the insistence of the Governor. In retrospect, all parties agreed that Gregory had done a superb job as special master. Although some questioned whether his reports too greatly emphasized the negatives of the defendant's actions, all agreed that had he not adopted an aggressive stance, there would have been much less progress in implementing the decree. The Rothmans (1984) made a similar point about the necessity for the monitoring panel in the Willowbrook case to have taken a hard line on implementation. The Next Phase

The new master was Lincoln Clark, the head of the state court mediation service. An experienced executive and a highly skilled mediator, Clark was a close friend of Judge Gignoux. He knew the major figures in state government and in the legislature. All of the major actors agreed to his appointment. Judge Gignoux appointed Clark to replace Gregory. With a new governor taking office, Zitnay resigned as commissioner, returned to Pineland Center as superintendent, and was replaced by Kevin Concannon. Clark decided to focus first on Pineland rather than the community facilities, because it had moved far along the road to compliance under Zitnay.' The most difficult part of the task was to establish criteria for deciding when the defendant had finally brought Pineland into compliance with the consent decree. Issues such as the number of beds in a

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room were easy to decide. Issues such as "adequate programming" required a great deal of subjective judgment. Clark held a great many negotiating sessions among Zit nay, Concannon, and the plaintiffs' attorneys to agree to standards for compliance. Once the parties agreed, Clark brought in an outside consultant to review Pineland against the standards that had been agreed to, and to offer an opinion as to whether its programs met the standards. On the basis of an extensive review, the consultant concluded that Pineland Center was in substantial compliance with the institutional provisions of the consent decree. Clark therefore recommended that Pineland be discharged from the court's active supervision. In September, 1981, Judge Gignoux formally discharged the center from the court's direct supervision through Clark's office. Although this was an important milestone, Clark still faced correcting the remaining deficiencies in the community based treatment system, such as substandard housing, poor programming, and an insufficient number of community residences. Concannon, as Director of the Bureau of Mental Retardation, and later as Commissioner, had made progress in opening new group homes. However, persons seeking to develop group homes were faced with conflicting regulations and fiscal controls that led to great delays in opening new facilities (Note, 1985). In a spirit of negotiation and cooperation, Clark and the plaintiff's attorneys were willing to accept as substantial compliance the establishment of organizational means of accomplishing solutions, even if the precise program for each class member had not yet been achieved. While Clark effectively employed the skills of a mediator, he was well aware that his effectiveness depended upon the coercive power of the court. Clark also used the threat of adverse publicity, as did Gregory before him, to move matters along when progress seemed to be blocked. Clark's reports to the court assisted the defendants' attempts to augment their budgets. Clark mailed his reports to all of the state legislators, to state officials, and to advocacy organizations. He also spoke informally with the chairman of the health committee of the state legislature, a person he knew well. Commissioner Concannon worked skillfully with the legislature as well to gain

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new resources and other legislation to assist the development of programs in the community (Clark, 1982, p. 17). Two years after Judge Gignoux had discharged Pineland Center from the court's active supervision, Clark believed that sufficient progress had been made in implementing the community portion of the decree. In the summer of 1983, Clark contracted with outside consultants to determine whether the defendants' claims of progress were warranted. One consultant concluded that not all of the requirements of the consent decree had been met, but that enough had been put into place that the defendants would be able to come into full compliance. Another consultant studied the lives of those class members who left Pineland Center and were living in the community. On the basis of interviews with a randomly selected sample of clients and staff, she concluded that the living, working, and learning experiences of the class members substantially adhered to the standards involved in the two major themes of the consent decree- normalization and habilitation. An obvious concern was whether the improvements and the progress would survive if the court were to give up jurisdiction and cease supervising the programs. Two methods were developed to continue to monitor the system. A Consumer Advisory Board, created earlier as part of the consent decree, was now given greater monitoring responsibilities. The Board began developing a network of "correspondents" - people to act as next friends to those who have no families or have been abandoned by their families and to help in monitoring conditions in the many group homes scattered throughout the state. The defendants also agreed to undertake an annual, independent and public review of compliance with standards for institutional and community care incorporated into the consent decree and to publish a plan to remedy any identified deficiencies. Clark's report, finding compliance with the terms of the consent decree as interpreted through the various stipulations, was submitted to the court in October, 1983. Shortly afterwards Judge Gignoux accepted the findings, discharged the special master, and relinquished active supervision of the case. It was one of the first cases of its kind to come to this degree of successful completion. In August, 1985, M. Levine visited Pineland

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Center and conducted interviews with important participants. Maine has developed a very good system of care for class members and has improved the system of care for all. Undoubtedly, one could find gaps in the provision of care, and some problems are relatively intractable, but the worst abuses have certainly been curbed, and for most, humane care at the state of the art is being provided. The state continues to identify problems in the system of care, and officials are making efforts to plan for the future. The goal of prevention is being met. Not all cases come to as expeditious a settlement as this one. In fact, in some instances, the attempt to reform institutions, such as prisons, through litigation has led to disorder, beatings, and killings as court ordered changes were put into place (Alpert, Crouch & Huff, 1984; Reavis, 1985). However, as this and other cases show, the court's order can stimulate change (Rothman & Rothman, 1984 ). In the recent past, the involvement of the courts has been exceptionally helpful in callin~ attention to unconscionable conditions when those conditions might not have otherwise pricked the public conscience. Although there are important political and value questions when the courts become involved in the human service fields, the process in this case illustrates that it is possible not only for the courts to right grievous wrongs through supervision of the change process but also to affect services rendered in the future and to foster prevention of harm. In the next section, we examine an example in which change with a preventive impact was brought about through influencing legislation rather than through litigation. INFLUENCING LEGISLATION

A study by Jason and Rose (1984) provides an interesting example of influencing legislation through the interplay of activism, prevention, and social science research. Working in cooperation with an advocacy group, they undertook two research projects, an observational study of the use of safety seats and a poll on attitudes toward legislation, to provide data to help influence the passage of legislation that would mandate the use of safety seats with children under the age of four in Illinois.

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Legislation mandating the use of safety seats had failed to pass when it was introduced in the previous legislative session. Knowledgeable observers predicted that the Illinois House would pass the legislation in the next legislative session. In fact the legislation was approved by that chamber. The vote in the state Senate was more uncertain. Because the outcome of the vote in the state Senate was in doubt, the investigators had the opportunity to test whether legislators would be influenced by scientific data. Nine days before the critical vote was due in the state Senate, the investigators sent a personal letter to a randomly selected half of the state senators, describing the data on seat restraint usage and the results of the citizen survey. The letter included state statistics on deaths and injuries over a five year period and estimates of the lifetime dollar costs of rehabilitating a child who had sustained a serious injury. Written on university stationery and identifying the authors as members of the faculty of a respected university in the state, the letter asked the senators to consider the data when deciding what position to take on the legislation. Of 29 senators who received the letter, 23 (79 percent) voted in favor of the legislation. Among the 30 who were not sent the letter, 16 (53 percent) voted yes. Although the number of cases was small, the difference was statistically significant. The authors properly raise the ethical dilemma of employing a research design to determine the effect of the manipulation against the risk that the bill might not have passed because of a low rate of support among the nonsolicited senators. They also note some limitations of their research and the fact that the use of research is not limited to the "good" side of any issue. There is empirical evidence supporting the preventive benefits of safety seat legislation. Guerin and MacKinnon (1985) did a sophisticated time series analysis of accidents resulting in injury to children under three years of age and between four and seven in California, beginning on January 1, 1983. California's statute required that children under three use safety seats; no such requirement was imposed for children between four and seven. The authors concluded that legislation targeted at the younger age group was effective in reducing injury, although they also note that California law includes strict penalties for violations. The

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precise form that legislation takes in inducing compliance is important and a subject worthy of consideration in a number of contexts (e.g., income tax). This brief example of the relationship between law and social science research indicates a mode of cooperation that will probably grow in the future. Legislatures often review pertinent facts in developing policy and when writing legislation to implement the policy. Social scientists can provide some of the legislative facts not only by sending letters to legislators but also by testifying before committees and by publicizing research in the popular media in order to influence public opinion. Clearly, social science research can influence the legal process (Levine & Howe, 1985) in the interests of prevention or the amelioration of harm. SUMMARY

All law has preventive implications in the sense that all law has implications for future conduct. We have noted that there are many sources of law, beginning with the Constitution of the United States and extending through legislation and administrative regulation. The judiciary has the function of interpreting the meaning of the various levels of law and their applicability to fact situations. In the course of deciding "cases and controversies," judges interpret and sometimes make rules of law. Advocates can attempt to influence future conduct by affecting any of the levels of law. In this chapter, we have provided an example of an individual lawsuit, resulting in a rule of law that affected the behavior of psychotherapists in the interests of preventing harm which might be inflicted by their clients. We also presented an example of a class action lawsuit aimed at reforming the care of the mentally retarded on a statewide basis and preventing further harm to those in treatment and to those who in the future would be treated by the reformed system. Finally, we presented an example of a successful attempt to influence legislation in the interest of preventing the injury of young children in automobile accidents. We have emphasized that the system of law is intimately intertwined with our political system, and that the change process cannot be understood without taking a broad, interdisciplinary perspective.

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It is clear that there are opportunities available in the legal system

to achieve effective prevention of future harm to large groups in our society. NOTES 1. The research reported in this section was completed under support from the National Science Foundation Law and Social Science program, Grant No. SES-802-3954. Sec M. Levine (1986) for a full report of this work. 2. The information in this section is derived from reports filed by the special masters and from interviews conducted in August, 1982 and July, 1985 with the major actors. 3. Zitnay had worked with members of the Yale Psychoeducational Clinic in the past. Some of the creative approaches he used in improving Pineland can be traced back to that association (Sarason, Zitnay & Grossman, 1971 ).

REFERENCES Alpert, G. P., Crouch, B. M. & Huff, C. R. (1984). Prison reform by judicial decree: The unintended consequences of Ruiz v. Estelle. The Justice System Journal, 9, 291-305. American Psychiatric Association, Area VI of the Assembly of the American Psychiatric Association, Northern California Psychiatric Society, California State Psychological Association, San Francisco Psychoanalytic Institute and Society, California Society for Clinical Social Work, National Association of Social Workers, Golden Gate Chapter, and California Hospital Association. Motion for Leave to File Brief Amicus Curiae and Brief Amicus Curiae in Support of Petition for Rehearing, Tarasoff v. Board of Regents of the University of California, 13 Cal. 3d 177, 529 P. 2d 553,118 Cal. Rptr. 129 (1974). Beck, J. C. (1982). When the patient threatens violence: An empirical study of clinical practice after Tarasoff. Bulletin of the American Academy of Psychiatry and the Law, /0, 189-201. Beck, J. C. (cd.). (1985). The potentially violent patient and the Tarasoff decision in psychiatric practice. Washington, DC: American Psychiatric Press. Bell, D. (1976). Serving two masters: Integration ideals and client interests in school desegregation litigation. Yale Law Journal, 85, 470-516. Bellah v. Grccnson, 73 Cal. App. 3d 892, 141 Cal. Rptr. 92 (1978). Berger, C. J. (1978). Away from the court house and into the field: The odyssey of a special master. Columbia Law Review, 78, 707-38. Brady v. Hopper, 570 F. Supp. 1333 (1983). Brazil, W. D. (1983). Referring discovery tasks to special masters: Is Rule 53 a source of authority and restrictions? American Bar Foundation Research Journal, Winter, 143-86. Brown v. Board of Education of Topeka, 347 U.S. 483 (1954). Chaycs, A. (1976). The role of the judge in public law litigation. Harvard Law Review, 89, 1281-1316. Cort v. Ash, 422 U.S. 66 (1975). Developments in the Law (1976). Class actions. Harvard Law Review, 89, 1454-1644.

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Diver, C. (1979). The judge as political power broker: Superintending structural change in public institutions. Virginia Law Review, 43, 67-106. Ferleger, D. & Boyd, P. A. (1979). Anti-institutionalization: The promise of the Pennhurst case. Stanford Law Review, 31, 717-752. Fiss, 0. (1979). Foreword: The forms of justice. Harvard Law Review, 93, 1-58. Friedenthal, J., Kane, M. & Miller, A. (1985). Civil procedure. St. Paul, MN: West Publishing Co. Frohboese, R. & Sales, B. D. (1980). Parental opposition to deinstitutionalization: A challenge in need of attention and resolution. Law and Human Behavior, 4, 1-88. Frug, G. E. (1978). The judicial power of the purse. University of Pennsylvania Law Review, 126, 715-94. Garth, B. (1982). Conflict and dissent in class actions: A suggested perspective. North· western Uni1•ersity Law Review, 77, 492-535. Givclbcr, D. J., Bowers, W. J. & Blitch, C. L. (1984). Tarasoff, myth and reality: An empirical study of private law in action. Wisconsin Law Review, 443-497. Griswold v. Connecticut, 381 U.S. 479 (1965). Guerin, D. & MacKinnon, D. P. (1985). An assessment of the California child passenger restraint requirement. American Journal of Public Health, 75, 142-144. Hall, J. (1960). General principles of criminal law, 2nd cd. Indianapolis, IN: BobbsMcrrill. Horowitz, D. L. (1982). The judiciary: Umpire or empire? Law and Human Behavior, 6, 129-143. Jason, L. A. & Rose, T. (1984 ). Influencing the passage of child passenger restraint legislation. American Journal of Community Psychology, 12, 485-495. Johnson, F. (1976). The Constitution and the federal district judge. Texas Law Review, 54, 903-916. Levine, D. I. (1984). The authority for the appointment of remedial special masters in federal institutional reform litigation: The history reconsidered. U.C. Davis Law Review, 17, 753-805. Levine, M. (1980). From state hospital to psychiatric center. The implementation of planned organizational change. Lexington, MA: Lexington Books. Levine, M. (1981). The history and politics of community mental health. New York: Oxford University Press. Levine, M. (1986). The role of the special master in institutional reform litigation. Law & Policy, 8, 275-321. Levine, M. & Howe, B. (1985). The penetration of social science into legal culture. Law& Policy, 7,173-198. Lipari v. Sears, Roebuck & Company, 497 F. Supp. 185 (D. Ncb. 1980). Mayers, L. (1964). The American legal system, Rev. ed. New York: Harper & Row. Marbury v. Madison, 1 Cranch 137 (1803). Mcintosh v. Milano, 168 N.J. Super. 466, 403 A. 2d 500 (1979). Mills v. Board of Education, 348 F. Supp. 866 (D.C. 1972). Nagel, R. F. (1978). Separation of powers and the scope of federal equitable remedies. Stanford Law Review, 30, 661-724. Nathan, V. M. (1979). The use of masters in institutional reform litigation. Toledo Law Review, 10, 419-464. National Institute of Corrections (1983). Handbook for special masters (Judicial version). Washington, DC: National Institute of Corrections. N.Y. State Ass'n for Retarded Children, Inc. v. Carey, 357 F. Supp. 752 (E.D. NY 1973).

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Note. (1985). Group homes for the mentally retarded in Maine. Maine Law Review, 37, 63-104. PARC v. Pennsylvania, 343 F. Supp. 279 (E.D. Pa. 1972). Peck v. Counseling Service of Addison County, Inc., 499 A. 2d 422 (Vt. 1985). Pcnnhurst State School and Hospital v. Halderman, 451 U.S. 1 (1981). Prosser, W. L. & Keeton, W. P. (1985). Handbook of the law of torts. 5th ed. St. Paul, MN: West Publishing Company. Reavis, D. J. (1985, May). How they ruined our prisons. Texas Monthly, pp. 152-159; 232-246. Rebell, M. & Block, A. (1982). Education policy making and the courts. Chicago: University of Chicago Press. Roc v. Wade, 410 U.S. 113 (1973). Rhode, D. (1982). Class conflicts in class actions. Stanford Law Re1•iew, 34, 11831262. Rosenberg, J. & Phillips, W. R. F. (1981-82). The institutionalization of conflict in the reform of schools: A case study of the PARC decree. Indiana Law Journal, 57, 42549. . Rothman, D. (1982). The courts and social reform: A postprogressive outlook. Law and Human Behavior, 6, 113-119. Rothman, D. J. & Rothman, S.M. (1984). The Willowbrook wars. New York: Harper & Row. Rule 23, Federal Rules of Civil Procedure. Sarason, S. B., Zitnay, G. & Grossman, F. K. (1971). The creation of a community selling. Syracuse, NY: Syracuse University Division of Special 'Education and Rehabilitation and the Center on Human Policy. Sargent, M. (1986). Tarasoff decision modified. ADAMHA News, 12(1 ), 12. Shaw v. Glickman, 45 Md. App. 718, 415 A. 2d 625 (1980). Stone, A. A. (1976). The Tarasoff decisions: Suing psychotherapists to safeguard society. Harvard Law Review, 90, 358-378. Stone, A. A. (1984). Law, psychiatry and morality: Essays and analysis. Washington, DC: American Psychiatric Press. Tarasoffv. Regents of the University of California, 108 Cal. Rptr. 878 (Ct. App. 1973); reversed and remanded, 13 Cal. 3d 177, 529 P. 2d 533, 118 Cal. Rptr. 129 (1974); modified, 17 Cal. 3d 425, 551 P. 2d 334, 131 Cal. Rptr. 14 (1976). Thompson v. County of Alameda, 167 Cal. Rptr. 70, 614, P. 2d 728 (1980). Vottclcr, Matter of Estate of, 327 N.W. 2d 759 (Iowa 1982). Welsch v. Likins, 373 F. Supp. 487 (D. Minn. 1974). Wright, C., Miller, A. & Kane, M. K. (1985). Federal practice and procedure: Civil (1985 Supplement, Vol. 7A and 1985 Pocket Part, Vol. 7.) St. Paul, MN: West Publishing Co. Wuori v. Zitnay, Civ. No. 75-80 (D. Maine 1975) cont'd sub nom Wuori v. Concannon. Wyatt v. Stickney, 325 F. Supp. 781 (M.D. Ala. 1971); 344 F. Supp. 373 (M.D. Ala. 1972) aff'd sub nom Wyatt v. Aderholt 303 F. 2d 1305 (5th Cir. 1974). Wyatt v. Ireland II, Civ. No. 3195-N (M.D. Ala. 1979). Wulsin, L., Bursztajn, M. & Guthcil, T. (1983). Unexpected clinical features of the Tarasoff decision: The therapeutic alliance and the "duty to warn." American Journal of Psychiatry, 140, 601-603.

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Chapter 10

Preventive Interventions in the Environment: Examples and Issues Joseph A. Durlak Jill N. Reich Loyola University of Chicago

SUMMARY. This chapter describes preventively-oriented efforts at developing more satisfactory natural and built environments. Programs dealing with the collection and disposal of solid waste and the design of court facilities are presented as examples of the contributions municipal officials, citizen groups, environmentalists, engineers, architects, and psychologists have made in these areas. A final section highlights the general issues illustrated by current efforts in environmental intervention, including the complexities of initiating and sustaining preventive efforts at environmental change.

In general, environmental psychology is concerned with the interdependence and mutual influences occurring between organisms and their environment. Such a perspective involves virtually all of the social sciences in one way or another so that the field of environmental psychology defies brief description or definition. For example, there is the distinction between the natural (land, water, parks, and natural resources) and the built environment (schools, housing developments, and shopping centers). Reprints may be obtained from Joseph A. Durlak, Department of Psychology, Loyola University of Chicago, 6525 North Sheridan Road, Chicago, lL 60626. © 1987 by The Haworth Press, Inc. All rights reserved.

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Within each of these areas, one can assume a macro or micro level perspective by focusing on either entire communities or individual, specific settings (e.g., a single classroom). There is also the social environment which involves such variables as the behaviors and characteristics of setting inhabitants, their perceptions of the environment, and the environment's "social climate." Reviews of environmental psychology indicate that the area possesses no unifying theoretical or research perspective so much as a problem-oriented focus related to person-environment reciprocal interactions (see Darley & Gilbert, 1985; Stokols & Altman, 1986; Wandersman, Andrews, Riddle & Fancett, 1983). In this chapter we limit our attention to environmental design and discuss two examples, one drawn from the natural environment (the collection and disposal of solid waste), the other from the built environment (designing facilities for the judicial system). The unifying theme of environmental planning and design draws these two seemingly unrelated topics together. Further, we chose to focus on environmental design not merely because each of us has been active in this area, but because of why we have been active. There are two main reasons: first, environmental design offers much potential for preventive programming. And second, we have had the opportunity to learn many important lessons from the different professionals working in this area. Ideally, environmental planning assesses the strengths and limitations of the current situation in order to design future settings that maximize the former and minimize the latter. Hopefully, planning for the future includes anticipating future problems and effectively precluding them in the true spirit of prevention. The second reason drawing us toward environmental design is that we have been impressed with the important contributions made in this area by such groups as municipal officials, citizen groups, environmentalists, engineers, and architects. We _wi~h. to abstract some general principles from the work of these mdtvtduals that would be useful to others who wish to pursue their own efforts in this area. In effect, the focus on environmental design fits nicely with the major theme of the current volume: namely,

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there is heuristic value in describing and analyzing the work of preventively-oriented practitioners from many different fields. This chapter is divided into three sections. The first two sections describe preventively-oriented efforts at developing more satisfactory natural and built environments. In the last section, we highlight some general principles of environmental intervention and offer recommendations for future work in this area. SOLID WASTE The Garbage Problem

At first glance, garbage may not seem a very important issue, but it represents a growing problem for most communities, one that is approaching crisis proportions. Simply put, municipalities cannot deal effectively with the massive amounts of garbage that are produced. Over 15 years ago, a Health, Education, and Welfare study declared that the garbage problem " ... far outstrips the waste handling resources and facilities of virtually every community" (Degler, 1971, p. 37). Unfortunately, the problem has worsened in the intervening years. Depending on life style, the average citizen produces between 3 to 5 lbs. of solid waste (garbage) daily. Commercial and industrial waste usually exceeds residential volume. Therefore, a city with between 200,000 to 300,000 people generates from 400 to 500 tons of solid waste each day. In 1980, annual costs of solid waste collection and disposal in American cities exceeded 4 billion dollars; these expenditures were exceeded in most cities only by costs for schools and roads (Melosi, 1981). Moreover, garbage-related expenses have increased dramatically within the past few years and show no signs of stabilizing. The most common method of dealing with garbage is to collect all the refuse generated by residents and transport it to landfills for dumping. Sanitary landfills have always been considered the most economical and safest form of garbage disposal; however, this is no longer the case. Dumping charges at landfills are rising dramatically. Moreover, landfills are becoming full due to the massive amounts of garbage being generated, thus forcing municipalities to look further and further away from their bounda-

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ries for suitable landfill sites and greatly increasing the expense of merely transporting garbage much less dumping it. (The city of Philadelphia transports part of its daily garbage collection to a site over 200 miles away from the city.) There is also concern about the safety of landfills. The composition of garbage has changed over the years in terms of the increase of potentially dangerous synthetic compounds and chemicals in household wastes. Seepage from landfill sites has contaminated the soil and local water supplies. (Note, this discussion concerns "ordinary" landfills, not those designated to receive commercial and industrial toxic wastes which pose even greater health problems.) Back in 1974, data suggested that 94% of authorized landfill sites failed to meet minimum requirements for sanitary fills, and there were an estimated ten times as many unauthorized dumping sites being used (Shaleen, 1974). In summary, the use of sanitary landfills represents neither an economical nor safe way to dispose of garbage. Environmental Planning

Recent public policy developments have greatly accelerated more conscientious planning regarding solid waste. As a result of changes occurring first at the federal level, individual communities are now being charged with the responsibility for developing detailed plans for the future disposition of their waste. For example, regulatory bodies in some states have directed their constituent communities to reduce the amount of waste disposed of in landfills and have given communities deadlines and financial incentives for preparing, implementing and evaluating their new plans. As a result, perhaps for the first time, communities have had to think preventively; that is, to develop methods to reduce and reclaim future waste more effectively. Regulatory agencies vary in how carefully they monitor community plans and impose consequences for adequate or inadequate plans, and some communities have developed new plans on their own initiative. Nevertheless, new regulations and policy directives have motivated more communities toward more effective environmental planning. The following sections discuss the different preventively-oriented approaches that have been used.

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Primary Prevention: Waste Reduction

Waste reduction is aimed at reducing the amount of garbage produced in the first place. Packaging waste accounts for 20% of all household garbage, having increased by over 60% within the past two decades (Mantell, 1975). In fact, packaging cost the American public 25 billion dollars in 1966, which was 3% of the gross national product (Van Tasselky, 1973). The two most notable examples of waste reduction have occurred through legislative actions and in particular businesses. For example, "bottle bills" that outlaw the use of throwaway beverage containers have been enacted in several states. Not all returnable bottles are eventually returned, of course, yet most states with bottle bills have been pleased with the results. The waste reduction from such legislation can be tremendous. In the early 1970s, there were approximately 35 billion throwaway beverage containers manufactured in this country (Shaleen, 1971). Although we lack understanding of the exact factors affecting legislative behavior (see Chapters 4 & 11 ), the intense and consistent lobbying and testimony offered by environmental groups was apparently one potent factor in the eventual passage of bottle bill legislation. Although industry and environmentalists have been at odds with respect to the enactment of bottle bills, in other instances the former have been in the forefront of waste reduction efforts. The Pillsbury Company has reduced the metal in its packaging by approximately 1 million pounds per year (Peterson, 1975). Other companies such as Quaker Oats, Ft. Howard Paper, and Alcoa Aluminum have decided to use recycled products instead of those produced from natural resources as much as possible. The Union Carbide Corporation has indicated that its efforts at waste reduction have saved the company 20 million dollars a year for the past ten years (Knap, 1985). A crucial point for intervention in waste reduction is the point of product development. Accordingly, Hartman (1980) recommends that we consult with engineers during the initial design phases of product development to emphasize a product's environmental impact and potential for reuse. Ultimately, economic reasons are likely to motivate businesses to adopt waste reduction

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efforts, so such considerations should be emphasized. However, engineers may also value a product's efficiency of design and a product's durability, so these matters should not be ignored. In summary, although legislation in the form of bottle bills has successfully reduced waste in several states, many decisions regarding possible waste reduction efforts are made in individual businesses and industries by product engineers and marketing, manufacturing, and efficiency experts. Establishing contacts with such individuals can have far-ranging positive consequences. Secondary Prevention: Recycling

Recycling or resource recovery refers to reusing materials instead of tossing them away as garbage. Although many materials are recyclable, the most commonly recycled items are, in order: newspapers, aluminum cans, and glass bottles. Since the most commonly recycled materials constitute approximately 10-20% of the solid waste stream, recycling does not provide as many direct economic benefits as burn plants in terms of reducing the volume of garbage that must eventually be deposited in landfills (see below). However, it does provide gainful employment just as burn plants do and recycling possesses several additional benefits. Recycling programs are much less expensive to initiate and maintain than burn plants. Further, recycling results in positive ecological features since it prevents natural resources from being needlessly consumed; for example, every six-foot tall stack of newspapers that is recycled saves one tree from being felled to produce newspulp. This saving is considerable when viewed in the context that each Sunday edition of the New York Times requires newspulp that would be generated from 75,000 trees. There are an estimated 3,000 recycling programs in this country. They are basically constituted as buy-back, drop-off, or curbside programs. Buy-back programs offer a small incentive paid according to the weight of materials brought into the center. Drop-off centers as a rule do not pay for donated materials. The recycling center consists of several large bins for each recyclable material and residents come to the center at their convenience and deposit their sorted materials as indicated. The success of

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drop-off centers indicates that many residents do not need monetary incentives to recycle. Curbside programs are those in which residents separate their recyclable materials from the remainder of their garbage and place each out for collections at their homes. These programs can be implemented by local independent recycling centers but more often are operated by municipalities through their sanitation departments. As of 1982, 200 communities were operating curbside recycling programs. How effective are recycling programs? Most early research evaluated small, short-term projects initiated by the experimenter; many of these programs were not cost-effective (see Cone & Hayes, 1975; Geller, Winett & Everett, 1982). Yet one of the best controlled investigations of a large scale curbside program (Jacobs, Bailey & Crews, 1984) achieved a successful 50% participation rate. There is not much information on the success of buy-back programs. As a general rule of thumb, field reports suggest that between 40-60% participate in the most successful curbside programs. Unfortunately, it is not known if these participation rates are accurate, what factors affect each program's operation, or how much more successful current programs can be. Nevertheless, these seem to be a few general principles that characterize the most successful recycling programs. First, personal commitment and dedication are important. Many programs have come and gone through the years; the most long-lasting programs appear to have staff who are strongly committed to their work and who can marshall the necessary selfconfidence and optimism when a program's status becomes precarious. Second, both informal and formal support groups and networks have been developed and used extensively by recycling program staff. There is much sharing of technical information and resources, practical business matters, and emotional support so that individuals can learn from both the mistakes and successes of others in the field. Third, there is recognition that grass roots support of a program is essential, accompanied by numerous efforts to attain such support. Some programs recruit and use many community volunteers to assist in the labor intensive aspects of recycling; at times, formal neighborhood groups or block leaders are developed to promote recycling in their local

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areas. Often, the message is given "this is your (the community's) program and it is your responsibility to support it." Fourth, staff often recognize the importance of public education and awareness. Virtually every method is used to advertise a program: posters, flyers, door-to-door brochures, public service announcements, and speeches to schools, churches, and social groups. The development and evaluation of effective educational and advertising programs is one area to which the discipline of psychology can lend its expertise (see chapter on media). For example, a telephone survey recently disclosed that 40% of residents either were unaware of the existence of their community recycling program or did not know its location (Durlak & Brabec, 1983). Fifth, and finally, it is enlightening to observe how recycling groups have concentrated their efforts on legislation and public policy. Recyclers have recognized that new laws and regulations are necessary to change status quo arrangements into more proenvironmental and preventive approaches regarding the solid waste problem. Some have assisted in preparing new county or state regulations are necessary to change status quo arrangements into more pro-environmental and preventive approaches regarding the solid waste problem. Some have assisted in preparing new county or state regulations regarding waste disposal at the same time that others have helped communities respond to these regulations, insuring, of course, that recycling programs are given appropriate attention. In some states, special tax incentives have been developed for recycling-related businesses; in others, dumping surcharges have been levied at landfills and the resultant monies used to establish and expand local recycling programs. The Illinois Department of Environmental and Natural Resources recently awarded grants totalling $100,000 to community groups to develop innovative programs in waste reduction. Recycling groups were instrumental in preparing the "requests for proposals" and funding criteria for these grants. Tertiary Prevention: Burn Plants

A tertiary preventive approach in dealing with garbage consists of incinerating it at massive "burn plants." Depending upon its initial composition, the initial volume of garbage can be

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reduced substantially through incineration. Such a reduction results in great savings of landfill space and dumping fees. Burn plants also generate jobs for the local economy since staff is needed to operate the plants, usually on an around-the-clock basis. By increasing the economic base of a community, such strategies may have long-range preventive impact on the psychological well-being of community residents (see Chapter 5). Nevertheless, there are several major unresolved problems with burn plants. First, for maximum economic benefit, the energy (steam or electricity) produced by garbage combustion should be sold to local industry. However, such industries must be located near the burn plants and this is infrequently the case. Second, start-up costs are prohibitive (tens of millions of dollars), making burn plants impractical alternatives for small communities. Third, the technology of garbage combustion is imperfect; several plants have operated ineffectively and some plants have closed permanently. Fourth, there are serious concerns that the incineration process releases potentially dangerous air pollutants such as heavy metals and dioxins. Studies commissioned by the Environmental Protection Agency in the early 1970s revealed that "no more than a handful" of municipal incinerators met existing air quality standards (Melosi, 1981 ). In effect, a possible solution to one environmental problem regarding garbage may ultimately create another environmental problem affecting human health and safety. Americans' strong faith in technological solutions to problems would naturally lead to greater use of burn plants. However, the practical limitations and economic and health concerns regarding garbage incineration suggest that an abiding faith in technology may prove disappointing in the long run. Therefore, we recommend that relatively more effort be given to the primary and secondary approaches related to solid waste as described above. THE JUDICIAL SYSTEM

The Courthouse Problem

Court systems, their participants, and their constituents are facing environmental problems of a different kind and scope than

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the example just presented, but the problems are of great importance to their sense of justice, system of law, and cost to their communities. Caseloads have increased geometrically over the last decade; each level of the judicial system is backlogged and inefficient. We cannot build courthouses fast enough or large enough to house our many and varied needs. In many places, including the small jurisdictions, it is not unusual to wait several years to have your day in court, particularly if you bring a civil suit, the type which makes up the vast majority of most courts' work. Admittedly, bricks and mortar may at first seem mundane next to the dramatic conceptual issues raised by our justice system. However, the physical plant has a tangible effect on the people it houses and the community in which it is housed (Craik, 1976; Stokols, 1978) and the implications of not providing functional space to the courts are often costly. For example, if the Clerk of Court, who is the repositor of all court records, has an office spread out over many floors and even buildings, it is not surprising to find the operation inefficient and ineffectual. This resulting inefficiency usually means a staff that is larger than necessary. In a recent commission for one court, an estimated $48,000 in operating budget was saved each year by providing a more functional space for just one office. This kind of savings which can result from better environmental design is not unusual. Furthermore, since personnel costs normally consume about 90% of a county's operating budget, a functional building is not a luxury but a necessity. In addition, a frequently overlooked cost of nonfunctional spaces lies in the message communicated to those who work in them. Workers who lack enough space or suitable arrangements soon think less of their jobs and, often, of their own worth as well (O'Riordan, 1976). Moreover, a court building's message extends beyond its employees. A recent newspaper article (Dunlop, 1983) criticized the design of one community's new courthouse complex because it did not provide covered walkways between its various related elements. According to the review, the message communicated was one of "thoughtlessness," a message that hardly conveys the basis of our system of law. Indeed, one must ask if justice can be administered under conditions such as these. And, if not, how

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does one go about acquiring appropriate facilities for these activities? Primary Prevention: Reducing the Workload

One direct way to address the problems being faced by the courts is to reduce the caseload to be serviced by our justice system, bringing it in line with the resources presently allocated. This approach first requires identifying those factors that affect caseload growth and manipulating them accordingly to reduce growth. While not exhaustive, the list must include legislative, administrative, social, and economic factors as well as the more obvious one of population growth; that is, more people equals more cases if all other factors hold constant. However, since population growth is unlikely to be within the realm of realistic, or perhaps even desired, social control, we will turn to the "more likely'' candidates. Legislation is a critical factor in caseload growth and, as a result, has a significant impact on court space needs. For example, the decriminalization of possession of small amounts of marijuana significantly changed the number and character of criminal cases in many jurisdictions. Further, the introduction of determinate sentencing is hypothesized to impact on the incidence of at least certain types of criminal offenses. An example more directly related to specific space needs is provided by a legislative decision to require compulsory arbitration for civil matters under a specified amount. This procedural change saved one jurisdiction 3000 square feet that would have been required for a new judge's office and courtroom, thereby realizing an immediate savings of $192,000 (Sobel & Associates, 1984). Numerous jurisdictions across the country are attempting to establish rules and criteria in malpractice suits as they try to rid the courts of frivolous litigation. Such attempts likely foreshadow some success in the reduction of caseload. Yet analyses of jurisdictions around the country suggest that new areas of litigation will soon replace the old familiar ones (Sobel & Associates, 1983). Moreover, new case types without substantial case law precedents will stress our already crowded court calendars even more. New areas include such topics as environmental law, water rights, pollution responsibility, and multinational drug cases

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involving people speaking many different languages (each requiring his/her own translator). In all, there are no indications to date that legislative interventions alone can reduce the courts' work in any meaningful, long term way. Since it has long been identified as a strong predictor of caseload growth, a third area for potential change is the size of the Bar (i.e., the number of practicing attorneys). Unfortunately, this too appears equally unlikely to be controlled by outside manipulation. Although change in the number of practicing attorneys may result from certain intrinsic economic conditions (such as those produced by a glutted market), this area is neither a realistic nor desired factor for external manipulation. And so, one must turn to less direct modes of intervention to find the answer. Secondary Prevention: Long Range Planning and Implementation

Achieving an effective judicial system and a functional courthouse is not impossible. There are tested and rational methods of proceeding (Reich, Sobel, Mahan & Deam, 1984). The desired planning approach anticipates future events and needs in time to provide administrative, technological, and environmental changes to meet the courts' growing and changing workload. As a first step, one must study historically the major factors influencing growth in order to project future needs (Mahan, Reich, Sobel & Deam, 1984 ). At the same time, one must analyze the system with respect to its administrative policies to determine areas for organizational and policy change. The system's use of technology should be examined to identify areas for consolidation and increased efficiency through the use of such things as computers, (e.g., for caseload management), miniaturization (e.g., for record storage), and audio-visual systems (e.g., for arraignment). Finally, the planning project must attend to what architects traditionally refer to as architectural programming. That is, the basic components to be housed (present and future), number of people by their type of role (i.e., judge, juror, clerk, defendantin-custody, defendant-out-of-custody), number of spaces by

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type, and net square footage for each office must be delineated. This work should also identify and describe design criteria relevant to the courthouse, including site, scale, materials, and ornament. The result of this kind of long range planning is an environmental impact statement in the fullest sense of the phrase because it examines the wide-ranging implications of the whole system. Interestingly, such a statement is often generated by the need to address a specific space problem. That is, space acts as the stimulus to undertake a comprehensive review and analysis of the whole organization. The second author's experience in over eight years of architectural consulting with the firm of Walter H. Sobel has shown that a multidimensional approach organized around the particular demands of the project best meets the tasks of this kind of planning project. This approach uses many different ways to ask the question of what kind of space is needed: where, when and by whom? Archival information (e.g., court records of caseloads, past and current staff, jurisdictional population, and drawings of existing facilities) provides the basic facility and system data. A series of questionnaires to all users provides a broad-based overview of the users' perceptions and levels of satisfaction. Judgmental and detailed information is gathered through observations of and discussions with a representative sample of different users. These evaluations should be designed to obtain several kinds of information related to space and functional needs from judges, attorneys, staff, clerks, support personnel, defendants, witnesses, jurors, citizens, and building maintenance and service personnel. The result of this planning work provides the basic tool for the exciting but arduous task of translating this identified need into real space. Because of its ultimate use, it is essential that all users be surveyed for their perceptions and needs. The more carefully needs have been identified, the process understood, and priorities established, the more likely it is that responsible design decisions will be made and the more effective will be the space that results. After all, it is easier and more cost-effective to make changes in the building by using an eraser on the drawings than a sledge hammer on the wall!

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Of course, the building is more than a series of functional spaces. It also must be a symbol, aesthetically composed, harmonious with its surroundings, and pleasing to those who see it. Moreover, although the architects and engineers responsible for this aspect of the project can identify and even describe the design components, the achievement of design remains a creative process that depends on the unique resolution of human needs in time and space (Deam, Mahan, Sobel & Reich, 1985). This is why no one style of architectural treatment has ever monopolized courthouse design. At different periods and in different places, various styles have prospered. Yet, in most communities, in spite of this diversity, the courthouse stands out in bold relief from its neighbors. It is the treatment of major components of design, rather than a particular style, that constitutes the essence of a courthouse. The most important of these are presentation, progression of spaces, and dramatization of uniqueness; all of which make up the art and science of a building. Once completed, there are several potential uses for the results generated by this planning project. A large amount of information will have been gathered and put into a workable format. The resultant data base should not be used only for facility planning. It can also be the basis for informing the public of judicial functioning, its growth patterns, and the reasons and implications of such growth. In so doing, the information acts to educate the public to the judicial needs arising from the services they provide (Giamatti, 1983). For example, there is a common misrepresentation that the justice system serves only the criminal element of our society. In fact, over 65% of the functions within a court facility are devoted to civil matters which direct impact on the general, law-abiding citizen (Reich, Sobel, Mahan & Deam, 1985). In addition, the structure established in setting up this data base provides the means to monitor and anticipate future growth patterns and needs so that change (functional, administrative, technological, and/or spatial) can be implemented in a systematic and timely fashion. As is obvious, it is the initial start-up phase of data gathering, validation, and organization which is the most costly and time consuming. Once accomplished, its maintenance is minimal in cost and ever expanding in the situations to which it

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applies (e.g., analyzing the impact of changing legislation, justifying additional personnel, and evaluating technological advances). Unfortunately, this start-up phase generally occurs in response to a crisis- in reality, as part of a tertiary intervention. Tertiary Intervention: Crisis Planning

When space is tight, with personnel tripping on and over each other's toes and records deteriorating in the basement, the usual impulse is to short-circuit the planning phase of the project and dive right into building a new facility. Taking this approach, one generally builds more of the same in concrete and practice. Experience in more than 80 jurisdictions throughout the U.S., demonstrates that an imminent crisis is the catalyst for improvement of court facilities: the floor has begun to sag from overloading of files; there is no space for the new judge; or perhaps the shooting in a neighboring courthouse has made everyone conscious of a security problem (Palmer, 1981). These kinds of crisis situations generally prompt makeshift solutions which, in turn, create their own set of problems. For example, when one county in Georgia met their increased caseload needs by adding a new judge, they were then faced with finding space for this new judicial unit (i.e., a judge's office, support staff space, a courtroom in which to hear cases, a jury deliberation room for the jurors, and storage space for new files). County government decided to provide this space in a vacant theater located a few blocks from the courthouse. Looking back at the series of events, one can easily predict the ripple effect which resulted. The public does not know whether to go to the courthouse or to the "Bijoux" for their day in court; court papers are delivered late or misplaced; jurors have to shuffle between two places (thus requiring additional bailiffs to assist them- a cost which escalates annually); security is severely compromised; and communication is a nightmare (Sobel & Associates, 1983). Experience has demonstrated many times over that knee jerk solutions to crises are conducive neither to the implementation nor the achievement of effective solutions. The results are expensive in manpower, function, and operation costs as well as building costs (Sobel & Associates, 1984).

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Yet, such crises can serve an important function in achieving a prevention plan. This crisis point forces the judicial system to seek a solution to a problem often of long-standing. It is a critical time to educate the client in the benefits of secondary intervention techniques. By solving the immediate crises within the context of a long-range plan, both goals can be achieved and the client can move into a more successful model for dealing with environmental demands. The results of this kind of approach can demonstrate that the bulk of the cost for long-range solutions goes toward meeting the short-term need (generally over 60% of the cost). Further, since building costs escalate at approximately 8% per year, building now for long-range needs is very cost effective. Space intended for future use can be designed for multiple uses in the interim (e.g., grant-based programs for economic development or job training programs might be housed in the courthouse) until such time as needed by court related departments. Critical to the success of moving into a long-range plan is the realization that the short-term solution achieved in this context will more successfully meet the needs of the users, that the cost will not be significantly greater, and that the process can be completed in a timely fashion. Although not easy (Palmer, 1981), the pay-off to long-range planning is well worth the effort. After all, a courthouse is more than just a building; it is also a symbol that speaks to its public. It must communicate the strength and vitality of our system of law, the humanity of our form of government, and the equality of all our citizens. CHANGING THE ENVIRONMENT

What lessons can be learned from the environmental interventions just discussed? From our experiences we suggest that there are three important factors: (1) identifying a need for change; (2) establishing the necessity for long-range planning; and (3) providing resources and incentives for implementing the long-range plan. In both the solid waste and judicial areas just reviewed, it was the experience of crisis that prompted change. The individuals

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involved were faced with a pressing and ever-worsening problem, forcing the decision that something must be done. In fact, we believe that in the absence of crisis, few preventive, environmental interventions would occur. The notion of preventing some possible, but not yet experienced, future problem does not motivate many to change. People are more likely to engage in preventive activity once they have experienced the problem and some of its effects. If we can generalize from our observations in the environmental area to preventive work in general, more attention must be paid to the factors underlying the motivation to change. Until we know more about why people change, our ability to mount preventive interventions is constrained. The second critical aspect of the change process involves convincing those in crisis that long-range solutions are preferable to convincing those in crisis that long-range solutions are preferable to immediate ones. Ironically, the goal here involves delaying change, i.e., stopping the precipitous change that leads to shortsighted, makeshift solutions- the kind of change that frequently occurs in crisis situations. In other words, individuals faced with problems may not be willing to do long-range planning since this process requires them to carefully assess the problem, to weigh alternative solutions, or to consider the implications of different choices. Yet these are exactly the procedures used in the successful interventions described in this chapter. These long-range planning procedures are common in a variety of planning models developed and used by architects, engineers, urban planners, and environmentalists. As the professionals most successful in convincing the public to plan preventively, their work deserves much more attention. A final point to be made is that successful preventive intervention requires resources to reinforce change behavior. At this time, interventions in the solid waste area have developed to the point where legislation provides incentives and resources to generate changes. For example, Rhode Island recently mandated all its municipalities to begin recycling programs within a three year period. Concurrently, the state allocated start-up funds and grant monies to assist communities in meeting the new legislative mandate. Once support for environmental interventions becomes incorporated into social policy, change is more likely and efforts

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become more widespread. This process is evidenced again in the solid waste example. Given the extent of legislation in this area, we predict that more communities will develop preventive interventions directed at the solid waste problem than any other environmental problem. In the absence of supportive public policy, it is much more difficult to martial the necessary resources and funds to implement change as was observed in the example of court planning. Under such circumstances, change agents must turn to the customary techniques used to initiate change. They will need to educate the community about the need for change, establish and link community groups or individuals with mutual interests and concerns, provide guidance on how to reconcile differences, establish goals, and present issues. Such techniques are not unique to environmental problems; they are basic change mechanisms. In summary, our analysis of these two broad examples of environmental change serves to highlight the similarity of these interventions with the basic factors common to all preventive change. By extending these processes to include environmental problems, we hope to expand the scope of prevention, introduce models derived from environmental planning into the general preventive literature, and underscore the importance of asking the following set of questions before undertaking a preventive intervention project: Who perceives that a problem exists? Who supports the need for change? Which of the planning models that have been developed are best suited to your needs? What resources exist to plan for and implement change? REFERENCES Cone, J. D. & Hayes, S. C. (1977). Applied behavior analysis and the solution of environmental problems. In I. Altman & J. F. Wohlwill (cds.), Human behavior and environment: Advances in theory and research, Vol. II. New York: Plenum Press. Craik, K. H. & Zube, E. H. (eds. ). (1976 ). Perceiving environmental quality: Research and applications. New York: Plenum. Dcam, E. L., Mahan, D. H., Sobel, W. H. & Reich, J. N. (1985). A blueprint for the future. The Column, Spring, 15-17. Degler, S. E. (1971 ). Federal pollution control programs: Water, air and solid wastes, Rev. ed. Washington, DC: Bureau of National Affairs. Dunlop, B. (19~3, December 18). Miami Herald.

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Durlak, J. A. & Brabec, G. (1983). Assessing attitudes and behaviors regarding recycling. Paper presented at the meeting of the Illinois A. Recycling Conference, Arlington Heights, IL. Geller, E. S., Winett, R. A. & Everett, P. G. (1982). Preserving the environment: New strategies for behavior change. New York: Pergamon. Hartman, R. A. (1986). Product design for recycling. Resource Recycling, 4, 24-27. Jacobs, H. E., Bailey, J. S. & Crews, J. I. (1984). Development and analysis of a community-based resource recovery program. Journal of Applied Behavior Analysis, 17, 127-145. Kemper, 0. & Quigley, J. H. (1976). The economics of refuse collection. Cambridge: Ballinger Publishing Co. Knap, J. E. (1985). Recycling is good business. Resource Recycling, 4, 16-19. Mahan, D. H., Reich, J. N., Sobel, W. H. & Dcam, E. L. (1984). Designing a courthouse for today and tomorrow. The Column, Fall, 10-12. Mantell, C. L. (1975). Solid wastes: Origin, collection, processing and disposal. New York: Wiley. Mclosi, M. V. (1981). Garbage in the cities: Refuse, refonn and the environment, /880-1980. College Station, TX: Texas A&M University Press. O'Riordan, T. (1976). Attitudes, behavior and environmental policy issues. In I. Altman & J. Wohlwill (eds.), Human behavior and environment, Vol. 1. New York: Plenum Press. Palmer, M. (1981). The architect's guide to facility programming. New York: The American Institute of Architects. Redstone, L. G. (1980). Institutional buildings. New York: McGraw-Hill. Reich, J. N., Sobel, W. H., Mahan, D. H. & Dcam, E. L. (1986). Involving the public and serving the public: Keys to a successful courthouse. The Justice System Journal, 10(3), 339-352.

Reich, J. N., Sobel, W. H., Mahan, D. H. & Deam, E. L. (1984). Designing a functional courthouse. The Column, 15, 9-11. Shaheen, E. I. (1974). Environmental pollution: Awareness and control. Mahomet, IL: Engineering Technology. Sobel, W. H. & Associates (1983). Report to the Supreme Court of New Mexico on architectural needs. NM: Supreme Court Documents. Sobel, W. H. & Associates (1983). Technical report prepared for Gwinett County, Georgia. Available from the second author. Sobel, W. H. & Associates (1984). Bricks & mortar: A discussion of courthouse design. The Column, 15, 13-15. Stokols, D. (1978). Perspectives on environment and behavior. New York: Plenum. Wandersman, A., Andrews, A., Riddle, D. & Faneett, C. (1983). Environmental psychology and prevention. In R. D. Feldner, L. A. Jason, J. N. Moritsugu & S. S. Farber (eds.), Preventive psychology: Theory, research and practice. New York: Pergamon Press.

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Afterword J. R. Newbrough Vanderbilt University

The last position has its special opportunities and hazards. It is akin to being last in a line of ice skaters doing Crack the Whip; the challenge is to tie the chapters together as a whole. For me, the answer to this challenge lies in the construction of some meanings for the consideration of the three themes which seem to emerge from this volume- interdisciplinary, community, and prevention. INTERDISCIPLINARY

Interdisciplinary as a theme holds the promise of cooperation and common cause in the solution of problems. The editors pose their hope for the volume in the comment that "disciplines form a system, the components of which subtly intermingle with one another to produce a synergistic multidisciplinary effect." As with any system, there are attracting and repelling forces within it. The attractiveness of one discipline to another is that it has something to offer- a point of view, a research method, or an intervention strategy. We presume that another discipline is a resource to enrich our understanding so that we can be more effective in our work. Work between allied disciplines that has seemed to represent the attracting forces in the system is illustrated by the mental health treatment team. The psychiatrist, the psychologist, and the social worker have been the core actors providing services in mental health centers. While today there is more variability in the types of actors, the task is the same- to work with individuals © 1987 by The Haworth Press, Inc. All rights reserved.

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and their families to solve problems and to improve functioning. The treatment team has been a stable form for about 60 years. The repelling forces in a system are more likely to be seen with the interdisciplinary research team. It is different from the mental health service team since it brings together a diverse set of actors for a time limited period to pursue a particular question. The Northeast Committee on Rural Sociology (1966) provides a definition of the repelling forces in this kind of work: An interdisciplinary team is a group of persons who are trained in the use of different tools and concepts, among whom there is an organized division of labor around a common problem, with each member using his own tools, with continuous intercommunication and re-examination of postulates in terms of the limitations provided by the work of other members, and often with group responsibility for the final product. (p. 1) The Committee distinguished between group research and team research. Group research refers to two or more persons coming together from different disciplines to work on a common problem with a common method and orientation. The ideal with team research, on the other hand, is diversity in unity- to achieve enough common cause to work together and to maintain enough separateness so that the particular disciplinary contributions can be made. The management and synthesizing functions are critically important because, at the proper moment, some new synthesis, a unique kind of compromise, is expected to occur and to be supported by the different disciplinary members whose perspectives are expected to shift as they are affected by the working transactions. Described this way, I can see why interdisciplinary work is difficult to achieve. Rather than being challenged by filling in the empty spaces, each discipline will be inclined to resist- because what is being proposed is not theirs. The Northeast Committee noted that "interdisciplinary research is largely a matter of divergent subcultures" (1966, p. 6). Bronfenbrenner and Devereux (1966) described three years of experience on a seven member interdisciplinary team:

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A skilful (sic) leader can get the group to map out a specific problem, bring in the data, hew discussion to the line and hammer out a concrete project design that puts a large staff to work almost immediately. The entire operation can involve representatives of different disciplines and be good research. The likelihood, however, is that the basic theoretical and methodological approaches will remain substantially unaltered. As he functions in the job, each specialist will work with the same conceptual frame and the same orientation toward techniques that he brought with him to the first conference. In the extreme, this results in an interdisciplinary project in which nothing is shared but the subjects- a consequence not entirely without precedent in the short history of group research. (pp. 5-6) Each discipline has a belief system or world view (Kearney, 1975) that has been constructed by and is maintained by contact with disciplinary colleagues. Functioning as a subculture, the world view is quite resistent to change. This is the basic difficulty with the interdisciplinary team and why it is hard to integrate it into a creative form. My own experience with managing a large interdisciplinary research project (Newbrough & Christenfeld, 1974) leads me to believe that the challenge is not the unification of the world views on the team, but rather the synthesis of their knowledge. This synthesis is the process of bringing diverse ideas together into some coherent framework. It may occur at a variety of levels: within a project, within a conference, within a review article, or within a volume such as this. It is these syntheses that are the occasion for integration across allied disciplines. From such endeavors as this volume, we as readers can enrich and broaden our individual perspectives. COMMUNITY Community holds the promise of community organization that provides belonging and is effective in meeting human needs. In this volume, community is the theme that is most clearly linked across the chapters. As a concept, community is multifaceted,

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referring to the particular location where one lives, the sense of shared sentiments, and the social structure in which daily life is organized and managed. I have found the notion of community as municipality to be the most useful for my work (cf., Newbrough & Christenfeld, 1974; Stucky & Newbrough, 1983). Community as municipality can contain all parts of the locality (population, organization, environment, technology; Duncan, 1959) and can provide for the coming together of disciplines that study the city from a range of perspectives and levels of analysis. What has seemed most useful has been a combination of ecological theory and systems theory. Hawley (1950) translates ecological theory into an application to the city which is place-based. Long (1958) offers the concepts of place (where the activities are located), rules (that organize each part of the city), players (who take the various roles, often playing more than one), and games (the subactivities that fall into different activity sectors in the city). To illustrate the utility of this perspective, Stucky and Newbrough (1983) applied the game metaphor in considering how to integrate the mentally retarded (a socially marginal group) into the local community. Drewes (1969), from a systems theory perspective, has identified six subfunctions that the local community carries out while in pursuit of the major goal of survival. Various organizations and individuals engage interactively in political, economic, educative, religious, welfare (maintenance), and familial (residential) functions at different places at different times. Warren (1972) offers a systems view of organization where the community as municipality is organized horizontally (within) and vertically (to levels above). This reminds us that all communities are responsive to state, regional, and national influences and cannot be understood outside of their particular context. Organization is the most frequently used aspect of community in the social and behavior sciences, primarily because it provides the most direct and apparent set of connections for the individual through the notion of mediating structures (Berger & Neuhaus, 1975) with the web of community life (Hawley, 1950). The chapters in this volume all address organizational matters and thus highlight that part of the community.

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Keys considers community within three levels used by the Chicago School: individual, social group, and the city. Dysfunction of the organization was thought to yield deviance and individual disorder. Social improvement was to be obtained through a better organized and functioning community created through social participation. Keys reports that some of the original neighborhood organizations have survived for more than eighty years. The interventions were structural and enduring. McKeown, Rubenstein and Kelly show how the meaning of community developed between the early and later studies by Redfield and by Epstein. Redfield and Epstein began with a narrow use of the concept of community as being one of a mutually exclusive type and then elaborated the concept into a more contemporary notion of interrelated hierarchies of types of communities. Within this systems perspective, McKeown, Rubenstein and Kelly consider Kelly's studies of the ecologies of two high schools. They identify a place, a social process of ownership, and the evolving role of field coordinator as ways to exemplify the complexities of community. This is a useful elaboration of Kelly's work on the ecologies of the school as place-based ecological niches and makes it similar to Long's (1958) eco1ogy of games. They make the further point that there is a local culture (world view) into which intervention attempts have to be fitted. Fawcett, Seekins, and Moody take a political approach to understanding the relationship between the citizens and officials. For them, community exists in the form of the rules that can be changed. Policymaking refers to rule making that is postulated to go through a set of steps described by a rational problem solving model involving Agenda Formation, Policy Adaptation, and Policy Implementation. They applied the model in Lawrence, Kansas; the community polarized against their position. In the end, they were "beaten" by the opposition, but the process created rules that addressed the problem of availability of natural gas to fixed income residents. Social organization was improved, but not as effectively as the authors would have liked. They preferred to use a functional procedure where resources are made available directly, rather than indirectly through a structural procedure, where opportunities to participate in the process were made

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available. Intervention agents have the option of choosing which procedure they prefer to pursue for policymaking. Dooley, Catalano and Serxner consider the community as a unit in an economic structure that has local, state, regional, and national levels (illustrating Warren's, 1976, vertical dimensions of community). They try to specify a direct link between economic shifts (as stressful life change events) and psychological symptoms. What they have not yet sorted out is whether the economic shift provokes mental disorder or whether it indirectly evokes help-seeking that will have a later preventive effect. It will probably be found that both functions are operative, since the distribution of income in the local community is directly affected by the ebb and flow of capital at higher levels of the economic system. Winett reviews an important feature of community life- television. There has been considerable public and professional concern about the possibility of images in the media inciting individuals to violent acts. Winett addresses the more indirect issue of the creation and maintenance of consciousness within particular segments of the viewing audience. He sees such consciousness management to be a powerful influence on susceptibility and resistance of individuals to stress. The television industry that controls these influences operates as a complex and closed merchandising system that is driven by the ratings and profit margins. Here is a force external to the local community (Warren's vertical linkage) that has direct influence on the mental health of people residing in each locality. Winett notes that social scientists have not been able to influence the system effectively as direct participants. External and indirect efforts are suggested for use at the local level. Perhaps federal level legislation introducing regulation could have desired local community impacts. A more direct influence on community 'consciousness is through religion. Maton and Pargament describe religion in American life as an approach to the creation of community. Religion in the form of local churches functions as a mediating structure (Berger & Neuhaus, 1975), providing a sense of belonging for individuals. Based on its values, the church is a meaning generating subsystem within the larger community. Maton and Pargament distinguish between inreach and outreach activities-

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dealing with cohesion building, on the one hand, and integration with the larger system, on the other. Social scientists could potentially find common cause with religious organizations in combating alienation and demoralization, but individual workers will have to come to terms with the particular values of a given denomination. Some values will be acceptable; others will not. Albino and Tedesco provide an historical view of public health as one of the first applied disciplines that operated on the social level for the public good. Nearly a century ago, lack of milk in the diet and factory working conditions were great hazards to the normal development of many children. Intervention directed toward the psychosocial conditions of children yielded an improvement in their health status. The authors use the same perspective in considering the matter of AIDS as a disease where containment is the only known control procedure, as it was historically with cholera and typhoid. Procedures interrupting transmission can be effective, but this requires lifestyle alterations. Prevention professionals can draw inspiration from the tactics of public health for community-oriented programs to interrupt the spread of a condition or to strengthen the persons at particular risk. Community here is analogous to Long's (1958) playing field on which certain actions are taken to protect parts of the population. Albino and Tedesco indicate, however, that AIDS can also be seen as a psychosocial problem where community behavior change strategies make use of natural support systems and are aimed at empowering clients. Given the epidemic proportions of AIDS, intervention agents will need to pay special attention to the community aspects of programming. Otherwise, community in America can sustain substantial damage. Ewing, Levine and Levine discuss the use of the law for promoting the public interest. As with the Fawcett, Seekins and Moody chapter, there is a particular emphasis on the community as a structure existing in rules. The authority of the judiciary branch is described as narrow, but powerful. That is, where there is an invasion of a legally protected interest, the law can be brought in to decide which interests are to be protected, to deliver protection with legal sanctions, and to assess damages if appropriate. Judicial decisions, with the force of law behind them, are generally respected and can be changed only through a formal

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process of appeal. This is political functioning as described by Drewes (1969), wherein decisions are made and conflict is mediated. It is different from the legislative process where decisions are made among interest groups. In the judiciary, the public interest is the guiding ideal. Durlak and Reich approach the community as an organization to be influenced by planning. Planning is a rational process, similar to that suggested by Fawcett, Seekins and Moody, and is engaged in by particular stakeholders. It is also part of Drewes' (1969) political function in that it is technical assistance at the management level. Durlak and Reich address the community problems of waste disposal and the overcrowded courthouse. They use primary, secondary, and tertiary prevention as categories to consider the long-, medium-, and short-range solutions associated with changes in each problem area. Whatever the time perspective, the planning approach assumes that change can be effected by rational strategies. When enabled through the organization of a planning commission, or other duly constituted bodies (and is primarily technical, as in these examples), rational planning at the community level can be effective. When ad hoc and popularly based (involving value differences), planning would have to be done in more of a participative fashion, resembling community development (Biddle & Biddle, 1965). These chapters all relate in one fashion or another to the locality. The city as locality, social organization, and municipality provides the backdrop against which theory and practice described in the chapters can come together and be interrelated. In order to get beyond conceptual interrelations, one would need to go to work on a particular locality to study it from several perspectives and across time. Newbrough and Christenfeld (1974) tried that with a focus on depressed mood in a community context. They used the dynamic modelling approach of Forrester (1961, 1969) since it was able to provide the system for creating a web of causal functions. Although Forrester (1969) has applied the modelling approach to the city, the developmental work was done with industrial applications (1961). One studies the interrelationships of activities portrayed as rhythms, cycles, trends, and events. A computer language (DYNAMO) has been developed

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based on an hydraulic conception of the system with flows, holding tanks, and valves that are all interconnected. The city as system conceptualized as community can bring together the disciplines that have intervention goals by offering a common system to observe. Routine data are collected, which can be augmented with special collections. There is an organization that endures and provides the ways for service transactions to occur. With such an approach, one could imagine an interdisciplinary, longitudinal research station analogous to Kelly's (1970) proposed Woods Hole for community psychology. Significant movement toward a multidisciplinary approach would seem to require it. PREVENTION Prevention holds the promise of improvement of the community and the enhancement of individual lives by the actions of persons within it. It implies a planned approach to social change (Bennis, Benne & Chin, 1985). Rappaport ( 1981) notes that empowerment can be distinguished from prevention on the basis of basic value assumptions. Prevention is oriented toward meeting the needs of people who require protection from environmental hazards or strengthening their resistance to those hazards (e.g., stress inoculation). Empowerment is oriented toward the rights of people who need aid in asserting themselves and pursuing their interests. Intervention within the context of empowerment is oriented toward strengthening people or changing the system so that the same patterns will not be repeated. These chapters can be classified into these two categories. My classification placed them as follows: Prevention

Fawcett, Seekins & Moody Dooley, Catalano & Serxner Albino & Tedesco Ewing, Levine & Levine Durlak & Reich

Empowennent

Keys McKeown, Rubenstein & Kelly Winett Maton & Pargament

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All but one of them seem to fit clearly into one or the other. With Fawcett, Seekins and Moody, they designed a program (in Lifeline) that was an empowering one, but when the opposition won, that solution (Warm Hearts) was more like Rappaport's prevention, meeting needs but providing no way for changing the system. The reader is offered the two types of intervention in this volume and can have a choice between the two value positions. Rappaport (in press) argues that community psychology should be totally committed to the empowerment position as an ideology and should select prevention programs that exemplify that position. Empowerment has been the ideology underlying much of the community development movement (Biddle & Biddle, 1965) and was articulated in 1926 by John Dewey (1946) as the basis for American democracy in the development of the Great Community. The public health tradition (exemplified by Albino and Tedesco) is not so clearly oriented toward social change values and is more centered on preserving or enhancing lives of groups of individuals. This is a safer perspective for intervention agents who would find themselves perceived as being too political by trying to empower people. Both approaches involve intervention for human welfare in the public interest. They require a usable theory of community and they allow for interdisciplinary work. This volume offers strong examples of each approach. The reader can choose which suits better. REFERENCES Bennis, W. G., Benne, K. D. & Chin, R. (cds.) (1985). The planning of change, 2nd cd. New York: Holt, Rinehart & Winston. Berger, P. J. & Neuhaus, R. J. (1977). To empower people: The role of mediating stntct!lres in p11blic policy. Washington, DC: American Enterprise Institute for Pub· lie Policy Research. Biddle, W. W. & Biddle, L. J. (1965). The comm11nity development process: The rediscovery of local initiative. New York: Holt, Rinehart & Winston. Bronfenbrenner, U. & Devereux, E. C. (1966, March 29-30). Interdisciplinary planning for team research on constructive community behavior: The Springdale Project. Paper presented to the Seminar Discussion. (Excerpt from H11man Relations, 1951, v, 187-203).

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Dewey, J. (1946). The public and its problems: An essay in political inquiry. Chicago, IL: Gateway Books. Drewes, D. W. (1969). A systems approach to community: A preliminary report. Raleigh, NC: Regional Alcoholism Systems Project, South Central Region. Duncan, 0. D. (1959). Human ecology and population studies. In P. M. Hauser & 0. D. Duncan (eds.), The str1dy of population. Chicago: The University of Chicago Press. Forrester, J. W. (1961). Industrial dynamics. Cambridge, MA: MIT Press. Forrester, J. W. (1969). Urban dynamics. Cambridge, MA: MIT Press. Hawley, A. H. (1950). Human ecology: A the01y of community st111cture. Chicago: The University of Chicago Press. Kearney, M. (1975). Worldview theory and study. Annual Review of Anthropology, 4, 247-270. Kelly, J. G. (1970). Antidotes for arrogance: Training for community psychology. American Psychologist, 25, 524-531. Long, N. (1958). The local community as an ecology of games. American Sociological Rel'iew, 64, 251-261. Newbrough, J. R. & Christenfeld, R. M. (1974). Community mental health epidemiology: Nashville (Final report of a feasibility study for a program to monitor depressed mood in the local community: Grant MH-20681 ). John F. Kennedy Center for Research on Education and Human Development, George Peabody College for Teachers of Vanderbilt University, Nashville, TN. Northeast Committee on Rural Sociology (1966, March 29-30). What is "interdisciplinary team research?" Paper prepared for seminar discussion. Rappaport, J. (1981). In praise of paradox: A social policy of empowerment over prevention. American Journal of Community Psychology, 9, 1-25. Rappaport, J. (in press). Terms of empowerment/exemplars of prevention. American Journal of Community Psychology. Stucky, P. E. & Newbrough, J. R. (1983). Mentally retarded persons in the community. InK. Kernan, M. J. Begab & R. Edgerton (eds.), Environment and behavior. Baltimore, MD: University Park Press. Warren, R. L. (1972). The community in America, 2nd ed. Chicago: Rand-McNally.