NETTING, F.E., KETTNER, MP., McMURTRY, S.: Social Work Macro Practice. Longman, New York & London, 1993 .a ^-.3- . * 1 J -r J - T— --------ľ*-r. . chapter i________^]!^^smm —--------. i, [ An Introduction to Macro Practice in Social Work Overvieiv What Is Macro Practice? Macro Practice in Context Three Case Examples Case Example 1: Child Protective Services Case Example 2: Frail Elderly Case Management Case Example 3: Displaced Homemaker Services Surviving the Dilemmas "Why Macro Practice? Summary References WHAT IS MACRO PRACTICE? Macro practice is professionally directed intervention designed to bring about planned change in organizations and communities. Macro practice, as all social work practice, is built on theoretical foundations, proceeds within the framework of a practice model, and operates within the boundaries of professional values and ethics. Macro-level activities engage the practitioner in organizational, community, and policy arenas. These activities go beyond individual and group interventions but are often based on needs, problems, issues, and concerns identified in micro activities. Organizational activities include, but are not limited to, supervision of professional and paraprofessional staff, working with committees, participating in 3 4 VALUES AND HISTORICAL PERSPECTIVES budgeting, writing proposals, and developing programs. Community activities engage the practitioner in negotiating and bargaining with diverse groups, encouraging consumer participation in decision making, establishing and carrying out interagency agreements, conducting needs assessments, and advocating for client needs in a variety of community systems. Policy-related activities include coalition building, lobbying, testifying, tracking legislatíve developments that dřrectíy affect clients, and carrying out other efforts designed to affect legal or regulatory frameworks. Typically', macro social workers occupy positionsln social agencies and are involved in the agency's functioning. The agency may be a funding source, a planning organization, or a direct service provider, or it may perform multiple functions. The unifying concern of macro workers is how the agency relates to its environment and the forces that shape that environment. These forces include changing needs, shifting demographics, interest group politics, legislatíve influences, funding patterns, and a host of other factors. The macro worker, therefore, must understand the community within which an organization operates and the policies that affect the service deliver)' system within that community (Meenaghan 1987). Although most practitioners will work within organizations and have some understanding of communities, it is clear that not all committee and task force work is macro practice, and not all people who serve on committees and task forces are doing macro social work practice. Macro practice is carried out by people operating in a sanctioned professional capacity, following a soundly based set of procedures, and focusing on planned'change. Social work practice is broadly defined and allows for intervention at the micro (individual, group, or family) level, and at the macro (organization and community) level. Given this division of labor, some professional roles require i that the social worker be involved full-time in macro practice. These professional . roles are often referred to by such titles as planner, community organizer, manager, or administrator. The direct service worker or clinical social worker, however, also bears responsibility for initiating change in organizations and communities. The direct service worker is often the first to recognize patterns indicating the need for change. If one or two clients present a particular problem, the logical response is to deal with them as individuals. However, as more persons present the same situation, it quicldy becomes evident that something is awry within the systems in which these clients are interacting. It then becomes incumbent upon the social worker to help identify the system(s) in need of change and the type of change needed. The nature of the system(s) in need of change may lead to communitywide intervention or intervention in a single organization. Given these statements, practitioners may begin to feel overwhelmed. Is it not enough to do good clinical work? Is it not enough to listen to a client and offer options? Professional practice focusing only on an individual's intrapsychic concerns does not fit the definition of social work. Being a social worker requires seeing the client as part of multiple, overlapping systems that comprise the person's social and physical environment. If the social worker is not willing to engage in some macro-practice types of activities relating to these environments, then he or she is not practicing social work. 1 / AW INTRODUCTION TO MACRO PRACTICE IN SOCIAL WORK 5 Similarly, social workers who concentrate in macro practice must understand micro practice, which may be defined as intervention directed primarily at the individual or group level. Without this understanding, macro practice may be carried out in the absence of an adequate grounding in the nature of client needs. MBA and M5W administrators would act similarly in all situations, and cost alone-1-rather than an understanding of client need balanced with cost—would drive community planning. The interconnectedness of micro and macro roles are the heart of social work practice. In short, it is as important for social workers in macro-practice roles to understand the importance of individual and group interventions as it is for social workers in micro practice roles to understand the importance of organizational, community, and policy change. Because we believe that all social workers are professional change agents, we use the terms social worker, professional, and change agent interchangeably throughout this text. Social workers are always change agents because they are constantly identifying changes that need to occur in order to make systems more responsive or sensitive to target population needs. Change is so much a part of social work practice that one cannot separate the two. Professional Is a term that implies identification with a set of values and the judgment and skill to act on those values. In Chapter 3, we discuss the meaning of professional values Chat unite social workers across roles, arenas, and emphases. MACRO PRACTICE IN CONTEXT This book is intended for all social workers, regardless of whether Üiey specialize in micro or macro tracks within schools of social work. It is designed to be an introduction to the macro-practice roles social workers play. Although some practitioners will concentrate their efforts primarily in one arena rather than another, in some situations all social workers will engage in macro-level interventions as the appropriate response to a need or a problem. This book is not designed to educate full-time agency administrators, program planners, community organizers, or policy analysts. Those social workers who assume full-time macro roles will need a more advanced understanding than what this text will provide. This is not a book on specialization..The roles discussed in this and the following chapters are those that competent social work practitioners will play during their professional careers. In preparation for writing this text, we talked with a number of our former students who are now practicing social workers, some of whom work directly with clients and some of whom are planners, managers, or administrators. We asked them what they would say to current students about the differences between their expectations of social work practice when they were students and their actual experiences over the past few years. One student responded: "As a student, I have this very vivid memory of being idealistic. I liked social work's emphasis on serving clients as the primary focus of attention, and I thought that would carry over to my professional practice. Instead, I find that my professional life is G VALUES AND HISTORICAL PERSPECTIVES dominated by two things: fellow employees and money.. In making decisions, we find that we have to deal much more with staff egos than with client needs; And the 'bottom line' mentalit}' that pushes budget issues into every discussion and decision has been a real disappointment." A second student said: "What makes this profession .worthwhile for me is that there is a core of very committed people who really live up to the ideals of the profession. They're very talented people who could make a lot more money elsewhere, but they believe in what they're doing, and It is always a pleasure to work with them. Our biggest frustration has been that diere are so many people (like state legislators, for example) who wield so much power over this profession, but who have no understanding of what social problems and human needs are all about. Even though professionals may have spent the better part of their careers trying to understand how to deal with people in need, their opinions and perspectives are often not accepted or respected." A social worker recently employed by a community-based agency on an Indian reservation shared his experience: "Culture is so important to the work we do. I constantly have to ask indigenous people for advice ao that I do not make assumptions about the people with whom I work. The concept.of community and what it means to this tribe, even the value of the land as a part of their tradition, is so crucial. It is much more complex than I had assumed when I was in school." Another former student reinforced the importance of community: "I guess I never realized how porous agency boundaries are. We have board members coming in and out and we see clients. But the thing that has surprised me is how much I need to know about the community—people's values, where funding comes from, how to; assess community needs. Even though I do direct practice, I am constantly pulled onto task forces and committees that have to deal with the broader community issues." Concerns about limited public resources combined with overwork were expressed by a program specialist in foster care: "A big problem is the workload— the sheer size of people's job responsibilities. The state can't or won't provide the money to keep workloads at reasonable levels. It never occurred to me the frustration there would be in working with policies you can't change because you don't have any input at those levels. Our organization has two separate parts—volunteers and professional staff—and there's often no clear definition of who does what. It's very difficult to know which issues should be brought to the board and which ones should be settled by staff." Despite these problems, üiough, Ulis same person quickly added, ' 'A real positive is the feeling you are having a role in helping people. Seeing progress on the part of individual clients is one of the main things that keeps you going. It's also very reinforcing to have the opportunity to be an advocate for kids." Another former student was disappointed about the impact of limited resources on practice and employee morale:' 'It really wears you down after awhile when everything Is decided in terms of money. Furniture in our waiting room is falling apart, the place needs to be painted, there are so many things we should do to improve our efficiency and effectiveness, but we can't because we can't afford them. Just once I'd like to have the resources to really do things right, the way they can in big corporations." 1 / AN INTŘODUCTiON;Tp;-MÁGRďpRACTICE IN SOCIAL WORK 7 However, lest we begin to beuévé>thíiť^ sector does not have its own limitations, the clinical duxctor:'Öf%'^ agency had this to say: "Unlike a lot of social 1yoŕkerÍ£I^$J^^ and business consideradons always have tö be factofeä5Ít^upí|^^;^e have a fairly small operation, and 1 think the agency.ŕ^e'piqrjlj^^í^^^^^^oíiéerns about how clients are treated, but I've still had tp J&C^ä|DlKft^SMt can arise between making a profit and serving clients»■ÖÜt^^^^^^^p^^.^'lth .adoptions, and I've been very surprised by the ígnoraňcóí^^pjp^il^ jan;;ÉtíštaDput adoption even among other social workers.:A ioc^pf^^^^cíf^j^fř^feq^^ky-^poslng their values on women about how they shö.ulä^al^ys^^ and they usually do this without knowing anything äbpucVpae.löäse^yv^:;;;^';'"'.'! A child protective services worker said:" 'Iťš'reáU^'Hárä^tq'/äoqribei Within a few days last year in my caseload there was a'deatfroT^ öf my kids was abandoned in our waiting room, aňd-tóěre;w?re\tnr^ against our staff from people who think we just indiscriminately/: take,.ch'iidiťén^away from their parents. I often think of going into other lines qf work; "but-there; áre":lots of intangible rewards in social work, and other professions have theiŕ.héádachesjtbb." The director of a social services unit in a hospital talked abgut another client group, the elderly: "I have been here long enough to seě:th'e;,áclyenť:bf diagnostic-related categories. This is. the Medicare system's way qf nialung-'surěl'pÍdér;-patients are discharged efficiently, and If they are not, the hospital hasto pick up the tab. Social workers graduate from MSW programs ready to counsel patients in the hospital and they are sorely disappointed. What we háve to dq is work fast; counseling is done 'on the run,' and we are pushed and přqddeďby everyone from admissions to discharge planning to move these folks along'. Many of these older persons don't have people who can help them when tliey.are-discharged and they are really vulnerable to being placed in a nursing hpmě.It is as if policies and procedures make our decisions—where is the patient involved?," On a final note, a direct practice student who recentlý/graduäťeďiriadé this statement: "This may sound negative, but it is not meant to be^My.,education in social work taught me how little I know. I feel as if I have just scratched the surface. Learning is a long ongoing process. I work in a head injury center and what I learned from having had exposure to macro-practice roles is that you have to know the organization in which you work, particularly the philosophy behind what happens there. This Is more important than I ever imagined." These quotations tell their own stories. Many of the issues facing social workers in their daily practice are not only client problems but problems in agencies or communities that affect the worker's ability to serve their clients. We thank our former students for helping us raise these issues. THREE CASE EXAMPLES Other aspects of social work macro practice that need to be understood by the student and the beginning practitioner can best be illustrated by case examples. We selected the following because they contain similar themes but focus on different target papulation groups: children, the aged, and women. 16 VALUES AND HISTORICAL PERSPECTIVES '# ' \r- Much of the work done by functional noncapitulators is what we,refer to |i as macro practice, and is carried out with widely'varying degrees of skill. The Ä purpose of this text is to present a theoretical base and a practice model designed M to assist the professional social worker in bringing about change in organizations % and communities. We encourage its readers to become functional noncapitulators ff within the organizations and communities in which they will work. ?* I WHY MACRO PRACTICE? B The beginning student will Find that most social work literature reinforces the M importance of practitioners' macro-level responsibilities. Why is this such an tí important issue? The answer has a great deal to do with the mission and history •".§ of the profession, and the development of a value base which has become the 'M cornerstone of professional social work practice. || Although Chapter 2 will focus on historical development, understanding the \S professional mission of social work is esseridal to recognizing why macro practice ,3f is important. In a provocative argument, Specht (1990) challenges social work's rf, contemporary interest in the "popular psychbtherapies." | [They have] diverted social work from its original vision, a vision of the v§ perfectibility of society, the building of the "city beautiful," the "new society," '$, and the "new frontier." There is a yet unfulfilled mission for Social work that .■«! ■ might be resuscitated, it is a mission to deal with the enormous social problems '§ under which our society staggers! the social isolation of our aged, the anomie ~k experienced by our youths, the neglect and abuse of children, homelessness, .'i* drug addiction, and AIDS. ^ Our mission must be to build a meaning, a purpose, and a sense of obligation '£\- for the community, not one by one. It is only by creating a community that we % establish a basis for commitment, obligation, and social support. "We must build Jtl communities that are excited about their child-care systems, that find it |!; exhilarating to care for the mentally ill and the frail aged. [pp. 354-56) ':Tji '■-■.- f Earlier in this chapter we presented three case examples of what included •'$ seemingly unresolvable dilemmas. Yet, the lists of .questions and concerns -i£ expressed by the three social work practitioners reflect their attempts to hold ;| on to the mission described by Specht. This mission is built on a set of values. ^ Barker (1987) defines values as "the customs, standards of contact and & principles considered desirable by a culture, a group of people, or an individual" .£ (p. 171). He goes'on to explain that in 1982, social workers, as a professional :| group, stated some of the overriding values for their practice. These values were š£ published in the NASW Standards for the Classification of Social Work Practice. "^' They were: ,-|. Commitment to the primary importance of the individual in society, .":| Respect for the confidentiality of relationships with clients, >1 Commitment to social change to meet socially recognized needs, $ 1 / AN INTRODUCTION TO MACRO PRACTICE IM SOCIAL WORK 17 Willingness to keep personal feelings and needs separate from professional relationships, Willingness to transmit knowledge and skills to others, Respect and appreciation for individual and group differences, Commitment to develop clients' ability to help, themselves, Willingness to persist in efforts on behalf of clients despite frustration. Commitment to social justice and the economic, physical, and mental well-being of all in society, and Commitment to a high standard of personal and professional conduct. (Barker 19B7, 171) These values do not cover the entire NASW Code of Ethics, but they do provide a general orientation to the positions taken by the profession on the larger Issues relating to responsible and conscientious professional behavior. In all social-work practice, there is clearly an expectation that the social worker will, when ■the situation calls for it, become involved beyond the simple needs of a "case" or client and Initiate change at the organizational or community level. In many ways it is this commitment to the understanding and changing of larger systems that separates social work from other professional disciplines. Few other professions have adopted the same "systems perspective." Thus, while a committee or a task force might be made up of many disciplines, the professional social worker who is doing macro practice is operating from a knowledge and value base that includes a number of considerations: Informed Approach. First, the macro practitioner approaches the need for change with an understanding and expectation that decisions will he based on as complete a set of data and information as time and resources allow. Informed decision making is pursued in a systematic and scholarly manner, utilizing the best available theoretical, research-based, and practice-based knowledge. Consumer Input and Participation. Although it may be more time-consuming and take more energy to include clients in change processes, the social worker must always look for client input. Finding new and meaningful ways to facilitate citizen participation in organizational and community arenas is an ongoing challenge for the dedicated professional. Fit of Problem to Solution, Based on a Thorough Analysis. Defining the problem to be changed requires integrating what clients have to say with scholarly research and practice results. This analytical process is dynamic and interactive, often causing the change agent to rcframe the original problem statement. But once the problem statement is agreed upon, social workers must ascertain that their interventions make sense in relation to the problem at hand. Interventions often require a creative imagination that goes beyond traditional approaches. Go«/ Directed. Goals are broadly denned aims toward which practitioners guide their efforts. They are usually long term and sometimes idealistic. 1—r |_ .| L J u J Li L_l l_J l_J 18 VALUES AND HISTORICAL PERSPECTIVES However, goals provide a vision shared by clients and colleagues—a jji hope of what can be—and they assist the practitioner in maintaining = a focus. -| Outcome Oriented, Outcomes are defined as quality of life changes in á clients' lives, based on the intervendons planned by social work % practitioners. Outcomes can be determined by professionals, based ■] on what they think clients would want, but the best test of an outcome % is whether or not the clients themselves really see it as meaningful and ^ valuable. ,| Social workers have the opportunity to facilitate change. Based on a set of \ values, macro social work practíce progresses in an informed manner, incorporating -3 clients into the dynamic process, designing intervendons to meet well-analysed i| problems. Broad goals and specific outcomes provide the focused direction. f SUMMARY ■{ In this chapter we have tried to provide the basic foundations on which students -1 can build an understanding of social work macro practice. We defined macro 1 practice as professionally directed intervention designed to bring about planned | change in organizations and communiües, and we began a discussion of the | circumstances leading to the need for planned change. ;| To do this, we used comments from former students who are now practicing 'jí social workers. These comments Illustrate how the circumstances that are often j| most troubling to social workers are not only the concerns of their clients but 4 also the management of their organization or the resources available widiin -^ their community. These points were reinforced through diree case vignettes ?^ showing how policies, program structures, resource deficits, and other macro- "& related criteria have much to do with social workers' abilities to be effective in ';£ their jobs. if One way that social workers sometimes respond to these realities is to give ;| up fighting against them. This is done through capitulation, withdrawal, self- 3 martyrdom, or other approaches, all of which reduce the worker's professional 4 effectiveness. However, social workers who are skilled in macro pracúce have £ another opdon, that olfunctional noncapitulation, in which they use their under- -\ standing of macro systems to bring about needed changes in these systems. These | skills are not, and should not be, limited to those who are worldng in traditional vj macro-practice roles such as administration or planning. Instead, they are critical ;| for all social workers to know, including those engaged mostly In micro practice. | Parts II III and IV of this textbook will provide a macro-practice model to ■% guide social workers in undertaking change processes. But first, Chapters 2 and -| 3 will provide more detailed historical and values perspectives for macro practice ,-J- in social work ' J U-J Ui U_f U_J LäleJ!" 'tel':, feig!' >l»fo .:;tí^$'-..-Uiä 1 / AN INTRODUCTION TO MACRO;RňÁ#ÍCE^5^ REFERENCES \^-S^SŠ^$$$ Barker, R. I. (1987) Tbe social work dictionary. Silver Spring, MD: Natiahol AšsociakoP^'" ' of Social Workers. Meenaghan, T. M. (1987) Macro practíce: Current trends and issues. Encyclopedia bfsoci'äi work (18th ed., 2; 82-B9). Silver Spring, MD: National Association of Social •■Workers Sherman, W. R., and S. Wenocur. (1983) Empowering.pubilc welfare workers through mutual support. Social Work, 3S(5): 375-79. Specht, H. (I99O) Social work and popular psycho therapies. Social Service Review 64{V\- 345-57. '" VALUES AND HISTORICAL PERSPECTIVES f 2 I THE HISTORICAL ROOTS OF MACRO PRACTICE 31 Americans and the political order'.' (pp. 272-74). Other programs were less successful and in some cases resulted in harsh criticisms of social workers and their efforts. Within the field itself, however, accomplishments such as those of the CAP agencies helped to reestablish the importance of macro-practice rales. Reflecting .this trend, the Council on Social Work Education (CSWE), in 1962, ■ recognized community organization as a method of social work practice ; comparable to group work and case work. In 1963,. the Office of Juvenile Delinquency and Youth Development of the U.S. Department of Health, ; Hducation, and Welfare funded CSWE to develop curriculum for training j$ i community organizers. Between 1965 and 1969, the number of schools of social work providing training in community organization rose by 37 percent, eventually ■ including virtually every school in the country (Garvin & Cox 1987). Community j organization thus emerged as a legitimate part of social work practice. m* MACRO PRACTICE IN ORGANIZATIONS Communities are macro systems in which all social workers interact arid for which practice models have evolved. However, communities are comprised of networks of organizations, and it is these organizations that usually hold the direct responsibility for carrying out basic community functions. As such, organizations are a second type of macro system with which social workers must be familiar. With respect to human service organizations, one important consideration is historical patterns of shifting emphasis between centralization and decentralization of agencies and services. England's Elizabethan Poor Law of 1601, the first written law establishing a governmental system of services for the poor, adopted a decentralized approach to providing services. Under this law, assistance to the poor was a local function (as was taxation to pay for the assistance), and responsibility for service provision rested with an individual "overseer of the poor." This model was retained more or less intact in the American colonies, and until the 1800s, relief efforts for the needy remained primarily local and small in scale. The reformist movement of the early nineteenth century began a slow transition to larger-scale services in the form of state-run asylums for dependent children, the mentally ill, and others. Later, as population, urban concentration, and service needs increased, so did the diversity of both public and private programs. Eventually, it became apparent that some sort of coordinating mechanism was needed for these various efforts. As Trattner (1989) notes: The situation in Massachusetts was typical. In 1859, the commonwealth had three state mental institutions, a reform school for boys, an industrial school for girls, a hospital, and three almshouses for the state or nonresident poor. In addition, four private charitable institutions—schools for the blind, the deaf and dumb, the feeble-minded, and an eye and ear infirmary—received state aid. Each of these was managed by its own board of trustees. So uncoordinated a system not only increased the cost of operation, but It did not ptovide for a channel of 1 m m m. communication between institutions; a reform in one, then, might not be implemented in the others. The situation obviously called for some method of state supervision, (p. 81) The result was the creation of what became known-as the State Boards of Charities, "■firstin,Massachusetts in 1863, then in another fifteen states by the mid-1690s. : These boards represented the First real involvement of state governments in centralized coordination of welfare services, and they helped to establish standards for the administration of human service organizations. For roughly the next sixty-five years, rouch of the development of human .»'■service organizations took place in the private sector. The formation of the COS .agencies and settlement houses was a partial recognition of the advantages of ^establishing standard service practices within the framework of a strong organisational base. Efforts toward developing more comprehensive public agency •i Involvement in social welfare services occurred during the Progressive movement ■:in the early ,1900s. One example was, the creation of the first state public welfare .^department in Illinois in 1917. Still, the focus remained very much on decentralized serviceprovision. There was relatively little growth among human service .-organizations in the public sector. . . _ It was not until the Great Depression that public organizations for. the .'provision of human services were established on a large scale. The New Deal ■'programs created an infrastructurq of organizations at the federal level that became .■both the foundations of the welfare state and the First large, governmental human .^service bureaucracies. In addition,, a key function of these agencies was to :distribute relief funds to various states, and this in turn helped to spur the creation ;. o f .state-level public welfare organizations. Some programs, such as the Federal Emergency Relief Administration (FERA) and the Work Projects Administration vfWPA) were established to respond directiy to Depression-era problems and thus were relatively short-lived. Others, such as the Social Security Administration, .formed the institutional basis of ongoing federal social welfare programs, and ■they continue to play major roles. With the creation in 1956 of the Department of Health, Education, and Welfare (now the Department of Health and Human Services), most of these agencies were .combined into a single, cabinet-level organization through which governmental social welfare programs were centralized'. Since its early development, professional social work practice has been conducted within some type of organizational base. However, these organizations varied over time, and the skills needed for effective practice within them also changed. For example, in the early years of social work education, attention toward models of practice in social work organizations focused primarily on preparing a limited number of macro practitioners to assume roles as administrators of small agencies, usually in the private sector. The goal was to provide skills such as fund raising, working with voluntary boards, and supervising direct-■.service workers. With the growth of large public bureaucracies and nationwide networks of affiliated agencies in the private sector, the size and complexity of human service organizations changed. The role of macro practitioners within these organizations j—* r-i -r~~s í—t n í iL-,J í-__L ' l—J"" U.J'' "I__1 L__ «—f4 32 VALUES AND HISTOHICAL PERSPECTIVES 2 / THE HISTORICAL ROOTS OF MACRO PRACTICE 33 was also forced to change. For example, trends such as the increased size of hum-in service organizations, their increased complexity and diversity of services, and changes in standard budgetary policies forced administrators to seek new skills Lewis (1978) calls particular attention to the growth of concern for fiscal accountability that first became a dominant issue in the late 1960s. He argues diat these concerns forced sociai work administrators to shift from being "problem solvers" to being "managers." Implicit in this shift was a change in administrativ e orientation, moving away from external considerations of how best to deal with specific social problems and toward internal considerations of budgetary com pHance and operational efficiency. Considerable concern was expressed that if social work administrators did not acquire these skills, leadership' of human service agencies would pass to persons from other disciplines who did possess such training. Concern has also arisen that administrative decisions in human service agencies have become overwhelmed by managerial concerns and no longer reflect the consideration of client needs. In response, Patti (1987) and others have called for the development of an effectiveness-driven model of administrative practice in which the achievement of desirable outcomes for clients becomes the primary criterion for decision malting. The intent of this model is to view administrative practice in social work as a unique blend of managerial skills combined with broader knowledge of social problems and the means of addressing these problems. Finally, 'just as views of the role of human service administrators have changed, so too have notions about the organizations in which they work. Since most social workers now operate within the context of some type of organization their understanding of that organization may have much to do with the ability to do their job well. ■ For example, in a classic work entitled "The Good Bureaucrat," Robert Pruger (1973) made the point that sociai workers have two major roles. The helper role defines their activities as a social worker who assists clients widi various problems. The organizational role defines the responsibilities the worker has for completing forms, making reports, attending meetings, and other organizational tasks. These roles may compete, and the clash between them may lead to a worker's Inability to meet either satisfactorily. For example, a worker may have so many forms to fill out that he or she has little time for listening to detailed client problems. Pruger argues that a third role, the bureaucratic role, is possible . in which the worker develops skills in mediating the conflicts between the other two roles, learning to meet organizational demands without sacrificing profes 5ional skill. This is what the functional noncapitulator, discussed in Chapter 1 has to do in order to survive in a demanding environment. In subsequent chapters we will discuss how Pruger's model of the good bureaucrat fits well within the larger framework of the modern macro practitioner. CONTEMPORARY TRENDS At the beginning of tills chapter, we discussed major historical trends affecting f- the development of the social work profession. These were: (1) broad social ^ t conditions, (2) ideological conflicts, and (3) oppressed populations. In this section J^, fjsthe community that would bear the most severe consequences of Lhis decision « we examine these same trends in terms of their influence on contemporary developments in the field. Broad Sociai Conditions The combined effect of population growth, urbanization, industrialization, and changes In institutional structures have created communities that are very different toda} than during the early years of the profession. Though these changes have Fostered improvements in areas such as health, income, transportation, and others, not all aspects of the transformation have been positive. Warren (1978) calls attention to these concerns, noting that "discerning Americans have come to the uneasy realization that all is not right with their community living, that undesirable situations appear with growing frequency or intensity and that these are not the jadventltious difficulty of one community or another so much as the parts of a general pattern of community living" (p. 14). Warren calls this the community problem, and as an element of the contemporary society, it is an important concern for macro practitioners. One aspect of this problem has to do with the consequences of urbanization. ■ Though diey offer many benefits, targe, complex cities also breed large, complex problems, and the very size and complexity of a community can interfere with solving these problems. One casualty of metropolitan growth. For example, is a sense, of solidarity within the community. Small-town shared views of the , common good may, in large cities, devolve into narrow parochialism based on units such as a single apartment building, an area of gang turf, or family and ethnic ' group affiliations. The greater the number of these communities within communities the more difficult it is to identify and serve the interests of the whole. Closely tied to these consequences of urbanization is the loss of geographic relevance of many communities. In small-town America, communities were largely defined in terms of residents' physical proximity, as well as commonalities such is topography, soil conditions, water supply, and other circumstances of proximity. People lived in the same place they worked, frequently remained there throughout their lives, and shared with their neighbors both fortune and mis- . fortune (droughts, floods, good and bad harvests, and so forth). In contrast, many cities are now so immense that residents in one area may share little with those in another in terms of their economic base, political environment, lifestyle, or even climate and terrain. Because geographic, legislative, and social boundaries often intermingle and evolve, it may be difficult even to define the boundaries of a given community. As residents' identification widi local connections has ebbed, the. importance-" ntextracommunity affiliations has greatly expanded. These affiliations define " the relationships between community organizations and related organizations outside the community. For example, an auto plant may be essential to the economy of a particular community, but its^most important ties may not be to « fhfe community but to the home office of its corporation in another city far away i decision to close the plant might come entirely from the home office, yet i^^ ^ 34 VALUES AND HISTORICAL PERSPECTIVES Loss of control over such decisions.renders the community extremely vulnerable yet an excessive concern for external affiliations may blind community members to critical local needs. In addition to community Issues, contemporary developments in the organi zational structure of human services are also important to consider. One parallel between communities and organizations is that both have continued to grow and become more complex. In the organizational realm, this has given rise to the bureaucratization of service systems. The term bureaucracy has taken on a number of mostly negative connotations which,, as we shall discuss in Chapter 6 may or may not always be accurate. Here we refer to bureaucratization as the growth in size and structural complexity of human service organizations. This has been especially true in public agencies, which have generally continued to expand since the New Deal. Bureaucratic organization is a means of structuring tasks and relationships . among organizational members in order to maximize operational efficiency. In many ways, this model has made possible the development of modern organi zations, and its advent coincides with the vast increase in productive capacity associated with the Industrial Revolution. The problem with bureaucracies is that they often become as machineÜke as the tools they employ, and the result can be a rigid and dehumanizing style of operation. This style usually grows more pronounced as the organization gets larger, and vast governmental human service agencies have become some of the most notorious examples of the negative aspects' of bureaucratic structure. Partly in response to this problem, privatization became a significant trend during the last two'decades. Although the term can be used in many ways, we define privatization as "the deciding, financing, or providing of human services by the private sector to clients for whom the public sector is responsible" (Netting et al. 1990). The trend may be more accurately termed reprivatization because of its focus on returning to the private sector for responding to human need Beginning in tlie 1960s, recognition of the limitations of government bureaucracies prompted growth in purchase of service contracting. Public agencies paid for services but they were provided to their clients by private organizations. Between 1973 and 1984, for example, nonprofit purchase of service contracts grew from $262.9 million to £664.1 million (Kettner & Martin 1987) Decision-making and financing functions remained governmental responsibilities whereas the function of providing services shifted to the private sector. This arrangement was probably well accepted in many communities, since going to a local nonprofit agency to receive services is often less stigmatizing for clients However, other trends accompanying the move toward privatization complicated the community service delivery system. During the early 1980s, conservative views toward human services, combined with an economic slowdown, led to decreased public funding and decentralization of decision making. This meant that many nonprofit agencies, which had pre viously grown larger on public dollars, were suddenly faced with stiff competition for very limited resources. For example, facing a shortage of patients, hospitals began diversifying into service areas other than primary health care (i.e., substance 2 / THE HISTORICAL HOOTS OF MACRO PRACTICE 35 abuse centers, home health, etc.). .For-profit organizations began moving into human service provision, seeking cUents who could pay for their own services. The effect of this trend on community human servic'e.systemshasbeen most acute in the provision of services to low-income.clients.. Formerly,!many of these clients were served by nonprofit agencies either through contracts with public agencies or through excess revenues from clients who were able to pay. Now, ^ government funds are more scarce and.paying clients áre. often siphoned off by hospitals and for-profit providers. Many nonprofit agencies no,-longer have resources to pay for services to poor clients and there is increasing competition I between nonprofits for the funds that are available (McMurtry et al. 1991). *' A final trend is die advent of computerization. Society is moving toward a f model in which,information and services rather than manufactured goods are the '"most important commodities. As this takes place, communities will change. Heavy industries will diminish in importance and even the traditional character of the TVprkplace will be altered, such as by workers remaining home, and carrying out fljeir tasks on computers. Moreover, the ability to tie into national and international .Computer networks will further enhance the importance of extra-community ties. Social workers' roles will inevitably be affected by these changes. For jexample, Ginsberg (1988) discusses how computer technology has facilitated storage of vast numbers of client records by large public and private human service 1 organizations. He cites government researchers who challenge social workers to use computer technology, noting that "social workers *h write reports and progress notes pull and read numerous files take case histories and develop diagnoses tap into local area resource networks keep in touch with,professional developments provide factors and figures to contribute to agency accountability process." (Parker et al. 19S7, cited in Ginsberg 1988, 71) , Still, other writers argue that these changes pose grave dangers for the profession. For example, Fabricant (1985) asserts that the computer revolution -as simply another manifestation of. an ongoing process of "desldlling" social r^jrorkers. One example he offers is the role of workers who determine eligibility J lor benefits such as AFDC and food stamps. These positions are often filled by s poori} trained and poorly paid clerical employees who simply input data into -computers, and these computers determine clients' eligibility. The pointis that ^ if social workers cannot learn to adapt to and control new technologies (as well f*ns other social trends we have discussed) they risk being controlled by them. „i ideological Conflicts ^As with the discussion of broad social conditions, Warren's (1978) notions of ■fitthe community problem also provide a starting point for addressing contemporary ideological trends. One issue concerns community members' increasing difficulty 68 THE COMMUNITY AS THE TARGET OF CHANGE 4 / UNDERSTANDING COMMUNITIES AMD COMMUNITY SOCIAL PROBLEMS 69 '- taBLE 4 1 The Community Encounter Framework understand something as complex .as a community, much less propose ways to change it? First, it should be made clear that there is no single accepted, orderly, systematic J^ i/SfU^—-----------------------------------___ method that allows one to understand all the dements that go into making up a o, "jjlydaniifylng >ha Target Population community. Understanding, for die macro practitioner, means gathering as much"> ■*■ data and information as passible in a narrowly focused area of Interest or concern 1r\^ Determining Community Characteristics and malting the best informed decisions the information will allow. _,^ % There are three reasons why macro practitioners need a systematic approach. W -. \ Recognizing Differences to conceptualizing a community and its social problems. First, the person in ~M ^ environment view is critical to professional social work practice. The communityij^ a A in which one lives has a lot to do with who that person is, the problems he q^M j,S n>|[ienllfying Structure she faces, and die resources available to deal with these problems. Professional ^f^F social work prescriptions may not be feasible or realistic without an understanding t| i 3 of these community influences. The framework presented here for iinHfTRfinH;nj. -&/- ib community is designed to assist in conceptualizing the environment within whicu|%^u ^ Task 1. Understand characteristics of target-population members 2. identify community boundaries 3. Profile sadai problems 4. Understand dominant values 5. Identify formal and covert mechanisms of oppression 6. Identify evidence of discrimination 7. Recognize locations of power B. Determine resource availability 9. identify patterns of rssource control and service delivery clients experience hope and draw strength, as well as face oppression and fiaistraüorW^f? Second, community-level macro change requires an understanding of thej$ history and development of a community as well as an analysis of its current statug "Without this knowledge, the practitioner has a limited grasp of the breadth *tnd: depth of values, attitudes, and traditions, and their significance in either mainly taming the status quo or allowing for change. * rf Third, communities constantly change. Individuals and groups move into.7 power, economic structures change, sources of funding change, and citizens roleSV change. A framework for understanding community can be helpful in recognizing" and interpreting these changes. W ^TvJirst selecdng a target population, and that the communiry be understood from Ope perspective of the concerns and needs of that population. The target Jš^únulation Is defined as those'individuals, families, and/or groups who are . -^Mgerlencing a problem or need, and for whose benefit some type of community * siu^ange is being considered. iv'TSrS The choice of a particular target population is a choice of values. In every ^■w^fjramunity there are multiple groups with varying needs. Therefore, the social "^Worker must realize that in focusing on oné target population, he or she is faking a choice to examine the community from a specific perspective. It A FRAMEWORK FOR CONCEPTUALIZING COMMUNITY A first step toward understanding community is creating a framework that wi help in comparing elements in one community to elements in another SomBg communities are larger than others, some have different ethnic makeups sona^ are wealthier than others. In searching for a framework to help understand community, we turn Warren (1978). In his classic, The Community in America, Warren proposes thai communities can be better understood if selected community variables are analyzed. Based on these variables, we have identified nine tasks that comprise* a four-step framework to be used in conceptualizing and understanding a? community. In subsequent chapters, we will present methods for planning changes1* based on this understanding. This framework Is shown in Table 4.1. $" Focus A: Identifying Target Populations Many approaches to community analysis propose that the community bf understood in its totality to the greatest extent possible before Intervention. If planned. We propose, instead, that the definition of community be narrowe li.be important, then, to go back and look at.the community again from l^-tíŕb.perspective of more than one target population so that a richer understand- ^Iqg^can develop. For example, existing reports on community Issues and aöüülations may predetermine what target group the practitioner will serve, widi (yp- limited opportunity to familiarize oneself with other community needs "concerns. p_We suggest that a community be analyzed and understood from this limited Ipspective because (1) practically speaking, people who become involved in |Kirarnuruty change are generally people with full-time Jobs, and it is not unusual :macro-level intervention responsibilities are added to those jobs; and (2) there flä|^ limit to the amount of information that can be used in macro-level inter- Sgtttlons In short, we don't disagree with those who suggest that, in the ideal, LT^Eveiything possible should be known and understoodabout a community. We JR^Wslmply"suggesting that, with limited time and resources, responsible change ÍftiJsB'rE£ can De initiated by narrowing the parameters of community analysis. ^^■^^identifying a population in need can, in itself, be complex. None of us is ftŠ^paťcof only one community. Community can be defined in terms of ethnicity ^[■§1 the Latino community), religion (e.g., the Jewish community), commitment řy£rŠJíÍE°sitidn (e.g., the pro-choice community), profession (e.g., die social work bj^if^unity), avocational interest (e.g., recreational and sports enthusiasts), and ''"yother designations. Each of us, in fact, would be more realistically defined part of many different communities at once. 70 THE COMMUNITY AS THE' TARGET OF CHANGE We recognize that there are differences in urban and rural communities and that this approach may be difficult in a rural community where members of the target population are geographically dispersed. We also caution the reader not to assume that the target population can be disengaged or isolated from the larger community, even though one may focus on the target population in order to manage this complex undertaking. In fact, members of the target population may already feel isolated from the larger community. Certainly, we do not want to reinforce this Isolationism. Brager, et al. (1987), view communities as being composed of people who have relationships that are systematic, interactive, and interdependent. These relationships are based on shared history, mutual expectations, predictable roles, values, norms, and patterns of status differentiation. These reiadonships are part of what constitutes individual identity; these reiadonships may be neutral or positive or negative; they may involve low to high degrees'of reciprocity and alienation, (p. 33) "Viewed graphically, a community would look lilce a series of overlapping circles As an individual, any person from a community, pictured graphically, might look lilce a circle subdivided into many different reference groups, as illustrated in^ Figure 4.1. By beginning with a population in need, we are suggesting that a person J attempting to understand a community first identify the population of focus. This \ begins a narrowing-down process. Inidal definitions of population can be broad ™ with the understanding that the more precise the definition selected, the morc^ feasible a full understanding of the community context for this population \ For example, issues surrounding alcoholism prompt a concern for macro Š level change,.the population of focus for a particular community analysis coulů í be "people with alcohol problems who live in Riverdale County" or "ethnic ti minority women alcoholics who have been convicted of driving while intoxicated^ within the past two years in Riverdale Count)7." One is more inclusive, the other H more focused. It is probably advisable, at this early stage, that a broader definition £ be adopted, with an understanding that it will become more precise as a clearer;|, understanding of needed change emerges. Once a population has been identified and the definition appropriate!)"? narrowed, all other dimensions of the community are explored arid examined^ from the perspective of that population. For each dimension to be explored, we j will identify a task intended to bring focus to the collection of data andj information. We will next focus on questions about the population. Finally^ we will propose some questions about a community that will aid in understand^ fjjfc ing each dimension, and in comparing it to other communities. Although thisj 3 ffi framework contains a number of tasks, the process of analyzing any comrhu . ^ nity requires the social worker to go back and forth, returning to refine previous J \j^ tasks as new information is gathered. The social worker is urged to use'the r^~ framework as an interactive guide rather than a rigid formula for approach j ^ 3ä 4 / UNDERSTANDING COMMUNITIES AND COMMUNITY SOCIAL PROBLEMS 71 FIGURE 4.1 The Individual" wllhin tlie Community i-ra ■\ JTask 1 Understand Characteristics of Target-Population Members. * --^uesuons to be asked: 'Str* in 7 ing community. 'i'fc* i*. /.i • What is known about the history of the target population in this community? • How many persons comprise the target population and what are their characteristics? • How do persons in the target population perceive their needs? ■ How do persons in the target population perceive their community and its responsiveness to their needs? In their book on community organization, Brager, et al. (1987), remind us that: demographic differences [do not] exhaust the variations among subgroups of the poor. Although attitudinal differences arc more difficult to define and identify, a w ide diversity of world views exists even within demographicaliy homogenous tSKSaajj 72 THE COMMUNITY AS THE TARGET OF CHANGE populations. Thus, some poor are moce alienated than others, some more upwardly aspiring, and some angrier. Where they fall on these dimensions has a bearing on how they will respond to particular efforts to involve them in organizing projects, (p. 60) It is precisely these shades of difference about the target population that the macro practitioner is attempting to understand. The study usually begins with an examination of available demographic data. Basic to any understanding is analysis of socioeconomic status, age, race, and gender by census tract. It is Important to identify areas of poverty and high need, and to determine whether the target populadon is heavily concentrated In these areas or spread across an entire county. In addition to gathering statistics, it is also important to talk with people who understand Its history, as perceived by the target population. Bellah, et al. (1985), explain why this Is important! A community Is a group of people who are socially interdependent, who participate together in discussion and decision-making, and who share certain practices that both define the community and are nurtured by it. Such a community is not quickly farmed. It almost always has a history and so is also a community of memory, defined in part by its past and its memory of its past, (p. 313) Examining the characteristics of the target population and Identifying where they are located, together with gathering information from die perspective of people in the target population, completes the first step in the community encounter. The following questions can be helpful in collecting and using data and information: 1. What are the key demographic characteristics of the target population.: and how do they compare to the demographic profile of the various;. political subdivisions (e.g. city, county, state, whichever is relevant)': within which the community is located? Key demographic characteristics should include at least socioeconomic status variables, trace, gender, and: age, by census tract. 2. Generally, how do people in this target population (and others close toj them) perceive their concerns, problems, issues, and/or needs? Do they; tend to see them in terms of a need for empowerment and freedom from, oppression? In terms of access to opportunity and removal of barriers?-. In terms of a need for resources, protection, or services? 3. Generally how do people in this target population perceive the corrunu-. nity's responsiveness to their concerns, problems, issues, and/or needs?; -I / UNDERSTANDING COMMUNITIES AND COMMUNITY SOCIAL PROBLEMS 73, ?j\---o. Focu5 B: Determining Community Characteristics Size is an important characteristic of a community, and can be assessed in a number J^» of ways. Size can be calculated in terms of the amount of space covered, bY-";|pg;. the number of people living within its boundaries, or both. It is an important jfc;^ characteristic for the macro practitioner because geographical boundaries established for macro-level interventions can range from neighborhood to county and even larger. Clearly the size of the community as defined will affect die nature of the macro-level analysis, and ultimately the intervention. Task 2: Identify Community Boundaries. Questions to be asked: • What are the geographical boundaries within which intervention on behalf of the target population will occur? • Where are members of the target population located within the geographical boundaries? • What physical barriers exist for the target population? • How compatible are jurisdictional boundaries of health and human service programs that serve the target population? Space is the distance or area covered by a community. It is one dimension of a community's size. Focusing on space allows the practitioner to establish manageable boundaries. If resources are available to focus on the entire city or county, then these may be appropriate boundaries in diat instance. If, however, the effort is to be undertaken by a small committee of volunteers who have limited time and resources available, then one may decide to focus the encounter on a limited part of the city where there appears to be die greatest need for intervention. Establishing boundaries for macro-level intervention, therefore, is initially done by focusing on a target population and, secondly, is further refined by selecting a geographical boundary. For most macro-level interventions we recommend beginning one's understanding of community by limiting boundaries to county or its equivalent, and focusing down from that level to more limited ^boundaries if appropriate. This is in no way intended to indicate that intervention at state, regional, or national levels Is not appropriate. It is simply to recognize ; that, for the vast majority of interventions, a level of county or smaller wili be .most relevant. Figure 4.2 illustrates the boundary-setting process. Knowing that one cannot address all target population needs within large arenas, the encounter focuses .on the target population within a manageable portion of the broader community. This becomes the focus of the macro-level intervention. A community may be a small section of the inner city or a fairly large expanse encompassing scattered farms in a rural area. For example, community as space Is applicable to barrios In which groups of Hispanic people reside within a larger metropolitan area. Spacial concepts of community are also relevant in less population-dense areas but may be more difficult to determine. This was painted out by a Navajo social worker who explained how difficult it was to determine ípacial boundaries on a reservation. There were no street systems, property information or signs indicating county lines, or well-defined human service areas. Another characteristic important in understanding community as space is jurisdictional units established by various government agencies for planning and 3iä go THE COMMUNITY AS THE TARGET OF CHANGE m requires (1) focused arid precise data collection, (2) analysis of historical irendsif Ä&fallieWOrk f Oľ COILCeptUalizÜlK ComOlUtlitV and (3) a thorough understandine of Qualitative elements that reflect hum^ifc ^íáŕl ■ .. ° J and (3) a thorough understanding of, qualitative elements that reflect humátrlÉ experiences, interactions, and relationships. ■ -^plŕííň REFERENCES S't^^räslc 1: Understand Characteristics ■■'■=^ai r's^rif Target-Population Members Barker, R. L. (1987) The social work dictionary. Silver Spring, MD: National Association,^ '$%$$ ' ■■• of Social Workers. Belenky, M. P., B. M. Clinchy, N. R. Goldberger, and J. M. Tarule. (1086) Women's wáyŠM ''MĚ&j of knowing. New York: Basic Boolcs. ' ytyjí ÍČ&M1.' APPENDIX 9ĚĚT ~~~ «§: ■'íS&íí3í3?ff;.;. sa----- í\ii - ">vsiä A: IDENTIFYING TARGET POPULATIONS Bellah, R.' N-, R. Madsen, W. M. Sullivan, A. Swldler, and S. M. Tip ton. (1985) Habits.pfft the heart: Individualism and commitment in American life. New York: Harper & Rófe^i falrS??*? Barrcra, M-, C. Munaz, and C. Ornelas. (1972) The barrio as an internal colony. Urbaiißpi Affairs Annual Review, 6: 480-98. V^Miß^^ Brnger, G., H. Specht, and j. L. Torczyner. (1987) Community organizing. New Yofl«#| |£f|Íí' BrSer^ídrÍ^aS Nancy R- Hooyman, edS. (1986) Not for women only. Silver SpdnÄ ÍÄIpCUS B: DETERMINING COMMUNITY CHARACTERISTICS MD; National Association of Social "Workers. '" ~i% ^ Hifc i&. Burke, E. M. (1963) Citizen participation strategies. Journal of the American Institute öf '■?$ Planners, 3^(5): 293- '1p Choldin, H. M. (1985) Cities and suburbs. New York: McGraw-Hill. ;;r: Cross, T. L., B.J. Bazron, K. W. Dennis, and M. R. Isaacs. (1989) Towards a culturally com-'r^, jpf:^, petent system of care, Washington, DC: Georgetown University Child Development Center?;-?! "Plfei Fellln, P. (1987) The community and the social worker. Itasca, IL: Peacock. '■£& fJpĽr_!V. Gillígan, C. (1982) In a different voice. Cambridge, MS: Harvard University Press. ;ť«?| |§p||V Jansson, B. S. (1988) The reluctant welfare state: A history of American social welfare^ policies. Belmont, CA: Wadsworth. , ^ Kettncr, P. M.,J. M. Daley, and A. W. Nichols. (1985) Initiating change in organization's]^. and communities. Monterey, CA: Brooks/Cole. ■'£]& King, S. W. and R. S. Mayers. (1984) A course syllabus on developing self-help groups^ É^IP5^ 3: among minority elderly *" * c 'Li'-',',="—'c ™" >->-- -->- *--.-•_.-._■—f------r™.«f.nn/«n:í!§p, .;,&■«=.■'. mental health and m Publication supported Margolis, R. J. (1990) Risking old age in America. Boulder, CO: Westview Press. -3| i^jlV Meenaghan, T., R. O. Washington, and R. M. Ryan. (1982) Macro practice in the humäii^h j|Jp2 services. New York: Free Press.'' " .^#SÉI!s Rabin, D. L. and P. Stockton. (1987) Long-term care for the elderly: A factbook. Oxford,.,^,.„^ England: Oxford University Press; ^JtíŠÉÄ' Specht, H. (1986) Social support, social networks, social exchange, and social work practice.',;,;?, Social Service Review, 60(2): 218-40. Tannen, D. (1990) You just don't widerstand. New York: William Morrow. Waring, M. (1988) If women counted. San Francisco: Harper & Row. Warren, R. L. (1978) The community in America (3rd ed.). Chicago: Rand McNalty, SMÍ What is known about the history of the target population in this community? How many persons comprise the target population and what are their characteristics? How do persons in the target population perceive their needs? How do persons in the target population perceive their community and Its responsiveness to their needs? Identify Community Boundaries What are the geographical boundaries within which intervention on behalf of the target population will occur? Where are members of the target population located within the geographical ' boundaries? What physical barriers exist for the target population? How compatible are jurisdictional boundaries of health and human service programs that serve the target population? Profile Social Problems What are the major social problems affecting the target population within this community? Are there subgroups of the target population that are experiencing major social problems? What data Is available on the identified social problems and how is available data used within the community? Who collects the data, and is this an ongoing process? fefoiTask 4: Understand Dominant Values .111! ■"!'---ic íSäfeší-' What cultural values, traditions, or beliefs are important to the target population? What are the predominant values that affect the target population within the community? What groups and individuals espouse these values and who opposes them? What are the value conflicts surrounding the target population? 92 THE COMMUNITY AS THE TARGET OF CHANGE FOCUS C: RECOGNIZING DIFFERENCES Task 5= Identify Formal and Covert Mechanisms of Oppression fgCHAPTER 5 » What differences are observed among members of Che target population? " What differences are observed between members of the target population rind^'tPVi' other groups within the community? "?-""T^vlr • How are target population differences viewed by the larger community? • In what way is the target population oppressed because of these differences?-. • What target population strengths can be identified and how might these strengths contribute to empowerment? Task 6: Identify Evidence of Discrimination ■ Are there barriers that inhibit the target population from becoming fully integrated into the community? ■ What forms of discrimination are experienced by the target population within the community? :.,...iV.,;.A.,.. FOCUS Dr IDENTIFYING STRUCTURE 4pS^ • What are the primary sources of funding (both local and extra community) foc-:^fe'lfV^ health and human services designed for die target population within the communltyřijK|jiíň;-'' ■ Are there strong leaders within the segment of the health and human service^jg!^^';^." community that serves the target population? r-;-^Ví^v:'' " What type of community power structure influences the service delivery network designed for the target population? _ _h_......._ Task 8: Determine Resource Availability ;;ľ?tóŕrí£ " What are the existing community agencies and groups currently seen as ma|pnk|u|f^';. service providers to the target population? '''0M'i^t^'.- Task 7: Recognize Locations of Power " What are the major funding sources for services to the target population? ■ What nonmonetary resources are needed and available? Task 9: Identify Patterns of Resource Control and Service Delivery Overview Introduction A Framework for Analyzing Community Human Service Systems Focus A: Understanding Need ■)-■ -(( Task 1: Identify the Target Population Task 2: Define a Continuum of Need Task 3: Assess Target Population Needs Task 4-, Identify Collective Community Needs Focus B: Identifying Auspice or Sponsoring Organizations Task 5= Examine Informal Service-Delivery Units Task 6: Examine Mediating Service-Delivery Units Task 7: Examine Formal Service-Delivery Units Focus C: Determining Systemic Competence Task S: Determine Linkages Between Units Summary References Appendix: je an assessment a^*RODUCTION What groups and associations advocate for and provide assistance to the tar|jĚ(|fe|^v population? ilipSl^/1^ situation where an assessment is called for, whether it be How is resource distribution to the target population influenced by Inieractip'^|®^;Wi.an.-individual, a family, or an entire community, it is helpful to use a framework, within the community? • .f|^pi^|^framework aids in identifying each of the variables to be examined, just as was gffohe in the previous chapter. Few such analytical frameworks are available for ir^fö^?5SSmS local community human service systems. In this chapter, we will propose How is resource disnribution to the target population influenced by extra-community forces? 94 THE COMMUNITY AS THE TARGET OF CHANGE 1« a conceptual approach intended.to permit a student or practitioner to exaniin^ífeibíTABLE 5-"í a constellation of services within a given locale to determine adequacy of existirirP^^S-"*—~~ ™ 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM Framework (or Assessing Community Human Service Systems 95 resources to deal with current or projected levels of need. '. .^'||M^^v^í-------------...... While we will use the term human service system to describe the focus ö3|l|frA-.L,ndBrstBnding Nead the assessment, we caution students and practitioners not to place too muchS®^" emphasis or credence in the term "system." There is rarely a master plan. Hurna'nfSI||S.ľ service systems are generally made up of loosely related or unrelated client-seryin|ppsff$l(n- idantlfying programs operating under a variety of auspices, rather than clearly planned parta^lli^k' DrgBn'zatlc that come together into a comprehensive whole. "We will attempt to present^pl^'v! framework for assessing the extent to which this network of existing resourcöl&il^- Determining Systemic Competence is capable of meeting need. Tasks Auspice or Sponsoring Ions A FRAMEWORK FOR ANALYZING COMMUNITY HUMAN SERVICE SYSTEMS 1. Identify the target population 2. Define a continuum ol need 3. Assess target population needs 4. Identify collective community needs 5. Examine informal service-delivery units 6. Examine mediating service-delivery units 7. Examine formal service-delivery units 8. Determine linkages between units" ť'^|fe^§iarě■common to that culture" (p. 2). Because the characteristics of community ■-■i^-fe^|rěsidents vary, there may be subgroups that require special attention. For example, ''-"^E^fcíf-'í1 community has a high proportion of retirees, one can expect that many of assessed Sp&-- its people, and (3) that the needs of the people in a community should be ■ not only In terms of individual need, but also in terms of collective need. Following these assumptions, we propose a framework for analyzing anrfg flippy evaluating a community's human service system. The tasks that comprise ú^JÉII^fe'"' framework are shown in Table 5.1. í ~-'jŘ SfiŔfeítôund these categories: examine^ &á^?i .eed. '^tpípÉp- ■ ■ •■isla ä™'äí5?iiíV Focus A: Understanding Need Task 1: Identify the Target Population. Questions to be asked: For the sake of discussion, consider the following seven target populations, frequendy used for planning purposes, and funding tends to be clustered Children Youdi Families Older adults Adults Developmentally challenged Physically challenged "What target populations are identified within the Community, and how are they categorized? "What target population will be the focus of this assessment? What priority is given to the needs of the target population in this; ;^Bptample' U ^ ^^ P°Pulation is children, it is important to recognize that ^Obviously, these groups are neither exhaustive nor mutually exclusive. In addition, - >^EM^tliey do not specify the many subgroups that fall within each category. For community? ■■f^j^^ÉEhildren come from families of ^!§|0]||lpBroups, and locations within a c all socioeconomic statuses, racial and ethnic řj-yji.ifi*-L'"jJi'1 U.UU lULnuuua wiLtiiii a. community. People who are identified as being in a target population are consumers.Q^pŠ?|fe- Although we have identified seven categories of people who may have services, and ideally the services provided are designed to meet their neeii^|^0jiprnrnon characteristics and needs, individual communities will have their own However, it is important to recognize that people's needs are always changiugp^^^éfimtions of target populations. How does the community categorize client This requires a human service system that has flexbility to respond to changiŕjfeM^fetgĽoups for planning purposes? Local and regional planning agencies, United "Ways, needs: Gonzalez, et al. (19915, remind us that even cultural identity changes. "On^l^^Éqmmunity councils, and associations of agencies often produce agreed-upon can always expect to find both change and diversity within any coirimum^:.%||g^^caassification schemes for data collection and planning purposes. Regardless of fact, even a community that appears to represent one culture or cultural Sr°V^1^^šIřÍÉistinS categories, it is ultimately the task of the individual or group conducting will actually be quite mixed, demonstrating a range of behaviors and beliefs ^f^^^fe^ community assessment to define the target population. i r 1___J—\ 9B THE COMMUNITY AS THE TARGET OF CHANGE TABLE 5.2 Community Service Identification Widows Aged S5+ Living Alone in West Kingston Type of Need Services Typically Designed to Meet Need Services Available In This Community 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 99 Sell-actualization NeBds Esteem Needs Social Needs Safety and Security Needs Survival Needs Education Programs Volunteer Opportunities Support Groups Psychosocial Counseling Mental Health Centers Recreational and Social Groups Senior Centers Home Visitors Emergency Response System Adult Family Homes Congregate Care Facilities Senior Housing Continuing Care Retirement Communltleš-Wellness Clinics Telephone Contact Home Delivered Meats Senior Discounts Mobile Meals Transportation H am e m alter HomB Health Personal Care Medical Care Available at Kingston Senior Center Two support groups Mental health center has limited services One senior center t[]e community; (4) key informant surveys that focus on knowledgeable and -influential community residents; (5) secondary data analysis of existing statistics i0ri the target population; (6) review of social indicators such as income or ■"' oCCupational levels of the target population; (7) administrative or managerial '- jecof d review; and (S) review of information from other agencies (Meenaghan _£al 1982). ' :ff j The preferred approach in assessing need for a particular population is to :*~ 2mSC e-visting data. Original data collection is expensive and time-consuming, and £js usually beyond the scope of the macro practitioner unless a particular change ~ effort has widespread community and financial backing. Table 5-3 summarizes ' fk^e advantages and disadvantages using each approach'. No emergency system Three unlicensed homes Ohb congregate facility No senior housing No retirement community Public health department has wellness clinic Church runs telephone reassurance program Limited delivered meals program Twenty mobile meals slots No bus system, one senior van available One licensed homemaker program-'Js No home health provider ! ~" V^L Ideally, the macro practitioner would like to know (1) the number of people -4 Mb ifn the target population who are experiencing each problem, and (2) the number "f ^ of people that can be served using existing resources. The First number minus 1 b, fjie. second, number presents the community's unmet need. Unmet need, inade- „ jjjnuateiy met need, or inappropriately met need are frequently the focus of macro--Jh-' I "With special population groups that require multiple services, classification 3 , LIABLE 5 3 # "Plevel change efforts. I "With special pop , .schemes are often based on the concept of a continuum of care. A continuum Needs Assessment Methods: Advantages and Disadvantages [[ifttiod Description Advantages Disadvantages '$neral Two licensed personal care agennlBSír'fSfĽr: , „ Ono nnmm,mll„ hn.nllt.1 nnri nna t&tlfe*E^Illation purveys . %gfet npÄpiJlalion One community hospital and one nursing home -."* such as art and language (cultural); for learning from the past (historical); for the«" use of power (political); for viewing the past, present and future through actloa Jsj words and movement (creative/spiritual); and for explanations that connect wharf u| happens in one's world through investigation and experimentation (intellectual) ^ Task 3: Assess Target Population Needs. Question to be asked: -|i surveys " i provider „"SEHlrvays IÍJglarmant iSbrvays Interviews with community residents Interviews with e select group Interviews with providers that service target population Interviews with knowledgeable/influential residents t-JäBCQndary Analyzing existing data What are feasible and appropriate ways in which to find out how many people are in need in each of the areas identified as relevant tu ^ this target population? *¥-C5.L \fe£ Öüralysis Vindicators ■ft %Hi, Eight general methods of approaching a needs assessment have been discussed 1 yjtad in die literature. They include (1) general population surveys, which consistof 5) *h Jsi/law interviews with a sample of community residents; (2) target population survejS ^ ^ Jpmation that interview members of a select group; (3) service provider surveys, which i; yjÉJgL interview those groups and organizations that serve the target population within iV "1 Reviews ol data such as incomB, age, occupation Review administrative/ managerial documentation Review any other data from county, state, local agencies Provides broad overview o( needs Obtains data directly from target Gives perspective from those who serve the target group Provides a community leaders' perspective Data Is already collected and usually accessible . Data Is available and provides broad overview of community Provides insights Into major issues and concerns May provide new information not available elsewhere Requires great time and expense Often difficult to locate survey respondents, is time-consuming and costly Providers may be professionally biased Community leaders may represent power structure, but may not represent target Analysis is restricted by what data was collected Indicators do not provide detailed information Is subjective and may be difficult to access May be difficult to locate I 1 r - > 3 í f B .. ff E. f 1 J 1 í E. -,R|?Hl____i ä. 'i E 100 THE COMMUNITY AS THE TARGET OF CHANGE 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 101 TABLE 5.4 Continuum of Long-Tarm Cars Services by Category In-home Services Outreach Information and Referral Comprehensive Geriatrie Assessment Emergency Response Syslsm Companionship/Friendly Visiting Telephone Reassurance Caregiver Respite Services Homemaker end Chore Services Household Repair Services Personal Care-Home Delivered Meals Home Health In-HamB High Technology Therapy Hospice Co m m unity-based Services Case Management Transportation Senior Centers Senior Discount Programs Recreational Activities Caregiver Support Groups Self-help Groups Counseling Foster Homes Adult Care Homes Shared Housing Congregate Housing Wellness and Health Promotion Clinics Geriatric Assessment Clinics Physician Services Aduit Day Care Mental Health Clinics Outpatient Clinics Institutional Services Alcohol and Drug Treatment Rehabilitation Psychiatric Care Swing Beds Skilled Nursing Care Extended Care l?;y . What we have discussed thus far is really individual need experienced by *"'■•'If': many people. When one person is hungry, it is an individual problem. When —.. £:'' hundreds of people are hungry and the community is not prepared to feed diem, ; K. jt becomes a social problem. When needs clearly outstrip resources, it is a '"•' !'■:' '^oniraunitywide problem and may require a human service response. More food m'panics, more homeless shelters, and more employment training services may be ■::L'.'-'needed. It is important to note, however, that just because social workers believe I,-'"that a community should respond to a problem does not mean that this belief .''KÍVtfill be shared by everyone in that community. '/K;;-- There is yet another perspective on need that should be understood by.the "^ fvl':--"macro practitioner. It is a need that requires something other than á human service I'p-tesponse. It may even require some fundamental redesign of structures and ' ':§^systems. As discussed In the previous chapter, structure and power are important '" »-^variables for community analysis. Wlien a whole community suffers from inferior ^-PÍKousing, transportation, or schools, or from an inadequate economic base, these -'-#i:problems may be more than simply individual problems on a large scale. They \-i*tes[iould be understood as collective needs. -:~|K:'i/ It is an assumption in the social work field that communities need adequately ~. ^functioning basic systems to achieve at least a minimally acceptable quality of — /ffilife. They need an economic base that will produce jobs and income. They need ■-;'.ff^ifordable housing, adequate transportation, sound community health practices, § ^protection from disease, good quality and relevant education for their children, — r ^protection Trom harm and violence, and freedom to pursue obligations and rl^ihterests without fear. When these conditions are absent, a service response (more ' ti'lfliioney, more resources of any kind) may provide temporary relief without dealing of care consists of a broad menu of services from which items can be selecteüVM^ith fundamental structural problems. to address the specific heeds of certain individuals or groups. Conceivably, each). menu will vary based on what is needed for the target population served. Table 5-.4Í provides one method of classifying continuum of care services for those persons? requiring long-term care. '.'; Task 4: Identify Collective Community Needs. Questions to be asked:. r ■ Are there needs In this community that require something other than ; a human service response? » What data supports the existence of these needs? '•::- a How are these needs expressed by the people of this community? While understanding need and examining community responses to each level? are important steps In conceptualizing a hierarchy, this is not enough. Need is any elusive, complex concept that must be understood from a variety of perspectives;? At the simplest level are needs experienced by individuals that require some;, type of response: a hungry person needs food; an unemployed person needs a' job. If there axe resources to meet these needs, the needy person is matched.urj; with the resources and the need is met. The long-term need may be for collective empowerment, a collective sense of ^dignity, full participation in decisions that affect die lives of people in the communitv, :f '^self-direction, and self-control. Assessing collective need requires an understanding l&pi rhe history and development of the community, an ability to compare economic *v:-.data and social problem data to other surrounding communities, and a sensitivity |y!tb. the needs and aspirations of those who live in the community. Collective need ■ ;£ipay also need to be addressed at another level such as the state legislature or U.S. ^Congress. The focus can remain on the local community where actions can be taitenf fi;_but the point of intervention may be outside the community. • fe|. When collective need for empowerment, participation, control and oďier such ^factors Is identified or expressed, the role of the macro practitioner is different from l^the role taken when the need is for a human service response. These roles will be Sgpscussed in Part TV (Chapters 8 through 10). ;|'||bcus B: Identifying Auspice yipr Sponsoring Organizations ■jj^íííí assessing and understanding a community's human service system, it is Important ^ífrexamine the sponsoring unit or organization. Table 5.5 Identifies the types of |*Wiit5 that should be considered when assessing service provision in a community. 102 THE COMMUNITY AS THE TARGET OF CHANGE TABLE 5.5 .Units Within the Health and Human Service Dslivery System Informal Units Household Units Neighborhood/Groups Mediating Units SBlf-help Groups Voluntary Associations Formal Units Nonprofit Agencies Public Agencies For-profit Agencies These units, taken together, comprise the total health and human service. * delivery system within the community, each operating inter dep endently. A given community, depending on availability of resources, may emphasize the provision funded formal services can be obtained. However, in all communities, elements oft informal, mediating, and formal service units will be found. The astute practitioner will carefully assess all avenues of service delivery for the target population -' -1 TaskS: Examine Informal Service-Delivery Units. Questions to be asked "^ j- ■ What informal units would typically assist the target population within a local community? * What importance does the household unit have to the target population within this community? ■ "What importance do natural support systems or social networks have ^ to the target population within this community? • What informal units are actively engaged in service delivery to the target population within this community? » Are race, ethnicity, or gender factors in the provision of informal services and support? 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 103 equivalent to the household, but in recent decades more and more people have yved together in dwelling units without being related, making household a more broadly useful term" (Smith 1991, 138)/ Service provision in this unit generally takes the form of caregiving and tends "to fall heavily on women In our society. The potential for caregiver burden or strain suggests that mutual support provided jq the informal system may require assistance from others within the community. Respite services are often needed in the interest of sustaining the physical and nientil well-being of the caregiver. In assessing the extent of service provided in household units within a given community, one should look for indicators of what is happening within private dwellings for the target population. For example, are identified caregivers within the community overburdened? Is there an.identified need for respite sendees for caregivers of the physically disabled, developmentally disabled, elderly, and/or I '-young children? Are requests for live-ins and shared housing increasing? Answers " ^o these and related questions will aid in the process of assessing the domestic dwelling as a service-delivery unit. £. Of particular concern is identifying the importance of the household unit Ij^lbr the target population. For. example, if the target population consists of frail trSwadows living alone, the household unit does not contain others who can assist. of services through one set of units more thananother. For example, inaresource , poor community, reliance on informal units may be a necessity until pubücly^t*',°^y ^caregivers not available, but formerly active older women may ' -»'■ ^uddenly find themselves alone after years of providing care to children and ^spouses. On the other hand, target populations such as inner-city children, who f^ often live in crowded households where privacy is limited and tension is high, L^jna.} draw support from siblings, peers, and parents. Respite for single mothers ^ma> be difficult to locate; poverty may have reduced opportunities and life ^C^choices Yet the household unit can be a critical source of support for these children, p i^fragHe as it may be. Recognizing the household unit as a source of community £ Istrength and developing services to support this unit can produce a double benefit * Jui strengüierüng families and reducing the need for other support services. Iftfatural Support Systems anď Social Networks. Often, an unstructured, informal ^ -approach to mutual support will evolve as natural or social support systems develop. /Must people are part of social networks, but this in itself does not constitute a natural ' ^support system. A natural support system, according to Mclntyre (1936), exists when ™ resources have actually been exchanged. ~p.!\ The existence of natural support systems have been recognized for years. :,. Accent studies and an emphasis on informal support have prompted a more intense ^examination, particularly among minority and aging populations (Specht 1986). Because networks do not have established boundaries and depend upon L r* — Informal units are those that are not publicly incorporated as legal enhto, "^^ to deliver health and human services. Often, these units have not been recogn^d |^ ^ ^ CQmm Mumal ^ ^ ^ fae ded for their importance m the service delivery^system, whereas &ey in fact perfom |pograptü ^ ^ ^ ^ mcaI1 cl ^^ members. a vast assortment of mutual support tasks. They include the household unit ana if n11!np-c_ j „Dm,„ i ,. „ -n j ^ 1S , . w« Ul !uuu «a o ťť j _ŕ uispersed networks will depend upon linkages such as transportation systems 41 3d- telephones, and may, dierefore, be vulnerable in times of crisis. Balgopal 0988) explains the-importance of social networks; natural support systems and social networks. Household Units, The household unit consists of those persons who reside If within a common dwelling, whether they consider themselves famliies, significant A others, friends, partners, or roommates. "The concept of the family is roughlT f ~\ Social networks such as kin, friends, neighbors, and coworkers are suppor-■^_ tive environmental resources that function as important instruments of help, 104 THE COMMUNITY AS THE TARGET OF CHANGE especially during times of crisis. Social networks provide emotional resources and strength for meeting the need of human relatedness, recognition, and affirmation. They also serve as mutual aid systems for the exchange of resources such as money, emotional support, housing, and child care. Well-developed social networks often consciously and purposefully serve as helpers to families in crisis, making it unnecessary for these families to resort to institutionalized services through publicly and privately supported health and welfare agencies. The concept of a family's social network emphasizes the idea of the family with multiple affiliations, some of which overlap and some of which do not, as well as the idea of the family as an active selector, manipulator, and creator of its environment, (p. 18) 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 105 Depending on the target population identified, self-help groups rasy be more :"-'fŕ'ifnrless important. For example, groups that already have access to the service ^'ľ:fe:ji,steni 2nd its resources may find diem less necessary, while populations that ■'■ "W^ce struggling to have their needs recognized may find them extremely helpful ^'ť'-ífii supporting their efforts. 1: i'i. J.cW-:-í-'■ ''.;■*££''■ :r ! -M^j\icihintary> Associations. Voluntary associations often serve as a bridge between -:'fe:qhe informal and formal components of a human service system. Voluntary -■•■;:/;^čf*iŽsociation is defined as "a structured group whose members have united for ;-.i£i \Qj$e purpose of advancing an interest or achieving some social purpose. Theirs ,vf i • t i i •„ u i j- f „i. * , p ■ e '"(rž lr-řis:'a'clear aim toward a chosen form of 'social betterment' " (Van Til 1988, 81. Within the local community there are Indicators of the extent of informal'-- r:-K? ľ' . , .,_,,._, . . ,,.,,-,,., , , . . . , „B.T.UUUM ,.__-.-,, i .._,-•'! £!í.eanimunity groups such as neighborhood associations or local churches fall within neichborhood groups and support systems. Neighborhood associations, cluldi-d =#■#". c- •■ ,(, , ■ , , , , . . K . , , . . . . :, t. n j u * e i..'í-fc'fííhiš" category. Similar to self-help groups, voluntary associations vary in their care exchanges, and neiqhbor-to-neighbor interaction are all indicators of th£v.J<=". „ ,. , „, ,_ L , . , r .,, c ^ -i Z, „-*t • .u- i,. rÄ&i&íleeree of formalization. Since they are membership groups, a dues structure will extent of support available within this unit. / -^fe; b ,, , „, c , . , .. . , ť .,,„,, _. , ,„ r ' , . . , _ , ..i j '■?< r*:'öften be in place. Therefore, tlieir boundaries become mare ciearlv defined than The significance of natural support systems and social networks will depend^:§4%".^ . ť . ' , . , ^*~*>-*y u^n^u uiw , . ii j c j -j • ■■ l{X~- feinformal groups in terms of mose who are paying members and those who are not on the target population. Networks diat advocate for and provide ongoing suppon^Ké'p" „ , ■ , t. i i_ U1^"-ía *"1U Lllua^- wuu ,U1-tlUL- ■ , , , , ,. ., .,- j c , . . ; ^■?¥#=/■:- Voluntary associations have several characteristics. Members share a sense for the target population should be identified as a part of die human service system^/fr%.c- , J .. . , . „ . . . . " ., , , ° ^ ť ■■.jjj'i, (íyprcommunity, which provides a collective identity. Social status may be enhanced ■;•;-£; &$$■'membership; social control may be exercised over members. A function of í: Examine Mediating Service-Delivery Units. Questions to be aslo^gay^ association may be to enhance the well-being of its members in a supportive . '5í ^manner. If the association is strong, it may serve as a powerful force to non-: What mediating units would typically assist the target population sg| ^Jgembers. This influence may be positive or negative (Williams & Williams 1984). within a local community? ,;;.% 'tßfhz example, associations such as the Ku Klux Klan are powerful yet destructive What self-help groups are available to the target population within ;.i;^ pfforces within certain communities. this community? £% l.^r;'' Voluntary associations are a study in inclusiveness as well as exclusiveness. What voluntary associations have members from, or take an interest:v jÄ^Uams Md Williams (1984) discuss the importance of the black church in the in the target population within this community? ':?M gjlevdopment and growth of mutual aid societies. Historically, many mainstream , , -ufi ^activities beyond the church were closed to blades who migrated to urban centers. What mediating units are actively engaged m service delivery to the; ^ hC^,^ organized voluntary associate is cnmmimitv? .■■■-'$&£■::..-. ... .... . Task 6: target population within this community? associations in the church in such forms as sick and ''^fiiJIpfiMal societies, economic self-help groups, mission societies, and various secret ■ -,:;M||^d fraternal orders" (Williams Sc Williams 1984, 21). Voluntary associations Self-help Groups. Self-help groups are one of the fastest growing elements oĚaĚ^jvfthin the black church became an adaptive mechanism to deal widi discrimi-communiry support. They have been formed to deal with a variety of personálu ŕ^flation. Numerous studies report higher participation rates of blades in voluntary and social problems and needs including bereavement and loss, depressioh,^|řašsDCÍatíons than for any other groups (Florin et al. 1986). In fact, ethnic minorities, parenting, and many other issues. A number of self-help groups (probably thé-^^]esbians and gays, and other oppressed groups may generally use informal and best known being Alcoholics Anonymous) have formed national and internaÜonall;£p^ediating units to a larger degree than other populations. Neighborhood groups, chapters and are recognized vehicles of service delivery. ^;|;ftvSeIf-help groups, and voluntary associations serve as means of mutual support, as Hutcheson and Dominguez (1986) acknowledge the importance of ethriic^pgpplace for clarifying perspectives, and as a focal point for action. In some cases self-help groups in their research on Hispanics. Because language and cultairaTJ-M^cse activities lead to recognition and wider support, and to improved access to barriers can confront ethnic populations, self-help groups assist in mamtainta^p=jEJi& existing formal units of human service delivery in a community. community identity and involvement. V-? I?íj£'^ *n assessing available services for a target population, it is important that the Self-help groups are often viewed as being compatible with a feminišt^y|£|nacro practitioner identify voluntary associations. Churches, unions, and perspective as well. Such groups are directed at widows, women who have beeo^i-;fe;j|rofessional groups are all potential sources of support for the target population. exploited or abused, and caregivers. Mutual support provided through self-helpi-íp^liey may not be listed in human service directories, yet they may be the first groups may assist in protecting the mental and physical health of caregiverSiu^Kj^Sburce to which some people turn when in need. 106 THE COMMUNITY AS THE.TARGET OF CHANGE Task 7: Examine Formal Service-Delivery Units. Questions to be asked ■ "What nonprofit agencies deliver services to the target population within this community?' • What public agencies deliver services to the target population within .this community? • What for-profit agencies deliver services to the target population within this community? . . " Are there differences in service delivery across formal units that appear to be based on race or ethnicity, gender, affectional preference, disability, or age? In this section, we are concerned with formal vehicles of health and human service delivery. Although these service.providers are interconnected in numerous ways, we shall examine them according to three types of auspice: r Nonprofit (voluntary) Public (governmental) For-profit (commercial) Nonprofit Agencies. As voluntary associations become more formalized, they may become incorporated as nonprofit agencies, recognized as publicly chartered tax free organizations (Van Til 1988). There are many types of nonprofit agencies bub here we will focus on nonprofit human service agencies, defined by Kramer (1981) as: "those [organizations] that are essentially bureaucratic in structure, governed bj an elected volunteer board of directors, [and] employing professional or volunteer staff to provide a continuing human service to a clientele in the community" (p 9) t : Nonprofit agencies are formal vehicles of health and human service delivery ŕ They are often viewed traditionally within local communities as the agency of ^ choice—a voluntary initiative that targets a specialized clientele. This traditional^ view is based on the early welfare system in this country which arose from a £ profusion of agencies sponsored by various religious and secular groups. ' Today, health services represents 51 percent of the operating expenditures within the nonprofit sector (Hodgkinson & Weitzman 1989, 22). Health services primarily includes hospitals, nursing and personal-care facilities, and outpatient j care and allied services. The 1982 Census of Service Industries indicated that there were 52,571 nonprofit human service organizations in the United States (U S Department of Commerce 1984). Although expenditures within this sector had t 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 107 j i ft regard to race or gender, diere is a growing trend toward agencies designed to serve die special needs of ethnic minority communities and families, women who are victims of discrimination and/or violence, and other groups underserved by more traditional agencies. The macro praeddoner should identify which nonprofit agencies Ser\ e die target population and whether they have particular service emphases. public Agencies. The public sector consists of federai, state, regional, county and city government entities. When the mutual support function is performed by government, it is referred to as social welfare. The United States social welfare sjstem has been described as a "patchwork quilt" which "does not represent ,1 coordinated, comprehensive, integrated, and nonredundant series of social welfare services-, instead, it is a helter-skelter mix of programs and policies that defy a systematic understanding of the welfare state" (Karger & Stoesz 1990,167). By the time federal'programs are operatiónalized within.the local community, they have usually gone through several levels of bureaucracy. Depending on the structure, which will vary by program type. there may be several extracommunity levels through which dollars have flowed. There may be regional as well as state mandates, rules, regulations, and procedures that instruct local providers regarding whit tbey can and cannot do. Local decision maldng and autonomy will vary depending on the policies that drive a particular program. In short, extracom-munity sources have a definite influence on the local delivery of public services. In assessing a community's human service system, it is important to gain knowledge about policies and programs that affect the target population. For .example, worldngwith the elderly means that one must be familiar with the Older .Americans Act. Familiarity with the Older Americans Act tells us that there is a designated state unit on aging in every state and a network of area agencies on aging (AAAs). Every state must have a three- to five-year plan for services to the jr- elderly, and each AAA must have a more localized plan. Therefore, every t ^community within the United States will be included in a plan diat addresses the needs of the elderly. Experience suggests that this does not mean that every ^""community meets the needs of their elderly members. Resources will be limited, i and actually carrying out the plan will include the use of Older Americans Act ^dollirs, in partnership with other public and private initiatives. In addition, many \ 5 communities have waiting lists for services, and state cornrnitments to carrying out the objectives of the federal legislation vary. If one's target papulation is single mothers receiving Aid to Families with \~s v Dependent Children (AFDC), the social worker will need to know that states vary in what income is counted against benefits received. States also establish their íŕV 01vn needs standard for families in that state. Therefore, although AFDC Í5 a large risen until the early 1980s, federal budget cuts caused some declines In growth * * J^blic assistance program developed at the federal level, state-level decisions r influence the benefits families receive. To be effective, the social worker will need lo understand how federal and state governments Interact and how community £ attitudes toward AFDC recipients influence clients. ft - In assessing the distribution of public resources across an entire community, including the funding of social service programs, it is important once again to Many agencies reacted to budget cuts by increasing their revenues from duts j j fees and charges (Hodgkinson & Weitzman 1986, 111). Therefore, nonprofit ^ agencies often charge fees and have expanded over the years through the infusion of government funds. Nonprofit agencies provide many different services within local communities While all nonprofit agencies using government funding serve clients without £1 famine community practices from the perspective of special populations ■~.....t_ a i—s—uf t I M i t.....ť 'L * l. „i L JH.. J L-MJ Li U_i 1_J L_fr L J -L.1 U_fr LÍ 108 THE COMMUNITY AS THE TARGET OF CHANGE Voluntary associations often serve as advocates for their members and have had varying degrees of success in influencing the allocation of resources. In many communities the elderly have been highly successful in these efforts, but attention to the needs of children varies. Ethnic minority groups have exercised increasing . , political power over the last few decades, but still find, in many' communities,, ' that their Interests and needs are considered a low priority. Lesbian and gay groups ::' have increasingly taken up causes such as funding for AIDS research, and have, i participated in the political arena to Influence allocation of resources, but they.: '..' still face widespread discrimination. Understanding the political system within the community is a challenge, in.. . the United States, jurisdiction over health and human service programs is,;,.; "distributed across municipal, county, state, and federal governments, in addition..: to specialized governmental units such as school districts, housing authorities,..' and regional and metropolitan governments" (Brager et al. 1987, 20). '.- Assessing the public sector requires stamina. Not only are there federal; ': statutes, regulations, administrative rules, and funding formulae to contend with;.', '■' but there are state and local laws and funding procedures to identify. Professional .-colleagues, however, can provide perspectives on types of services and whether- -\ government is truly addressing the needs of the target population. Eor example,.-for macro practitioners working in a public housing development, social workers-in other developments will be helpful In interpreting how regulations assist as.; well as constrain their efforts. Locating colleagues in similar settings is important to developing a professional support system to aid in coping with public policies,.; procedures, and rules. For-profit Agencies. In the past, the for-profit or commercial sector assumed/ a lesser role in providing mutual support within the community than either the' nonprofit or public sector. However, this does not discount the role corporate -foundations have played In funding programs that benefit local communities or-the many corporations that have provided employee benefits addressing health) human service, and retirement needs. Indeed, a growing number of social workers-are involved in the corporate workplace through employee assistance programs* (EAFs). These programs have developed as corporations realize that productive employees are those who are supported in all aspects of their lives (Abramovitz & Epstein 1983). In an aging society, some large corporations have created elder-care support networks for employees caring for aged parents. In the last decade, the actual delivery of health and human services has been. increasingly carried out by for-profit corporations. For example, the majority of-•nursing homes are now for-profit organizations (Margolis 1990, 154). According to Gronbjerg (1987), the entry of proprietary or for-profit organizations into any-given service area is marked by a cooling effect on the relationship between the public and nonprofit sectors. Because proprietary organizations tend to dominate ■within the economy, patterns of interaction shift. These shifting patterns were first noticed in the health care arena, when proprietary hospitals began competing with traditional nonprofit providers*; mf 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 109 :m>. iMJ-;< ťW":> Marmor, et al. (1987), explain this shift in terms of a life-cycle model involving fthese Steps: >. A new service is developed by nonprofits; ' i; the service is broadly accepted; use in the proprietary sector increases; policymakers become concerned about those unable to pay for this service. First, a new service is developed through technical or social innovation. Typically, these efforts are initiated by nonprofits because new services are normally expensive and require subsidization from private or public sources. Second, once ■die service Is well-received, broad acceptance follows. Third, interest from the proprietary sector is sparked and proprietary organizations enter the arena, competing with the nonprofit providers. In efforts to keep up with the competition, nonprofit providers begin behaving much like their for-profit competitors. Last, policymakers become concerned about those persons who cannot pay for the service because both for-profit and nonprofit organizations are .'competing for those who can pay. If the service is important enough, the public sector will finance the poor and uninsured, "which in turn tends to reduce the importance of charitable provision of care by private nonprofit agencies" (p. 229). inevitably, some consumers fall into the gaps—not being able to purchase the service themselves, but not qualifying under the strict eligibility criteria set for public subsidy. iThis life-cycle model reflects patterns identified in the health care field, as proprietary ^corporations have begun competing with nonprofits in die community. V public financing of health care through private mechanisms was only the -beginning.. StoesE (1988) tells us more: By the 1980s, human service corporations had established prominence in child care, ambulatory health care, substance abuse and psychiatric care, home care, and life care. Increasingly, proprietary firms obtained funds for facilities through commercial loans or sales of stock and met ongoing costs by charging fees to individuals, companies, and nongovernmental third parties. Insofar as resources for human service corporations were noc provided by the state, firms were free to function independently of the government, (pp. 54-5) ■'liO^,-. As profit-making corporations bid for public contracts, competition with ;rS:Snonprofit organizations increases. Ten years ago our discussion of the health and inhuman service systems would have focused almost entirely on the government :£il/and nonprofit sectors and their partnership. Today, as we approach the twenty-|i^:first century, the term mixed economy, including government, nonprofit, and |-sif for-profit services is clearly a more accurate description. ÍÍIkV Given the complexity of the formal service delivery system, the purpose of ' ífílfthis assessment ts to gain a better understanding of what organizations are UM',providing services to the target population in this community. Having a general Í4.|?'idea of what nonprofit, public, and for-profit agencies are available leads to an ■ !§§:p£aminatian of h°w ^Y worIi together. J^p. m m 110 THE COMMUNITY AS THE TARGET OF CHANGE Focus C: Determining Systemic Competence Knowing what agencies are available does not go -far enough. It is important for the macro practitioner to know whether or not those, agencies actually work together so that target groups do not fall through,gaps in the service-delivery-system.' The next am task/ in the assessment process thus examine the linkages that are evident to the practitioner and require a judgment as to whether these. interacting units truly comprise a system that is responsive to multiple needs Task. 8: Determine Linkages Between Units. Questions to be asked • How are the various types of service units generally connected within a community? ■ "What are the established linkages between units that serve the target population within this community? ■ Where are linkages between service units obviously needed, but not currendy established? " Are the interests of ethnic minorities and women represented in the network established through linkages between units? If there are multiple agencies with overlapping relationships and numerous types of services, Is there a glue that holds the community delivery system together? Certainly there may be competition among units, but there will also be connections. Just as the individual is embedded in a social network, so are the group and organizational units within the community. These relational patterns may change over time. Tobinetal. (1986), identify Five levels of interaction between human service agencies within the community. Table 5.6 provides an overview of their inter actional'types. Communication. Communication can be formal or informal. Information and referral exemplifies formal communication that occurs between units on a daily basis. Communication designed to increase interagency information and under standing may be enhanced through the use of brochures, pamphlets and media Informal "communication occurs between units as groups meet to discuss community issues or staff members talk about their programs at conferences Although communication Is assumed, breakdowns in die delivery,system often occur because this process of sharing information between units is not nurtured Frequently, written agreements are developed as a reminder of the importance of constant communication as staff changes within organizations and new-groups are formed within the community. Cooperation. Cooperation occurs when units within the community agree to work toward similar goals. A local private child day-care center may work closely with a public human service agency. Both want to provide supports for single if 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 111 TABLE 5.6 Five LbveIs of Interaction Leading Id Improved Programming Level of Interaction Type of Interaction Communication Verbal, written, or other forms of communication limited to sharing Information or ideas between organizations. Includes consultation. Cooperation Two or .more separate organizations plan and implement- independent programs, but all work toward similar, nonconfining goals. The organizations share information but act-on It Independently. Organizations advertise for each other and try to avoid . unnecessary duplication of services. Coordination Two or more separate organizations work together ta plan programs and ensure that they Interact smoothly and avoid conflict, waste, and unnecessary duplication of services. Organizations share information, advertise for each other, and make referrals to each other. Collaboration Two or more separate organizations join together to provide a single program or service. Each organization maintains its own Identity but resources are jointly shared. Confederation _ Two or more organizations merge to provide programs or services. None of the participating organizations maintains a separate identity or separate resources. source:. Enabling the Eldarly: by Sheldon S. Tabin, Jamas W. Ellor, and Susan Anderson-Flay. C/tsrr 9.7 Fivn Levels at íníeracl/on Leading la improved Programming, p. 149, Slala University at New York Press, 19B6. l~-r mothers with young children, yet these units provide different resources. Social f^ -workers at die day-care center meet with staff at the human service agency once a month to discuss common concerns and to maintain a sense of continuity for mothers who are clients of both agencies. If the target population is single mothers, one practitioner needs to know diät diese linkages are established. 'l-f~~ Corporate voiunteerism represents a cooperative linkage between ttíe for- rf profit and nonprofit sectors. The Levi Strauss'Company provides an example. r\ In communities throughout the United States in which Levi Strauss factories are =? + located, there are community Involvement teams. In one southeastern city, die company encouraged its employees to become actively involved with a multi-county nonprofit home aide service for the elderly and physically handicapped. Employees donated time to painting and repairing the homes of older shut-ins, as well as providing friendly visits to the agency's clients. If the target population is older widows, the social worker needs to know that the corporate sector is willing to address client needs. The concept of corporate voiunteerism is manifested in a number of ways. A business may subsidize their employees by giving them release time to do community service work. Other companies will loan employees to human service agencies for a specified period of time so that die expertise required for a project can be provided at no cost to the agency. As employees near retirement, the for-profit sector often provides preretirement training in which postrctirement volunteer opportunities are presented. In this way, the for-profit sector actually performs a recruitment function for the nonprofit service delivery system. fr- 1? TU * y ii íiní 112 THE COMMUNITY AS THE TARGET OF CHANGE 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 113 The interchange between the for-profit and nonprofit sectors also occursiti^l^^sociations, public agencies, and interested individuals have Joined forces to work the form of corporate cash and in-ldnd contributions. Computer manufacmŕets^lpl^jawatd a common goal—health care for all citizens. In coming together, a new may donate hardware to a Local service agency, assisting in computerizing ltŕ;%J|£l%oÍLintary association is formed. Even though the diverse members of this coalition information system. Restaurants may donate food to homeless shelters. A Iocai^P^|%gncesent various interests across community units, their collaboration on health for-profit nursing home may open Its doors to older community residents whn:i^f^are concerns provides a strong and focused network for change. In some corn-live alone in a large metropolitan area during a time of anxiety over a crime wavŕ.^lí^/^ti'nities,'agencies created to serve the needs of a special population collaborate In this community, what cooperative efforts exist between service units withir^^p^fg^assess need, to examine the fit between needs and services, and Co present different sectors that focus an the target population's needs? Are ethnicity, gender^^l^united front and a stronger voice in pursuing funding for programs, or affectional preference factors that need to be taken into" consideration iir.^fe^i Albrecht and Brewer (1990) call for change agents within communities to assessing service system interactions? Are any of these interests left out when they}-i§p^npve beyond coalition building, which is often temporary, and toward building should be Included? . ..)'i^|g|^[jiiaace5. The. "concept of alliance as a new level of commitment that is longer- '":^!|S®If^in8' deePer- anc[ built upon more trusting political relationships" requires Coordination. Coordination implies a concerted effort to work together. Often.iplSliisUng questions such as: "Who sets the agenda? What are the power differentials? separate units will draft agreements, outlining ways in which coordination will occur;/;^p|^f;L|air different sldlls do we bring to the table? "What different visions of social In a continuum of care system that attempts to address the needs of sutŮ^ĚféljíÉJange db we have? And what different leadership styles do we use and do we populations as older persons, those with disabilities, or AIDS victims within-tlie'SÉp^^Í&??" (P- 4) community, coordination is necessary. As consumers exit the acute care hospitdl'i^^^^jn this community, what coalitions are focused on target population needs? discharge planners work to develop a care plan. This requires knowledge of and^i^^Opw; active are coalitions in advocating for change? Are there Joint ventures (new close coordination with local service providers. Service plans often include |i|i^^|§|qgrams) developed by two or more service units? Are there coalitions that are package to support the client's needs—mobile meals, visiting nurses, and hornej jgipifôving toward building long-term alliances? maker services. Depending on the level of disability and length of time expecteoi^|^^^^v.-: for recovery, this service plan may malce the difference between returning hqľáé^§^^^qjifedercitiori. Units within the community may actually merge, often when or convalescing in a long-term care facility. Extensive coordination is requiredi^|p^_be:pr both units becomes unable to function autonomously. A horizontal merger The growth of case management within local communities reflects the neetl^rl^^'ectirs, for example, when two mental health centers consolidate into a single for interunit oversight as consumers receive services from multiple units. Gase^^l^QĽganization. A vertical merger occurs when a hospital absorbs a home health management programs attempt to provide a coordination function so that service^!^^||bvidér. A conglomerate merger occurs when units within the community form delivery flows across informal and formal providers of care. Where there are cašé^.©^^ÉpnfederatÍon of multiple smaller units under a large umbrella agency. These managers serving the target population it is useful to learn how they view thc|^^^^ppns are generally limited to nongovernmental agencies, relationships between service units that serve the target population and ^hetií|||^Ě|^Agency interaction inevitably involves competition and conflict. Change they see gaps. . : 'Víi^^^S^lts leam to cope with competition and conflict on a regular basis. These types t'tMfe|rttEinteraction5 will be discussed in Part III. Collaboration. Collaboration implies the concept of a Joint venture. Jo^^g^gi'.r ventures are agreements in which two or more units within the community aSreřv^^|||;f to set up a new program or service. This usually occurs when no one separateJ-^^QVIMARY unit within the community is able or willing to establish the new venture al°n'^^|ij||^v'. For example, a local senior citizens center identified the need for repair^^^ppj^this chapter, we have endeavored to present a means for assessing a services for many of its participants. Because older persons tend to own oldéc^|^^pmmunÍty's human service system. The assessment process begins with the homes, repairs were often needed. The center did not have the resources to begÍňf^||^^^finÍtion of a target population, whose needs must then be conceptualised in this program alone, but by working with a communiry action agency within iJhe-M^pterarchy according to their urgency. Following this, the human service response community, a home repair service was sponsored jointiy by the center and-th^^^pbtplored and collective needs are considered. Sources of help are then agency. Eventually, the home repair service became a separate unit, incorporated^^g^aressed, including informal sources such as households and social networks as a nonprofit organization. ' ^^M^''inci:'illtiaS sources such as self-help groups and voluntary associations. Formal Coalition building is another form of collaboration. A coalition is a ioosely-||J^^|ätces of services include nonprofit, public, and for-profit providers, and both developed association of constituent groups and organizations, each of whose primáčlj#^ř||nature and orientation of services may differ in important ways across these identification is outside the coalition. For example, state coalitions have been fonncd^^^^ÖIces. Determining the competence of these systems in combining to meet as part of die National Health Care Campaign. Community organizations, TOluntaryfe||^gpds in an effective way Is the final consideration. .■.i-^tfř5ť^s,*JäBi&^- ■ and support? ■'f';SBv&ik 6: Examine Mediating Service-Delivery Units '\*U&3M,&:$■• What mediating units would typically assist the target population within a """' local community? What self-help groups are available to the target population within this community? V What voluntary associations have members from, or take an interest in, the '•^MÍÄ^fC*,' target population within this community? '":Ví;p£#ř&v • What mediating units are actively engaged in service delivery to the target '-ŕisEs^H''-!' population within this community? :#Pfířijkšlc 7: Examine Formal,Service-Delivery Units • How can target population needs be conceptualized so that a determination iÄMíiíoť'- — i.„-----1„ „u„... ..i.„ „„»„_* .-----u!_t. -i— — /--------------\ u„j-----------. ■'■AĚp^^í- ■ What nonprofit agencies deliver services to the target population within this Task 2: Define a Continuum of Need How can target population needs be c can he made about the extent to which they are (or are not) being met? Task 3; Assess Target Population Needs • What are feasible and appropriate ways in which to find'out how many people are in need in each of the areas identified as relevant to this target population? Task 4: Identify Collective Community Needs igencies deliver services to the target population within this "'^fPflĚ-J'-1- community?' .^'ilfiii'-vil;''"' • What for-profit agencies deliver services to the target population within this '''■^is^ifi''- community? ''^llN^- " ^re tnere differences in service delivery across formal units that appear'to be based on race or ethnicity, gender, affectional preference, disability, or age? ■ Are there needs in this community that require something other than a ""™njg||jj3Cus c. DETERMINING SYSTEMIC COMPETENCE service response? What data supports the existence of these needs? How are these needs expressed by the people of this community? FOCUS B: IDENTIFYING AUSPICE OR SPONSORING ORGANIZATIONS Task 5= Examine Informal Service-Delivery Units W&l 116 .^ifeTäslt 8: Determine Linkages between Units '-^pKvŕ . ■ "ľ®'íí"i- " How are the various types of service units generally connected within a community? .'r^ŕŕ! • What are the established linkages between units that serve the.target population within this community? • Where are linkages between service units obviously needed, but not currently established? "■ pS.1'-?-' " Are the interests of ethnic minorities and women represented in die network What informal units would typically assist the target population within-a locd.^|g|^ cstablislicd .through linkages between units? community? ■ -pkMs.v' What importance does the household unit have to the target population npVri.''L- within tliis community? '^ife^ - What importance do natural support and social nenvorks have to the target 'C,f%C: population within this community? .>|i'tei APPENDIX Framework for Analyzing a Human Service Organization FOCUS A: IDENTIFYING THE AGENCY'S TASK ENVIRONMENT Task 1: Identify Funding Sources ' - What are the agency's funding sources? • How much and what percentage of funds are received from each source? - Which funds arc earmarked for certain programs or services and which are flexible? Task 2: Identify Sources of Noncash Revenues ■ Does the organization use volunteers? If'yes, how many and for what purposes? ■ Wlmt material resources (e.g., fbad, clothing, physical facilities, etc.) does the organization receive? • What tax benefits does the organization receive? '• How Important are noncash revenues to the organization's operation? Task 3: Identify Clients and Client Sources ." What client groups does this organization serve? • How many unduplicated clients are served by each program? • How are client needs determined? • Within each client group, how. many.(or what percentage) are able to pay? Contract eligible? Unable to pay (low-pay or no-pay)? • What percentage of clients are ethnic/racial minorities, women, gays or lesbians, or members of other oppressed groups? • How and by whom (i.e., self, family, provider) are clients referred to this organization? - How and to which agencies does this organization refer clients? Task 4: Identify Other Constituents • What state and federal regulatory bodies oversee programs provided by this organization? " What agencies contract with this organization for service delivery? Vi 7 / PRACTICE IN HUMAN SERVICE ORGANIZATIONS 193 1 • What professional associations, labor unions, or accrediting bodies influence t ŕ agency operations? 1 »Is this organization affiliated with or sponsored by religious, ethnic, or | fraternal bodies? J ■ How does this organization define its "public," and what groups are part of p this definition? í i^pOCUS B: RECOGNIZING THE DYNAMICS I OF AGENCY/ENVIRONMENT RELATIONS I J? Task 5: Observe Relationships with Clients "^ • Has this organization targeted new or different clients within the last ^ five years? T ■ What is the Organization's domain (specifically, what types of clients docs the organization serve)? iK ' Are these clients ones who bring resources to the agency or for whose services resources must be obtained elsewhere? ^ • Docs the organization claim a larger domain than it serves, and are significant numbers of clients turned away? ^ • What types of clients does the organization refuse (e.g., are most of these the poorest or most troubled clients; are most of these minorities as opposed to nonmlnorities)? What happens to these clients? £_ Task 6: Observe Relationships with Resource Sources T" ■ How good are the relationships between funding sources and organizational i leaders? ■ How does the organization use and work with volunteers? ■ How good arc the relationships between important external various constituencies and organizational members? •' What types of changes have recently affected the organization, particularly in the area oF access to resources? • . f- Task 7: Observe Relationships with Competitors ■ What other agencies provide the same services to the same clientele as this Organization? • Axe there mechanisms for interagency cooperation and are they used? • With whom does the organization compete? • With whom does the organization cooperate? Are these relationships formal or informal (e.g., is the organization part oF a coalition or an alliance)? 194 THE ORGANIZATION AS THE TARGET OF CHANGE FOCUS C: ANALYZING THE ORGANIZATION Task 8: Identify Corporate Authority and Mission • Is the organization operating in a manner that is consistent with its mission and authority? ■ To what extent is the mission supported by staff who perform different roles within the organization? " Are policies and procedures consistent with mission and authority? . ' Task 9: Understand Organizational Structure ■ What'is'the organizing theme for the basic organizational structure (e.g., bureaucratic, organized around programs, organized around professional disciplines, alternative or nontraditioňal, etc.)? . ° Is this die mast logical structure? Is it consistent with and supportive of ■; the mission? ■ Are staff clear about reporting lines and accountability? ■ Is supervision logical and capable of performing expected functions? •" Is there an informal organization (people who carry authority because they are respected by staff, and thus exert influence outside those in formally designated positions)? ■ Are there clear distinctions between staff and line functions? Task 10: Understand Administration, Management, and Leadership • How is the workplace organized and work allocated? ■ Is appropriate authority assigned along with responsibility? ... ■ How close is supervision and what, exactly, is supervised? Is it tasks, or is it functions, or is it the employee, depending on need? . ■ How are people treated in the workplace, including die very lowest level employees? " Do employees feel valued at every level? Do they believe they are making a contribution to the success of the organization? ■ How are decisions made? Is information solicited from those affected? Is it used? Are there individuals or units within the organization that are left out of decision making? If so, why? • How f5 conflict handled? Task 11: Recognize the Organization's Culture • How would one begin to describe the organization's culture? • What are the organization's artifacts and creations? • What are the organization's stated values and what is actually valued within the organization? &:&?; mm 195 If ■ ■;S§- • 7 / PRACTICE IN HUMAN SERVICE ORGANIZATION How do leaders within the organization influence organizational Va)Ue_ and assumptions? What are the taken-for-granted patterns within this organization? Is behavior consistent with culture? Arc there minorities or odiers who feel left out of the accepted °rganjza-tlonal culture? 12: Assess the Organization's Programs and Services What programs are offered? What services are offered within each nro ? Are the services consistent with the goals and objectives of the progra t • Is there a common understanding among management and line staff w-|-j,-each program about problems to be addressed, populations to be served services to be provided, and outcomes to be achieved? ' » Are staffing patterns appropriate to the services to be provided? Are an ff over or under qualified? Are workload expectations reasonable given „ tions for achievement with each client and within each service and nr~ •> , Program? Is consideration given to cultural and racial understanding of workers and rl> rs? • What data is collected on clients and how is it used? • What evaluative information is expected from the evaluation plan? Is there ^ nh to gather information about clients and the extent of improvement at the'nn'' of terminadon and in a follow-up survey or interview? Is there an eff0rr- rn determine level of client satisfaction with services? What do the findings reveal to date? SJ-,': k|Fask 13: Assess Organizational Technology What are the job expectations for each level of staff within the 0rganÍ2adon? What background education and experience is required to perform these fobs? Do those who hold these jobs have the appropriate credentials? Are staff members performing competently in their positions? Are they meerinti expectations? Arc they effective (do they get good results) In working wjEl rijPri)._7 Is each discipline supervised and evaluated by someone with aPPropriatp knowledge, values, skills, and professional identification? In what ways are various units representing different disciplines (e.g^ socjaj work, psychology, medical, data processing, etc.) linked with each other for the purposes of collaboration and communication? 14: Locate Personnel Policies and Procedures How diverse is the workforce? Are differences valued in this organization? How do managers and administrators view staff? As people who carry out tasks? As members of teams or units? As creative problem solvers who have an important stake in organizational success? What formal and Informal criteria are used for evaluating performance? What kinds of behaviors does the organization reward? m I m.. fTask i lil. ■ö ib. i íl. - i in. ' ,Q '■ 'B ' '"- - ' '" 196 . THE ORGANIZATION AS THE TARGET OF CHANGE • What is the organization's philosophy and policy about staff development and training? What resources are invested in it? ■ How attractive are wages, hours, working conditions, and fringe benefits? How attractive is the facility .and the work environment? " What are the affirmative action policies and how are they implemented? • To what extent does the organization groom people for higher level positions, and to what extent do they promote from within? Task 15; Recognize How the Organization Deals with Community Relations ■ Is there a clearly defined public image, and is there a strategy for communicating this image to the public? What kinds of resources, Including funding, does the organizadon invest In promoting its public image? ■ What is the reputation of the agency, its programs and services, its board, executive, management, and line staff with the general public, other agencies, funding sources, clients, and other relevant constituencies such as minority communities? • Da the agency's facilities and published materials contribute to its desired public image? " Does the agency respond when needed by other community agencies for political activities, fund raising, dealing with community social problems, or other issues? Task 16: Recognize Methods of Financial Management and Accountability • Is the budget prepared in accordance with accepted standards of accounting and financial reporting? Are annual audits conducted? ■ Are program staff involved in a meaningful way in preparing the budget, and do they get useful feedback about expenditures and unit costs during the year? Do program staff use budget data as a measure by which they attempt tb improve efficiency? ■ Do resources appear to be adequate to achieve stated program goals and objectives? • What are the major sources of revenue for the organization? What demands and restrictions does each funding source place on the organization and its programs? Task 17: Assess Facilities, Equipment, Computer Utilization, and Records Management • Do employees feel that they have enough space? Is the physical work environment attractive and conducive to high productivity? • Have problems been identified with current facilities and equipment? Is there a plan to address the problems and to fund solutions? 7 / PRACTICE IM HUMAN SERVICE ORGANIZATIONS 197 • Are there conditions related to facilities or equipment that appear to act as barriers to productivity or work flow? Is the agency able to produce data that will answer important questions about clients, programs, and services? Does the agency have a computerized recordkeeping and management information system that includes client data? ■i 202 MACHO CHANGE INTRODUCTION Social work is a profession oriented toward acdon and change. People who.. practice social work commit themselves to. serve as a resource for those who have problems', who have limited or no control over the changes that need to be made -. in order to resolve their problems,.and who request or are willing to accept help. The majority of social workers deal with change directly with clients, usually working with individuals one to one or with families or small groups. Some practitioners focus on commurtitywide problems. Others practice in the areas of planning, management, and.administration of organizations. Regardless of the,-,. professional social worker's practice orientation, it is crucial that practitioners of all types understand that, while some problems can be resolved at an individual- --or family level, others will require intervention at higher levels, including the-need to effect changes in organizations and communities. . Managing macro-level change.requires a good deal of professional knowledge*; and skill. Poor management and flawed decision malting in the change process can result in serious setbacks, sometimes malting things worse for those already/, in need.. On the other hand, many very positive changes in organizations and" communities have been orchestrated by social workers and others who have; carefully planned, designed, and carried out the change process. It is not unusual for direct practitioners to have clients ask for help with problems diat appear to be individual or interpersonal but, upon further probing. are clearly macro-level problems. A family that loses its primary source of income, is evicted, and Finds that there is a three-month waiting list to get into a homeless shelter represents a symptom of a community problem. Clearly their immediate; shelter problem must be resolved, but just as obviously the communitywide lack ; of emergency housing must be addressed. A mother may describe the pressures put on her son to join a gang and become involved in the drug trade. While the -immediate need for this family can perhaps be met by building a support system for the boy designed to keep him in school, in a part-time job, and In constructive activities, this casework approach would not solve the problem for the many other families who must live daily with the same threats.. Identifying and dealing with organizational and community conditions/ problems and needs presents a complex set of challenges to a social worker. Over the years, the image of the change agent has developed around some of the early, social change pioneers—people like Dorothea Dfx or Florence Kelley. Others view change agents as superorganlzers like the late Saul Alinslcy, or as high profile individuals like Ralph Nader who has had great success in bringing about social change through nationwide organization and exceptional political skill. In reality, most social workers have neither the resources, the media exposure, the charisma, the experience, the following, or the power that these leaders have had available to them. Yet, in spite of seemingly overwhelming challenges, social workers have been effective in bringing, about changes in organizations and communities. Effectiveness, however, does not necessarily come from the power of personality or the ability to mobilize thousands to a cause. It comes from careful, thoughtful, and creative planning undertaken by a group committed to change. 8 / PREPARING FOR MACRO-LEVEL INTERVENTIONS 203 The change, effort may be led or coordinated by a professional social worker, but those involved will represent a broad range of interest groups. ;i~ GUIDELINES FOR PLANNING CHANGE The three tasks and their accompanying steps outlined in Table 8.1 represent guidelines for planning an organizational or a community change. The tasks described in this chapter will require input from knowledgeable and experienced people. They are also taslcs that fall within the capacity of a professional social worker who can skillfully draw on various talents present among a group of ■i,.-., committed professionals, volunteers, and consumers. tt-1 Sr ft! Hocus A: Identifying the Population and. the Problem £-, Although many macro-level interventions seem to begin at the point of proposing solutions, they should begin with a focus on developing a clear understanding ■of the problem. While this may sound simple and straightforward, in practice it can become quite complex. Take, for example, a community in which highway deaths due to alcohol are up 37 percent in the last two years. How might the .problem in this case be defined? One group will be convinced that the problem is the lack of strict enforcement of existing laws prohibiting driving under the - influence of alcohol. Another group will describe it as a problem of easy avail- . ability of alcohol to teenagers. Another will see alcohol abuse as a symptom of increasing stress. Still another will see it as a symptom of family breakdown. These represent just a few of the perspectives that might be introduced in an attempt to understand some of the reasons behind drunk driving, even when there is •agreement that the increase in alcohol-related highway deaths is the problem. : TABLE 8.1 Framework far Planning Changs Focus . Tasks A. Identifying lne Population and the Problem B. Analyzing the Problem C. Developing the Intervention Hypothesis 1. Identify organizational or community conditions 2. Collect supporting data 3. Identify barriers to condition resolution 4. Determine whether a condition Is a problem 5. Identify relevant historical incidents 6. Identity and apply relevant theoretical perspectives 7. Apply findings from research, program evaluation, and practice B. Examine ethnic, gender, and target-population perspectives 9. Speculate about the etiology of the problem 10. Refina the problem statement 11. State a hypothesis 12. Propose relationships between changes and results I __a « ■ ■ r bi bi 11 ■ i .■■ . -, 204 MACRO CHANGE The important point is. that identifying and defining the problem in different ways leads to very different interventions. The way the problem is conceptually and defined, therefore, can be critical in achieving the desired result—reducing the number of alcohol-related highway deaths. For this reason, quick responses should be resisted while the necessary discipline is employed to conduct a careful study and documentation effort. "We propose that change agents proceed through a series of steps designed to gather as much useful information about the problem as can be made available. The steps involved in compiling this information include; (1) identifying an orgam zational or community condition; (2) collecting supporting data; (3) identifying-barriers to condition resolution; and (4) determining whether the condition, ts seen as {or can be made to be seen as) a problem. Task 1: Identify Organisational or Community Conditions. A condition, is a phenomenon that is present In an organization or a community that may be troublesome to a number of people, but that has not been formally identified or publicly labeled as a problem. Every organization and community is- full of both conditions and problems. Social consequences of urban living such as traffic, air pollution, crime, drug abuse, broken families, and suicide can all be considered social or community conditions. Similarly in rural communities isolation, inaccessible health care, or a declining economic base can all becan sidered social conditions. The same concept applies to organizations. Troublesome phenomena are-also present in organizations, but they have not always been formally identified'or labeled as a problem. For example, staff in a long-term care facility for the elderly may be concerned about what they consider to be overmedication of some of the residents. Similarly, program managers may recognize a troublesome trend to extend services to those who can pay and to put those who cannot pay on a waiting list. To be recognized as a problem, a condition must in some way be incorporated, into a community's or an organization's agenda for action. This may mean that elected officials propose formal programs or policy solutions. It may mean, that a task force within an organization is officially sanctioned to address the condition. Whatever the proposed action, formal recognition is important for legitimization. The distinction between a condition and a problem is significant to a social worker planning a macro-level intervention. If a condition has not been formally recognized in some way, the First task must be to obtain that formal recognition. For example, for many years homelessness was dealt with as a personal employ ment problem and AIDS was dealt with as a personal health problem. Most com munlties simply viewed diese as existing conditions, not as social or community problems. When these conditions began to affect greater segments of society and reached the point where they could no longer be ignored, national, state and local community leaders began to perceive them as problems. Once formally recognized and acknowledged as problems (usually as a result of persistent media }l a 1 PREPARING FOR MACRO-LEVEL INTERVENTIONS 205 f * mention), these conditions become candidates for organized intervention efforts. ^ The creation of task forces for the homeless in cities across die country and federal -3 funding for AIDS research are results of recognizing conditions and defining .K them as problems. ^ The first step in problem identification, then, is to develop a condition ~ statement. A condition statement must include a target population, a geographical ; j boundary, and the difficulty facing that population. Statements should be descrip-±f tive and free of qualifying or judgmental words or phrases, such as poor or \i disadvantaged, as possible. í t= Statements will be adapted depending on whether the condition exists within -^o. community or in an organization. For example, a condition statement might -^"be "Suicide among teenagers in Preston County is increasing.-" Generally ' pi speaking, the more precise the statement, the greater the likelihood of a successful í/ intervention. The above statement, for example, could vary from extremely £ general to very precise, as depicted below. '^Sample Condition Statements General Teen suicide is Increasing. Teen suicide in Preston County is increasing. Teens from lower socioeconomic families in Preston County have shown increasing suicide rates. Teens from lower socioeconomic families in Preston County, primarily in the Washington and Lincoln High School attendance areas have shown increasing suicide rates. Etc. A similar process within an organization would begin with a general state-£V,ment. For example, an organizational condition might involve an Increasing išř dropout rate among low-Income families in a family counseling program. Data IjK-and information would need to be compiled to help pinpoint the condition as Imprecisely as possible. r* Condition statements are made more precise through a process of research jp- and documentation of the nature, size, and scope of die problem. As one proceeds X' With the steps in Task 1, the condition statement may be refined many times as Jj new facts arise. i\ Y?Task 2: Collect Supporting Data. There was a time when a community could ^become sensitized to a condition and recognize it as a problem based on a few V incidents. Churches started orphanages and counties started poor houses with "f%Tittle or no data beyond personal knowledge of a few people in need and the 1 Jjř^pectation that there would be more. !__; Today, however, with so many social and community problems competing f^for limited resources, data must be compiled to justify the existence of a problem jEot need. Collecting data on a community social problem can be a challenge. 210 MACFIQ CHANGE TABLE B.4 Identification of Barriers to'Candltion Resolution Condition Resolution Statement Barriers Statement The Incidence at teen suicide An Increasing number of TeEsn suicide should he is increasing in Preston teens suffer from law self- declining or nan-existent in County ' esteem in Preston County Preston County Many parents are only mini- •■ mally Involved with their Examples of supporting data: teanage children ThB number of suicides Teens are experiencing . Increased from two in 1Sa4 Increased stress to seyan In 199D Teen depression is Increasing Stress related Illness in high- Many teens feel increasingly school studeníš increased isolated end alienated from 4B percent In five years thBir peers Use and abuse ol drugs and alcohol is increasing among teens of the factors that appear to be associated with the condition. A more thorough study -will be undertaken in the problem analysis phase. Examination of data supporting the existence of the condition together with identification of barriers helps to build an understanding of the scope and complexity of the condition This is useful in bringing sufficient attention to the condition that it becomes recognized as a problem by those whose support is needed to bring about change Task 4: Determine Whether a Condition Is a Problem. There is no precise definition of when a condition becomes a problem in terms of time of appearance size, or severity. Except in crisis situations, problems are identified and labeled gradually due to shifting perspectives, changing political positions, or increasing awareness. Is horaeiessness a problem in any given community? Drug abuse? Crime? Air pollution? The answer to all these questions is, "It depends." A condition becomes a problem when it receives enough public attention that it can no longer be ignored by community leaders, or when one or more leaders declare a condition unacceptable and decide that something must be done For example, when a city councilperson's son is arrested for possession of crack a community leader may suddenly become very interested in what others have long perceived as the "drug problem." Note that people may suffer from a condition long before it is recognized as a problem. However, for the macro practitioner recognition of the problem is important because it is only with such recognition that efforts to solve the problem can be mounted on a meaningful scale. For the change agent, it is then important to consider the question of who will support and who will oppose the proposed change. If it is already recognized as a problem by many community or organizational leaders, or by community i h L B / PREPARING FOR MACRO-LEVEL INTERVENTIONS 211 citizens or agency staff members, then a proposed change may be readily accepted. If not, it must first receive enough attendon that decision malcers cannot ignore U This raises a pivotal question for the change agent. Has die problem been acknowledged and does a commitment exist to address the need, or must efforts first be directed toward having the organization or community in some way formally acknowledge its existence and agree that intervention is appropriate? The answer will affect the immediate and long-range focus of the change effort. Ultimately significant decision makers must be persuaded that the condition is a problem. If this cannot be done, the chances of successfully bringing about change are slim. For this reason, the focus of a change effort is sometimes shifted from the substantive change to an effort to bring attention to the problem. . 7 Summary of Steps Involved in Problem Identification, In summary, the ŕ following important points have been made so far about identifying a condition p. and creating an awareness that it is a problem. I* -r1 1. Initiating, macro-level interventions in organizations and communities , £ begins with the Identification of a condition or problem. tv. 2. For a condition to be considered a problem, some type of formal recog- ^ ' nition is necessary. Securing this recognition may become a subsequent 1/ step in the intervention process. 3. 'When a condition statement has been framed, relevant data should be collected to support the contention that a problem exists and to aid in understanding its nature, size, and scope. 4. Data displays should be carefully designed to illustrate the perspective Od the problem that the change agent wishes to convey. Displays can v^f illustrate comparisons to other conditions, changes in conditions over time, relationship of conditions to standards, or relationship to con-£l tributing factors. # 5. Identification of barriers to condition resolution help to make clear 7 Í* the complexity of the condition and the sources of support needed . x| for change. 6, The purpose of the presentation of data is to convince the appropriate ; % individuals or systems that the condition is a problem in need of attention Mt and intervention. at l^ Bogus B: Analyzing the Problem J& Human problems are complex phenomena and, as such, often require a good deal Jjgjp of study and thoughtful consideration. ^While the lay public may have simple 3*|£ answers to many social problems, the professional can afford no such luxury. t%\ Analyzing social or community problems is undertaken in an attempt to under- ^e stand why the problem exists. "Why are some people chronically unemployed? Jr "Why do some parents neglect their children? "Why do some teens attempt suicide? V This is no time for simplistic answers! It is a time for the most thorough study W[ and analysis that time and resources will allow. 4F kBh iJtfmttj uíMMb j ""Mf LfQSAi; Lff&as^ 218 MACRO CHANGE Some students drop out of school because there is such intense discord in their home and family life that they are incapable of dealing with the added stress of academic demands. The decision that must then be made is not one of choosing the "correct perspective on etiology, but rather on selecting the subgroup to be served As with many (probably all) target populations and problems, one understanding of etiology and one intervention does not fit all. Task 10: Refine the Problem Statement. "When the above activities have been accomplished, the working draft of the condition statement can be refined into a problem statement. A simple, clear statement that includes a target popula tion, boundary, and problem is most appropriate. Explanatory statements or supportive documentation may follow, but the statement should provide a consensus position for all those who are expected to support the change effort The following might be used in the high school dropout example: Dropouts from the Washington, Lincoln, and. Jefferson attendance areas of the Preston City School* district have been increasing steadily over the last five years and have reached a level that is unacceptable to the citizens of this community. Additional statements might be added highlighting whatever is considered necessary to build consensus and support, such as specific dropout rates for the five-year period and a listing of what are considered to be the major causes. This statement will serve as a focal point around which a support system will be built Summary of Steps in Problem Analysis. The following is a summary checklist reviewing all the important points made so far about developing a thorough understanding of the problem and gaining consensus from the partia pants about a common or shared understanding. 1. Analysis is undertaken in the interest of gaining a better understanding of the problem. The professional practitioner never jumps directly from problem identification to intervention. 2. Thorough problem analysis requires an understanding of problem history theory, research, ethnicity, gender, target population perspectives, and problem etiology. 3. The focus of a study of problem history is on understanding how it has been framed in the past, what are the critical incidents in the history of the problem, how it has been addressed, and how the community has responded to various attempts to deal with it. 4. The use of theory brings to the problem contexts or frameworks within which various explanations can be explored. In the selection of theoretical frameworks one should be aware of the potential for bias in whatever explanation is drawn from the theory. 5. Journal articles on research and program evaluation from a variety of Interdisciplinary journals are useful in developing an understanding oi what has worked and not worked in other attempts to address the same or similar problems. '■3 B I PREPARING FOR MACRO-LEVEL INTERVENTIONS 219 6. Ethnic and gender perspectives are sought in the interest of learning how various ethnic groups may perceive a problem differently from each other or women differently from men. 7. Target population perspectives are solicited as directly as possible from people considered to be in a position to represent this group. Perspectives developed through data analysis or through the use of theory and research should be put to the test in direct contact with target population representatives. 8. All knowledge,- information, and value perspectives gathered are weighed, and cause/effect relationships are postulated. A shared understanding of causes is pursued in the interest of bringing focus to a proposed intervendon. 9- Finally, the working draft of the condition statement is rewritten into ^ a clear, concise problem statement which, together with supporting documentation, is used to provide direction, build consensus, and lead to proposing a change or recommending a specific intervention. f^ i locus C: Developing the Intervention Hypothesis i During the early phases of problem identification, many people involved in change efforts, both professionals and volunteers, are eager to propose a specific inter- ! vendon. Many have experienced the frustration of worldng in what they perceive * to he flawed programs or under what they perceive to be oppressive organizational C policies, and they are eager to propose immediate change. A A disciplined, scholarly approach to macro-level change requires that the -. foregoing tasks associated with problem identification and analysis be addressed. ^ However, it is the unusual change agent who is not constantly mindful of a u preferred intervention and who is' not continually molding and shaping it as the jj analysis unfolds. y Decisions about the nature, shape, and design of the intervention should wait ** undl the problem analysis has been completed. When an acceptable degree of consensus has been achieved about the nature of the problem and its etiology, J an intervention hypothesis is proposed. " Task Hi State a Hypothesis. Based on all the information gathered in the H problem identification and analysis phases, an intervention hypothesis is developed. The hypothesis is a declarative statement (or series of statements) that 1 proposes a relationship between a specific intervention and a result or outcome. £ The statement identifies the following: (1) a target population (or specific S subgroup) and problem, (2) the change or intervention proposed, and (3) the ] A results expected from the intervention. These elements combine to form a - complete sentence that makes clear the expected relationship between problem, - Intervention and result. For example, a hypothesis for a program to prevent teens ^ from dropping out of high school might read: If teens with economic problems are placed in a work study program which allows them to earn at least minimum !j wage for at least 30 hours a week and take evening classes, then the dropout jT-rate among this group will decline at least 10% per year for the next five years. r p." ^" ■-"'■■ I * I « I-----« 1----J| UÄ UhS a_____i 220 «.. MACRO CHANGE This would he considered a testable hypothesis, and the expectation would be that the intervention would be designed to provide die features specified In the hypothesis. One method of developing this statement is discussion and. brainstorming among a representative group of participants who are knowledgeable about the information produced in the process of problem analysis, Representatives should also be included from groups that can be crucial to the success of die change effort, such as ethnic groups, women, and target population members. Task 12: Propose Relationships Between Changes and Results. A proposed policy change might be hypothesized to affect the target population in the following way: If family counseling by a licensed clinical social worker is required. as a condition for readmlssion of all students expelled for behavioral problems,, then the readjustment rate of diese students will improve and the dropout rate' will decline. It is not necessary at this point to flesh out the intervention in detail. However, for die change effort to proceed, it is necessary to make at least a. preliminary decision about die nature and form of the intervention so that planning a strategy to introduce the change may proceed. Summary of Steps in Developing the Intervention Hypothesis. The following is a summary checklist reviewing all the important points made so far about developing an intervention hypothesis: 1. The macro practitioner should reexamine data, history, theory, research,, ethnicity, gender, target population perspectives, and shared under-. standing of etiology. 2. Drawing on the knowledge base built on the above content areas, ideas. about interventions that appear to be relevant to the need as it is currendý understood should be discussed. 3. Using these proposed Interventions, a set of intervention hypotheses (andľ possibly sub hyp o theses) should be developed. These statements should: lay out a clear set of understandings about the population and problem,.. the nature of the intervention, and the expected outcomes. 4. These hypotheses and subhypotheses should be spelled out hi a series of if/then statements; for example: If {population) with {problem) can be identified and recruited into this program and if they receive (services)^. then we expect that they will achieve {outcomes). SUMMARY This chapter has proposed a methodology for planning macro-level change int organizations and communities. The methodology begins with a thorough-examination of die current condition in the organization or community that has; led to the perception that there is a problem. Condition ľs seen as a more neutral., and objective term; its use recognizes that not everyone agrees on the existence B / PREPARING FOR MACRO-LEVEL INTERVENTIONS 221 ■l.-:: I* I i of a problem (or negatively defined condition). Someone must first Identify the negatives that make this condition a cause for concern. This is accomplished by developing a clear statement of the condition, by collecting data about the incidence and prevalence of the condition, by assisting individuals whose support is needed to see the condition as a problem, and by Identifying barriers to problem resolution. As a clear picture of the problem begins to emerge, problem analysis is undertaken. This requires drawing on knowledgeable individuals for their insights and on the existing literature in order to understand history, theory, research, and the perspectives of various special populations on the subject. Gathering information from these sources leads to a shared understanding of etiology—cause(s) and effect(s)—which, in turn, leads to a refinement of die problem statement. The final task is to propose, based on information gathered during problem identification and analysis, an intervention hypothesis which identifies a population, a problem, a proposed change, and an outcome, and speculates on their relationship in a series of if/then statements. This methodology is intended to maximize the professional social worker's understanding of a problem and the relationship between problem, change, and result, thereby increasing the possibility that the proposed changes, if implemented, will be successful in achieving the desired results. Í; REFERENCES % ■■£• ■m- ■ -#£: jav jffiV. 'I -£V-'. IT-"', ■W- M ■■'w .''.-•Si*''-' ■-S&i v* Barnhart, C. L., and R. K. Barnhart, eds. (1979) The world book dictionary. London: world Book International. Data Network for Human Services. (1987) Socio-economic indicators for Maricopa county. Phoenix, AZ: Audior. Ericlcsoa, E. (1968) Identity: Youth and crisis. New York: Norton. Fetterman, D. M. (1989) Ethnography: Step by step. Newbury Park, CA: Sage. Gilligan, C. (1982) In a different voice. Cambridge, MS: Harvard University Press. Green, J. w". (1982) Cultural awareness in tbe human services. Englewood Cliffs, NJ: Prentice-Hall. Kettner, P. M.,J.M. Daley, and A. W. Nichols. (1985) Initiating change in organizations and communities. Monterey, CA: Brooks/Cole. Kettner, P. M., and L. L. Martin. (1987) Purchase of service contracting. Newbury Fade, CA: Sage. Maslow, A. H. (1943) A theory of motivation. Psychological Review, 50: 370-96% Norton, D. G. (1978) The dual perspective: Inclusion of ethnic minority content in the social work curriculum.. New York: Council on Social "Work Education. Pivcn, F. F., and K. Cloward. (1971) Regulating thepoor: The functions of public welfare. New York; Pantheon. Skinner, B. V. (1971) Beyond freedom and dignity. New York: Knopf. 224 MACRO CHANGE GUIDELINES FOR DEVELOPING AN INTERVENTION STRATEGY As in previous chapters, we will present the process of developing a strategy m terms of a number of areas toward which the macro practitioner must focus his or her attention. These foci Include: (A) defining participants, (B) examin ing system readiness for change, (C) selecting a change approach, (D) assessing political and interpersonal considerations, (E) assessing economic consideration^ (J?) weighing the likelihood of success, (G) setting goals and objectives, (H) selecting appropriate tactics, and (I) preparing a written plan. This chapter is organized around the first seven foci, whereas Focus H and Focus I will be discussed m Chapter 10. Table 9.1 summarizes the major foci and relevant tasks involved In developing an intervention strategy. Focus A: Defining Participants Up to this point in the change process it is not unusual for the people involved, to be a small core of committed individuals, possibly even close friends or fellow employees, who recognize a condition or problem and are concerned enough TABLE 9.1 Framework for Developing an Intervention Strategy Focus Tasks A. Defining Participants B. Examining System Readiness for ChangB C. Selecting a Change Approach D. Assa55lng Political and Interpersonal Considerations E. Assessing Resource Considerations F. Weighing the Likelihood of Success G. Setting Goals and Objectives 1. Identify the initiator system 2. identify the change agent systam 3. Identlly the client system 4. Identify the support system 5. Identity thB controlling system 6. Identify the host and Implementing systems 7. Identify the terget system B. Identify the action system 9. Assess general openness to change 10. Identify anticipated or actual response 11. Determine availability of resources 12. Examine outside opposition to change 13. Select a policy, program, project, personnel or practice approach 14. Address public image and successful change 15. Identify alternative perspectives 1B. Assess duration and urgency 17. Determine the cost of change 1B. Determine the cost of doing nothing 19. Assess support from Individuals, groups and organizations 20. Assess support from facts and perspectives 21. Identify goals 22. Formulate outcome and process ob|actlves 23. Plan activities __ •"-'-" '......--;■*-■".-' '.V '—■■mill l......—IT TT IMFMII.ýSj'^ 9 / DEVELOPING AN INTERVENTION STRATEGY 225 -ľr'íf-ríľ" ŕ£ to take action. It is perfectly appropriate For this small group to undertake some iS,, of the earIy activities of problem identification and analysis, as long as they do &> not become totally committed to a particular perspective on the problem. th ■ In order-for effective macro change to occur it is necessary to have allies. f| A.g°od deal of strategy development involves the building of coalitions. People í j willing to commit themselves to change rarely accept someone else's definitions ~ha and perspectives without some revision. (If full participation of all critical actors yf WM accomplished in the problem identification and analysis phases, then m achievement of consensus on the problem and proposed solution should not be pj a barrier to progress at this point.) W One method of identifying, in an orderly, systematic manner, the participants l-v1 critical to die success of a change effort is to identify people who are affiliated It» In some way wich certain groups or organizations that make up the many systems Vand subsystems of the change effort. jý We will use the term system to describe these critical participants. This term |, is used in the context of systems theory, implying that participants should be |; viewed as more than simply a collection of individuals who happen to have.some tÍ common interests and characteristics. As a system or subsystem critical to the 4j success of the change effort, they represent a complex set of Interrelationships 3} having system-like attributes that must be recognized and attended to by the core Sw planning group. One of these attributes, for example, is called entropy and refers W-to the natural tendency of systems to expire without input and regeneration from l^outside the system. The concept is directly applicable to the types of systems W involved in planned change. (For further discussion of systems theory, see von P'pcrtalanfFy 1956, or Katz & Kahn 1987.) "dT The systems to be considered include (1) an initiator system, (2) a change Urgent system, (3) a client system, (4) a support system, (5) a controlling system, pWó) *i host system, (7) an implementing system, (8) a target system, and (9) an action M.system (see also Kettner et al. 1985). It is worth noting here that these terras are ^tised strictly for conceptual purposes to assist in understanding who should be ^involved and why. They are not terms commonly used among people involved y-in change efforts. It Is more likely that terms like committee or task force will infbe used to designate groups, but the professional person who coordinates the išeffort should be aware, conceptually, of what systems are represented by the insignificant participants. ifjjrflsfe 1: Identify the Initiator System. The initiator system is made up of l^-those individuals who first recognize the existence of a problem and bring J#attention to it. This could be a group of parents raising concerns with a school, "rĚboard about increasing violence in their schools or a group of staff members ^concerned about a lengthening waiting list for service in the counseling program.. E Individuals who first raise the issue may or may not also become a part of^ě initial planning process. ;.. :.v -■'..'■ %k It is sometimes necessary and worthwhile to work with a gřpupof muiyiduajs fbvho fill appropriate roles and have a thorough knowledge of the problem, but «see themselves as powerless to affect the system. Empowerment strategies such 226 MACRO CHANGE 9 / DEVELOPING AN INTERVENTION STRATEGY 227 as teaching, training, group counseling, or consciousness-raising efforts at this point can pay rich dividends in the long run, and can place appropriate spokes persons into leadership positions rather than substituting less appropriate leaders Task 2: Identify the Change Agent System. From the initiator system thc issue moves to identification of the change agent system. In a professional!) assisted change effort this involves an individual designated as the leader of the change effort. "We will refer to this person as the change agent. The change a^ent together with an Initial core planning committee or task force, comprises the change agent system. If the change activity will require drawing on the resources of an organization, it is essential that the organization sanction the change and also be identified as part of the change agent system. This may involve getting formal approval from executive or board, and may require released time from, other duties, secretarial support, and other allocation of resources. The makeup of this system is critical to the change effort because much, af what is accomplished will be framed in the perspectives of these individuals Ideally this system will include representation from the initiator system, people who have experienced the identified problem, people who have had experience, in trying to solve the problem, and people who can be influential in getting the change accepted. The function of the change agent system is to act as a central coordinating point. Many participants in the change effort will be taking on different activities at the same time. It is the job of the change agent system to insure that the change effort is properly organized and carried out from its early conceptualization to the point where it is turned over to others for implementation. As the major systems and perspectives are identified and the action system (discussed in a later section) is formed, the coordinating functions are shifted to the action system. The work of the change agent system begins with carrying out the problem identification and analysis described in Chapter 8. This planning effort continues-as each of the systems and participants is defined and a strategy is developed for getting the change accepted. Task 3: Identify the Client System. The client system is made up of those individuals who ate asking'for and will become the direct beneficiaries of the change if it is implemented. In Chapter 8, we pointed out tiiat macro change efforts begin with identification of a target population and a problem. The client system would be a subset of the target population for whom the specific change effort is being undertaken. In some cases it is possible that the target population and the client system could even be synonymous. For example, if the target population is all homeless people in the town of Liberty, and the purpose of the community change effort is to provide housing and services for all homeless people in Liberty, then the target population and client system are the same-Different terms are used for conceptual purposes. A target population brings focus to tile problem analysis and usually represents a broader spectrum of people A client system refers to the people who are intended to benefit from the change effort. In the town of Liberty, for example, for a specialized project, the client system could be homeless women and children. tin defining the client system, the change agent should resist the temptation to jump to die easy and obvious definition of the primary beneficiaries, and should jiT pitientiy and carefully analyze details. For example, if the identified problem Wti Is drugs in-the schools, several potential beneficiaries could be considered fpŕ as the client system. A partial list of people who would benefit from eliminating yT drugs from tiie schools would include students, teachers, administrators, parents, fe- local police, campus security, neighbors, the school board, and the comrau-|l£ nirj as a whole. The question, then, becomes one of establishing priorities spí for direct benefits, and distinguishing between, primary and secondary- bene-íšjáficiaries. The decision will have an important impact on the change effort. If *-v- students who want a good education in a drug free environment" are identified as primary beneficiaries, then die intervention may well be directed toward .rtijahter security and stricter discipline. If, on the other hand, primary beneficiaries fi-are described as "students who use drugs and are unable to maximize their ,i educational opportunities due to impairment," then the intervention may be directed toward treatment. However the primary beneficiaries are defined, the remaining groups should jSj^be identified and listed as secondary beneficiaries. Secondary beneficiaries may 'Mbe important and may need to be called upon when the change effort needs public lap support. "We will refer to this group, as the support system. Task 4: Identify the Support System. The support system refers to that segment of the community or organization who have an interest in the success of the proposed change and who may receive secondary benefits. This group is ',} expected to be involved in supporting and advocating for the change if they ate 5 needed. The boundaries for macro-level changes tend to be defined in a way that the primary focus is on a segment of a community or organization. Total com- jSrinunities as defined by political boundaries (entire towns, cities, counties) or total organizations are rarely the focus of a change effort. Wh The support system is defined largely by the target population (or client ■pjr system) and the problem. People have an interest in certain populations and iiiFrproblems for a variety of reasons: a loved one is afflicted with die problem, their employment brings them into close contact, their church or service organization f his selected this population for assistance. They are sometimes described by the related concern or Issue, such as the "mental health community," or the "foster cire community." These are the people the change agent will count on to become £* involved if decision makers need to be persuaded that the change is necessary. Cf Figure 9-ť'illustrates the relationship between initiator, change agent, client JX and support systems. rS~ Initiator, change agent, and client systems can be seen as incorporated within JpUhe boundaries of the support system in that they all have an Interest in addressing jStthe need for change. Initiator, client, and change agent systems may overlap, or "Simay represent separate and distinct constituencies. ;3W TTVtsfc 5.- Identify the Controlling System. The controlling system is defined fc^as that group of individuals with the formally delegated authority and the power ■to approve and order the implementation of the proposed change. Macro-level h—I K i usnú l l^^—T^ CqeeEUÜ tiSBSIRi 228 MACRO CHANGE Initiator System Client SystBm Change Agent System FIGURE 9.1 Relationship af Systems change Invariably involves approval by some formally designated authority. If the change involves a public agency or publicly funded or regulated services control may rest with a body of elected officials. If the change involves a private agency, control may rest with a board of directors. These bodies are significant co acceptance and implementation of the change effort, and their positions an the proposed- change must be known and considered. Task 6: Identify tbe Host and Implementing Systems. The host system is the organization or group responsible for implementation of the change, "within the host system.is a smaller group who will have day-to-day responsibility for carrying out the change. We refer to diis as the implementing system. Imple menters are employed by or volunteer for the host system. In most instances of macro-level change the host system will be an organization that will be expected to implement a policy change, a new program, or a project. The listing of systems in Table 9.2 identifies controlling, host, and implementing systems in a school system and in a law enforcement system. The change agent should be careful not to assume that the positions of the controlling system, host system, and implemenüng system are identical. It is not unusual for those involved in the execution of policy to disagree with the policymakers- TABLE 9.2 Examples of Controlling, Host, and Implementing Systems Controlling Host Implementing School System Law Enforcement System School Board A particular school end ils principal City Council Police Chief and department Teachers in the school Involved in the change Police officers Involved in the change I E D 9 / DEVELOPING AN INTERVENTION STRATEGY 229 and vice versa. Each system should be assessed separately. Figure 9.2 depicts the typical relationships of the controlling, host, and implementing systems. Task 7: Identify tbe Target System. The target system is the individual, group, structure, policy, or practice that needs to be changed for the primary beneficiaries to achieve the desired benefits. The target system is a complex concept that cannot always be defined in clear and simple terms. Often what needs to be changed may include philosophy, values, attitudes, practices, and policies as well as die provision of services. Another complicating factor is that many change efforts must address multiple targets. For example, in addressing the high school's drug problem It may be necessary to educate the faculty and staff about what is happening before they are willing to allow the change to occur. They are targeted for change first. Next, It may be necessary to target the school board to gain their approval to intervene. Finally, having gained the approval and support of teachers and school board members, the intervention, focusing on the "real" target group—high school students using drugs—can be implemented. Two questions need to be answered in defining the target system: (1) what change (or series of changes) needs to take place in order for the primary beneficiaries to achieve die desired benefits? and (2) what individuals or groups need to agree to die change (or series of changes)? We have defined these Individuals or groups as controlling, host, and Implementing systems. The target system may lie within the boundaries of any or all of these systems, or it may lie entirely outside of any of them. Target could include, for example, selected school board members, a principal and assistant principals, or a subgroup of teachers, or the target system could be a selected group of students. Task 8: Identify tbe Action System. As all other systems are being defined and participants selected, an action system is being formed. The action system is made up of those individuals from other systems who have an acdve role in FIGURE 9.2 Relationships between Controlling, Host, and Implementing Systems Host System Controlling System Implementing System 230 MACRO CHANGE planning the change and moving it towardimplementation. Clearly there is a good deal of overlap here with the change agent system, earlier defined as the professional change.agent, sanctioning organization, and sometimes a core planning group. While the change agent system forms the core of the action system, other actors also have important roles in providing input into decision malting. The action system, should include, whenever possible, representatives from all other systems, including those systems in need of change, if the relationship is not.' excessively adversarial. For example, if the social problem under consideration.is the unmet needs of the homeless, the concern might first be raised by a person who passes by a few old men sleeping in doorways every day on her way from the bus to her place of work (initiator). She Finds that several other employees at her place of work have the same concern and raises the issue to the city council (controlling system), where it is assigned to the City Department of Human Services (change agenrsystem and host system). The social worker (change agent and possibly implementer) forms a task force which includes those who brought the issue to». the council. As the condition is researched and analyzed, more people are added. to the task force. Professionals who work with the homeless (support system) would be asked to join, as would some current or former homeless people (client ' system)'and someone from the city's political or administrative structure who■■'. understands the potentialities and limitations of the city's participation (controlling system). When all the significant participants have been identified, this group;-.; would become the central decision-making body in the change effort and would be defined as the action system. , ' Systems in interaction. In examining these systems in interaction, it is important to remember that we distinguish among them and define them separately for conceptual purposes only. In actual practice, all systems could be within one organization, and it is highly probable that many systems will overlap. The interrelationships of all systems is depicted in Figure 9.3. FIGURE 9.3 Systems In Interaction 9 / DEVELOPING AN INTERVENTION STRATEGY 231 One side of the diagram includes those systems proposing and favoring change. The larger system is die support system, and includes all systems favoring change. Contained within the support system we find the initiator, client, and change agent systems, all with possible varying degrees of overlap. On the other side of the diagram we find those systems identified as in need of change. The controlling, host, and implementing systems are represented by concentric circles in that each subsystem is typically contained within the span of control of the next larger system. The target system may lie within any of these systems or even outside all three. The action system may overlap any or all of these systems. An example illustrating all systems within one organization would be a situation in which an organizational change is proposed. For example, a human service agency may have a special program for "crack babies" and their mothers (the client system) which includes detoxification, rehabilitation, counseling, and parent training. After six months, a supervisor (initiator system and change agent system) notices that the case managers (implementing system) have been practicing "creaming," providing the bulk of services to the most highly motivated clients and ignoring the needs of the least motivated. In this example, diis practice of "creaming" would be the target—that which is to be changed. The supervisor calls the problem to the attention of the executive director (representing the host system) and the executive director raises it with the board (the controlling system), and recommends that incentives (the proposed change) be developed for case managers to work with less motivated clients. A task force (action system) made up of the supervisor, a case manager, a board member, administrator, and an ex-client now volunteering for the agency examine the problems and possibilities of directing more service to unmotivated clients. All this has taken place within the boundaries of a single organization with essentially no input from extraorganizational sources. This illustrates the nature of the shifting boundaries of systems, while demonstrating the value of retaining conceptual clarity in defining the systems. Even though die terms controlling, host, and implementing may never be used, it is important that the change agent understand the domain, authority, and power of each, and keep roles, responsibilities, and expectations for each clear and distinct. Focus B: Examining System Readiness for Change As the change process unfolds, each of the systems defined above should be assessed for its readiness to support the proposed change. An assessment of readiness should include consideration of an openness to change in general, commitment to the proposed change, availability of resources to implement the proposed change, and the degree of outside resistance to the proposed change. These considerations will most likely be assessed differently for different systems. However, it is likely that there will be some similarities among those systems promoting change (initiator, change agent, client, support, and action systems) and among those with whom they are hoping to bring about change (controlling, host, implementing, and target). 240 MACRO CHANGE etiology, interpersonal and political i'actors, or resource considerations. Each should be examined for its potential driving or restraining effects on the change effort. Figure 9.6 illustrates examples of support from facts and perspectives. Using this format, action system participants next initiate a discussion session focused on making the "go/no-go" decision. An option, of course, is to gather more facts or to postpone the decision to a more opportune time. Additional fact gathering, if absolutely necessary, is considered advisable only if it Is highly focused and time-limited. If, however, fact gathering is proposed as a delaying tactic or intended simply to avoid making a difficult decision, it should be recogr nized for what it is and rejected. It should also be recognised that this may be the point where some participants will believe the proposed change to be unattainable and will decide to drop out, while others may choose to pursue the effort. Here again, it should be emphasized that the professional person acting as change agent raust make as rational, noh-emotionai a decision as possible. Necessary changes that have a good chance of success should be supported. Causes that are likely to be defeatedas currently conceptualized should be tabled until they are more fully developed or the timing is better. Focus G: Setting Goals and Objectives Goals are brief, one sentence or phrase, general statements of expected outcomes [e.g;>Io reduce the number of dropouts in the Jefferson district). Objectives spell out the details for each goal in measurable terms, including expected outcoraes-and the processes to achieve them: Activities, are lists of tasks that must be undertaken and completed In order to achieve each objective. If the decision is made to proceed, the Final step before selecting tactics is to ■ establish a set of goals, objectives, and activities for the change. Goals and objectives are intended to act as a beacon to aid in keeping the change effort on track. Activities > specify precisely what is to be done, by whom, and within what time frame. Setting goals and objectives is probably as much art as it is science. The purpose is to take what can be a very large and complex undertaking and to break it up into manageable subsets. Each subset has its own set of goals, objectives, and activities. FIGURE 9.6 Support Erom Facta and Perspectives an tha Problems of Homeless Teens Driving/Supporting Forces -+|+— Restraining/Opposing Farces 1. Teen homelsssnsss Is increasing by 1. Resources are already inadequate to 20 percent per year meet existing needs of homeless families. 2. Homeless teens haue been drawn Into 2. No federal or state funding is available;-drug trafficking, prostitution and many hamelsssness Is considered a local property crimes problem 3. Media have increased coverage oi the 3. Suburban cities are not willing to problem; the public increasingly favors contribute needed support; major urban same action city council feels it should be considered a regional problém 9 / DEVELOPING AN INTERVENTION STRATEGY 241 The process begins with re-examining the change effort and organizing it Into categories or sections. This calces some practice and requires knowledge of the subject area, which is why problem analysis Is so important in macro-level change. The problem, as analyzed and conceptualized in the problem analysis phase, becomes a theme that is repeated throughout the change episode. The following examples illustrate how one might go about this first step of breaking a large and complex change effort into subsections or categories. They are built on the assumption that the preceding community or organizational analysis and the problem analysis work have been completed. Example 1 The proposed change is a three-year project at-risk teens to graduate from high school. to reduce teen pregnancy and enable Project Subcategories 1. Building self-esteem 2. Providing healdi, hygiene, and sex 3- Providing academic support 4. Providing financial support education In the example, we have depicted a four-part program designed to achieve the purpose as stated above. In botii examples, each of the four areas listed above would have its own set of goals, objectives, and activities. Example 2 The proposed change is a policy change üiat provides for financial incentives for programs demonstrating measurable improvement with alcohol-abusing clients. Project Subcategories 1. Developing valid and reliable indicators 2. Developing the fiscal incentive package 3. Developing quality assurance measure By dividing the change effort into subcategories, each part of the effort can proceed toward achieving its own set of goals and objectives in a way that is more concentrated and focused than if all objectives and activities were organized under a single goal. The exception to this principle of subdividing is when the change effort is so clear and simple that it does not require subcategories. For example, a project to conduct a client satisfaction survey might be a project that requires only a single set of goals, objectives, and activities. It is often true, however, that simple, unopposed change efforts come about without complications, and 242 MACRO CHANGE do not require the type of change process described In this book. If one follows Che steps recommended in this book, it is likely that one is dealing with relatively complex change. Once the subcategories are selected, a set of goals, objectives, and activities should be developed for each. They should always be thought of as a set or package, not as items that stand alone, even though they are occasionally used alone. Task 21; Identify Goals. A goal Is a general statement of expected outcomes or a desired future state (Kettner et al. 1985)- It need not be observable or measurable. It is simply a statement of hopes or expectations, stated in a positive and general enough way to get agreement and support. Continuing with the above examples, the following goal statements would be appropriate. Teen Pregnancy Project ., .Goal ľ To.improve client self-esteem. Goal 2. To increase client knowledge of health, hygiene, and contraception. • :Goal 3 To strengthen client academic abilities. • Goal 4 To increase client financial resources. Measuring Client Outcomes ' Goal 1 To develop indicators of client change. Goal 2 To develop fiscal incentives to promote client improvement. Goal3 To develop methods for assuring service quality. Task 22: Formulate Outcome and Process Objectives. Once a goal statement is written, the next step is to specify objectives. Objectives are intended to move the change effort toward the goal. They are highly specific and measurable. There are two types: (1) outcome objectives, and (2) process objectives. One outcome objective is written for each goal, and specifies the results or outcomes to be achieved. One or more process objectives then specify the process to he followed in order to achieve the result. When the outcome objective and all Its related process objectives are completed and written out, it should be evident that the process objectives, when completed, will lead to achievement of the, outcome objective, and that the outcome objective, when accomplished, will move the effort toward the goal, A complete objective, whether outcome or process, has four parts: (1) a time frame, (2) a target, (3) a result, and (4) a criterion for measuring or documenting the result (Kettner et al. 1985). In the following pages, examples will be given of both outcome and process objectives. The time frame is stated in terms of the month, day, and year by which the result will be achieved. In situations where a project's start date is unknown, the time frame may be specified in terms of time elapsed from the beginning of the project (e.g., "within three months of the beginning of the project,' 1 3 / DEVELOPING AN INTERVENTION STRATEGY 243 m A. kŕ- a it-' I * or "fry the end of the Srst year"). Once a start date is known, it is wise to go back and fill in actual dates, since objectives are often also used as monitoring tools. The second part of an objective, the target, specifies the individuals or focal point for which the objective is written. Outcome objectives are focused on a quality of life change and will Identify the individuals for whom the change is intended. Process objectives may have an object (such as a program or a department] as a target, instead of a population. Statements should be as precise as current knowledge will allow. A drug treatment program, for example, might specify "twenty-four cocaine addicts at least eighteen years of age and currently employed" as its target. A process objective might specify "the counseling program" or the "performance evaluation system" as its target or focal point. Bor reasons stated in earlier chapters in this text, the more precise the target, the greater the likelihood of a successful intervention. As an example, the teen pregnancy program mentioned above will be used to illustrate how outcome andprocess objectives Fit together to form a plan of action. The following diagram illustrates partial objectives, including a time frame and a target. ■■ \ tet i -Ä- ■Ü* ■I #:; ■«" ■ .Bmj ■■ ■fc ir ;ÉSV" k ■fe M Outcome objective: [ time frame ] By June 30, 19XX, [ "target at least fifty teens considered to be at risk of pregnancy . ] Process objective: [ time frame ] By February 1, 19.XX, . . . will be developed for • ■ [ . target, a group of teens considered to tie at risk of pregnancy . 1 In this illustration, the target is the same. The reason will become evident as the objectives are developed further. The third part of an.objective is a phrase that specifies the expected outcome or result to be achieved when all activities are corapieted. This phrase differs depending'on whether the objective is an outcome or a process objective. An outcome objective focuses on a quality of life change for the target population. Outcome objectives refer to such factors as improved knowledge and skill, improved relationships with spouse, reduction of alcohol abuse and other such changes. Process objectives focus on the result expected at the completion of the process. Results might include such objects as a report, a plan, or a new data collection form. Continuing with the example of the outcome and process objectives used above, we add the following outcome and result. 244 MACRO CHANGE Outcome objective; [ time frame ] By June 30, 19XX, [ target J . at least fifty teens considered to be at risk of pregnancy ... [ outcome ] will increase their knowledge of health, hygiene, and contracepüon . . . Process objective: [ dme frame ] By February 1, 19XX, [ result ] a training curriculum on health, hygiene, and contraception will be developed [ target ] for teens considered to be at risk of pregnancy . . . The final part of an objective is the criterion which will be used to determine whether or not the objective has been achieved. Objectives must be precise and. measurable, yet sometimes the result to be achieved seems vague and elusive. Some programs, for example, are designed to improve self-esteem. The question is, how does one know whether or not self-esteem has been improved? The criterion specified in the objective insures that only one standard will be used; If improving self-esteem is the result, then it must be measured by a standardized. test designed to measure self-esteem. The criterion for an outcome objective usually begins with the phrase, " . . .as measured by . . ." Increased self-esteem might be measured by the Index of Self-Esteem (Hudson, 19B2). Process objectives generally produce products or achieve milestones in a process, and use a different-type of criterion to measure the result. In most cases, process objectives will use the phrase, " . . .as documented by . . ." Indicating some formal product or result that will be accepted as documentation that the process objective has been completed. Continuing examples of outcome and process objectives on the teen pregnancy project follow. Outcome objective: [ time frame ] - By June 30, 19XX, -■'■'•[■; target ] at least fifty teens considered to be at risk of pregnancy . . . [ outcome will increase their knowledge of healtii, hygiene and contracepdon . [ criterion ] as measured by a pretest/posttest developed for the course. 9 / DEVELOPING AN INTERVENTION STRATEGY 245 Process objective: [ time frame ] l By February I, 19XX, [ result ] a training curriculum on health, hygiene, and contraception will be developed I target ] for teens considered to be at risk of pregnancy . . . [ criterion ] as documented by receipt of a completed training package. "When all four parts—time frame, target, result, and criterion—have been written, the objective is complete. The foregoing examples are reproduced in Table 9.4 to reinforce the understanding of the differences between outcome and process objectives. Typically a set of goals and objectives will include one goal, one outcome objective, and several process objectives. For example, in the program outlined in Table 9.4, die following might be the focus of goals and objectives. Goal To increase knowledge about health and pregnancy for teens at risk. Outcome Objective By June 30, 19XX, to increase knowledge of health, hygiene, and contraception for fifty teens considered to be at risk of pregnancy as measured by a pretest/posttest developed for the course. Some possible process objectives: 1. Develop training curriculum 2. Develop and reproduce training materials 5- Recruit fifty teens at risk of pregnancy 4. Secure a suitable training location 5. Hire trainers . 6. Implement the program 7. Evaluate the program Task 23: Plan Activities. The final step hi Focus G is to itemize activities. Activities represent the highest level of detail incorporated into the plan. Each activity represents a step which, when accomplished, moves the project closer to achievement of a process objective. Activities should specify the work to be done, the person responsible, and a time frame. The Gantt chart, originated early in the century by management pioneer Henry L. Gantt, has proved to be a useful format for setting up activities. A Gantt chart is made up of columns and rows. 246 MACRO CHANGE TABLE 9.4 Sample Outcome and Process Objectives Outcome Process Time Frame Target Outcome/Result' Criterion By June 30, 19XX 50 leans considered lo he at risk of pregnancy will Increase their knowledge oi health, hygiene, and contracepllon as measured by a pretesUposttest developed (or the course. By February 1, 19XX for teens considered to be at risk of pregnancy a training curriculum on health, hygiene, and contraception will be developed as documented by receipt of a completed training package. Each row represents an activity, and columns are used to identify activity number, person responsible, and the beginning and ending month. Illustrated below is an example of a Gantt chart applied to one of the process objectives for the pregnancy prevention program. The Gantt chart in Figure 9.7 depicts a training project beginning July 1, phasing In each activity sequentially over the next seven months, and delivering the completed training package as promised on February 1. The horizontal lines; across the columns indicate the approximate anticipated beginning and ending _ times for those activities. The 1 in the February column next, to activity number 7 indicates that the completed training package is due on that specific date. In preparing an action plan for a macro-level change, each subsection of the. intervention should include a set of goals, objectives, and activities. "When these are developed at an acceptable level of precision, with responsibilities and time- FIGURE 9.7 A Gantt Chart Process Objective: By February 1, 19XX, to develop a training curriculum on health, hygiene,.' and contraception for teens at risk of pregnancy, as documented by receipt of a completed training package. Activity Person Number Activity Responsible Time Frame J F M A M J JASOND 1. Develop course objectives. J. Smith 2. Prepare content outline J, Smith/ modules on health, hygiene, L. Black and contraception. 3. Select teaching methods L Black for each module. Campaign ■*-*■ Contest Although we categorize these relationships, success may hinge on the change agent's ability to keep the action and target systems in a state of continual interaction. It is possible diať what begins as a collaborative relationship will move to conflict when new issues arise during the change process. It is equally likely "üiat the relationship will vascUlate between various gradations of communication, with both systems uncertain about the other, even when compromise can be reached. In short, these relationships ebb and flow, sometimes unpredictably, given the political situation, and sometimes all too predictably, given the change agent's prior experience with the target system. Our concern is that the social worker never take the relationship between the action and target system for granted. To assume that the target is immovable before communication has been attempted demonstrates poor use of professional judgment. To assume that the target will embrace the cause once the facts are known is naive. Assumptions have litüe place in assessing the relationship between ■ the action and the target system. "We believe that regardless of what types of tactics. are used, communication should be maintained with the target system If at all jjMf-^*-^'>:^^~ It 10 / SELECTING APPROPRIATE TACTICS 2S1 ■jr y\ ar possible. If communication ceases, it should be because the target system refuses to continue interaction. Within each of the three categories are tactics that are typically used. The framework in Table 10.1 guides our discussion. Some of the following conceptualization-is. drawn from previous literature (Brager & Holloway 1978; Brager et al. 19B7). In some areas, we offer slightly different perspectives and add new tactics.- Throughout the following discussion, we attempt to provide an analytical framework to guide an action system in selecting the most appropriate mix of tactics. ■i &- i:- 21-' ■£■ 1 f If. Collaboration Implementation. Collaborative approaches include instances when the target and action systems agree that change is needed. Under collaboration, we place (1) implementation and (2) capacity building tactics. Implementation tactics are used when the action and target systems work together cooperatively. "When these systems agree that change is needed and allocation of resources is supported by critical decision makers, the change simply needs to be implemented. Implementation will most likely involve some problem solving, but it is hot expected that adversarial relationships will be ä concern in these type of collaborative efforts. Capacity Building. Capacity building includes the tactics of participation and empowerment. Participation refers to those activities that involve members of the client system in the change effort. Empowerment is the process of "helping TABLE 10.1 ' Tactical Behaviors Relationship of Action and Target Systems Tactics :lr t ■ft Coí/aboraí/on Target system agrees (or Is easily convinced lo agree) with action system that change is needed and supports allocation of resources Campaign Target Bystern is willing to communicate with action systam, but there is little consensus that change Is needed; or target systam supports change hut not allocation Df resources Contest Target system opposes change and/or allocation of resources and is not open to further communication about opposition 1. Implementation 2. Capacity building a. Participation b. Empowerment 3. Education 4. Persuasion a. Cooptation b. Lobbying 5. Mass madia appeal 6. Bargaining and negotiation 7. Large-group or community action a. Legal (e.g., demonstrations) b. Illegal (e.g., civil disobedience) 8. Class action lawsuit 252 MACRO CHANGE a group orcomrnunity to achieve political influence or relevant legal authority" (Barker 1987, 49). For example, a problem may be defined as exclusion of a neighborhood from decisions that affect them. The focus of the intervention is on building a capacity for greater self-direction and self-control—that is, actually teaching people how to get involved in the decision-making processes in their communities and taking greater control over the decisions that affect their lives. This approach often emerges in situations where disenfranchised communities become targets for development, freeways, airport expansion, and other such encroachments. Through professionally assisted change efforts, perhaps led by a neighborhood social service organization (change agent system), neighborhood resident (client system),- and city council (controlling system and perhaps target system) agree that community citizens should have a greater voice in developments that affect their community. The focus of the change or intervention, however, is not on the target system (city council/planning commission) but on educating, training, and preparing community citizens for a fuller participation in decisions that affect their communities. Tactics would include education, training, and actual participation in civic organizations and activities. Empowerment involves enabling people to become aware of their rights, and-teacbing them'how to exercise those rights so that they become better able to take control over factors that affect their lives. Mobilizing the efforts of self-help groups and voluntary associations identified in Chapter 5 as well as the client system's informal support'structure may be used to assist In guiding" the target system toward consensus with the change effort. Campaign Campaign implies a group effort to convince target system members that a cause Is just or a change is needed, and that resources should be allocated. Campaign tactics require.a good deal of skill on the part of the change agent and action system. Lack of consensus rules out collaboration, yet a firm disagreement has not been established. Under this heading we include the use of education, persuasion, and mass media appeals designed to influence public opinion. Education. Educational tactics can be an integral part of campaigns. Therefore, we use educational tactics, to describe those interactions in which the action system presents perceptions, attitudes, opinions, data, and information about the proposed change with the intent of convincing the-target system to think or to acťäíffereriuy. The objective is to inform. The assumption is that more and better information will lead to a change in behavior. It is a difficult tactic to use because -opponents of the change can also be expected to inform decision makers armed: ■ with different sets of data and information, and there is seldom an absolute '" truth'' in dealing witii complex organizational and community problems. In many cases where education fails to produce the desired result or falls short of having the. desired impact, the change agent turns to persuasion. -^i-^r.-M-j.....r^tt~-X*a***č5XZZX-třs:***^^ $—SLS& 10 / SELECTING APPROPRIATE TACTICS 253 Persuasion. Persuasion refers to the art of convincing others to accept and support one's, point of view or perspective on an issue. Social workers must frequently use persuasive tactics in addition to collaboration because their causes are not always embraced by decision makers, who often must be convinced through persuasion that the change is word: pursuing. This means that the change agent must understand the motives and reasoning of the target system in order to Identify what incentives can be used to negotiate an agreement. Skillful communication requires that the action system must carefully select Its leadership from those persons who have the ability to persuade. Persons who are seen as nonthreatenlng to the target system and who can articulate "the reasoning behind the planned change are particularly useful. For example, in a change effort, particular actors may be perceived as unreasonable, as troublemakers, or as chronic complainers by members of die controlling system. It is not in die best interest of the client system for those persons to be the only 5pokespeople for the change. Clients themselves can also be powerful spokespersons, providing information and a viewpoint that persuades people of the need for change. Framing the problem statement to make it more palatable to target system members is a persuasive technique; This requires the ability to think as the target thinks. For example, a social worker hired as a long-term care ombudsperson was working closely with a coalition of advocates for nursing-home reform to end abuse in long-term care facilities. Nursing-home administrators were very upset over the nursing-home reform coalition and perceived them as not understanding the difficulties with which they coped on a daily basis. They sincerely wanted to provide quality care, but were frustrated by staff who were not properly trained to work with geriatric populations. By framing the problem as a training problem designed to better prepare employees and reduce turnover, the ombudsperson -was able to persuade administrators to cooperate -with the acdon system. When the ombudsperson met with the local nursing home association, she acknowledged that she was aware that the administrators wanted to operate high-quality facilities. She also noted that recent studies revealed that high staff turnover rates often contributed to lack of continuity and lower patient care, sometimes leading to abuse. She explained that she and her colleagues would be willing to develop training for nurses aides because Üiey interacted most intimately with patients, yet were most vulnerable to high turnover. Essentially, one of the contributing factors leading to abuse was being addressed, but it was framed as reducing an administrative nightmare—high staff turnover. Cooptation is defined as minimizing anticipated opposition by absorbing or including members"of the target-system in die action system. Once target system members are part of the planned change effort, it is likely that they will assume some ownership of the change process. Persuasion is used to coopt new persons into the action system. This is valuable to the success of the change effort because it is important to include persons who are viewed as powerful by the target system. These persons may be relatively neutral and may have little interest in obstructing the change effort. However, if they can be convinced to support the change effort (or even to allow their names to be used in publicity), their participation may 254 MACRO CHANGE sway others who respect their opinions. Cooptation is most effective as a tactic when opponents or neutral parties can be helped to recognize a self-interest in the proposed change. ' "■■■-. Cooptation can be formal or informal. Coopting individuals is called informal coaptation, whereas cooptingorganized groups is referred to as formal cooptation. Formal cooptation means that án entire group agrees to support a cause. Because their governing structure agrees that the change effort is worthwhile, the group may issue a statement to that effect. This formalizes the commitment, even though there are always members of any group who may, as individuals, disagree with the'proposed change! Formal cooptation of a number of groups leads to ■ coalition building. A coalition is a loosely woven, ad hoc association of constituent groups, each of whose primary identification is outside the coalition (Haynes & Mlckelson 1986). For example, the purpose of the National' Health Care Campaign is to provide health care coverage to ail American citizens. This change effort brings together hundreds of orgar'zations such as the National Association of Social Workers and the American Public Health Association. On a state by state basis, health care campaign chapters are forming. Interested change agents have encouraged local groups to join in the efforts—forming n coalition dedicated to the stated goal. The diversity of the coalition contributes to a/powerful alliance of individuals and- groups,.that vasctllate between collaboration and campaign tactics as they attempt'to address health care needs. Lobbying is a form of persuasion that addresses policy change under the domain of the controlling system. The action system will have to determine if it is necessary to change agency policy, to amend current legislation or to develop new legislation-in lOrder to .achieve their goal. Haynes and Mickelson (1986) delineate three essential concepts for social work/lobbyists to consider. First, one should always be factual and honest. Trying to second guess or stretching the facts to support one's position is devastating to one's professional reputation as well as to the change effort's credibility. Second, any presentation should be straightforward and supported by the available data. The problem identification and analysis process discussed in Chapter 8 will assist the change agent in organizing the rationale for change. Third, any discussion should include the two - critical concerns of decision makers—cost and social impact of what is proposed. If the cost is high, the social worker is advised to calculate the costs of allowing the identified problem to remain unresolved. Mass Media Appeal. Mass media appeal refers to the development and release of newsworthy stories to, the print and electronic media for the purpose of influencing public opinion. This tacticis used to pressure decision makers into a favorable-resolution to the identified problem. The expectation is that if the proposed change can be presented to the public in a positive way and decision makers' refusal to support the proposed change can be presented as obstructionist or somehow negative, then decision makers will feel pressured to change.their position. Where decision makers are high-profile people like elected representees who depend on a positive public perception, this can be an effective tactic. Use 10 / SELECTING APPROPRIATE TACTICS 255 of mass media depends on news reporters' agreement that the proposed change is a newsworthy story, and assurance that one's cause will be presented accurately. Use of any media must always include consideration of clients' rights to privacy. Contest Under the heading of contest we include the use of bargaining and negotiating, the use of large group or community action, or class action lawsuits. Large groups in community action can be further divided into legal and illegal tactics. Contest tactics are used in situations where: (1) the target system cannot be persuaded by the action system, (2) the target system refuses to communicate with the action system, or (3) it is perceived that only lipservice is being given to the proposed change. Co.ntest tactics mean that the change effort becomes an open, public conflict as attempts are made to draw broad support and/or to pressure or even force the target system into supporting or at least accepting the change. Once this occurs, the action system muse be prepared to face open confrontation and to escalate its coercive techniques." Conflict is inevitable in social work practice. There will be times in the experience of every macro practitioner when incredible resistance is encountered in addressing the needs of oppressed population groups. Social work as a profession developed in response to a basic societal conflict—the persistent anatagonism over individualism and the common good. Conflicts, over the rights of various population groups have spawned violent confrontations rooted in basic value systems and beliefs. We believe that physical violence and terriorism can not be condoned in any change efforts in a civilized society. Nonviolent confrontation, however, including civil disobedience, is an option when there is a communication stalemate between the target and action systems. Contest tactics will require widespread commitment and possible participation from members of the support system. It is critical to the success of these tactics that the support system and its subsystems—initiator, client, and change agent—are comfortable with contest tactics because there are risks that are not present when using collaboration and campaign tactics. It is likely that the time and energy necessary for effective change will increase and relationships can become disrupted. When collaborative and campaign tactics are employed, tactics can move toward contest. However, once contest tactics are employed it is not likely that one can return to collaborative or campaign tactics. Without a clear understanding of what contest tactics involve and without full commitment from the support system, contest tactics are not advised. Bargaining and Negotiation. Bargaining and 'negotiation refer to Üiose situations in which the action and target system confront one another with the reasons for their-opposition. Bargaining and negotiation occur when there is a recognized power differential between parties and a compromise needs to be made. These tactics are more formalized than persuasion, often involving a third-party mediator. Members of the target system will typically agree to negotiate when the following factors are in place: (1) there is some understanding of the 256 MACRO CHANGE intentions and preferred outcomes of.the,action system, (2) there is a degree of urgency, (3) the relative importance and scope of die proposed change is known, (4) there are resources that facilitate the exercise of power, and (5) they perceive the action system as having some legitimacy. In order to negotiate, both the action and the target systems must perceive that each has something, the other wants, otherwise there is no reason to come together (Brager et al. 1987). Bargaining and negotiation can result in a win-win situation, where both target and action systems are pleased witii and fully support the outcome. The result can be a win-lose where one system is clearly the victor, or a lose-lose where both systems give something up and are disappointed in the results. Large Group or Community Action.. Large group or community action refers to the preparing, training, and organizing of large numbers of people who are willing to form.a pressure group and advocate for change through various forms of such collective action as picketing, disruption of meetings, sit-ins, boycotting, and other pressure tactics. Peaceful demonstrations.are legal acdyities, often used by both groups at either extreme of an issue, to express their views. Civil disobedience activities intentionally^ b^eak the law. When action system members deliberately engage in illegal activities, diey must be ready to accept the consequences of their actions. The change agent is responsible for malting potential participants fully aware of diese risks before the decision is made to proceed. Class Action Lawsuits. Class action lawsuits refer to those instances where an entity is sued for a perceived violation of the law and it is expected that the finding of the court will apply to an entire class of people. These tactics are often used with highly vulnerable populations stich as the chronically mentally ill, the homeless, or children, where it is unlikely that they, have the capacity or the resources to protect their own rights. Public interest.law organizations.may be resources'for the action system In developing class action tactics. Considerations in Selecting Tactics A few salient considerations need to be weighed in selecting the best tactic or mix of tactics. These considerations include: 1. "What are the current objectives of the change effort? 2. "What is the perception (by those promoting change) of the controlling and host systems? 3- "What is the perception (by those promoting change) of the role of the client system? "4. "What resources are needed and available for each tactic? 5/ What are the ethical dilemmas inherent in the range of tactical choices? Objectives. Objectives often tend to evolve as die change process moves along, and a rc-examination prior to selection of tactics is in order. For example, With the problem of domestic violence, the condition may have been brought to public. 10 / SELECTING APPROPRIATE TACTICS 257 awareness by che perceived need for additional emergency shelter space for battered women. However, as the problem is analyzed and better understood, the objectives. may shift toward consciousness raising for all women in the' community who are perceived to be at risk of violence. Thus strategy and tactics would move from advocating for service provision to educating for empowerment. Since tactics can change as objectives change, it is worthwhile to make one last check to insure that all are clear and in agreement on current objectives. The following questions can be used to guide the action system's re-examination of the change objectives. 1. What are the stated objectives of this change effort? 2. Given what has been learned in the change process thus far, do the stated objectives need to be revised? 3- Which best describes the intent of the current objectives? a. to solve a substantive problem or provide a needed service ■ b. to increase self-direction or self-control of the client system c. to influence decision makers d. to. change public opinion. . e. to shift power f. to mandate acdori 4. Do members of the action system have any concerns about the intent of the. current objectives that require further discussion? The range of objectives and likely accompanying tactics are indicated in Table 10.2. TABLE 10.2 Relationship of Current Objectives to Tactics Current Objective 1. Salving a substantive problem; providing a needed service 2. Self-direction; sBlf-conlrol 3. Influencing decision maliBrs 4. Changing public opinion 5. Shifting power B. Mandating action Relationship of Target and Action System Collaborative Collaborative In disagreement but wlth'open communication In disagreement but with open communication Adversarial Adversarial . Adversarial Possible Tactics Implementation through Joint action Capacity building through participation and empowerment Education, and persuasion through cooplation, lobbying, etc. Education, persuasion, mass media appeal, Large group or .community action Large group or community action Class action lawsuit