NETTING, F.E., KETTNER, MP., McMURTRY, S.: Social Work Macro Practice, Longman, New York & London, 1993 I Ail Introduction to Macro I Practice in Social Work I i i \ I \ Overview \ What Is Macro Practice? j 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 I Surviving the Dilemmas i 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 frame-work 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 microactivities. 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 malting, establishing and carrying out interagency agreements, conducting needs assessments, and advocating for client needs in a variety of communiq' systems. Policy-related activities include coalition building, lobbying, testifying, tracking legislative developments that direcdy 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, legislative 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 delivery 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 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 quickly 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 community-wide 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 / an 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 but in the absence of an adequate grounding in the nature of client needs. MBA and MSW administrators would act similarly in all situations, and cost alone—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 that unite social workers across roles, arenas, and emphases. MACRO PRACTICE IN CONTEXT This book is intended for all social workers, regardless of whether they 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 workpracdce 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 diat would carry over to my" professional practice. Instead, I find that my professional life is 6 values and historical perspectives dominated by two things: fellow employees and money.. In making decisions, we End chat we have to deal much more with staff egos than with client needs; And the 'bottom line' mentality 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 lils experience: "Culture is so important tD the work we do. I constantly have to ask indigenous people for advice so 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 die money to keep worldoads 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 definidan of who does what. It's very difficult to know which issues should be brought to the board and which ones should be setded by staff." Despite these problems, though, this 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 teaily do things right, the way they can in big corporations." 1 / AN INTRODUCTION TO.tylACPP' PRACTICE IN SOCIAL WORK 7 However, lest we begin to believe'that'tlie com sector does not have its own limitations, the clinical dířeéfSř^^S^ál^^ť^ličiflt .adoption agency had this to say: "Unlike a lot of social Vór^j^ljl^l^^^^ll^^ency, and business considerations always have to te'.^|qfe^^^^^^^^^5 ^Yé a fairly small operation, and I think the agency ^ectóf;^ about how clients are treated, but I've still had to arise between making a profit and serving clientó,; Our/agra and I've been very surprised by the ignorance;Hnd^pTO^ adoption even among other social workers.:A lot of these^'pcop£'•::!r^ čonstántíy imposing their values on women about how they should 'al\vays keep théiť child, and they usually do this without knowing anything. abour/tíiě.eašé;?.' "•!• --. A child protective services worker said: "It's really.hard'tri 'describe. Within a few days last year in my caseload there; was a death of a élůld,-Vánptheř óf my ldds was abandoned in our waiting room, and t here were .threats' of violence against our staff from people who think we just indiscriinihafely; take, children away from their parents. I often think of going into other lines of work, but there are lots of intangible rewards in social work, and other professions have tíiěfř.heádáches^too." The director of a social services unit in a hospital talked about another client group, the elderly.- "I have been here long enough tD see:the\i;dycnt;bf related categories. This is. the Medicare system's way Of rrialUiig'sur^ are discharged efficiently, and if they are not, the hospital has to pick up the tab. Social workers graduate from MSW programs ready to cbiihsel patients' in the hospital and they are sorely disappointed. What we have to dp. 15 work fast; counseling is done 'on the run,' and we are pushed and, prpdcleďby 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 they are discharged and they are really vulnerable to being placed in a nursing home. It is as if policies and procedures make our decisions—where Is the patient involved?" On a final note, a direct practice student who recently graduated made this statement: "This may sound negative, but it is not meant to• b#'Mý\.éau'cátion 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 heginrtiflg 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 Much of the work done by-functional noncapimlators is what we.refer to as macro practice, and is carried out with widely Varying degrees of sitill. The' purpose of this text is to present a theoretical base and a practice model designed to assist the professional social worker in bringing about change in organizations and communities. We encourage its readers to become functional noncapitulatqrs within the organizations and communities in which they will work. WHY MACRO PRACTICE? The beginning student will find that most social work literature reinforces the importance of practitioners' macro-level responsibilities. Why is this such an 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 cornerstone of professional social work practice. Although Chapter 2 will focus on historical development, understanding the professional mission of social work is essential to recognizing why macro practice is important. In a provocative argument, Specht (1990) challenges social work's contemporary interest in the "popular psychotherapies." [They have] diverted social work from its original vision, a vision of the 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 anomte experienced by our youths, the neglect and abuse of children, homelessness, 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 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) Earlier in this chapter we presented three case examples of what included seemingly unresolvable dilemmas. Yet, the lists of questions and concerns 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 published in the NASWStandardsfor 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. Commitment to social change to meet socially recognized needs, 1- I lis 1 1 1 I" 5t 1 / an introduction to macro practice in 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, die macro practitioner approaches the need for change with an understanding and expectation that decisions will be 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. Goal Directed. Goals are broadly denned aims toward which practitioners guide their efforts. They are usually long term and sometimes Idealistic. i..... i L. .1 !.. L- j l-J '—L-J Lj" LJpLJr L_Jf l_J- L-JE UiJ l^f ^ M; . ^ 18 values and historical perspectives However, goals provide a vision shared by clients and colleagues—a 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 clients' lives, based on the interventions 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 practice progresses in an informed manner, incorporating -'jf clients into the dynamic process, designing interventions to meet well-analyzed problems. Broad goals and specific outcomes provide the focused direction. f 1 / AN INTRODUCTION TO MACRO PRACTICE IN.SQGIAlI^M REFERENCES 19, Barker, R. I. (1987) The social work dictionary. Silver Spring.'MD: Naddriailssocfation? of Social Workers. Meenaghan, T. M. (I9B7) Macro practice: Current trends and issues. £ncjicIoperiift of social work (18di ed., 2: 82-89). Silver Spring, MD: National Association of Social 'Workers. Sherman, W. It., and S. Wenocur. (19B3) Empowering,public welfare workers through, mutual support. Social Work, 28(5): 375-79. Specht, H. (1990) Social work and popular psychotherapies. Social-Service Review 6VßV 345-57. SUMMARY In this chapter we have tried to provide the basic foundations on which students can build an understanding of social work macro practice. We defined macro practice as professionally directed intervention designed to bring about planned change in organizations and communities, 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 social workers. These comments illustrate how the circumstances that are often most troubling to social workers are not only the concerns of their clients but also the management of their organization or the resources available within their community. These points were reinforced through three 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. One way that social workers sometimes respond to these realities is to give up fighting against them. This Is done through capitulation, withdrawal, self-martyrdom, or other approaches, all of which reduce the worker's professional effecdveness. However, social workers who are skilled in macro pracdee have another opdon, that of functional noncapitulation, In which they use their understanding of macro systems to bring about needed changes in these systems. These sldlls are not, and should not be, limited to those who are working in traditional 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 in social.work. 30 values amd historical' perspectives 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 wo.rk 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, Education, and Welfare funded CSWE to develop curriculum for training 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 organization thus emerged as a legitimate part of social work practice. MACRO PRACTICE IN ORGANIZATIONS Communities are macro systems in which all social workers interact and 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 (198?) 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, ?nd 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 ol these was managed by its own board of trustees. So uncoordinated a system not only increased the cost of operation, but it did not provide for a channel ol 2 1 the historical roots of macro practice 31 fv.. v l: .■- •/} ' , communication between institutions,- a reform in one, then, might not be '|| • implemented in the others. The situation obviously called for some method of. 'Si-: ■ :" ' state supervision, (p. 81) " " . :§ ;The result was the creation of what became lenown-as the State Boards of Charities, St'■!:':first.in.Massachusetts in 1863, then in another fifteen states by the mid-1890s. If These boards represented the first real involvement of state governments in .'V. . ^centralized coordination of welfare services, and they helped to establish standards 4|' ' ■: for the administration of human service organizations. «1 ::. For roughly the next sixty-five years, much of the development of human I service organizations took place in the private sector. The formation of the COS :lf;- V: .agencies and settlement houses was a partial recognition of the advantages of ,'J establishing standard service practices within the framework of a strong organi-E zational. base. Efforts toward developing more comprehensive public agency S|J.:;;u>:, 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 J department in Illinois in 1917. Still, the. focus remained very much on decen-1 -trakzed serviceprovision. There was relatively little growth among human service J organizations in the public sector. . • if*'5&; 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 1 programs created an infrastructure; of organizations at the federal level that became 4 both the foundations of the welfare state and the first large, governmental human iservice 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 r.'.;v:': r;of.state-level public welfare organizations. Some programs, such as the Federal Emergency Kelief Administration (FERA) and the Work Projects Administration ''^:vo(WPA) were established to respond directly 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 ; 'J-'V-'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 organi-. zation 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 that these concerns forced social work administrators to shift from being "problem solvers" to being "managers." Implicit in this shift was a change in administrative J|v orientation, moving away from external considerations of how best to deal with if specific social problems and toward internal considerations of budgetary com- -'M' pllance and operational efficiency. Considerable concern was expressed that if social a / THE HISTORICAL ROOTS OF MACRO PRACTICE 33 examine these same trends in terms of their influence on contemporary 'developments in the field. -.we Broad Social Conditions ■-ihe combined effect of population growth, urbanization, industrialization, and changes in institutional structures have created communities that are very different today than during the early years of the profession. Though these changes have 2'".' fostered improvements in areas such as health, income, transportation, and others, work administrators did not acquire these skills, leadership of human service agencies "!| ' •' not all aspects of the transformation have been positive. Warren (197B) calls 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 t||;: most social workers now operate within the context of some type of organization, ,§} ■ ■:■ attention to these concerns, noting that "discerning Americans have come to the ; ^liheasy realization that all is not right with their community living, that undesirable ■ v::Situations appear with growing frequency or intensity and that these are not the ll'":.'.'^:iadventitiaus difficulty of one community or another so much as the parts of a Wi. ■i'3|jeneral pattern of community living" (p. 14). Warren calls diis the community §$^blem, and as an element of the contemporary society, it is an important ;|| 'j':'^'^oncern for macro practitioners. i-'■'One aspect of this problem has to do with the consequences of urbanisation. "J ' vi;iThough they offer many benefits, large, complex cities also breed large, complex '^'vTirnblerns, anc' the very size and complexity of a community can interfere with •sblying these problems. One casualty of metropolitan growth, for example, is ■ sense, of solidarity within the community. Small-town shared views of the their understanding of that organization may have much to do with the ability ^ common good may, in large cities, devolve into narrow parochialism based on to do their job well. -^o^'ujuts such as a single apartment building, an area of gang turf, or family and ethnic ■ For example, in a classic work entitled "The Good Bureaucrat," Robert :iij(i&gup affiliations. The greater the number of these communities wilbin commu-Pruger (1973) made the point that social workers have two major roles. The helper ||" nities, the more difficult it is to identify and serve the interests of the whole, role defines their activities ns a social worker who assists clients widi various 'i$j§j$j^4.; Closely tied to these consequences of urbanization is the loss of geographic problems. The organizational role defines the responsibilities the worker has (ot%'&'>0irBlevanca of many communities. In small-town America, communities were completing forms, making reports, attending meetings, and other organizational 'X^f'SiCISrpely defined in terms of residents' physical proximity, as well as commonalities tasks. These roles may compete, and the clash between them may lead to x/^/^^such as topography, soil conditions, water supply, and other circumstances of worker's inability to meet either satisfactorily. For example, a worker may have .•^^.i^prpximity. People lived in the same place they worked, frequently remained there so many forms to fill out that he or she has little time for listening to detailed ft'^throughout their lives, and shared with their neighbors both fortune and mis-client problems. Pruger argues that a third role, the bureaucratic role, is possible,.^V'..:Sil?',*line (droughts, floods, good and bad harvests, and so forth). In contrast, many in which the worker develops skills in mediating the conflicts between the other- JfflVvi:;^^" are now so immense that residents in one area may share little with those two roles, learning to meet organizational demands without sacrificing profes- >- in another in terms of their economic base, political environment, lifestyle, or sional skill. This is what the functional noncapitulator, discussed in Chapter 1, ^ even climate and terrain. Because geographic, legislative, and social boundaries has to do in order to survive in a demanding environment. In subsequent chapters, :||::: }: /often intermingle and evolve, it may be difficult even to define the boundaries we will discuss how Pruger's model of the good bureaucrat fits well within the-:^=^5,iQf:,a: given community, larger framework of the modern macro practitioner. ™v CONTEMPORARY TRENDS At the beginning of diis chapter, we discussed major historical the development of the social work profession. These were: (1) .conditions, W\:£$?- As residents' identification widi focal connections has ebbed, the importance*-' 'JH„11 olextracommunity affiliations has greatly expanded. These affiliations define s||p':;|Kpe;relationships between community organizations and related organizations •.^^'I^Sutside the community,. For example, an auto plant may be essential-to^tht ^■X -"economy of a particular community, but itsmost important ties may not be. to,.-, trends affecting %;t community but to die home office of its corporation in another city far away '1) broad sociahMF^f'tlecision to close the plant might come entirely from the home office jet it (2) ideological conflicts, and (3) oppressed populations. In this section, jgppS?&?be community that would bear the most severe consequences of this decision Wteg 34 VALUES AND HISTORICAL PERSPECTIVES 2 / THE HISTORICAL HOOTS OF MACRO PRACTICE 35 Loss of control over such decisions.renders the community extremely vulnerable, % t "flbuse centers, home health, etc.). .For-profit organizations began moving into yet an excessive concern for external affiliations may blind community mejtnbe'rs>|||.^uman service provision, seeking clients who could pay for their own services. to critical local needs. The effect of diis trend on community human servic'esysternsiiasbeen most number of may or may In addition to community issues, contemporary developments in the WganŕÄ^^te tri the provision of services to lów-income.clients Form I zational structure of human services are also important to consider. One pat^^^^^g were served by nonprofit agencies either through co T " m*n7 ese between communities and organisations is that both have continued to grow anaMriX^ndes or through excess revenues from clients who we e M ^ ™ w become more complex. In the organizational realm, this has given rise to theiffe^overnment funds are more scarce and paying clients áre ofte s* "h tru' bureaucratization of "service systems. The term bureaucracy has taken on a^^^ospltals and for-profit providers. Many nonprofit agencieT'no Ion « hav "'^sources to pay for services to poor clients and there is increasing" competition onprofits for the funds that are available (McMurtry et al 19911 growth in size and structural complexity ot Human service wgauii*,^. ^".is.^rfi. ,« trend is die advent of computerisation. Society is movine to d has been especially true in public agencies, which have generally continued to Wp^o'del In which, information and services rather than manufactured goods ateth* expand since the New Deal. J:mšŠtaast important commodities. As this takes place, communities will change Heavv Bureaucratic organization is a means of structuring tasks and relatíonships.CiyJS|äBdnstries will diminish in importance and even the traditional character of th among organizational members in order to maximize operational efficiency, in ;;||'|'S^grkpIace will be altered, such as by workers remaining home and carrylna out many ways, this mp'del has made possible the development of modern orgaru-.^||ff||bflir tasks on computers. Moreover, the ability to tie into national and interoad °!l zations, and its advent coincides with the vast increase in productive capacityl|||^áoinputer networks will farther enhance the'importance of cxträ-communitv ťcs associated with the Industrial Revolution. The problem with bureaucracies is that "iff-Ykru Social workers' roles will inevitably be affected by these changes F they often become as machineiikeas the tools they employ, and the result can^^cample, Ginsberg (1988) discusses how computer technology has facilitated be a rigid and dehumanizing style of operation. This style usually grows raoreM^storage of vast numbers of client records'by large public and private human service pronounced as the organization gets larger, and vast governmental human service •^"'•^organizations. He cites government researchers who challenge social workers to agencies have become some of the most notorious examples of the negatíve-.^js^'ftijse computer technology, noting that "social workers aspects of bureaucratic structure. V^¥^|%-' Partly in response to this problem, privatization became a significant trend,.^^f; during the last two decades. Although the term can be used in many ways, we M<^Sf-define privatization as "the deciding, financing, or providing of human services i-i^l'-v-' by the private sector to clients for whom the public sector is responsible" (Netting M$s£jife-et.al. 1990). The trend may be more accurately termed reprivatization because iT^Pr. of its focus on returning to the private sector for responding to human need. '}}í" \^ Beginning in the 1960s, recognition of the limitations of government a>';J^ bureaucracies prompted growth in purchase of service contracting. Public write reports and progress notes pull and read numerous files take case histories and develop diagnoses tap into local area resource networlcs keep in touch with.professional developments provide factors and figures to contribute to agency accountability process.' (Parker et al. 1987, cited in Ginsberg 19BB, 71) Still, other writers argue that these changes pose grave dangers for the agencies oaid for services but they were provided to their clients by private £ ^W^Hnns Between 1971 and 1984 for example, nonprofit purchase of service ?fe&profession. For example, Fabricant (1985) asserts that the computer revolution cont™Erew from $262.9 million to S664.1 million (Kettner & Martin 1987). j ^ simply another, manifestation of an ongoing process of "deskillmg" social ^computers, and these computers determine clients' eligibility. The point is that arrangement was probably well accepted in many However, other trencis accompanying uic m v €;#Bs other social trends we have discussed) they risk being controlled by them, the community service delivery system. ■ ;;j .n|a*' During the early 1980s, conservative views toward human services, combined | ^gg£-with an economic slowdown, led to decreased public funding and decentralization .||:.-5|ti[ieological Conflicts of decision making. This meant that many nonprofit agencies, which had P'c-^|gir . viously grown larger on public dollars, were suddenly faced with stiff compeddon AM with the discussion of broad social conditions, Warren's (1978) notions of for very limited resources. For example, facing a shortage of patients, hospitals community problem also provide a startmg point for addressing contemporary began diversifying into service areas other than primary health care (i.e., substance''Ideological trends, One issue concerns community members' Increasing difficulty 58 THE COMMUNITY AS THE TARGET DF CHANGE 1111 4 / UNDERSTANDING COMMUNITIES AMD COMMUNITY SOCIAL PROBLEMS 69 understand something as complex .as a community, much less propose ways to^^^^jSlK 4.1 change it? -• — The Community Encounter Framework First, it should be made clear that there is no single accepted, orderly, systematic method that allows one to understand all the elements that go into malting up. ^0%£!^e?ti,y'na the TafBet p°PulaUon community. Understanding, for the macro practitioner, means gathering as mucK^lfe^^-- _ „ data and information as possible in a narrowly focused area of interest or concCri^f|i|?lermInin9 Communl,y CharaCarlflllos Task and making the best informed decisions the information will allow. There are three reasons why macro practitioners need a systematic approa"clt^K':M|f ^cognizing onceptualizing a community and its social problems. First, the persan-in;^^^^*i". Differences to conceptualizing a community environment view is critical to pre in which one lives has a lot to do with who that person is, the problems he □ environment view is critical to professional social work practice. The communl^^|^^':v .^^pinw Siruc,ure she faces, and die resources available to deal with these problems. Professionapi||tfe^>; ' social work prescriptions may not be feasible or realistic without an undecstandin^^^^^§"-' ed here for understanding* of these community Influences. The framework presented '. 1. Understand characteristics ol larget-populatton members 2. Identify community boundaries 3. Profile social problems 4. Understand dominant values 5. Identify formal and covrjrt mechanisms of oppression 6. Idenlify evidence ol discrimination 7. Recognize locallbns of power B. Determine resource aval lability 9. Identify patterns of resource control and service delivery community Is designed to assist In conceptualizing the environment within whicttj clients experience hope and draw strength, as well as face oppression and fawcattoqjlppgg: Second, community-level macro change requires an understanding of ilJ^p^^Bfit selecting a target population, and that the community be understood from history and development of a community as well as an analysis of its current statuig'/j^^^'^^erspective of the concerns and needs of that population. The target Without this knowledge, the practitioner has a limited grasp of the breadth an'l^^^^^ol^tion is defined as those'individuals, families, and/or groups who are depth of values, attitudes, and traditions, and their significance in either mairi^p^^geriencmg a problem or heed, and for whose benefit some type of community taining the status quo or allowing for change. " .-^^^^Intge is being considered. , Third, communities constantly change. Individuals and groups move int^^^^^^Efie choice of a particular target population is a choice of values. In every power, economic structures change, sources of funding change, and citizens' rol^,S^^ininunity there are multiple groups with varying needs. Therefore, the social change. A framework for understanding community can be helpful in recognizing and interpreting these changes. A FRAMEWORK FOR CONCEPTUALIZING COMMUNITY A first step toward understanding community is creating a framework that yvlM help In comparing elements in one community to elements in another. Soni^ communities are larger than others, some have different ethnic malteups, soing 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 th|| communities can be better understood if selected community variables ate analyzed. Based on these variables, we have identified nine tasks that comprise-a four-step framework to be used in conceptualizing and understanding^ community. In subsequent chapters, we will present mediods for planning chang® based on this understanding. This framework is shown in Table 4.1. ^S^8^ft^entif5rinB a population in need can, in itself, be complex. None of us is ^■f^^^^^i.t:'Pr.orJy one community. Community can be defined in terms of ethnicity ?|^^^p;the Latino community), religion (e.g., the Jewish community), commitment Lff|S||^iitidn (e.g., the pro-choice community), profession (e.g., die social work ^^^Sitiiiity), avocational interest (e.g., recreational and sports enthusiasts), and |yB|pj-pther designations. Each of us, In fact, would be more realistically defined JIP^1" °^ manY different communities at once. ^orlter must realize that In focusing on oné target population, he or she is aTMng' a choice to examine the community from a specific perspective. It ^.jj^be Important, then, to go back and look at.the community again from g^Jg'erspective of more than one target population so that a richer understand-'~||Ípjgícan develop. For example, existing reports on community issues and ^"gljulations may predetermine what target group the practitioner will serve, with pllmited opportunity to familiarize oneself with other community needs fepneerns. iŤJřesuggest that a community be analyzed and understood from this limited Ijsgpectlve because (1) practically speaking, people who become involved in ?flf«arritinlty change are generally people with full-time jobs, and it is not unusual 'Ěmacro-level intervention responsibilities are added to those jobs; and (2) there L'mit to the amount of information that can be used in macro-level inter-S^ttlqns. In short, we don't disagree with those who suggest that, In the ideal, ihing possible should be known and understood about a community. We |slinply-suggesting that, with limited time and resources, responsible change iJt^can be initiated by narrowing the parameters of community analysis. Focus A: Identifying Target Populations Many approaches to community analysis propose that the community/.bfe understood in its totality to the greatest extent possible before interventiorrisjs planned. We propose, instead, that the defmitio'n of community be narrow.^ 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 nQt 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 ma> " 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 relationships are part of what constitutes individual identity; these relationships niay be neutral or positive or negative; they may involve low to high dcEreesof reciprocity and alienation, (p. 33) Viewed graphically, a community would look like a series of overlapping circles! As an individual, any person from a community, pictured graphically, might loot , like a circle subdivided into many different reference groups, as illustrated in=l£ 'Figure 4.1. By beginning with a population in need, we are suggesting that a persotrs attempting to understand a community first identify the population of focus. Toi 5 begins a narrowing-down prbcess. Initial definitions of population can be broad, i|| s' with the understanding that the more precise the definition selected, the more! feasible a full understanding of the community context for this population ,(p.f,-3' For example, issues surrounding alcoholism prompt a concern for macro 1\E£f,\-level change,.the population of focus for a particular community analysis could«|v50r be "people with alcohol problems who live in Riverdale County" or "ethniciijrj • £5 minority women alcoholics who have been convicted of driving while' intoxicated^! within the past two years in Riverdale Count)'." One is more inclusive, the other wv^Titsk J; more focused. It is probably advisable, at this early stage, that a broader definition ^^rfjlue-uons to be asked: be adopted, with an understanding that it will become more precise as a dearer understanding of needed change emerges. ' % ^ Once a population has been identified and the definition appropriatel) TsFr'Sf^: narrowed, all other dimensions of the community are explored arid examined jy^^C from the perspective of that population. For each dimension to be explored, we jlJ^jS.-will identify a task intended to bring focus to the collection of data andJLi.; information. We will next focus on questions about the population. FtaaUyj^t "^j^ we will propose some questions about a community that will aid In understand^p£rf5=r ing each dimension, and in comparing it to other communities. Although framework contains a number of tasks, the process of analyzing any comfnu ^jTj^ nlty requires the social worker to go bade and forth, returning to refine prevlou h casks as new information is gathered. The social worker is urged to use the ,f .3 FIGURE 4.1 The Individual" within tlie Community Understand Characteristics- of Target-Fopnlation Members. • 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: framework as an interactive guide rather than a rigid formula for approach ^L^J^ ing community. Demographic differences [do not] exhaust the variations among subgroups of the poor. Although attitudina] differences arc more difficult to define and identify, a wide diversity of world views exists even within donoKmphically homogenous 72 THE COMMUNITY AS THE TARGET OF CHANGE populations. Thus, sorne poor are moce alienated than others, some mote upwardly aspiring, and sorne angrier. Where they fall on these dimensions has a bearing □n how they will respond to particular efforts to involve tlicrn 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 population 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 papulation. 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 formed. 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, race, gender, and., age, by census tract. 2. Generally, how do people in this target population (and others close to ■ them) perceive their concerns, problems, issues, and/or needs? Do diey 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 commu, nity's responsiveness to their concerns, problem's, issues, and/or needs?;. Focus B: Determining Community Characteristics Size is an important characteristic of a community, and can be assessed in a number of ways. Size can be calculated in terms of the amount of space covered, by! the number of people living within its boundaries, or both. It is an impoiianl -i / understanding communities amd community social problems -■■73v characteristic for the macro practitioner because geographical boundaries estab-lished 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 die 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 that 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 will 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 vout by a Navajo social worker who explained how difficult it was to determine iSpacial 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 furisdictional units established by various government agencies for planning and 90 THE COMMUNITY AS THE TARGET OF CHANGE requires (1) focused arid precise data collection, (2) analysis of historical trends APPENDIX and (3) a thorough understanding of qualitative elements that reflect human ^ J experiences, interactions, and relationships REFERENCES IS -f Barker, R. L. (1987) The social work dictionary. Silver Spring, MD: National Association \ of Social Workers. ' Belenky, M. F,, B. M. Ctinchy, N. It. GDldberger, andj. M. Tarule. (1986) Women' vja of knowing. New York: Basic Books. Bellah, R.' N., R. Madsen, W. M, Sullivan, A. Swidler, and S. M. Tipton. (1985) HabiUqft^ the heart: Individualism and commitment in American life. New York: Harper & Row Lt] f Tm ) Barrcra, M., C. Munaz, and C. Ornelas. (1972) The barrio as an interna! colony. Urbany Affairs Annual Review, 6: 480-98. -j Brager, G., H. Specht, andj. L. Torczyner. (19B7) Community organizing. New "York' Columbia University Press.' Bricker-Jenklns, M., and Nancy R. Hooyman, cds. (1986) Notfor women only. Stiver 5pring.-- MD: National Association of Social Workers. Burke, E. M. (1968) Citizen participation strategies. Journal of the American Institute of *, Planners, .34(5): 293-Choklin, H. M. (1985) Cities and suburbs. New York: McGraw-Hill. Cross, T. L., B.J. Bazton, K. W. Dennis, and M. R. Isaacs. (1989) Towards a culturally com petent system of care. Washington, DC: Georgetown University Child Development Center n|Jc Fellin, P. (1987) The community and the social worker. Itasca, IL: Peacock. Gilligan; C. (1982) In a different voice. Cambridge, MS: Harvard University Press Jansson, B. S. (1988) The reluctant welfare state: A history of American social welfara-.,^ policies. Belmont, CA: Wadsworth. ■\-r$ Kettner, P. M.,J, M. Daley, and A. W. Nichols. (1985) Initiating change in organizations/^ and communities. Monterey", CA: Brooks/Cole. if rOCUS B: 4 fill King, S. W. and R. 5. Mayers. (1984) A course syllabus on developing self-help groups■..-ft.rvf„ among minority elderly. Inj. S. McNeil and S. W. King, eds., Guidelines far developing ß}ä$f~ mental health and minority aging curriculum with a focus on self help group* 1 Publication supported by National institute of Mental Health Grant #MH 13944-O-L Margoli5, R. J. (1990) Risking old age in America. Boulder, CO: Westview Press. Meenaghan, T., R. O. Washington, and R. M. Ryan. (1982) Macro practice in the human j services. New York: Free Press.' Rabin, D. L. and P. Stockton. (1987) Long-term care for the elderly: A factbobk. Oxford; England: Oxford University Press; 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 understand. New York: William Morrow. Waring, M, (198B) If women counted. San Francisco: Harper & Row. Warren, R. L. (1978) The community in America (3rd ed.). Chicago: Rand McNally. i '•- .Kin J 1 " Framework for Conceptualizing Community f roCUS A: IDENTIFYING TARGET POPULATIONS "(Task 1: Understand Characteristics of T.rrget-Population Members J 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? DETERMINING COMMUNITY CHARACTERISTICS ijaslt 2: Identify Community Boundaries -it* ' 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? i Jask 3: 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? i lask 4: Understand Dominant Values V What cultural values, traditions, or beliefs are important to the target papulation? 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 papulation? 92 THE COMMUNITY AS THE TARGET OF CHANGE FOCUS C: RECOGNIZING DIFFERENCES Task 5: Identify Formal and Covert Mechanisms of Oppression IBIhapter 5 ] Understanding a Community • What differences are observed among members of the target population? * What differences are observed between members of the target population and^r^:"- _ , --------------.....•----------' - r Human Service System other groups within the community? • How are target population differences viewed by the larger community? . ... jy<::.'- ■ In what way is the target population oppressed because of these di£ferenccs??'flfsr'*i' ■ What target population strengths can be identified and how might diese 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? FOCUS D: IDENTIFYING STRUCTURE Sp What arc the primary sources of funding (both local and extracommunity) foc-^'p^p^ Task 7: Recognize Locations of Power health and human services designed for the target population within the coramunIty^!p"|^j**i> ■ Are there strong leaders within the segment of tiie health and human service^if^^' community that serves the target population? -^^fe* ■ What type of community power structure influences the service delivery network designed for the target population? ■■■*tfW3&i.v -I- 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 8: Determine Linkages Between Units Summary References Appendix: Task 8: Determine Resource Availability • What are the existing community agencies and groups currently seen as majat service providers to the target population? • What are the major funding sources for services to the target population? • What nonmonetary resources are needed and available? Task S>: Identify Patterns of Resource Control and Service Delivery , INTRODUCTION • What groups and associations advocate for and provide assistance to the target" population? ijbj^ihj any situation where an assessment is called for, whether it be an assessment • How is resource distribution to the target population influenced by lnteractiqn |r^°f an. individual, a family, or an entire community, it is helpful to use a framework, within the community? j t/^f,framework aids in identifying each of the variables to be examined, Just as was ■ How is resource distribution to the target population influenced by extra *Mf-^0ne ln th-e previous chapter. Few Such analytical frameworks are available for community forces? 5£^%ess'n8 Iocal community human service systems. In this chapter, we will propose 93 94 THE COMMUNITY AS THE TAHGET OF CHANGE a conceptual approach intended.to permit a student or practitioner to exanune "j^"'* TABLE a constellation of services within a given locale to determine adequacy of existing li iji"—"~ resources to deal with current or projected levels of need. Fo<^5 While we will use the term human service system to describe the focu of^E the assessment, we caution students and practitioners not to place too mucliS^ emphasis or credence in the term ' "system.'" There is rarely a master plan. Hum ifn" service systems are generally made up of loosely related or unrelated client-servinu I programs operating under a variety of auspices, rather than clearly planned parEs^l that come together into a comprehensive whole. "We will attempt to present-^! framework for assessing the extent to which this network of existing resources is capable of meeting need. II $ J 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 95 Framework for Assessing Community Human Sarvica Systems Tasks A FRAMEWORK FOR ANALYZING COMMUNITY HUMAN SERVICE SYSTEMS Understanding Need Identifying Auspice or Sponsoring Organizations determining Systemic Competence 1. Identify the target population 2. Define a continuum ol need 3. Assess isrgat population riBeds 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' jre <_ommon to that culture" (p. 2). Because the characteristics of community "i1 residents vary, there may be subgroups diat require special attention. For example, —J^lf a community' has a high proportion of retirees, one can expect that many of Vl~ the ervices will address the needs of older people. If services are not available, We approach the assessment of a community's existing human service system'^ with several assumptions: (1) that an entire human service system in most commie ^H, - ^. j 1 jj .._ ., , v ; , , . , * , jfe *1 fiie delivery system may not be adequately addressing community needs roumties is too complex to analyze as a whole, and therefore services must be asses ttffW ^ for a specified target population, (2) that a community's human service system shai3a-f«p3-' c 1 tc 1 • j <=. j 1 . , , ^. ,. , , , , ' J&'^ Ihei are frequendy used for planning purposes, and funding tends to be clustered be assessed and evaluated in relation to the extent to which it meets the needs of lF# ^ ' „■ „ „ „ . _ , . . ^Jriffn .around these categories: its people, and (3) that the needs of the people in a community should be examincM^^!^ not only In terms of individual need, but also in terms of collective need. ^jlvsf Following these assumptions, we propose a framework for analyzing nd3fs-r jjp evaluating a community's human service system. The tasks that comprise thk^gjjiiji, framework are shown in Table 5.1. Focus A: Understanding Need Task 1: Identify the Target Population. Questions to be asked: What target populations are identified within the community, and how are they categorized? What target population will be die focus of this assessment? What priority is given to the needs of the target population in this community? Ar* .TU Children "Y oudi Families Older adults Adults nevelopmentally challenged Physically challenged -Ja&StP' Dbviously, these groups are neither exhaustive nor mutually exclusive. In addition, l^1 fth^l d° not Specify the many subgroups that fall within each category. For t^Kj^"1 example, if the target population is children, it is important to recognize that lijjjfajf-cchildren come from families of all socioeconomic statuses, racial and ethnic - i 1 ^groups, and locations within a community. People who are identified as being in a target population are consumers oL-L H s Although we have identified seven categories of people who may have services, and ideally the services provided are designed to meet their need rfct™mnioii characteristics and needs, individual communities will have their own However, it is important to recognize that people's needs are always changin£^f^ ^ definitions of target populadons. How does the community categorize client This requires a human service system diat has flexbility to respond to change Mffi firoups for planning purposes? local and regional planning agencies, United Ways, needs: Gonzalez, et al. (19913. remind us that even cultural identity changes. ' 0n6*h>J|- community councils, and associations of agencies often produce agreed-upon can always expect to find both change and diversity within any community ft J*^ cla -tficadon schemes for data collection and planning purposes. Regardless of fact, even a community that appears to represent one culture or cultural grou^fe*1- ^existing categories, it is ultimately the task of the individual or group conducting will actually be quite mixed, demonstradng a range of behaviors and beliefs Jf ^ community assessment to define the target populadon. as THE COMMUNITY AS THE TARGET OF CHANGE 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM gg TABLE 5.2 Community Service Identification Wldqws Aged B5+ Living Alone In West Kingston Type of Weed Services Typically Services Available . Dssignad to Meet Need in This Community 'fa the target population; (6) review of social indicators such as income or occupational levels of the target population; (7) administrative or managerial Needs Esleem Needs Social Naads Safety and Security Needs Survival Needs Education Programs Volunteer Opportunities Support Groups Psychosocial Counseling Mental Haalth Centers Recreational and Social Groups Senior Centers Hams Visitors Emergency Response, System Adult Family Homes Congregate Care Facilities Senior Housing Continuing CarB Retirement Communltles-WBllnsss Clinics Telephone Contact Home Delivered Maala Senior Discounts Mobile Meals Transportation Homemak'er HomB Health Personal Care Medical Cara Available at Kingston Sanier Center- Two support groups Mental tiBatth canter has limited services One senior canter .jjpj.jjjlje community; (4) key informant surveys that focus on knowledgeable and '^Pl^flueotial community residents; (5) secondary: data analysis of existing statistics ;jM«t|.gc0vrf review; and (8) review of information from other agencies (Meenaghan JEr* 1982). =!§P%- ■ The preferred approach in assessing need for a particular population is to &fitiiu5e existing data. Original data collection is expensive and time-consuming, and ■•: ;:frfl|^i^-:usuariy beyond the scope of the macro practitioner unless a particular change ^'ifi^Btfp.rt has widespread community and financial backing. Table 5.3 summarizes Jifi|e advantages and disadvantages using each approach'. '■ 'jgtJBffi the target population who are experiencing each problem, and (2) the number '£llll|?f-People d»at can be served using existing resources. The first number minus ~~K' "Ipfjie-second number presents the community's unmet need. Unmet need, inadequately met need, or inappropriately met need are frequentiy the focus of macro- Idealiy, the macro practitioner would like to know (1) the number of people No amerganoy system Three unlicensed nomas OnB congregate facility No senior housing No retirement community »'mtr— Public health department has :.?8ffl8B^ cnanSe efforts. wellness clinic ~^MH^^ ' 'With special population groups that require multiple services, classification Church runs telephone reassurance program 'SlS^t. Limited delivered meals proB/am^JBHrSt'' ■ .'-'J'jjiiffi ^^liemes are often based on the concept of a continuum of care. A continuum TwBnly mobile meals slots No bus system, one senior van; avaltBbia Needs Assessment Methods: Advantages and Disadvantages One licensed homemakar pragrHiTr^^ppg§lhod No home health provider ?• rT^I^ ^ Two licensed personal care BBen#glgf|;a One community hospital and cnBc-MiSSS'- ■ Description Advantages Disadvantages nursing home IcpulnSion such as art and language (cultural); for learning from the past (historical); forjJie»pf Ifgsvider use of power (political); for viewing the past, present and future through actiorip'|| ^sffjvays words and movement (creative/spiritual); and for explanations that connect whifffe ijp^jtS"' happens in one's world through investigation and experimentation (intellectual^^ j|ppjnnant Task 3: Assess Target Population Needs. Question to be asked: rjgjSiJrvays ■' 3&" "What are feasible and appropriate ways in -which to find out how many people are in need in each of the this target population? ÉKSálvsis areas identified as relevant to.t|Epjgg&t' Eight general methods of approaching a needs assessment have been disctisst^^^^iS in tlie literature. They include (I) general population surveys, which consist o^^S^aw interviews with a sample of community residents; (2) target population surve}f^B^.^on that interview members of a select group; (3) service provider surveys, whl|^^^^;0^r interview those groups and organizations that serve the target population wi^ft?Sjp|ys Interviews with community residents Interviews with a select group Interviews with providers that servlcB target papulation IntBrvlaws with knowledgeable/influential TBsidBnts Analyzing existing data Reviews ol data such as incomB, age, occupation Review administrative/ managerial documentation Review any other data from county, state, local agenclBS Providss broad overview o( needs Obtains data directly from target Gives parspBctiva 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 eisswhare 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 da not provide detailed information Is subjective and may be difficult to access May be difficult to locate —i. - -.-'ms ft \ si r " > I 5 i ii b t r a f t f i r 100 THE COMMUNITY AS THE TARGET OF CHANGE j I. .-fip^l :f;;i i. ■ r f x s 1 If i 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 101 TABLE S.4 Continuum of Long-Term Care Services by Category In-liDme Services Outreach Information and Referral Comprehensive GBrlatric Assessment Emergency Response Syslem Companionship/Friendly Visiting Telephone Reassurance Caregiver Respite Services Homamakar and Chore ServicBS Household Repafr Services Personal Care-Home Delivered Meals Home Health In-HomB High Technology Therapy Hospice Community-based Services Case Management Adult Care Homes Transportation Shared Housing Senior CentBrs Congregate Housing Senior Discount Programs Wellness and Health Promotion Clinics Recrsalional Activities Geriatric Assessment Clinics Caregiver Support Groups Physician Services Self-help Groups Adult Day Cars Counseling Mental Health Clinics Foster Homes Outpatient Clinics Institutional Services Alcohol and Drug Treatment Swing Beds Rehabilitation Skilled Nursing Care Psychiatric Care Extended Care of care consists of a broad menu of services from which items can be selected* to address the specific needs of certain individuals or groups. Conceivably, eacliW menu will vary based on what is needed for the target population served. Table 5-:dita and social problem data to other surrounding communities, and a sensitivity IfiCftj. the needs and aspirations of those who live in the community. Collective need .|;.':roay also need to be addressed at another level such as the state legislature or U.S. I^Cbngress. The focus can remain on the local community where actions can be taken* jKijjut the point of intervention may be outside the community, fsf: When collective need for empowerment, participation, control and other such r^j&ctors Is identified oc expressed, the role of the macro practitioner is different from . fefhe role taken when the need is for a human service response. These roles will be l-^pucussed in Parr IV (Chapters 8 through 10). Jpjjbcus B: Identifying Auspice ppr Sponsoring Organizations ;'jf|!kassessing and understanding a community's human service system, it is important '^;jb'examine die sponsoring unit or organization. Table 5,5 Identifies the types of |*Biits that should be considered when assessing service provision in a community. 102 THE COMMUNITY AS THE TARGET OF CHANGE TABLE 5.5 Unlls Within the Health and Human Service Delivery System 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 103 Informal Units Household Units Neighborhood/Groups Mediating Units . Self-help Groups Voluntary Associations Formal Units Nonprofit Agencies Public Agencies For-profit Agencies , , , , v«Hl^r«clHng as a service-delivery- unit. These units, taken together, comprise the total health and human servtcisai;-:^-^ .•1SI|!^9u'valent to tne household, but in recent decades more and more people have j, lived together in dwelling units without being related, malting household a more ■^Mipfoadly useful term" (Smith 1991, 138)/-Service provision in this unit generally .VS^Sf&kes the form of caregiving and tends to fall heavily on women in our society, .-^tevlflie potential for caregiver burden or strain suggests that mutual support provided f-Sijby the informal system may require assistance from others within the community, •flpllatespite services are often needed in the interest of sustaining the physical- and jiSliiiental well-being of the caregiver. In assessing the extent of service provided in household units within a given '^te^orarnunity, one should look far indicators of what is happening within private dwellings for the target population. For example, are identified caregivers within rffijthe community overburdened? Is there an.identified need for respite services for -iSSp^Gireglvers of die physically disabled, developmentaliy disabled, elderly, and/or 4^E|$QUng children? Are requests for live-ins and shared housing increasing? Answers Ijljftp-these and related questions will aid in the process of assessing the domestic , . , . . 5^teSSlr Of particular concern is identifying the importance of the household unit delivery system within tne community, each operating interdependent^. A-give^.^. populaEion. For example, if the target population consists of frail community, depending on availability of resources, may emphasize the provls,,^^ alone, the household unit does not contain others who can assist, of services through one set of units more than another. For example, «^ a'csourc^^^^ .onl afe c ivers not availahLe, but formerly active older women may poor community, reliance on informal units may be a necessity until P»b" v _ ^ „„„„mw««- >'•^^SAen uVe m crowded households where privacy is limited and tension is high, .^Ipiffnay.draw support from siblings, peers, and parents. Respite for single mothers O tions to be askeu^^l^ **c ^tejíóř example, associations such as the Ku IClux Klan are powerful yet destructive ;.i;i|p?jfirces within certain communities. Voluntary associations are a study in Incuisiveness as well as exciusiveness. ^illiams and Williams (1984) discuss the importance of the black church in the ,";^pf|ae.velopment and growth of mutual aid societies. Historically, many mainstream l^fójctfvltíes beyond the church were closed to blades who migrated to urban centers. ;S;||f "Blaclcs organized voluntary associations in the church in such forms as sick and ilfffeburial societies, economic self-help groups, mission societies, and various secret ,-'.jj|||jhdfraternal orders" (Williams & Williams 1984, 21). Voluntary associations Self-help Groups. Self-help groups are one of the fastest growing elements o^f^ríthin the black church became an adaptive mechanism to deal with discrimi-community support. They have been formed to deal with a variety of personals|||g§adon. Numerous studies report higher participation rates of blades involuntary and social problems and needs including bereavement and loss, depres5iohi|^|£?Boclatlons 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 the|fe»^bians and gays, and other oppressed groups may generally use informal and best known being Alcoholics Anonymous) have formed national and mtematíoniiBíf. (jg^iediating units to a larger degree than other populations. Neighborhood groups, chapters and are recognized vehicles of service delivery. "^lyíelf-help groups, and voluntary assodations serve as means of mutual support, as Hutcheson and Dominguez (1986) acknowledge the importance of ethnto^j^^lace for clarifying perspectives, and as a focal point for action. In some cases self-help groups in their research on Hispanics. Because language and cultura|| |gtóeie activities lead to recognition and wider support, and to improved access to barriers can confront ethnic populations, self-help groups assist in matatainirig? j^wrexisting formal units of human service delivery in a community, community identity and involvement, In assessing available services for a target population, it is important that the Self-help groups are often viewed as being compatible with a femimšt^ |i,g|nacro practitioner identify voluntary associations. Churches, unions, and perspective as well. Such groups are directed at widows, women who have beechf; ^professional groups are all potential sources of support for the target population, exploited or abused, and caregivers. Mutual support provided through self-helflií ^?|jiey 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 caregivers;.;.^ §jj|fburce to which some people turn when in need. 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? What voluntary associations have members from, or take an interest: in, the target population within this community? What mediating units are actively engaged in service delivery to the;' target population within this community? 106 THE COMMUNITY AS THE.TARGET OF CHANGE S I UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 107 Task 7: Examine Formal Service-Delivery Units. Questions to be askedr ■■ • 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: Nonprofit (voluntary) Public (governmental) Far-profit (commercial) Nonprofit Agencies. As voluntary associations become more formalized, they may become incorporated as nonprofit agencies, recognized as publicly chartered lax free organizations (Van Til 1988). There ate many types of nonprofit agencies but here we will focus on nonprofit human service agencies, defined by Kramer (1981) as: "those [organizations] that are essentially bureaucratic in structure, governed by-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) 1 Nonprofit agencies are formal vehicles of health and human service delivery ^ They are often viewed traditionally within local communities as the agency dl*1 ——....... jrt;^:^r;^T» i-l-iif rrtT-oft-c ^ dn^r-ialiTpH rUentplf This traditionalr--.-, view is based on the eariy welfare system in this country which arose from tt; profusion of agencies sponsored by various religious and. secular groups, Today, health services represents 51 percent of the operating expenditures within the nonprofit sector (Hodgklnson & Weitzman 1989, 22). Health services primarily includes hospitals, nursing and personal-care facilities, and outpatien' care and allied services. The 1982 Census of Service Industries indicated that there were 52,571 nonprofit human service organizations in the United States (US Department of Commerce 1984). Although expenditures within this sector had fJ ■ regard to race or gender, there is a growing trend toward agencies designed to serve the special needs of ethnic minority communities and families, women who are -. victims of discrimination arid/or violence, and other groups underserved by more -.traditional agencies. The macro practitioner should identify which nonprofit agencies ., 5erve the target population and whether they have particular service emphases. '-Public Agencies. The public sector consists of federal, state, regional, county vand city government entities. When the mutual support function is performed ;---by government, it is referred to as social welfare. The United States social welfare r-sj'Stem has been described as a "patchwork quilt" which "does not represent ;i-a coordinated, comprehensive, integrated, and nonredundant series of social r'-'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 operatidnalized within.the local community, 5;they have usually gone through several leyels 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 irwhat they can and cannot do. Local decision malting and autonomy will vary .^depending on the policies that drive a particular program. In short, extracom-i.'.-'Hiunity 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 j. example, working with the elderly means that one must be familiar with the Older . feiAroericans 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 :agmg (AAAs). Every state must have a three- to five-year plan for services to the ^^elderly, and each AAA must have a more localized plan. Therefore, every community within the United States will be included in a plan that addresses the needs of the elderly. Experience suggests that this does not mean that every cuoice_a voluntary initiative that targets a specialized clientele. This traditional £p i J'bommunity meets the needs of their elderly members. Resources will be limited . . . . ___ic---. . *\-.tc r,^„.1rr.r nmcp Pi-run ii&>^!w.-^:iflnrl arfn31Ev r^irrvino nut thf* nlnn w(H inrlnrlf* flip itsp nf nlrirr Arnprirtin^ Ar 4 Si " and actually carrying out the plan wilt include the use of Older Americans Act ^dollars, in partnership with other public and private initiatives. In addition, many .^communities have waiting lists for services, and state commitments to carrying out the objectives of the federal legislation vary. ^~ f If one's target population is single mothers receiving Aid to Families with Dependent Children (AFDC), the social worker will need to know that states vary da what income is counted against benefits received. States also establish their own needs standard for families in that state. Therefore, although AFDC is a large risen until the early 1980s, federal budget-cuts caused some declines in growth d j^ubllc assistance program developed at the federal level, state-level decisions Many agencies reacted to'budget cuts by increasing their revenues from dues }W^mfWnr,. fh~ h^fUe f-mdi« rp^to Tniv,^*,. ri,» =r,r-i*i ™r.rlri-rwMi nperi 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 ^ Willie all nonprofit agencies using government funding serve clients without j ...^influence the benefits families receive. To be effective, the social worker will need to understand how federal and state governments interact and how community - attitudes toward AFDC recipients influence clients. fFj- In assessing the distribution of public resources across an entire community, -•^gflcludlng the funding of social service programs, it is important once again to examine community practices from the perspective of special populations. S-------L I—.—■»8 IwxnJ bassstE frrrmrC 106 t.„.r I. 1 L.J L J L_.J L_^|J"LJ I_t I_&• 1__fe1 I___t M_____I' L_ THE COMMUNITY AS THE TARGET OF CHANGE 5 1 UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 109 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 its funding for AIDS research, and have.. 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, reguladons, 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 dtose 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;. Marmor, et al. (1987), explain this shift in terms of a life-cycle model involving 'Sfetfthese steps: A new service is developed by nonprofits; ' the service is broadly accepted; use in the proprietary sector Increases; policymakers become concerned about those unable to pay for this service. ^Firat, a new service is developed through technical or social innovation. Typically, |jv|i'these efforts are initiated by nonprofits because new services are normally ^jpimensive and require subsidization from private or public sources. Second, once f0ihe service is well-received, broad acceptance follows. Third, interest from the [[^proprietary sector is sparked and proprietary organizations enter the arena, £gf competing with the nonprofit providers. In efforts to keep up with the f^competition, nonprofit providers begin behaving much like their for-profit compe- ' gigSjitors. Last, policymakers become concerned about those persons who cannot f°rthe service because both for-profit and nonprofit organizations are ^.competing for those who can pay. If the service Is important enough, the public ^*£seccor will finance the poor and uninsured, "which in turn tends to reduce the ^ttnportaace 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. fl^Thfe life-cycle model reflects patterns Identified in the health care field, as proprietary corporations have begun competing with nonprofits in die community. ' Public financing of health care through private mechanisms was only the vfi®beginning.. Stoesz (1988) tells us more: r-rS:":; 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 not provided by the state, firms were free to function independently of the government, fpp. 54-5) ii As profit-making corporations bid for public contracts, competition with ;r§5nonprofit organizations increases. Ten years ago our discussion of the health and fc^iiuman service systems would have focused almost entirely on die government |ii|and nonprofit sectors and their partnership. Today, as we approach the twenty-'f3§:first century, the term mixed economy, including government, nonprofit, and ^£yjfor-proflt services is clearly a more accurate description. Given the complexity of die formal service delivery system, the purpose of US Sethis assessment is to gain a better understanding of what organizations are ^providing services to the target population in this community. Having a general *:§'"idea of what nonprofit, public, and for-profit agencies are available leads to an ^examination of how they work together. H 11D THE COMMUNITY AS THE TARGET OF CHANGE Focus C: Detcnninihg Systemic Competence Knowing what agencies ace available does not go far enough. It is important for -die 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 nextprfo 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 Betiveen Units. Questions to be asked; • How are the various types of service units generally connected within;' a community? -V • "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. Tobin et al. (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 mediii 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 the 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 newgroups 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. ?•'£■*.;' Level of Interaction H ■;:-;.J.c ."I -'^li- S / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 111 TABLE S.B Five Levels of Interaction Leading !□ Improved Programming 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 avofd . ■.. unnecessary duplication of services. .^Coordination Two or more separate organizations work together to plan programs and ensurB that they Interact smoothly and avoid conflict, waste, and unnecessary duplication of services. Organizations sharB Information, advertise lor each other, and ■'. maltB 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. ■;,Canfederatlon _ Two ar more organizations marge to provide programs or services. i';: None of the participating organizations maintains a separate ."': Identity or separate resources. ■'eouhce: Enabling (rie EWer/y: by ShBldon S. TaHn, Jamas W. Ellor, and Susan Anderson-Play. Chart 9.1 Five itavefe at Interaction Leading to Improved Programming, p. 14a, Stale Unluuiolly al Nsiv Yadt Press, 1936. !?*£ jmothers with young children, yet these units provide different resources. Social !|Ssworkers at die day-care center meet with staff at the human service agency once i^J-v.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, f^iitbc practitioner needs to know that these linkages are established. '$§■1:.' Corporate volunteerisra represents a cooperative linkage between die for-profit and nonprofit sectors. The Levi Strauss Company provides an example. p£^rUn communities throughout the United States in which Levi Strauss factories are 4 r^Jfifp.cated, there are community involvement teams. In one southeastern city, die s"!£j5jcompany encouraged its employees to become actively involved with a multi-jjijlcounty nonprofit home aide service for the elderly and physically handicapped. Sg^/JEmpLoyees donated time to painting and repairing the homes of older shut-ins, ^£jL.:,as'well as providing friendly visits to the agency's clients. If the target population ftlfels older widows, the social worker needs to know that the corporate sector is .willing to address client needs. :V The concept of corporate volunteerism is manifested in a number of ways, i |pi&:".bu5iness may subsidize their employees by giving them release time to do ijlj^ommunir}' service work. Other companies will loan employees to human service j^jpagencies for a specified period of time so that die expertise required for a project P;|^ican be provided at no cost to the agency. As employees near retirement, the for-|tffl;iPr°fit sector often provides preretirement training in which posrrctirement |*<|£>yolunteer opportunities are presented. In tills way, the for-profit sector actually liJl^iPerfDrrns a recruitment function for the nonprofit service delivery system. a/" •M§f^g;.v 112 THE COMMUNITY AS THE TARGET OF CHANGE -$i!ip^' 5 / UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 113 ... The interchange between the for-profit and nonprofit sectors also occurs-.uil^^^gpdations, public agencies, and interested individuals have joined forces to work the form of corporate cash and in-ldnd contributions. Computer manufacn]rers,;v|Kl^aw2rd a common goal—health care for all citizens. In coming together, a new may donate hardware to a: local service agency, assisting in computerizing k^%fe^oBintary association is farmed. Even though the diverse members of this coalition information system. Restaurants may donate food to homeless shelters. A ioca'^^^pccscnt various interests across community units, their collaboration on health for-profit nursing home may open its doors to older community residents whrj&tsjpi^econcerns 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 Wave~-^^J^AunIdes; agencies created to serve the needs of a special population collaborate In this community, what cooperative efforts exist between service units withir6^p^i"assess need, to examine the fit between needs and services, and to present different sectors diat focus on the target population's needs? Are ethnicity, gender,"!%^^^\iinited front and a stronger voice In pursuing funding for programs, or affectional preference factors that need to be taken into consideration inf's^i^;: Albrecht and Brewer (1990) call for change agents within communities to assessing service system interactions? Are any of these interests left out when theyi:^fep|Qve beyond coalition building, which is often temporary, and toward building should be Included? .J^^^|ances. The. "concept of alliance as a new level of commitment that is longer- "r!:S-lS®|f^inS' deeper, and built upon more trusting political relationships" requires Coordination. Coordination implies a concerted effort to work together. Often^^^||sfcing questions such asr "Who sets the agenda? What are the power differentials? separate units will draft agreements, outlining ways in which coordination will ocais^^^par different skills do we bring to the table? What different visions of social In a continuum of care system that attempts to address the needs of sacfll^^^^jflge do we have? And what different leadership styles do we use and do we populations as older persons, those with disabilities, or AIDS victims withmthe'SE^^^Jue?'' (p. 4) community, coordination is necessary. As consumers exit the acute care hosptta[j-lJ^p|5jjpii In this community, what coalitions are focused on target population needs? discharge planners work to develop a care plan. This requires knowledge of andjj^^|!fc active are coalitions in advocating for change? Are there Joint ventures (new close coordination with local service providers. Service plans often include ii|?!|^^|dgrams) developed by two or more service units? Are there coalitions that are package to support the client's needs—mobile meals, visiting nurses, and homeS^pp|'|j^vlng toward building long-term alliances?' maker services. Depending on the level of disability and length of time c^pected^fi^^.g- for recovery, this service plan may make the difference between returning hqm&^^^tqjifederation. Units within the community may actually merge, often when or convalescing In a long-term care facility. Extensive coordination is required;S||p^ibc;pr both units becomes unable to function autonomously. A horizontal merger The growth of case management within local communities reflects the neet]?^^^'Gc'tirs, for example, when two mental health centers consolidate into a single for interunit oversight as consumers receive services from multiple units. CaseK|^^;Q^ganizatlon. A vertical merger occurs when a hospital absorbs a home health management programs attempt to provide a coordination function so that service^^^|rovide'r. A conglomerate merger occurs when units within the cornmunity form delivery flaws across informal and formal providers of care. Where there are cas'e!^.g^^Bnfederation of multiple smaller units under a large umbrella agency. These managers serving the target population it is useful to learn how they view thej^^^dpns are generally limited to. nongovernmental agencies, relationships between service units that serve the target population and whe^^^p^^JAgency interaction inevitably involves competition and conflict. Change they see gaps. •'■'■ii^^^^^ats 'earn to cope with competition and conflict on a regular basis. These types t'1||^^^interaction5 will be discussed in Part III. Collaboration. Collaboration implies the concept of a joint venture. Joiii(^g^|/ ventures are agreements in which two or more units within the community agre^v^g||^' to set up a new program or service. This usually occurs when no one sepaMte|^-^g^MMARY unit within the community is able or willing to establish the new venture alorie|^^|^v: For example, a local senior citizens center Identified the need for repan^p^p;this chapter, we have endeavored to present a means for assessing a services for many of its participants. Because older persons tend to own oldep^^^lpmmunity's human service system. The assessment process begins with the homes, repairs were often needed. The center did not have the resources to begin^|^Seflnition of a target population, whose needs must then be conceptualized in this program alone, but by working with a community action agency within the^^S^ferarchy according to their urgency. Following this, the human service response community, a home repair service was sponsored jointly by the center and.thc|^^pexplored and collective needs are considered. Sources of help are then agency. Eventually, the home repair service became a separate unit, incorporated^^^cesscd, including informal sources such as households and social networks as a nonprofit organization /i^^^^tnediating sources such as self-help groups and voluntary associations. Formal Coalition building is another form of collaboration. A coalition is a iooseiy^g^irces of services include nonprofit, public, and for-profit providers, and both developed association of constituent groups and organizations, each of whose primai^^&^nttture and orientation of services may differ in Important ways across these identification is outside the coalition. For example, state coalitions have been fonred^^^stiices. Determining the competence of these systems in combining to meet as part of die National Health Care Campaign. Community organizations, voluntarj^^Bds in an effective way is the Final consideration. APPENDIX Framework for Analyzing Conmmnity Human Service Systems FOCUS A: UNDERSTANDING NEED Task 1: Identify the Target Population ■ What target populations are identified within die community, and how arc 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 community? 5 I UNDERSTANDING A COMMUNITY HUMAN SERVICE SYSTEM 117 ;. What Informal units are actively engaged in service delivery to the target — *| tp population within this community? ~-J^ ^ f. Are race, ethnicity, or gender factors in the provision of informal services j^^ri nd support? X 6". Examine Mediating Service-Delivery Units lilK fif&M-'Si'S » What mediating units would typically assist the target population within a !Mfi?i^fev local community? What self-help groups are available to the target population within this '^ife^^SC community? jte^t^j'f-t;. What voluntary associations have members from, or take an interest in, the ^igaSj^'"' target population within this community? ^pafi:. What mediating units are actively engaged In service delivery to the target /Sgsljjl^:' population within this community? m It 7 Examine Formal,Service-Delivery Units How can target population needs be conceptualized so that a determinate i ^.T • What nonprofit agencies deliver services to the target population within this !§|j£i:'' community? Ijff." • What public agencies deliver services to the target population within this community?' What for-profit agencies deliver services to the target population within this §&S!s&*'. community? ^b-J-r ■ Are there differences in service delivery across formal units that appear to be '•: based on race or ethnicity, gender, affectional preference, disability, or age? Task 2: Define a Continuum of Need • How can target population needs be o can be 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 flnd'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 • Are there needs In this community that require something other than a human j^pQCUS Q 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 • What Informal units would typically assist the target population within "a locals community? r What importance does the household unit have to the target papulation within tills community? - What Importance do natural support and social networks have to the target population within this community? 116 ■ Task S: Determine Linkages between Units • Iluw arc 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 currently established? ■ Vre the interests of ethnic minorities and women represented in the network i c tobllshcd through linkages between units? 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 arc flexible? Task 2: Identify Sources of Noncash Revenues ■ Does the organization use volunteers? If'yes, how many and for what purposes? ■ What material resources (e.g., food, 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? -A 7 / PRACTICE IN HUMAN SERVICE ORGANIZATIONS 193 • What professional associations, labor unions, or accrediting bodies influence agency operations? • Is this organization affiliated with or sponsored by religious, ethnic, or fraternal bodies? ■ How does this organization define its "public," and what groups ace part of this definition? ' JpjFOCUS B: RECOGNIZING THE DYNAMICS :-p OF AGENCY/ENVIRONMENT RELATIONS p;Xask 5-- Observe Relationships with Clients • Has this organization targeted new or different clients within the last five years? • What is the organization's domain (specifically, what types of clients does the organization serve)? • Are these clients ones who bring resources ta the agency or for whose services resources must be obtained elsewhere? • Does 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 nonminoritles)? What happens to diese clients? m '-Si" Task 6: Observe Relationships with Resource Sources How good are the relationships between funding sources and organizational leaders? How does the organization use and work with volunteers? How good are 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? S Task 7: Observe Relationships with Competitors B • What other agencies provide the same services to the same cticnteie as this organization? • Are 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 7 / PRACTICE IN HUMAN SERVICE ORGANIZATION ' 195 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 nontraditiorial, etc.)? , ■ Is this die most 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 10i Understand Administration, Management, aiid Leadership • How is the workplace organized and work allocated? • Is appropriate authority assigned along with responsibility? . ... ■ Flow 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 fs conflict handled? Task Hi Recognize the Organization's Culture • How would one begin to describe the organization's culture? • What are the organisation's artifacts and creations? ■ What are the organization's stated values and what is actually valued within ■ the organization? How do leaders within the organization influence organizational values and assumptions? What are the taken-for-granted patterns within this organization? is behavior consistent with culture? Are there minorities or odiers who feel left out of the accepted orgat,iza_ tlonal culture? jiTisk 12: Assess the Organization's Programs and Services ■ What programs are offered? What services are offered within each program? Are the services consistent with the goals and objectives of the program? • Is there a common understanding among management and line staff Within 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 any staff over or under qualified? Are workload expectations reasonable given cx ccta tions for achievement with each client and within each service and program? \s consideration given to cultural and racial understanding of workers ancj clients? • What data is collected on clients and how is it used? • What evaluative Information is expected from the evaluation plan? is there a plan to gather information about clients and the extent of improvement at the point of termination and in a follow-up survey or interview? Is there an effort m determine level of client satisfaction with services? What do the findings reveal to date? S^Task 13: Assess Organizational Technology What are the job expectations for each level of staff within the °rganljation? What background education and experience is required to perform these jobs? Do those who hold these jobs have the appropriate credentials? Are staff members performing competently in their positions? Are diey meeting expectations? Arc they effective (do they get good results) in working clients? Is each discipline supervised and evaluated by someone with approprinte knowledge, values, skills, and professional identification? In what ways are various units representing different disciplines (e.g^ socia\ work, psychology, medical, data processing, etc.) linked with each other for the purposes of collaboration and communication? 1^ Tjsk 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? ■■ir. •' What formal and informal criteria are used for evaluating performance? ■ What kinds of behaviors does the organization reward? C ■ ' ■ I 196 THE ORGANIZATION AS THE TARGET OF CHANGE 7 I PRACTICE IN HUMAN SERVICE ORGANIZATIONS 197 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? Haw 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 organization 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? * Do die 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 to 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? ft. 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? srn 202 macho change INTRODUCTION Social work is a profession oriented toward action 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. Soma practitioners focus' on communitywide problems. Others practice in the areas • of planning, management, and.adrninistration of organizations. Regardless of the.-, professional social worker's practice orientation, it is crucial that practitioners of ail 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, pur 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 Dix or Florence Kelley. Others view change agents as superorganizers 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 bad 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. Sil.' li-1- V P 8 / PREPARING FOR MACRO-LEVEL INTERVENTIONS 203 ;.; The change, effort may be led or coordinated by a professional social worker, ;J:but those involved will represent a broad range of interest groups. |? 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 V;. described in this chapter will require input from knowledgeable and experienced people. They are also tasks that fall within the capacity of a professional social worker who can Skillfully draw on various talents present among a group of committed professionals, volunteers, and consumers. Focus 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 deadis 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 availability 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 B.1 Framework far Planning Change ;. Focus Tasks ' A. Identifying !he Population and the Problem Ö. Analyzing the Problem C. Developing trie 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. Identify and apply relevant theoretical perspectives 7. Apply findings from research, prcgram evaluation, and practice B. Examine ethnic, gender, and target-population perspectives 9. Speculate about the etiology of the problem 10. Refine the problem statement 11. State a hypothesis 12. Propose relationships between changes and results 4SÍ 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 conceptualized and defined, therefore, can be cridcal 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 organ!-' zational or community condition; (2) collecting supporting data; (3) identifying barriers to condition resolution; and (4) determining whether the conditioais"' 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. Strnilarly in rural communities.' isolation, Inaccessible health care, or a declining economic base can all he-considered social conditions. • ■ The same concept applies to organizations. Troublesome phenomena arealso.; present in organizations, but they have, not always been formally identified'orr-iabeled as a problem. For example, staff in a long-term care facility for the eldedy..; 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 payoiK a waiting list. ■ To be recognized as a problem, a condition must in some way be incorporated-,1; 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 mearr; 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^ munities 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, states: and local community leaders began to perceive them as problems. Once formally recognized and acknowledged as problems (usually as a result of persistent media; f a / PREPARING FOR MACRO-LEVEL INTERVENTIONS 205 W- attention), these conditions become candidates for organized intervention efforts. -.'sp'-The creation of task forces for the homeless in cities across die country and federal ■ill-funding for AIDS research are results of recognizing conditions and defining .'8*them as problems. The first step In problem identification, then, is to develop a condition - -It*- statement. A condition statement must include a target population, a geographical •/^.boundary, and the difficulty facing that population. Statements should be descrip-'I^Ttive and free of qualifying or judgmental words or phrases, such as poor or ^^disadvantaged, as possible. .Vipi?': Statements will be adapted depending on whether the condition exists within :. pffii community or in an organization. For example, a condition statement might 's'SfrbC, "Suicide among teenagers in Preston County is increasing/' Generally ..-■^jpealdng, the more precise the statement, the greater the likelihood of a successful '^intervention. The above statement, for example, could vary from extremely rfe-general to very precise, as depicted below. ^Sample Condition Statements V'-'fi^&eneral Teen suicide is increasing. '■■-"^*^' Teen suicide in Preston County is increasing. U'-tpfe - Teens from lower socioeconomic families In Preston County have ■::.-:.J^T- shown increasing suicide rates. :. .;|jf|i;: Teens from lower socioeconomic families in Preston County, primarily in the Washington and Lincoln High School attendance ■ .fjfflS areas have shown increasing suicide rates. i"'v':*^ppeclHc Etc. =£.-. A Similar process within an organization would begin witii a general state-'i: -Jllpent, For example, an organizational condition might involve an Increasing .^'^-fdropout rate among low-income families in a family counseling program. Data ■;:'A.|{ip'rid information would need to be compiled to help pinpoint the condition as , ^i3g§grcdsely as possible. ;.; YliJK Condition statements are made more precise through a process of research •IjPJtad documentation of the nature, size, and scope of die problem. As one proceeds . i-iS'With the steps In Task 1, the condition statement may be refined many times as ■ .ip?new facts arise. -■m - :"fe ■ . pg-Tosfe 2: Collect Supporting Data. There was a time when a communiry could ■ ..^become sensitized to a condition and recognize it as a problem based on a few ;.-i'^|ncidents. Churches started orphanages and counties started poor houses with ./_:;J||Jittie or no data beyond personal knowledge of a few people in need and the '5';^i|xpectation that there would be more. ••" ;'S$?" Today, however, with so many social and community problems competing l{|||jbr limited resources, data must be compiled to justify the existence of a problem '..'■V-ptor need. Collecting data on a community social problem can be a challenge. '•''■Sfflw?. 210 MACRO CHANGE B I PREPARING FOR MACRO-LEVEL INTERVENTIONS 211 TAHLE B.4 Identification of Barriers ta Condition Resolution Condition Statement Barriers Resolution Statement The incidence of teen suicide is increasing In PrBslon County Examples ol supporting data: The number or. suicides Increased Irom two in 1984 to seven in 19SD Stress related Illness In high-school students increased 48 percent In five years An Increasing number of teens suffer from low self-esteem in Preston County Many parents are only minimally Involved with their teenage children Teens are experiencing . Increased stress . Teen depression Is increasing Many teens feel Increasingly isolated and alienated Irom their peers Use and abuse of drugs and alcohol is Increasing among leans Teen suicide should be declining or nonexistent In Preston County 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 XFbetber a Condition Is a Problem. There is no prea e 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 homelessness 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 thaf it can no longer be ignored by communicy leaders, or when one or more leader... 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- citizens or agency staff members, then a proposed change may be readily accepted.-ff not, it must first receive enough attention that decision makers cannot ignore It. This raises a pivotal question for die 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 die substantive change to an effort to bring attention to the problem. Summary of Steps Involved in Problem Identification, In summary, the following important points have been made so far about identifying a condition and creating' an awareness that it is a problem. 1. Initiating, macro-level interventions in organizations and communities begins with the identification of a condition or problem. 2. For a condition to be considered a problem, some type of formal recognition is necessary. Securing this recognition may become a subsequent 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 on. the problem that the change agent wishes to convey. Displays can illustrate comparisons to other conditions, changes in conditions over time, relationship of conditions to standards, or relationship to contributing factors. 5. Identification of barriers to condition resolution help to make clear the complexity of the condition and the sources of support needed 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 and intervention. Focus B: Analyzing the Problem Human problems are complex phenomena and, as such, often require a good deal i-of study and thoughtful consideration. While the lay public may have simple answers to many social problems, the professional can afford no such luxury. Analyzing social or community problems is undertaken in an attempt to understand why the problem exists. Why are some people chronically unemployed? Why do some parents neglect their children? Why do some teens attempt suicide? This is no time for simplistic answers! It is a time for the most thorough study . and analysis that time and resources will allow. LmmÜ Lunf LmL f-m—t! 218 MACRO CHANGE B / PREPARING FOR MACHO-LEVEL INTERVENTIONS 219 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 refined1 into aproblem 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 fromr the Washington, Lincoln, and Jefferson attendance areas of the Preston City school district have been increasing steadily over the last Ave 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 a1; thorough understanding of the problem and gaining consensus from the participants about a common or shared understanding. y\ 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 of what has worked and not worked in other attempts to address the same ' or similar problems. m 5. 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 tiieory and research should he put to the test in direct contact with target population representatives. }. 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 intervention. ). 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. 'VFbcus C: Developing the Intervention Hypothesis V During the early phases of problem identification, many people involved in change •.efforts, both professionals and volunteers, are eager to propose a specific inter-' yention. Many have experienced the frustration of working in what they perceive itto be flawed programs or under what they perceive to be oppressive organizational ^policies, and they are eager to propose immediate change. A disciplined, scholarly approach to macro-level change requires that the (foregoing tasks associated with problem identification and analysis be addressed. f.However, it is the unusual change agent who is not constantly mindful of a '('preferred intervention and who is not continually molding and shaping it as the ?analysis unfolds. Decisions about the nature, shape, and design of the intervention should wait f-'untii the problem analysis has been completed. When an acceptable degree of ^'consensus has been achieved about the nature of the problem and its etiology, ^an intervention hypothesis is proposed. • Task lit State a Hypothesis. Based on all the information gathered in the .problem identification and analysis phases, an intervention hypothesis is ^developed. The hypothesis is a declarative statement (or series of statements) that ^proposes a relationship between a specific intervention and a result or outcome. L;The statement identifies the following: (1) a target population (or specific |5ubgroup) and problem, (2) the change or intervention proposed, and (3) the ^-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 pfrom dropping out of high school might read: If teens with economic problems ft'-ire placed in a work study program which allows them to earn at least minimum ["wage for at least 30 hours a week and take evening classes, then the dropout rate among this group will decline at least 10% per year for the next five years. 220 MACRO CHANGE This would be 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 knowledge- . able about the information produced in the process of problem analysis. Repce- '■ 5entatives 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 Betzueen Changes and Results. A proposed policy change might be hypothesized to affect the targetpopuiation in the following way: If family counseling by a licensed clinical social worker is required, as a condition for readmission of all students expelled for behavioral problems,., then the readjustment rate of these students will improve and the dropout rater 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 understanding of etiology. 2. Drawing on the knowledge base built on the above concent areas, ideas about interventions that appear to be relevant to the need as it is currendy; understood should be discussed. 3. Using these proposed Interventions, a set of intervention hypotheses (and" possibly subhypotheses} 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 in a series of If/then statements; fori example: If (population) with (problem) cart 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 in? 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 is seen as a more neutral,, and objective term; its use recognizes that not everyone agrees on the existence 1 f.- i. IP- '■M B / PHEPAHING FOR MACRO-LEVEL INTERVENTIONS 221 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. .1, REFERENCES «sei Barnhart, C. L., and R. K. Barrthart, eds. (1979) Tbe world book dictionary. London: World Boole International. Data Network for Human Services. (19B7) Socio-economic indicators for Maricopa county. Phoenix, AZ: Autiior. Ericlcson, E. (1968) Identity: Youth and crisis. New York: Norton. Fetterman, D. M. (1989) Ethnography: Step by step. Newbury Park, CA: Sage. Gilligan, C. (19B2) In a different voice. Cambridge, MS: Harvard University Press. Green, J. W. (1982) Cultural awareness in tbe human services. Engiewood Cliffs, NJ: Prentice-Hall. Kettner, P. M., J. M. Daley, and A. "v/. Nichols. (1985) Initiating change in organizations and communities. Monterey, CA: Brooks/Cole. Kettner, P. M,, and L. L. Mardn. (1987) Purchase of service contracting. Newbury Park, 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. : Piven, F. P., and R. Cloward. (1971) Regulating the poor: Tfje functions of public welfare. New York: Pantheon. Skinner, B. V. (1971) Beyond freedom and dignity. New York: Knopf. M * % ■r5£t w 224 MACRO CHANGE GUIDELINES FOR DEVELOPING AN INTERVENTION STRATEGY As in previous chapters, we will present the process of developing a strategy jn.'■■ terms of a number of areas toward which the macro practitioner must focus his or her attention. These foci include; (A) defining participants, (B) exarnhv ing system readiness for change, (C) selecting a change approach, (D) assessing.. political and interpersonal considerations, (E) assessing economic considerations; (F) weighing the likelihood of success, (G) setting goals and objectives, (H) selecting;. appropriate tactics, and (I) preparing a written plan. This chapter is organized.. afound the first seven foci, whereas Focus H and Focus I will be discussed in 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 SystBtn Readiness for Changs C. Selecting a Change Approach . D. Assessing Political and Interpersonal Considerations E. Assessing ResourcB Considerations F. Weighing the Likelihood ol Success G. Setting Goals and' Objectives 1. Identity the initiator system 2. Identify the change agent systsm . '■■ 3. Identity the client system A. Identify the support system 5. Identify the controlling system ■■' 6. Identify the host and implementing systems',; 7. Identify the target system ,'/,|;.; B. Identify the action system 3-9. Assbss general openness to change .', 10. Identify anticipated or actual response 11. Determine availability o( resources ■;"■'■ 12. Examine outside opposition to change -;;> 13. Select a policy, program, project, personnel;'..; or practice approach ; 14. AddrBSS public Irnage and successful change-.' 15. Identify alternative perspectives 16. Assess duration and urgency 17. Determine the cost of change 1B. Determine the cost of doing nothing ■' *,; 19. Assess support Irom Individuals, groups;.' and organizations . ,J*\ 20. Assbss support from facts and perspectives.;., 21. Identify goals ' ' 22. Formulate outcome and procESS objectives?. 23. Plan activities 9 / DEVELOPING AN INTERVENTION STRATEGY •'K-f|--to take action. It is perfectly appropriate for this small group to undertake some rSbf1116 carIv activities of problem identification and analysis, as long as they do • islp^npt become totally committed to a particular perspective on the problem. %|!,* ' In orderfor effective macro change to occur it is necessary to have allies. :/.M§A,good deal of strategy development involves the building of coalitions. People '••"^willing to commit themselves to change rarely accept someone else's definitions -'. ^'Ip'iind perspectives without some revision. (If full participation of all critical actors :':MjfiS accomplished in the problem identification and analysis phases, then ':.' •pJachievernent of consensus on the problem and proposed solution should not be ■■'.'!!§&•■ barrier to progress at this point.) p|;! One method of identifying, in an orderly, systematic manner, the participants ■Jfeaitical to the success of a change effort is to identify people who are affiliated pSj'lrisome way with certain groups or organizations that make up the many systems ■\^«ad subsystems of the change effort. . • ""Ips;.; We will use the term system to describe these critical participants. This term Misused in the context of systems theory, implying that participants should be i;|Jjlyiewed as more than simply a collection of individuals who happen to have.some , ...|||'eprnmon interests and characteristics. As a system or subsystem critical to the ^"success of the change effort, they represent a complex set of interrelationships ^'having system-like attributes that must be recognized and attended to by the core M;!planning group. One of these attributes, for example, is called entropy and refers ' 'IS^ t*,c natur!Ji tendency of systems to expire without input and regeneration from ,.^|||nutside the system. The concept is directly applicable to the types of systems - l^ynvofved if planned change. (For further discussion of systems theory, see von .".^Siertalanffy 1956, or Katz & Kahn 1987.) '*."■' "BC The systems to be considered include (1) an initiator system, (2) a change ,""'sjjlagenc system, (3) a client system, (4) a support system, (5) a controlling system, , :'V;S|i5) a host system, (7) an implementing system, (8) a target system, and (9) an action j^System (see also Kettner et al, 1985). It is worth noting here that these teems are ':• JSpiised strictly for conceptual purposes to assist in understanding who should be ''jMljivolved and why. They are not terms commonly used among people involved -'.iffph change efforts; It is more likely that terms like committee or task force will ■.:;.'lpbe used to designate groups, but the professional person who coordinates the ' Jsbffort should be aware, conceptually, of what systems are represented by the ."iiS?ignificant participants. fjjjJVKfc 1: Identify the Initiator System. The initiator system is made up of Jjthose individuals who first recognize the existence of a problem and bring : ypgattention to it. This could be a group of parents raising concerns with a school '■&c||pbard about increasing violence in their schools or a group of staff members "v?|plpncerned about a lengthening waiting list for service in the counseling program, if Individuals who first raise the issue may or may not also become a part of the K.Tjllfaitial planning process. [.-. ,:v . It is sometimes necessary and worthwhile to work with a group of individuals '$BF*° fill appropriate roles and have a thorough knowledge qf the problem,, but i-*lMiee themselves as powerless to affect the system. Empowerment strategies such 226 MACRO CHANGE - # 9 / DEVELOPING AN INTERVENTION STRATEGY 227 In defining tne client system, the change agent should resist the temptation as teaching, training, group counseling, or consciousness-raising efforts at this "W ^wp- point can pay rich dividends in the long run, and can place appropriate SfM3ke»'V-:'!f!ww jump to die easy and obvious definition of the primary beneficiaries, and should persons into leadership positions rather than substituting less appropriate leaders;. ^'Mppadently and carefully analyze details. For example, if die Identified problem ;'vi^illsl^ls drugs in-die schools, several potential beneficiaries could be considered Task 2: Identify the Change Agent System. From the initiator system,. tbe b^ /;-Sv;as the client system. A partial list of people -who would benefit from eliminating issue moves to identification of the change agent system. In a professionally,''.':VvJp|:<3ruHs ^rom tlle schools would include students, teachers, administrators, parents, assisted change effort this involves an individual designated as the leader of the ''Vivl^nocal police, campus security, neighbors, the school board, and the commu-change effort. "We -will refer to this person as the change agent The change agent*'. '^f^-hlty as a whole. The question, then, becomes one of establishing priorities together with an Initial core planning committee or taste force, comprises the-'.^'.l^f'L'tor direct benefits, and distinguishing between, primary and secondary bene-cliange agent system. If the change activity will require drawing on the resources-"^^iSffificiaries. The decision will have an important impact on the change effort. If of an organization, it is essential that the organization sanction the change and- < -§%,''students wno want a good education in a drug free environment" are iden-also be identified as part of the change agent system. This may involve gettingCl^^^ifi^15 primary beneficiaries, then the intervention may well be directed toward formal approval from executive or board, and may require released time from, >lff|tighter security and stricter discipline. If, on the other hand, primary beneficiaries other duties, secretarial support, and other allocation of resources. '•.-••"j--:^^^arc described as "students who use drugs and are unable to maximize their The makeup of this system is critical to the change effort because much.afi|liSfeducational opportunities due to impairment," then the intervention may be what is accomplished will be framed in the perspectives of these indlviduajsii^li^^clirected toward treatment. Ideally this system will Include representation from the initiator system, peopl&J^I^/. However the primary beneficiaries are defined, the remaining groups should who have experienced the identified problem, people who have had experiene'a^'ijfi^Whe identified and listed as secondary beneficiaries. Secondary beneficiaries may in trying to solve the problem, and people who can be influential in getting 'the^^llfpbe important and may need to be called upon when tbe change effort needs public change accepted. . -V^V'^S^^^Support. "We will refer to this group, as the support system. The function of the change agent system is to act as a central coordlriadiig;.'^^^.-point. Many participants in the change effort wilt be taking on different actiMt^yi^B^kash 4* Identify tbe Support System. The support system refers to that at the same time. It is the job of the change agent system to insure that the claangeA^p^segment of the community or organization who have an interest in the success effort is properly organized and carried out from its early concepmaUzation-.trJ^g^ptif the proposed change and who may receive secondary benefits. This group is the point where it is turned over to others for implementation. As the major > ?i±Sffl expected to be involved In supporting and advocating for the change if they are systems and perspectives are identified and the action system (discussed in alater^l^Sfneeded. The boundaries for macro-level changes tend to be defined in a way that section) is formed, the coordinating functions are shifted to the action system. . /'J.fe'.the primary focus is on a segment of a community or organization. Total com- The work of the change agent system begins with carrying out the prpbleai|^^E--munltJes as defined by political boundaries (entire towns, cities, counties) or total identification and analysis described in Chapter 8. This planning effort continues'.' ^r;»-organlzations are rarely the focus of a change effort. as each of the systems and participants is defined and a strategy is developed^ir^|M-: The support system is defined largely by the target population (or client getting the change accepted.' '"' "jí-is ^system) and the problem. People have an interest in certain populations and Ifproblems for a variety of reasons: a loved one is afflicted widi die problem, their Task 3: Identify the Client System. The client system is made up of mose'rj^'^^Employment brings'them into close contact, their church or service organisation individuals who are asking'for and will become the direct beneficiaries of me;\fej^phas selected this population for assistance. They are sometimes described by the change if it is implemented. In Chapter 8, we pointed out that macro change^:VJj^pielated concern or issue, such as the "mental health community," or the "foster efforts begin with identification of a target population and a problem. The cllent;:;'!g^Kcare community.'' These are the people the change agent will count on to became system would be a subset of the target population for whom the specific change.;^;;r.|ginvolved if decision makers need to be persuaded that the change is necessary, effort is being undertaken. In some cases it is possible that the target population .^^feRgure 9.1'Illustrates the relationship between initiator, change agent, client and the client system could even be synonymous. For example, if the target ■^^and support systems. population is all homeless people in the town of Liberty, and the purpose ot^j^tRt ■ Initiator, change agent, and client systems can be seen as incorporated within community change effort is to provide housing and services for all homeless:,;^ ||||the boundaries of the support system in that they all have an interest in addressing people in Liberty, then the target population and client system are the same;- ^;j|I|the need for change. Initiator, client, and change agent systems may overlap, or Different terms are used for conceptual purposes. A target papulation brings -'^«riiay represent separate and distinct constituencies, focus to die problem analysis and usually represents a broader spectrum of people, \?gfjffis> A client system refers to the people who are intended to benefit from the change-^ ^^O^Tctsh 5.- Identify the Controlling System. The controlling system is defined effort. In the town of Liberty, for example, for a specialized project, the client system could be homeless women and children. ";': ;.J|pas that group of individuals with the formally delegated autiiority and the power |j£to approve and order the implementation of the proposed change. Macro-level 1.1 '1 i fi 228 MACHO CHANGE 9 / DEVELOPING AN INTERVENTION STRATEGY 229 Initiator System Cliant System Changs Agent System FIGURE 3.1 Relationship of 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 widi a body of elected officials. If the change involves a private1 agency, control may rest with a board of directors. These bodies are significant-to acceptance and implementation of the change effort, and their positions on-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. Withiti.: the host system.is a smaller group who will have day-to-day responsibility for carrying out the change. We refer to this as the implementing system. Imple menrers 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 implementing system are identical. It is not unusual for those involved in the execution of policy to disagree with the policymakers' TASLE 9.2 Examples of Controlling, Host, and Implementing Systems Controlling Host Implementing School Schonl Board A particular school and Teachers in the school System its principal Involved In the change Law Enforcement City Council Police Chief and department Police officers Involved in System the change 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 the 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 He 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 active role in FIGURE 9.2 Relationships between Controlling, Host, and Implementing Systems Controlling System Host System Implementing System 230 MACRO CHANGE 9 / DEVELOPING AN INTERVENTION STRATEGY 231 planning the change and moving it toward implementation. 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 af work have the same concern and raises the issue to the city council (controlling system),'where it is assigned to die City Department of Human Services (change agent system and host system). The social worker (change agent and possibly impiementer) 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 formerhorneless people (client system)' and someone from the ciry'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 impor-. tant 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 Intsracllon ACTION SYSTEM 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 die 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 die 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, tiiis 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 widi 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 die 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 lllcely 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 MACHO CHANGE 9 I developing an intervention strategy 241 etiology, interpersonal and political .factors, 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 mare 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 malting a difficult decision, it should be recogr nized for what it is and rejected. It should also be recognized 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 must make as rational, noh-emotional a decision as possible. Necessary changes diat have a good chance of success should be supported. Causes that' are likely to be defeated.as currendy conceptualized should be tabled until they are more fully developed of the timing is better. Focus G: Setting Goals and Objectives Goals are brief, one sentence or phrase, general statements of expected outcomes (e.g:>T-a reduce the number of dropouts in the Jefferson district). Objectives spell □ut the details for each goal in measurable terms, Including expected outcomes, and the processes to achieve them: Activities, are lists of tasks that must he 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 from Facts and Perspectives on tiiB Problems of Homeless Teens Driving/Supporting Forces Restraining/Opposing Forces 1. Tqbh homulassnBsa Is Increasing by 20 percent per year 2. Homelsss teens have been drawn Into drug trafficking, prostliulfc-n and many property crimes 3. Media have IncrBaSBd covsrage ol ttiB problem; the publlu Increasingly favors some action 1. Resources are already inadequate lo meet existing needs at homeless families. 2. No federal or state funding is available;-hamBlessnsss la considered a local problem 3. Suburban cities are not willing to conlrlbute needed support; major urban city council feels it should ba considered a regional problem ?r:- W ■Jit"' 1 ■Šlí- •;tste . 11. ■m i The process begins with re-examining the change effort and organizing it into categories or sections. This takes 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 to reduce teen pregnancy and enable at-rlak teens to graduate from high school. Project Subcategories 1. Building self-esteem 2. Providing health, hygiene, and sex education 3. Providing academic support 4. Providing financial support In the example, we have depicted a four-part program designed to achieve the purpose as stated above. In bodi 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 diat ptovides 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 9 / DEVELOPING AN INTERVENTION STRATEGY 243 do not require the type of change process described in this book. If one follows die 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. I: To.Improve client self-esteem. Goal 2: To increase client knowledge of health, hygiene, and contraception. ■ -Goal 3: To strengthen client academic abilities. ■ Goal-h To increase client financial resources. Measuring Client Outcomes ' Goal 1: To develop indicators of client change. Goal 2: To flevelop fiscal incentives to promote client improvement. Goal-3: 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 be followed in order to achieve the result. When the outcome objective and ail 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 pr 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 begmning of the project, i: ■V;. 'j.v 1 or ' 'by the end of the first year"). Once a start date is Itnown, 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. For 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 and process objectives fit together to form a plan of action. The following diagram illustrates partial objectives, including a time frame and a target. Outcome objective: [ time frame ] By June 30, 19XX, [ "target ] , at least fifty teens considered to be at risk of pregnancy . . . Process objective: I time frame ] By February 1, 19XX, . . . will be developed for [ target a group of teens considered to be at risk of pregnancy 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 completed. 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 9 / DEVELOPING AN INTERVENTION STRATEGY 245 ■is: Outcome objective: [ time frame ] By June 30, I9XX. [ target ] . at least fifty teens considered to be at risk of pregnancy ... [ outcome ) will Increase their knowledge of health, hygiene, and contraception . . . Process objective: [ time 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, 1982). 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 henltii, hygiene and contraception . [ criterion ] as measured by a ptetest/posttcst developed far the course. 1 I I I JSfe- I iB*- t f if Process objective: [ time frame ] ■ ■ ' By February 1, 19SX, ( result J a training curriculum on health, hygiene, and contraception will be developed [ 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, the 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 pretcst/posttest developed for the course. Some possible process objectives: 1. Develop training curriculum 2. Develop and reproduce training materials 3. Recruit fifty teens at risk of pregnancy 4. Secure a suitable training location 5. Hire trainers 6. Implement the program 7. Evaluate the program Tosh 23: Plan Activities. The final step in Focus G is to Itemize activities. Activities represent the highest level of detail incorporated into the plan. Bach 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 9 / DEVELOPING AN INTERVENTION STRATEGY 247 TABLE 9.4 Sample Outcome and Process Objectives Outcome Process Time Frame Target Qutcame/Rasuli Crltarlon By June 30, 19XX 50 leens considered to be at risk of pregnancy will Increase their knowledge ol health, hygjane, and contracapllon as measured by a pretest/posttest developed for the course. By February 1, 19XX for teens considered to be at risk of pregnancy a training curriculum on haalth, hygiBns, and contraception will ba 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- frames clearly specified, the action plan is complete. The last steps in macro-level change involve the selection of tactics and the development of a written plan. These final Steps are discussed in the next chapter. REFERENCES Brugcr, G., and S. Holloway. (1978) Changing human service organizations: Politics and practice. New York: Free Press. Braget, G., H, Specht, and J. L. Torczyner. (19B7) Community organizing. New York: Columbia University Press. Hudson. "W. W. (19B2) J7jö clinical measurement package. Homcwood, IL: Dorsey Press. Katz, D., andR, L. Kahn. (1966) Tbesocial psj'cbolagy oforganisations. New York: John Wiley & Sons. ' • Kermer, Fl M.,J. M. Daley, andA. W. Nichols. (1935) Initiating change in organizations and communities. Monterey, CA: Brooks/Cole. Lewin, IC. (1951) Field theory in social science. New York: Harper & How. Tropman, j. E., and J. L. Erlich. (1987) Introduction to strategies. In V.M. Cox, J. L. Erllch, J. Rothmnn, and J, E. Tropman, eds.,. Strategies of community organisation (2nd ed., pp. '257-69). Itasca, IL.- F. E. Peacock, von Bcrtalanffy, L. (1950) An outline of general system theory. The British Journal for the Philosophy of Science, 1(2): 493-512. FIGURE 9.7 A Gantt Chart Process objective: By February 1, 19XX, tD develop a training curriculum on health, hygiene,. and contraception far teens at risk of pregnancy, as documented by receipt ol a completed training package. Activity Number Activity Person Responsible J F Time Frame MAMJJASOND 1. Develop course objectives. J. Smith 2. Prepare content outline J. Smith/ modules an health, hygiene, L. Black and contraception. 3. Select teaching methods L. Black for each module. 4. Prepare workbooks and C. Rich handouts for aacn module. 5. Print up workbooks and B. Wood handouts. 6. Develop prelest/posttest. J. Smith 7. Deliver complete training J. Smith package. — I 1D / SELECTING APPROPRIATE TACTICS 249 CHAPTER 1' Selecting Appropriate Tactics Overview Introduction. Focus A: Selecting Appropriate Tactics Collaboration Implementation Capacity Building Campaign Education Persuasion ' Mass Media Appeal Contest - Bargaining and Negotiation Large Group or Community Action Class Action Lawsuits Considerations in Selecting Tactics Objectives Controlling and Host Systems Primary Client Resources Professional Ethics Focus B: Preparing a Written Plan Conclusion References Appendices INTRODUCTION Chapter 9 addressed strategy, which refers to the development of a written plan directed at bringing about the proposed change. Deciding on a strategy can be a time-consuming and detailed process. Although many may agree that a problem exists, getting agreement on just how the situation should be changed Is seldom easy. Special efforts must be concentrated on tactics designed to get the change accepted. Tactic selection tests the professional judgment of the change agent, particularly in how to approach the target system. Certain tactics can raise ethical dilemmas. Selecting tactics calls for mature, professional judgment in community and organizational change. Social workers should be open to the possibility that practices in many of the arenas in which chey operate are well entrenched and there will be a natural tendency to resist. The fact that agency missions are stated in inspiring words does not mean that all agencies carry out those missions. Practitioners must be aware that they are a part of legitimized systems that often contribute to the oppression experienced by the client group they are trying to serve. Selecting appropriate tactics requires one to think critically and to carefully analyze the target system. FOCUS A: SELECTING APPROPRIATE TACTICS The choice of tactics is a critical decision point in planned change. Tactics have been defined as. "any sldllful method used to gain an end" (Brager et al. 1987, 288). Whereas strategy is the long-range Uniting of activities to achieve the desired goal, tactics are reflected in day-to-day behaviors (Brager & Holloway 1978). As the change agent engages in tactical behavior, it is important not to lose sight' of the goal toward which these behaviors are directed. Brager, et al. (1987), identify four essential properties of tactics used by ■professional change agents.- "(1) they are planned ... (2) they are used to evoke specific responses ... (3) they involve interaction with odters . . . and (4) they are goal-oriented" (p. 288). In addition, it is our contention that a fifth property must be in place in professional social work change efforts: (5) the tactic will do no harm to members of the client system and, whenever possible, members of that system will be involved in tactical decision malting. Change almost always involves influencing the allocation of scarce resources—authority, status, power, goods, services, or money. Decisions about tactics, therefore, must take into consideration whether the resources are being allocated willingly or whether someone must be persuaded to make the allocation. If there is agreement on the part of the action and target Systems that the proposed change is acceptable and that resources will be allocated, a collaborative approach can be adopted. If there is agreement that the proposed change is acceptable but a reluctance or refusal to allocate resources, or If there is disagreement about the 250 MACRO CHANGE need for tbe proposed change, then a more coercive approach may be necessary if the change effort.is to proceed. For example, a change effort may focus on the inability of physically disabled people to get around the city and travel to needed service providers. A thorough snjkj^abcuments the problem, and a dial-a-ride transportation service is proposed. •The planning commission and city council graciously accept the report, agree oh the need, arid thanlc the Transportation for the Disabled Task Force. Three city council members favor funding, three are opposed, and one is undecided. If-the undecided council member can be persuaded to favor funding, then, collaborative tactics can be adopted. If, however, he or she decides to oppose funding or if a compromise would undermine the change effort, then tactics designed to coerce support must be adopted. For collaborative approaches to be adopted,, there must be agreement on both the proposed change and the allocation of rfieerjed resources. in the social work literature, tactics have been divided into three broad categories; collaboration, campaign, and contest (Brager & Holloway 1978; Brager et al. 'T'§87). In this chapter, we use these terms to describe the relationship between the action and target systems. Collaboration implies a working relationship where the two systems agree that change must occur, whereas contest tacdeis1 indicate disagreement between the two systems. Campaign tactics are used when the target must be convinced of the importance of the change, but when communication is still possible between the two systems. The effectiveness of the " campaign" may determine whether collaboration or contest follows. Contest tactics are used when'-neither of the other two are possible any longer. Change efforts that begin with one set of tactics may progress to other sets, depending on the evolving relationship between the action and target systems. The continuum along which these tactical categories fall is as follows: Collaboration 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. lit is possible diat'what begins as a collaborative relationship will move to conflict when new issues arise during the change process. It is equally likely "that the relationship will vasclllate 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 litde place in assessing the relationship between ' the action and the target system. We believe that regardless of what types of tactics. arc used, communication should be maintained with the target system if at all 10 / SELECTING APPROPRIATE TACTICS 2bl 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 & Hoiloway 1978; Brager et al. 1987). 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. 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 a 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 Goilabarallan Tergal system egress (or Is easily convinced Id agree) ■ wllh action system that change Is needed and supports allocation of resources Campaign Target system is willing to comrnunloale with action system, but there is little consensus (hat change Is needed; or targBt system supports change but not allocation o\ 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. Caoptation b. Lobbying 5. Mass media appBal 6. Bargaining and negotiation 7. Large-group or community action a. Legal (B.g., demonstrations) b. Illegal (e.g., civil disobedience) B. Class action lawsuit 252 MACRO CHANGE 10 / SELECTING APPROPRIATE TACTICS 253 a group orcommunity 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 seif-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 communiry. 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-teaching 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 welt as the client system's informal support structure may be used to assist in guiding the target system tpward 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 média 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 acťtíiffereritly. The objective is to inform. The assumption Is'diat more and better infórtnatíon 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. y 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 5; through persuasion that the change is worth pursuing. This means that the change agent must understand the motives and reasoning of the target system in order ib to Identify what incentives can be used to negotiate an agreement. Skillful communication requires that the action system must carefully select a- 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 I. reasoning behind the planned change are particularly useful. For example, in a g- change effort, particular actors may be perceived as unreasonable, as trouble- makers, or as chronic complainers by members of die controlling system. It is if. not In die best interest of the client system for those persons to be the only V spokespeople for the change. Clients themselves can also be powerful spokes-ijr persons, providing information and a viewpoint that persuades people of the i,;' need for change. 'i\ 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 jr. 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 p; understanding the difficulties with which they coped on a daily basis. They £T 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 g, as a training problem designed to better prepare employees and reduce turnover, (v the ombudsperson was able to persuade administrators to cooperate ^with the If; action system.. When the ombudsperson met with the local nursing home it association, she acknowledged that she was aware that the administrators wanted to operate high-quality facilities. She also noted that recent studies revealed that ff high staff turnover rates often contributed to lack of continuity and lower patient |f care, sometimes leading to abuse. She explained that she and her colleagues would J| be willing to develop training for nurses aides because diey interacted most jt^ 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 l|f framed as reducing an administrative nightmare—high staff turnover. P Cooptatlon is defined as minimizing anticipated opposition by absorbing or 'ft' including membersof 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 p.' it is important to include persons who are viewed as powerful by the target system, 'fj;' These persons may be relatively neutral and may have little interest in obstructing H the change effort. However, If they can be convinced to support die change effort |Vt (or even to allow their names to be used in publicity), their participation may 2S4 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 CQOptation, whereas coopting organized groups is referred to as formal c'oopta-tion. Format cooptation means that an 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 cornmitment, even though there are always members of any group who may, as individuals, disagree with theprdposed 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 & Mickelson 1986). For example, the purpose of the National Health Care Campaign is to provide health care coverage to all American citizens. This change effort brings together hundreds of orgar:zations sucli 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 a coalition dedicated to the stated goal. The diversity of the coalition contributes to a powerful alliance of individuals and- groups,.that vascillate between collaboration and campaign tactics as they actempt'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 .order 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 tactic is used to pressure decision makers into a favorableresolution 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 makersare 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 Jj is a newsworthy story, and assurance that one's cause will be presented accurately. J, Use of any media must always include consideration of clients' rights to privacy. | 3: Contest :<. - .... ■■ 1 ■ -|; 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 at tactics are used in situations where: (1) the target system cannot be persuaded |v' by the action system, (2) the target system refuses to communicate'widi 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 il>,. 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 i-. this occurs, the action system must be prepared to face open confrontation and 1' 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 If profession developed in response to a basic societal conflict—the persistent *| anatagonism over individualism and the common good. Conflicts, over the rights •l' of various population groups have spawned violent confrontations rooted in basic ,| value systems and beliefs. We believe that physical violence and terriorism can I not be condoned in any change efforts in a civilized society. Nonviolent con- ■ ff frontation, however, including civil disobedience, is an option when there is a r communication stalemate between the target and action systems. I Contest tactics will require widespread commitment and possible participa- V tion 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 c 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 ■i. and energy necessary for effective change will increase and relationships can I become disrupted. When collaborative and campaign tactics are employed, tactics | can move toward contest. However, once contest tactics are employed it is not i likely that one can return to collaborative or campaign tactics. Without a clear j understanding of what contest tactics involve and without full commitment from j the support system, contest tactics are not advised. i i Bargaining and Negotiation. Bargaining and 'negotiation refer to those v situations in which the action and target system confront one another with the :f; reasons for their-opposition. Bargaining and negotiation occur when there is a • recognized power differential between parties and a compromise needs to be 'i; made. These tactics are more formalized than persuasion, often involving a third- j- party mediator. Members of the target system will typically agree to negotiate j when the following factors are in place: (1) there is some understanding of the 256 MACRO CHANGE 1Q / SELECTING APPROPRIATE TACTICS 257 intentions and preferred outcomes of.the.actloh system, (2) there is a degree of urgency, (3) the relative importance and scope of the 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 wltii and fully support the outcome. The result can be a win-lose where one system is clearly die 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 die 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 activities, often used by both groups at either extreme of an issue, to express their views. Civil disobedience activities intentionally, break 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 making potential participants fully aware of these-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 wilt apply to an entire class of people. These tactics are often used with highly vulnerable populations such 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 sj'stemsJ' 3. What is the perception (by those promoting change) of the role of the client sjistem? "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 reexamination prior to selection of tactics is in order. For example, with Che problem of domestic violence, the condition may have been brought to public. awareness by the 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. f. ' 1- What ate the stated objectives of this change effort? -,. -■ 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 ■ i';.. b. to increase self-direction or self-control of the client system |; c. to influence decision makers ■■ d. to change public opinion, j ■ e. to shift power f. to mandate action 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 L Table 10.2. TABLE 10.2 Relationship of Current Objectives to Tactics Hi' % Relationship of Target and & j:: Current Objective Action System Passible Tactics 1. Salving a substantive prabtam; Collaborative Implementation, through Joint action 3*;- providing a needed service k a. Self-direction; salf-conlrol Collaborative Capacity building through participation and empowerment ii. 3. Influencing decision makers In disagreement ■ but with open communication Education, and persuasion through cooptatlon, lobbying, etc. >* 4. Changing public opinion In disagreement but with open Education, persuasion, mass media appeal, communication Si- Adversarial Large group or .community action % f 5. Shifting power Adversarial . Largs group Dr community action B. Mandating actlnn Adversarial Class action lawsuit