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SOCIAL SERVICES FOR CHILDREN, YOUTH AND FAMILIES:
THE NEW YORK CITY STUDY
by
Brenda G. McGowan
with
Alfred J. Kahn and Sheila B. Kamerman
Columbia University School of Social Work
SOCIAL SERVICES FOR CHILDREN, YOUTH AND FAMILIES:
THE NEW YORK CITY STUDY
by
Brenda G. McGowan
with
Alfred J. Kahn and Sheila B. Kamerman
Cross National Studies
Columbia University School
of Social Work
622 West 113 Street
New York, NY 10025
212-854-5444
C
1990
BRENDA G. MCGOWAN, ALFRED J. KAHN, AND SHEILA B. KAMERMAN
JUNE 1990
ALL RIGHTS RESERVED
TABLE OF CONTENTS
PREFACE
i
I. INTRODUCTION
1
- Context and Rationale
2
- Research Approach
10
II. THE NEW YORK CITY PUBLIC-PRIVATE NON-SYSTEM
21
- The Child Welfare Administation in the Context of
Children's Services
21
- The Child Welfare Administration within the Human
Resources Administration
25
III. THE AGENCIES
43
- Leake and Watts
48
- Brooklyn Bureau of Community Service
62
- Good Shepherd Services
80
- Rheedlen Foundation
97
- Center for Family Life in Sunset Park,
St. Christopher-Ottilie
112
- Brandeis High School Programs
128
- United Families of South Bronx, Edwin Gould
Services for Children
139
- Bronx Homebuilders Program, Behavioral
Sciences Institute
150
- Family and Children's AIDS Case Management Program
Human Resources Administration
167
- Jewish Board of Family and Children's Services
177
IV. FINDINGS AND RECOMMENDATIONS
195
APPENDIX
A. Executive Summary, national study
A-1
B. Case Study Guide, New York City study
B-1
C. "A Memorandum on Method", national study
C-1
i
PREFACE
This is the report of a study of social service
programs for children, youth and families in New York City.
Funded by the Foundation for Child Development, the research
was conducted in cojunction with a two-year national study
funded by the Annie E. Casey Foundation and directed by
Sheila B. Kamerman and Alfred J. Kahn. * Paralleling the
approach employed in the national study, the project was
conceived as a search for successful problem-solving and
service in the context of increasing social problems and
diminished support.
The authors are indebted to Barbara Blum and Jane
Dustan of the Foundation for Child Development who, upon the
launching of the national social services study, saw the
opportunities inherent in an interrelated New York City
effort and made it possible.
We are also grateful to the administrators and staff of
the agencies included in the study and to the many other
experts in family and children's services who participated
in individual and group meetings with the research team.
These respondents all shared their time, ideas, and
experiences willingly, and the agency executives took a
special risk in opening their programs to what would
*
Sheila B. Kamerman and Alfred J. Kahn, Social Services
for Children, Youth and Families in the U.S.. (Greenwich,
Conn: Annie E. Casey Foundation, June 1989). Also published
as a Special Issue of Children and Youth Services Review,
Vol. 12, Nos. 1 and 2 (1990).
ii
ultimately become public review.
The special focus of the New York City study was
community-based practice and programs for families and
children at risk. Brenda G. McGowan, principal
investigator, took full responsibility for the case studies
and their analyses - and, thus, for the study core. She
was assisted by two doctoral students, Linda Bernstein and
Karen Rosenzweig. Focusing on service delivery from the
national perspective, the other two investigators, Alfred J.
Kahn and Sheila B. Kamerman, devoted considerable efforts to
the City's Human Resources Administration and to the Jewish
Board of Child and Family Services as a special, multi-
system voluntary agency. They shared in the writing of all
sections of the report apart from the "core" agency reports
in Part III.
The entire team of course stands behind the final
report.
**
The report draws as well on two studies published
earlier that describe the context. See Brenda G. McGowan et
al, The Continuing Crisis: New York City's Response to
Families Requiring Protective and Preventive Services. (New
York: Neighborhood Family Service Coalition, 1986) ; Brenda
G. McGowan and Elaine Walsh, "Services to Children" in
Charles Brecher and Raymond Horton, eds., Setting Municipal
Priorities, 1990 (New York: New York University Press,
1989).
1
I. INTRODUCTION
This New York City study focused on family and child
service programs or clusters of programs generally
identified as "strong" or "promising". Designed to examine
state-of-the-art practice and program organization in New
York City today, the objective was to develop grounded
hypotheses about directions for service program or delivery
system reform. Patterns of service delivery and their
organizational settings were studied intensively. The
research also explored the relative merits and trade-offs
inherent in organizing services on a categorical versus a
holistic basis. Together, this study and the national
effort¹ looked at the delivery design inherent in the
relationships of these programs with the New York City Human
Resources Administration (HRA), their major funding source.
The national study offered the contrasting models of other
jurisdictions. The case studies were completed between July
1, 1987 and June 30, 1989 but there was some factual and
data updating to the end of 1989.
The report begins with a discussion of the local
context and rationale for the New York City study. The
2
research approach and data collection methods are described
in the final section of this introduction. The role of the
HRA and its relationships with the local agencies constitute
Part II of the report. Part III, which forms the core of
the report, presents the findings from the major study
sites. The report concludes with a summary of findings, an
analysis of the key issues and questions posed by the
research, and recommendations for reform, demonstration,
research, and experimentation.
Context and Rationale for Study
Our point of departure is this: despite multiple
legislative and administrative reform efforts and large
public and private investments, it is generally acknowledged
that services for families and children in New York City are
in disarray. There are now 18 City agencies plus two
Mayoral offices, each holding some responsibility for
delivery of children's services - the result of periodic
"reforms", "solutions", new initiatives. Traditional
voluntary sector family service agencies have all but
disappeared. HRA has all but abandoned its widely-heralded
reorganization plan of 1985 designed to promote
comprehensive service provision to families and children at
risk. The child welfare system is reported by state
examiners and other observers to be failing in its efforts
to provide even minimal care and protection to children who
are at risk in their own homes.
3
Responding to exposés, studies and public concern,
public officials have proposed numerous solutions. In 1989
alone:
Special Services for Children (SSC) was renamed the
Child Welfare Administration (CWA) and a series of
management initiatives introduced.
The City Council passed legislation mandating that
the Youth Bureau be reorganized as a separate City
Department of Youth Services.
The City Comptroller's Office issued a report
calling for a new Department for Children and an Executive
Directorate composed of high-level officials 2 from all public
agencies with responsibility for children.
And the Manhattan Borough President's Advisory
Council on Child Welfare released a report recommending
significant services. 3 expansion and restructuring of child welfare
Resource commitments have increased substantially. The
City's adopted budget of $960.5 million for the Child
Welfare Administration in Fiscal Year 1990 represents a 40
percent increase over the budget adopted for the agency in
fiscal year 1988, and that, in turn, represented a 38
percent increase over the preceding year. 4 Yet the media
exposés about child abuse and foster care scandals in the
City continue and professional evaluations remain critical.
Moreover, as various agencies and institutions strive
to cope, customary service boundaries have begun to shift.
Family and child welfare agencies develop school-based
programs and mental health clinics, while health care
facilities and public schools initiate child abuse
prevention and treatment programs, family support and
counseling services, and teen parenting and child care
4
programs. The implications of such developments are yet to
be discussed adequately and absorbed by the field.
Despite new funds, tighter management, and new service
providers, there is widespread agreement that available
services are not keeping up with demand, that many of the
services offered are of questionable quality, and that the
City's current record-keeping and accountability systems do
not provide the data required to make an accurate assessment
of public agency performance. In a 1989 assessment of the
operations of the Child Welfare Administration based on a
random sample of case records, the New York State Department
of Social Services concluded: " In a significant number of
cases, CWA is not providing adequate and appropriate child
protective and/or child welfare services for children and
families who are in need of such services. "5 Similarly, a
review by the State Comptroller's Office in 1988 concluded:
"Neither the City nor the State has information on how many
children referred to SSC or a voluntary agency subsequently
received preventive services, were placed in foster care,
were put up for adoption, or received no services at all.
In addition, there is no information on what the outcome was
for each referred child
116
Criticisms such as these are not new. Child welfare
services in the City have long been the subject of repeated
attacks by the media, professional organizations, public
officials, advocacy groups, and legal rights organizations.
What has changed in recent years is that there has been a
5
dramatic upsurge in service demand. This is due not only to
increased poverty, homelessness, and substance abuse, but
also to the media attention that has heightened public
alertness to child abuse. The number of children cited in
reports of alleged child maltreatment rose 266 percent from
1978 to 1988; and there were a total of 59,353 reports filed
in fiscal year 1989, reflecting a 27 percent increase during
the preceding two years. 7 Moreover, although the number of
children in foster care in the City declined steadily from
1978 to 1985, it began to increase again the following year,
reaching a total of 23,957, at the end of fiscal year 1989,
plus 10,924 in the new program of kinship homes. This is
almost double the population requiring care in fiscal year
1986. 8 And currently predictions are that the total may
exceed 50,000 by the end of 1990.
Predating the increased demand for statutory-based
child welfare services - and undoubtedly contributing to it
- were the cutbacks in federal funding for social programs
and shifts in social policy introduced during the Reagan
Administration. As a consequence, the City has had to
respond to expanding service needs during a period of fiscal
and political constraint. Rather than implement the
recommendations of the many blue-ribbon commissions and
advocacy groups that have called for the development of a
neighborhood-based family service system that could provide
a comprehensive range of support services to the increasing
number of troubled families and children in the City, the
6
responsible public officials have responded to the crisis by
moving - perhaps inevitably - toward increased regulation,
tighter management, and more categorical targeting of
services, i.e., directing services to very specific problem-
defined client groups. (The neighborhood plan has never
been rejected as a concept but is said to be difficult to do
- or to require gradual implementation - or unavailable
resources). Some benefits can be anticipated from these
efforts to enhance service output and productivity while
rationing the use of limited resources. But increased
targeting of services has led to a proliferation of
categorical programs. Although these are often effective in
achieving specific, short-term objectives, they frequently
result in serious fragmentation of families at risk and of
the agencies that are attempting to serve them.
The national context is useful here. As noted in the
Executive Summary of the national report (Appendix A),
narrow targeting on child abuse and foster care is noted in
many jurisdictions. In fact concern about child abuse and
neglect is driving child welfare services nationally. New
York City goes beyond this, adding more and more categorical
"contracts" to serve unserved populations or groups, as
problems explode and gaps are highlighted. Many types of
cases and issues ignored elsewhere are noticed and get some
attention in New York City, but the targeting and
categorization that prevails here, while not as narrow as
the national trend, defeats what is really needed - a
7
comprehensive and holistic strategy, a reliable neighborhood
coverage system in all areas of need, services available
before the problems become acute. Nonetheless, for present
purposes, some of the "different" categorical initiatives do
carry lessons for intervention strategies and, perhaps, the
delivery system. These will be examined in this report.
Social ills such as teen parenthood, limited education,
welfare dependency, joblessness and crime tend to cluster in
poor, urban, minority communities among the population
Wilson has described as the "truly disadvantaged" 9 There
is also evidence that pathologies such as substance abuse,
mental health problems, and child maltreatment tend to be
highly concentrated in these same communities. 10 Findings
such as these suggest that the social problems leading
families to the attention of child welfare agencies today
are multi-determined and require multi-faceted
interventions. They require community and neighborhood
adaptations and involvement. Several recent efforts to
examine effective family service programs have reached
similar conclusions.
In a systematic review of intervention with neglectful
parents, Gaudin concluded that the successful programs were
characterized by in-home services, supportive professional
relationships, comprehensive multi-service approaches,
parent groups for socialization, support, and parenting
training, extended service of at least a year's duration,
and use of lay parent aides to offer supplementary
8
support.
11
Similarly, in a review of services for
disadvantaged children and families, Schorr concluded that
the successful programs offer a wide range of services, are
easily accessible, cross traditional bureaucratic and
professional boundaries, and view the child in the context
of the family and the community. 12 These are not new
conclusions; they represent mainstream professional
experience and deserve attention.
Indeed, findings such as these raise serious question
about the viability of the categorical principles
undergirding the way services in this City - or any
jurisdiction - currently are conceptualized, funded,
delivered, and evaluated. It remains the case, however,
that public officials face strong pressures created by
public sentiment as well as legislative mandates and
available funding streams to concentrate resources on those
children who are at most immediate risk. These same
officials are also under pressure to develop programs that
are at least immediately, if sometimes superficially,
responsive to the demand to do something about the various
populations that manage to capture media attention, e.g.,
boarder babies, nomad children, homeless youth who have
"aged" out of foster care, crack-addicted mothers, and
sexually abused children. These pressures inevitably lead
to extreme and sometimes irrational fragmentation in the
organization of services.
Thus a major question for this study was whether state-
9
of-the-art practice - if it can be located and analyzed -
suggests that the greatest potential for improvement in
social service delivery for children and families lies in
strengthening and continued investment in categorical (and
sub-categorical) systems or in creating what many have
urged, a community social service system, focused on the
family unit, and conceived in a somewhat more holistic
sense. Or is the solution to be found in some combination
of the two?
This study's premise at the outset, built on
professional consensus and the research record, was that
whereas no one program or agency can be expected to meet the
full range of child and family service needs, effective
systems of community service provision should demonstrate
most of the following general characteristics:
Adequate outreach to groups at risk
Efficient and equitable procedures for client access
and channeling to needed resources
Provision for a continuum of care based on client
need
Availability of a sufficient range and diversity of
services to insure appropriate and effective service
provision
Coordination of services on a case and program level
Competent staff and high staff morale
High rates of client utilization and satisfaction
High productivity
System and program capacity for systematic planning,
monitoring, and reporting
System and program capacity for innovation and
10
responsiveness to changing needs.
The study was organized to examine how the discrete
programs studied are - or are not - able to achieve
qualities such as these, and to operate within broader
systems consistent with this outlook. The study also
explored the trade-offs associated with the alternative
approaches to service provision observed or implicit in the
programs studied.
Research Approach
This was an exploratory study employing an approach
that could loosely be termed analytic induction or
development of grounded hypotheses. It was designed to
build on the national study and on some of the principal
investigator's prior research in this area. 13 The research
process began with a review of the relevant literature on
services in New York City and on issues related to service
coordination, planning, and program effectiveness. At the
same time the entire project team initiated a series of
meetings with experts on the delivery of family and
children's services in the City. Interview respondents
included a group of voluntary agency executives, current and
former administrators in HRA, foundation officers,
researchers, and representatives of a range of professional
and advocacy organizations concerned with children's
services.
Our original plan was to identify specific criteria for
11
site selection based in part on the program models to be
identified in the national study and, in part, on the
characteristics of programs defined as strong and successful
by acknowledged leaders in the field. However, we quickly
discovered that not only are there no clear-cut program
models, but also there is now little agreement about how the
core or boundaries of "exemplary" child and family service
programs should be defined. Some argue for comprehensive,
universal services, while others underscore the
effectiveness of narrowly targeted, categorical programs.
Some value range and inclusiveness of services, others,
service quality and intensity.
Decisions about criteria for site selection were
further complicated by the fact that the different clusters
of respondents with whom we met tended to emphasize
different indicators of successful programming and to focus
on process rather than outcome variables. To illustrate,
those in the public sector generally stressed 1) performance
on utilization reviews; 2) readiness to accept "difficult,
hard-core" clients; and 3) willingness to develop new
programs to meet categorical needs as defined by the City.
In contrast, most interviewees in the voluntary sector
stressed the importance of comprehensive, innovative, highly
individualized services; and a number suggested that one of
the criteria for a good program may be its readiness and
capacity to challenge or ignore public regulations and
12
funding requirements that interfere with individualized
service planning. They also emphasized that successful
agencies usually enjoy a quality of leadership and/or level
of financial security (endowment or access to private funds)
that permit flexibility and independence of action.
Sometimes independence of action was described as a
criterion of effectiveness.
Given the lack of consensus about program models and
about what constitutes a "good" program, we decided to
examine a range of service programs that vary along some
significant structural dimensions and are by professional
and community reputation identified as "strong" or
"promising". In other words, rather than trying to identify
programs defined as exemplary of specific service models, we
selected sites that were identified as strong or promising
programs by at least two independent expert sources* and
offered an opportunity to study the trade-offs associated
with alternative structures and approaches to service
delivery.
A "strong" or "promising" program in this sense
contributes, at the level of the agency, to the system
requirements highlighted by the larger study (Appendix c).
These generate criteria relating to access, effective
channeling, coverage, ability to deliver constructive help
*
This criterion does not apply to the programs at
Brandeis High School, which was included in the study solely
because it offered an opportunity to explore school-based
services for children at risk from the perspective of the
school site rather than the operating agency.
13
to the client groups served, sound professional practice
(case assessment and case planning, for example), a
sufficient and qualified staff, capacity for on-going help
if more than brief service is needed. Again, these are
"process" not "outcome" variables.
The programs studied, we would stress, are not the only
ones in the City recognized in this sense as "strong" or
"promising". Indeed they are not necessarily the "best."
Having met the basic "strong" or "promising" criteria, what
the particular sites selected offered was some diversity
along the dimensions generally described as significant in
delivery system planning: age; size; geographic base;
auspice/ affiliation; original service mission; target
population; level and source(s) of funding; organizational
structure; and range of services.
There was yet another criterion. Because of the focus
of the study, each of the sites selected offers a program of
community-based services for families and children as part
of its total service repertoire. Some define the program
studied as their primary or sole service mission, others are
multi-service agencies. In the sense of this study, the
community-base is essential.
The final sample consisted of the following
programs/agencies (in addition to HRA itself as the
responsible public delivery agency and major funder).
Bronx Homebuilders Program, Behavioral Sciences
Institute
Brooklyn Bureau of Community Service
Center for Family Life in Sunset Park, St. Christopher-
14
Ottilie
Good Shepherd Services
Jewish Board of Family and Children's Services (JBFCS)
Leake and Watts
Rheedlen Foundation
United Families of South Bronx, Edwin Gould Services
for Children
Family and Children's AIDS Case Management Program, HRA
Brandeis High School Programs
The first seven sites listed, studied in greatest
depth, are voluntary family and child service agencies that
rely heavily on contracts with the City's Child Welfare
Administration (CWA) for program funding. Some also receive
funding from the Youth Bureau and the Board of Education,
Department of Mental Health and/or Department of Employment.
Just as HRA was analyzed for the national study as a
big-city department in a state-supervised, county-operated
public agency (along with Los Angeles), so the Jewish Board
of Family and Children's Services was also included in the
national study as a major voluntary agency. It is a heavily
publicly-funded organization that operates in a variety of
service networks (education, juvenile justice, medical care
and - especially - mental health) in addition to child-
family-youth social services.
Although Edwin Gould Services is also a voluntary
family and child service agency, the particular program
studied, United Families of South Bronx, was developed as
part of the Multi-Problem Family Demonstration Project of
HRA's Office of Family Services, and HRA assumed a major
role in service design and implementation. The Family and
Children's AIDS Case Management Project is based in HRA's
15
Adult Services Administration. Although the Youth service
programs at Brandeis High are all administered by voluntary
agencies, they are funded through direct contracts with the
school system and have no direct links with CWA. These
latter three sites were studied because they offered an
opportunity to examine programs not based in the traditional
family and child welfare system.
Site visits were organized around a data collection and
interview guide (Appendix B), and ordinarily involved two
members of the study team. Extensive interviews were
carried out with agency administrators and/or program
directors and selected direct service staff. All available
agency reports, statistics, and evaluations were studied,
and, where permitted, a member of the study team read a few
representative case records. The study team spent the
equivalent of three to five days or more in each sample
site, with two exceptions having to do with delayed access.
In addition, a number of discussions were held with
"collateral" contacts and with administrators of similar
services, to test out some of our observations and tentative
hypotheses.
The following questions guided the actual on-site data
collection activities:
- What are the main planning instigators? To which
environmental, professional, political, and/or financial
pressures does the agency/program respond?
- In which system or systems, e.g., mental health,
16
education, social services, juvenile justice, child welfare
(prevention/protection/foster care) does the agency/program
base itself?
- How does the agency/program "package" enough money to
operate? From what sources?
- How does the agency/program cope with public funding
systems and their rules? With agency and community service
networks and their patterns of interaction? Is the agency/
program leader involved in larger service planning or social
action initiatives?
- How does the agency/program recruit its clients? Who
is referred? Who gets in? Who is refused? How are cases
channelled internally and through the community service
network?
- What practice theory and principles guide the various
agency/program operations? How do these mesh with funding
and accountability demands? With changing client service
needs?
- What kinds of personnel does the agency/program
recruit? What are their qualifications? How is staff
morale? Are there any problems with staff recruitment,
turnover and/or training? How are these addressed?
- How do the administrators and staff evaluate the
results of their work? What variables account for their
relative success? What are the key obstacles to effective
service delivery? What are the trade-offs inherent in their
service approach? What changes would they recommend?
17
No effort was made in this study to undertake a formal
evaluation of the case-level impact of services at any of
the sites. This was not the plan of the research and would
not have been feasible. Where relevant we reviewed case-
level assessments; several have been cited earlier. Except
for the Brandeis High School site, we studied only programs
which by professional consensus and process criteria are
"strong" or "promising". The intent throughout was to study
how these programs/agencies cope in the current service
context and what lessons can be gained from their
experience.
Although a first draft of the study report was
completed in late 1989, the authors did not view the
research as completed until the agency/program
administrators had an opportunity to review the entire
report, make any needed factual corrections in the sections
regarding their own programs, and offer their ideas
regarding alternative interpretations of the data. Early in
1990 the researchers also organized a day-long conference at
which panels of experts presented their views on policy
issues related to the study. This group of about 50 invited
participants, all of whom had been given an opportunity to
read the draft report, were encouraged to debate the issues
and make recommendations for change. The research team took
the suggestions offered at the meeting very seriously. We
have made a concerted effort to incorporate the insights
gained at the conference in this final report, which
18
presents our observations, tentative hypotheses, and
recommendations.
19
Notes
1
Sheila B. Kamerman and Alfred J. Kahn, Social Services
for Children, Youth and Families in the U.S., (Greenwich,
Conn: Annie E. Casey Foundation, June 1989). Also published
as a Special Issue of Children and Youth Services Review,
Vol. 12, Nos. 1 and 2 (1990).
2
City of New York Office of the Comptroller, Office of
Policy Management, "A Blueprint for a Department for
Children," February 1989.
3
Manhattan Borough President's Advisory Council on Child
Welfare, "Failed Promises, Child Welfare in New York City:
A Look at the Past, A Vision for the Future," July 1989.
4
City of New York, Human Resources Administration,
"Consolidated Services Plan FY1988-FY1990, Adopted Budget
FY1988," n.d.
5
State of New York Department of Social Services, "An
Assessment of the Operations of the Child Welfare
Administration of the Human Resources Administration of New
York City," May 1989, p.2.
6
State of New York Office of the New York State
Comptroller, State Deputy Comptroller for the City of New
York, "New York City's Foster Care Program Under the Child
Welfare Reform Act: Issues of Enforcement and Compliance,"
Report 29-88, May 26, 1988, p. 12.
7
City of New York, Office of Operations, The Mayor's
Management Report, 1978-1989 editions.
8
HRA/Child Welfare Administration, "Foster Care Overview
Fiscal Year 1989," n.d.; and City of New York, Office of
Operations, The Mayor's Management Report, September 1989,
p. 512.
9
William Julius Wilson, The Truly Disadvantaged.
(Chicago: University of Chicago Press, 1987) ; See also,
Errol R. Ricketts and Isabel V. Sawhill, "Defining and
Measuring the Underclass," Journal of Policy Analysis and
Measurement, 7:2 (Winter 1988), pp.316-325.
10
See United States Congress, Office of Technology
Assessment, Children's Mental Health: Problems and Services
- A Background Paper, OTA-BP-H-33 (Washington, D.C.:
U.S. Government Printing Office, 1986), p.8; and Deborah
Daro, Confronting Child Abuse: Research for Effective
Program Design. (New York: Free Press, 1988), pp. 63-66.
20
11
James M. Gaudin, Jr., "Treatment of Families Who
Neglect Their Children," in Elam W. Nunnally et al., Mental
Illness, Delinquencies, Addictions, and Neglect. (Newbury
Park, CA: Sage Publications, 1988), pp. 170-171.
12
Elizabeth B. Schorr with Daniel Schorr, Within Our
Reach. (New York: Anchor Press, Doubleday, 1988), p.256.
13
See, for example, Brenda G. McGowan et al, The
Continuing Crisis: New York City's Response to Families
Requiring Protective and Preventive Services. (New York:
Neighborhood Family Service Coalition, 1986); Brenda G.
McGowan and Elaine Walsh, "Services to Children" in Charles
Brecher and Raymond Horton, eds., Setting Municipal
Priorities, 1990 (New York: New York University Press,
1989); "Helping Puerto Rican Families at Risk: Responsive
Use of Time, Space and Relationship" in Carolyn Jacobs and
Dorcas D. Bowles, eds., Ethnicity and Race: Critical
Concepts in Social Work (Silver Spring, MD: NASW, 1988);
and "Family-Based Services and Public Policy" in James K.
Whittaker et al, eds., Reaching High-Risk Families:
Intensive Family Preservation in Human Services (Hawthorne,
N.Y.: Aldine de Gruyter, 1989).
21
II. THE NEW YORK CITY PUBLIC-PRIVATE NON-SYSTEM
The Child Welfare Administration in the Context of
Children's Services
It is useful to begin by locating the Child Welfare
Administration (CWA) of New York City's Human Resources
Administration (HRA) - the focus of this discussion - in the
context of the City's public programs for meeting child and
youth needs. The recent McGowan and Walsh analysis yields
an overview of agencies and their expenditures. 1 Many of
the agencies which serve children/youth cannot, by the
nature of their operations, separate out a child/youth
component.
Two things about these expenditures must be understood.
First, a large proportion of the relevant revenue comes from
state and federal governments, and thus carries various
statutory mandates and administrative/ regulatory
constraints. Second, a large component of each of the
service budgets is in fact expended through contacts with
the voluntary non-profit and for-profit sectors.
22
What follows reports expenditures during New York
City's 1987 fiscal year:
Table 1:
Public Child and Youth Agencies and their Expenditures
(in millions of dollars)
Special Services for Children (HRA) *
$668
Agency for Child Development (HRA)
238
Office of Family Services (HRA)
NA**
Crisis Intervention Services (HRA)
NA
Health and Hospitals Corporation
262
Mental Health, Mental Retardation,
and Alcoholism Services
190
Health
91
Juvenile Justice
66
Employment (adolescent *** services)
54
Youth Bureau
27
After-school and sports at Board of
Education
22.4
Housing Authority
10
Parks and Recreation
9.2
Cultural Affairs
5.5
Community Development Agency
4
Corrections
NA
Mayor's Office of Adolescent Pregnancy
and Parenting Services
NA
Mayor's Office of Youth Services
NA
Police
NA
Probation
NA
Total
$1,642.1
Here, as in the national study, we find New York to be
expending very large sums for its child and youth services,
not surprising given its population and their problems, as
well as the high poverty rates. Indeed, New York City may
be the per capita expenditure leader for child welfare among
*
Now, Child Welfare Administration (CWA).
**
"NA" signifies that the child component of the program
cannot be differentiated.
*** Now, the Department of Youth Services.
23
the big cities and big states.
2
This does not mean that
even more money may not be needed, nor that the money is
currently being deployed in the most effective and efficient
fashion possible. We shall in fact raise some question
about this.
For present purposes, the CWA is in focus - child
welfare - as covering child protection, foster care, related
service and treatment. HRA's Agency for Child Development
(ACD) is the child care agency (covering group day care,
family day care, Head Start) enormously important for the
children of the City generally and for those here of
interest - but not the study focus. 3 The City's Youth
Bureau spent its 1989 budget of $30.7 million through 582
agency contracts. Its rationale is anti-delinquency
programming and related planning. Most of its programs are
recreational, vocational, educational counseling and
cultural services. There are several transitional shelters
for runaway or homeless youth. None of this is
systematically planned in relation to the child welfare
program to be discussed.
Many of the 703 mental health/retardation/ alcoholism
services represented by the relevant budget item above, do
affect the children and families here discussed, but there
is no data system which permits one to analyze the
interplays. Even more important, these services do not
themselves constitute a coherent delivery system. Nor do
they have a patterned relationship of defined roles and
24
mutual reinforcement with CWA and the service agencies it
funds. There are instances of superb team work and many
more of ships that unknowingly pass in the night.
The interplay of CWA with the health programs is less
intensive, with exceptions such as the "boarder babies" to
be mentioned. Most of the other relationships involve
mutual cooperation on referral or access around special
projects or problems, but the court tie is, as specified and
elaborated in the national report, central to child
protection and foster care. Apart from ongoing, serious
operational problems - which of late have been improved by
some agreements - there remain central issues about roles,
particularly as to whether the court per se has or should
have a treatment responsibility. 4 The Community Development
Agency, the City-funded holdover from the poverty war,
provides an infrastructure for employment, training, access,
and advocacy services in the poorest areas and is not
integrated into a social service delivery system. The two
"Mayor's Offices
" and the Department of Youth Services
have overlapping or poorly inter-related coordination and
planning functions, while CWA is in fact the largest service
component "planned" within the HRA in its interactions with
State and federal mandates and requirements.
None of this adds up to a very hopeful context for
systematic service delivery planning or even for program
coordination. McGowan and Walsh sum up a picture of: the
absence of comprehensive, long term planning; ad hoc problem
25
"solving"; blue ribbon commissions whose findings are seldom
absorbed or - if implemented at all - are not fully
implemented; an inevitable pattern of "fire fighting" that
leads to partial, categorical solutions; poor operational
coordination; heavy reliance on large numbers of agencies,
many very small, of varied levels of competence and
efficiency as dictated by patronage and interest-group
politics; private agencies facing constant uncertainty about
obtaining needed funds and meeting the many different
requirements associated with categorical programs. 5
The Child Welfare Administration in the Human Resources
Administration
Under a variety of rubrics, over the years, and through
a series of reorganizations, the HRA superagency, created in
1966, has encompassed income maintenance and food programs
as well as those employment services relating to assistance
clients, child support, day care and Head Start programs,
some services for adults, home care services, services for
the homeless, and child welfare. What was long known as
Special Services for Children - now the Child Welfare
Administration - includes child protection, foster care and
adoptions, and an ambitious social services contracting
program known as "preventive services", in the sense of
prevention of placement - but hardly limited to that. The
most recent agency-wide reorganization rearranged these as
four major program units, and some secondary ones, giving
26
special emphasis to a new grouping ("Opportunities
Initiative Administration") to function along the lines of
the 1988 Federal Family Support ("welfare reform")
legislation, bringing together child support enforcement,
employment services and the ACD child care programs. The
other major units, in addition to CWA, are the Income and
Medical Assistance Administration and the Adult Services
Administration. Other units are responsible for food
programs, the community development program, and management
support. The Office of Family Services, once conceived as
the vehicle for creating a city-wide, neighborhood-based,
integrated delivery system is now located in the
Opportunities Initiative Administration, targeting on
special projects to prevent homelessness and delivering home
care services (and a variety of small projects which would
belong in any effort at creating an integrated delivery
system).
The City's complex social and housing problems, its
high poverty rates, its large numbers of single-parent
families - and all that follows from its role as a
"receiving station" for large numbers of poor legal and
undocumented immigrants - has faced the HRA with
extraordinarily complex challenges in recent years. Its
Special Services for Children (now CWA) responded to cases
which periodically caused public outrage and concern with
efforts to restructure, a series of changes in leadership,
and staff expansions. Various commissions, task forces and
27
studies offered proposals, many calling for a degree of
decentralization to so-called "neighborhoods" and creation
of a more comprehensive family service system - which was
said not to be practical, or at least not immediately so.
The HRA administration concentrated during 1987-89 on
major strengthening of management, substantial expansion of
the child protection field staff, the inauguration of a
training academy for protective workers, and some expansion
of innovative service and case coordination projects. It
also expanded direct care where contract agencies could not
take on hospital-stalled "boarder baby" cases and similarly
unserved children of other ages.
New York City's resources and traditions are such that
its HRA cannot announce a targeted and minimalist mission,
in the sense of some other jurisdictions. It is expected in
its services to protect, to treat, to prevent - even to
enhance family development. The City's patterns of coping
have produced both serious major gaps and problems and some
outstanding agencies. It does not at present offer a
coherent and convincing big city exemplar of child and
family social services, however. Much of its energy and
large-scale resources are dedicated to a crisis-management
regime in a volatile political environment.
If an observer had to describe the implicit plan for
child and family social services it is this, all except the
final element operating within HRA itself:
- A city-operated Child Protection System (CPS)
28
including ongoing, community supervision of some
families (in the local vocabulary, the latter is
called a city-run preventive service!).
- A city-operated foster care access system.
- A largely city-funded but privately operated foster
care service system (foster homes and group care).
- A small city-operated direct service foster care
program (for "boarder babies" and similar cases that
the private agencies do not serve).
- A large and mostly publicly-funded direct service
program in non-profit agencies (called prevention),
serving both the CPS effort and voluntary cases and
cases which come through other channels.
- Some other, related child and youth services,
federally, state, city, and privately funded through
other human service systems.
Size, complexity, private agency prerogatives and
tradition made it difficult for the City to mobilize its
social services during the early 1980s, despite large
expenditure, and there were the inevitable exposés,
critiques, and "improvements". Task forces offered designs
and attacked failures to implement proposals for
decentralization and neighborhood-based family services.
The current operational design has emerged incrementally as
the result of a series of case tragedies, recent agency
planning and management reform, and categorical targeting in
response to problems of high public concern.
29
We shall not here refer to foster care except to note
that it is guided by a 1979 New York State Child Welfare
Reform Act along the lines of the later, federal Adoption
Assistance and Child Welfare Act of 1980, P.L. 96-272. A
public staff is responsible for access (Office of
Placement), but 90 percent of the children in care at the
time of our study were placed with 60 contracted voluntary
agencies. The remainder, the most difficult to place
children, were the responsibility of an Office of Direct
Child Care Services. The latter load is growing since the
voluntary sector cannot meet some needs.
Following a State directive of October, 1986 that
builds on a 1984 Supreme Court decision, the City is now
also certifying eligible kinship homes as foster boarding
homes. This new legislative mandate has presented many
problems. The City's overall foster care load declined from
23,700 to 16,787 children between 1978 and 1985, then
climbed to almost 21,000 at the end of 1988 (about where Los
Angeles was); but it had more than doubled to over 44,000 by
the end of 1989 as relative care was formalized as foster
care! On December 31, 1989, there were 19,663 children in
kinship foster homes in the City. This group, which
represented about 44 percent of the total population in care
at that time, now constitutes the largest single category of
children in care. 6 The staffing needs precipitated by this
rapid development are rather staggering, as are the fiscal
30
consequences, especially in a period of budgetary
constraint.
The general foster home recruitment problems being
experienced almost everywhere in big cities nationally
obtain in New York as well, but are compounded here by lack
of sufficient staff to monitor the foster placements once
homes are recruited. The recent resolution by consent
decree of a long-standing dispute about foster care in
agencies under religious auspices may or may not be another
factor in coming years.
Foster homes, institutional care, subsidized adoptions
and related costs inevitably consume the bulk of the CWA
budget, some 73 percent for the current 1990 fiscal year.
The cost of support for daily living and tuition always
exceeds the expenditure for community based services and
treatment, but analysts inevitably ask whether the
proportions are nonetheless in sensible balance. Although
public assistance expenditures ("welfare") for the families
in the child and family social service networks are not
included in the calculations, their inadequacy and erosion
under inflation occasion many of the pressures reflected in
the social service caseloads.
In the present context, the CPS program "design" is of
interest. In 1980 the City processed some 18,000 abuse
complaints; in the last fiscal year this number, including
"repeats", was over 59,000, involving almost 95,000
children. Currently, the state central register receives
31
the calls, and sends a telex to the appropriate borough
office to begin the process of clearance and evaluation.
The City is divided into five "boroughs" delivering
services, and each borough is subdivided into "zones", based
on population and reported incidents of abuse and neglect.
Manhattan has four "zones" for coverage and - except for a
special zone for hospitals, hotels, sex abuse cases - each
zone office has 10 units, to which cases are assigned on a
rotation basis. * The processing is familiar - computer
clearances, supervisory guidance to the investigating
worker, rapid field visits if there is the possibility of an
endangered child. Then there are the reports prepared by
investigators and the distinctions between the "indicated"
or validated and the "unfounded" cases (61 percent of the
investigations in fiscal 1989, many of which are believed to
actually have serious problems, even though, technically,
the allegation in the complaint cannot be sustained). Of
the "indicated", some go to court for placement, some are
retained for court-ordered supervision in HRA (at last
report, 7,000 cases in the supervision units), and some are
referred to the contracted preventive services.
The P/D units (protective/diagnostic) within CPS are
set up to investigate abuse allegations and to be
responsible for assessment and case supervision until the
case is "settled". Staff are in constant turnover; the rate
*
The zone system has added considerably to CPS
operational efficiency. The zones remain too large to
support a community-oriented service philosophy, however.
32
was 60 percent at one point but has improved of late. Few
of the field workers have more preparation for this work
than college education and the brief orientation at HRA's
in-service training Academy, as well as slightly lower
caseloads for a training period of a few months.
Supervisors guide the investigation work closely; some are
better qualified than others. A special staff carries out
much of the court liaison work, a recent major improvement,
intended to save field staff time; and there is a large
staff of HRA attorneys and special consultants.
Overwhelming loads, a series of public scandals about
specific cases, and some confusion about case processing and
accountability, including the loss of cases within the
system, yielded in the course of 1989 increased funding and
a larger and stronger management cadre, better provision for
unit supervision, and considerable policy clarification.
Protective services staff was increased substantially by
replacements and new hires to over 1,000. Caseloads were
substantially reduced to meet accepted norms. Response time
to reports is now claimed to be excellent.
The City also has been coping with problems of the
quality and size of the "Family Service" units in CPS doing
ongoing community supervision of endangered children by
court order. Average loads are now for the first time said
to be reasonable and are headed to 18. However, the
Department is not yet satisfied with the operations in the
qualitative or management control sense and there are
33
charges from outside that the alleged improvements are not
yet apparent in some parts of the system.
To this point we have described a not unfamiliar
targeted and limited operation, struggling to gain control
and raise quality and with frequent difficulties. What
makes the New York HRA picture almost unique, however, is
another component, some 129 contracted service programs,
covering almost 15,000 families during fiscal year 1989.
These are the agencies to which the P/D units refer the
"voluntary" cases (where there is no placement order or
court-ordered supervision by the HRA's own Family Services
units), as well as some cases under supervision. The Family
Service units make referrals, too.
The roster of programs under this "prevention" service
(to prevent placement) includes some of the leading
children's clinics and family agencies in the country, drug
and alcohol treatment programs, adolescent programs,
parenting programs and numerous family support centers and
experimental efforts. Several are among the agencies/
programs reported in the next section. Many of these are
based in highly professional social agencies and medical
facilities, but there are also simple, even primitive and
struggling, one-service grass roots and neighborhood
agencies and programs concentrated on various ethnic-racial-
religious groupings. It is also of some significance that
some of the "preventive" contracts are highly targeted,
reflecting response at one time or another to a publicly
34
noticed problem or special tensions and pressures in the
service system. Thus, some are for status offenders
("PINS") diverted from the Family Court. Others are for
children of incarcerated mothers or children with serious
physical handicaps. The issue is to ensure access, not the
knowledge that the particular case category actually
requires its own treatment program, apart from other child
and family cases.
Also within this overall rubric, Homebuilders has
launched a small demonstration program in the Bronx, and CWA
has contracted with two voluntary agencies to develop small
family preservation components. Despite these initiatives
and an additional Homebuilders-type program funded by the
Department of Juvenile Justice for delinquents in Brooklyn,
the City, at the time of our study, had made no significant
investment in intensive home-based, family preservation
services of the sort described in the national study for
Washington, Maryland, Florida, Massachusetts, or Minnesota
(See Appendix A). However, there has more recently been
evidence of interest in accelerated development.
Nobody involved would claim that this overall CWA
pattern now offers or can become an attractive model for
big-city social services. While the contract agencies are
publicly financed, they have their own doorways and can have
their cases certified as eligible for city reimbursement.
It has taken some time for the City to assert some priority
rights. The P/D units and the Family Service units still
35
feed only a minority of the cases (45 percent of the new
cases in fiscal year 1989) that get to the preventive
contract agencies for which HRA "pays". On the one hand,
City priorities may not be followed; on the other hand, the
large numbers of self-referrals and the referred "voluntary"
cases mean that the City is serving/treating a far broader
range of situations with specialized services than most
communities do, including many voluntary, chronic, and
"early intervention" cases, or serious abuse/neglect cases
which do not come to the notice of the mandated CPS
reporting system. New York case categories receiving
service cover a wider range of need than is addressed in
many jurisdictions.
Apart from the priority issue (some of the private
contract agencies close intake when P/D units need
services), there has been a problem of response time in
taking up HRA referrals of serious situations, recently
mitigated somewhat by agreement. There are still troubling
problems related to the clients "lost" in the referral
process because the P/D units may not follow through closely
enough and the agencies may not reach out or are unduly
selective or slow. Reporting is poor in some parts of the
system and efficacy of services unclear, despite an annual
contract audit; fiscal audit apart, there is no HRA
monitoring system.
This brief description of New York HRA's children's
program and of the lack of a fully integrated city-wide
36
child welfare operation does not pretend to offer sufficient
data for a new evaluation. It is urgent to note, however,
that recent efforts to strengthen management, add staff,
clarify procedures, train staff, and enrich preventive
services do not seem to have calmed media, state, and public
criticism any more than did the successive reports and
reorganizations of earlier periods. Particularly over the
past two years, public disclosure of department failings or
alleged inadequacies in several tragic case situations, and
a series of critical reports from State agencies, advocacy
groups, internal task forces, and others have pointed to the
complexity of the HRA task and the difficulty of achieving a
better level of coping.
Critics have continuously complained about poor
implementation of P.L. 96-272 or the parallel State
legislation, noting especially inadequate resources and poor
management. The City has countered with reference to the
complexity of its social problems, its progress, and the
need for more resources. It also has invested in management
resources and capacity. Some of the results are obviously
positive, but these shifts have also created strong
pressures for deprofessionalization, both because most of
the new managers are not members of the social work
profession and because some of them equate caseload coverage
statistics with staffing adequacy. Investigations are
routinized and monitored step by step. Forms and reports
proliferate. The elements in the process - not their
37
quality - are counted and inventoried. The job, in short,
has been redesigned for relatively poorly trained college
graduates who learn on the job; and - in a self-fulfilling
prophecy - no one else can be recruited. The discretion and
initiative of the professional now has no place in the line
jobs in CPS and foster care. And, in any case, the City has
not been willing to raise salaries so as to achieve equity
for fully-qualified social work staff.
The picture confronting the new Mayor and the new Human
Resources Administrator is not encouraging. Recently, a new
state audit, a local Health Department report, and a report
of an HRA fatality review board have elaborated charges to
the effect that:
- In significant numbers of cases reviewed, "there was
no evidence of attempts to secure and review records
of previous reports of child abuse or maltreatment".
- Despite attempts to initiate emerging investigations
within the required time period in the overwhelming
majority of cases, in some cases attempted contacts
were unsuccessful and in others risk assessment was
inadequate. Sometimes there was inadequate
assessment of risk to other children in the home.
- In some cases, not all children in the home were
interviewed or observed.
- In some cases, not all adults who were subject to the
allegations were seen.
- In some cases there was no determination of
38
allegations (or of some allegations) in the reports.
- Some cases were closed in a fashion that did not meet
service standards.
- There was inadequate feedback to the State central
register data base.
- Some of the rules about face to face contact were not
followed in some cases.
- There were a variety of failings with regard to
permanency planning requirements.
- Families for whom there was a court-ordered
supervision requirement "were not seen in a timely
manner".
- Some case records could not be located in a timely
fashion for review.
- There were significant delays in the picking up of
cases in preventive services as in court-ordered
supervision within HRA, and there was practically no
evidence of "input" into case planning by the child
protective workers assigned to monitor the case
plan. 7
- "Dozens of infants and toddlers" in the City's Direct
Service foster care program in eleven city-run group
homes, are "living in understaffed, overcrowded group
homes that routinely fail to meet city Health
Department standards and violate state regulations",
according to local Health Department inspection
reports.
8
39
- The major role of substance abuse in child fatality
cases requires new policies and laws for CPS
processing of drug abusing parents, more drug-
treatment resources, improved medical resources and
procedures to meet the needs of the children
involved, better drug-prevention education,
especially with women.
- There is need for interagency review and stronger
case management in coping with the divided agency
systems required to respond to serious child
protective situations sometimes leading to
fatalities.
- There is important improvement needed in the State
central registry and its procedures in so far as
these contribute to case service failures in very
serious cases.
- Internally, the Child Welfare Administration needs to
tighten case transfer procedures, strengthen family
supervision or monitoring, and to clarify
(administratively and in the development of manuals
and training) a variety of uncertain policies and
procedures
9
One could cite similar findings and criticisms in
dozens of reports throughout the country. The City is able
to respond, as it sometimes does, with claims of unfair
review, poor sampling, and a tendency of critics to accent
40
the negative. After all, the critiques deal with "some"
cases, specific percents (usually the minority), and do not
fully accredit the obvious progress in coverage, caseload
sizes, procedural compliance, improved response time and the
rest. Yet each case failure means an endangered child, so
the criticism is harsh and sustained. HRA, while reporting
other improvements it intends to make and its own more
general recommendations (with regard to drugs, for example)
also challenges the State to take over the operation and do
better.
For this study's review of service delivery options,
the New York City HRA "case" offers yet another insight.
The presence in the community of a rich diversity of
voluntary agencies and multi-system treatment resources does
not decrease the need for a strong CPS system. That
essential core must be attended to in all the possible
delivery designs.
The central point is that the New York City delivery
"model", implicitly at least, features: a public access
system concentrating on CPS and foster care and with modest
in-house direct service capacity, feeding into an elaborate,
large and diverse, publicly-funded, perhaps multi-system,
service "pool". We use the word "pool" because the
voluntary agencies are of many types, some outstanding and
some weak. Some are more subject to HRA influence than
others. Political inhibitions limit the City's ability to
drop programs - and make its purchase priorities difficult
41
to rationalize. There is overlap and there are gaps. This
is not a network. Moreover, there is little, if any,
comprehensive and effective joint planning and coordination
with other social services in such agencies as the courts,
the mental health agency, the youth department and so forth.
The overhead costs of so complex a system and so many small
voluntary contract agencies and the City's required
investment in a monitoring, coordination, and contracting
capacity are enormous.
Only the achievement of a stronger public/private
planning system and stronger public leadership of the whole
could turn this into an efficient and effective delivery
network. The immediate problems in the way are political;
the difficult conceptual issues are never fully faced as a
result. In the meantime, HRA is concentrating where it can
and must: on improving the CPS and foster care components,
infrastructure, and linkages. We look in the next section
at some agencies and programs upon which those who plan for
the future might build - while noting as well that a full
solution also demands attention to the city-wide design for
service delivery.
42
Notes
1
Brenda G. McGowan and Elaine Walsh, "Services to
Children" in Charles Brecher and Raymond Horton, eds.,
Setting Municipal Priorities, 1990 (New York: New York
University Press, 1989).
2
Sheila B. Kamerman and Alfred J. Kahn, Social Services
for Children, Youth and Families in the U.S.. (Greenwich,
Conn: Annie E. Casey Foundation, June 1989), p. 314.
3
For some perspectives on child care in New York City
see Alfred J. Kahn and Sheila B. Kamerman, Child Care:
Facing the Hard Choices (Dover, MA: Auburn House, 1987).
4
Citizen's Committee for Children "To Form a More
Perfect Union for Juvenile Justice: Mental Health Services
and the Family Court" (New York: 1988).
5
McGowan and Walsh, op. cit.
6
State of New York Department of Social Services,
"Quarterly Summary of Characteristics of Children in Foster
Care", District Report, February 2, 1990.
7
State of New York Department of Social Services, "An
Assessment of the Operations of the Child Welfare
Administration of the Human Resources Administration of New
York City," May 1989.
8
The New York Times, May 20, 1989, pp. 1, 5.
9
"1988 Report of the Child Fatality Review Panel" (New
York: Human Resources Administration, April, 1989).
43
III. THE AGENCIES
This section presents the study findings regarding each
of the ten study sites. As discussed earlier, the agencies
or programs included in the study were selected because they
differ along some significant structural dimensions and are
generally identified as "strong" or "promising". (The one
exception is Brandeis High School, which was included
because it offered the opportunity to explore an array of
school-based services operated by community agencies from
the perspective of the school system rather than the
sponsoring agency.)
As will be noted, in some of the settings, the research
focused on a specific service program; in others, the study
encompassed the entire range of agency services. The effort
throughout was to understand how practice and program
options are shaped by a range of structural and professional
variables, not to evaluate specific services.
Because program age and history are clearly major
determinants of service structure and orientation, the study
sites described in this section are presented in order of
their original establishment. For reasons which will be
44
obvious from the text, an exception is made for JBFCS. For
purposes of comparison, some of the salient structural
characteristics of each of these sites are presented in
Table 1 below. (Please note that the table is designed to
convey a general picture of each sample site. The specific
funding sources and services identified are not necessarily
all-inclusive.)
45
Table 1.
Comparison of Sample Sites by Selected Variables
Agency
Date
Location
Auspice/
Major
Approx-
Target
Range of
Estab-
of
Affiliation
Public
imate
Population (s)
Services
lished
Central
Funding
Annual
Provided
2
3
Office
Sources
Budget
Leake and
1831
Yonkers
Independent
CWA
$18.5m
Children in need
preventive
Watts
OMH
('89)
of placement
residential
ACD
throughtout
treatment
city; children
group home care
and families
day care
with special
foster care
needs in Bronx
Brooklyn
1866 1
Brooklyn
Independent
CWA
$10m
Disadvantaged
preventive
Bureau of
(1978)
OVR
('90)
children and
homemaker
Community
DMH
families and
day care
Service
OMRDD
disabled adults
work training
DSS
in Brooklyn
and placement
Jewish
1874 I
Man-
UJA/
CWA
$37 m
City residents
preventive
Board of
(1978)
hattan
Federation
DMH
('88)
with mental
mental health
Family
of Jewish
OMH
health needs
counseling
and
Philanthro-
BOE
(Special
residential
Children's
pies
OMRDD
emphasis on
treatment
Services
Medi-
Jewish
court services
caid
community) ;
group home care
youth in need of
child development
residential
day treatment
treatment;
employee
children and
counseling
families at risk
family life
in selected
education
communities
46
Agency
Date
Location
Auspice/
Major
Approx-
Target
Range of
Estab-
of
Affiliation
Public
imate
Population (s)
Services
lished
Central
Funding
Annual
Provided
2
3
Office
Sources'
Budget
Good
1947
Man-
Sisters of
CWA
$8.5m
Children and
preventive
Shepherd
hattan
Good
BOE
('90)
families in
residential
Services
Shepherd
DYS
South Brooklyn;
treatment
DOL
Children in
diagnostic centers
DOH
need of
day treatment
CDA
placement
drop-out prevention
throughout City
literacy training
youth development
housing for
battered women
Rheedlen
1970
Man-
Independent
CWA
$2.7m
Children aged
preventive
Foundation
hattan
DYS
('90)
6-17 at risk of
drop-out
BOE
truancy and/or
prevention
placement in
youth development
Manhattan Valley
host homes
Clinton and
South Central
Harlem
Center
1978
Brooklyn
St.
CWA
$1.5m
Children and
preventive
for
Christopher-
DYS
('89)
families in
foster care
Family
Ottalie
DOE
Sunset Park
after-school
child care
Life
youth services
youth development
employment
advocacy clinic
47
Agency
Date
Location
Auspice/
Major
Approx-
Target
Range of
Estab-
of
Affiliation
Public
imate
Population
Services
lished
Central
Funding
Annual
Provided
Office
Sources2
3
Budget
Brandeis
Varies
Man-
Board of
BOE
N.A.
Students at risk
counseling
medical clinic
High
(Most
hattan
Education,
of dropping-out
School
in
6 Community
at Brandeis High
sex education
Programs
mid-
Based
School
mediation
1980s)
Organiza-
tutoring
tions
youth development
United
1986
Bronx
Edwin Gould
DSS
$375,000
Multi-problem
counseling
Families
Services
('88)
families in in
advocacy
of South
for
rem HPD
youth socialization
Bronx
Children
buildings in
Interagency
South Bronx
council
Home-
1987
Bronx
Behavioral
CWA
$400,000
Children and
preventive
builders
Sciences
('88)
youth at risk
(short-term,
Institute
of placement in
intensive)
Northwest Bronx
AIDS Case
1988
Bronx
HRA,
City Tax
N.A.
Families in
counseling
Management
Division of
Levy
which 1 or
medical
Project
AIDS
Funds
more members is
assistance
Services
DOH
AIDS-infected
income
maintenance
I
Year in parenthesis refers to year agency was incorporated in current form.
2
Key: ACD = Agency for Child Development
DOL = Department of Labor
BOE = Board of Education
DSS = Department of Social Services
CDA = Community Development Agency
DYS = Department of Youth Services
CWA = Child Welfare Administration
OMH = Office of Mental Health
DMH = Department of Mental Health
OMRDD = Office of Mental Retardation and
DOE = Department of Employment
Developmental Disabilities
DOH = Department of Health
OVR = Office of Vocational Rehabilitation
3 Year in parenthesis refers to budget year for which annual budget is reported.
48
Leake and Watts
Leake and Watts is a large, voluntary, multi-service
child welfare agency established in 1831 as an orphanage for
boys on the current site of the Episcopal Cathedral of St.
John the Divine. The orphanage began to admit girls in 1850
and moved to its current location in Yonkers in 1891. This
campus, which now houses the agency's central administrative
offices, residential treatment center and two schools, was
designed by Frederick Law Olmstead and conveys a lovely
rural atmosphere. However, it is situated right on the
border of the Bronx, giving residents and staff easy access
to City subway lines.
The agency functioned as a relatively traditional child
care agency until 1976 when it began to develop community-
based programs to supplement its residential programs. It
currently defines its mission as providing innovative
services to address the unmet needs of families and
children. Within this broad framework, the Board has
decided to concentrate on serving children in the Bronx
(although children from other areas are accepted in the
residential programs) and to maintain the agency's base in
the child welfare system. Therefore, although the agency
accepts some mental health funding and serves clients with
clear mental health needs, it remains identified with its
child welfare tradition and is attempting to adapt clinical
technologies to the needs of low-income, minority youth,
49
rather than to shift client populations.
The agency has an endowment of approximately $14
million and a projected annual budget of $18.5 for fiscal
year 1989. Most of the agency's funding is provided by
public child welfare contracts, but the agency also receives
some mental health and day care funds. Income from the
endowment and gifts, although sizable, accounted for only 13
percent of the agency's budget in 1985.
One of the core objectives underlying the agency's
recent efforts to initiate new programs is to develop
continua of care for different clusters of children whose
service needs inevitably change over time as they age,
family circumstances change, and they become more or less
disturbed or more or less sick and incapacitated. The
intent is to ensure that the type of care provided shifts
with the needs of the youngster, not with the availability
of various categorical funding grants. In this context, the
executive director said that he envisions the agency's
residential center as the hub of the wheel, with other
services moving out from the residence - rather than viewing
the residence as an adjunct to a range of community-based
family services. He attributes this mindset to the agency's
origins and his own professional history in residential
care, and suggests that if one were to design an entirely
new service system, it would be logical to begin with
community-based services.
At the time of our site visit the agency's service
50
programs included the following:
- Residential treatment center, composed of 10 cottages
caring for some 90 youth aged 12-21. (Two of the cottages
are designed for youth presenting severe emotional and
behavioral difficulties and are used to avoid
hospitalization.)
- Two on-campus special education schools serving youth
from the residence as well as day students from the City and
from Yonkers who demonstrate severe educational handicaps or
behavioral problems. (All youth in residence who can attend
schools in the community are encouraged to do so.)
- Five group homes (three in the Bronx and two in
Queens) serving 50 emotionally disturbed adolescents.
- A foster home and adoption department serving over
400 children in care. This includes a special foster home
project for children with AIDS, the first such program in
the City.
- Four day care centers in the Bronx, including one
that has an after-school component, serving a total of over
350 children a month.
- East Bronx Family Service Center, providing
community-based preventive and PINS diversion services to
over 100 families a month. (See discussion below.)
This simple listing of agency programs - although
impressive - does not convey the careful links that have
been developed to ensure continuity of services for clients.
For example, when the agency began to accept adolescents
51
with more severe psychiatric disabilities, an affiliation
was worked out with Bronx Children's Psychiatric Hospital to
insure that the youngsters in the special therapeutic
cottages and in the Bronx group homes could be hospitalized
there, if necessary, and to assure the hospital that there
would be a place available when hospital patients from Leake
and Watts were ready for discharge. A similar affiliation
has since been worked out with Creedmore Hospital to cover
the youth in the group homes in Queens. In a parallel
development, links have been established between the East
Bronx Family Service Center and one of the agency's day care
centers to facilitate referrals and case consultation; and,
building on the agency's experience with the AIDS foster
home project, the Center opened an intensive family
counseling project for parents with AIDS in April 1988. In
addition, there are plans to open an agency-operated
boarding home for children with AIDS who cannot remain in
regular foster homes; and the director thinks the agency
will eventually have to open a group residence with easy
access to a hospital to ensure appropriate care for these
children as their medical needs increase.
The program listing above also fails to convey the
agency's ongoing program development activities. To
illustrate, since the time of our site visit, Leake and
Watts has opened a residence for nine homeless teen-age
mothers and their babies in the Bronx. Designed to
encourage mother-child bonding and to help the young mothers
52
develop independent living and parenting skills and to
enable them to complete their education and/or obtain a job,
the program is targeted to young women who have been
discharged or rejected by other agencies. During the site
visit the director noted that several other program ideas
were also under active consideration. These include a
community center in the Bronx, a residence for youth moving
into independent living, and apartments for formerly drug-
addicted parents and their children who have been in care in
order to provide intensive services during the early phase
of family reunification.
Leake and Watts' executive director is obviously the
prime mover behind many of the agency's planning
initiatives, saying that he decided long ago that the lives
of many of the children in the child welfare system are so
bad that agencies cannot afford not to take risks in
extending the boundaries of their services. Therefore, he
presses himself to examine unmet needs and to push the
agency forward rather than resting on the fact that they may
be doing a good job now. To keep informed about changing
needs and funding opportunities, he participates regularly
in many State and community planning bodies and keeps in
regular contact with public agency officials. An obvious
advantage he has in trying to initiate new services at Leake
and Watts is a sizeable endowment and an active, involved,
powerful board. However, the board sometimes opposes new
programs because it is very concerned about maintaining the
53
agency's traditions and conserving the endowment; and
repeated experience has taught that new public grants always
cost the agency money because they seldom cover start-up or
overhead costs. To encourage active board support for new
programming initiatives, the director tries to present new
proposals in the context of the agency's history and mission
and to set up joint board-staff committees to work on each
new project. This approach is usually effective, but to
conserve the endowment, the board has set a five percent cap
on the amount of endowment income that can be spent on
operating costs in any one year, e.g., $650,000 in 1989.
This seems to be a viable arrangement because it enables the
director to move the agency into some new projects without
overspending and provides an incentive for additional fund-
raising for any special projects.
In addition to its program development activities,
Leake and Watts is engaged in ongoing efforts to improve its
current services. At the time of the site visit the agency
was moving from a decentralized to a centralized intake
system because of concerns about levels of service in some
divisions, and it was introducing a management information
system in which all workers will have their own computers in
order to ease record-keeping and free more time for direct
work with clients. (The board raised $800,000 for the
latter project.) In addition, a group of foster parents and
workers was just completing a two-year training project with
staff from Dr. Salvator Minuchin's Family Studies Institute
54
in order to help them develop service teams that could work
more effectively with parents of children in foster care;
and the agency was trying to work out arrangements for
similar training for other staff members. Also, the
agency's medical director, who recently developed a
standards review committee for the residential treatment
center and successfully introduced some behavioral
modification techniques to cottage staff, was working on
plans to train staff in some of the other programs in use of
these approaches. These efforts collectively reflect a
dynamic response to changing client needs and service
demands as well as a thoughtful effort to move staff away
from the agency's traditional psychodynamic orientation
without confronting workers' belief systems directly.
Unlike most of the other programs or agencies studied,
Leake and Watts does not have any serious difficulties with
staff recruitment and retention. The director has no clear
explanation for this difference. One factor may be the
availability of endowment funds to supplement salaries as
needed. For example, a small differential is paid to social
workers and child care staff working in the specialized
programs with more disturbed youngsters. Also, salaries are
negotiated on an individual basis so an increase may be
given to retain a strong person who threatens to leave for a
higher outside salary. Because of the relatively low turn-
over among staff, the agency has a seasoned clinical staff
that is able to offer high quality supervision, and it
55
provides a number of specialized advanced training
opportunities. Also, the board allocates $30,000 annually
from the endowment for a tuition aid program to assist
workers who want to pursue masters degrees. Finally, the
location of the main institution is a big advantage,
particularly for recruiting child care staff, because public
transportation is readily available and Yonkers has a high
unemployment rate.
In reflecting on administrative and planning issues
confronting the agency today, the director commented that in
addition to discovering meaningful interventions to help
with the serious types of problems youngsters are now
presenting in both the residential and community-based
programs, he thinks their biggest struggle is finding an
appropriate balance between centralization and
decentralization. He believes the agency must try to
provide a network of integrated services, which requires
some degree of centralized planning and coordination. On
the other hand, he thinks that decentralization of decision-
making at the program director level helps to enhance staff
morale and performance. Therefore, he constantly has to
weigh the relative advantages of moving further in one
direction or the other. For example, although the agency
recently moved to centralized intake, each program director
is expected to develop his or her own budget based on a
zero-based budgeting system. The challenge of discovering
an appropriate balance, he added, is clearly complicated by
56
the current pattern of highly categorical public funding,
which seems designed to sabotage efforts to create
coordinated services.
East Bronx Family Service Center
The East Bronx Family Service Center, the agency
program outside the main institution visited by a member of
the study team, illustrates some of the issues related to
program integration. Established in 1979 to serve families
at risk in Community Board #9, the Center is located in a
small new building in a local shopping center and open four
nights a week. The program, which is funded by preventive
service contracts from CWA and a PINS diversion contract,
served 114 families with 272 children when visited.
In many ways this program resembles some of the small,
independent preventive service agencies. The Center has a
strong family focus and provides what the program director
said could be described as "concrete mental health
services", involving more outreach and concrete help than is
customary in mental health programs. In addition to
offering a range of individual, family and group counseling
services, the social workers engage in extensive outreach
and advocacy, provide some tutoring, recreational and other
support services, work collaboratively with the schools and
other service organizations, and offer information and
referral services. The staff also processes applications
for camp scholarships and the Fresh Air Fund summer program
57
and provides some consultation to three day care centers
administered by Leake and Watts in the local area.
About 60 percent of the clients are Hispanic, 40
percent black, and 85 percent live in single parent
households. Although the clients present a wide range of
service needs, school problems are very common and housing
is usually a concern. Substance abuse problems are becoming
more frequent as are cases in which the grandmother is the
primary caretaker because the children's mother is a drug
user. About 15-20 percent of the preventive service cases
are currently active with CWA's protective services.
Approximately 30 percent of these families are self-
referred, 30-35 percent referred by the schools, and 20
percent referred by CWA. The only cases refused are those
in which a potential client is acutely suicidal or presents
intensive psychiatric problems. The average duration of
services is 10-11 months, but about one-fourth of the cases
are very short-term - 4 months or less - and the others tend
to remain active for about 15 months.
Although the PINS diversion project is technically
distinct from the preventive service program and has its own
staff, it has similar objectives and seems to function quite
similarly in practice. One difference the program
administrators note is that it is almost impossible to
recommend and arrange placement for the PINS cases, even
when this is obviously indicated; and there are few
resources available to maintain the youngsters in the
58
community. For this reason, a primary therapeutic task with
parents of PINS clients is often to help them gain the
control required to set appropriate limits for their
children. However, the agency often enters the family too
late to have sufficient impact.
Although the program administrators are obviously
frustrated by the regulatory structures governing their work
(e.g., the State's decision to disallow tutoring expenses as
a form of preventive services, even though tutoring may be
critical in a particular case), and by the scarcity of
community resources available to their clients, they are
generally quite happy about the quality and range of
services offered at the center and about their success in
avoiding placement for their clients. Only 1-3 percent of
the cases each year have resulted in child placement. Both
the director and his assistant carry a few cases on a
regular basis in order maintain their clinical skills and
stay in touch with the types of problems their workers are
confronting in the field. This direct involvement with
clients also seems to create a sense of enthusiasm and
curiosity about clinical issues that is not always apparent
among service administrators.
The program director noted that there are clear trade-
offs inherent in operating the center as part of Leake and
Watts. The main disadvantage is that due to agency size and
structure, decision-making processes tend to be very
prolonged so it is impossible to move quickly on any
59
initiative that requires board approval. On the positive
side, the center is allowed to function quite autonomously,
which is important, and it has access to funds and to
specialized training resources that would not be available
if this were an independent agency. The training
opportunities are important in enabling the center to
maintain a high level of professionalism among staff and in
creating career development opportunities for workers.
Access to some extra funding gives the center a small degree
of independence from public funding sources that is
critical. For example, the center director decided not to
use Youth Bureau funds because the paperwork demands are
excessive for the amount of money involved and waste
valuable staff time. Also, he has been able to be somewhat
selective about which CWA contracts the center would accept,
thus preserving the integrity of the program.
Observations, Lessons, Questions
Leake and Watts offers an interesting example of a
well-established voluntary agency changing service emphases
over time in response to perceived community need and
available resources. Unlike many other such agencies that
have elected to diversify by offering a range of relatively
independent services organized in response to available
funding streams, Leake and Watts has attempted to develop
integrated service networks around its core institutional
program. This expansion into community-based service
60
provision suggests a major shift in orientation for a
children's institution, but it is very consistent with
current thinking regarding the need for a continuum of
services for children at risk; and it reflects the
widespread skepticism among leaders in the voluntary sector
about the City's capacity to develop and administer
coordinated child welfare services.
Leake and Watts' decision to open the foster home
program for children with AIDS, as well as some of its other
current programming initiatives, demonstrate the important
innovative role that can be assumed by voluntary agencies
with the leadership and resources required to function
independently. The executive's description of the agency's
internal program development processes and the
interrelationship of these processes with developments in
the public sector embodies in many ways the best of both
voluntary agency independence and responsiveness to public
need.
Not surprisingly, the key factors contributing to the
success of this agency in adapting to changing needs while
retaining its commitment to its original mission seem to be
executive leadership, active board involvement, and a
healthy endowment. Unfortunately, few other child and
family service agencies are as well-endowed as Leake and
Watts. But endowment alone cannot produce an effective and
responsive voluntary agency. And there is no reason that
other, smaller agencies cannot enjoy the quality of
61
executive and board leadership exhibited at Leake and Watts.
The question that must be addressed is how to ensure that
these agencies can obtain the minimum financial stability
required to encourage service innovation.
The struggle identified by the executive director
regarding the appropriate balance between centralization and
decentralization in a large, multi-service agency is clearly
an issue that deserves further exploration. Another issue
posed by recent developments at Leake and Watts is the
relationship between programming initiatives and existing
services and the way in which development of new programs
may serve as an impetus to change in established programs.
Finally, it is interesting to note Leake and Watts apparent
effort to broaden clinicians' practice orientation and
service repertoire. This may be a necessary component of
meaningful program change; yet it is frequently overlooked
by administrators preoccupied with obtaining needed fiscal
and community support.
62
Brooklyn Bureau of Community Service
The Brooklyn Bureau of Community Service (BBCS) is a
large, voluntary multi-function agency in Brooklyn, serving
families and their children, as well as adults with
physical, emotional, and cognitive disabilities. The
successor to the Brooklyn Children's Aid Society, founded in
1866, and the Brooklyn Bureau of Charities, founded in 1878,
the agency has roots in both the family service and child
welfare traditions. It is the oldest non-profit, non-
sectarian social service agency in Brooklyn and has
historically offered a fairly unique mix of foster care,
family support, and adult rehabilitative services.
The Bureau enjoys strong executive leadership and a
tradition of active board involvement. A number of
Brooklyn's leading citizens are members of the board,
including some for whom commitment to the Agency has become
almost a family tradition. The board members devote
extensive time and energy to ensuring the continued success
and financial stability of the agency. In addition to
raising substantial voluntary contributions annually, the
board is actively involved in setting policy and program
directions for the Bureau and in advocating implementation
of its public policy agenda.
The agency's mission, which reflects the Bureau's
origins as well as its current program priorities, is
described as follows:
63
To serve families and disabled men and women seeking
opportunities to be more productive, thus contributing
to a healthier community. Services are offered that
foster development leading to economic and social
independence, and that help establish stable, nurturing
families in which children may develop to their fullest
potential.
Despite the sense of continuity conveyed by this
statement, BBCS has made a number of shifts in program
emphasis in recent years, reflecting its response to
changing community needs and resources. To illustrate, its
traditional family service division was licensed as a mental
health clinic in the late 1970's so that the agency could
provide more comprehensive services to the families in that
program, but an insufficient number of clients were eligible
for Medicaid funding to support continuation of the program.
The Bureau's foster home program, which served a high
proportion of severely disabled children who had been
"boarder babies" at King's County Hospital, was closed in
1983 because the agency was incurring large deficits in
serving this population and there was an excess capacity
citywide in foster home programs at the time. In 1988 the
agency discontinued operation of its Camp Shelter Island for
the Aged and Handicapped because the program, while
valuable, was not central to its mission and utilized
resources needed for core services. During this same
period, the agency started to use the private resources
formerly expended on these programs to expand its community-
based services for families at risk and homemaker services
and to initiate a pre-vocational program for adult clients
64
with psychiatric disabilities.
The Bureau's annual budget (just over $10 million in
fiscal year 1990) has increased substantially in recent
years. It is supported about 70 percent by public funds,
but the remainder is contributed by income from the agency's
relatively modest endowment of approximately $4 million and
annual fund-raising efforts. The budget is divided almost
equally between BBCS's two major program divisions:
programs for disabled adults and programs for families and
children. The two divisions are operated quite separately,
except at the top administrative and board levels.
This study focused solely on the Bureau's programs for
families and children. However, it is important to note
that these services represent only one aspect of the
agency's work. BBCS has a long and successful record of
providing vocational evaluation, job training and job
placement services for Brooklyn residents with a wide range
of cognitive, emotional and physical disabilities.
At the time of our site visit, the division for
families and children included three CWA-funded "preventive"
service programs (again, "preventive" in the special sense
of preventing placement), a school-based child abuse
prevention program, and a homemaker service program. Since
we completed the study, the agency has added two new
components to this division: social work consultation
services to seven day care centers in East New York; and
"Family Partners," a small, intensive family preservation
65
program modeled on the Homebuilders program. Also, it is
now initiating a new program funded by the Office of Family
Services for multi-problem families relocating from shelters
and hotels to permanent housing in Brooklyn.
Preventive Service Programs: The agency perceives its
participation in the New York State Preventive Services
Demonstration Project, authorized by Chapter 911 of the Laws
of 1973, as a significant event in its history. BBCS was
one of the seven voluntary agencies in the City selected to
participate in the project initially. In designing the
demonstration program, the Bureau relied heavily on its
experience in serving multi-problem families in its foster
care and family services programs. During the demonstration
project phase, BBCS served preventive service cases from the
entire borough. With the implementation in 1981 of the
Child Welfare Reform Act of 1979, the preventive service
staff was expanded, and the Bureau established a branch
office in Bedford-Stuyvesant. In 1984 the agency started
another preventive program in the East New York Section of
Brooklyn; and in 1985 it expanded its service capacity in
the Bedford-Stuyvesant area through CWA's "PEG" (Programs to
Eliminate the Gap) initiative designed to increase the
number of indicated child abuse and neglect cases receiving
preventive services.
Thus when we made the site visit, the agency had three
preventive service programs funded by CWA, each administered
separately but ultimately accountable to the director of
66
programs for families and children. At that time the
original program in Bedford-Stuyvesant was funded to serve
140 families with 12 social workers, the East New York
program was funded to serve 54 families with 4 social
workers, and the PEG initiative was expected to serve 48
families with 4 social workers. (The East New York program
has since been expanded to serve 78 families at any one time
with a staff of 6 workers.)
Although CWA funds the preventive service programs, the
executive director notes that the agency was able to expand
its services so substantially only by reallocating some of
its private financial resources as well. It should be noted
in this context that when developing its preventive
services, the Bureau decided to target communities of
greatest need as reflected in common social indicators, e.g.
number of children entering foster care, reports of child
abuse and neglect, teen pregnancy, and school drop-out
rates, quality of housing stock. This decision has, of
course, had significant implications in terms of demands on
program staff and resources. It also illustrates the extent
to which agency, rather than CWA, initiative shapes the
overall configuration of child welfare services. Additions
are not generally governed by a network plan.
About one-quarter of the agency's preventive cases are
served in BBCS's central office, a large building that it
owns in downtown Brooklyn. However, the preventive service
programs are based in two satellite offices, and most
67
preventive clients are served there. The office visited in
Bedford-Stuyvesant is new, spacious, and attractively
decorated. Since this office and the one in East New York
are located in what are commonly viewed as dangerous
neighborhoods, workers are often reluctant to make home
visits alone, especially after dark. To address this
problem, the agency provides a car and a driver to escort
workers on some of their home visits. Also, the offices are
open two to three evenings a week to accommodate families
who find evening hours more convenient.
The population served in these programs must meet the
eligibility requirements established for all publicly funded
preventive services and reside in the appropriate catchment
area. The agency must refuse 50-60 calls a month about
potential clients who do not meet these eligibility criteria
or who present problems that BBCS is not equipped to serve,
largely related to hard drug use or psychiatric problems.
Although the programs were run at less than full capacity
for several years due to shortages in staffing, they
ordinarily receive referrals in excess of contracted
capacity.
The typical client in the preventive programs is
described as a young, black single mother with 3-4 children
who receives AFDC and lives in over-crowded, substandard
housing. She usually has limited education and no job
skills, demonstrates difficulty handling interpersonal
relationships, and may be the victim of domestic violence or
68
have problems with substance abuse. Evidence or risk of
child neglect is common as are inadequate parenting skills.
Frequent presenting problems include housing concerns,
school performance or behavior problems, family violence and
need for advocacy help with income maintenance authorities.
Most clients are self-referred or referred by other clients,
schools, hospitals, and other agencies in the community.
CWA accounted for about one-fourth of the referrals in 1987,
but this proportion had increased to about one-third by
1989. In the annual client survey, parents often respond
when asked what they wanted from the Bureau, "someone to
talk to" or "help with my emotional problems", in addition
to help with concrete problems.
The clinical orientation of the programs has been
developed on the basis of the agency's experience in family
services, foster care, and the preventive service
demonstration project. Staff provide comprehensive
services, responding to concrete as well as emotional and
relationship issues. The emphasis is on understanding the
client (generally the parent) psychodynamically, relieving
stressors, and developing ego strengths.
The parent is usually the focus of treatment. Children
are seldom seen individually by their mothers' workers
because "in the agency's experience, the very needy, lonely
women to whom it is providing service often find it
difficult to share their workers with their children."
Although the workers have always been free to work with the
69
family as a unit, in the past they seldom choose to use this
approach; in recent years, as the agency began to invest in
increased training for family practice, there has been a
concomitant increase in family treatment. Also a number of
groups have been organized around such issues as women's
health, safety of children, and adolescent concerns.
Workers serve a maximum of 12-14 families at a time, and the
average duration of treatment is 10-16 months.
Agency administrators see the availability of flexible
funds for special needs as one of the strengths of the
preventive service program. Through this, workers are able
to assist clients with the payment of overdue bills,
purchase furniture or household goods necessary for family
life (e.g. beds), and relieve other immediate stresses.
However, the provision of direct cash assistance to clients
is instituted cautiously because of agency experience
suggesting that inappropriate use can interfere with the
therapeutic relationship. Workers are expected to teach
clients what other resources are available, how to ask for
help, and how to use resources efficiently. The relief
budget is heavily subsidized by the Bureau's private funds.
Both staff and administrators are proud of their
capacity to provide the integrated counseling and concrete
services required to engage families normally viewed as very
hard to serve, and of their success in reducing child
maltreatment and preventing inappropriate foster care
placements. They express frustration around three major
70
issues: 1) Absence of needed resources in the larger
community (e.g. housing) often limits the progress that
client families can make. 2) In those cases that do come
through CWA, lack of appropriate client preparation prior to
referral by CWA workers often leaves families reluctant to
accept help because they feel angry and stigmatized. 3) The
broad and extensive nature of the clients' problems often
leads workers to feel that their work is incomplete or
inadequate when families decide to terminate as soon as some
of their presenting problems have been ameliorated rather
than working on more of the long-term issues.
In addition, program administrators share the concern
of others in the field about the problems experienced in
recent years with staff recruitment and retention in direct
service positions. Although BBCS's front-line supervisors
in preventive service programs have an average of 20 years
post-masters experience, the average length of employment
for MSW workers in preventive programs had dropped by 1988
from 2-3 years to 18 months or less. This turnover among
beginning-level workers has a negative impact on the quality
and continuity of services that this or any agency can
provide and creates great stress for supervisory staff who
must constantly train new workers. The Bureau has attempted
to address these staffing problems by enriching its staff
development program, providing generous assistance to
workers who wish to pursue further education, and
supplementing the preventive service salaries authorized by
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the City with its own funding. Yet the staffing needs
persist; in fact, the agency has actively recruited social
workers from Great Britain, to supplement the staff. The
program director suggests that some of the factors
contributing to the staff recruitment and retention problem
are that workers are fearful of working in the communities
where the preventive programs are located, receive limited
professional satisfaction and societal recognition for the
work they do, see few opportunities within the field for
advancement or work enhancement, and are offered higher
salaries and better working conditions in other fields of
practice. These issues are obviously not unique to BBCS and
deserve discussion in a broader policy context.
Homemaker Service Program: The Bureau is one of the
City's few providers of homemaker service. This large
program serves families throughout Brooklyn and is funded
through a contract with HRA's Office of Family Services
(OFS). It served over 700 children and adults in fiscal
year 1988 with a staff of four social workers and about 100
homemakers. Designed to prevent family breakup due to
serious illness or hardship or parental incapacity to
provide adequate care, the program provides trained
homemakers who remain in designated homes for specified
periods of time to provide stability, help parents manage
children, teach nutrition and home management, and offer
encouragement and support.
Because of the City's administrative structure and
72
funding guidelines, this program is operated quite
separately from the agency's preventive service programs.
In fact, if one of the preventive cases requires homemaker
assistance, BBCS must refer this family to OFS who may or
may not refer the case back to the agency's homemaker
program. OFS makes the determination about approval of the
request for service and number of hours to be allocated to a
particular case. The case workers at BBCS are responsible
for conducting intakes, developing the service plans,
visiting the homes monthly, and supervising and training the
homemakers. They try to assess family needs on an ongoing
basis and to make referrals and advocate for clients as
needed, but they do not have any case management
responsibility because the families ordinarily have a
preventive service worker from BBCS or some other agency.
Moreover, they carry high caseloads (mean = 33-35 cases) as
required by City contract so the time that can be devoted to
any individual case is limited.
Clients and staff seem quite satisfied with the
homemaker program, and the agency has no difficulty
recruiting social workers or homemakers for this service.
However, there are a number of structural difficulties
documented repeatedly that concern agency administration
because they limit the important contribution that homemaker
services can make to work with families at risk. Perhaps
most serious are the Citywide cap on funding for homemaker
service and the lack of emphasis on quality control. Other
73
issues include the complicated approval process, the lack of
reimbursement to contract agencies for overhead costs, and
the payment of homemakers as hourly workers rather than as
full salaried employees. A concern highlighted clearly by
the programs at BBCS is the lack of integration between
preventive and homemaker service programs.
Islands of Safety: This is a small school-based child
abuse prevention program initiated in response to a
recommendation of the Mayor's Task Force on Child Abuse in
1982. The agency has put considerable effort into obtaining
private support to make expansion possible. The program now
has three social workers stationed in 4 elementary schools
in the Ocean Hill-Brownsville and East New York areas of
Brooklyn. The workers are teaching school administrators
and teachers to recognize potential indicators of child
abuse and to assist them in reporting to the State Child
Abuse Hotline and in working with the child and family
during the investigatory process. They also give
presentations to community groups and social agencies to
educate them about indicators of child abuse and reporting
requirements. In addition, the workers meet with the
children in every class to educate them about their right
not to be abused and how to take greater responsibility for
their own behavior, and they conduct group sessions for
parents about patterns of child development and non-violent
methods of discipline. Although the primary emphasis is on
these latter educational functions, the workers may also
74
work with individual cases or make referrals for service, if
help is needed during and/or after a child protective
investigation. Finally, crisis intervention counseling is
provided to children and families when risk of abuse or
neglect is identified.
This program, which serves approximately 2500 children
and parents, is funded by private foundations, CWA, and a
grant from the New York State Children and Family Trust
Fund. Located in neighborhoods in which economic and social
stress place children at high risk of abuse, it is the only
program at BBCS that can be defined as serving a truly
preventive function for families and children, despite the
State's use of the word "preventive" to describe the more
narrowly targeted placement prevention programs. Although
situated in the same geographical area as the agency's so-
called preventive service programs, it is staffed quite
separately.
Observations, Lessons, Questions
Brooklyn Bureau of Community Service illustrates the
evolution of a major voluntary agency with a mission to
provide child and family services and an equally strong
commitment to disabled adults. Many shifts in program
direction and emphases must be made over time as such an
agency attempts to carry out its established mission in the
context of changing community needs and funding
opportunities. The Bureau has maintained a clear focus on
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the provision of high quality, professional services to low
income client populations with special needs that may
inhibit their capacity to function independently. Its child
and family service programs, which are concentrated in areas
of great need, directly reflect this service orientation, as
do its employment programs for adults with severe handicaps
and disabilities. Despite the obvious value of these
services, funding limitations restrict the Bureau's capacity
to serve all families in need in its target communities and
to integrate its various service options.
The regulations governing the categorical funds now
available from various public sources tend to define in
large measure the type, range and extent of services
available from voluntary agencies such as BBCS, as well as
others in the study. This development raises troubling
questions about the capacity of the voluntary sector to
function independently or to exercise what has been
traditionally been valued as a unique potential for
leadership and innovation in the delivery of social
services. The negative impact of public funding constraints
is very evident, for example, in the seemingly irrational,
City-imposed split in administration of preventive and
homemaker services at BBCS. Similarly, the sharp division
between the agency's employment and family services reflects
the dysfunctional effect that public funding can have on
service delivery. The Bureau has an unusual combination of
expertise related to the provision of work training services
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for disabled adults and counseling services for
disadvantaged families. Yet because of grant restrictions
and relatively limited private funds, the agency has been
hindered in its capacity to share the resources of these
programs and/or to link the services, despite the potential
overlap between the client populations.
Another troubling issue posed by the experience at BBCS
relates to the staff recruitment and retention problem in
preventive services. Although many other preventive
programs are experiencing similar difficulties, the problem
is especially noteworthy here because the agency
administrators have been creative in developing various
initiatives designed to address staffing needs and have
refused to compromise on staff quality. One factor that may
distinguish the Bureau is that its services are located in
areas perceived as more dangerous than many of the other
programs. This, of course, is a price that must be paid for
attempting to serve families most in need; but it seems
clear that the City must give programs located in such high-
risk areas more help in addressing the safety concerns of
their workers (e.g., salary differentials, additional
funding to pay for escort service and/or treatment teams,
lower caseloads, etc.).
It also seems important to examine the other variables
that may contribute to staff turnover. To illustrate, in
addition to the factors identified by the program director,
preventive service workers in very high risk communities may
77
feel somewhat more isolated from other agency staff; and
they have fewer opportunities to work with clients who are
not at imminent risk than professional workers in agencies
that serve more "optional" preventive cases and/or permit
workers to carry a broader range of assignments. A less
categorical organization of services might diminish workers'
sense of isolation and increase their opportunities to
experience "success" in their practice.
Another factor in social worker job dissatisfaction
could be the obvious interest of some in practicing
psychodynamically-oriented therapy; that is seldom possible
with these caseloads. Thus these workers may experience a
greater gap between their aspirations about the type of
practice they would like to do and the reality of their
clients' immediate service needs than do workers in programs
that explicitly promote a very different practice
orientation or whose clients may be more amenable to a
traditional psychodynamic approach. (The fact that
preventive programs at the Jewish Board of Family and
Children's Services, as discussed below, also experience
high staff turnover problems - in contrast to other JBFCS
units - lends some support to this hypothesis.) Clearly,
there is great need for additional study of staff
recruitment and retention issues in all preventive services
because no program can succeed without consistent, high
quality staff.
Finally, it is important to note that BBCS, like many
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of the other agencies included in the study, seems to be in
a continuous process of self-examination, growth and change.
The agency completed a joint board, administration and staff
strategic planning process in 1988 that resulted in re-
affirmation of the agency mission statement and
identification of strategic directions and goals for the
next four years. These include expansion and enhancement of
prevention and rehabilitation services, development of
mechanisms to strengthen the professional staff,
establishment of measures to increase the agency's financial
capacity to carry out its plans, initiation of new services
to populations not currently served or served more narrowly,
and identification of advocacy positions and mechanisms to
facilitate implementation of the Bureau's public policy
agenda. Interestingly, one of the priorities identified was
creation of a new senior management position for a director
of recruitment and training who is expected to address some
of staffing issues identified above.
Also, two of the agency's new programs are designed to
form linkages that may fill some of the gaps between
employment and family services discussed earlier. Last
summer the agency initiated a successful employment training
program for youth in foster care; and it is now actively
seeking funding to inaugurate a work training program with a
day care component for women on public assistance, including
those receiving preventive services. The latter program,
which is identified as a high priority for the agency,
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clearly reflects the executive's effort to build on the
expertise and experience developed in the agency's
employment programs to address newly identified needs and to
bridge the traditional gaps between work training, child
care and family services - along the lines of current
federal "welfare reform" efforts, as being planned in the
City.
Since the Bureau was the first agency visited for this
study, it was particularly interesting at the end of the
study to obtain an update on the changes it made during our
data collection period. These confirmed the conclusions we
were reaching about the importance of variables such as
executive leadership, active board involvement, access to
some private funds, willingness to cross traditional service
system boundaries, program growth, and investment in staff
training. These are the factors that seem to characterize
agencies that remain viable and responsive to client need in
the current social context.
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Good Shepherd Services
Good Shepherd Services is a large, voluntary, multi-
service child welfare agency administered by the Sisters of
Good Shepherd, a worldwide religious community with a long
history of caring for homeless women and children. Although
the first New York House of the Good Shepherd was
established in 1857, the current agency was not incorporated
until 1947. The services provided today, as in earlier
days, reflect the order's traditional emphasis on the
importance of individualizing clients, developing young
people to their fullest potential, and responding to needs
in a holistic, culturally-sensitive manner.
The agency has three major program divisions. Its
neighborhood family services, which were the focus of this
study, consists of a range of community-based programs in
the Park Slope, Gowanus, and Red Hook areas of Brooklyn.
These programs serve over 3500 children and parents
annually. The agency's residential services include two
diagnostic reception centers that serve about 460 youth
annually, Euphrasian Residence and the Barbara Blum
Residence, and three long-term residential treatment centers
that serve 56 adolescent girls, St. Germaine's, St.
Helena's, and Marian Hall. Finally, the agency offers child
welfare training through its Human Services Workshops, a
training institute that provides low-cost, theme-centered
training sessions to almost 1300 workers from over 200
81
agencies annually.
The central administrative offices for the agency are
located in Manhattan, sharing space on East 17th Street with
Euphrasian Residence, Marian Hall, and a Good Shepherd
convent. The Sisters of the Good Shepherd appoint the
agency's board of directors, some of whom are members of the
religious order while others are lay people. Budget and
personnel operations are centralized, but otherwise the
program divisions function quite independently. The
administrators of the neighborhood family service programs
are based in Brooklyn. Although the agency is affiliated
with New York Catholic Charities, it is an independent
agency and receives no funding from the diocese.
The agency's projected budget for fiscal year 1990 is
over $8.5 million, about $3.2 million of which is for
neighborhood family services. Preventive service funds from
CWA account for about one-third of this budget, and most of
the remainder is provided by grants from a range of other
government agencies including the New York City Youth Bureau
(2 contracts), Board of Education (3 contracts), Community
Development Agency (2 contracts), Department of Health, and
the State Department of Labor. Private foundation grants
and gifts contribute only about $340,000 to the total
budget. However, Good Shepherd Services has access to
interest-free loans from its sponsoring religious community.
This is an important benefit because of the cash flow
problems that occur so frequently in agencies that are
82
primarily dependent on public funds.
Good Shepherd's network of neighborhood family services
offers a range of community-based programs designed to serve
residents in the South Brooklyn area. Although each program
has its own director and handles its own intake, there is
close coordination at the program director level and
frequent referral from one program to another. Thus,
clients often receive services from several agency programs
simultaneously. There is a clear sense of cohesion evident
within the division, which seems to derive from the
administrators' experience of working together, their shared
philosophy of service, and their commitment to helping the
residents of the same community. Although there are few
formalized policies or procedures to govern service
integration, each of the program components clearly operates
as part of an integrated service network.
The Family Reception Center established in 1972 was
Good Shepherd Services' first community-based program.
Funded initially as an LEAA court diversion demonstration
project, the Center was designed to support families in
their own community by providing comprehensive, early
intervention services. After extensive study and
consultation, the Park Slope area was selected as the
initial project site because at that time it was a multi-
ethnic community with few social and health services and a
rapidly rising rate of juvenile delinquency. Although the
Center originally offered a wide range of therapeutic,
83
developmental, and advocacy services, it gradually narrowed
its scope as funding sources changed and various new
programs were developed to supplement its work. The Family
Reception Center is now funded entirely by preventive
service contracts with CWA and provides individual, family,
and group counseling as well as concrete and advocacy
services to families in which there are serious problems in
social functioning and children are at risk of placement.
In addition, the program offers a range of socialization
activities such as Parents' Night, camping and day trips for
youth, a thrift shop, emergency food, and registration for
summer camp. (The Center is open 6 days a week until 9:00
P.M.) Guided by a systemic perspective on practice, the
staff is relatively eclectic and uses a range of
interventive approaches as needed.
There are two other programs administered under the
director of the Family Reception Center: Teen Parent
Project and Park Slope Mini School. The Teen Parent Project
is a comprehensive program providing counseling, specialized
information and referral, educational advocacy and emergency
supplies to teen mothers in South Brooklyn. In fiscal year
1988 the program served 122 parents and 143 infants and
toddlers, many of whom had multiple service needs. For
example, 37 percent of the mothers were homeless and could
not meet their children's basic needs.
The Park Slope Mini School is a day treatment service
funded by the Board of Education and CWA for children at
84
risk because of family problems and poor academic
functioning. Initiated in 1973 as an alternative school for
neighborhood children aged 10-14 who could not learn in
regular classroom settings, the program is now located in
separate classrooms in three public schools and serves about
110 children ranging in age from 4.9-16 years annually.
Some of the students have been clients at the Center and a
few are the children of former participants in the Teen
Parent Project. This is an intensive educational and social
service program that places heavy emphasis on work with
families as well as children and attempts to deal with the
"whole child," not just the child's problems in school.
Individual, family and group counseling is offered as well
as weekly discussion groups and a number of recreational
activities for the youngsters.
Despite increased regulation by the Division of Special
Education, the agency has been able to maintain considerable
control over intake. However, Good Shepherd Services has no
voice in hiring the educational staff because the Board of
Education supplies the classroom teachers. This limitation
on agency authority inevitably creates some program
tensions. In addition, the agency workers are often
frustrated by the stresses inherent in trying to provide a
controlled environment for children who live in chaotic home
situations. Yet, they remain very convinced of the value of
providing community-based treatment services rather than
sending these youngsters to specialized mental health
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programs where the children would be segregated and labeled,
thus limiting their opportunities for normalization.
Children and Youth Development Services (CYDS),
initiated in 1973 with a grant from the U.S. Department of
Health, Education, and Welfare, Office of Youth Development,
is the community development arm of neighborhood family
services. Designed to coordinate community resources for
youth, mobilize the development of needed services, and
provide direct services and advocacy as needed, CYDS offers
a range of programs that have been developed on an ad hoc
basis over time in response to changing needs and available
funding resources. CYDS currently includes a Jobs and Youth
Development program that provides job development,
counseling and full and part-time job placement service to
about 200 adolescents annually; a Community Services Project
administered in cooperation with John Jay High School that
places about 130 youth in volunteer positions in community
service organizations and health facilities where they gain
work readiness and career skills and gain academic credit;
an Odd Jobs Market that links youth with community members
who have called for help with odd jobs; a summer day camp
for children aged 6-12 that offers summer employment to
teenage junior counselors; and a drop-out prevention program
that provides outreach and advocacy, crisis intervention
counseling, and after-school academic and recreation
services to about 110 youth in need of special education at
John Jay High School annually. Many of CYDS' youth programs
86
are based in the LOFT (Leadership Organization for Teens),
which is an evening center for youth aged 12-21.
Neighborhood teens are welcome to drop in here to
participate in recreation activities, small group meetings,
and community service projects. The age group cohort that
frequents the LOFT tends to vary from year to year, as do
the interests of the participants, but the youth are
expected to help in planning and implementing the activities
each year. In fiscal year 1988, 190 additional teens were
involved in this program.
CYDS also has a housing assistance program that
includes tenant counseling, emergency assistance, housing
court advocacy, and tenant organizing. The Park Slope Safe
Homes Project, which evolved from one of CYDS' early
community organization efforts, was the first community-
based safe homes project in the state for battered women and
their families. Initiated as a consequence of a community
needs survey, the project has its own post office box and
telephone number and a separate coordinator in order to
preserve confidentiality and protect the security of the
women. This project provides safe apartments in the
community where two families can live for up to two months.
Because most battered women's shelters are designed for
women on AFDC, the Safe Homes Project gives priority in
admission to working women and to undocumented residents.
AFDC recipients are referred to other shelter programs when
necessary because of limited space. The project also
87
sponsors a hotline staffed primarily by volunteers and
offers crisis intervention and advocacy services and a
support group for battered women. In fiscal year 1988, 23
women and their families were given shelter, and crisis
counseling was provided to 160 women. The hotline responded
to 1800 calls during the same year. In addition to
providing direct services, the staff is heavily involved in
community education and advocacy efforts on behalf of
battered women.
All of the work of CYDS reflects a strong emphasis on
community organizing and advocacy. Although direct services
are provided in some of the programs, the participants are
not referred to as clients and the staff avoids getting
involved in sustained therapeutic relationships.
Participants in need of ongoing clinical services are
referred to the Family Reception Center or some other
resource as appropriate. Since CYDS' primary objective
relates to community improvement and child and youth
development, the administrators and staff feel strongly
about the need to maintain appropriate boundaries and to
avoid "psychologizing" participants. At the same time, they
view themselves as part of Good Shepherd's comprehensive
neighborhood family services, thus insuring that counseling
and related resources are available to participants when
needed. The various programs within CYDS are viewed as a
service network in that each program has a separate
coordinator and its own integrity, but they are expected to
88
work together to meet a range of community needs.
There are four additional programs administered under
the neighborhood family services that are not part of CYDS:
South Brooklyn Community High School, Crossroads, WISH, and
Open Book. South Brooklyn Community High School (SBCHS) is
an alternative high school established in 1980 for older
adolescents who have dropped out of traditional high school.
Located in Red Hook in the Police Athletic League's Brooklyn
Center, the school is administered by Good Shepherd
Services, which provides a range of student support and
counseling services. The Board of Education provides the
teaching staff. The school can serve sixty-five students at
any one time, but enrolls about one hundred a year. Since
students can remain in the school until graduation, those
who complete the program stay an average of two to three
years. Most potential students are recruited from a list
provided by John Jay High School, but some are self-referred
or referred by high school personnel.
The staff, which includes a site coordinator, four
advocate counselors, and three Board of Education teachers
provide individual and group counseling, leadership
training, employment assistance, recreational activities,
and advocacy services. The School is open 12 months a year
to enable students to earn as many credits as quickly as
possible. SBCHS also serves about 150-200 youth a year who
cannot enroll but are offered information and referral.
The mission of the school, like other Good Shepherd
89
programs, was defined as providing both direct services
(educational and counseling) and advocacy. Strong emphasis
is placed on re-engaging youth with their families (broadly
defined to include anyone who is significant to the
student). The staff makes a concerted effort to involve
parents in the program, encouraging them to believe in their
children again, and facilitating the process of
reconciliation. Parents are given reports of academic and
social progress, contacted if their child is not attending
school on a daily basis and given assistance and referral
when crises arise.
Drawing on the agency's extensive experience in
providing residential care for adolescents, the site
coordinator has been assigned the role of chief child care
worker with responsibility for maintaining discipline in
relation to school policies. This frees the advocate
counselors to concentrate on youth development activities
designed to support educational achievement. Also, the
staff has sought to foster a strong sense of community
within the day school program. The sense of being in a
"residential program without the residence" is quite
tangible to an outside visitor.
Crossroads, a drop-out prevention program initiated in
1986, is located in three junior high schools in District 15
in Brooklyn. (The agency had worked with two of these
schools previously.) Funded by the Board of Education as
part of a citywide effort to have community-based
90
organizations (CBO's) work with community school districts
at the junior high school level, the local program operators
have had to struggle with multiple barriers to effective
program implementation. These derive in large measure from
the need to work simultaneously with the Board of Education,
community school boards, and local school principals. The
associate executive director noted that program initiation
may have been somewhat easier for Good Shepherd Services
than for some of the other CBO's due to their earlier
experience with two of the schools. The first year was very
difficult because of what she termed the "transplant
phenomenon," i.e., the movement of CBO's into schools
created enormous resistance because the school had not been
consulted about the Board of Education's plan and resented
the infringement on their turf. However, Crossroads is now
well institutionalized.
The program has a staff of three (a site supervisor and
two caseworkers) in each of the three junior highs and is
expected to serve one hundred children in each school by
offering comprehensive casework, group work, socialization
and outreach services. Although the official program goal
is to improve school attendance, the staff attempts to
broaden that objective in their work with children and
families. In contrast to Rheedlen's Gallery program which
is funded by the same contract (see discussion below),
Crossroads places stronger emphasis on work with the schools
and work with children in schools, doing extensive mediation
91
between the youth, their parents and the schools.
Although the program was initially hampered by the
Board of Education's demand that the agency specify a priori
each piece of service it planned to provide, the Board now
permits needed local autonomy and control. A persisting
problem is the relatively low level of funding for this
program. The Board of Education allocates about $1300 per
child for the services provided in this program annually,
whereas CWA allows approximately $3000 - $4000 a year per
case for work with youth and families demonstrating many of
the same service needs.
Open Book is an adult literacy program that was
initiated in 1984 as a consequence of a literacy task force
organized by the Mayor's Office of Youth Services. The
program has four classes, two for those reading at grade
levels 0-4.9 and two for those reading at grade levels 5-8.
There are fifteen registered in each class, which yields a
mean attendance of ten per class. Students are recruited
from throughout South Brooklyn, and there is a waiting list
for those wishing to enter the class for non-readers.
The associate executive director described Open Book as
a "real jewel", noting that the program director uses a
group work model and creates a clear sense of community
among the participants. He encourages students in the
senior class to tutor those in the junior class and
consistently uses the literacy training to enhance the
participants' belief in themselves and in their
92
competencies. Hence the program ultimately employs a human
development strategy that reflects the core philosophy of
the agency.
Funded by City tax levy income, reimbursement is based
on direct instructional costs. This formula, which
constrains service delivery, particularly disadvantages
CBO's because ordinarily no money is provided for overhead
costs or for services designed to supplement direct
instruction. However, for fiscal year 1989 the agency
submitted a budget for its full costs rather than for the
costs prescribed in the RFP ("request for proposals") and
was funded at that level. This has made an important
difference in the program, but no one is certain what this
portends for the future. Aside from the funding
constraints, the only drawbacks to this program from the
agency perspective are the excessive paperwork and
accountability demands.
The WISH program was initiated in 1979 as one of the
original "displaced homemakers" programs. Its focus is on
women aged 35 and older who are out of the job market or
underemployed. Many of the participants are recently
widowed or divorced, but others are long-term single
parents. The program is organized around regular job
readiness cycles of 4-7 weeks for 9-16 persons at a time.
The intent is to help the women examine their own lives in
order to identify the skills they now possess and what they
might have to offer in the job market, and to develop the
93
necessary additional skills. For example, the first
activity for the women is to write an autobiography, which
they are expected to share with the group. While assisting
with skill development, the staff also helps the
participants with the job search, teaching them how to use
the library and other resources, and how to "sell" the
skills they possess.
There is an important connection between the WISH and
the Open Book programs because many women who complete the
WISH program decide to enter Open Book to strengthen their
academic skills before attempting to compete in the job
market. In the course of a year WISH provides job readiness
training to approximately 125 women and places about 65 in
full or part-time employment.
Funding for this program is provided by the Department
of Labor. In addition, WISH recently received a grant of
equipment from IBM in order to develop a skills center that
will prepare women to work in data entry and processing
jobs. Program participants are drawn from all over
Brooklyn, but they are primarily minority group, older women
with very limited job skills. Recruitment is a constant
problem requiring extensive outreach. (The Daily News
Community Bulletin Board is the most important single
referral source.)
One agency concern identified in relation to this
program is the unit cost funding mechanism employed. It is
clearly more costly to serve this target population than to
94
run a displaced homemaker program in an upper middle class
suburb, yet no distinction is made by the Department of
Labor in determining unit costs. Although there is a very
strong statewide lobbying group that has maintained support
for displaced homemaker programs since 1979, it has had
little impact on this problem. It takes extensive political
work just to keep the program going. However, as the
associate executive director noted, the success of this
effort demonstrates how much easier it is to secure funding
for job-related programs, particularly those that may also
benefit middle-class clients, than to obtain money for some
of the other service programs the agency administers.
Observations, Lessons, Questions
Good Shepherd Services provides a clear illustration of
the use of categorical funds to create a local network of
community-based service programs. Although each of the
components of this division has its own intake processes,
staff, operating procedures, and intervention repertoire,
the programs share a common service philosophy that
emphasizes child, family, and community development through
the provision of educational, counseling and advocacy
services. There are no formal mechanisms for case
integration, but staff often link clients to other programs
or resources within the agency to insure comprehensive
service delivery. Internal communication and program
coordination at Good Shepherd Services is facilitated by the
95
fact that a number of the program directors have worked
together for many years. However, the key factor enabling
this agency to develop an integrated neighborhood service
network is the executive staff's readiness to assume the
dual burdens of coordinating discrete program regulations
and funding streams and of developing the political, fiscal,
and community support required to sustain the services over
time. The agency was given the greater New York Fund's
"Best Managed Social Service Agency" award in 1988.
The agency administrators have had to cope with the
same problems of inadequate funding and staff recruitment
and retention that plague other community service programs,
but they have approached these issues in a persistent,
pragmatic matter, "making do" when necessary while
constantly seeking more satisfactory solutions. From the
executive director down, there is a strong emphasis on
sharing responsibility while encouraging professional
autonomy and creativity. Also, rather than insisting on a
very rational organizational structure and fitting people
into fixed organizational slots, the administration has
chosen to organize programs around staff strengths and
available community resources and linkages. As a
consequence there is relatively high morale in the agency
and a shared pride in the agency's service programs.
The executive director of the agency has been very
committed to making the neighborhood family service program
replicable. However, she now questions whether this is
96
feasible given the current political environment and the
widespread emphasis on narrow targeting of categorical
services to those most at risk. The director, like the
others with whom we met during the study, feels strongly
that their success with the "hardest cases" is directly
related to their capacity to provide comprehensive services
to a wide range of families and children in relatively
normalizing contexts. And she is concerned about whether
new agencies or programs will be able to secure the support
required to initiate and sustain comprehensive service.
97
Rheedlen Foundation
Rheedlen Foundation is a relatively new, voluntary,
community-based service organization incorporated in 1970 to
work with and for children aged 6-12 who are frequently
truant from school. Founded by the current executive
director' and a group of his friends on a volunteer basis,
the organization originally sought to raise scholarship
money from private sources in order to send city children at
risk of leaving school to alternative boarding schools.
Their original purpose explains the agency's title, which is
now somewhat misleading.
After about three years of experimenting with this
approach, the board decided that it was not working because
the youth whom they were trying to help informally had
difficulty adjusting when they returned to the City, even
though they may have done well in the alternative schools to
which they were sent. At that point, the director decided
to take three months off from work (in an unrelated field)
in order to get the organization moving in a different
direction, secure additional funding, and hire a
professional director. The three months extended into three
years before he was able to obtain outside funding, a
$138,000 grant, from LEAA. During this early period a small
number of volunteers started to work on a one-to-one basis
with youngsters in various parts of the City; but based on
*
Appointed Commissioner of the Department of Youth
Services in April, 1990.
98
this experience, they decided that in order to have real
impact on children, they would have to work with their
families and local community institutions as well.
Thus, by the time Rheedlen obtained its first grant, it
was ready to move out of what the founder now describes as
its "child saving" period; and he had decided to stay on as
executive director. The LEAA grant enabled the agency to
open a modest office where the main office is still located,
above a movie theater at 107th Street and Broadway in
Manhattan, and to hire some staff. The board decided to
concentrate its services in a particular geographic
community rather than trying to cover the entire City.
School District 3 in upper Manhattan was selected, and the
director and his assistants began to solicit the names and
addresses of truants from local elementary schools. Their
service approach at that time was very basic; they simply
started knocking on the door of the children's homes in
order to talk with the parents and the youngster and to do
whatever seemed necessary to get the truant back to school.
Through these early experiences, the board and staff
quickly learned that truancy is rarely an isolated problem.
It often reflects a family in crisis with a range of
economic, social, and emotional problems, and it is
frequently associated with delinquency and child abuse and
neglect. Thus when the agency received another grant from
the State Department of Social Services, it was ready to
initiate a more formalized approach to service delivery.
99
This money was used to hire a social worker with an MSW
degree who was stationed full-time at P.S. 207 to work with
abused and neglected children as well as frequent truants.
The agency has expanded quite rapidly since that time
and has, perhaps inevitably, become increasingly
professionalized and bureaucratized as it has assumed
additional responsibilities. This change has diminished
Rheedlen's reliance on volunteers; but it has not altered
its basic approach to service delivery, which places heavy
emphasis on outreach and home visiting and the provision of
educational support and concrete services. Although the
agency provides a wide range of traditional social services
including individual, group, and family counseling, it
defines itself as a "non-profit educational organization"
and makes a point in its public relations material of
specifying that it is not a mental health agency. Also,
although Rheedlen employs a number of professional social
workers, its staff is more mixed that of the other programs
studied, and a number of key personnel have backgrounds in
education rather than social work.
Rheedlen's primary target population is defined as
children aged 6-12 who are at risk of truancy, educational
neglect (a formal court term), and/or child maltreatment and
who reside on the upper West Side in the South Central
Harlem, Manhattan Valley and Clinton communities. (Specific
intake criteria vary somewhat among different programs
depending on funding source requirements.) The population
100
served is composed primarily of low-income, minority, single
parent families with a range of serious psychiatric,
substance abuse, domestic violence, housing and other
environmental problems.
Rheedlen currently provides service to approximately
500 families a year and reaches over 2,000 children annually
through its school-based program. Additional numbers are
offered "on-site" services such as a food pantry, clothing
exchange, and information and referral. The agency's annual
budget of $2.7 million is supported primarily by contracts
with the City Board of Education, State Department of
Education, Department of Youth Services and CWA. There is
no real endowment but public and private contributions
provide about $240,000 annually. The agency now has six
core service programs.
The Truancy Prevention Program, located in the main
office, was the agency's first program, and provides a model
for the other programs. Designed to serve children at risk
in Community Districts 7, 9, and 10, the program is funded
by a preventive service contract with CWA and by the
Department of Youth Services, and provides a range of case
management, individual and family counseling, parent
training, advocacy, brokerage and concrete services to about
140 families annually. A key component is the after-school
program, which is open five days a week and Saturdays.
Children are offered a hot meal, homework assistance and
remedial help in reading and math, and a range of activity
101
groups. Staff and/or volunteers often escort children to
and from the program in order to encourage attendance.
Center 54, an after-school and evening recreational
program for youth aged 10-21, was established at Junior High
School 54 in 1979 with funds from the New York City Youth
Bureau. Open to all youth from community districts served
by the Truancy Prevention Program, the program is open 9:00
A.M. to 10:00 P.M. during the school year and 9:00 A.M. to
5:00 P.M. the rest of the year. It offers a range of
recreational activities. All participants are required to
take an achievement test as part of their registration and
to attend at least one formal class weekly at the Truancy
Center, which offers teaching, homework assistance, G.E.D.
preparation, and English as a Second Language, as well as
classes in creative writing, arts and crafts and computer
programming. There is a social worker on site during school
hours to offer information and referral, advocacy and brief
counseling services as needed. A Teen Council composed of
neighborhood youth helps to govern the Center.
The Parents Help Center was established at P.S. 207 in
1982. Funded originally as part of a State minority
contractor initiative, then by a preventive service contract
with CWA as well as a VISTA grant and some private monies,
the program provides mandated preventive services to
families at risk. It also offers open "one-stop" services
to any parent who may need a place to talk about common
102
concerns, information and referral, crisis intervention and
referral, or opportunity to participate in a parent
workshop. The center has an after-school program offering
recreation and homework assistance in which parent
volunteers work with the children. Clothing is distributed
once a week for a nominal fee, as is emergency food.
The Motivation Room at P.S. 154 on West 127th Street
and Rheedlen Place at Sacred Heart School in the "Hell's
Kitchen" area are newer programs, but are modeled very
closely on the Parents Help Center. They are funded by
preventive service contracts with CWA and designed to serve
children and families at risk in their respective catchment
areas. Both have social workers on site at the schools to
provide the customary range of mandated preventive services
as well as after-school programs for the children.
The service emphasis in these programs as in Rheedlen's
other preventive programs is what one program director
described as "advocacy counseling". He explains this by
saying that although many of the clients present serious
emotional problems, the workers function primarily as
service brokers and coordinators, not as therapists. The
counseling offered is very "present, reality oriented", and
the workers "stay mobile", making frequent home visits and
outreach efforts to other service institutions as well as to
families. As in the Truancy Prevention Program, staff and
volunteers often provide escort service to children
attending the after-school program and attempt to encourage
103
normal socialization with adult supervision so the
youngsters can learn what it is like to be properly
supervised. Although each preventive service case is
assigned a particular worker, all of the staff members try
to make themselves available to the parents and children on
the assumption that clients can benefit from developing
meaningful relationships with a range of people.
The stated mission in all of the preventive programs is
to try to keep families together, but the agency tends to be
child-centered and to place primary emphasis on protecting
the children's interests. Thus placement in foster care may
be recommended when necessary because a child is at serious
risk. Also Rheedlen has recently opened a small "host
homes" program composed of volunteers who are willing to
provide a home, companionship, and supervision for a brief
period to youngsters in crisis who cannot remain with their
own families. Designed as an informal alternative to
emergency foster care, the program recognizes that some
separation of parent and child during a crisis can be
beneficial to each and can give time to staff to work on
stabilizing the situation.
The Gallery is a drop-out prevention program
established in 1985 for youth at four junior high schools.
The program is funded by the Board of Education and provides
outreach, counseling, and advocacy services as well as
after-school activities for about 150 youth annually who are
identified as at risk by the school system. Program
104
administration is based at I.S. 88 (Wadleigh Junior High
School), one of the target schools, and Gallery staff also
provides services at J.H.S. 54 as a supplement to the work
of Center 54. The program subcontracts with another
community-based organization, the DOME, to provide the drop-
out prevention services at J.H.S. 44 and J.H.S. 118.
The Drop-Out Prevention Program was initiated by the
central office of the Board of Education, which establishes
clear eligibility guidelines, and negotiates and monitors
contracts. The local schools provide space for the program
and names of eligible students. Because this program was
developed by the central board with little input from local
school districts, there have been a number of conflicts
related to program implementation and wide variability in
the way it is implemented in different districts. District
3 where the Gallery is located, is generally supportive of
the objectives of the program despite disputes related to
office space and turf.
The program eligibility criteria specify that
participants should have been out of school 30 or more days
in the preceding school year, be failing two or more
subjects, be late repeatedly, and/or demonstrate other
indicators of school performance difficulties. If a youth
is out more than 75 days, (s) he cannot remain in the program
because this is defined as long-term absence. All cases are
terminated at the end of each school year, and a new cohort
enrolled in the program the next year.
105
During the summer, the program director ordinarily is
given a list of potential participants with their
corresponding number of absence the preceding year; then
with no other information to go on, the workers who are
assigned 40-50 cases each, start making home visits. Their
objectives at that point are to obtain permission from
parents to have their children participate in the program
and to get to know as many members of each family as
possible. Therefore, they may make 2-3 home visits
initially, and then they visit monthly during the school
year to give positive feedback and address issues that may
be affecting attendance. The workers arrange private
interviews with each youth during the intake process and
develop individualized "contracts" regarding their
participation in the program.
In their ongoing work with the students, the workers
focus on doing whatever is necessary to get them to school
and to help them deal with any school or family issues that
may be interfering with their attendance. Most youth
participate willingly in the program and take advantage of
the opportunity to drop by the program often or chat briefly
with the staff during the school day. Many also participate
actively in the after-school program that is run in
collaboration with the drop-out prevention program and
offers a range of recreation, group counseling, and tutoring
services. However, these youth often have multiple family
problems and long histories of school performance and
106
attendance difficulties. Therefore, only limited progress
can be expected, and the program director finds they must
anticipate a 10-15 percent failure rate. The success they
do experience, he suggests, derives primarily from the case
managers' readiness to "hang in" until they really connect
with the youngsters and can offer the emotional support the
participants need to stay in school.
The program director, who is an experienced clinician
with extensive experience in child and family mental health
services, noted that he thinks it is essential that services
such as these be school-based. The presence of the staff
full-time in the school creates a "different sort" of
presence and has a positive impact on the students and on
the school personnel. For example, the case managers visit
each class during the first period to check on attendance
and then start calling those who are absent. This is
obviously meaningful to the youth and also serves a
consciousness-raising function with some of the teachers and
school attendance officers. Similarly, although it is
difficult for the workers to be confined to the one room
allocated to the program and to feel they have to be "on"
all the time, since they are watched carefully by school
officials and children drop in frequently, their presence
serves two important functions. They are able to model more
effective communication with "troublesome" students for
school personnel, and they are available to the youth when
the latter are ready to talk.
107
The biggest drawback to the program is the complicated
administrative structure that requires frequent negotiations
with the Board of Education, the District Superintendent's
office, and the various school principals. Other obstacles
to program effectiveness derive from the lack of follow-up
(some youngsters start truanting again after discharge from
the program) and the high caseloads. On the positive side,
the workers are not overwhelmed with paperwork, so they are
able to devote most of their time to direct work with
clients, averaging 3-4 home visits a day in addition to the
time spent with youth at the schools. Overall, the director
thinks that the program compares favorably with preventive
service programs that serve similar types of families at
much higher cost per case. The Gallery program could
probably do much more with a smaller number of youngsters,
but he is not convinced additional clinical services for the
youth would make much difference in case outcomes.
The Gallery program is illustrative in many ways of the
evolution of Rheedlen's service orientation and current
program pursuits. Targeted at youth at severe risk, the
program incorporates not only direct work with children and
families, case advocacy, and provision of concrete services,
but also a clear emphasis on influencing the local school
system and larger forces shaping children's educational
experience. Troubled by the CWA's shift toward increased
targeting of preventive services on specific problem
populations and its restrictions on the range of services
108
that can be offered, the agency is moving toward increased
use of other sources of funding and toward development of
community-school projects. The latter is based on the
assumption that the local schools provide a natural locus
for the delivery of child and family services designed to
fulfill developmental as well as remedial functions and that
public schools should be viewed as community space available
for many uses in addition to education.
In this context, Rheedlen has taken a leadership role
in the effort to keep schools open to parents and children
in the afternoon and evening hours. It organizes
partnerships involving the school system, parent and youth
groups, local community planning boards, and local
community-based organizations to plan for expanded use of
community schools. Rheedlen has also led a campaign to keep
Wadleigh Intermediate School open, make needed renovations
and convert this into a community school for 7th - 12th
grade students that will emphasize development of technical
skills. (Closure has been threatened because the building
has fallen into disrepair and there is a declining need for
Intermediate Schools. However, closure is opposed by the
local community because Wadleigh is a beautiful, old
building with a proud educational history, and abandonment
of the building would have a deleterious effect on the
neighborhood. Also, there is no public high school in the
Harlem community.)
The executive director of Rheedlen also serves as chair
109
of the Neighborhood Family Services Coalition, an advocacy
coalition of community-based preventive service
organizations, and he has been a prime mover in the
development of the City Project, which produces the
Alterbudget for the City, and of Funds for Families, a
coalition of voluntary organization focused on influencing
the annual budget for CWA. Although these latter programs
are kept administratively separate from Rheedlen, they are
based in its main office and there is obvious overlap in the
social action agenda of these various groups. This,
undoubtedly, influences the way Rheedlen is perceived in the
local community, by public officials, and by its own
professional staff.
Observations, Lessons, Ouestions
Rheedlen's relatively brief history again illustrates
the importance of executive leadership, board support, and a
clear view of agency mission in building a viable service
program. Its orientation also raises some interesting
questions regarding the potential for increased integration
of child welfare and school-based services and the
corresponding benefits that may accrue from staff teams
composed of people with backgrounds in education and social
service who perform similar tasks and have a similar
orientation to service delivery. By ignoring customary
disciplinary differences, the agency seems to eliminate some
of the conflicts that ordinarily develop in
110
interdisciplinary settings without eliminating the benefits
that derive from different professional orientations.
The comments made by administration and staff about the
value of delivering services on site at the schools, gaining
access to families around educational issues, and using
normal socialization groups as well as extensive outreach
and advocacy in order to promote change are quite
compelling. What is not known, of course, is the long-term
impact of interventions such as these compared to programs
with a more traditional therapeutic orientation.
The fact that Rheedlen has little difficulty with staff
retention, although it does experience the same obstacles to
staff recruitment as other preventive programs, suggests
that once employed, direct services staff enjoy the program
orientation. The executive director noted that he thinks
the opportunity for extensive direct work with children
makes a big difference in the level of staff satisfaction,
as does the fact that staff has an opportunity to work with
children in a open, normalizing environment. Although some
of the workers' preventive cases involve very destructive
family situations, in the agency's open programs they are
also able to work with children for whom the potential for
progress and change is much greater.
Rheedlen's decision to open its "host homes" program
despite its initial commitment to working with children in
their own homes underscores the need for emergency placement
resources and the potential value of keeping these resources
111
informal, community-based, and directly linked to preventive
services, at least until there can be a full assessment of
the child's long-term placement needs.
Finally, it seems important to highlight Rheedlen's
decision to link its categorically-targeted with its "open"
programs in order to organize services around the needs of a
specific geographic community rather than targeting its
services by problem groups. Despite the administrative and
technical difficulties such an approach creates, the
administration and board are adamant about the need to
provide services on this comprehensive basis.
112
Center for Family Life in Sunset Park,
St. Christopher-Ottilie
The Center for Family Life is a comprehensive
neighborhood-based, family service program located in the
Sunset Park area of Brooklyn. The Center was initiated in
1978 by two Sisters of Good Shepherd, one of whom had
previously established a number of residential and
community-based programs for Good Shepherd Services (see
earlier discussion). Plans for the Center for Family Life
evolved from the experience of both sisters at the Family
Reception Center and a careful needs assessment of the
community. The latter involved months of analysis of
demographic data and various indicators of service need as
well as intensive discussions with community leaders,
citizen groups, and other service providers in Sunset Park.
St. Christopher's Home (later merged with Ottilie Home for
Children) agreed to sponsor the program, so although the
Center functions quite autonomously, it is technically a
division of St. Christopher-Ottilie. It is not licensed as
an independent child care agency.
St. Christopher-Ottilie is a large, multi-function
voluntary agency based in Sea Cliff, Long Island that serves
children and families from Nassau and Suffolk counties as
well as New York City. With over 40 programs sites, a staff
of 950, and an annual budget of about $32 million, this is
the largest voluntary child welfare agency in the State and
113
probably one of the largest in the country. Although the
agency mission statement is very broad, the primary program
emphasis is provision of substitute care for children. At
any one time, St. Christopher-Ottilie has approximately 1800
children in care including over 1400 in foster care and 320
in special residential facilities. In addition to its
foster home, group home and adoption services, the agency
operates: several intermediate care facilities for severely
and profoundly retarded adolescents and one for physically
handicapped and medically frail children; a residential
treatment center in Sea Cliff for multiply-handicapped,
profoundly retarded youth; a residential treatment facility
at the Ottilie campus in Queens for dually-diagnosed
adolescents; and three preventive service programs, one of
which is the Center for Family Life.
The agency has expanded dramatically during the past
decade in response to service needs and to funding
initiatives from CWA, the State Office of Mental Health, and
the State Office of Mental Retardation and Developmental
Disabilities. Given the continuing need for placement
resources, the only real obstacle to continued expansion,
according to the executive director, is the limited number
of qualified people available to staff new programs.
However, he expressed concern that the agency has committed
so large a portion of its resources to bed development and
said he hopes in the future to concentrate more on the
development of community-based preventive services.
114
Although St. Christopher-Ottilie is now structured in a
fairly traditional, hierarchical model, the director is
moving toward what he envisions as a satellite concept. He
thinks it is often useful for central administration in a
large agency to function somewhat as a holding company,
allowing individual programs to function relatively
independently while making the specialized resources of the
larger agency available to various program components as
needed. In this context he thinks the organizational model
employed for the Center for Family Life could well be
replicated by other programs. This approach places the
program people who know the client population best at the
forefront in service planning and implementation, but
provides economy of scale and needed resource back-up to
small programs that might have difficulty surviving without
such support.
Start-up funds for the Center for Family Life were
provided by foundation grants, but the program is now
supported in large part by public funds. Its annual budget
(just under $1.5 million for fiscal year 1989) is based
primarily on contracts with CWA, Department of Youth
Services, and the Department of Employment. Foundation
grants and gifts from individuals and corporations
constitute about 20 percent of the budget each year. One of
the key impediments to service expansion at the Center is
its refusal to accept funding that requires any labeling of
clients by problem category.
115
Rather than organize its services on the basis of
problem type, the Center is committed to serving any family
living in Sunset Park with a child under the age of 18. It
has a single intake process in which the focus is on
understanding individual needs in the context of the family
and community. Thus the family is defined as the unit of
attention, regardless of which individual family member is
first identified as in need of help, and strong emphasis is
placed on creating opportunities for group and community
development.
The Center is located on a residential street in Sunset
Park accessible to public transportation and within walking
distance of large sections of the community. It is open 7
days a week from 8:00 A.M. - 11:00 P.M., and the two
sisters, who have a private residence on the top floor, are
available by telephone for emergencies during other hours.
The overall atmosphere of the Center is one of openness,
informality and warmth, thereby encouraging clients and
other community residents to drop in and to define the
Center as a resource belonging to the community. In
addition to its main site, the Center rents a nearby
storefront building for its Thrift Shop, Advocacy Clinic and
Community-wide Emergency Food Program. Also, it has offices
located in the Bush Terminal industrial area of the
neighborhood for its Employment Services Program. Extensive
use is made of public school buildings for the agency's
after school and evening programs for youth. Thus, every
116
effort has been made to situate various program components
in the community locations where they are most accessible to
those who might want to utilize the services.
The Center defines as its purpose "the provision of an
integrated and full range of personal and social services to
sustain children and families in their own homes, to counter
the forces of marginalization and disequilibrium which
impact on families, to stem influences on children, youth
and families which contribute to delinquency and alienation,
and to provide alternatives to foster care or
institutionalization." To this end, the program provides a
broad range of integrated services.
The "official" client population of the Center consists
of about 450 families annually, most of which are certified
and funded by CWA as preventive service clients. These
clients all receive comprehensive assessments and brief and
intensive individual and family counseling services as well
as information, referral, and advocacy with other community
agencies as needed.
Based on individual case assessments, these clients can
also be linked to specialized treatment resources in the
community (e.g., substance abuse programs) and/or be asked
to participate in a range of therapeutic programs sponsored
by the Center, including:
- Therapeutic activity groups for children,
adolescents, and parents;
- Foster Grandparent Program in which older individuals
117
provide in-home support to families requiring assistance
with parenting;
- Infant/Toddler/Parent program that offers infant
stimulation and group play activities led by early childhood
educators for children aged 6 months to 3 years, and a
simultaneous support group for parents;
- Weekly Mother-Child group for children aged 3-4
designed to promote positive parent-child interaction and to
improve parenting skills.
In addition to these direct client services, the Center
sponsors a number of programs that are open to all community
residents. Approximately, 8,000 children and parents take
advantage of these "open" activities annually, They
include:
- Comprehensive after-school, 5 day a week child care
activity programs at two public elementary schools;
- Summer day camp for youngsters in the after-school
program and for young adolescents;
- Evening Center for teenagers that provides a range of
recreational, socialization and tutoring opportunities two
nights a week at a local public school;
- Family Life Theater program for training teenagers in
improvisational drama, dance, and music;
- Socialization and recreation activities for families
and monthly dances for teenagers;
- Community-wide forums and workshops on various
parenting issues and concerns;
118
- An employment services program that provides job
counseling, job search and placement assistance to
unemployed adults in the community;
- Advocacy clinic and Emergency Food Program, sponsored
in collaboration with other community agencies, located at
the Center's storefront Thrift Shop.
The agency's newest service initiative, a pilot "core-
satellite" foster family program, was opened in 1988. This
program, which recruits local foster homes in Sunset Park to
care for children from the community who must be removed
from their own homes for protective reasons, provides a
dramatic illustration of the Center's community service
orientation. Designed to alleviate some of the stress and
disruption customarily associated with emergency foster
placement, the program ensures that children are placed in
close geographic proximity to their biological parents.
The children, their biological and foster parents, all of
whom are seen by the same social worker, have immediate
access to the Center's services and to other community
resources.
Family visiting is instituted almost immediately,
children are encouraged to maintain their friendships and
school linkages, and the biological and foster parents are
helped to share parenting responsibilities. For example,
the biological mother may be encouraged to walk her child to
school or to attend the Center's Mother-Child group with the
foster mother and her child. Services are offered rapidly
119
and intensively with the goal of normalizing and
abbreviating the placement experience for the child and
motivating the parents to move toward problem resolution as
quickly as possible. When the child can be returned home,
the Center maintains responsibility for aftercare, thus
insuring continuity of relationships and intensive service
provision and monitoring of the home situation in order to
reduce recidivism.
This project is too new to permit any formal evaluation
but the early results look promising. The initiative
demonstrates a creative effort to link family support and
child protective interventions in a community-based setting,
thus providing a fuller continuum of care for children and
families at risk. The foster home program also provides a
good illustration of the practice orientation that pervades
the work at the Center. Encouraged to think systemically
about client problems and potential service intervention,
the workers draw heavily on concepts from ego psychology and
general systems theory to identify case objectives and to
design their service plans. In the activity group programs
as well as the clinical services, strong emphasis is placed
on building client self-esteem and competence, developing
linkages and mutual support among various individuals and
groups, using conflict to promote change, and mobilizing the
latent community resources required to sustain healthy
development. A basic theme that is used to characterize
much of the Center's work is that of creating "normalizing
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opportunities" for families living with all the stresses
prevalent in poor, urban communities today.
The Center for Family Life is structured in a
relatively centralized manner in that the two founders, who
now function as program director and director of clinical
services, assume primary responsibility for service planning
and administration. They function essentially as a team
with much sharing of work and program responsibilities.
Both are active in the community, serving on a number of
local, City, and State advisory bodies; and both also
contribute actively to the Center's direct service program.
In addition to their other responsibilities, the clinical
director handles a large proportion of the Center's intakes;
the program director routinely leads some of the youth
activities and carries a few family cases. They both feel
strongly that their participation at the "front-line"
enables them to understand better the changing needs of
their client community and gives them the feed-back they
need to maintain their obvious enthusiasm about the work of
the Center.
There are five distinct program divisions at the
Center: preventive services; foster family service;
employment services; emergency services; and school-based
youth services. The workers are each assigned to one of
these program divisions, but they meet together regularly in
weekly staff meetings and collaborate frequently with regard
to families who may be enrolled in several programs
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simultaneously.
The Center has a full-time professional staff of 38
plus about 40 part-time employees who help with the youth
activity program. The agency also serves as a field
placement for a number of graduate students each year. The
youth workers are community residents, and a number are
"graduates" of the Center's programs.
The professional staff can generally be characterized
as young, enthusiastic, skilled, and strongly committed to
the Center's orientation to practice. Morale is basically
high, despite some complaints about the low salaries and the
high level of performance demands. For example, the
preventive service workers are asked to devote at least 25
hours a week to direct client service. This is much higher
than the expectation in a number of other preventive
programs and leaves little time for meeting paperwork
demands. But this guideline places the record-keeping in
perspective and allows workers to concentrate on the
opportunities for direct client services that enticed them
to enter the field originally and that provides the positive
feedback they need to stay motivated.
Another factor that clearly contributes to the high
morale at the Center is the clinical and program leadership
provided by the directors. They themselves derive obvious
satisfaction from direct work with clients, and they display
unflagging interest in the workers' struggles and
accomplishments. Modeling and emphasizing teamwork, they
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encourage constant professional growth, creativity, and
flexibility. Thus, the workers usually feel supported and
stimulated to stretch themselves in order to reach and serve
clients more effectively.
Despite this positive atmosphere, like other programs
included in this study, the Center has had to cope with
difficulties related to staff recruitment, particularly of
Spanish speaking workers, and of staff turnover. The
directors, who attribute these problems primarily to the
salary schedule, have put extensive effort into private
fund-raising and negotiating with public funding sources in
order to raise staff salaries. This effort has helped to
raise salaries somewhat, and staffing difficulties have
declined over time. But the social workers at the Center,
like those in other child welfare agencies, are still paid
less than comparable workers in other fields of practice.
Compounding the salary problem may be the high level of
commitment that the practice approach employed at the Center
requires from staff. Although the workers appreciate the
apparent effectiveness of this model, they find it very
demanding. As a consequence, a few have apparently
concluded that they simply could not maintain the needed
level of investment in their practice to remain at the
Center. Others appear to have decided that they would have
more opportunities for professional advancement in a larger
agency in which more turnover among administrative staff
could be anticipated.
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These observations raise a troubling question about how
best to sustain talented staff in a program such as the
Center for Family Life. The directors have attempted to
meet this challenge by creating several opportunities for
professional advancement, offering flex-time positions to
those with child care responsibilities, and even making
child care arrangements at the Center available in special
circumstances. But these "solutions" do not address the
broader staffing issues posed by the experience at the
Center.
The agency has been the subject of extensive publicity,
including a cover story in Time magazine, and it has been
studied repeatedly. Despite this attention, no one has
found a way to quantify its results satisfactorily. (The
same observation could, of course, be made about several of
the other programs included in the study.) Repeated client
surveys indicate a high level of consumer satisfaction. The
foster placement rate for children in families seen at the
agency is only 2.9 percent. But measures such as these
convey relatively little about the core work of the Center,
which may be as much a process as a product. The project
director says that in addition to the individual case
success stories, what she feels proudest about is that they
are beginning to effect the sense of victimhood that was so
prevalent among the residents in Sunset Park when they first
opened. Despite increased family problems related to
increased drug abuse, poverty and homelessness, the staff is
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beginning to sense increased mutual support among various
community groups and a greater willingness among clients to
acknowledge the need for help and to seek out appropriate
resources. These changes, she believes, indicate that the
agency is beginning to have some impact in encouraging
community residents to have a stronger sense of efficacy and
power in dealing with their daily lives.
Observations, Lessons, Questions
The Center for Family Life presents perhaps the
clearest illustration of the important functions that can be
served by a community-based, comprehensive service program
and the dilemmas inherent in attempting to sustain such an
effort. What makes the model seem so promising is that
unlike most other publicly-funded family and child service
programs, it places no diagnostic or categorical barriers on
access to help and offers services designed to serve a broad
spectrum of needs.
The Center helps families presenting serious problems
of family violence, substance abuse, poverty and mental
illness as well as those requesting limited assistance with
normal developmental and environmental problems.
Consequently, it is able to adjust the level and range of
services provided to families at risk as needs change over
time, while insuring the availability of help before crises
emerge and maintaining relatively low service costs per
family. Moreover, by offering a range of "open" programs
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and group services and staying actively involved in a range
of community institutions, the staff is able to contribute,
at least in a modest way, to development of the larger
Sunset Park community.
The tension present derives from the fact that the
model of practice guiding the work at the Center goes quite
counter to the current emphasis in public policy on narrow
targeting of carefully structured, time-limited service
interventions to families in which children are most at
risk. Thus, it takes enormous energy, imagination and
stretching of resources for the Center to secure the funds
required to sustain its services. Moreover, because of
limited resources, the program demands an unusual level of
commitment and skill from its directors and the front-line
workers who often feel "over-worked and underpaid."
Given these strains, it would be foolish to recommend
widespread replication without increased public funding and
support for the model. This program has been developed by
two exceptionally talented, personally dedicated leaders who
have been able to recruit a young professional staff that
shares the same service mission. These qualities are not
easy to duplicate or to institutionalize. Moreover, as with
all such service innovations, it is impossible to determine
how much of the Center's success is due to its service model
and how much to the commitment and skills of the leadership
and staff.
What is very clear is that this model deserves careful
126
experimentation to determine whether it can be successfully
replicated in other communities and, if so, what additional
resources are required to insure that success does not
depend on the availability of administrators willing and
able to devote virtually all of their waking hours to the
program. For example, if it is determined that the
director(s) must live on site to create the type of family
atmosphere and community presence apparent at the Center,
then it would be important to consider how to arrange this
while preserving some free time and privacy for the
executive, as is done in many residential treatment
programs. It would undoubtedly be more costly to replicate
this program in other settings because of the need for
additional administrative and direct service staff. But
that does not necessarily mean that it would not be feasible
or cost-effective to do SO.
Careful longitudinal research is required to assess the
true impact on families and children of a program such as
the Center for Family Life. In the interim the anecdotal
evidence presented is quite compelling. Complicating any
effort to assess and compare the work at the Center with
that of other family service programs is the obvious
difference in time frame. The program director noted that
they have a long-term perspective on their work, an
orientation that was reflected in her discussion of the
changes observed in Sunset Park over the past decade. This
long-term orientation, which is obviously consonant with
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normal developmental processes, is quite typical of
traditional modes of informal helping; but it is very
different from the segmented, time-limited orientation that
normally characterizes professional helping efforts. And
because the objectives of this type of sustained involvement
in the community are quite different from those of practices
designed to resolve specific family problems, it is almost
impossible to compare the outcomes of these strategies in
any meaningful way.
One clear lesson that can be derived from the Center's
experience to date is the importance of sponsorship by a
large umbrella agency in sustaining a small program through
the early process of service initiation and implementation.
The satellite model of service administration that the
director of St. Christopher-Ottilie expounds, i.e.,
encouraging professionals at the local level to assume
leadership in program planning and service delivery while
using the resources of the larger organization to provide
needed institutional support, seems to offer a productive
way of resolving the centralization - decentralization
dilemma.
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Brandeis High School Programs
Brandeis High School is a public school located in the
Upper West Side of Manhattan. Although it is located in a
relatively affluent neighborhood, it draws most of its
students from the much poorer neighboring communities of
Central Harlem and Washington Heights. The student body of
2,500 is composed primarily of Hispanics, African-Americans,
and West Indians. The school's official catchment area is
the immediate neighborhood, but few local residents send
their children to Brandeis. Conveying a different
atmosphere than any of the neighboring institutions, the
school is a loud, crowded, chaotic presence in an area
filled with boutiques, cafes and brownstones. Since it is
considered a general academic high school, Brandeis has no
admission requirements other than place of residence.
Brandeis offers a wide variety of special programs for
its students, including special education, a "mini-school"
for students considered to be at high risk of dropping out,
and a cooperative business program with Baruch College and
Shearson-Lehman-Hutton. But despite these efforts to meet
individual needs, the school has a very institutional feel
about it, with electronic ID cards, uniformed security
guards, and locked doors.
The school has long been unique in relation to the
number of community based organizations (CBO's) invited to
run on-site and outreach programs at the school. The
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historic rationale for the school's affiliation with so many
CBO's is unclear, but appears related to the fact that for
many it provides an ideal site, i.e., Brandeis is a public
school with a minority population in a safe and accessible
neighborhood.
This trend was accelerated four years ago when the
school was selected by the New York City Board of Education
to be a model school for a new Dropout Prevention Program.
The school was given a grant to spend at its own discretion
on the provision of services aimed at reducing the drop-out
rate. The Brandeis administrators chose to spend most of
the money on contracting with two community-based
organizations in order to develop a wider range of
supportive social and academic services on-site for their
students.
One of the Dropout Prevention Programs is Manhattan
Valley, an outreach program of The Episcopal Cathedral of
St. John the Divine. This program has three full-time staff
members who provide academic counseling, job readiness
training programs, vocational counseling, and a job
placement services. Located in a large room adjacent to the
cafeteria, Manhattan Valley is unique for the fact that its
staff is all minority and primarily male. The program has a
designated caseload of 125 students considered to be at high
risk of dropping out. An additional 25 students who are
walk-ins are seen annually as well.
The other Dropout Prevention Program, which is
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administered by Victim Services Agency, provides a full-time
caseworker to mediate disciplinary hearings and to develop
alternatives to student suspensions. This program was
started in the 1988 school year, so full service data were
not available at the time of our visit. It replaced Green
Chimney's Project Continue, which was terminated in 1987 at
the request of the School. This program had two social
workers who provided individual and family counseling for
personal and familial problems interfering with schoolwork.
The other organizations providing services for youth at
Brandeis High School include the following:
- St. Luke's-Roosevelt Hospital runs an on-site full-
time medical clinic that provides basic medical and
psychiatric care to all Brandeis students. Located
in its own suite on the first floor of the building,
the clinic is staffed by a full-time nurse clinician,
a part-time social worker, and part-time medical
internists and psychiatrists from the hospital. In
addition, there are several clerks, health
professionals, and a full-time Health Education
Coordinator. The clinic has about 1,800 student
visits per year and is regarded as a model program by
both St. Luke's-Roosevelt and Brandeis.
- The Youth Counseling League (YCL) provides a full-
time social worker who offers individual and group
psychotherapy to students referred by the guidance
department. The program is housed in a small office
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in a basement suite shared with other guidance
department personnel. The social worker sees about
15 students in treatment at any given time.
- Teen Choice, an outreach program run by Inwood House,
has two full-time social workers who give classroom
presentations and see students individually and in
groups to provide sex education and counseling. Teen
Choice is located in a large room on the first floor
of the building, and the office has an inviting air,
with several chairs, racks of books and pamphlets,
and educational posters. Teen Choice accepts walk-in
referrals, but it also works closely with the
guidance department and classroom teachers. The
staff reaches about 600 students in the classroom and
sees about 200 in groups and 100 in individual
sessions each year.
- The Boys of Yesteryear provides a part-time
psychologist for academic counseling and tutoring
services. Fewer than 10 students are seen at any
given time.
These organizations and services are coordinated by the
Director of Dropout Prevention, who is a former Brandeis
guidance counselor. The director is responsible for
coordinating the activities of the CBO's, acting as a
liaison to neighborhood coalitions, and representing
Brandeis on the Board of Education's Drop-out Prevention
Committee.
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While all of the programs will accept walk-in
referrals, most of the students are referred by the guidance
department (except those who attend the St. Luke's-Roosevelt
Medical Clinic). Thus the guidance department, consisting
of trained guidance counselors and grade advisors (teachers
who assume additional guidance responsibilities), acts as a
clearinghouse and is responsible for recognizing and
assessing students problems as well as for making
appropriate referrals. Although theoretically sound, in
practice this referral process has proven to be somewhat
problematic. One reason is that from the perspective of the
contract agencies, the guidance counselors do not always
recognize and refer problems correctly. More troublesome,
however, is the basic lack of fit between the service needs
identified by the guidance staff and the actual services
provided by the CBO's.
The guidance counselors carry caseloads of
approximately 500 students each. With caseloads of this
size, it is impossible for them to track or know the
students in their caseloads well. This problem is
compounded by the fact that they do not retain the same
caseload from year to year, but instead are constantly being
assigned different students. The counselors must move from
crisis to crisis, with little time for even the most severe
situations. Therefore, crisis intervention services would
be most helpful to them. Yet with the exception of the St.
Luke's-Roosevelt Clinic and Teen Choice, the CBO's are set
133
up as preventive rather than crisis services. As a result,
when the guidance counselors attempt to make referrals, they
are often told by the CBO's that it is too late to be of
assistance or that it is an inappropriate referral. When
the guidance counselor's referral is accepted, it often is
too late for the program to be of assistance. As a
consequence, the guidance counselors tend to perceive the
CBO's as uncooperative and ineffectual and to be wary of
making future referrals.
This is not an easy problem for workers in the CBO's to
resolve because they serve two masters: their sponsoring
agencies and the school. While the guidance department may
only be able to operate on a crisis basis, the service
agency may on principle advocate preventive or long-term
services. The workers are then placed in the delicate role
of mediating and negotiating between conflicting needs and
ideologies. Unfortunately, many workers are unable to do
this effectively and instead, shift their allegiance towards
their agencies, becoming angry and frustrated with the
school administration. They often attempt to educate the
guidance counselors to help them see the value of the
proffered services - an approach which only serves to
increase tensions and conflicts. In those instances in
which the workers can maintain an appropriate balance
between agency and school expectations, the school's
response is very positive. The two CBO's in which staff
have been able to do this most effectively, St. Luke's-
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Roosevelt Clinic and Teen Choice, both have sponsoring
organizations that are responsive and flexible, and on-site
professionally trained staff with substantial clinical
experience.
Another major reason for tensions between the agencies
and the schools is the question of "turf". Despite the fact
that the guidance counselors are overwhelmed with work, they
are protective of their territory. Any program perceived as
impinging on the academic domain is immediately threatening.
Those programs that are clearly non-academic, such as the
Youth Counseling League, St. Luke's-Roosevelt, and Teen
Choice, are not perceived as threatening because they offer
totally separate services. Manhattan Valley and Green
Chimneys (when it was on site) were designed to offer
general supportive services to students and their families.
Both were also perceived negatively by the guidance staff
because they offered services that have traditionally been
relegated to the guidance department such as mediating
student-teacher disputes, providing academic counseling, and
monitoring attendance. The guidance counselors resent being
usurped and excluded from these processes so this causes
frequent conflict. Another factor exacerbating this problem
is the adoption of advocacy roles by some of the CBO staff.
While there is undoubtedly a need for student advocates, it
is questionable whether invited organizations can
effectively serve what is perceived as an adversarial
function.
135
To illustrate, Manhattan Valley is in a particularly
difficult position at Brandeis because its staff offers
supportive academic services and advocates for students,
both of which antagonize the guidance department. In
addition, the staff is composed of young, primarily non-
professional, ethnic minority workers. While these workers
share the guidance department's goals for their students,
their styles are radically different. The Manhattan Valley
program uses a system of rewards (trips and movies) rather
than punishment as a behavioral incentive, its activities
are group-oriented and preventive, it employs successful
students and recent graduates to act as staff/role models,
and it maintains an informal, collegial atmosphere in the
office and meeting space. This program is generally
perceived negatively within the school. When asked to
elaborate on their feelings about Manhattan Valley, Brandeis
personnel describe being disturbed by the noisy and chaotic
office, the blurred lines of authority created by the hiring
of former students as program staff, and the seemingly non-
professional attitudes of the full-time counselors.
However, the program statistics indicate that the program is
quite successful. In the 1988-89 academic year, for
example, they placed over 120 students in jobs (following
job readiness training) and 90 percent of those students are
still employed. They have helped students who were frequent
truants go to Tuskegee Institute and Howard University.
When interviewed, the Manhattan Valley workers seemed to be
136
remarkably in tune with the students and more effective in
meeting their needs directly than most of the other CBO's on
site. The question is whether a program like this one,
which presents sensitive cultural, turf and advocacy issues,
has a different services orientation, and uses non-
traditional interventive techniques, can ever be
successfully integrated into a mainstream public high
school. Further research is needed at other sites to
determine whether programs akin to this one face similar
problems with their host schools or whether they have been
able to find ways to resolve them effectively.
Observations, Lessons, Ouestions
The CBO programs that seem to work most easily within
the existing school administrative structure and to obtain
greatest support from the guidance department are those that
offer a clearly defined, non-academic service; have a
professionally trained staff; operate from an organizational
base that is aware of and responsive to the needs of the
school setting; and are accessible to handle individual
crisis situations. What is not known, of course, is whether
the types of services provided by these programs are most
effective with youth at risk.
One of the key questions posed by the service programs
at Brandeis High School is whether the benefits of offering
a range of contracted services outweigh the possible
advantages of expanding the school's own guidance department
137
staff and school social work personnel or contracting with a
single community-based organization to develop a coordinated
services program based at the school. One obvious reason
for the decision to use contracted services is that
counselors in community-based organizations usually work
longer hours and receive lower salaries than Board of
Education employees. However, contracting with a number of
independent organizations reduces administrative control,
service coordination, and long-term planning.
An obvious potential alternative is the development of
a "community-school project" designed to create a
partnership between the local school and a single community-
based organization with active participation by parents and
community leaders in service planning. This service
strategy, which has been actively pursued in different ways
by agencies such as the Center for Family Life, Good
Shepherd Services, and Rheedlen Foundation, expands the role
of the school in the lives of children while inevitably
reducing the control that can be exercised by a school
principal and creating some struggle for professional
dominance between teachers and social service providers.
The early results of these community-school projects look
promising, but they have been developed only in settings in
which both the school and the CBO administrators were open
to sharing authority while expanding their responsibilities.
It seems doubtful that such projects could work as
effectively if simply mandated by the Board of Education or
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HRA.
The other important question posed by the experience at
Brandeis High School is whether the school is the optimal
location for the delivery of services to children at risk,
given the apparent tendency of such school-based services to
focus almost exclusively on the children, ignoring the
family problems that may precipitate or perpetuate
children's difficulties.
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United Families of South Bronx,
Edwin Gould Services for Children
This program, a division of Edwin Gould Services for
Children, is one of the two initiated as part of the
Multiproblem Family Demonstration Project (MPFDP) sponsored
by HRA's Office of Family Services (OFS). Funded with the
preventive services monies ordinarily administered through
CWA, the project was designed to test the effectiveness of
comprehensive, coordinated, community-based services in
enhancing the functioning of troubled families and
decreasing the use of foster care. The programs were funded
in response to an RFP ("request for proposals") at $350,000
each the first year and $375,000 each the second year.
Urban Systems Research and Engineering in Washington, D.C.
was awarded $110,000 to conduct an outcome evaluation, which
was completed in June 1988. At the end of the two-year
demonstration period, the programs were given renewal grants
with the expectation that they would increase their client
populations and shift to targeting on relocated homeless
families. (It was later decided that the other program
administered by Builders for Family and Youth of Brooklyn
Catholic Charities should be moved to a different location
in Brooklyn because of greater identified need in the latter
area.)
As part of the context for discussion of the
Multiproblem Family Demonstration Project (MPFDP), it should
140
be noted that the Office of Family Services was established
as part of the short-lived Family and Children's Service
Administration with great hopes that OFS could develop a
network of community-based, comprehensive case assessment
and management services for families at risk. Because of
funding and turf issues and administrative turn-over, this
aspiration was never realized. Instead, OFS is now an
administrative unit responsible for managing a series of
very targeted programs designed to prevent any increase in
the number of homeless families - and also responsible for
home care services to the elderly and handicapped.
Using what a senior administrator described as
"creative financing", the office draws on a series of
funding streams to support its programmatic efforts to
target and serve families at risk of homelessness. These
efforts include a Utility Assistance program, a Housing
Alert program, an Income Maintenance Case Alert program, a
Housing Court program, and an HPD Initiative, as well as
Services for Pregnant and Parenting Teens and Services to
Relocated Families. In addition, through its network of 44
community offices (in 34 locations), the agency attempts (at
least in theory) to serve as a single point of entry and
access to family and children's services and HRA entitlement
programs. In fact, due to limited staff and financing,
these offices can provide only limited information and
referral services and can work with a total of only about
7200 families at any one time.
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The obvious gap between the initial objectives for the
Office for Family Services and the current reality may
explain, at least in part, why so much publicity and
attention has been given to the Multiproblem Family
Demonstration Project, which in fact is little more than two
effective but small preventive service programs. (The one
major difference is the Interagency Council discussed
below.) The shift in definition of the mission of OFA may
also explain the decision not to institutionalize or
replicate MPFDP despite the recommendations of the project
evaluator.
Edwin Gould Services for Children is the largest
minority child welfare agency in the State. Initiated under
the auspice of the Edwin Gould Foundation to provide
services to orphaned black children in the city, the agency
is now separately incorporated with the mission of providing
innovative services designed to meet the specialized needs
of minority children and their families. In addition to the
MPFDP and its foster care and adoption services, the agency
administers: six group homes for special needs adolescents;
an incarcerated mothers program; a domestic violence center;
a learning and employment program for youth in child welfare
agencies; a preventive service program in East Harlem; and
an Espiritismo Project which provides spiritualists to work
with Puerto Rican families in the preventive service
program.
United Families of South Bronx was designed to serve 50
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multi-problem families living in in rem Housing Preservation
and Development (HPD) buildings in Community Board 4 in the
Bronx. The objectives of the program are to help multi-
problem families and avoid evictions through measures
designed to alleviate socio-economic stresses on family
life, enhance the self-esteem of family members, and link
families to community resources in order to create an
ongoing support network. Initial referrals to the program
were made by the local HPD managers, but referrals from
other sources are also accepted. To insure that the
families served are indeed multi-problem, they are required
to demonstrate three or more of the family, child or
environmental problems identified on a standardized family
problem checklist. Once engaged, families tend to remain
active clients for an average of 12-18 months.
As mandated by project guidelines, each family is
served by a team consisting of an MSW counselor and a
paraprofessional family advocate. The program has four
teams, each working with 12-13 families and providing
intensive individual and family counseling and advocacy
services. The program also offers after-school and Saturday
recreational and group socialization services for children.
Although the program originally hired a tenant organizer,
the direct service workers and program administrators now
share various community liaison, organizing, and technical
assistance tasks.
In commenting on the staffing arrangements, the program
143
director noted that the team model has been very effective.
More by coincidence than design, each of the teams consists
of a male and a female and this has worked well. The teams
are able to accomplish a lot in a brief period by sharing
ideas and tasks. Also the team model helps to lessen
anxiety and to provide physical back-up when workers are
entering potentially dangerous situations. Although the
initial expectation was that the MSW social worker would
emphasize clinical service and the paraprofessional
advocate, concrete services, each team has handled this
differently. Supervisory sessions are always held with
service teams rather than individual workers, which places
additional demand on the supervisor. However, experience to
date suggests that this arrangement is important to avoid
splitting and to assist with the communication difficulties
that inevitably arise. Despite the obvious support given to
staff and the low caseloads, United Families of South Bronx,
like many of the other community-based preventive service
programs, has had to struggle with the problem of staff
recruitment and turnover. The director attributes this to
low salaries and safety concerns rather than to any inherent
program component.
In describing the actual work with families, the
director said that the staff has had to do extensive
outreach and to focus on meeting concrete needs immediately.
Although the staff addresses many clinical issues over time,
the client families are generally not willing to discuss
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these concerns until their concrete needs are met and the
workers have essentially "proven" themselves.
Initial client recruitment was particularly difficult
because the HPD manager who referred families was unwilling
to be identified or to inform the families that he was
making a referral. Consequently, the staff had to start by
simply knocking on doors in the identified buildings and
offering services. Although there was more intensive
outreach to the families that had been referred as problem
tenants, these families were never labeled and services were
provided to all who responded to the offer of help.
Fortunately, according to the director, the program got
connected to many families before workers were required to
follow all of the City regulations for registering clients
eligible for preventive services, so the potential client
families were not "scared off". Now that the program is
well-known and trusted in the community, the bureaucratic
requirements do not present such a barrier and staff does
not have to do as much general community outreach,
concentrating instead on families who are referred and self-
referrals.
One of the key factors contributing to program success
according to the director is the staff's involvement in the
community and intensive tenant organizing efforts. The
Interagency Council has been critical in this regard.
Convened by the Deputy Mayor and chaired by the project
manager for the MPFDP at OFS, the Interagency Council
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consists of senior level people from about 20 municipal
agencies as well as local representatives and the
administrators from the two demonstration programs.
Designed to help the programs obtain and coordinate needed
services for clients and to identify ways to make systematic
improvements in the coordination and delivery of services to
families at risk, the Council meets monthly. Subcommittees
are organized to address issues identified by the program
administrators.
United Families of South Bronx has made extensive use
of the Council in obtaining needed services for clients and
mobilizing attention to community problems. Since the
primary concern identified by the residents whom they
contacted was building safety, program staff has worked
extensively on tenant organizing. In one building, for
example, the tenants were literally afraid of attending a
tenant meeting because the building was controlled by drug
dealers who might retaliate. However, they were finally
able to hold several meetings off-site to initiate the
tenant organizing process. In this context the agency
worked with the Interagency Council to form a partnership
with community patrol officers from the Police Department
and representatives from HPD who could work on increasing
tenant safety, removing the drug dealers, and stabilizing
the tenant population in this and other similar buildings.
Program staff has also worked to get tenants involved with
the local Community Board, form tenant organizations, and
146
make links with existing tenant support groups.
At the time of our visit in Spring 1989, the director's
primary concern was how the new contract with OFS requiring
that the program serve 140 client families from Community
Boards 1-6 referred by OFS staff would reshape the service
program and whether the mandate that at least 50 percent of
the new clients be relocated families would create new
demands. She attributed their apparent earlier success to
the intensity of their direct services and their community
development efforts. By expanding its geographic base, she
feared the program would lose its close connection with the
local community, and that the demand for increased numbers
would diminish the services than could be offered to any one
family. These shifts might also exacerbate the program's
staff recruitment and retention difficulties.
Observations, Lessons, Questions
The formal evaluation of the MPFDP was very through and
quite encouraging. In addition to tracking the progress and
outcome of all issues presented for resolution to the
Interagency Council during a one year period, the evaluators
compared the changes in family functioning during the same
year among 50 cases in each of the two demonstration
programs and 50 cases in comparison "purchased preventive
service" programs (PPRS) operated by the same two vendor
agencies. The researchers reviewed the data routinely
collected on cases financed by preventive service funds,
147
administered the Child Well-Being Scale developed by the
Child Welfare League of America to children in the sample
families, obtained outcome data from referral sources about
the MPFDP cases, and conducted interviews with clients who
volunteered at the end of the study year in order to gain
some measure of client satisfaction.
Although the cases served in the MPFDP program
demonstrated more problems in family functioning than those
served in the PPRS program, the outcomes were quite
positive. However, the MPFDP clients tended to make more
progress on concrete service needs than on problems in
family functioning. Overall 26 percent of the client goals
in the MPFDP cases were achieved compared to 23 percent of
those in the PPRS cases. The reports from referral sources
were also very positive as were the data obtained in the
client feedback interviews. HDP, for example, reported no
new incidents in 4 out of 5 of the cases referred.
Another encouraging aspect of the evaluatory study was
the apparent effectiveness of the Interagency Council.
Seventy-four percent of the 69 specific issues identified by
the evaluators as the major activities of the council were
resolved during the study period. No hard comparison data
are available, but to anyone who has engaged in comparable
efforts to effect change in service delivery systems, this
is an impressive result.
Given these findings and the obvious enthusiasm of the
project manager at OFS and the program director at United
148
Families of South Bronx (the other program site was not
included in our study), it is difficult to understand HRA's
rationale for failing to replicate the two demonstration
programs and for restructuring these in ways that could
undermine their apparent effectiveness.
Although no hard cost data were made available to us,
total budget and service figures suggest an annual cost of
roughly $7000 per family, plus high HRA administrative
expenditures. This is expensive and somewhat higher than
the average costs in most of the PPRS programs. But if the
MPFDP model is effectively reaching some of the very
troubled families not accessible to other services, the
investment would seem worthwhile. Moreover, because of
economies of scale, per case costs could probably be reduced
if the programs were expanded.
Further experimentation is needed to assess the impact
of the major variables that distinguish the MPFDP programs
from other community-based preventive service programs. For
example, it would be useful to determine whether sponsorship
by OFS or CWA makes any real difference or whether the
targeting of services to families in specific housing units
creates more effective access to troubled families than does
targeting on families in which children are at risk of
placement. It could also be important to examine the
relative cost-benefits of the team model employed in the
MPFDP and the ways in which staff involvement in community
organizing activities with clients can enrich or detract
149
from direct service provision. Neither of these activities
is customarily covered under preventive service contracts,
but they could be valuable additions.
150
Bronx Homebuilders Program
Behavioral Sciences Institute
The Bronx Homebuilders Program, a division of the
Behavioral Sciences Institute in Tacoma, Washington, was
opened in May, 1987. The culmination of a lengthy planning
process conducted by a steering committee composed of
representatives from CWA, the Department of Juvenile
Justice, several voluntary agencies, advocacy and research
groups and supported by the Edna McConnell Clark Foundation,
the project is designed to replicate the original
Homebuilders Program in Tacoma, Washington. Because the
program was quite new at the time of our data collection, it
could not be studied in as much depth* as many of the other
sample sites. 1 However, it was included in the study
because Homebuilders has become the prototype of the "family
preservation service" programs now being established in an
increasing number of sites around the country.
Homebuilders, like other family preservation services,
is a short-term, crisis oriented, intensive, home-based
family service program designed specifically to prevent
unnecessary placement of children in families in which there
is immediate risk of placement. It was the original program
of this type and unlike many of the others, follows a very
*
Data for this report are drawn from published materials
and the principal investigator's prior visits to the
Homebuilders program in Washington as well as from meetings
with the founders and a site visit to the Bronx program.
151
clearly defined service model. The critical components of
this model² can be described as follows:
a) Immediate Response to Crisis - The program is
designed to accept referrals from public agency
workers when children are in imminent danger of
placement because of alleged child abuse or neglect,
spouse abuse, child behavior problems, developmental
disabilities, delinquency, status offenses, or
mental illness of a child or parent. By responding
immediately to the crisis of threatened family
separation, it is assumed that the service can begin
to mobilize the family's natural coping resources.
Face-to-face meetings are held within the first 24
hours of referral.
b) Availability - Families are seen in their own homes;
and the workers in the program, usually called
"therapists", are expected to be available to their
clients at the families' request or convenience, 7
days a week, 24 hours a day. Clients are given
their therapists' and the supervisor's home numbers
as well as a beeper number where the "on call"
therapist can always be reached. To insure such
availability, workers carry responsibility for only
two cases at any one time.
c) Flexibility - Therapists are encouraged to
demonstrate great flexibility in scheduling client
contacts and in the range of services offered.
152
Instead of the traditional hourly sessions scheduled
at the same time, once every week or two,
Homebuilder therapists may meet with their clients
for several hours at a time several days a week
during different times of the day or evening; in
addition they may arrange intermittent telephone
conversations or brief visits. They sometimes meet
with the entire family, sometimes with one or more
members, in different locations. And they are
expected to offer a wide range of services using
different therapeutic approaches, all based on
carefully individualized family assessments.
Heavy emphasis is placed on provision of concrete
help (including actual participation of the
therapist in daily living activities) and advocacy
as well as educational and counseling services.
Overall, the therapeutic strategy in the
Homebuilders program reflects a blend of concepts
derived from crisis intervention, family systems,
ecological, and social learning theories - with
primarily emphasis on cognitive/behavioral
interventions.
d) Intensity and Brevity - As discussed above, full-
time workers carry only two cases at a time so that
they can be available to provide as much assistance
as needed and be as flexible as possible in
responding to the needs of families during the
153
crisis period. Homebuilders ordinarily stays
involved with its families only for 4-6 weeks. (In
the Bronx program some extensions to 8 weeks have
been required because of the time involved in
dealing with various City bureaucracies). This time
limit, which is consistent with the basic tenets of
crisis intervention, was set because it helps to
mobilize clients to make rapid change, permits both
clients and therapists to sustain the required
intensity in their work, and allows the therapist to
devote as much time to a case as a worker in a
traditional program would during the course of a
year. From an administrative perspective, the time
limit, of course, also helps to maintain reasonable
per case costs. Experience with various time limits
over the years has led the agency directors to
conclude that an average of 4 weeks intervention is
ordinarily sufficient to avert placement (except in
the Bronx). After this period the crisis has
usually abated and families seem to "plateau".
Hence the motivation for continued change
diminishes.
e) Limited Objectives - Homebuilders defines its
program goals solely as preventing unnecessary
placement and teaching families the skills they need
to remain living together. Administrators and staff
alike accept the fact that they cannot "fix" all or
154
most of the problems that it make it difficult for
families to function effectively and, therefore, are
able to define success in a limited way. At the
same time there is clear belief system undergirding
the program that emphasizes clients' capacity for
independent growth, the importance of family
autonomy, and the value of optimism or hope. Thus
the short time frame is justified in the context of
the program's limited service objectives and a
general belief system related to the limits of
professional intervention. If clients are motivated
to seek additional services, the therapists will
ensure that they are linked to an appropriate
community resource; and they are always told that
they can contact their therapist again if some
crisis should emerge. However, there is no
assumption that case "success" requires continued
treatment.
f) Staffing - Strong emphasis is placed on hiring
sensitive, competent staff who can become committed
to the Homebuilders model and are able to be
accessible to clients on a 24 hour basis. The
preference is for social workers or psychologists
with Master's degrees, but B.A. level workers who
have experience with families and children are also
hired. Homebuilders then offers a very intensive
training program for all new workers as well as
155
ongoing staff development opportunities.
A single therapist is assigned to each family on
the assumption that the use of treatment teams often
creates unnecessary communication difficulties,
wastes time, and blurs accountability. * However,
strong team back-up is provided to each therapist
via close supervision and weekly team meetings
focused on current cases. As the therapists are
expected to be available to their clients, so the
supervisors and administrators are "on call" to the
workers. Ongoing training is defined as a key type
of support for all staff, and the administrators
make a consistent effort to give positive feedback
and to build a real sense of team spirit.
g) Accountability - The Homebuilders program has been
the subject of repeated formal evaluations, focused
primarily on relative cost-effectiveness in
preventing placement. In addition, it has
instituted a number of mechanisms designed to
measure progress and demonstrate accountability to
clients who are defined as "colleagues" in the
change process. Goal Attainment Scaling is used as
the base for the agency's core record-keeping
system, and client feedback surveys are conducted
routinely at termination. Also, cases are followed
up three and twelve months after intake, to
*
See the national report for variations in staffing in
other family preservation programs.
156
determine whether there has been any child
placement.
Homebuilders originated as part of a child welfare
demonstration project at Catholic Community Services in
Tacoma, Washington in 1974 and gradually evolved into the
large service organization, training and research center
that the Behavioral Sciences Institute is today. It was
started by two young psychologists and a group of friends
who were eager to experiment with alternative modes of
specialized foster care. The intensive, in-home service
component was essentially an "add-on" developed in response
to interest from the funding source. Almost by surprise the
founders discovered that this component was serving a
positive preventive function, and they began to develop and
evaluate the program more systematically.
A separate training division was established in 1977 to
provide training to other organizations. As additional
funding became available, the program was expanded to other
communities and to other populations of children at risk of
placement, where there was an explicit objective of
preventing placement, e.g., status offenders and mentally
ill children. In 1982 the staff of the program decided to
incorporate separately as a non-profit organization. The
broad title, Behavioral Science Institute, was selected
because the founders hoped to begin placing greater emphasis
on training and research. The married couple who directs
the agency mortgaged their home as did the associate
157
director and her husband in order to obtain start-up funds
for the new organization.
Once incorporated, Homebuilders was able to obtain
additional funding and began to expand rapidly. There are
now Homebuilders programs in nine counties in Washington
State, as well as the program in the Bronx, with further
expansion planned. Moreover, the program has been
replicated or imitated in varying ways, with varying
results, in multiple sites around the country. The training
division of the Institute does extensive training and
consultation about the model in various locations. Also, a
small training center has been established in New York City
because the demand for training on the East Coast began to
exceed the resources of the Washington-based staff. One
senior trainer began working out of the Bronx office in
1988, and additional trainers, who will be based in New York
City, are being hired now.
The Edna McConnell Clark Foundation was the prime mover
in encouraging Homebuilders to open the program in the
Bronx. The foundation started to fund Homebuilders
initiatives in 1984 as part of its interest in family
preservation services. About the same time, a steering
committee was formed in New York City to examine
possibilities for establishing a family preservation program
in the City. After examining various alternative models,
the committee recommended establishment of the Homebuilders
program here. After many negotiations with various public
158
agencies and the Board of Estimate, it was agreed that
Homebuilders would be given a $400,000 preventive service
contract for the first program year. The foundation agreed
to pay a 25 percent match as well as all the start up costs
including moving the directors to New York City for a year
and sending all the initial staff to Washington State for
two months for training.
The program was deliberately located in the Northwest
Bronx to ensure a wide socioeconomic spread in the catchment
area. Referrals are solicited from the Bronx office of CWA,
the Department of Probation, and the Pius XII PINS Diversion
project, but the majority of cases are CWA referrals. As in
their other programs, Homebuilders has agreed to accept any
cases referred in which a child is at imminent risk of
placement as long as a therapist is available to take the
case. They had planned to cover only three community
districts in the Bronx but had to expand to the entire
borough at one point because the public agencies were slow
in making referrals. As is their custom, rather than
maintaining a waiting list, the program director calls to
notify each of the agencies as soon as a vacancy becomes
available and agrees simply to accept the next case ready
for referral.
The directors of the Behavioral Research Institute
remained in the Bronx for a year in order to train the
permanent program director (who has now assumed full
administrative responsibility). In addition, a team
159
supervisor/therapist and three full-time therapists were
hired. During the first 8 months of operation the program
served 30 families with 55 children. At full capacity
Homebuilders will serve 70 families annually. The cases
served demonstrate a wide range of serious problems in
family functioning and are described by CWA personnel as
being more troubled than most of the families served by
other preventive programs in the Bronx. The early results
of a formal evaluation of work with these families looks
promising, but the program is too new to draw any firm
conclusions. 3
Since one of the factors that motivated the co-
directors to open the program in the Bronx was their desire
to assess the adaptability of the model to a large urban
area, it is interesting to note their observations about the
differences in providing services here and in Washington
State. The major administrative problem they have
encountered in the Bronx is staff recruitment. In
Washington they have a number of qualified applicants for
each position and very low turn-over. In contrast, they
have experienced enormous difficulty recruiting qualified
professional staff in New York City and have had to rely
primarily on paraprofessionals with child welfare
experience. One contributing factor may be Homebuilders'
heavy reliance on social learning theory as a framework for
intervention. Few social workers in this area have been
exposed to this orientation in any depth. However, the key
160
factor seems to be workers' reluctance to be "on call" 24
hours a day. In reality, few Homebuilders clients call
their therapists at nights or weekends, and some of the
staff in Washington enjoy the flexibility of their hours;
but social workers in the City are understandably fearful of
being asked to travel to clients' homes during night hours.
This issue of home visits during night-time, especially in
dangerous neighborhoods, has been the focus of ongoing
discussion among administration and staff who are attempting
to think creatively about how to insure client service while
maintaining worker and client safety.
Other major differences in the Bronx program noted by
the program directors relate primarily to the context for
service delivery and the severity of the families' problems.
Although the Washington programs have worked with some
families with substance abuse problems, in the Bronx almost
every case involves some type of drug problem. Similarly,
the level of violence and crime the therapists have
encountered is much greater in the Bronx than elsewhere;
they have frequently been exposed to guns, knives, and other
weapons. In fact the directors decided after much review
not to accept cases in the Soundview area because they felt
it was simply too dangerous for the staff to enter homes in
this area.
The phenomenon of families living doubled up has also
been a new experience for the Homebuilders people who found
they had to address new questions related to deciding how
161
the family unit should be defined, what help can be offered
to clients who have no sense of privacy or family space, and
how to help families decide what is best for them when this
may result in the eviction of their relatives. Despite - or
perhaps because of - this forced sharing of living space,
the directors believe that many of the clients in the Bronx
have fewer real informal supports or more negative informal
connections than the families they saw in Washington State.
Since one of the objectives of the Homebuilders therapists
is often to help families make better use of informal
resources, the absence of potential supports becomes a clear
barrier to effective service.
The administrators have also identified a number of
interesting differences related to the formal service
systems in each area. Important assets they have identified
for the Bronx program include the tremendous range of
service options available to families; the large number of
knowledgeable, committed people who are involved in child
welfare issues in the City; and the availability of small
sums of money for emergency financial assistance to
preventive service clients. On the negative side, they have
been very troubled by the difficulties encountered in trying
to obtain cooperation from the school systems here. And
they have been shocked by the highly bureaucratic and
politicized nature of decision-making in the social service
system. Despite the greater availability of resources in
the City, it takes much longer for the program to link its
162
clients with ongoing service resources because of all the
red-tape and all the unwritten traditions as well as written
regulations governing service delivery. In this context,
the directors have experienced their clients in the City as
being more fearful of referral to other agencies and more
suspicious of what sort of help is actually available for
them than their clients in Washington.
Because of these differences, one of the co-directors
noted that the question they must keep posing is just what
it means for children to be brought up in this atmosphere.
If, as they have observed, the reality of the City life is
worse than all the myths, how does one weigh the trade-offs
for children inherent in remaining at home or entering
placement?
Observations, Lessons, Ouestions
The fact that the Homebuilders program has been widely
replicated and imitated in various locations around the
country testifies to the obvious appeal of this service
model to public agency administrators and funding sources.
Although New York City was slow to explore the "family
preservation" approach, since establishment of the Bronx
program, the Department of Juvenile Justice has funded a
Homebuilders-type program for delinquents in Brooklyn and
CWA has contracted with a voluntary agency to develop small
family preservation components. Also, the Office of Mental
Health has recently started some replication efforts in the
163
City and in upstate New York. This suggests at least
initial acceptance of the model in this area.
It is not difficult to understand the factors that make
the Homebuilders model so attractive to public officials.
It is short-term, family-centered, narrowly targeted on
those most at risk of placement, apparently cost-effective,
and offers a clear-cut service technology that is easily
understood and communicated, at least on a superficial
level. What is not known, of course, is how much of
Homebuilders' success is due to the leadership provided by
its directors and how much to the practice model itself.
Although the program is quite different in many respects
from the others included in this study, as will be noted,
there are also some striking similarities. These include:
the view that prevention services are part of a continuum of
services to families and children at risk; a heavy emphasis
placed on recruiting qualified, committed staff and
providing ongoing staff training; use of an integrated range
of counseling, concrete and advocacy services to engage and
help families; an eagerness to assess and refine the
interventive approach over time so as to insure service
effectiveness; strong sense of mission and conviction about
the value of the program; and perhaps most important, the
leadership style of the program directors.
The real question the Homebuilders program poses is
whether a tightly targeted, short-term approach is enough.
Can families in which there is severe dysfunction make
164
sufficient progress in a brief period to insure an
acceptable level of functioning over the long-term? What
additional community resources are needed to provide the
support families at risk may require over time? Although
prevention of placement may be an important goal in and of
itself, few would argue that this alone is sufficient to
ensure children's developmental well-being. Thus there
could be real disadvantage to making treatment or so-called
preventive services in the City synonymous with family
preservation services (something that has occurred in some
jurisdictions elsewhere in the country).
Despite this limitation, the experience to date
suggests that Homebuilders can serve an important function
as one major component of a continuum of services.
Moreover, the service model employed in this program offers
some interesting clinical insights related to the potential
value of using time differentially; the importance of
working on the clients' own "turf"; and the usefulness of
social learning theory as a framework for selected types of
family intervention.
Finally, it seems important to underscore the co-
directors' observations about the difficulties experienced
in linking families with needed resources in this area as
compared to other geographic communities. All service
providers in the City face similar bureaucratic and
attitudinal obstacles, but over time these barriers come to
be viewed as expected, if not routine. The very fact that
165
the Homebuilders program has experienced these obstacles as
new and unexpected suggests that such difficulties are not
an inevitable component of service delivery to high risk
families and may contribute to the unusually high costs of
service provision in New York City.
166
Notes
1
See James K. Whittaker et al., eds., Reaching High-Risk
Families: Intensive Family Preservation in Human Services
(Hawthorne, NY: Aldine de Gruyter, 1989).
2
The material presented in this section draws heavily on
Jill Kinney, et al., "The Homebuilders Model" in Whittaker
et al, op. cit., pp. 37-67.
3
Christine Mitchell, et al., "Evaluating The Bronx
Homebuilders Program: The First Thirty Families" (New York:
Bank Street College of Education, June 1988).
167
Family and Children's AIDS Case Management Program,
Human Resources Administration
In 1985 Mayor Edward Koch asked HRA to assume
responsibility for providing out-of-hospital services to
persons with AIDS who were indigent or had depleted their
resources due to the catastrophic nature of the illness. In
response, HRA established the Division of AIDS Services
within the Medical Assistance Program. The division is
organized into three departments: Planning and Community
Affairs, Contracts, and Case Management. The Family and
Children's AIDS Case Management Program was established in
April, 1988, as a specialized program of the Case Management
Unit.
HRA has designed the case management program as a one-
stop, accessible, comprehensive and continuous service.
Following referral to the program, cases are assigned to a
case manager who remains with the case from beginning to
end. Services provided to clients include help in securing
income maintenance, housing, medical assistance, and home
care, as well as family counseling, health education, and
support. These are provided directly by HRA staff and
through an organized referral system. The AIDS Case
Management Unit has contracted for specific services with
several organizations such as, the Gay Men's Health Crisis
for legal and financial services, the AIDS Resource Center
for housing, and the Visiting Nurse Service for home care.
168
For purposes of eligibility, a family is defined as any
household that includes an adult and a child under the age
of 18, at least one of whom has AIDS. To be eligible for
the program, the family must have one or more persons
diagnosed with AIDS or advanced HIV illness, be Medicaid
eligible, and require either home care services, homemaking
services or housing assistance. Referrals are accepted by
telephone and by mail from hospitals, correctional
facilities, drug treatment facilities, and community
organizations. Two to three hundred or more family cases
are served each month.
There are three teams in the Family and Children's
Demonstration Program, one for each of the boroughs
currently being served (Bronx, Brooklyn, and Manhattan).
Each team consists of five caseworkers and an MSW-trained
social work supervisor. Each caseworker serves a maximum of
fifteen families. In addition, the units share a nurse to
assess risk and provide health education to families and a
family specialist who provides a link with the Child Welfare
Administration. There is also a student unit composed of a
coordinator and four to six MSW students. The Family and
Children's Program is now located in an income maintenance
center in the South Bronx. Workers from that site serve all
three boroughs, but there are plans to move the units to
separate offices in their respective catchment boroughs.
Because the Family and Children's AIDS Case Management
Unit is new, only limited statistical data are available.
169
As of January, 18, 1989, there were 362 active family cases.
The average length of time from referral until termination,
which usually occurs shortly after the death of the
diagnosed patient, is approximately nine months. The Family
and Children's Program is funded by three sources: City tax
levy funds channeled through the Division of AIDS Services,
a Federal Health Services Resource Administration grant, and
a public health service grant.
The income maintenance building in the South Bronx
where the program is now located is in a neighborhood
typical of the area, with many burned-out, abandoned
buildings, dirty streets, and few active businesses. The
AIDS unit operates on the first floor of the building, in a
large central room, with four rows of eight to ten desks
each. The caseworkers' desks are grouped by catchment area.
There are two spacious lounges for staff and clients, a play
room for children, and several individual offices for family
caseworkers to meet privately with their clients. Despite
the institutional and dingy feel of the setting, the office
is animated and friendly. Clients, particularly those with
children, and those who are healthy enough, drop in
frequently, and the staff appears welcoming, concerned, and
accessible.
The goal of the Family and Children's Unit is to allow
families affected by AIDS to remain together as long as
possible. Case managers work towards this goal by providing
home visits, arranging home care and homemaking services,
170
securing adequate housing, negotiating for entitlements and
benefits, providing counseling, arranging for legal
services, arranging for transportation to medical
appointments, running support groups, and providing health
education. Due to the fatal nature of this disease, success
is difficult to define. Words like support, empowerment,
and control were used repeatedly by the caseworkers and
supervisors in describing their work, suggesting that
keeping the family together and helping them to live as well
as they can under the circumstances remain important goals.
Referrals are accepted through the AIDS Serviceline,
which is a single entry point for information and referral
to AIDS services within HRA. HRA has done extensive
outreach through the distribution of literature in Spanish
and English to hospitals, drug treatment programs, and
throughout the community so that referrals come in
frequently. Each referral is immediately assigned to a case
manager who will remain with the case until it is closed,
thus insuring continuity of service. This has worked well
for clients because the case managers become their friends
and confidants, and, in some cases, their only contact with
the outside world. But it is also problematic in that the
workers report spending 90 percent of their time on the 10
percent of the cases that are most difficult. These are
usually cases in which the patient or other family member is
actively abusing drugs. Discussions are now being held as
to how to remedy this. However, the administrators and the
171
caseworkers share a strong commitment to keeping each case
assigned to a single worker rather than transferring cases
to different workers as client needs change. This approach
to case management is one of the unique aspects of the
program and seems to satisfy both clients and workers.
One of the factors that makes this program different
from most HRA programs is that all of the caseworkers and
supervisors in the program requested this assignment.
Morale is high and staff turnover is extremely low. Most of
the workers who left the program during the past year left
because they received promotions. The staff members are
very supportive of each other, sharing resources and relying
on each other for emotional support during particularly
difficult times such as the death of a client or placement
of children outside the home. The staff lounge is perceived
as key in facilitating these important staff relationships,
as it provides a place for the staff to relax, to speak with
each other, and to develop informal relationships.
The type of services offered by the program can perhaps
best be conveyed by describing what was presented as a
typical case. The primary patient in the case is a 40-year
old black woman with AIDS, who had been an IV drug abuser
for four years, but stopped three years ago when she became
pregnant with her son. When the case was referred, she had
recently been discharged from a hospital in New York with a
diagnosis of AIDS. The referral was part of the disposition
plan made in the hospital. At this time, she was living
172
with her son in the basement room of a rooming house
frequented by known drug abusers. Her two-and-a-half year-
old son was diagnosed with AIDS-Related Complex (ARC), was
not speaking or toilet trained, and was considered by his
physician to be suffering developmental delays as a result
of the ARC. She herself had problems with walking and
vision and was extremely weak, but she cared for herself
with the occasional help of a woman who lived in a room
upstairs. Although this neighbor was an active drug abuser,
she was able to provide some basic assistance to this
patient and her son.
The worker's initial contact with her patient was made
through a home visit that she made to the rooming house.
Subsequent contacts were also made through home visits
because there was no phone on the premises. Her first goal
was to relocate the family into a more suitable apartment.
This was accomplished within two weeks, despite the fact
that there was no housing available through the housing
agency with which HRA contracts. The worker found the
apartment through phone calls that she made to landlords who
were known to other caseworkers in the program. She then
arranged for home care services for the mother and
homemaking services to take care of the little boy. As the
patient's health began to decline, she became totally blind
and bedridden. The worker then contacted the patient's
sister and was able to arrange for the sister to move to the
City and to assume responsibility for running the household.
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The worker recognized that the patient was a woman who
had been in control of life until her illness, despite
having had a period of active drug abuse. The most
difficult issue for this woman was the loss of control that
she had to confront with the illness. By focusing on ways
that the patient could remain in control of what was left of
her life, the worker was able to engage her. She referred
the client to the Gay Men's Health Crisis so that she could
arrange for a living will, power of attorney, and provide
for the guardianship of her son following her death.
Despite the fact that the client remained blind and
bedridden, the worker consulted with her on each decision
that had to be made regarding her care and the care of her
son, and she also worked with the homemakers, home health
care aides, and her sister, encouraging them to do the same
so that the client could maintain some sense of autonomy and
adulthood.
The boy seems to have responded well to the changes in
his environment and to the increased attention that he
received from the homemaker and his aunt. He has begun to
speak and is also becoming toilet trained. The worker has
arranged for him to begin treatment with a speech
pathologist at a New York hospital to work on remaining
speech problems. He may soon attend a day care center
program for children with AIDS at Montefiore Hospital.
Also, it has been agreed, that when his mother dies, his
aunt will become his legal guardian. Because the boy
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himself has tested HIV-positive, the case will remain active
after his mother's death, and the same caseworker will
continue to follow the family.
Observations, Lessons, Questions
Despite the difficult and tragic nature of many of
these clients' lives, this is a program that can be
considered successful. Families are kept together, services
are delivered in a clear and consistent manner, caseworkers
are pleased with the work they are doing, and the clients
are responsive and feel well cared-for. It is difficult to
identify all the variables that have contributed to its
apparent success, but what may be more important is that the
program was formulated primarily around what works best for
the clients, not around what works best administratively.
This orientation can be felt in almost every facet of the
program. The clearest example of this is the strong
commitment to having the same caseworker remain with the
family from the opening of the case until the case is
terminated. At times when this proves to be a problem, such
as with particularly difficult cases, the administrator has
listened responsively to the caseworkers, and she is now
actively talking with them about ways that this problem can
be solved.
The fact that HRA has allowed the workers to maintain a
maximum caseload of fifteen families per worker, which is
much lower than the norm in public agencies, is also
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significant. The policy shows respect for the workers and
for the difficulty of their caseloads and allows them to put
the time into each case that is so desperately needed. It
is also important to note again that all of the workers in
this unit specifically requested to be there. They seem to
have a sense of pride about their work, and a sense of pride
about their ability to handle this particularly difficult
and painful work. The group is very close, its members
using each other actively for support and for information.
The supervisor noted this closeness and said that she
encouraged it in every way possible. The closeness is also
facilitated by the presence of a large staff lounge which
gives workers a place to have lunch, a place to relax, and a
place to take all of their breaks. Finally, the flexibility
of the supervisory and administrative staff is an important
factor in keeping the program going as successfully as it
does. For instance, a field instructor was supposed to be
hired to supervise the student unit; however, for reasons
which remain unclear, no one was hired during the first year
of program operation. This problem was solved by the on-
site supervisor and the Director of Planning and Community
Affairs jointly assuming the responsibility of supervising
the students.
In summary, keen sensitivity to the needs of clients
combined with an administrative structure that allows
workers to meet those needs would seem to be the key factors
making this a successful program. The fact that the program
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is based in the Medical Assistance Division of HRA, not the
CWA, raises interesting questions about the appropriate base
for delivery of family and children's services and whether
CWA as currently structured can respond as effectively to
changing client needs. What is not known, of course, is
whether the current high level of staff morale and
performance can be maintained when this program is expanded
and becomes more institutionalized. Will new workers who
may not have requested this assignment adapt so readily to
the single case management model? Will the program be able
to maintain its flexibility and tolerance for ambiguity and
creativity once the accountability demands increase? What
the program does demonstrate clearly is the potential for
service innovation in the public sector, given decentralized
decision-making, strong program leadership, and
administrative support.
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The Jewish Board of Family and Children's Services (JBFCS)
The JBFCS does not exaggerate when it tells new staff
that it is the "largest and most diversified mental health
and social agency in the nation, notable for quality of
services, for significant contributions to the field and for
the range of treatment programs offered" (Orientation
Manual, p. 1).
The full research team participated in the JBFCS study
because of its relevance to the national exploration of
delivery options and to clarifying choices facing the New
York City service system.
Some of the reasons for this interest are apparent even
in the brief paragraph quoted: an agency which sees itself
as both "mental health" and "social service", a stress on
"range of treatment programs" and pride in "quality".
Moreover, if this is the "largest" such voluntary agency in
the country, it is useful to inquire: to what extent does a
largely publicly- funded voluntary agency take over a
definable responsibility for geographic or functionally-
defined coverage thus relieving the public agency? If it
does not, what is the public-private fit?
As will be seen, this large, expansive, excellent,
pioneering agency is a valuable public resource but it is
not an integrated delivery system. It is better described
as an umbrella agency or holding company. The examination
raises important questions about the direction for reform of
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the public social service system for families and children
in New York City. It also offers important clues for
recruitment and retention of quality staff and the
encouragement of practice and program innovation.
While, like other voluntary agencies, it is largely
dependent on public funds, JBFCS also is a beneficiary of
the United Jewish Appeal-Federation. It thus has
commitments both to "serve the Jewish community" and to
provide "services to all segments of the community". Since
the agency is dynamic and the City needs are exploding,
program reports and statistics are soon outdated. The
latest information available at the time of the study listed
91 programs and contacts with over 45,000 people (we roughly
estimate the more intensive individualized service load as
in the neighborhood of 6,000-7,000), throughout the New York
metropolitan area, Westchester County and Long Island; the
latter areas are beyond the responsibility of HRA.
By our rough count, JBFCS was operating out of 47 sites
when we studied the agency but some agency reports mention
about 60 locations. This number of sites is matched by few
county departments in the country and is about equal to the
number of New York City HRA districts. The sites vary from
the central office on West 57th Street in Manhattan, an
agency-owned building which houses the executive staff, the
child development center, an educational therapy program,
employee counseling for labor unions and corporations, a
community services outlet, staff education, "remarriage"
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counseling, sex therapy - and more - to store-front outlets,
services in four family court buildings, as well as a
diversity of school, residential treatment and group home
facilities. Organizationally, the services are assigned to
major units for "community services", "residential
treatment" and "day treatment-preventive-court services".
There is a separate structure for employee assistance. The
agency also has administrative provision for training and
for quality assurance/planning. Three "chiefs" provide
overall guidance and supervision to psychology, psychiatry,
and medical aspects of the program (and help meet various
statutory requirements related to the many funding streams
on which the agency draws).
The full range may be illustrated by noting that beyond
the core child guidance, community family treatment,
adolescent and child court services, group homes, and
residential treatment, JBFCS offers: consultation to
nursery schools, Jewish family life education, special
services to Iranian and Russian Jews, a program of
residential treatment for very orthodox children, a cult
"hot-line", an alternative secondary school, a therapeutic
nursery school, day treatment for psychotic children, an
AIDS service, and an elaborate volunteers program. By all
professional criteria, these are generally good or excellent
programs.
Unlike the presentation pattern for the other agencies
studied, we shall not here review any one program in detail.
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JBFCS was one of two large voluntary agencies included in
the national study of service delivery options because of
its size and multi-system identifications. New York City
study purposes are better served by an overview, rather than
one program description. Thus we concentrate on a series of
critical issues, many of these already introduced.
Wherefrom, this pattern?
The current JBFCS originated out of a 1978 merger of
two large, nationally prominent, outstanding agencies in
their fields. Each had served the City for more than 75
years. Jewish Family Services, which originated in the
Jewish Social Service Association established in 1874, was
known for family social services generally, and for
individual counseling. The Jewish Board of Guardians, which
derived from the Jewish Prisoners Aid Society established in
1893, had given leadership in the development of the child
guidance movement and in residential treatment of
emotionally disturbed and delinquent children. Each had
grown out of predecessor services to prisoners and
immigrants in the Jewish community late in the nineteenth
century, which had subsequently taken on delinquent
services, and had developed a tradition of professional
excellence and pioneering work.
As one explores the increase in range of services and
the scale of offerings in recent years it becomes clear that
several dynamics are at work, that they vary in importance
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from time to time, that nobody would defend all the elements
in the pattern, but that staff at the leadership level
consider the overall result to be good, in the sense that
they are proud of the agency, its services, and its
commitments.
First, there are internally-generated program
initiatives and modifications. These may originate with
ideas brought by line staff to supervisory conferences and
fed upward to middle management by supervisors. or they may
come out of discussions in the many training programs, often
led by top staff. Or the agency's top managers may be
stimulated through their experiences as agency
representatives on various city and state boards, task
forces, and advisory committees, or similar activity in
professional associations. Or division heads may be
evolving their concepts of effective programs. Quite
frequently the lead comes from the Executive Vice President
in his leadership role in the State and City with reference
to mental health and social service programs.
Of equal - or at times far greater and more immediate -
importance the agency is responsive to public initiatives
and requests. These initiatives may take the form of RFPs
("requests for proposals") or of specific invitations to
help meet a serious public need with regard to a social
problem or an inadequately served population group. JBFCS
feels committed to responsiveness, if the needed service is
within its scope and can be undertaken in a way with which
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it is comfortable, under the conditions imposed and with the
resources offered.
Beyond these public initiatives are the needs disclosed
in interaction with United Jewish Appeal-Federation, and the
outcome of that group's planning process.
Program planning tends to be carried out by top
operating people responding to public and United Jewish
Appeal initiatives as well as agency/leadership initiatives.
The highly qualified planning director tends to have
something of a coordination task (and also carries other
analytic and special functions).
Not a Delivery System
Impressed as we were with the richness of the service
and treatment resources and the agency's size/scope we
inevitably inquired as to whether it constituted an
integrated delivery system. The above description of
sources of initiatives make it clear that it is not, nor
could it be. While the community service units (the
Madeline Borg Community Service, 14 clinics in three
boroughs) set a standard and a pattern which influence many
of the categorical "add ons" developed in response to public
requests, this is not the same as planning with the
requirements of a geographic-coverage network and delivery
system (or the needs of a specific population or problem
group) in mind and asking what is needed next and most to
improve and integrate the network. Similarly, while a day
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treatment, group home, and residential treatment network
could in theory be parts of a well-orchestrated treatment
continuum, relating to the agency's community services and
preventive services, that is not here the case. There are
some privileged referral links from the community units to
the day and residential programs, but other channels also
exist and reflect roles for the residential programs based
on agency contracts, admission requirements and separate
intake paths. Hawthorne Cedar Knolls is both a residential
treatment center, funded by the New York State Department of
Social Services and a residential treatment facility
supported by the New York State Office of Mental Health.
Rules, requirements, objectives, and to some extent
population characteristics, require two separate programs in
the one institution. And, especially relevant here, the
part of Hawthorne which is a residential treatment facility
for the New York State Office of Mental Health, and a
similar facility at Linden Hill, are assigned their cases
out of a state-controlled admissions system; they may reject
cases, but have no other way to accept patients other than
through the state system.
There are some islands of exception in the system.
Thus, because of the nature of leadership and the particular
"preventive" programs financed by Special Services for
Children (now CWA) in two Brooklyn areas, there is some
movement towards integration of preventive and community
services. But the agency lacks control of its intake in
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major units, and has not set up its delivery system,
priorities, case routing and related policies to move
towards overall agency integration. Nor is it clear, given
all else that is occurring in the City service system, that
such an initiative would be welcome. The leadership gives
most of its planning attention to deciding about and
implementing particular program initiatives - not to the
refinement of an overall integrated system. Nor does the
funding pattern facilitate comprehensive planning for a
service continuum.
Categorical Funding
An analysis for 1987-88 shows a budget of $37 million,
assembled from private philanthropy ($23.7%), fees (3.7%),
rentals (.5%) and government (72%) Public funds come from
Medicaid (34.6%), Department of Social Services (22.4%),
Department of Mental Health (12.7%) and "other" (2.7%). The
social services funds reflect both state projects and
contracts with CWA for so-called preventive services (really
treatment and social services for families and children
intended to prevent placement). There are also included
public funds from the New York State Office of Mental
Retardation and Developmental Disabilities, as well as the
New York City Department of Mental Health and the New York
City Board of Education. Some of the United Jewish Appeal-
Federation support is for the "traditional" family service,
child guidance, and residential treatment functions, and
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some for special categorical initiatives relating to
specific sub-population needs within the Jewish community.
Inevitably, without provision to pool or decategorize
all such funds, the agency cannot in fact shape an
integrated delivery system. As noted above with regard to
the residential treatment facilities at Hawthorne or Linden
Hill, but we might also illustrate with West Side School, an
alternative school which gets all of its referrals through
the City Committee of Special Education, some of the intake
machinery is out of the agency's hands.
Further, some of the money comes with requirements for
control of treatment/service by psychiatrists or medical
doctors - which may not make sense for some other parts of
the program. Further, whether for much needed
accountability, or to satisfy turf claims, many of the
contracts involve complex and demanding procedural,
paperwork, case record, and statistical reporting
compliance. These are not readily integrated, and each is
extraordinarily demanding on its own terms. An integrated
delivery system implemented without state-level (and even
federal) coordination and waivers, could subject operating
units to even heavier burdens and more questionable use of
energies. Unlike some programs we have observed nationally,
JBFCS has resisted the tendency of accountability
requirements to clericalize and downgrade professional
practice. Any goal of integrated delivery in a multiple-
funded system would require careful planning.
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Social Services or Mental Health?
There is perhaps a more fundamental question which
would need to be answered if one were interested in a more
integrated delivery system. Is this a mental health agency
with social service components or a social service agency
with mental health resources and capacities? Or is the
question itself meaningful? An exploration of these matters
uncovers unresolved issues relevant to future planning in
New York City and elsewhere.
While there is by no means complete consensus within
the agency, and while even within the general consensus
there are different emphases, most of the executives and top
program leaders consider this to be a mental health agency.
They all mean by this that clients/patients are always
approached on the basis of differential diagnosis, that
everything - even administration - is seen in a "clinical
frame". The case assessments are considered central and
involve consideration of both person and environment but the
dominant agency culture is to hold up a psychoanalytic
prism, meaning psychoanalytic understanding, not
psychoanalytic intervention. Nonetheless, one also finds in
use in various units such conceptual orientations and
methods as behavior modification, drug treatment,
confrontational approaches, special education techniques.
There is clear readiness to be responsive to evidence of
efficacy.
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Without doubt, the JBFCS staff as a whole is far more
"psychodynamically informed" than are the staffs of most of
the child and family social service programs in the City.
Yet some of the top clinicians and administrators say that
the mental health treatment services require and are
provided a "social service envelope", meaning an awareness
of environmental context and a willingness to intervene to
help families in practical matters.
As one explores the individual programs it is clear
that some of the community-based, day treatment, and
residential efforts involve control - treatment -
rehabilitation of the seriously disturbed. This meets even
a constricted definition of "mental health" - and might be
better put as "psychiatrically-guided treatment". Much of
the rest is sophisticated, psychiatrically and
psychologically informed, case assessment and intervention.
Social workers consider this to be good social work.
Funding requirements for particular categorical programs, or
professional status and turf considerations, often generate
the "mental health", rather than the social service, label
for such work, however. In the JBFCS instance, the City's
requirements with regard to preventive services contracts do
not permit the more traditional treatment routines of the
clinic as seen in the Madeline Borg Community Services
clinics. Thus, many of the preventive service clients are
court and CWA referred, not "voluntary". Home visits are
required. The families tend to be more fragmented, more
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disorganized, more impaired, more often in poverty. Much of
what must be done and in what time-frame is mandated and
there is enormous paperwork. Yet JBFCS staff say that some
of the preventive services approximate their Madeline Borg
service model.
Obviously, too, the case management or practical needs
which are the features of some of the refugee or AIDS
services, or the time frames and requirements of some of the
court services, may support a social work, rather than a
mental health, conceptualization.
Whatever the vagueness of its intervention or service
boundaries, the mental health "system" is a funding stream,
and an important one at that. Its rules about intake,
reports, and psychiatric supervision shape the delivery
system. Much that the social worker might consider
essential does not enter into the case count which the
contract specifies. (Here we refer to getting people to the
hospital, placing children, dealing with an all-day crisis,
home visits, collateral contacts with family members, law
guardians, etc.) It is difficult to free time for training
while meeting the "level of service" rules of some mental
health contracts. The paperwork often discourages work
involving brief contacts and outreach to people with poor
records of keeping appointments. All this is left to the
"social service" part of the equation.
In a world without requirements from funding streams or
professional status hierarchicies, one would say that JBFCS
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is a psychodymamically-informed social service program,
which also operates some psychiatrically-guided treatment
programs. Or one would invent a new label for it all. But
the realities of categorical funding, professional status,
and delivery system complexities do require serious
attention to cross-system planning and modes of operation.
Whatever the reasons, this rich resource in an umbrella
structure called JBFCS crosses a large number of systems
which are not captured by the vague appellation "mental
health", or by "social services", whether separately or
combined.
JBFCS is not generally defined within the area's
professional community as primarily a child welfare agency.
Although it contracts with CWA for "preventive" child and
family services and for residential treatment, another
sectarian Jewish agency, the Jewish Child Care Association,
is considered the child welfare agency in the sense of
foster care, adoption (and, also, preventive services).
JBFCS has its foundations in mental health and social
services as generally delineated. Moreover, the multi-
problem, multi-diagnosed children and families with whom it
works, require as well the resources of special education,
developmental disabilities programs, juvenile justice,
addiction services and others. One interviewee told us:
"The money may be categorical but the needs are holistic."
No one agency alone can on its own initiative solve the
integration problem for the community. And even if a large
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and important agency continues as an "umbrella- or holding
company", the City needs a delivery system.
Quality
The public social services system for families and
children faces major problems of quality assurance. Staff
recruitment, retention, training, supervision, compensation,
and job definition are all involved. JBFCS offers many
lessons to those seeking solutions. Its quality is widely
acknowledged by referral sources in all systems, by public
agencies which ask it to develop new programs, and by
trainees from psychiatry, psychology, social work, and
related fields who apply for internships. As put by one
middle manager, "we are blessed with a preoccupation with
high quality."
For one thing, as indicated, the agency has a long
history of quality service, stability in its lay and
professional leadership, and an ethic of concern for its
patients/clients. All of its top administrators have risen
via the clinical route; they have been and many still are
part-time practioners. These are managers who value the
direct level practioners; expertise in working at the case
level is visible because of the elaborate system of seminars
and case staffing devices - and it is recognized. A lack of
rigid hierarchy at the top level and some loose elements in
administrative structure puts qualified and interested
middle and third-tier managers and supervisors in task force
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and liaison roles.
The agency's unmatched training program is an important
factor in its attractiveness for staff and in its quality
standards. The investment is very large. Staff members
have access to a basic seminar, two advanced level seminars,
and specialized offerings reflecting new issues - problems -
techniques. Most of the instructors are top-level
administrators/ managers. There is high status involved in
being invited to take on one of the offerings.
All of this, combined with a significant degree of line
practitioner and program director autonomy, supports a
quality operation. Over the years this has generated much
agency attachment and staff stability. A relative salary
decline in the late 80s did have destabilizing effects and
was only partially solved in a recent contract. Like the
rest of the agencies, however, JBFCS has not overcome the
unattractiveness of the CWA preventive services jobs, as
affected by the nature of the problems dealt with,
administration requirements and constraints, and
compensation levels. When in 1987 there was a 16 percent
staff turnover in JBFCS residential treatment, the rate in
preventive services was 56 percent - despite reasonable
caseloads. There is agreement that "less draining"
workloads, with more of a "mix", would be essential to hold
qualified staff - who want to be responsible professionals,
with range and opportunity for initiative.
It is the opportunity to be a clinician that brings
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people to the core JBFCS community and residential services,
as compared with the prevention programs. One school of
thought would make the prevention programs more like the
Madeline Borg clinics, integrating the two systems. Another
would surrender to the difficulty in recruiting and holding
M.S. social workers and would turn elsewhere. An
alternative approach, suggested by some of the New York City
programs that are more successful in retaining service
staff, would be to adopt a systematic practice orientation
more consistent with the needs of clients in this division.
Public/Private
One notes at once that half the JBFCS budget is
expended on behalf of adolescents, a rather unusual pattern
in a national social service picture in which there is a
crisis in adolescent services and few involved in inventing
solutions. One also notes that despite contrary national
trends of a decade and a half, this is an agency in which
residential treatment is accepted as essential to a
treatment network, considered important to do well - and is
a recognized specialty. The agency is turned to by public
authorities and the voluntary sector - as well as by youth
and their parents - for these services, and the agency is a
valued and appreciated provider.
Some of this specialization with adolescents and in
institutional care represents historical continuity with
earlier missions, but the continuity is there because of
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success and reputation, which ensured staffing and funding.
In part, too, this is the role of the voluntary agency,
which responds to a need and is not compelled to follow all
the nuances of public policies or fads. Here the funding
from United Jewish Appeal-Federation provides a measure of
security and leverage, allowing board and staff to protect
and develop the agency mission. (We heard this argument
even for very modest private funds from many of the programs
studied). It is not that JBFCS has not also departed from
its historical mission and added to its service range, out
of its own initiatives and in responding to publicly-defined
needs. But its status and private funding give it leverage
and the basis to refuse offers, too. Only agencies with
private resources can do this; there are many other non-
profits and for-profits in the City which are completely
public agents and totally dependent on RFPs to survive.
Yet it is urgent to recall that in a sense the JBFCS -
like most voluntary, non-profit social agencies - is part of
the public system. A large portion of its budget - now
close to 80 percent - comes out of public funds. It
therefore should be publicly accountable, and that includes
a contribution to the development of a coherent effective
service network. The City spends too large a portion of its
service funds through the private sector and JBFCS and
others get too much of their financing from the public to
justify the pattern as research and development (R and D).
The money spent by the public must either support or buy an
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integrated delivery system.
The responsible JBFCS leadership would not contest
this. Some among the executive staff, basing themselves on
decades of New York City experience, doubt that the public
agency can itself deliver complex, high-quality clinical and
other social services. Contracts and subsidiaries therefore
are seen as helping develop and expand the offerings through
agencies with a capacity for effective service. The issues
would be: what public policy and apparatus is required to
use this capacity effectively and what rights do the public
authorities require to make good use of the opportunity?
Whatever one may believe about these issues and how they
should be resolved, one must endorse and take at full faith
the proposal made to us by the agency's Executive Vice
President that the public social service authorities take
the lead in creating a public/ private social service
planning system dedicated to raising the level of New York's
offerings and optimizing the benefits of the considerable
public expenditures.
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IV. FINDINGS AND RECOMMENDATIONS
This study was shaped by the premise that government
has a responsibility to ensure the provision of
comprehensive services to disadvantaged families and
children in order to help children who are at risk of a
range of social and personal ills to achieve their
developmental potential. Our orientation is consistent with
the recommendations of the many public advisory bodies, that
argue that such service provision is essential to ensure
future societal well-being. 1 However, we recognize that
this premise goes well beyond the current policy mandates of
the public agencies responsible for funding the programs we
studied. Also, we stress that social services alone cannot
eliminate poverty or any of the other seemingly intractable
social pathologies plaguing the country today. As noted in
the report of the national study of social services for
children, youth and families:
Social service systems do what they can and must
in such an environment, protecting children and
attempting to strengthen families, offering guidance
and trying to deal with pathology. In the midst of
this they may need to protect their own staffs against
violence. At their best the social services rescue,
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sustain, help, rehabilitate, and even enrich
development. However, the massive flow of cases with
severe problems and pathology will continue and the
interventive programs will for the most part have only
very limited results unless much else goes on
simultaneously in other sectors and systems: community
development, employment and training, education,
medical care, housing, and law enforcement.
2
Thus although our conclusions and recommendations are
oriented to the provision of comprehensive social services
to families and children at risk, they are constrained in
many ways by the limitations inherent in the City's current
system of social service delivery and by the lack of
societal responses to the larger social problems. Social
services can sometimes help the disadvantaged to cope with
some problems; they cannot be expected to eliminate them.
In this context it is important to note that all the
administrators at our study sites talked at length about
their frustrations in being able to accomplish so little in
relation to the many social pathologies confronting families
and children today. Voluntary social service agencies in
general, and child welfare agencies in particular, are often
criticized for their failure to attend to the "real" needs
of poor families. Thus it was striking to note how attuned
voluntary agency leadership as well as public officials were
to the range of social and economic problems affecting their
client communities and their eagerness to identify ways of
addressing these basic problems more effectively - yet
within the obvious constraints of a social service mission.
Voluntary social agency administrators and their staff
also spoke quite uniformly about their dissatisfaction with
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the current structure of services for families and children
in the City and their major concern about what has been
termed a minimalist perspective on the use of resources,
i.e., the effort to target services narrowly to those most
at risk - or experiencing a problem currently "featured" in
the media - and to provide the minimum required to ensure
child protection and to limit foster placement. All of the
programs selected for intensive examination in this study
clearly have a broader perspective on the function of social
services than that currently being promulgated by public
officials. Even the Homebuilders program, which targets its
own services very narrowly, values the availability of other
community services that can sustain families at risk prior
to and following their own intensive service intervention.
Thus the respondents were all troubled by what they view as
a lack of leadership and planning at both the City and State
levels and the corresponding tendency constantly to shift
service priorities in response to media exposés, law suits,
and changing political pressures.
Contract agencies as well as public service programs
are increasingly being rewarded for the quantity of service
provided, procedural compliance, and willingness to jump to
new populations as public priorities shift. In contrast,
they are not rewarded for the quality or intensity of the
services they offer or for the creativity they demonstrate
in reaching new populations at risk and addressing some of
the City's most intractable problems. In addition, service
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programs in both the public and voluntary sectors are
currently often hampered by severe staff recruitment and
retention problems and fiscal shortages that prevent full
attainment of even limited service objectives. As a
consequence, there is a widespread sense of futility evident
among many program administrators and direct service
providers in family and child welfare agencies. By way of
contrast, although the study respondents - a select group
within the provider universe - clearly shared frustration
about the lack of a clear service mandate and inadequate
resources, most had chosen to "fight back". Public agency
administrators stressed the need for more support from
federal and state government. The voluntary agency
directors followed the line of advocating actively for more
comprehensive service provision and for making innovative
use of available resources (including decategorization of
some funds) in order to stretch the boundaries of their own
service programs. The prevalence of this attitude among the
select voluntary agency administrators in this study
suggests that it may be one of the variables distinguishing
strong or promising service programs from others in the
service network.
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Summary of Key Findings
The Social Service Delivery System
Despite perhaps the richest and most diversified array
of voluntary child and family social services of any major
city in the country, and despite one of the most extensive
public child welfare agencies, New York City still does not
have a coherent child and family social service delivery
system. Nor is there a clear and consistent pattern of
defined roles and division of responsibilities between the
public agency and its private contract agencies. Nor is
there sufficient clarity of roles between the public child
welfare agency and such other public child serving agencies
as: the court, the schools, the public health system.
Most of the ongoing child and family social services in
New York City are provided under private contract with one
or more public agencies. Most of the voluntary agencies
providing such services are heavily publicly financed.
Confronted by a plethora of severely troubled families, New
York has responded with more extensive public support than
has almost any other large city. Yet this is not
sufficient.
The New York "model" is a public access system for
Child Protective Services (CPS) and foster care, with most
other services provided through a large group of private
contract agencies, some of which are outstanding and some
weak. New York has not succumbed to the pressures for a
minimalist mission, in the sense of some other
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jurisdictions, although there is some tendency in that
direction. The Child Welfare Administration (CWA) itself is
minimalist, but (in addition to some limited services in
CWA) ongoing services are available through the city's
contract agencies. The best of these agencies are staffed
by some of the most qualified professional staff in the
nation, while some of the others and some of the public
agencies are staffed by some of the least qualified. The
City continues to sustain its traditional commitment to
services despite growing pressure to target on a narrower
group. It continues to try to serve a wider range of
troubled children and families. But it does so despite
constant and pervasive personnel problems. And it does so
despite limited control over, or even defined relationships
to, its contract agencies. Thus, for example, the City
still cannot assure its high risk priority clients access to
its contract services.
By itself the child protective service (CPS) is not
sufficient. Nonetheless, it is quite evident that the
availability of a rich and diverse voluntary agency system
does not decrease the need for a strong CPS system.
Clearly, the City needs a strong child protective service,
and it still does not have even that.
Certainly, New York City does not constitute an
exemplar of what big cities should be doing. Some would
argue the City still has too centralized a delivery system
while others argue that the key problem is that many of the
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services publicly paid for are outside of the City's span of
control. A strong private sector continues to press its own
agenda, sometimes adding to service fragmentation while at
other times creating the kind of dynamic tension between the
public and private sectors that could ultimately lead to a
more creative, stronger, improved service delivery system
than now exists. Yet, despite the problems and
inadequacies, there is little evidence of comprehensive,
long term planning for social services in the City; and even
where planning has been carried out, implementation is
inadequate.
Two more conclusions follow:
Again and again, agency administrators complained to us
about the constraints imposed by categorical funding. In
effect, both public and private social agencies' ability to
plan a more coherent service program is undermined by the
rigidity of federal and state categorical funding
requirements and the CWA's pattern of designing narrowly
targeted contracts in response to specified problems which
come to public awareness. The result is an extremely
fragmented service delivery system, increased barriers to
more holistic service developments, and increased activity
by small entrepreneurial agencies that design their entire
programs to reflect what can get public funds, not what the
service needs of the community might be or what creates a
coherent delivery system.
Some private agency administrators, nonetheless, manage
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to develop a more holistic program, and the results
underscore another conclusion. Successful resolution of
some of the toughest, most difficult cases seems to be
directly related to an agency's ability to provide
comprehensive services. Several agencies have developed
their own continua of care, testifying both to the City's
failure to coordinate its various contract agencies, and to
the importance of making such systems of care available if
the agency is to serve troubled children and families
effectively. Targeting on a geographic community rather
than on a specific problem or population group, as
exemplified in several of the programs reported, illustrates
an effective strategy for more comprehensive and holistic
service delivery.
Programs and Practice Interventions
A number of important variables characterize those
programs able to cope effectively in the context of
increased social problems and diminished support for social
services. Most striking perhaps is the similarity in
leadership style of the top administrators in the various
programs described in Part III, despite clear differences in
their theoretical orientations and the service structures
they lead. In many ways these executives all seem to see
themselves in what might be termed an "ambushed position",
trying to survive and provide high quality service despite
constant fiscal, programmatic, and political pressures.
They demonstrate a clear sense of mission, a firm commitment
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to whatever model of client service they have developed, an
eagerness to expand as they identify new populations in
need, and a readiness to keep moving and adapting in
response to changing opportunities and constraints in the
environment.
The strong voluntary agency executives are active in
the community and know how to develop and use political
influence. Although ready to do battle with public
officials in order to advocate for client interests, they
also make every effort to collaborate when asked to take on
a new service or population or to serve on some advisory
body. Despite wide variations in the levels of their agency
endowments and the composition of their boards, it is clear
that each of these executives works to develop access to
private sources of funding and influence that will extend
the freedom to maneuver and to shape a service structure.
In other words, they are well-aware of the risks of being
overly dependent on any one funding source and clearly work
to ensure that their agencies can withstand cut-backs in any
one area.
Finally, these administrators are all keenly aware of
the need, on the one hand, to maintain high public
visibility and a positive image in the community, and on the
other, to keep in close touch with staff members and with
representative client groups. Most are skilled clinicians
themselves; and they often employ what has been termed a
"hands on, value driven" management approach that keeps them
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informed about what is happening while helping to create
exciting work environments through "personal attention,
persistence, and direct intervention - far down the line. 113
A second key variable that characterizes the study
sites is a clear sense of service mission related to a
specific client population or community group. Some of the
programs are identified with a particular geographic
community, others with clients experiencing specific types
of problems, but none restrict themselves to providing only
one type of service. Moreover, although they all engage in
incremental planning and are willing and eager to take
advantage of new funding opportunities that are made
available, they are generally very clear about which new
ventures would help to advance their primary service mission
and which would merely divert energies. Consequently,
instead of jumping at each new "request for proposals"
(RFP), as some agencies are inclined to do, and/or
attempting to address any new service need that may be
identified, each of these programs seems to expand in a
planful manner that protects its core identity while
enabling it to seize appropriate new funding opportunities
as they may arise. The two agencies studied that define
themselves somewhat as holding companies for a range of
service programs - Jewish Board of Family and Children's
Services and St. Christopher - Ottilie (sponsor for the
Center for Family Life) - are much quicker to expand in a
number of diverse directions because they make no pretense
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of functioning as an integrated service network. However,
their discrete program components display the sense of clear
service mission and commitment to their own standards.
This picture of strong leadership and commitment to
agency mission suggests an inevitable planning dilemma. We
both praise and encourage entrepreneurship, capacity to
maneuver, and the type of independence which are essential
to coping and creativity - and we subsequently urge stronger
planning, service coordination, and accountability. Long-
range solutions will need to incorporate these conflicting
values and to find essential balancing points. This makes
the task difficult, yet it would appear to be unavoidable.
It would also suggest that there are no final or permanent
designs and solutions. All of this must be considered in
the subsequent discussion of program models and of planning
mechanisms as well.
The third critical variable that could be identified
from the study is program growth. Although some of these
agencies started out very small, they all seem to thrive on
expansion. Each program administrator spoke of the need to
move out to new populations and/or to develop new services
in order to carry out the agency mission and to stay afloat
financially. Agencies may develop multiple, small
decentralized units, but they apparently need a large
organizational base and multiple funding sources to insure
survival and to maintain the range of specialized staff
resources required to deliver high quality services. In
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other words, in family and children's services in the City
today, small is not seen as beautiful. This observation
raises obvious questions about expectations that some very
small, independent community-based organizations will
deliver effective services.
A related observation is that the agencies in the
sample all seem quick to identify new service needs and
ready to experiment with new programs. (Homebuilders seems
at first glance to prove an exception in that it has not
sought to expand its service repertoire. However, the Bronx
program is itself an example of expansion by its sponsoring
agency, Behavioral Sciences Institute, and the latter has
diversified in recent years by developing large training and
consultation components.) Rather than resting on their
laurels and defining their service boundaries in narrow
categorical terms, these agencies have consistently sought
to be responsive to new funding opportunities and new
potential service populations. But these agencies are not
simply jumping to new, potentially "easier" or more
financially viable populations. In each case, expansion has
been carefully planned as an enrichment or extension of the
agency's core service, not as a substitute for it. Overall,
this trend toward diversification seems to reflect a
recognition that the service needs of families and children
at risk cannot be fit into the small categorical boxes
created by current funding streams.
A fourth organizational variable of significance is the
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willingness to develop programs that cross traditional
service system boundaries. Although the sample sites all
emphasize the importance of their core family and child
welfare service functions, most are moving further into
other service sectors - recreation, health and mental
health, special education, child care, employment, and/or
housing - in order to reach increased numbers of families
and children at risk and to utilize a broader range of
helping strategies. Child welfare agencies have been
criticized for many years for their failure to provide
sufficient early intervention services to families at risk
and their inability to provide appropriate care for children
requiring specialized treatment resources. Yet neither the
State Department of Social Services nor the City's Human
Resources Administration has had the resources and will
required to support any significant expansion of the
traditional child welfare system boundaries. Consequently,
many of the leading voluntary agencies have had to secure
sanction and funding from other public service systems in
order to implement needed program initiatives. While adding
to administrative and fiscal complexity, this move has
clearly enabled them to provide more comprehensive services
to children and families at risk. It raises questions, to
which we shall return, about better cross-system
coordination - or even the need to challenge present system
boundaries.
The fifth important variable relates to the quality of
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staff and the value placed on staff training and morale.
Although most of the programs in our sample, like others in
the field, must struggle constantly with issues of staff
recruitment and retention, they seldom compromise their
staffing standards or expectations. Instead the
administrators devote considerable attention to staffing
concerns, attaching great importance to selection of
professional staff who share the agency perspective on
practice and can be expected to work effectively and
collaboratively with others in the organization. Several of
these agencies have very elaborate staff development
programs, and all place a real value on in-service training
and creation of opportunities for professional advancement.
As a consequence, although a number of the workers
interviewed complained about their salaries and the lack of
available community resources for the clients, all were
quite enthusiastic about their respective agency programs
and spoke very thoughtfully about their own practice and
broader service delivery issues. Moreover, these workers
all clearly defined themselves as having primary
responsibility for case assessment and service delivery.
Although CWA technically holds "case management"
responsibility, in practice the workers in these programs
hold themselves accountable for serving this essential case
planning and coordinating function.
A final important characteristic of the sample programs
that deserves consideration is the importance attached to
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internal measures of quality assurance and service
effectiveness. These programs must, of course, meet the
performance criteria established by their various funding
sources, but the administrators seem to place little value
on these external reviews (except in relation to insuring
continuity of funding). Instead, these programs have
developed their own mechanisms for assessing service quality
and outcome, and the administrators are committed to
ensuring that the programs meet the quality standards they
have established for themselves. In addition, several have
initiated independent studies or participated actively in
research projects aimed at studying their practice. What
seems important about this finding is that it highlights the
readiness of these programs to be evaluated according to
criteria they deem appropriate and the relative disdain
program administrators feel for accountability demands not
related to their sense of professional standards and program
mission.
Unfortunately, little can be said about the key
variable of service model because the study by its very
nature could not lead to any firm conclusions about the
relative efficacy of alternative service approaches in
meeting client needs. Since each of the programs defines
its target population and objectives somewhat differently -
despite general reliance on common funding sources - it
would be meaningless to compare service outcomes. What is
notable is that in each of the sample sites there was a high
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degree of congruence between treatment approach and service
objective. Moreover, there was widespread commitment among
the staff members interviewed in each program to the
theoretical orientation and service approach emphasized by
the agency. Thus what seems to matter is the level of
conviction about the type of service being offered, not the
particular practice approach being followed.
This observation, which may be distressing to those
committed to a particular practice approach, is very
consistent with the findings of many studies regarding the
effectiveness of alternative models of psychotherapy and
social work practice. 4 However, it raises an important
question - as posed above - about the potentially counter-
productive effect of recent efforts to regulate and
structure family and children's service programs more
tightly in the name of protection and accountability,
without simultaneous emphasis on the fact that this field
clearly needs more creativity. Happily, practitioners in
the more successful programs are encouraged to innovate -
and future plans must protect such impulses.
In the course of this study, for example, we have
observed interesting efforts to introduce concepts from
structural family therapy to work with foster parents, to
create more powerful roles for parents in local public
schools, to develop ethnic-sensitive parent training
programs, to teach parents and children more effective
behavioral management techniques, to provide clinical
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services on site to children in day care and school
settings, to develop foster homes for children with AIDS, to
create new models of shared parenting, to maintain youth
with serious behavioral and emotional disorders in day
treatment, and to use the traditional concepts of time and
relationships more creatively to meet both crisis and long-
term service needs. Such innovations are desperately needed
if we are to develop more effective means of responding to
the clinical challenges presented by the very troubled
children and parents coming to the attention of agencies
today.
Directions for Reform
As a new City administration and a new HRA leadership
begin their work, they enjoy a strategic opportunity for
facing basic problems confronting child and family services,
ee of commitments to vested interests and old policies.
Obviously new leadership cannot ignore crises that
arise repeatedly in programs designed to address the City's
most intractable social problems, i.e., child abuse and
neglect, homelessness, AIDS, chronic mental illness, school
failure and drop-out poverty and unemployment. And services
currently in place for various populations cannot be
dismantled until new arrangements are in place.
Nonetheless, this is a time that also calls for stepping
back, asking basic questions, taking bold steps. The City
has been working hard, spending significant funds, and doing
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poorly. There are opportunities and promising suggestions.
Building on the tentative findings of this study as
well as our related national study and prior research on
social services in New York City, we are able to identify a
number of ways that the City could begin to improve the
delivery of needed services to families and children at
risk. It is also possible to specify dilemmas which need to
be resolved and potential trade-offs which cannot be
avoided.
We start with philosophy and basic orientation. What
follows grows out of the case studies and discussions with
leadership in the field: Treatment, service, and
rehabilitation programs for families and their children
should not - indeed cannot - ignore the fact that their
potential clients are living in environments which are major
sources of danger, deprivation and poor models. They are
heavily concentrated in minority populations, among the
poorest of citizens, in the most difficult of neighborhoods.
Child and family development needs broad neighborhood and
community support even as agencies work directly with
individual families, and small groups. Thus the umbrella
for social services is a community development context and a
thrust towards normalization, mainstreaming, integration.
These abstract words are meant to affirm a commitment to
offer the families served resources and opportunities to
share in normal community life - even as they are helped to
confront their personal problems. Nothing else will work.
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When direct help is given, as we shall repeat and
elaborate, it should not be narrowly targeted, categorical
service. It must be family-oriented, holistic, integrated
across formal service systems - in short, a continuum of
care. These are by professional consensus the requirements
for effective work.
The question is inevitably and legitimately raised as
to whether calls for earlier intervention and service to a
broader range of cases than those targeted by CPS and foster
care programs will not lead to an inefficient use of scarce
resources and a loss of public priorities. Would the load
not become so large as to be unmanageable? The answer has
two parts:
(a) First, there are many problems beyond abuse and
neglect, or the lack of a parental capacity to
offer a suitable home environment, that also
represent serious personal and interpersonal
problems. A community cannot ignore these if it
strives to provide adequate environments for
developing children, to alleviate suffering, to
decrease anti-social behavior, and to intervene
where needed in the face of pathology and
difficulty that can only get worse. New York City
has demonstrated in its so-called prevention
programs that it understands this better than many
jurisdictions. It needs to better project and
implement its philosophy.
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(b) Some of the most promising strategies are those in
which a community - centered around an institution
or an agency - asserts its responsibility to ensure
a suitable environment for the development of its
children. There are examples in the settlement
houses of various eras, including the 1960s. One
might cite the illustration in this report of the
Center for Family Life. Such a community response
to its children must involve socialization,
developmental, and direct-service activities. The
children must be served in whatever ways are
necessary, in the context of family and community,
in a spirit well beyond the narrow targeting that
might seem superficially economical and efficient.
The investment of needed funds for this broader
approach is also "efficient" in a long-term sense,
representing an "investment" in precious human
capital. It is affordable if selectively applied
to obvious high-priority neighborhoods.
This much said, we offer specific priority
recommendations:
1) The HRA-CWA-private agency goal shall be to develop
comprehensive, community-based child and family service
networks that feature early access and integrated service
provision.
Every available indicator suggests that it is not good
policy to make child protective investigations the only
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major entry point to services for families at risk or to
make child protective and substitute care services the only
significant elements of a City's child and family welfare
system. Both of these are essential components of any
service network. They should provide the safety net, but
not the totality of response to troubled families.
Families and children at risk should be offered access
to a range of supportive and developmental service
including: child care; parent education; recreation,
socialization, and community development activities;
individual, family and group counseling; respite care and
homemaking assistance; day treatment; and information,
referral, brokerage and advocacy services as needed. These
services, as well as child protection and substitute care,
can be delivered most effectively at the local community
level where they are readily available to families and where
workers know and have ready access to the range of
institutions with which they must collaborate to insure
integrated service provision. Some more specialized
services such as substance abuse programs and residential
treatment facilities may need to serve a larger catchment
area and be located elsewhere, but they can still have
access points in the local community.
A variety of ways to organize such local service
network are found in different places, are proposed, or may
be projected by extrapolating from some of the agencies/
programs we have described. Here we offer for an early
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planning agenda four visible options. The first two derive
from our agency case studies. The third and fourth derive
respectively, from earlier New York City studies and our
national studies. A planning group will want to consider
their respective advantages and issues of feasibility.
We begin first, by explaining what we mean by
"community-based service".
Since the mid 1960s terms like "community involvement",
"local" or "citizen participation", and "neighborhood-" or
"community-" based service have appeared in many discussions
and proposals for reform. These terms carry many meanings,
and efforts to implement them have been difficult and often
disappointing. The advocates have included both people
concerned with the quality of services and those with other
agendas. The opponents sometimes are protecting turf,
sometimes remain committed to outmoded values; but at other
times they may be only cautious. New York City's long
history of efforts at reform suggests the difficulty of the
decentralization task.
If child and family social services in New York City
are to be successfully decentralized so as to rely
significantly on a neighborhood-based delivery system, the
concepts will need to be specified and operationalized in
the course of the planning process. Here we offer some of
our own thinking as part of that discussion.
At the minimum, community- or neighborhood-based (we
217
use the terms interchangeably) refers to location. The
city-wide coverage system should be a physically
decentralized one, offering easy access from all areas.
Also at the very least, these local agencies should have
special sensitivity to ethnic, racial, religious, class,
family-structural, and cultural characteristics of the local
clientele. These are basic tenets of effective social work.
In addition to geographic location, a more fully
developed community-based service program would include
local citizens' involvement in the governance of the service
programs, and some of the local residents in both
professional and other staff roles.
Ideally, a community-based social service delivery
system would be located in a community development context,
in which the large community is at work on its economy and
various aspects of its housing and quality-of-life, with
local residents in many leadership and staff roles in this
community change process, and with the community assuming
responsibility for the conditions of development,
socialization, education and treatment - where needed - of
its children and their families.
We also see "community-based" as carrying yet another
idea. A living community is a place of constant change:
economic, demographic, cultural. One would therefore expect
programs and services to evolve and change not only in
response to broad city-wide and professional initiatives,
but as part of change in the local community.
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All of this requires several caveats which must be
considered by planners.
First, the choice of a local service model in a
community-based system could create a local monopoly which -
we must assume - could in some instances be of poor quality,
or worse. Thus, the planned system must allow "escape"
channels for dissatisfied consumers and those out of tune
with local governing groups. "Equal protection" is a city-
wide criterion.
Second, there are some abandoned children (babies as
well as adolescents) who have no family or community
identifications. Ideally, one would seek localities that
might "adopt" them. However, the City also requires some
service networks and service continua, held together by the
"glue" of case management, which are not neighborhood-based.
They will be conceptualized in functional terms. They would
serve those without community identifications and perhaps,
also, those who do not wish to remain within the local
system.
Third, by stressing the importance of community-based
services, we do not mean to imply that there will be no need
for residential programs. Obviously, such programs will be
needed. Our point here, however, is to emphasize that
sufficient services should be available within the
communities in which children and their families live for
them to have access to support and help while at home,
before problems emerge which might require placement.
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Moreover, we would hope that some residential arrangements
can be made within communities as well so that even troubled
children who need to be removed from their families -
hopefully very briefly - can still remain in their own
communities.
We turn now to a description of four alternative
community-based service delivery models.
a. A Diversified Model of Child and Family Service.
This approach builds on existing voluntary and
public agency initiatives, some of which are most
impressive. It would mobilize local planning capacity
and guarantee new resources to capitalize on voluntary
agency presence and available social service, school, and
health resources. Such an approach would shape the
structure of services differently in each community in
accord with experience, existing programs, and expressed
community needs and preferences. The auspice could be a
voluntary agency, the public agency, or could vary across
the communities. A minimum condition of acceptability
would be assurance that there be a child and family
service network with multiple entry points at the local
level and clear mechanisms for case assessment and
planning, referral and service integration. We have no
doubt that some communities could mobilize the planning
capacity, political will and integrity such an approach
demands. Moreover, they already have the essential core
programs.
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The issue is whether this approach can assure city-
wide coverage and whether (contrary to experiences with
the schools following decentralization) City government
is capable of the needed monitoring, certification, and
coordination.
b. A Community Development Model of Child and Family
Services.
Another model could be characterized as a neighborhood-
based, comprehensive, integrated child and family
service. It is designed to link child protective
services, family support services, adolescent services,
mental health services, residential and non-residential
services, and foster care, all in a community development
program. Such a program, illustrated in part by the
Center for Family Life, as described in this report,
stresses individualized assessment of family need and
refuses to label clients by problem category - or to
accept narrowly categorical funds that restrict sound
agency practice. In some sense reminiscent of the 19th
century settlement houses, but built around sophisticated
therapeutic concepts, this program is designed to provide
the continuum of care and services that may be required
to sustain high risk children and families in their own
homes, to counter the forces that contribute to family
disequilibrium and alienation, to foster access to
normalizing opportunities and resources, and to
contribute to local community development and service
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planning processes.
Here the premise (in contrast to suggestion "a") is
that we know what to do and what the delivery system
should include. The issue is feasibility. The unique
pattern of leadership and dedication in the Center for
Family Life may not be replicable. Perhaps the City
might establish 4-5 such programs in very high need
areas, even if not possible throughout the city; clearly,
the model deserves serious consideration.
C. A Neighborhood-based, Family-focused Access Service
System. (Implementing the Beattie Report)
This is an obvious option, long proposed by experts
in the field, justified by the national study and some of
our own earlier work. 5 The City has long been committed
to it. The City would develop a coverage service in the
form of a neighborhood-based, family-focused access
service (information, referral, brokerage, and advocacy)
in which high risk children and families come through one
doorway with a variety of needs and requests for help.
Case management staff would be the linch-pin for assuring
provision of more specialized treatment and remediation
services from elsewhere in the community, drawing upon
public and private agencies.
It should be stressed that this model assumes public
capacity to staff and operate a neighborhood network,
developing local services which are publicly operated as
well as maximizing use of voluntary "contracting" and
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"purchase" capacity to ensure a sufficiently "rich"
offering in each neighborhood. The broader community
development role would be left to others.
The issue is one of feasibility. It is not yet clear
whether the City's failure to implement the Beattie
report derived from resource lacks, serious deficits in
the management capacity of HRA's social service
personnel, or doubts about the model. We cannot argue
from our current study, therefore, that original
obstacles no longer exist. At the end of 1989, the
outgoing HRA administration seemed to suggest that it
still favored moving in this direction. We do not know
that it is either less or more difficult to achieve than
options "a" or "b". It therefore remains on the agenda.
d. A Cross-systems Initiative.
This model, which derives from the national study,
may be beyond the City's immediate capacity. The cross-
system delivery model points to the fact that many of the
most difficult cases involve dual-diagnosed or triple-
diagnosed children, and siblings or parents with other
multiple problems. It is chance which determines whether
the case originates with law enforcement, child welfare,
special education, mental health - and so on. Current
system boundaries are explained historically but do not
ensure the most effective interventions. The model
proposed is one in which children and families get access
to the helping network through a system of multiple
223
categorical doorways such as abuse/neglect, status
offense, dependency, developmental disability, handicap,
severe mental disorder, retardation, and the like.
Whatever the doorway, there would be one care/ service/
treatment network, organized and administered as a
comprehensive service continuum and delivered by a system
ensuring responsible case management, program
coordination, and the pooling of supportive categorical
funds. The care/service/treatment system would cover the
range of in-home and clinic-based services, individual-
group-family-focused intervention, day-residential-
specialized institutional treatment, foster home-respite-
residential care that now represent the state-of-the-art
for dealing with the social service and mental health
needs of the respective population groups.
The cross-system model requires elaboration and
testing. In the course of explorations, special
attention should be given to the potential role of
schools as either locus or component of community based
service systems. There are currently a number of
initiatives in New York City but no policy or systematic
planning.
Here, too, the issue is feasibility. The potential
problems arise from the categorical nature of many
funding streams, federal and state rules, turf concerns,
differences of orientation among the professions
concerned, and much more. Merely creating a unified
224
children's department, as has been proposed frequently
and attempted elsewhere, does not accomplish much. It
would take a new and strong agency to implement such an
approach. It also would require provision for
decentralized operations - given the city size and the
numbers of categorical services involved.
We conclude our recommendation regarding the
establishment of a system of a community-based, family-
focused child and family service system by noting that we
could argue either for a uniform pattern of service delivery
throughout the City, with the City choosing one of these
models, or for a diversified pattern, with City and
community planners together agreeing on whichever of the
models seems most appropriate for that community. We would
argue strongly, however, that whichever pattern is selected,
the model should be implemented with particular alertness to
the cross-system linkages stressed in "d." above - and with
assurance that all communities would in fact have coverage.
The choices made should reflect philosophy, readiness
to undertake major resource commitments, expected management
capacity, and estimation as to feasibility. The City needs
a reliable, visible coverage plan that can be monitored as
to its progress. The current pattern is so confused and ad
hoc as to defy management control and public monitoring -
and it frustrates those who need help.
2) Urgent attention must be directed to establishing
225
mechanisms to facilitate joint public-voluntary sector
planning at the central and community district levels.
Because of fiscal and political constraints in the
public sector and historic tradition, leadership in the
development and delivery of child and family services
(except for child protective services) is often exercised by
those in the voluntary sector. Yet the public agencies that
have mandated responsibility for delivery of various
children's services shape voluntary service provision
through control of funding. Unfortunately, the major public
and voluntary agencies often enter into adversarial
relationships because of tensions around service regulation
and funding. Moreover, instead of working together to
develop coordinated service plans, the different public
agencies with responsibility for children's service often
function in a competitive manner or simply work on parallel
tracks, ignoring the overlap among their target populations,
contract agencies, and service objectives. As a consequence
of these dysfunctional relationships, planning efforts aimed
at the development of comprehensive, community-based
services are frequently thwarted. No lasting, considered
choices are made among the delivery-system options cited
above - or others.
To address this problem, we would recommend that
mechanisms be created and mandated for joint public-
voluntary service planning at the citywide and, eventually,
the community district levels as well. Given historic
226
tensions described above, such planning will not be easy to
implement. Therefore, it is important that the Mayor's
Office assume responsibility for developing and staffing a
citywide joint planning body (which eventually would take
responsibility for organizing the local planning groups
essential to several of the options) and for insuring that
the various child serving agencies participate and implement
whatever recommendations are made. Without such action,
little real change can be anticipated and the City will
persist with alternative, shifting delivery models and
expensive but poorly meshed public and private programs.
The history of New York City children's programs and of
several decades of studies, panels, commissions, and
reorganizations is sufficient to remind all concerned that
creating effective public/private planning will not be an
easy task. It will be particularly difficult because of the
need, already identified, to protect agency creativity and
initiatives in the context of strong overall citywide
leadership, provision for accountability, and unambiguous
choices with regard to programs and priorities.
Some of the elements of an agenda for planning which
must be taken on by City Hall personnel assigned the task of
facilitating a planning process would be the following:
- How to ensure the availability of Mayoral power to
overcome blockage and obstacles.
- How to define the boundaries and locus of the
planning system. CWS is a big component but the
227
scope and vision must be larger. Planning should
cover not only all relevant HRA components but also
as many of several other elements as can be dealt
with effectively, and offer a high probability of
implementation: Elements of mental health programs?
Some health components? Some school-based programs?
Some court services? Developmental disability
programs? Only some of these? Others? The core
CPS, foster care and preventive programs only?
- The appropriate involvement of the State. The State
systems that are related to the above components are
essential partners. Just how much they can
contribute to the planning process per se will depend
on other State decisions (how much involvement
precludes oversight?).
- The readiness of the City to offer strong leadership,
given its public mandate and the public role as the
major funder of these programs. This also involves
monitoring and accountability machinery, the
development of public service capacity or "excess"
and redundant capacity in some fields, if the City is
not to be hostage, for lack of alternatives, to
defiant and unsatisfactory agencies.
- Simultaneous determination to plan so as to encourage
community-based services, community involvement, and
participation, in the sense outlined above - and to
support innovative and creative leadership both
228
within the public bureaucracy and in the voluntary
sector.
An early topic for a planning agenda would be the issue
of public/private "parity". Parity would be a useful early
goal, even if not immediately attainable. The system is
plagued with resentment and staff instability created in
part by inequities in salaries, caseloads, fringe benefits,
job qualifications, and working conditions between and among
public and private agencies, agencies with different target
groups or in different "systems", agencies with good
endowments and those unable to supplement what they receive
through public contracts.
The inequities run in several directions. Although we
might cite many illustrations, they are readily at hand.
They need to be considered if reform is to take hold and be
effective. The parity principle would be: equal job
qualifications, pay, fringe benefits, and working conditions
for similar work - whether in a public or a voluntary
agency, in one system (social services, health, mental
health, education, etc.) or another. Achievement of full
parity could take some time, but effective and significant
improvement is within reach.
3) It is urgent in the context of reorganization and
planning efforts that City representatives work with state
and federal officials to institute administrative
regulations that encourage pooled funding of integrated
service programs and use of coordinated multi-year contracts
229
and compliance review mechanisms for voluntary provider
agencies.
As discussed repeatedly in the body of the report,
program administrators find that categorical funding is one
of the key obstacles to comprehensive service delivery. Yet
given the nature of our political system, it seems
inevitable that some significant public funds will be
directed to specific "problem" populations that have
captured public attention and concern. Therefore agencies/
programs attempting to provide more comprehensive services
must develop their own means of coordinating the monies
available through discrete funding streams and pooling the
funds. Experienced large-program administrators with
sufficient resources and vision are often quite skilled at
inventing solutions, but small programs are at a distinct
disadvantage in this process; and many find it easier simply
not to bother trying to integrate services. Public agency
administrators could help to address this problem by working
out coordinated contracting and contract review guidelines
and negotiating with federal and state officials to develop
simplified procedures for obtaining waivers to regulations
that restrict pooling of program funds and staff or that
limit client eligibility and services in unrealistic ways.
We have concluded that neither New York City nor New York
State has fully grasped the possibilities.
Unlike the majority of states which have state-operated
systems of personal social services, New York's is a state-
230
supervised, locally-operated system. Nonetheless, the State
is in a position to encourage and support City initiatives
and to intervene in Washington on behalf of the City.
Without active State support, the City cannot achieve
greater flexibility in using resources. The State is called
upon to address itself to measures which will help the City
confront a serious crisis. There are exemplars of stronger
state leadership in other states with county-operated
systems.
4) As the City moves to strengthen its delivery system
and enrich its offerings, it should give high priority to a
coordinated management information system able to provide
the demographic, social problem, service availability, and
utilization data required for effective service planning and
evaluation across the various child and family service
systems.
One of the major deterrents to comprehensive service
planning is the fact that each of the public child and
family service agencies now maintains its own - often rather
antiquated - data collection system; and some also maintain
separate record-keeping systems for each program, in
response to contract requirements. Since these information
systems often use different definitions of unit of service,
client contact, program year and so forth, it is almost
impossible to aggregate data from different programs or to
make meaningful inter-agency comparisons. Moreover, program
data are seldom related systematically to information about
231
community district needs that can be derived from census
data and other data available from the City's Department of
Planning. There can be no realistic planning for
comprehensive service provision without an adequate
information base. Therefore, development of a coordinated
management information system for delivery of child and
family services should be given high priority on any reform
agenda.
5) Government programs at all levels, as well as
private foundations should be urged to give new and
increased attention to delivery system concerns, assigning
priority to support of innovative program ideas that reflect
a clear sense of agency service mission and are or can be
linked to an established service network.
It is urgent to encourage small, creative initiatives
without obvious pay-offs. However, the overall "portfolio"
for a funding source might attend more regularly to the sort
of delivery system impacts not likely to accrue from the
very small, unconnected "project". At the very least, if
they are not to be lost, efforts might be made to link
successful small, free-standing creative initiatives to
larger systems. In this context it is also important to
emphasize that service strategies that integrate direct
clinical interventions with case-level advocacy, concrete
services, and community development efforts seem to offer
more potential for helping disadvantaged families than those
that rely on a more limited service repertoire. Also, as
232
already noted, those that stress early intervention with
families in which children are at risk seem likely to
achieve more meaningful and cost-effective change than those
that are targeted only on children already experiencing
serious psychosocial problems.
The latter programs, of course, are equally deserving
of help, but we stress that children with complex problems
seem to be served most effectively in programs that reach a
broader target population. Moreover, since publicly-funded
services are now directed almost exclusively to children and
families who are already harmed in some significant but
narrowly categorized way, some limited private funds should
be directed at programs designed to prevent these harms;
others should break out of traditional boundaries. The most
promising initiatives at present seem to be those that
attempt to stretch or cross the boundaries of traditional
child service systems in order to pursue more comprehensive
interventive strategies. Thus these may offer the "best
bet" for investment of demonstration service funds.
6) Public funds will need to be heavily invested in
solving the current staff recruitment and retention problems
and in expanding the pool of qualified people able to assume
top leadership positions in the child and family service
field.
Staff vacancy and turnover rates in both the public and
voluntary service sectors have reached almost scandalous
proportions. For example, a survey of the member agencies
233
of the New York Council of Family and Child Care Agencies in
1988 indicated that there had been a 47 percent coverage
turnover in preventive service workers the preceding year 6
Turnover in some parts of CWA has been reported at times to
be even higher. There can be little hope of enhancing
service effectiveness without addressing the staffing
problem. And the obvious place to start is by increasing
salaries substantially for staff at all organizational
levels. It is difficult to make such a recommendation in
the context of the City's current budgetary crisis, but
there is no choice. Social workers in child welfare
agencies traditionally earn significantly less than those in
many other fields of practice. As the City has had to find
the money required to increase salaries for public school
teachers and nurses, so must it obtain the funds needed to
raise salaries for child and family service workers.
Although agency administrators generally attribute
their staffing difficulties to the low salary structure in
child welfare services - and this may well be the primary
factor - there is strong anecdotal evidence suggesting the
impact of other contributing variables as well. Agencies
such as JBFCS that offer both mental health and child
welfare services report higher turnover rates in their child
welfare programs, despite uniform salaries and fringe
benefit packages. Graduate students in school of social
work who are interested in practice with children and
families generally prefer field placement in mental health
234
or school-based settings to those in child welfare agencies.
Caseworkers and supervisors in the CWA, including those who
enjoy the small salary differential provided in child
protective services, often request transfers as soon as
openings are posted for parallel positions in other
divisions of HRA. These trends all suggest that low
salaries are not the only factor contributing to staff
recruitment and retention problems in this field of
practice. Some of the other variables suggested by
conversations with workers and supervisors include fear of
mandated home visits in dangerous neighborhoods; excessive
paperwork and accountability demands; frequent
administrative and court reviews that limit workers' sense
of professional autonomy; the frustrations practitioners
often experience in attempting to achieve significant
progress with families and children who are already very
damaged; the inappropriateness of the traditional
psychotherapeutic model of practice that many workers would
like to employ for most of the clients served in preventive
programs; limited opportunities for participation in
advanced training and staff development programs that
promote growth; and diminished respect for professional
expertise in a system increasingly dominated by legal and
management concerns.
Given these conflicts, there is obvious need for
increased public funding not only to raise staff salaries,
but also to identify and address the problematic working
235
conditions that discourage talented professionals in
general, and potential minority leaders in particular, from
building careers in this field of practice. Without
sufficient numbers of committed, skilled workers and
administrators, few real changes can be anticipated in the
quality of service delivery.
7) There is need for one or more forums and practice
exchanges to support growth of the system and sound
planning.
The group discussions and individual interviews during
and following our field work disclosed that private agency
executives and top staff would regard it as most useful to
meet for exchange of experience and views, and to explore
difficult questions of policy and philosophy among
themselves, and with their public counterparts, as well as
with academics and researchers in the field. We were
surprised at the expressed need until it became clear that
whereas these are people who often meet, it is in the
context of negotiations, complaint, advocacy, and problems
of the moment. They and the system could benefit from
opportunities for more relaxed exploration and probing in a
neutral environment.
A closely related need, perhaps overlapping, is for a
"practice exchange". Dissemination of professional practice
and programming experiences and its possible adaptations and
variations may take too long given the City's size, agency
competition for the resources, and the lack of suitable
236
communication vehicles.
Foundations, coordinating bodies, and educational
institutions may be in a position to experiment with
creating one or more forums or practice exchanges.
8) Several specific research and demonstration
questions merit emphasis, as the City seeks a firm basis for
improved planning and administration.
The study raised a number of important questions that
cannot be fully resolved without additional research.
Several are highly relevant to any effort to reform current
modes of service delivery in New York City. Therefore,
while urging some parameter-setting planning at once, we
conclude by recommending more systematic study,
demonstration, and experimentation aimed at expanding
knowledge related to the following questions:
a) What are the trade-offs inherent in offering school-
based support services to children and families at risk
through programs run under different auspices? Are such
school-based services most effective under the direct
auspice of the local school, the community school district,
or the Board of Education? Are they better placed under the
auspice of a designated community-based organization (CBO)
or a number of local CBO's? or should they evolve through a
community/school initiative that establishes a partnership
between the local school, one or more local child and family
service providers, and the school parent organization?
There is now widespread support for the idea of using
237
public schools as the entry and focal point for the delivery
of a range of needed child and family support services and
for making fuller use of the school buildings on a year-
round, extended day, evening and weekend basis. Moreover,
as reflected in this study, there are now a wide range of
school-based service programs established for different
purposes with different target populations and operated
under different funding streams and organizational bases.
This may be a promising trend. Yet little is known about
the relative merits and costs of these various service
initiatives or whether this use of schools should be general
or limited to high-risk communities.
The experience with the Brandeis programs suggests
serious limitations in a model in which the school merely
reproduces the unresolved problems faced by the City, but
now in a more "miniature" form (to deliver services
directly; to contract with one agency; to contract with
multiple agencies - and if so, how to monitor contract
agencies.) Before the City makes a major investment in any
particular approach or large expansion, - or decides to
reduce funding for what are often viewed as nonessential
services - it would seem important to conduct comparative
evaluation studies. In this context it might also be useful
to analyze the relative advantages and disadvantages of
school-based family support services versus those based in
free-standing social service agencies.
b) How can case management responsibilities best be
238
allocated to insure continuity and integration of services
over time and across service systems? The very concept of
case management has lost much of its original meaning in
recent years because of the State requirement that there be
a "single case manager" for each preventive service case,
responsible for completing or monitoring completion of the
State Uniform Case Record (UCR). In the City this
requirement has been handled by labeling as case managers
the CWA accountability workers who review the UCR's prepared
by the contract preventive service workers. But since these
workers never even meet with clients, it is absurd to assume
that they can serve a true case management function. At the
same time, although the preventive service workers often
attempt to provide case management services in the sense of
defining themselves as having primary responsibility for
case assessment, service planning and coordination and
offering a range of therapeutic, concrete, and
brokerage/advocacy service, they have no real authority to
assume this role. Moreover, they are often undermined in
their efforts to implement various service plans by
decisions made within CWA, other parts of HRA, or other
service systems.
There can be no real solution to the dilemma of how
best to allocate case management responsibility without
careful demonstration projects aimed at assessing the trade-
offs inherent in various approaches. As discussed in the
report of the national study, there are now a number of
239
ongoing efforts to examine alternative case management
strategies. But because of the unique circumstances
governing delivery of family and children's services in the
City (historic heavy reliance on voluntary agencies, State
regulations regarding the UCR, multiplicity of public and
voluntary agencies involved in service delivery), it is
unlikely that any of the case management strategies that are
successful in other areas can be adopted here without
extensive modification. Since the ambiguities regarding
responsibility for case management within and among City
service agencies will hamper any effort to insure more
comprehensive service provision, demonstration projects
aimed at identifying more effective means of providing case
management services should be given priority on any research
agenda.
One dilemma deserving attention in this context is the
claim of some foster care agencies that given their broad
range of responsibilities and intimate knowledge of case
needs, there are circumstances when the agency with children
in care should also be defined as the family's primary
service provider - and carry case management responsibility.
c) What changes should be initiated in the service
delivery system to promote better recruitment and retention
of highly qualified professional staff? As discussed above,
the traditionally low salary structure in family and
children's services, particularly as compared to other
fields of social work practice, poses the major barrier to
240
staff recruitment and retention. But salaries are not the
only determinant of career decisions. Although a number of
other variables such as working conditions, safety concerns,
paperwork demands, and lack of professional autonomy have
been identified as possible contributors to the current
staffing crisis in child welfare, there are no hard data
available. What is known is that there are significant
differences in the capacity of different programs to attract
qualified staff within and among agencies paying roughly the
same salaries. It is also very clear that no program of
service can be effective without knowledgeable, skilled
staff. Thus there is an obvious need for research designed
to identify the program variables that motivate or
discourage talented workers and the types of changes - in
addition to improved salaries - that could be implemented to
enable child and family service agencies to attract and
retain sufficient numbers of competent, enthusiastic staff
and to expand the pool of professionals able to assume top
leadership positions.
* * *
We have focused in these recommendations on those
local, state, and federal officials who control policy and
funds, as well as on the large and small agencies who must
work to improve the public-private planning partnership and
delivery systems. The responsibility goes further, however.
Private foundation funds offer critical leverage and
encouragement; we have urged that they increase their
241
alertness to the need for practice and program innovation
and to delivery system context. (Some research leads are
listed above). Citizen advocacy groups and voluntary agency
board members are critical in informing the public and
interpreting rather complex issues, in the midst of case
"crises" and media hysteria. Unless they, too, align their
efforts with basic solutions, the specialists and agency
interests will not have the necessary credibility.
In short, the crisis in child and family social
services is a Citywide crisis. Improvement will depend on
the responses of professional, political, civic, and citizen
groups at all levels and throughout the City and State. The
history and traditions of this City give grounds for
optimism.
242
Notes
1
See, for example, Committee for Economic Development,
Children in Need: Investment Strategies for the
Educationally Disadvantaged (New York: Committee for
Economic Development, 1987) ; Ford Foundation Project on
Social Welfare and the American Future, The Common Good:
Social Welfare and the American Future (New York: The Ford
Foundation, May, 1989) ; Report of the Commission on the Year
2000, New York Ascendent (New York, June, 1987) ; and
Manhattan Borough President's Advisory Council on Child
Welfare, Failed Promises, Child Welfare in New York City: A
Look at the Past, A Vision for the Future (New York, July,
1989).
2
Sheila B. Kamerman and Alfred J. Kahn, Social Services
for Children, Youth and Families in the U.S. (Greenwich,
Conn: Annie E. Casey Foundation, June 1989), p. 267.
3
Thomas J. Peters and Robert H. Waterman, Jr., In Search
of Excellence (New York: Warner Books, 1982), p. 279.
4
See, for example, Morris Parloff, "Psychotherapy and
Research: An Anaclitic Depression", Psychiatry, Vol. 43
(November 1980), pp. 279-283; and Lynn Videka-Sherman, "The
Harriet M. Bartlett Effectiveness Project Report to NASW
Board of Directors" (Silver Springs, MD: National
Association of Social Workers, July 10, 1985).
5
Commission on Human Service Reorganization, Richard I.
Beattie, Chairperson, Outline for Action: New Directions
for HRA (City of New York: Office of the Mayor, 1985);
David Tobis, Restructuring the Human Resources
Administration: The Implementation of the Beattie
Commission Report (New York: Foundation for Child
Development, 1986) ; Brenda G. McGowan, Jeanne A. Bertrand,
Amy Kohn, The Continuing Crisis (New York: Neighborhood
Family Service Coalition, 1986). For earlier formulations,
along similar lines, see: Alfred J. Kahn and Sheila B.
Kamerman, "The Course of Personal Social Services" Public
Welfare, Vol. 36, No. 3 (Summer 1978), pp. 29-42; and Alfred
J. Kahn, "New Directions in Social Services" Public Welfare,
Vol. 34, No. 2 (Spring 1976), pp. 26-32; Sheila B. Kamerman
and Alfred J. Kahn, Social Services in the United States
(Philadelphia: Temple University Press, 1976) ; Citizen's
Committee for Children of New York, A Dream Deferred: Child
Welfare in New York City (New York: Citizen's Committee for
Children of New York, 1971). One might cite many others.
6
Council of Family and Child Caring Agencies, Children
At Risk (New York: Council of Family and Child Caring
Agencies, June 1988).
APPENDIX MATERIALS
A-1
Appendix A.
Executive Summary from the National Study
Social Services for Children, Youth and Families in the U.S.
This is the report of a two-year study of alternative
approaches adopted in states and counties around the country
to delivering social services to children, youth and their
families. The focus is on public social service agencies
and the private agencies that also deliver these services,
usually with public funding. Two large private (voluntary)
agencies were included in the study to clarify certain
issues. Our overall objective was to identify patterns of
service delivery that are working reasonably well - or have
the potential for working well - in the current environment
of social policy and social problems, and to locate service
initiatives that seem promising.
The study was funded by the Annie E. Casey Foundation
and co-directed by Sheila B. Kamerman and Alfred J. Kahn of
the Columbia University School of Social Work.
As used here, the term "social services for children,
youth and families" refers to programs with names such as
the following:
- child welfare services (foster care, adoption,
etc.)
- child protection services (child abuse and
neglect services)
- residential treatment services
- family counseling, family preservation, and
family support services
- adolescent pregnancy and parenting services
- parent education and parent aide services
- adolescent social services
A-2
- youth services.
We organized the study so as to provide an overview of
the current state of social services for children, youth and
families nationally. During the 1980s these services
underwent a series of changes as a result of both federal
policies and developments in the society. These changes,
imposed on what appeared to be an increasingly overburdened
system, created crises in some places, uncertainty in
others, and pressure everywhere. The full report
constitutes a state of the art review of child and family
social service developments around the country, a conceptual
framework for discussion of the issues, and proposals for
improving delivery systems.
Our study "sample" included 25 sites where we spent an
extensive amount of time and 3 that involved only one-day
visits, many other interviews, and reviews of countless
reports. The sites were selected to include both state-
administered social service systems (e.g. Florida,
Massachusets, Maryland) and state-supervised, county-
administered systems (e.g. Ramsey and Hennepin counties in
Minnesota, Los Angeles, New York City). Furthermore, they
were selected to include public agencies that delivered most
of their social services directly as well as those that
purchased most services from the private sector. We
deliberately included several very large cities: Baltimore,
Los Angeles, New York, Boston, Miami. In selecting our
sites, we followed the recommendations of well-informed,
A-3
recognized national experts in the field. Before making our
final decisions we explored alternatives and discussed
criteria for selection with staff and leadership of such
organizations as: American Public Welfare Association
[APWA], Child Welfare League of America [CWLA], Children's
Defense Fund [CDF], various governmental associations,
Congressional staff, foundation executives, other
researchers.
The structure of the report is as follows: Chapter I
provides a picture of the problems facing social services
for children, youth and families around the country and some
of the factors that seem to account for developments.
Chapter II focuses on historical background and legislative
enactments that shed further light on the current service
delivery system. Chapters III and IV describe in some
detail the alternative coping strategies for service
delivery, as seen in our state - county - city - voluntary
agency case studies. Chapter V explores some cross-cutting
issues and Chapter VI describes and assesses the "social
innovations" emerging in public child and family agencies.
Finally, Chapter VII presents our conclusions and
recommendations. This Executive Summary covers report
highlights.
A-4
THE PROBLEMS FACING SOCIAL SERVICES FOR CHILDREN, YOUTH AND
FAMILIES
The major problems that we identified as facing the
child and family social services include the following:
- Child Protective Services (CPS) (covering physical
abuse, sexual abuse, and neglect reports, investigations,
assessments, and resultant actions) have emerged as the
dominant public child and family service, in effect
"driving" the public agency and often taking over child
welfare entirely. A repeated theme in state after state,
county after county, is that the social service system has
become so constricted that children can gain access to help
only if they have been abused or severely neglected, are
found delinquent, or run away. Doorways for "less serious"
or differently defined problems are closed. Many
communities cannot serve "voluntary" cases. Even for
accepted cases, the needed help may not be forthcoming, or
if it is, may not be adequate.
- Despite some important positive results, P.L. 96-272,
the Adoption Assistance and Child Welfare Act of 1980, has
had some unanticipated and negative consequences for child
and family social services. Foster care has been denigrated
and the system suffers as a consequence. There has been an
enormous increase in paperwork and compliance monitoring,
creating additional burdens for administrators and staff.
- Increased numbers of seriously troubled adolescents,
very young children, babies, and multi-problems youngsters
A-5
now are entering the child welfare system and community
service network without sufficient increases in financial or
professional resources to provide the specialized help these
youngsters need.
- The major new and serious social problems that have
emerged in the 1980s also have placed new burdens on child
and family social services - once again without any increase
in resources. These new problems include the dramatic
increase in drug addiction, homelessness, AIDS, as well as
the growing numbers of deinstitutionalized or not-
institutionalized young developmentally disabled and
mentally ill, some of whom are also becoming parents now.
- The inadequacy of federal funding for social
services, as contrasted with expectations generated by
legislation and legislative history, the decline in the
availability of urgently needed professional staffs, and the
absence of a federal presence in the field have created
major problems almost everywhere.
- The inconsistent, unclear, and often inappropriate
interventions of some courts create additional problems for
staff and administrators in the social services. On the
other hand, court interventions can also be and sometimes
are effective instruments of direct service and reform.
Inadequate social service reports and poor CPS staff
performance often frustrate court efforts. How to
strengthen the positive contribution of the courts while
reducing their negative role presents an as yet unresolved
A-6
problem despite the presence of very successful exemplars.
- It is difficult to obtain a clear national picture of
child and family social services because of the inadequacy
of national data regarding: the numbers and characteristics
of the children in the system, the characteristics of
providers, the supply of services, the interventions used.
There is considerable inconsistency in the terms used to
describe child and family social services and their
component parts, yet these are points of departure for data
systems.
THE PATTERNS OF COPING
We began the study with a search for "exemplars" which
might be offered as models but found instead several
different patterns, some experimentation and innovation, and
some interesting thinking. We found several exemplary
components of delivery systems but not any model systems.
The states and the counties within states have both
richer and poorer social service offerings. There is very
little geographic equity in the response to major social
problems affecting children and families either across
states or even within states. For those who would set
objectives for the future it is useful to understand two
things: (1) Various jurisdictions are striving to achieve
quite diverse service coverage goals, being influenced both
by resource realities and conceptions of what government
should be doing in this field. (2) The consequences for
A-7
children and families of the quite narrow offerings in some
departments are in part determined by what other public
departments or private agencies in their areas may, or may
not, have available.
There has been a general trend towards greater
targeting in recent years. Governors, legislators, and
commissioners are affected by federal incentives and
compliance requirements and by media pressure growing out of
statistical reports of social problems and dramatic case
stories. They have variously committed themselves to
concentration on those groups seen as having "emergency" or
"most serious" problems. In the social services field this
usually means alleged child abuse and neglect. Among those
other groups receiving special attention in one place or
another are: delinquents, the severely mentally ill, the
developmentally disabled, the abused frail elderly, AFDC
recipients, teen-age mothers, babies born addicted to drugs,
babies born HIV-infected. Less-favored categories may not
be ignored, but resources are limited, and they are not the
centers of attention.
The widespread presence of targeting, on the premise
that public resources are limited, means a general
acceptance of the social service system's inability to
undertake much prevention activity or to offer much service
to those with chronic problems which do not explode
dramatically - or have not as yet. The specific
implications of targeting in a given community will depend
A-8
upon the answers to several questions: How narrow is the
targeting? What occurs in connection with the targeting?
One can target and do the minimum considered to protect
child and/or community - or one can deal extensively with
the problem. Or one can settle on something in-between.
Targeting, in brief, is the overall strategy but it is
an umbrella approach which covers some major variations.
Among the targeted systems, some find that they must limit
themselves to the core child protective service (CPS)
functions, whether for reasons of resource constraint or
because that is all that local philosophies support.
Others, aware of the varied and complex needs of children
and families brought into that system, operate a targeted,
but enhanced, CPS program. They go beyond reports,
investigations, assessment, supervision/placement. They
provide at least some sorts of specialized help and ongoing
service.
Some go beyond the CPS doorway or repertoire. These
may be identified as child welfare agencies in the 1950
sense of the term, serving dependent, neglected, abused, and
status offender cases. Some are very traditional, "carrying
cases" for long periods, heavily engaged in foster care and
adoption and little else, but less diffuse in service than
in an earlier era because they are impacted by the
requirements and philosophies of P.L. 96-272. Others offer
some innovative programs of several kinds but are seldom
able to meet the full range of needs presented. They are
A-9
under constant pressure for ever more targeting.
There also is what might be thought of as an enhanced
child welfare program, which is in part integrated with
other systems. At its best, we would describe these as
child and family service programs. Varying by state agency,
mandate, and structure, family and child services in such
places may variously include components from child mental
health, delinquency and/or status offender programs,
occasionally maternal and child health, sometimes adolescent
family life or adolescent parent services. This range may
appear in a child and family division of a human resource
agency (with one of many alternative names!) or in a
special, spin-off children's department.
There also are what we might sum up as "new vision"
proposals: the delivery system may be one of the above,
most likely enhanced child welfare, but there is also
present the goal of placing the child and family service
response in a community development context, emphasizing
community (meaning church, business, school, etc.)
"ownership" of children's problems and seeing the social
service component only as the direct, formal service element
in a network where others should "prevent", "case find", and
help cope.
In the full report each of these four "patterns" is
illustrated with reference to specific sites.
In addition, we note the special problems of the big
cities throughout the country. They pose an overwhelming
A-10
challenge to child and family social services everywhere;
there are no exemplars. The scale and intensity of social
problems are enormous. We describe developments in such
cities as: New York, Los Angeles, Boston, Miami, Baltimore.
We raise questions, identify some possibilities, but offer
no solutions. This is indeed an area needing further
attention.
We also identify a series of ongoing and emerging
issues that require attention if there is to be any serious
effort to improve social services for children and families.
Among these are: the role of the voluntary sector, likely
to become even more important given the increased purchasing
of care from such agencies by the public departments; the
problems of staffing, professionalization, and leadership;
the need for review and reform of foster care as a
consequence of the declining pool of foster parents in some
places and/or the increased demand for higher quality and
more specialized foster care; the complex relationship
problems between courts and child/family social services;
and consent decrees as change instruments.
We have explored several innovative practice and
administrative initiatives, developed either as important
components of coping strategies or (in one instance) as an
alternative method of service delivery. We have confined
our use of the term "innovation" in this context to
developments occurring in several places, to "movements" or
"trends". No matter how interesting or attractive, the
A-11
free-standing local experiment or demonstration that has not
yet "taken off" is not included.
The innovations to be discussed include some that are
directed at specific work with the individual case and
others concerned with administrative practice and structure.
The two are inevitably and properly intertwined. Our
discussion proceeds in the following sequence. First, we
describe the strategies directed at facilitating a more
integrated approach to service delivery: case management;
flexible or pooled funding; structural reorganization.
Second, are the innovations designed to achieve a more
holistic view of families with children and a client or
neighborhood focus for service delivery: intensive, home-
based services; family support services; neighborhood based
child and family services in a community development
context. Third, are the services designed to facilitate the
processing of cases: case review panels and teams; risk
assessment tools; the use of automation and personal
computer technology.
We conclude this discussion by noting that regardless
of how creative they may be, and how effective some are,
none yet constitute the basic components or framework for a
full service delivery system.
A-12
MAJOR CONCLUSIONS AND RECOMMENDATIONS
Here we summarize our major conclusions and
recommendations.
1. Public Education. It is most urgent that civic leaders
and public officials find opportunity to talk to the public
regularly, directly, and frankly about the major social
problems, child and family needs, and social service
requirements which must be faced. Only such continuous
efforts will win support for the policies needed: to
prevent serious problems; to ensure helpful, systematic
response to those in difficulty; and to avoid crisis-
reactions which do not improve conditions at all.
2. The Role of Government. While government cannot "fix"
all families and should certainly not intrude unless
essential, government in a complex modern society cannot
forego a major role in ensuring both the universal services
and benefits necessary for all citizens and a continuum of
specialized services for those families and children in need
of individualized help.
3. A Strong CPS. All localities require strong child
protective services (CPS) and should be expected by their
state governments to meet the standards for such services as
promulgated by recognized national standard setting groups
(NAPCWA, CWLA, AACP).
A-13
4. Targeting Is Not Enough. While current targeting of
helping programs and resources in many states on only the
most severely abused and neglected children is certainly
understandable, it is not wise. Communities are called upon
to do more. There are others in the society who are
seriously troubled and troubling. If they are not noticed
and helped, indeed if they are turned away, their problems
will become acute. Of course it is not appropriate to
intervene coercively with families where there is no
statutory mandate to do so. However, this does not justify
public neglect of others, a refusal to offer help, a failure
to respond to a cry for aid.
5. Comprehensive Child and Family Social Services. Because
localities must go beyond narrow CPS targeting, if they are
to help many families and children in serious difficulty,
CPS - even effective CPS services - cannot be considered the
totality of a local child and family service system.
Communities should be helped to obtain whatever assistance
and resources are needed to locate CPS in a more
comprehensive child and family social service system. At the
minimum they need to add enhancements to the CPS.
6. The Search for Cross-System Reforms. Even larger reforms
are essential, clearly called for by the many complex cross-
system issues facing social service delivery systems. It is
A-14
urgent that leadership communities, state agencies,
foundations, and national organizations undertake to
explore, define, study, and test possible models for such
reforms.
Child and family problems do not neatly divide
themselves into: "foster care", "child abuse and neglect",
"special education", "mental health", "juvenile justice",
"developmental disabilities", "teen pregnancy", "runaways",
and the rest. The same children appear in different systems
at different times or at the same time. The most difficult
child and family problems in all systems are the "dual" and
"triple" diagnosed problems.
Current systems evolved in their present roles and
missions long ago. The goals of efficient and effective
help for children today call for either (1) a rethinking of
the boundaries and roles of major systems (what services for
children can and should be located in schools, medical
programs, social services, recreation, etc.?) ; or (2)
identification of the most successful modes of cross-system
cooperation, coordination, administration/management.
There are small beginnings in the form of organizational
innovation, demonstrations, and experiments in a number of
places. Careful analytic work and research on cross
national issues has become urgent.
7. The Special Big-City Problem. Big cities are a complex
and very major problem arena for child and family services.
A-15
There are no visible exemplars. It is urgent that
government, the foundations, and the cities themselves find
or create vehicles for exchange, exploration, cooperation,
and experimentation with new service delivery modes.
8. Restoring the Federal Presence. The needed improvements
in service delivery must eventually be achieved at the local
and district levels. Strong state support is required if
this is to occur, and some states have shown the way.
However, for full success there is need as well for a strong
federal presence as elaborated in the report. Such federal
presence does not now exist despite implicit and explicit
legislative and administrative commitments. This is a
problem for immediate attention by the Administration,
Congress, and the interested public.
9. Foster Care and the Future. Foster care, a service
system facing major transitions, must be a major component
of the needed reform in the child and family social
services. New and complex problems experienced by the
children needing help, as well as the demographic and labor
force changes which affect the supply of foster parents,
join to confront foster care with its largest challenge in a
century. Creative and stronger supportive action is called
for from federal and state governments, leading foundations,
national organizations, professional associations and
schools of social work. We have outlined some initial
A-16
suggestions.
10. Enriching the Service and Practice Repertoire. The
child and family service systems in place are not adequately
responsive to the complex and intertwined needs of the
children and parents in need of help. Apart from personnel
and resource issues, and from the needed reform of the
delivery system, we refer here to the repertoire of helping
measures and its need for enrichment, expansion, and
updating. There are encouraging beginnings with family
preservation, case management, family support and other
efforts we have reviewed; but much more is required. Here
we call attention to the special opportunities for
government, foundations, and the voluntary sector to
encourage and support creativity and new initiatives. We
also note the importance of funding which will convert small
initiatives into "standard" services systems.
11. Funds Are Needed. Social services are not big budget
items in a national social program budget that includes
social insurance, public assistance, medical care, and
education. Nonetheless, serious social service reform will
require new funds; and this is an era of tight federal
budgets. States have been increasing their participation
and some will need to do more. The problems involved are
too central to the quality of American community life and
the well-being of large numbers of children and families to
A-17
be deferred to other times. Advocates of reform therefore
must and do give support to those officials who undertake to
raise sufficient revenue for urgent public purposes.
12. Staffing Policy and Strategy. The major crisis in the
staffing of on-line child welfare operations is variously
explained and not experienced in the same way everywhere.
Few jurisdictions have escaped the problem, however. The
fact that there is as yet no consensus as to answers makes
it ever more urgent that answers be sought. Some issues,
points of view, and measures available have been discussed.
National leadership organizations, public and voluntary
agencies, professional schools, and accrediting bodies
cannot continue to ignore this central challenge.
13. Social Service Reform Alone Is Not Enough. We conclude
with a reminder: Social services are essential for helping
troubled children, youth and families. At their best, these
services rescue, sustain, help, rehabilitate and even enrich
development. Nonetheless, only the naive or the
irresponsible would blame major social problems on social
service failures or claim that social services reform will
eliminate poverty or social pathology. Social service
reform is urgent but it cannot be successful unless the
society attends to much else as well.
B-1
Appendix B.
Case Study Guide, New York City Study
CASE STUDY GUIDE
I. Background Data (Some of information may be available in
annual reports and/or other written material, if not, obtain
from top administrator)
1. History
- Year established
- Impetus for initation
- Milestone events (Dates of mergers, significant
expansions, major new programs)
2. Service Mission, Objectives
- How defined
- Changes over time
3. Target Population(s)
- How described
- Numbers served (daily & annually)
4. Physical Facilities
- Location of headquarters
- Number and location of sites
B-2
- Catchment area
5. Sponsorship and Accreditation
- How described
- Affiliations
6. Programs
- Number
- Types
7. Organizational Structure
- Number & Types of Departments
- Levels of hierarchy
8. Board
- Size
- Type of membership
9. Staff
- Size
- Composition
B-3
10. Budget
- Annual Total
- Endowment
- Number & type of funding sources
- Breakdown by program
B-4
II. Interview with Agency Administrator(s)
(Record names and dates; Describe physical setting)
1. Definition of agency mission.
- Core services
- Criteria of success
- Proudest accomplishment(s)
- Unfinished agenda
2. Planning processes, instigators (get examples).
- Role of board, staff, executives
- Responsiveness to community need, funding
opportunities, etc.
- Number and types of new programs introduced in past
3 years
3. Role of Board.
- Decision-making
- Access to power, resources
4. Organizational Control and Decision-making.
- Degree of decentralization (What's delegated, what's
controlled by top administration)
B-5
- Membership in core administrative body
- Pros and cons of current structure
5. Accountability and Evaluation Mechanisms.
- Accrediting body
- Funding sources
- Internal proceedures for program evaluation
- Opportunities for client, community input
6. Staffing.
- Number @ different organizational levels
- Breakdown by program
- Breakdown by professional qualifications
- Beginning salary for MSW's
- Turnover (How many left in past year, average length
of stay, particular problems or succeses in
addressing this issue.)
- Opportunities for staff training, education
B-6
- Recruitment issues
7. Leadership Role of Executive
- How primary responsibilities defined
- Major stresses (administrative, fundraising,
programmatic, etc.)
- Community involvement, activities
- Reference group, primacy supports, linkages
8. Evaluation of Agency
- Major strengths
- Deficits, weaknesses - "What would you most like to
change?"
- Relative assessment of efficiency (use of available
resources) ; effectiveness (quality of services
delivered) ; and availability (to population in need)
- Major external obstacles to providing type of
services desired
- Major internal obstacles
- Tradeoffs in current structure, programs of service,
funding sources
B-7
- Expectations, aspirations for next decade
- Recommendations for a successor or new administrator
in similar position
9. General Comments.
- Views of categorical versus integrated services
(tradeoffs identified)
- Recommendations for changes in public financing,
administration
- Views regarding what makes a "good" program
B-8
III. Interviews with Program Administrators.
(Record names and dates; Describe physical setting)
1. Client Population.
- How described
- Eligibility criteria
- Presenting problems
- Demographic characteristics
- Number served (monthly and annually)
2. Services Provided
- Type
- Amount of each
- Service ideology/practice theories
3. Client Processing.
- Referral sources (relative proportions)
- Waiting time
- Outreach efforts
B-9
- Intake procedures
- Typical service package - (get examples)
- Case management activities
- Referral mechanisms
- Follow up activities
4. Program Coordination.
- Intra-agency
- Inter-agency
- Indentified service gaps, obstacles
5. Organization of Program/Departments
- Structure
- Decision-making processes
- Accountability mechanisms
6. Staffing Issues.
- Morale
B-10
- Recruitment
- Turnover
- Training needs, resources
7. Planning Processes, Instigators.
- Opportunities for innovation
- Limitations, pressures
8. Evaluation of Program
- Major strengths
- Deficiencies, weaknesses
- Relative assessment of efficiency (use of available
resources), effectiveness (quality of service
delivered) and availability (to population by need)
- Major accomplishments, successes
- Changes desired
- External obstacles
- Internal obstacles
B-11
- Tradeoffs in current structure, programs of service
- Views regarding what makes a "good" program
9. Potential for Follow-up.
- Interviews with workers
- Observations
- Review of "typical" case records
C-1
Appendix C.
A Memorandum on Method for the U.S. Social Services Study.
We had thought initially that we might identify a
variety of "exemplars" about which there was general
consensus and then see if we could focus on the tradeoffs
involved in going in each direction. It became clear,
however, that because of different concepts of the field and
its mission, there could hardly be consensus on "exemplars"
or even on criteria for "exemplars".
The traditional researcher would have wanted to choose
programs as "strong" or to choose among programs only after
they were so identified on the basis of outcomes for
children. This would involve a large scale study, a
statistical emphasis, and considerable work to be sure that
outcomes in different states, different locations, and
judged through different data systems, were actually
comparable. This would have been a large and expensive
study, never intended, never funded, and not feasible for
us. We are still not sure whether anybody could do it. It
has certainly not been attempted.
Our compromise method was "soft" in the traditional
research sense. What we did was to seek workable and
alternative "solutions" at the delivery level for doing the
job "acceptably". But what is it that has to be acceptable?
What is the job? And if we mean acceptability in the
perspective of interested publics and on the basis of
reasonable criteria, what are these criteria?
In short, we developed modest expectations, seeking
what Herbert Simon, has called "satisficing", not optimums.
The approach is empirical and pragmatic and in the context
of the reality that states must make "best judgement"
choices of direction regularly. Then, they seek validation
so that resources can be better deployed. What is
"acceptable" is nothing esoteric. We sought minima from the
point of view of public and professional expectations.
In our administrative and service delivery case
studies, therefore, we looked at structures, staffing,
caseload, client pathways, all available assessments and
evaluations. We met with staff at all levels and walked
through client pathways with them. We talked to observers
as well and asked whether there is an acceptable public
agency response, meaning the following:
*
From Social Services for Children, Youth and Families
in the United States.
C-2
1. Are abused-endangered neglected children located
and brought into the system? Are their problems dealt with
helpfully?
2. Are children without parental care channeled to
acceptable alternative family or group care?
3. Does the system offer constructive help to
child/family situations which do not at the moment justify
coercive public action, yet which suggest high likelihood of
trouble, which cause concern to one or more parents, which
include a child not developing well? (In short, is
reasonable help offered to what many people call "voluntary"
cases?)
4. If the Juvenile Justice system does not offer
comparable help to latency age and adolescent status
offenders, does the public social service system do so?
5. The same question should be asked about teen
parents.
6. Is there in place adequate machinery and service
provision that gets identified cases into a service system
which is viable?
7. For those cases clearly requiring two system or
multi-system coordination, is there adequate machinery in
place to achieve this via such devices as: case assessment,
clarity of rules, a cooperative operation?
8. Is all of the decision making for these purposes
based on competent case assessment and case planning as
judged by the qualification of the people doing the work,
their numbers, their stability on staff, their opportunity
to do work based on reasonable caseloads and expectations?
9. If there are special projects and initiatives,
special innovations, do they touch a significant percentage
of the caseload, are they integrated into the delivery
systems, or are they "paste-ons" small "gestures" but not
affecting the caseload as such and not accessible to the
typical case through the normal case flow?
10. If there are obvious gaps, failings, inadequacies
in the system, who knows it? What is being done about it?
What are the prospects for effective change?
11. Is there a capacity in the system to give on-going
help to families or children with complex problems: Is
there adequate response to social and psychological problems
requiring more than short-term fire fighting? If not, is
this by deliberate choice, or is it inadvertent?
C-3
12. What portion of all this on-going work, continuing
work, more than "fire fighting" help gets carried on within
the public system, by voluntary social service agencies, by
public community mental health systems, on the basis of
purchase and/or referral in other ways? Is all of this,
e.g., the division of labor, planned and what is its
rationale?
It must be understood that in the absence of direct
client outcome surveys we could not forego preoccupation
with reliability, validity, the basis for our
generalizations. We were essentially approaching our
analysis by seeking what the social science texts sometimes
call "grounded theory." We have also seen reference to the
term "analytic induction", which may describe what we did.
In effect the process as been as follows:
We concluded our experience survey, our literature
review, and our exploratory discussions with a group of
tentative notions. Then we went on to Minnesota and
conducted studies in Ramsey, Hennepin, and the Children's
Home Society, as well as talking to the state people. By
the time we had come out of Minnesota we had a series of
tentative hypotheses about what was being dealt with and
with what delivery strategies, which we discussed and put
down. These were the hypotheses we took to the second state
study. In the course of the second study we reformulated
the hypotheses and added to the dimensions discussed several
times. The second case study had its conclusions, e.g., a
new version of the study's hypotheses. This in effect is
what we did as we moved from place to place. As we went
along we corrected, modified, added and reformulated as the
insights increased. When we reached a point where we began
to encounter confirmation, further illustration and
documentation, rather than evidence which made us change our
mind, we knew that the sample was getting to be large
enough. We understood what was confronted. We had
conceptualized the coping options and how they looked in
action.
Then, we moved into the phase of collateral interviews,
interviews with commissioners whose states were not
included, and one-day stands in which we would interview top
management and leadership in a department but not carry out
our full case studies (which in the initial sites had
involved everything from commissioners, deputies, and
managers, then area and regional chiefs, to supervisors and
line staff). Now, exploring only at the managerial level,
people began to say "Yes, that's it". That is where we were
by the fall of 1988. We then could concentrate only on
collaterals and interviews in parts of the country not
previously covered.
We did not yet regard the process as completed,
C-4
however. In March, 1989, the A.E. Casey Foundation hosted a
40-person reporting conference to give the commissioners,
deputies, and area directors an opportunity to have some
feedback and to tell us if we had the story right. Also
present were national agency leaders and key foundations, as
well as researchers. That became part of the validity
process. While there were some factual corrections and
discussions as to emphasis, the meeting was overwhelmingly
confirming. We then could regard the field work as
completed and focus entirely on the question of what this
picture means and what to do about it.
PUBLIC WILLARE USSN 3816)
JOURNAL OF THE AMERICAN PUBLIC WELFARE ASSOCIATION
IS published quarterly by the
American Public Welfare Associa-
tion. Editorial and Executive
We
Offices. 810 First Street, NE. Suite
500, Washington, D.C. 20002.
©19901 by the American Public
Welfare Association Second-class
postage paid at Washington, D.C.,
and all additional mailing offices.
POSTMASTER: Send address
changes to PUBLIC WELFARE 810
First Street. N.E., Suite 500,
Washington, D.C. 20002
American Public Welfare
Public Welfare
Association
WINTER 1990, VOL. 48, NO.1
President: Ruth Massinga
Executive Director:
A. Sidney Johnson III
FEATURES
Deputy Director: Linda A. Wolt
Child Protective Services:
Associate Director: Beverly Yanich
Director of Communications:
A System Under Stress
7
Kathleen Patterson
Public Welfare
If CPS Is Driving Child Welfare-
Editor: Bill Detweller
Where Do We Go from Here?
Assistant Editor: John F. Kane
Burgeoning social problems are putting the system to the test.
Art Director: Craig Keith
SHEILA B. KAMERMAN AND ALFRED J. KAHN
9
Subscriptions: Brenda lones
Journal Advisory Committee
Redefining Abuse and Neglect
Chair:
A narrower focus could affect children at risk.
Herbert S. Fowler, public affairs
JOAN R. RYCRAFT
14
consultant Pensacola, Florida
Ken Apfel. legislative assistant to Senator
Bill Bradley. Washington, DC
CPS Can't Go It Alone
Jules H. Berman, associate professor
MICHAEL WEBER
18
emeritus. School of Social Work and
Community Planning, University of
Maryland, Baltimore
Is Child Abuse Overreported?
Joan Carrera, program analyst. Family
Support Administration, Washington,
The data rebut arguments for less intervention.
D.C.
DAVID FINKELHOR
22
Barbara L. Glaser, chief, Division of
Social Services, Department of Human
Resources, Arlington, Virginia
Mandated Reporters and CPS:
Tom Joe, director. Washington Office.
Center for the Study of Social Policy,
A Study in Frustration
Washington, DC
Misunderstanding and miscommunication threaten the system.
Albert P. Russo, human service
GAIL L. ZELLMAN AND STEPHEN ANTLER
30
consultant. Providence, Rhode Island
Alair A. Townsend, deputy mayor for
finance and economic development for
Good News for CPS Workers
the City of New York, New York
John A. Yankey, professor, School of
An lowa survey shows parents value services.
Applied Social Sciences, Case Western
Reserve University, Cleveland, Ohio
GEORGE E. FRYER, JR., DONALD C. BROSS,
Credits
RICHARD D. KRUGMAN, DAVID B. DENSON, AND DIANE BAIRD
38
Art for cover and all arth les by John Pack.
DEPARTMENTS
LETTERS, 5
CONFERENCES, 45
BOOK NOTES, 42
NOTES & REFERENCES, 46
NAK
the
If CPS Is Driving
Child Welfare-
Where Do We Go
from Here?
BURGEONING SOCIAL PROBLEMS
ARE PUTTING THE SYSTEM TO THE TEST.
BY SHEILA B. KAMERMAN AND ALFRED J. KAHN
A
S we enter the 1990s, child protective services
privately delivered social services in states, counties, and
(CPS) has emerged as the dominant child and
cities, hoping to identify patterns of service delivery and
family social service provided by public agen-
promising new service initiatives. The current social and
cies. Some would argue that CPS in effect is
political environment of categorical funding, federal
driving the child welfare system, often taking it over com-
funding constraints, decentralization, and privatization
pletely. Many administrators would claim that child
was taken into account, as were the growing social prob-
protection is child welfare, that the increased demand for
lems of child poverty, teen pregnancy and parenting,
child protection has absorbed virtually all of the system's
single parenthood, drug abuse, and homelessness.
resources. Foster care and adoption services have sur-
We paid extended site visits to 25 state, county, and
vived largely because they serve CPS.
city agencies. Brief visits were also made to three other
It increasingly seems that only abused or severely
agencies, and welfare and social service commissioners
neglected, delinquent, or runaway children can hope to
were interviewed in states and counties that we did not
receive public services in most jurisdictions. Doors are
visit. A variety of other experts, researchers, and advo-
closed to cases labeled "less serious" or "voluntary."
cates were also interviewed; and countless reports were
Even high-priority cases may have to go without help or
reviewed. We studied both state-administered social serv-
at best make do with short-term or inadequate assistance.
ice systems in Florida, Massachusetts, and Maryland and
In this article, we will focus on the causes and conse-
state-supervised, county-administered systems in Ram-
quences of this situation and offer some possible solu-
sey and Hennepin counties in Minnesota. Large urban
tions.
agencies, including Los Angeles, New York, Boston, and
Miami, were also examined. Our sample included public
The Study
agencies that provided services themselves and those
that purchased most services from the private sector. We
B
etween 1986 and early 1989, we conducted a
study, supported by the Annie E. Casey Found-
explored site alternatives with the staff and leadership of
ation, of alternative approaches to delivering so-
such organizations as the American Public Welfare Asso-
cial services for children, youths, and their fami-
ciation, the Children's Defense Fund, the Child Welfare
lies.' We focused on public and publicly funded but
League of America, and various government agencies, as
well as with congressional staff, foundation executives,
© 1990 The American Public Welfare Association
and other researchers.
PUBLIC WELFARE/WINTER 1990
9
What We Found
The drawbacks of a limited child welfare system have
been made even more visible by the explosion of new
M
ost child welfare activities of public agen-
cies are largely directed toward the prob-
social problems. Increasing numbers of cocaine- and
lem of child abuse and neglect. Agency
crack-addicted babies are entering the child welfare svs-
efforts focus on investigating reports and
tem, offering challenges the system was not designed to
protecting children when allegations are verified. Few
address. HIV-positive babies pose other challenges; many
resources remain for troubled families who do not fall
foster parents are not able to provide the care these chil-
under the purview of CPS. In many jurisdictions, there
dren require. Homelessness among families with chil-
are few supportive services or treatment options for these
dren has increased. What delivery system will reach
families. Agencies often turn away parents with out-of-
those families? And the retarded, disabled, and emotion-
control or defiant children. Services for latency or early
ally disturbed children who have been deinstitutional-
adolescent children also are limited. Chronic multi-
ized are now older and often are more difficult for parents
problem cases in troubled families often are overlooked.
to manage. Some are having children of their own; there
In fact, if a case is not marked by dramatic events, it may
are few resources to sustain these troubled young parents
receive only token processing and response.
in their roles. Immigrant and refugee populations with
Promising new initiatives, however, have received in-
their own approaches to child rearing further strain the
creasing attention. These include intensive, family-fo-
system.
cused, home-based, short-term, and goal-oriented serv-
Back in the mid-1970s, the service integration initia-
ices, which are now available in many jurisdictions. When
tives and planning mandates of Title XX of the Social
carefully implemented by qualified staff, these programs
Security Act created hope that a more comprehensive
seem to help forestall family crises and avoid the need for
social service system would be devised: locally based,
placement. It is too soon to tell, however, whether long-
family oriented, and designed for accountable practice.³
term effects will be sustained without continued support
Yet today there seem to be more troubled children and
for these families. Moreover, many areas that provide
families than ever. Moreover, the service system de-
such services are hampered by less
signed to serve these clients seems
qualified staff and inconsistent im-
plementation. Not surprisingly,
Title XX of the Social
fragmented and inadequate. For
these families, the categorical impera-
programs in these areas have been
Security Act created hope
tives of the current system are just
less successful. And despite these
that a more comprehensive
one more barrier to the services they
innovations, we failed to find a
desperately need.
single state that provides enough
social service system
family services to meet generally
would be devised.
Why Has This Occurred?
accepted standards of community
n response to the Child Abuse
responsibility. Most agencies
I
and Neglect Prevention Act
focus almost exclusively on child
of 1974, states increased the
and family crises. Chronic parenting prob-
number and types of mandat-
lems are ignored.
ed reporters. Concurrently, states imple-
We found that as abuse and neglect cases
mented stringent requirements on public
increase, agencies frequently offer family life
agencies to investigate reports of child abuse.
or parenting education. This is obviously an
Although federal funding was very limited,
important socialization service and preven-
the political and public response was not.
tive component. It is not a wholly adequate
States acted quickly and broadly because once
response, however, in serious cases of abuse
the public became aware of child abuse, no
and neglect. These programs are particularly
other social service need was seen as equally
ineffective in meeting the complex needs of
important. Computerized registries and 24-
the low-income families who make up the
hour hotlines have facilitated reporting,
vast majority of CPS clients.²
spawning even more investigations.
Various reform proposals stress case man-
At the same time, foster care placement
agement or family support services. Others
was questioned by professionals and advo-
call for the restructuring of public child wel-
cates who believed that it was inappropriate
fare agencies. When carefully designed and
or unsatisfactory for many children. Public
implemented, these initiatives can improve
Law 96-272, the Adoption Assistance and
social service delivery. These strategies, how-
Child Welfare Act of 1980, was designed to
ever, presuppose adequate resources for treat-
reduce the number of children placed in fos-
ment and related services within the commu-
ter care and to provide more help for troubled
nitv; too often, these resources simply are not
children while they are sustained at home
available. Consequently, even the most prom-
with their families. Unfortunately, the im-
ising reform efforts have been only sporadi-
pact of the legislation has been problematic.
cally successful.
10
Social service agencies have been unable to provide
receive services from other community agencies because
help on the scale that lawmakers envisioned, with inade-
of their behavior: this includes schools, the courts, or the
W
quate funding seriously hampering implementation ef-
mental health system. In recent years, Congress has funded
d
forts. In addition, new social problems mushroomed
a variety of mostly modest special programs for children
after the law's passage. As a result, child welfare admin-
with specific problems. Under such categories as develop-
o
istrators have been left to weigh conflicting mandates:
mental disabilities, special education, juvenile justice, and
V
"Don't take chances; place endangered children in out-
mental health, federal and state programs now offer some
of-home care." and "Don't interfere with families; avoid
alternative resources and treatment options. Problems
1-
placement whenever possible."
remain, however. Disputes continue over which services
h
Given the emphasis on keeping children at home
are appropriate for which children and over who should
1-
rather than placing them in foster care, errors in judg-
pay for those services. Even when such questions are re-
I-
ment were inevitable. In a pluralistic and democratic so-
solved, too many children with multiple needs fail to re-
5
ciety that supports cultural diversity and family privacy,
ceive any services, or available help is divided among
e
it is easy to see how agency personnel could make seri-
noncooperating agencies.
ts
ous mistakes concerning the safety of vulnerable chil-
These factors combine to create a social service system
h
dren. When this happens staff and agencies are criticized
devoted almost exclusively to the problem of child abuse.
in the media and in the courtroom. Staff become frus-
Unfortunately, even that is not being handled very well.
trated and demoralized, caught in a bind between pro-
Some agencies are cutting back their caseloads, defining
tecting children, keeping them in their homes, and satis-
child abuse more narrowly to avoid being overwhelmed.
fying a public that does not understand either resource
Often public officials undertake these efforts under the
contraints or the inherent risk in all case decisions.
guise of setting priorities and identifying and serving
The 1980s brought major cutbacks in federal social
high-risk cases. As a result, large numbers of children and
services funds; most states have been unable to fill the re-
families are denied help or receive little more than per-
d
source gaps. At the same time, basic social problems such
functory paperwork processing.
as poverty and inadequate health
Some states are trying to provide a
care have worsened, further exac-
broader range of services to families
erbating family stress. Such prob-
Even scant existing agency
and children, but they are hampered
lems as inadequate parenting,
resources are often
by a number of factors. Resource
chronic neglect, inability to man-
constraints are the most visible, but
y
age aggressive adolescents, and
unavailable because
there are larger, less tangible prob-
emotional disturbance receive
officials and legislatures
lems as well, including distorted
little or no attention from child
have mandated services to
public understanding of the nature of
welfare staff because of a lack of
child welfare issues and of the limita-
time and resources. Even scant
other target populations.
tions on what public agencies can do.
existing agency resources are
There are also basic questions about
often unavailable because offi-
the ability-or appropriateness-of a
t-
cials and legislatures have man-
social service agency to address
dated services to other target populations.
singlehandedly such fundamental social prob-
The potential value of foster care services
lems as poverty, homelessness, inadequate
has been inadvertently undermined by an
health care, and a drug epidemic. Issues of
overriding emphasis on preserving fami-
philosophy exist as well. Furthermore, the
lies and avoiding placement. Yet the service
government cannot intervene in all aspects of
is needed, and there is growing evidence
family life, nor can a social service agency
that it is the most appropriate service and
respond to every child and family in trouble.
y
truly helpful in certain situations. Recruit-
Yet, no one can deny that a social service crisis
I-
ing foster parents is becoming increasingly
faces children and families in many commu-
difficult, however, as more women enter
nities, and particularly in large cities.
full-time jobs and as the number of nontra-
Admittedly, impressive and effective child
ditional family types increases. Moreover,
welfare initiatives exist-family preservation,
traditional foster care was not designed to
Homebuilders, and family support are ex-
address some of today's thorniest social
amples.⁵ But these innovations are not typi-
problems. Special qualifications and train-
cally a standard part of state or county serv-
d
ing are needed for these situations. New ap-
ice delivery systems; in many areas society's
proaches to foster care are being developed,
response to child and family welfare issues is
but service levels remain inadequate.
simply inadequate.
d
Children come to the attention of public
Agencies also face an impending person-
social service agencies because of depend-
nel crisis. Staffing problems are growing,
ence or because of allegations of child abuse
especially on the front lines of child welfare.
and neglect. These same children often also
Many social workers have moved to mental
PUBLIC WELFARE/WINTER 1990
11
health treatment settings. At the same time, attempts to
ulgated guidelines for policy and service development.
make child maltreatment reporting and investigation
Nonetheless, child and family social service systems
more accountable have put added burdens on the work-
must not be limited to child protective services and foster
ers who remain. Further, the measures that were imple-
care. Targeting services to the most severely abused and
mented to ensure adherence to the philosophy of Public
neglected children is certainly understandable, but it is
Law 96-272 often transformed professional positions into
not a sufficient societal response to the needs of children.
fragmented, tightly monitored administrative routines.
Others in the society are seriously troubled and troubling.
Many professionals have left the field because jobs
If these families and children are not identified and
have changed so radically. Others have fled because of
helped, their problems will become acute. We must not
public attacks on workers who appear to be responsible
intervene coercively with families where there is no statu-
when cases blow up. And even in agencies that have been
torv mandate to do so. Neither, however, should we over-
spared such incidents, workers flee the endless pressure
look people truly in need of services.
to avoid errors or catastrophes in a world where almost
We must establish locally based, comprehensive child
everything is beyond their control. Consequently, agency
and family service systems that will provide for conti-
directors gradually loosen job criteria and recruit people
nuity of care both over time and across service systems.
with less education and experience-often from outside
A limited attempt to enhance child protective services
social work. Job expectations are adjusted downward.
will not resolve the broad structural problems plaguing
Some exceptional jurisdictions stand out, but their ad-
the system. We need to develop new child and family
ministrators wonder how long they can hold the line.
services that are family focused rather than child-fo-
cused. These services will include CPS, but only as one
What Can Be Done?
element of a more comprehensive system. In particular,
ased on our findings, we offer some sugges-
such child and family services should address the long-
B
tions for improving the child and family
term problems of chronic parental neglect that endanger
social service system. Resources can be en-
and deprive children. They should offer effective assis-
riched and expanded
tance to drug-addicted and HIV-
while the balance between child
positive babies, as well as disabled,
protective services and other types
Federal support is needed
retarded, and disturbed children.
of services is reasserted. Successful
both to provide
Several proposals have been ad-
reforms will require the active sup-
vanced. Some focus on a core of in-
port of both federal and state gov-
additional money
tensive family services-the family
ernments. The federal government,
and to allow
preservation model. Others call for a
which has held back funds, leader-
greater flexibility in the
cluster of family support services,
ship, and technical aid since 1981,
such as drop-in centers, counseling,
must reclaim a larger responsibil-
use of existing funds.
and intensive home-based services.
itv-both practically and politi-
Still another is built around a re-
cally-for child welfare. State fi-
structured child welfare agency-
nancial participation has increased.
with neighborhood access and a well-
Some states have been creative and innova-
developed core of case management and
tive, and many want to do more, but they
counseling services.
cannot do so without help. Social services
One attractive model now being tested
are not big budget items, but any serious re-
involves neighborhood-based, family-fo-
form will require new funds. Federal sup-
cused services that give clients access to in-
port is needed both to provide additional
formation and referral, brokerage, and advo-
money and to allow greater flexibility in the
cacy services. In this model, case managers
use of existing funds.
ensure that various community agencies
Our specific conclusions and recommen-
provide specialized treatment and remedia-
dations, which are intended to encourage
tion services. Variations of this model have
discussion, follow.
been proposed since the 1970s, and new
A strong child protective service is es-
projects are underway in several communi-
sential, but it alone is not sufficient to meet
ties.
the needs of children and families. All lo-
Still another approach involves a series of
calities require strong protective services.
categorically defined doorways, such as
CPS agencies should be expected to meet
abuse and neglect, status offense, depend-
carefully developed standards. Several na-
ency, developmental disability. and severe
tional standard-setting groups-including
mental disorder. These would all lead to one
the National Association of Public Child
comprehensive service continuum, delivered
Welfare Administrators, the Child Welfare
by a system ensuring responsible case man-
League of America, and the American Asso-
agement, program coordination, and the
ciation for Protecting Children-have prom-
pooling of supportive categorical funds. The
12
PUBLIC WELFARE/WINTER 1990
system would cover in-home and clinic-based services,
ing new possibilities. These efforts can help ensure that
individual and institutional treatment, foster care, and
multiproblem youngsters promptly and efficiently re-
respite and institutional care.
ceive needed services.
Neighborhood-based, comprehensive, integrated child
Child and family services must develop richer, more
and family services are another option. They would link
effective interventions to respond to the complex and
child protective services, family support services, thera-
intertwined needs of children and families. The current
peutic interventions, and residential and nonresidential
limited array of service options must be overhauled.
services in a single community development program.
Revision demands innovation, enrichment, expansion,
The Center for Family Life in the Sunset Park neighbor-
and updating. There are encouraging beginnings with
hood of Brooklyn, New York, is such a program. It
family preservation, case management, family support,
stresses individualized assessment of family needs and
and other service and practice efforts. Such expanded
refuses to label clients by problem category. Moreover, it
services should be routinely available in all states, rather
does not accept funds that require such classifications.
than limited to pilot programs or demonstration proj-
Modeled after 19th-century settlement houses, but built
ects-and their impact must be monitored as expansion
around sophisticated therapeutic concepts, the center
takes place.
provides the continuum of care required to sustain high-
Solutions must be sought on many levels: federal and
risk families. The program counters forces contributing
state leadership, resources, personnel, delivery structure,
to family disequilibrium and alienation, fosters access to
and interventive technology.
normalizing opportunities and resources, and contrib-
Foster care must be a major component of any reform
utes to local community development and service plan-
in child and family social services. The foster care sys-
ning processes.
tem faces its greatest challenge in a century. Children are
Cross-system issues facing social service delivery
experiencing new and complex problems. Demographic
systems require major reforms. Child and family prob-
and labor force changes affecting the supply of foster par-
lems do not neatly divide themselves into service catego-
ents pose other challenges. Creative efforts will be needed
ries. The same children may appear
to recruit foster parents and upgrade
in different systems at different
The move toward
their status and compensation. The
times, or at the same time: mental
move toward a component of spe-
health, juvenile justice, or foster
specialized "professional"
cialized "professional" foster care
care, for example. The most diffi-
foster care needs
needs examination and experimen-
cult child and family problems in
tation.
examination and
any system involve multiple diag-
Social service reform alone is
noses. To effectively help these
experimentation.
not enough. Even if all our recom-
people, the service system must be
mendations are implemented and
restructured and the most success-
prove successful, troubled children
ful strategies for cross-system co-
and families will remain. Social serv-
operation, coordination, and ad-
ices hold no mystical power to wipe
ministration must be identified.
away human suffering. At best, we
The reorganizations that created state human
can hope to sustain, rehabilitate, and per-
service superagencies in the 1970s have es-
haps enrich people's lives. But these lim-
tablished professional leadership and organ-
ited accomplishments are vitally important,
izational mandates that could facilitate the
and social service reforms are urgently
process. Some states have shown the way.
needed to bring them about. We also need
Some jurisdictions have restructured their
to do more. Social service reforms should
child welfare agencies as family service agen-
be but one facet of a comprehensive crusade
cies. These new organizations include part or
against the root causes of pain and misery:
all of the child protective service components
poverty, substance abuse, homelessness,
of other systems, including juvenile justice,
hunger, and disease. Only a committed
special education, and mental health. Other
effort on all levels of society can eliminate
jurisdictions have created discrete children's
these scourges and finally produce lasting
agencies. Thus far, there is no evidence that
benefits for children and families. PW
restructuring alone will solve current child
welfare problems. Nonetheless, those com-
Sheila B. Kamerman is professor and
munities that have moved toward reorgani-
co-director, Cross-National Studies,
zation should monitor their programs to de-
Columbia University School of Social Work,
termine if service delivery has been enhanced
New York.
by reform.
Alfred J. Kahn is professor emeritus and
Coordination strategies, including case
co-director, Cross-National Studies, Columbia
management, pooled funding, and multidis-
University School of Social Work, New York.
ciplinary case review teams all offer interest-
For "Notes and References," see page 46
PUBLIC WELFARE/WINTER 1990
13
NOTES & REFERENCES
Children, Highlights of Official Child Neglect
row the Grounds for State Intervention" in
KAMERMAN
and Abuse Reporting 1988.
Douglas]. Besharov (Ed.), Protecting Children
7. Norma Harris, "Toward Consensus--Is a
from Abuse and Neglect Policy and Practice.
AND KAHN
Framework Emerging for Protecting Children
Springfield, 111 C.C. Thomas, 1988; see also
and Strengthening Families?, Protecting Chil-
Douglas J. Besharov, "Right versus Rights:
CPS and Child Welfare
dren, 1988, vol. 5, no. 4, pp. 12-13.
The Dilemma of Child Protection." Public
8. American Association for Protecting Chil-
Welfare, 1985, vol. 43, PP. 19-46.
1. Sheila B. Kamerman and Alfred 1. Kahn,
dren; Deborah Daro and 1. Mitchell, Child
4. Douglas Besharov, Child Abuse and Ne-
Social Services for Children, Youth. and Families
Abuse Fatalities Remain High. The Results of the
glect Reporting and Investigation: Policy Guide-
111 the United States Greenwich, Conn.: Annie
1987 Annual Fitty State Survey. Chicago, III.:
lines for Decision-Making. Washington. D.C
B Casey Foundation, 1989.
The National Committee for Prevention of
American Bar Association, 1988
2. Elizabeth Tracy and James K Whittaker,
Child Abuse, 1988.
5. In child protection parlance, the synony-
"The Evidence Base for Social Support Inter-
9. National Center on Child Abuse and
mous terms "unfounded" and "unsubstanti-
ventions in Child and Family Practice. Emerg-
Neglect.
ated" do not really mean false or scurrilous. as
ing Issues for Research and Practice," Children
10. National Center on Child Abuse and Ne-
they doin colloquial usage. Rather, they mean
and Youth Services Review, 1987, vol. 9, PP 249-
glect, Studv of National Incidence and Preva-
"not" founded or "not" substantiated, where
270;) Dumas and R.G. Wahler, "Prediction
of Child Abuseand Neglect: 1988. Wash-
founded and substantiated have a technical
of Treatment Outcome in Parent Skills Train-
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administrative implication. Not founded may
ing: Mother Insularity and Socioeconomic
Human Services, 1988.
simply mean not investigated. Although
vantages," Behavior Assessment 1983, vol
11. Douglas 1. Besharov, "The Future of Child
Besharov sometimes writes about increases in
5, pp. 301-313.
Protective Services: Contending with Over-
the percentage of "unfounded" cases, it is
3. Alfred J. Kahn and Sheila B. Kamerman,
blown Expectations," Public Weltare, 1987, vol.
clearer to talk about decreases in the percentage
"The Courseof Personal Services,' Public
45. no 1. PP 7-11; Larry Brown, "The Futureof
of founded cases, or decreases in the substan-
Welfare, 1978, vol. 36, no 3, pp. 29-42; and
Child Protective Services: Seeking a National
tiation rate.
Altred J Kahn, "New Directions in Social
Consensus," Public Welfare, 1987, vol 45, no 1,
6 Besharov's continued use of this figure il-
Services," Public Welfare, 1976, vol. 34, no. 2.
PP 12-18; Douglas J Besharov and Larry
lustrates the poorly documented foundation
pp. 26-32.
Brown, "The Future of Child Protective Serv-
of his argument. The citation is to page 11 of
4. David Fanshel, Stephen Finch, and John
ices: Questions and Answers," Public Welfare,
the American Humane Association (AHA) re-
F. Grundy, Foster Children in Life Course Per-
1987, vol. 45, no 1, PP. 18-21.
port on 1976 data, which reads, "The number
spective New York: Columbia University
12 lbid, P.
of validated cases reported by the fully par-
Press. forthcoming.
13. Karen J. Farestad, "Can We Achieve a
ticipating states was 167 or 47 percent of the
5 James K Whittaker, et al, Improving Prac-
National Consensus?, Protecting Children,
total reported cases. The reported validity in
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1989, vol. 5, no. 4, P. 2.
the past has been 60 percent and the validity
Lessons from the "Homebuilders" Social Work
14. Susan 1. Wells, "Decisionmaking in
rate in 1976 for the other states reporting only
Education Project. Seattle, Wash. Universityot
Child Protective Services Intake and
aggregate data was 66 percent."
Washington School of Social Work, 1989;
Investigation," Protecting Children, 1985, vol. 2,
AHA has consistently based its estimate of
Sharon 1.. Kagan, et al, America's Family Sup.
no. 3, PP 3-8.
substantiation-svnonymous in this report
port Programs New Haven. Conn Yale Uni-
with "validation" -on the fully participating
versity Press. 1987
states, which submitted data on individual
FINKELHOR
cases, because this was more complete data of
RYCRAFT
known quality compared with states that just
Reporting
provided aggregate figures. Thus, the true
Redefining Abuse
figure for comparison with later figures should
I would like tothank Anne Cohn, Jon Conte,
be 47 percent, not 66 percent. (Presumably
and Neglect
Deborah Daro, James Garbarino, Andrea Sed-
Besharov's 65 percent is a rounding off of the
lak, Murray Straus, Linda Williams. Charles
66 percent.)
The author gratefully knowledges the as-
Wilson, and members of the Family Violence
The 60 percent "validity in the past" cited in
sistance and comments on earlier drafts of this
Research Seminar for comments on earher
the AHA study IS not a rehable figure. The
article by Dr. Kathleen Proch, associate profes-
draftsof the manuscript. would like tothank
first year in which national data were col-
sor. University of Denver, and Dr. James R
Donna Wilson for assistance in preparing it.
lected and published was 1976, and any ear-
Moran. assistant professor, University of Den-
1. Richard I Gelles and Murrav A. Straus,
lier figures must have been based on small
ver
Intimate Violence New York, N.Y. Simon and
numbers of states, using idiosyncratic meth-
1. National Association of Public Child Wel-
Schuster. 1988; Andrea Sedlak, Study Find-
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glected Children and Then Families Washing-
DC Department of Health and Human Serv-
7 Victor E. Flango, Central Registries for Child
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Abuseand Neglec A National Reviewof Records
Welfare Administrators, 1988,
2 David Finkelhor, Gerald T. Hotaling, I.
Management, Due Process Safeguards, and Data
2. lbid. P 23-25.
Lewis, and Christine Smith, "Sexual Abusein
Utilization. Williamsburg, Va. National Cen-
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a National Survey of Adult Men and Women:
ter for State Courts, 1988; American Humane
Children. Highlights of Official Child Neglect
Prevalence, Characteristics and Risk Factors."
Association. National Analysis of Official Child
and Abuse Reporting 1988. Denver, Colo.
Child Abuse and Neglect, in press; S. Peters, G.
Neglecto and Abuse Reporting: 1979. Englewood,
American Humane Association, 1988.
Wvatt, and David Finkelhor "Prevalence."
Colo.: American Humane Association, 1981.
4. lbid
In David Finkelhor and Associates (Eds.), A
S. John Eckenrode. "The Substantiation of
5 American Association for Protecting Chil-
Sourcebookon Child Sexual Abuse. Beverly Hills,
Child Abuse and Neglect Reports Summary
dren, National Dateline. CPS News Around
California: Sage Public ations, 1986. D Russell.
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