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Decentralization and Citizen Participation in Social ServicesAuthor(s): Martin ReinSource: Public Administration Review, Vol. 32, Special Issue: Curriculum Essays on Citizens,Politics, and Administration in Urban Neighborhoods (Oct., 1972), pp. 687-700Published by: Wiley on behalf of the American Society for Public AdministrationStable URL: http://www.jstor.org/stable/975233 .

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687

Decentralization and Citizen

Participation in Social Services

Martin Rein, Massachusetts Institute of Technology

Efforts to plan for the delivery of services have been inhibited by the failure to define the specific activities that are to be distributed and the

objectives they are to address. Before considering the question of decentralization and citizen participation in social services we must mark out the turf we propose to explore. What do we mean by the term "social services"? To what purposes are social services related? What are the philosophical traditions that give direction to social service

policies? And how do the issues of definition, purpose, and philosophy relate to the movement toward decentralization, citizen participation, and

neighborhood control? In this troublesome question of definition, one

useful way to proceed is to consider the ex-

perience of the federal government in establishing administrative guidelines for defining what social services are. This exercise should help identify the sources of conceptual confusion. The commission- er of the Rehabilitative Service Administration in HEW explained the concept of social services with reasonable clarity at House Appropriation Com- mittee hearings:

The essence of the program is to marshall all resources in a coordinated way, to bring [the client] to his best functioning level. The... counselor is the key ingredient, making the determination as to whether the individual is eligible, developing with the individual a plan for his rehabilitation, managing the arrangements for the necessary services, counselling and guiding the individual, and staying with him through successful placement on the job. Services are obtained.. from virtually the full span of community resources, depending on what the individual needs (10).

This process of sorting out an individual's

problems, offering some counsel and advice, and

referring to other community services when the counselor exhausts what he can reasonably do on behalf of a given individual while maintaining continuing contact until the problem is assumed to have abated is the essence of what social services are all about.

The definition of social services is still shrouded in vagueness because there are at least two other uses of social services: benefits available to groups in need (hence all means-tested services such as

public housing and Medicaid are included), and services which aid an institution in carrying out its uses medical care or manpower training, then these services assume an ancillary or instrumental role in

promoting an organizational objective. To define as a social service any activity which helps people get a job or remain in the community only adds to the confusion and blurs the distinctions between lower-case and upper-case social services.

From an administrative point of view, the ghost which haunts conceptualization of this field is the

inability to come to terms with the meaning of performance. The units of activity to be per- formed cannot be specified nor made comparable among different programs. This makes it difficult to study the more important relationship between performance standards and behavior outcomes. The failure to standardize services makes efforts to evaluate their effectiveness indeterminate, since counter-criticism absorbs the imputed failure and attributes it to the low quality of the inputs. The problem approach is typically accepted to avoid these difficulties on the assumption that "the services appropriate to any particular problem



PUBLIC ADMINISTRATION REVIEW

were common professional knowledge" (17). To what purposes are these poorly defined

social service activities related? Two primary purposes for social service activities can be identified, and while they do not exhaust the range of

competing aims, they do help to illustrate the recurrent sources of definitional ambiguity and

conceptual confusion. (a) Services may be viewed as a good in their

own right as defined solely by those who make use of these services. According to this framework, those who utilize social services engage in a transaction which is essentially no different from

acquiring any professional, commercial goods and services. To make explicit the assumption that the two areas of activity raise similar kinds of problems for their users, Syson and Brooke have

proposed "consumer shops" to be administratively decentralized and charged with handling requests and complaints related both to social services and commercial consumer goods (5).

(b) Services may also be viewed as instrumental, for they serve some purpose which is defined

by someone other than the user of the service, in order to help him achieve a standard of behavior which is imposed, rather than merely reflecting the

preference of the users. According to this view, social services are part of a broader field of activities which Vinter has called "people changing" or "people containing" (45). The recipients of services from this perspective are clients, a term which the Oxford English Dictionary defines as "one who is under the protectionor patronage of another, a dependent." These activities are directed at promoting compliance or achievement, which will endure beyond the contact that the individual has with the service; or they may promote controls "which will be claimed as

necessary for the protection of a man for himself

against himself, for the protection of his depen- dents, or for the protection of a wider public" (33).

There is disagreement over which groups of individuals should be defined as citizens whose

preferences are to be respected or clients, and

uncertainty as to which specific activities promote one or another of these purposes. Shall women with children who are on welfare be treated as citizens whose preferences are to be respected or as deviants and clients who are expected to conform to a set of standards that are imposed by others in society? How do services expand the

range of freedom or encourage conformity or

accepted norms? The problem is further compli- cated because programs such as citizen participation and decentralization are supported by proponents who passionately advocate each objective. These intractable questions are bypassed as Ameri- can public policy compromises on programs, but leaves its purposes indeterminate.

Competing Philosophical Traditions

Two conflicting service philosophies can be isolated: the universal-formalist and the selecti-

vist-discretionary positions. Both perspectives en-

joy a long intellectual tradition, but each is

incomplete and hence cannot provide an adequate framework for considering how services should be distributed, financed, and administered. The universal-formalist position has avoided the problems associated with the high cost of a universal

program and has neglected to take account of

necessary discretions if it is to be flexible and

adaptive to the complexities of the human condition. The selectivist-discretionary perspective seems reluctant to accept the implications of a substantial body of literature which affirms the limited effectiveness of lower-case social services in

promoting compliance or in encouraging achievement; and hence neglects its care-taking rather than treatment roles.

Universalist-Formalist Position

There are those who believe that individuals are the best judges of their complex and varied needs and preferences, and that the public policy which can best serve as the guarantor of the free exercise of these wishes is the availability of an adequate level of income which enables individuals to purchase the services they require as they define these requirements. When a consensus arises that the public provision of these services is necessary, as in the case of higher education and increasingly in medical care, then the provision of these services should be universally available and financed from general taxation. Barriers which inhibit access, such as fees, should be eliminated or reduced.

Open enrollment in universities and a free-on- demand health system illustrate the ideal. To this universalist doctrine is added a formalist position which "seeks to preserve individual autonomy in two respects: against dependence on legislative will (and shifting, individious social attitudes), and against willful or gratuitous administrative" (15)

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discretion (43). A primary aim is to protect citizens against what Alan Keith-Lucas described as the intrusion of public morality into administrative practice through the "law of anticipated reactions" made possible by vaguely defined administrative guidelines and professional vacillation between the realities of "adjustment" goals and the ideals of "self-determination" (25). The rule of case law as exercised through courts is thus to

replace arbitrary administrative decisions and the exercise of rule-making procedures. The "rights" position can be summarized as a call for an

integrated approach where adequate and guaran- teed income is combined with universally available and publicly financed services, reinforced by formal legal protection.

The universalist ideals already accepted for services such as education may in the near future be applied to those services which counsel, refer, and help link individuals and families to the established network of community facilities and institutions.

Universalism appeals to professions such as social work, which are caught in the tension between adjustment and self-determination as a means to resolve the contradictions. Professional satisfaction is further enhanced when the probabil- ity that the income class of the next client to be serviced in a queue is randomly distributed by class and race. A United Nations team of experts defined social services as the "mutual adjustment of individuals and their social environment" (44). They hoped that by building commitment to institutional change and adaptation into the con-

cept of service, the dangers that professionals may seek to promote individual adjustment to unjust and intolerable institutions could be avoided. In this tradition social control and rehabilitation

objectives assume, at least implicitly, a lower

priority, while the aim of promoting normal

development, facilitating access to, and providing information about the quality of social services assume greater prominence.

"Income" and "services" approaches find a

rapprochement in the doctrine sketched out above, for both repudiate administrative discretion and professional ambivalence. In the next stage personal social services will "make rights, benefits and entitlements available by nonmarket criteria to encourage and enhance development, to imple- ment concepts of social justice, to help rehabilitate and sometimes to control those in difficulty" (24).

But can formalism and universalism be recon-

ciled with the competing view that social services should promote compliance and control for selected populations? It seems insufficient simply to assert that there ought to be a mutual adjustment of individuals and institutions or to declare that services seek only "sometimes to control those in

difficulty" without spelling out how these tensions can be reconciled in practice. The doctrine provides no guidance as to how everyday administration can come to terms with both adjustment and self-determination objectives, when faced with

legislative commitment which reverses the priorities affirmed in the doctrine.

A leading American sociologist observed many years ago that "on the whole theory follows

practice and seeks to generalize, justify, and rationalize it" (30). A review of expenditures suggests that outlays for service to the poor now exceed expenditures for all direct money payments to those who are economically dependent. It is clear that selective-discretionary approaches dominate the development of social services as the ideas of the universal-formal position languishes for lack of legislative support.

A second problem arises when more people are

eligible to receive services than there are public funds available to pay for those services. Admin-

istrativerationing is thus required, but rationing has no place in a doctrine which affirms universal provision as a first principle. Thirty years ago Delafield Smith recognized the process when he noted that "broad discretion results from the...

practice.. .of enacting several measures which create a large class of eligibility, and then appropria- ting funds which are insufficient to aid all those who come within the terms of the legislation" (38). Thus the universalist position is forced to surrender in practice to discretion, "deterrence, delay, deflection or public ignorance" (31) to ration scarce resources. These rationing devices

unobstrusively intruded into administrative prac- tices; lack of an explicit policy to manage scarcity leads to the systematic exclusion of the poor and unwanted from the high-cost, high-quality programs. Universalism surrenders in practice to selec-

tivity without consensus as to the criteria for selection.

Selectivist-Discretionary Approach

The competing conception of social services

argues that services should be selectively available to the poor, the dependent, and the deviant. The preferences of the consumer should be subordina-

689




ted to the intent of the donor of public largess. This leads to the view that mandated or optional services should be provided to alter work-oriented and family behavior of groups, such as welfare

recipients, for the purpose of reducing poverty, dependency, and pathology - conditions which not only affect those who have them but the rest of society. Social services are therefore assumed to have external effects in that more than the direct consumers are expected to derive benefits from the consumption of these services. Community prerogatives rather than citizen rights and self-determination inform this perspective. The Social

Security Act, which is the federal legislation that created our major programs to aid those who are

economically dependent, declares itself to be an act "to provide for the general welfare [and] to

promote the well-being of the nation. . .". Thus it is clear that these statutes were not intended to serve only the particular interests of the benefi-

ciary groups which are to be served by these

programs (18). Service is to the community rather than to the individual for groups such as the

mentally ill, delinquents, criminals, addicts, etc. Welfare recipients represent a class of individuals who ambiguously fall between the two service

perspectives. Public assistance is an example of that class of programs which seeks both to protect the well-being of the general public, while aiding the consumption of the individual.

Because the recipient of welfare is dependent upon the state for his economic sustenance, his

inability to maintain stable family relationships or maintain attachment to the labor force is general- ized to a more fundamental inability to cope effectively with the social and economic environment. This view thus places the department of

public welfare in locus parentis to the client and her children (29). Social services provide one

approach to changing the behavior of those who are economically dependent.

The use of social services to reform individuals and to protect the well-to-do confronts two

problems: it constrains the liberty of the individual and is of doubtful effectiveness in promoting its aims. Joel Handler believes that when government officials have discretion over the distribution of

goods and services that other people need and want, the coercive power of government is increased as well. Governments may resort to coercion also when services fail to promote compliance or the cost of the services seems too high (18). To counter these arguments proponents of the

selectivist-discretionary position explain that since welfare policy is inspired by the desire to maximize the protection of one class of individuals when threatened by the behavior of another, it is therefore inappropriate to use an individual standard to judge a program when a collective standard is more appropriate.

We can readily find examples where society seeks to protect itself from its own largess, in the belief that such aid engenders the very problem it seeks to redress. When such groups remain outside the labor force, the distribution of resources to them can be interpreted as a threat to the

community's well-being. When Governor Rockefel- ler recently proposed a residency requirement for a five-year period in New York State, he did so on the grounds that economic dependency threatened the economic and social viability of the state. When exclusion is no longer an accepted strategy to protect community prerogatives, lower-case social services are promoted as a low-cost means to alter behavior and to assure that welfare recipients do not receive public aid longer than necessary.

The selectivist-discretionary service approach is, however, especially vulnerable because services are of doubtful effectiveness in promoting economic

independence or reducing social problems, and

they are very difficult to administer on a large- scale basis. Handler cautions that even when social services are effective they may be undesirable if

they also lead to coercion. "Effective...means that a program has something to offer...when

something of value is at stake, poor people become

very dependent on the officials who are in control" (18).

What selected groups such as the mentally retarded, the aged, the physically incapacitated require are decent shelter, adequate meals, personal contact - "caring" functions rather than a

"curing" role. These useful basic services extend the quality of living but do not reform behavior. For example, several empirical studies have noted that clients would like social workers who they can really get to know and with whom they can talk over their troubles (19). These families feel isolated, confused, and uncertain as to how to act.

They want support, comfort, and guidance. They do not see the home visits as an intrusion into privacy, nor do they see the social worker as an

agent of control preoccupied with determining eligibility or assessing family adequacy. Hence, they are better justified as services which reflect consumer preferences rather than those which are

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organized as part of a treatment or rehabilitative

program. But such a view of service does not fall

neatly into the competing conceptions of service as universal entitlement or work-oriented rehabilitation. A comfort and support system which some welfare clients seem to want implies a consumer- oriented approach to service delivery which is not limited to those who are economically dependent. This cannot be reconciled with the options reviewed and yet is not equivalent to them.

The Service Delivery Debate

Whatever the limitations of the two philosophical traditions we have sketched, they do serve as a

policy paradigm for delivery of social services in that they declare objectives, imply a theory of intervention to achieve these aims, and propose a set of organizational forms to translate the theory into specific action. But why choose between these incomplete and complementary perspectives? We need both choice and control, both universal and selective programs, both formal legal protection and professional discretion. Why should policies be forced to select between artificial dichotomies which in simplifying alternatives dis- tort reality.

Each perspective is not simply a statement about reality but is also a belief system which contains aspirations, ideals, and objectives, and as such it helps to interpret reality. The choice of a

paradigm "presumes a different conceptual framework, steers attention to different variables, poses problems of a different order, and suggests different methods of approach to solve these problems" (46). For these reasons artificial policy dichotomies which offend common understanding enjoy robustness in policy debates.

As we turn from theory to practice the situa- tion is different. Policies are pragmatic compromises between competing ideals. A specific program of action often embodies through compro- mise and bargaining its conflicting ideals. What different service delivery models actually do when implemented is, of course, an empirical question and cannot be resolved in advance. Many believe that all forms of intervention for the poor, whatever their intent at outset, do in the end surrender to the selective-discretionary model which seeks to impose external standards of control and restrict free choice. Understanding of the differences between intent and performance are therefore critical in social services.

Decentralization and Participation in the Social Services

I want to argue then that alternative delivery models now found in practice may be viewed as efforts to cope with questions of definition and

purpose. The intellectual tradition which hopes to

encourage free expression of individual preferences has sought to do so by both financial and administrative approaches. The former emphasizes the provision of a sufficient income to make it possible for individuals to exercise their own choices, while the latter proposes changes in

organizational format so that the preferences for

publicly provided goods can be revealed. And it is in this contest that the emphasis on citizen

participation and decentralization has played a prominent role. Both are part of the same intellectual tradition. However, as we move from the abstract argument to the real case, conceptual issues become blurred. It becomes difficult to distinguish priorities assigned to individual preferences and community prerogatives.

A similar pattern develops if one starts with the

uncompromising concern for protecting the com-

munity against deviants and marginal groups who threaten its stability. In the intellectual tradition of the 20th century, coercion and deterrence as the prevailing ethic has surrendered to treatment, rehabilitation, custodial care, and community services. If neither coercive nor the rehabilitative approaches strategy works, then a case can be made for treating the deviant and marginal as humanely as possible, taking into account their own preferences and needs (35).

The arguments for unrestricted cash payments are well known and need not be developed here (40) (32); however, the argument about how individual preferences can be applied to social services is less well known. One useful approach to this subject is the work of Tiebout, who tries

systematically to link personal preferences with decentralized services. The model he developed seeks to make government responsive to local preferences by enabling individuals to reveal their preferences for public goods. This general argument applies to upper-case social services, especially education and public services such as garbage collection, sewer disposal, road repairs, etc. But the logic of the argument can serve as a rationale for choice in the social services. Burton, in a statement before the Joint Economic Committee, has summarized the approach as follows:

691




The substance of the Tiebout doctrine is essentially as follows: in the modern world, each metropolitan area contains a (sufficient) number of local government jurisdictions such that each consumer-voter may actually reveal his preferences for local public goods by moving into that particular jurisdiction whose differentiated tax expenditure package is best adapted to his wants. Note that revealed preferences are not detected or exchanged voluntarily by use of prices for individual public goods, but rather by what may be described as a single, collective price for a package of public goods.. ..in the form of a local property tax payment (6, p. 41).

According to Tiebout's model, governmental units provide packages of services. By assuming that families have unrestricted mobility and that residence is determined by preferences for these service packages rather than by proximity between work and residence, individuals and families could

express their preferences by moving into subunits which offer them the service packages they want. The more varied are the individual preferences, the

larger the number of subunits of government that are needed to express them, even to the point of

having a one-person government. In addition to

assuming complete and unfettered mobility, the model must also assume a homogeneity of residen- tial interests which leads people to want to band

together to create subunits of government to have their service preferences satisfied (8).

In addition to political decentralization which involves the efforts of local officials to redistribute

political power and policy-making authority through the creation of new subunits of government with the power to tax, as in the case of school districts, other forms of decentralization can be identified, following the work of Henry Schmandt (36) (8). Territorial decentralization

ranges from a dispersal of local facilities to ease access by bringing government physically closer to

people, to efforts to facilitate by proximity the

expression of resident wishes and preferences. Administrative decentralization calls for the dele-

gation of decision-making authority to subordinate officials who operate public services in neighborhood areas. They are decentralized outposts of a more centralized public bureaucracy. The form of decentralization cannot be mechanically equated with its purposes. Administrative decentralization may be inspired by the ideals of uncovering preferences of individuals as in the case of little

city halls, or by the aim of imposing standards for those in economic need as in the example of detached gang workers. The function of a bureau-

cracy rather than its territorial and administrative decentralization pattern shapes its objectives.

With this caveat, the ideals put forth by decentalization are still best understood as efforts to increase the responsiveness of government to local preferences for public goods and services by permitting a diversity of programmatic responses more nearly congruent with the variety and

complexity of needs and preferences. Our interest is more narrowly limited to how decentralization and participation contribute to the reorganization of lower-case social services. The spatial reorganization of services is presumed to widen access and to facilitate neighborhood participation in choos-

ing policies and shaping programs. Both access and

participation are presumed to reinforce each other, thereby increasing the responsiveness and account-

ability of social service suppliers. There are, however, difficulties in translating

this general rationale in support of decentralization to a set of principles to guide the reorganization and redistribution of social services. These difficulties can be illustrated by inquiring more

precisely into how decentralization theory is ex-

pected to enhance service supplier responsiveness. There is by now an impressive body of literature which has attempted to document the phenome- non that the lower the socioeconomic status of the social service client the more likely he is "to receive the most severe diagnosis, the least reward-

ing professional response, the least adequate the

costly services" (13)(11)(26). But as Marc Fried has pointed out, this body of literature leaves

unspecified and indeterminate the processes which

yield inequalities in treatment by race and class. Fried proposes a systematic study of the hypothe- sis "that discrepancies between clients and agencies are core issues in service outcome and that these discrepancies occur more frequently or more

seriously among lower than higher status clients" (14).

If Fried is correct in his discrepancy thesis, then it is difficult to see how promoting greater access through participation and decentralization will themselves narrow the gap between client and

agencies concerning the origin of the problem, the

specific services to be rendered, and the ex- pectations of help. Low-income families see the source of their difficulties in terms of the lack of money and jobs and then housing and medical care, while social service referral agents lack access to these resources (7). The discrepancy in definition, whatever its origin, is reinforced because service agencies can only do what they can and then refer their clients to established institu-

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tions. To narrow the discrepancy gap, what has emerged are advocacy referrals and community action to expand resources and reform institutional performance. But the effectiveness of these approaches in promoting reform and reallocating resources has proved limited in the absence of national mechanisms for redistribution and the inconsistency of federal support of local institutions. However, this reformulation only further limits the scope and role of personal social services and shifts the locus of its activities from service to reform.

Citizen participation and decentralization are presumed to be closely interrelated strategies, each reinforcing a common commitment to discover local preferences and to transform them into specific programs. Kahn has usefully termed this process "participatory administration," and he describes it as a call for "locally shaped and controlled organization, with few guidelines and directives from higher levels, employing local people where possible, with local administrators (and/or line staff) hired by and subject to approval of 'the community' " (23). He counterposes the approach with one that calls for "professional responsibility, competence, efficient organization, standardization, accountability for funds" and argues there "can be neither a fully centralized nor fully decentralized strategy" - hence some mix or combination is necessary.

The call for participation can be viewed not as a contest between competing principles of bureaucracy and democracy, but as complements to each other. As social service bureaucracies are given broader, more open-ended and less clearly defined mandates, formal-legal principles of entitlement seem less appropriate. To succeed, these services must secure legitimacy, public support, and a better understanding of what people want. And this requires more citizen participation. Even officials whose interpretation of "participation" amounts to no more than the manipulation of public "opinion" need a forum of some kind in which to manipulate (12).

This recognition of the complementary contributions of political action and professional services seems especially timely when the controver- sies generated by participatory strategies seem to have undermined their acceptability. At the same time the complementarity makes it clear that participatory strategies is a daunting task. Experi- ence suggests that promoting one aim seems to inhibit the achievement of the other. Still many

would agree with Donnison that "we need a more sophisticated combination that 'meshes' each with the other, recognizes the inevitable conflicts between them, and provides more effective means for arbitration between government and the gov- erned to make these conflicts more productive" (12). We have not yet been able to devise stable institutional arrangements which embrace these principles. Perhaps none exist. Public policy instead seems to emphasize first one, then another of these alternatives.

I have tried to briefly review the case for decentralization and participation and the difficulties associated with the implementation of each in the social services. This review should make clear why attempts to draw sharp distinctions between individual preferences and community prerogatives are so difficult to sustain in practice.

Social Service Delivery Systems

We turn next to the consideration of alternative service delivery patterns. Along what dimensions can a typology be developed? I view the starting point for such an analysis as the relational-referring conception of social services and the problems which arise in implementing this conception. These problems encourage the search for alternative delivery patterns. The crucial difficulty turns on the defects in the referral nexus - the mechanisms of linkage and the adequacy of the institutions to be linked into. Decentralization and participation from this perspective are ways of resolving the problems of access, adequacy, rele- vance, and consumer preferences. I have, therefore, taken the coordinative-integrative task as the basis for a typology together with the circum- stances under which the individual or administrative machinery is seen as the route to integrate the diversity of services that individuals and families require. These can be broadly grouped under two headings: administrative and financial reforms. This dichotomy is consistent with the universalist- formalist and the selective-discretionary distinctions reviewed at the beginning of this essay but not equivalent to it. The same form can in many situations promote the objectives implicit in each model.

Coordination by a General Counselor

The task of a general counselor in the relational-referral model is to develop a relationship with his client which will enable him to offer a long and

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694 P U B L

complex history of the development of this role.

Briefly the early origins may be traced back to the 19th century Association for Improvement of the Condition of the Poor, which later changed its name to the Charity Organization Society, and in the post-World War II period was again renamed the Family Service Association.

At first these voluntary organizations regarded their function as preventing public destitution, by which was meant receipt of public funds financed

by local Poor Laws. The relational-referring general counselor role never blossomed with the Poor

Law, despite some notable early experiments to create advice and counseling roles within the

public sector. It was believed that private charity administratively separated from the public Poor Law could, through a program of friendly visiting and cash payments when needed, prevent the

receipt of public aid (pauperization). The guiding philosophy was that those who were economically dependent needed "not alms but a friend." This accounts for why the Charity Organization Society was opposed to the financing of old age and mothers' pensions from general taxation and why it supported the abolition of outdoor relief.

There is no counterpart today to this staunch

opposition by voluntary agencies of the use of

public funds. The philosophy and methods of the

voluntary casework agencies have instead been

incorporated within the public sector. The decision to pursue this course of action implied a model of service delivery, where social services were to be integrated into a cash program. In this context, lower-case social services were to aid in

determining whether welfare recipients were able to work, to develop plans to enable them to

acquire jobs or training, to render whatever direct services (such as day care) were necessary to enable them to carry out such plans, and to

provide counseling regarding family planning. Al- most ten years of experimentation with the

integration of services and cash revealed the difficulties of introducing relational-referring services into a large-scale, mass, poorly staffed, unpopular, public assistance program. But the failure did not lead to abandoning the ideal.

Instead, as Schorr has pointed out, "The locale of

integrated services may be shifting from departments of social services to state employment service offices, but individual investiagation and

mandatory training and other services represent closer integration than anyone in the 1960s imagined or proposed" (37).

IC ADMINISTRATION REVIEW

This move to integration of services and cash must be viewed as part of a broader trend to attach social services to upper-case social services. Here they function as a service to the host agencies and only incidentally as a service to the benefi-

ciary. But ambiguities in the relative priorities assigned to the adjustive and self-determination roles remain in such a system and the reach for broad and simple generalizations may be mislead-

ing. However, a counter-move also arose out of the

experience of trying to integrate cash and services. And new federal legislation in public assistance has

permitted separation of cash and service. Thus both the patterns of integration and separation have gone forward, leaving unsettled the broader

question of:

whether general social services are to "stand free" in each community and to constitute or be the hub of a network (i.e., neighborhood counseling centers, family agencies, local authority social work departments, etc.) or are to be adjunctive to schools, hospitals...social insurance offices.. .in some instances, acceptability and access would certainly be enhanced by the latter pattern. [Buti social services placed within systems which have other primary missions may become the handmaidens of such institutions. ..rather than focusing primarily on the client and his welfare, to the point of becoming his advocate (23).

A combination of general and specialized counselors provide the basic structure for the present social services delivery system. But each of these

arrangements is defective. The crucial flaw in both

approaches is the weakness of the referral system - low arrival rates to other community institutions; and the ineffectiveness of the relational

system as evidenced by the disparities between worker and client definition of the presenting problem, which in turn feeds back on the low

holding power of relational counseling, as agencies seem unable to keep the clients they service. This

system of specialized relational and referring centers combined with specialized direct service (day care, institutions, homemakers, etc.) encourages service competition, discontinuity, and diffuses

accountability for service outcomes. The term

"delivery problems" is a shorthand way of express- ing concern about the procedures by which individuals are routed among social welfare institutions, the mismatch between routing and arrivals, discontinuities of interrelated services, and an indeterminate accountability system which fails to isolate the causal agents of organizational failure.

The general counselor must rely upon pleading and shame as devices to get agencies with limited



SOCIAL SERVICES

resources to accept his clients. One approach to reduce these problems is by the purchase of services from other community institutions. The Vocational Rehabilitation Administration is a pro- totype of this approach. It buys the services it regards as necessary for the rehabilitiation of its clientele.

This solution creates a new problem if there is no corresponding expansion in the volume of

community resources, the purchase of care approach only redistributes scarce resources, thus

exacerbating the problem of access in some other

part of the service system. Increased efficiency in one sector can yield declining efficiency in another.

If one wanted to use a purchase of service strategy in order to maximize individual choice in

acquiring services rather than agency flexibility in

securing resources, then the approach could be modified to place the resources at the disposal of the consumer rather than of the agency. The vendor system removes economic barriers to access of services by arranging for third-party payments, usually in the form of prepaid insurance schemes for a series of identified services. Medicaid and Medicare are examples of voucher payment which earmark the service to let the consumer seek out his own services. While few social services are at

present included in prepaid packages, still a direction is suggested by which individual choice can be

expanded by removing financial barriers to access. Voucher schemes can be designed in principle to serve the same end. An eligible group can be

granted a voucher which permits them under the stipulations of the voucher to find their own service supplier who will be paid either directly by the agency responsible for the voucher or by the consumer who will later be reimbursed by the same agency (28). Those who support such voucher schemes do so on the grounds that they can promote competition among agencies and thereby improve their quality and that they encourage freedom of choice among consumers.

A cross between these two approaches has recently been proposed for public discussion by the Hartford Process, Inc., a nonprofit corporation whose board comprises the business and civic leadership of the city. It proposed that social services be handled on a "purchase for service" basis. Neighborhood residents would go to a neighborhood life counselor where together counselor and client would agree on a package of services which seemed appropriate to satisfy the

needs and wishes of the resident. The counselor controls money flows and is able to draw upon some predetermined amount of funds made available by a reallocation of existing resources and further augmented by resident contributions paid as annual premiums, hence assuring entitlement to services. However, the counselor purchases services from existing institutions on behalf of the client. The scheme thus provides resources for the purchase of services through a middle man (9). Neighborhood residents could serve as members of the board of the independent corporation who would hire the neighborhood life counselors and thereby also provide, at least in principle, some form of citizen involvement.

The task of the general counselor is now made easier, for he can now route individuals through the system without concern as to who will pay for the services and with some assurances that a referral will lead to the acquisition of the relevant service. Such a scheme could also make the role of the relational counselor redundant. What the individual acting as his own agent needs in acquiring specialized services as he defines the need for them, is information about where resources are located, and even more urgently, information about the differential quality of services, so that he can more intelligently choose from available resources. Information and referral services are unable to perform this role for they lack adequate information about the quality of services. What is needed is an independent group who can measure quality and assess value in relation to cost. It seems likely that such quality review could not efficiently be decentralized. Of course, hybrid forms can exist as in the proposal by Hartford Process, Inc., to limit consumer choice by making services available only when a joint decision between counselor and consumer is reached.

Integration Without Coordination

This model calls for the territorial decentralization of a number of services combined with administrative decentralization of discretion such that a variety of different services are located in a single physical setting. Administrators acting in these outpost centers have authority to make some decisions with respect to their programs. However, these services are not integrated with one another. Ease of access is presumably facilitated as individuals can select in one physical setting one of a number of different services they desire. Since all

695




services that individuals require cannot in principle be provided, referral continues to be necessary. Neighborhood service and one-stop centers are

examples. This approach is the result of compro- mise, rather than of explicit choice.

Public multiservice neighborhood centers blossomed during the 1960's in programs to prevent delinquency and proverty. One form that such centers followed can be traced back to a presiden- tial speech in August 1966 in which President Johnson called for the creation of 14 Neighbor- hood Service Programs. Each center was to provide participation by residents; linkage agreements with local social, economic, and political resources; core services including intake, diagnosis, and referral; and federally assisted component programs to fill

locally determined gaps in services. While the

vocabulary of core, component, and linkage are different, the basic ideas they express about social services are similar to those developed in this

essay. A national review of the centers conducted by

APT Associates in 1969 concluded that: * Resident participation . . . can take many forms, and it

has frequently not been tied clearly to program opera- tions. There is a clear tradeoff. ..: Short-term effi- ciencies gained by use of professionals vs. long-term benefits to resident

* Of the large amount of money publicized by the federal agencies...only a small fraction...actually reached [the centersl.. .that money which was deliv- ered usually came.. .only after long delays.

* Efforts were mounted by the interagency mechanisms, but died due to lack of departmental interest or support.

· Extensive interagency coordination failed to material- ize. Each agency acted unilaterally toward the program.

· Intergovernmental coordination did not occur (2). An HEW study reveals that despite these

difficulties, 1,000 multiservice centers, both public and private, flourished in 1970. For the purposes of this survey a multiservice center was defined as "one offering two or more direct services full-time to broad segments of the people in the area served" (27). Centers serving only the aged or other special groups or rendering only information and referral programs were excluded.

The HEW study, like its predecessors, also concluded that efforts "to pool facilities and

share...manpower. ..are not widespread. The im- age of an accessible agency into which special staffs from different community agencies are

placed is just not reflected in most . .centers. Two of every three use their own staff exclusively" (27).

Neighborhood resident participation was more

widespread. Seventy-one per cent of centers with

advisory boards report that one quarter of their board members reside in the neighborhood. Half of the centers which have advisory boards have

neighborhood residents making up the majority of the board. Still the survey concludes that "Neigh- borhood residents appear to play only minimal roles in directing and operating centers" (27).

These multiservice programs represent an effort at decentralized coordination with resident participation. The large number of such centers attest to the vitality of the idea. Beyond citing the limited

empirical evidence, what more general conclusions can be drawn? First is the cyclical pattern in the

development of policy. Scarcity of funds among voluntary agencies in the 1950's forced a move to centralized service delivery. At that time participation was largely limited to social and economic elites whose involvement seemed essential in help- ing these agencies capture limited resources from local United Funds. With the growth of public financing of social services and a revived interest in

poverty, the problems of access and professional disengagement from the poor became the ideas in

good currency. Still resources were limited. Decen- tralized interagency cooperative strategies with residents participating not only as consumers but also as employers and board advisors seemed a useful way to win legitimacy. Decentralization facilitated access by residents to services; coordinative linkages with established community agencies assured their availability; participation legitimized the services and helped make them responsive to local preferences. But the reform seemed to turn

against itself. While geographic proximity leads to increased

consumer use, the more limited geographic area in which the program operated inhibited its capacity to acquire the kinds of services its clients wanted - jobs and housing. Of the 4,000 persons in the Roxbury Multiservice Center of Boston who made 10,000 requests for service in a three-year period, only 85 could reasonably be classified as

presenting a mental hygiene problem. Yet less than 10 per cent of the cases account for 90 per cent of service staff time (22). Personnel, when con- fronted with consumer needs they cannot honor, do what they can - give advice and counsel. This experience suggests the need to organize multiservice centers on a much larger scale to take account of the city and region where jobs and housing are available. On the other hand, citizen participation

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SOCIAL SERVICES

can flourish in a more restricted area where communities of homogeneous interests are presumed to exist. However, participation and advo-

cacy conflict with the provision of direct services from outposted agencies, at least in the short run.

Coordination Plus Integration

Here a centralized intake system is developed and each local bureaucracy is not only administra-

tively decentralized but delegates some of its autonomous powers to this decentralized service.

Agencies must accept a case, if it is referred from the central intake. Bureaucracies are reluctant to

delegate such responsibilities and indeed many are

prohibited by law from doing so. While coordination combined with integration may-be held out as a goal, the more typical practice is likely to be

integration without coordination. Service delivery reform in Great Britian has

moved toward the service integration approach much more than in the United States. The Seebohm Report (a committee set up to recom- mend reorganization of social services and named after its chairman) recommended that each local

authority in England and Wales establish a single social service department to distribute most of the social work services provided by local authorities: child care, child guidance, educational welfare, welfare for the aged, some mental health work, home helps, and the welfare services provided by local departments of health and housing. Only probation and "after care" services for adult criminal offenders were excluded,largely because these functions were not rendered by local authorities. The report was accepted and enacted into law by the Local Authority Social Service Act of 1970, and the final transfer of authority began in

April 1971. Two years earlier Scottish social work was

reformed along similar lines, but in this plan medical and psychiatric social workers were ex-

cluded, while the probation services were included. While the matter of defining the service boundaries for the reform are of interest, I want to call attention to the broad mandate which the Scottish Social Work Act of 1968 called for:

It should be the duty of every local authority to promote social welfare by making available advice, guidance and assistance on such a scale as may be appropriate for their area, and in that behalf to make arrangements and to provide or secure the provision of such facilities... as they consider suitable (39).

Integrated social services was the delivery pattern

to promote these ambitious aims. The Allied Service Act of 1972 proposed by the President in a

message to Congress also holds out the ideal of

giving "state and local officials authority to consolidate the planning and implementation of the many separate social service programs into streamlined, comprehensive plans - each custom-

designed for a particular area." The President has

high hopes for these consolidated plans, for he declares that they "could eventually make it

possible to assess the total human service needs of an entire family at a single location with a single application" (1).

Comprehensive Care Organized Around a Single Organizational Function

An agency may seek to provide a whole range of interrelated social services, such as child care, information and referral, health, and literacy training, in order to carry out its mandate. In the fields of manpower and medical service, the

comprehensive model has been encouraged by federal legislation, because while communities may have a whole range of interrelated services, no

single centralized organization can effectively co- ordinate these services. A comprehensive approach can create a single institution, hiring and paying for most of these services within its own administrative framework, thereby reducing the necessity to rely upon referrals from autonomous agencies.

The Comprehensive Neighborhood Health Cen- ters Program funded under the Economic Oppor- tunity Act provides an example of the place of social services in a health care program. All these

programs are decentralized in that the basic rationale of the OEO program was to create new

ambulatory care centers in areas where there is a

paucity of medical care resources for the poor. Many centers have had extensive citizen participation as well.

These comprehensive health programs require a broader range of services than those usually available in a prepaid health center. Consider one

example. In Portland, Oregon, an OEO demon- stration program added 1,200 low-income families to an established Kaiser Permanente prepaid insurance program (4 per cent of the total). In the Kaiser approach, the cost of the prepaid plan depends upon the range and costs of services included, and the reliance upon.supplementary charges for clinic, office visits, laboratory services, etc. Different membership groups and individuals can tailor the specific coverage they want. How-

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ADMINISTRATION REVIEW

ever, the OEO health program for the poor cost almost 25 per cent more than the most comprehensive plan available to the regular Kaiser mem-

bership. Part of the increased cost is attributable to the greater reliance upon social services, such as mental health care, home health services, outreach

workers, health education (20) which includes

teaching the value of health care and the impor- tance of continuity and prevention.

In the Denver Neighborhood Health Service

experiment social services played an even more

prominent role. Here eight small, decentralized, satellite health stations were created, feeding into the more centrally located comprehensive neighborhood health programs. These stations are staffed by 15-20 people, and provide services to

3-5,000 residents. Details of staffing and service are not available, but a satellite station is designed not to render medical care directly but to do whatever diagnostic work it can and to make referrals as necessary (21). And this is essentially the way we have defined the social service role.

Not surprisingly, critics of these developments have argued that social services and other ancillary services have inflated medical care costs, and they have proposed that "stripped down" models be

developed, where ancillary services are stripped away from the hard-core medical program.

Administrative models vary not only in form, but also in the specific social services they develop, and the purposes they serve. In these different administrative approaches, decentralization and

community participation can flourish, but the form above does not reveal policy intent. Selecti- vist and universal aims can be promoted by decentralization and participation. Specifically, delivery models usually call for territorial and administrative decentralization. Political decentralization seldom devolves to these lower-case social service programs, such as education. Citizen participation varies from advisory roles, to advocacy, to social action, to employment of local residents. There is no reason, in principle, why communities could not elect the boards of social service

programs and assign to them the powers to tax the local community to raise money for the services. Such a proposal requires an integrated "free-stand-

ing" social service system, and although new

legislation supports such a move, the realities of

pluralism make this implementation doubtful. In addition to the administrative reforms we

have reviewed, there are models which seek to remove financial barriers or increase income so

that individuals can express their service preferences. Three variants of this general approach can be identified. Money payments can be made:

(a) directly to the individual based on his economic need augmenting his total income, but

leaving him free to decide on how the increase will be spent. This proposal for unrestricted increase in cash income is generally viewed as an alternative to a service approach. But where demand for services are relatively elastic, an income strategy can facilitate the acquisition of services as defined by the individual or the family.

(b) for a specified range of services, as in the case of voucher payments or reimbursement to vendors freely selected by the individual (see earlier discussion).

(c) for individuals who have a specified condition, such as physical disability. Here all individuals who have this condition are presumed to need services. For example, all persons suffering from severe physical disabilities are presumed to require an attendant to help them cope with their condition. A cash grant can be provided on the

assumption that the individual will use the cash to meet the needs associated with the condition, but no check is made on whether he, in fact, uses the services for these specified purposes. If receipts are

required, we have a voucher system. This approach permits selectivity, while preserving the principle of universalism - all those in a selected category receive benefits. Moreover, a service is presumed rather than mandated, thus giving scope for individual choice.

The strategy may be viewed as an attempt to resolve the problems associated with the high cost of the universal system and the restriction of choice that a service approach implies. These

proposals share a common intent for they are all

designed to enable the individual to select services based on his preferences to meet standards as he defines them.

American social service policies seem to emerge without full agreement on the primary aims they should serve. To the extent that there is congres- sional support for a social service strategy, it has been directed toward the aim of imposing com-

munity standards on groups who are economically dependent. Thus the largest service expenditures are directed toward promoting change in the work behavior of public assistance recipients. The commitment of resources in this area is growing and now exceeds the aggregate expenditures for cash payments. Thus despite a vigorous intellectual

698 PUB LIC



SOCIAL SERVICES

commitment to the ideal of the exercise of individual preferences, legislative policy appears to be moving in a somewhat different direction. Those who support a universalist-formalist position find that they lack political support.

It seems unlikely that programs will develop from policies which explicitly articulate a coherent

position. More likely, we will continue to support programs which serve multiple policy aims and to which the definition of services and their purposes will remain ambiguous. Those who will operate social services in the future may be better able to

carry out their mandate if they better understand the conceptual and political issues that surround the problems of decentralization and citizen participation in service delivery systems for lower-case social services.

Each approach reviewed has its characteristic

strengths and limitations. The weakness of the universalist-formalist position is its failure to resolve the problems of a larger universe of eligibles than available resources can accommodate and the failure to reach those in greatest need with

quality services. The selectivist-discretionary positions may serve as a blunt instrument for promoting compliance and thus surrender to compulsion, yet it has limited effectiveness in promoting these aims. It can therefore be argued on humane

grounds that the preference of their clientele should be honored. They typically want a comfort and support system, which conforms to neither model. Alternative service delivery models can be understood as an attempt to explicate each of these positions or to resolve the dilemma that each

approach implies.

References

1. Allied Service Act of 1972, Message from the President of the United States to Congress, Congres- sional Record, May 18, 1972, p. S8124.

2. APT & Associates, Incorporated, "A Study of the Neighborhood Center Pilot Program," Vol. 1, Sum- mary B, prepared for the Executive Office of the President, Bureau of the Budget, pp. 20, 27-29.

3. Edward C. Banfield, The Unheavenly City (Boston: Little, Brown & Co., 1970), p. 246.

4. Bureau of Public Assistance, Public Assistance Goals, 1951 (Washington, D.C.: Federal Security Agency, November 1950), p. 3.

5. Roseland Brooke and L. Syson, "The Voice of the Consumer," in B. Lapping and G. Radice (eds.), More Power to the People (London: Longmans, 1968).

6. Richard P. Burton, Statement before the Joint Economic Committee, October 15, 1970.

7. Genevieve W. Carter, "The Challenge of Accountabil- ity - How we Measure the Outcomes of Our Efforts," Public Welfare, Vol. XXIX, No. 3 (Summer 1971), p. 271.

8. John W. Dyckman, "Decentralization: A Challenge to Planning and Governmental Organization," a paper prepared for the Conference on Centrally Planned

Change, Durham, North Carolina, April 1972, mimeo.

9. Greater Hartford Process, Inc., Section 18, "Social Services and Recreation," a report prepared by the American City Corporation, 1972, pp. 113-119.

10. Committee on Appropriations, Hearings before the Subcommittee on the Departments of Labor and

Health, Education, and Welfare, and Related Agen- cies, House of Representatives, 91st Congress, 2nd Session (Washington, D.C.: U.S. Government Print- ing Office, 1970), p. 270.

11. Elaine Cumming, Systems of Social Regulation (New York: Aldine-Atherton Press, 1969).

12. David Donnison, "Micro-Politics of the City" (Lon- don: Centre for Environmental Studies, February 1972), mimeo., pp. 6, 21.

13. David Fanshel, "A Study of Caseworkers' Perception of Their Clients," Social Casework, Vol. 391958, pp. 543-551.

14. Marc Fried, "Client-Agency Discrepancies in Problem Definition," unpublished report, pp. 120, 121.

15. Charles E. Gilbert, "Administrative Responsibility in Public Welfare," a paper prepared for the 1964 American Political Science Association Conference, mimeo., p. 3.

16. Charles E. Gilbert, "Policy-Making in Public Welfare: The 1962 Amendments," Political Science Quarterly (June 1966), pp. 196-224.

17. Charles Gilbert, unpublished manuscript on the development of social service in the public assistance program, n.d., pp. 48, 49.

18. Joel Handler, Reforming the Poor: Welfare Policy, Federalism and Morality (New York: Basic Books, 1971).

19. and Ellen Jane Hollingsworth, "The Admini- stration of Social Services and the Structure of

Dependency: The Views of AFDC Recipients," The Social Service Review, (December 1969), pp. 4-6-420.

20. May Hipsman, "The Kaiser Foundation Medical Care Program of Oregon," June 1970, mimeo., p. 11.

21. Robert M. Hollister, "From Consumer Participation to Community Control of Neighborhood Health Centers," Ph.D. dissertation, M.I.T., February 1971, p. 151.

22. Wyatt Jones and Robert Pearlman, "The Roxbury Multi-Service Center: Operation and Clientele," mimeo., n.d.

23. Alfred J. Kahn, Policy Issues in the Social Services (New York: Random House, forthcoming), p. 164.

24. Alfred J. Kahn, "Public Social Services: The Next Phase," a paper presented at the American Public Welfare Association Conference, Dec. 9, 1971, mimeo.

25. Alan Keith Lucas, Decisions About People in Need (Chapel Hill: University of North Carolina Press, 1957).

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700 PUBLIC

26. Elliot Mishler and Nancy E. Waxler, "Decision Processes in Psychiatric Hospitalization: Patients Ref- erred, Accepted, and Admitted to a Psychiatric Hospital," American Sociological Review, Vol. 28

(1963), pp. 576-587. 27. Edward J. O'Donnell and Otto M. Reid, "The

Multiservice Neighborhood Center: Preliminary Find-

ings from a National Survey," Welfare in Review

(May-June 1971), pp. 7, 8.

28. Anthony H. Pascal, "Clients, Consumers, and Citi- zens: Using Market Mechanisms for the Delivery of Public Services," a paper prepared for the Conference on Centrally Planned Change, North Carolina, April 1972, p. 7.

29. Michael J. Piore, "Racial Negotiations: The Massa-

chusetts Confrontation," February 1970, mimeo., p. 15.

30. Robert E. Park, "The Social Sciences and the War," The American Journal of Sociology (1919), p. 65.

31. R. A. Parker, "Social Administration and Scarci-

ty: The Problem of Rationing," Social Work, Vol.

24, No. 2 (April 1967), p. 12. 32. Proverty Amid Plenty: The Report of the President's

Commission on Income Maintenance Programs (Washington, D.C.: U.S. Government Printing Office, 1969).

33. A. M. Rees, "Access to the Personal Health and Welfare Service," Social and Economic Administra-

tion, Vol. 6, No. 1 (January 1972), p. 12. 34. Martin Rein, Social Policy (New York: Random

House, 1970). 35. David J. Rothman, "Of Prisons, Asylums, and Other

ADMINISTRATION REVIEW

Decaying Institutions," Public Interest (Winter 1972).

36. Henry Schmandt, New Grass Roots Government

(Washington, D.C., 1972),, p. 3. 37. Alvin Schorr, "People, Not Slogans," Social Work,

Vol. 17, No. 2 (March 1972), p. 2. 38. A. Delafield Smith, "Public Assistance as a Social

Obligation," Harvard Law Review (1949) p. 266. 39. The Social Work Act for Scotland, 1968 (London:

Her Majesty's Stationery Office). 40. Gilbert Steiner, The State of Welfare (Washington,

D.C.: The Brookings Institution, 1971). 41. Charles Tiebout, "An Economic Theory of Fiscal

Decentralization," in Public Finances, Needs, Re-

sources and Utilization (Princeton, N.J.: Princeton

University Press, 1961). 42. Jacobus ten Broek, "California's Dual System of

Family Law: Its Origin, Development, and Present

Status," Stanford Law Review, Vol. 17, No. 4 (April 1968), p. 294.

43. Richard Titmuss, "Welfare Rights, Law and Discre-

tion," The Political Quarterly, Vol. 42, No. 3

(April-June 1971). 44. United Nations: Report by a Group of Experts, The

Development of National Social Service Programmes (New York: United Nations Social Commission, 1959, (Sales No. 60.IV,1), p. 6.

45. Robert Vinter, "Analysis of Treatment Organiza- tions," in R.E. Weinberger (ed), Perspectives on Social Welfare (New York: Collier MacMillan, 1969).

46. Roland L. Warren, "The Sociology of Knowledge and The Problems of the Inner Cities," Social Science

Quarterly (December 1971), p. 473.



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