an analysis of social service delivery re-organization

AN ANALYSIS OF SOCIAL SERVICE DELIVERY RE-ORGANIZATIONAuthor(s): Andrew ArmitageSource: Canadian Journal of Social Work Education / Revue canadienne d'éducation en servicesocial, Vol. 2, No. 3 (1976), pp. 59-67Published by: Canadian Association for Social Work Education (CASWE)Stable URL: http://www.jstor.org/stable/41678940 .

Accessed: 14/06/2014 08:47

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact [email protected].

.

Canadian Association for Social Work Education (CASWE) is collaborating with JSTOR to digitize, preserveand extend access to Canadian Journal of Social Work Education / Revue canadienne d'éducation en servicesocial.

http://www.jstor.org

This content downloaded from 194.29.185.216 on Sat, 14 Jun 2014 08:47:24 AMAll use subject to JSTOR Terms and Conditions

http://www.jstor.org/action/showPublisher?publisherCode=caswe

http://www.jstor.org/stable/41678940?origin=JSTOR-pdf

http://www.jstor.org/page/info/about/policies/terms.jsp


AN ANALYSIS OF SOCIAL SERVICE

DELIVERY RE-ORGANIZATION

Andrew Armitatre Calgary University

ABRÉGÉ Il s'amorce une réorganisation radicale des

services sociaux grâce à une nouvelle législation au Québec, en Colombie-Britannique, au Mani- toba et grâce à des décisions administratives dans quelques autres provinces. Les caractéristiques communes de ces changements sont la décentrali- sation, Pintégration et la participation commun- autaire. Les résultats escomptés aboutiront à une extension et (ou) à une amélioration des services sociaux. La présente communication examine quelques-unes des hypothèses fondamentales qui sous-tendent ces propositions; si on les analyse séparément, on s'aperçoit que les trois idées ne sont pas nécessairement compatibles les unes avec les autres et, qu'en réalité l'application de l'une peut empêcher la réalisation de l'autre. La dé- centralisation est une notion qui découle de l'idéologie des sciences politiques; sous ses formes antérieures, elle débouchait sur des services sociaux concurrentiels et non intégrés; dans ses ré- centes manifestations, les discours peuvent voiler le fait que la nouvelle organisation se prête mieux à un contrôle central que le système qu'elle a remplacé; on peut douter de la façon dont les services seront "améliorés". L'intégration est, idéologiquement, un produit de la sociologie qui veut contrecarrer les forces d'aliénation de la société; en même temps, elle exige de plus vastes structures organisationnelles et des échelons d'autorité plus étendus; en pratique, les questions "quoi" et "comment" de l'intégration demeurent sans réponse à cause d'ambiguïtés interdisciplin- aires. L'idéologie démocratique fournit la base des idées de participation des citoyens; en réalité, elle assure un mécanisme d'allocations qui permet de contrôler la demande et de dispenser de par- cimonieuses ressources (services); elle s'intéresse donc à F "amélioration" plutôt qu'à 1' "extension" des services; les problèmes posés par la représentativité restent au stade de l'expérience et mal établis.

La conclusion fait ressortir que les arguments d'ordre idéologique et économique sont souvent contradictoires, tandis que les formules prag- matiques ne garantissent ni 1' "amélioration", ni

1' "extension" des services sociaux. Les con- séquences à l'égard de la pratique et de l'enseignement du service social sont lourdes.

The changes in social service delivery organization with which this paper is concerned are represented in legislation by Quebec's Bill 65, (1971), "An Act to Organize Health and Social Services"; British Columbia's Bill 84 (1974) "Community Resource Board Act" and Manitoba's Bill 48 (1975) "The District Health and Social Services Act". Similar changes in the organizational structure of the social services are being made in some other provinces by administrative rather than legislative means. In total, the changes amount to a radical re- organization of the social services. As the personal social services are the principle employer of social workers, this re-organization has major impli- cations for both social workers and social work education.

The changes in social service organization have been documented and discussed in a series of Canadian Council on Social Development papers and meetings and it is not the purpose of this paper to repeat or summarize these discussions. The reader who is not familiar with the basic form of the changes and the issues for social service administration they raise, is referred to the C.C.S.D. work on the subject.1

'For example H.P. Hepworth "Personal Social Services in canada, Vol. 7 Access and Delivery", C.C.S.D. Ottawa 1975; "Community Multi- Service Centres" Proceedings of meeting in Quebec City Nov. 24-26, 1975; and the proceedings of the follow-up conference held in Vancouver February 22-24, 1976.

59



The purpose of this paper is to understand more fully some of the fundamental ideas that lie behind the re- organization. Such an analysis is not particularly concerned with whether specific decisions were made with explicit reference to a particular idea. Social policy is influenced by ideas in indirect as well as direct ways. A particular policy or programme is usually developed through the shared interests of a variety of groups, each of which are attracted by certain features of the proposal. The actual act of legislation and implementation may be framed with specific reference to certain of those ideas but the indirect influence of the others will have an effect upon support, administration, continuation and public perception of the policy or programme. The whole range of ideas relevant to a particular policy thus remains important - not only those ideas that were the immediate dominant ones in its adoption.

Two lines of inquiry that are not being pursued in this paper are the historical/ political line of inquiry and the rational/ evaluative line of inquiry. That is to say, the reader will look in vain for any attempt to investigate and document the events and politics that led to specific recent legislation dealing with social service delivery re-organization. The reader will also look in vain for empirical data related to a judgment as to the effects, intended or latent, of social service delivery re-organization - although the paper does indicate some ideas relevant to the development of such judgments.

zari, opening the meeting, referred to decentralization, integration and community participation as major shared features of contemporary Canadian social service delivery re-organization. In a general way each is supposedly related to improvement in the social services, which is usually assumed to be synonymous with more and/ or better social services. However, there is a tendency to treat decentralization, integration and community participation as ends in themselves. Further, it is possible to attach a variety of inter- pretations to each of these words and hence produce some confusion in the subject for debate. It should also be noted that, although the three ideas are usually associated with each other, there is no necessary association between them. One can re-organize services in a decentralized manner without integration or participation. One can produce integration between related services without decentralization or community participation. One can have community participation without integration or decentralization.

For the purpose of this paper the three ideas are treated separately so as to understand more fully the major characteristics of each. The relationship between the ideas is also examined, including the apparently unavoidable conflicts produced by their simultane- ous pursuit.

Decentralization: Decentralization is an administrative

and political concept that is basically reactive to a fundamental trend in the political and administrative institutions of our society - that is to say the trend towards centralized institutions at the level of the nation state. Decentraliza- tion, conversely, means the attempt to retain or create local political and/ or

Decentralization, Integration, Com- munity Participation

At the C.C.S.D. Social Services Conference in Vancouver (February 22- 24, 1976) Alderwoman Darlene Mar-

60



administrative units with autonomous decision-making powers.

The most important roots of the idea appear to be ideological and are a manifestation of a fundamental dis- satisfaction with the type of society created in the industrialized world, and a search for ways of simplifying the institutions of such a society. G. Myrdal had a vision of the day when the welfare state would be replaced by the welfare society in which the bureau- cratic and regulatory activities of the former would be replaced by the caring people of the latter. A practical step towards such a society was to support autonomous and co-operative forms of welfare activity through which determination of, and provision for welfare would be decentralized.2

This set of views is related to the pessimism with which most of the sociological literature dealing with organizations - from Weber on - treats the seeming inevitability of bureaucracy - secondary relationships between people and alienation. Here again, decentralization is seen as resisting these trends - keeping organizations smaller, making relationships between persons more direct and decreasing alienation.

Political science directs attention to the power relationships that exist within a decentralized system of government and/ or adminsitration. The British North America Act, and specifically its interpretation in relation to social policy, creates decentralization at the provincial level. In turn, the most important political interaction shaping the social services occurs between the federal and provincial authorities. The emerging new Federal Personal Social Services Act is a product of that 2G. Myrdal "Beyond the Welfare State" Duck- worth, London 1960, pages 70-74

dynamic. Within the provinces the social services have always been characterized by further forms of decentralization. This provincial decentralization has been the result of the provinces recognizing and supporting (directly and indirectly) a series of organizations that provide social services. Major forms of such decentralization include: -

- Municipal or Regional Govern- ment Acts that require munici- palities to make welfare pro- visions for their citizens;

- Children's Aid Societies, and other non-government organizations recognized by charter or legislation as providing for the collective welfare;

- Comissions, e.g. for Alcoholism or Drug Service that have partial autonomy in their policy and administration;

- Contracts, grants-in-aid, tax exemptions, etc., whereby government encourages charitable organizations to provide services either generally or for specific purposes;

- Regional organization within government departments.

The interaction between these units has deeply marked the general development of social services. The variety of units and their relative autonomy from one another has provided the context within which differences of philosophy, treatment approach, etc., could be fostered and organizationally entrench- ed. The variety of structures has provided for many different types of citizen involvement. The interaction between the units has been known as "politics" (with a small "p"); a feature of social service activity treated with marked ambivalence by social workers for although some are experts, few rank

61



their expertise as highest amongst their accomplishments. A secondary conse- quence of these forms of decentralization has tended to be a non-integrated and competitive set of social services.

Given this history of decentralization, the proponents of the newer forms of social service organization, e.g. Bill 64 (Quebec), Bill 84 (B.C.); Bill 48 (Manitoba) can scarcely claim that the idea of decentralization in social service delivery is new. Indeed there is reason to think that the claims for decentralization may be more rhetorical than substantial.

For example, in Vancouver, the former (N.D.P.) government reor- ganized social services, taking power away from the chartered Children's Aid Societies and City of Vancouver and creating the Vancouver Resource Board and a series of local area resource Boards. However, the Community Resource Board Act that made these changes possible was worded in terms of ministerial discretion. The Minister "may" call for election in order to establish Board, the Minister "may" entrust authority for specific services to Boards - etc. With a change of government it became very clear that what a Minister "may" do is not necessarily what is going to happen. Thus the Vancouver area Resource Boards were dismissed by Ministerial action - and were much more vulner- able to centralized authority than the structures they replaced which required legislation to alter. Legislation in Quebec and Manitoba has similar features - leading to the conclusion that although the newer forms of social service organization recognize the need for decentralization, the means for accomplishing this objective may be less able to resist centralized authority than were the more traditional social service

systems that were abolished. It is also interesting to note that this

whole debate about decentralization in relation to both older and newer structures is carried on with little attention to its possible impact upon services. Are decentralized services supposed to be of better quality than centralized services? The predominant trend has been to link high quality of service to specialization and hence to the centralization necessary to con- centrate resources and those needing help. It is possible to argue that decentralized services would be of higher quality because of their greater freedom to attend to individual cir- cumstance, but either way the arguments are not clear and there is little evidence to support either side. Simil- arly, it is not clear whether decentralized services are supposed to be more efficient (in terms of units of service output for given resources) than centralized services. Again there are occasional arguments presented on either side but little evidence and no clear conclusions.

Thus much of the concern for decentralization appears to be rhetorical. A theoretical analysis tends to the conclusion that the rhetoric is super- ficial and is being contradicted by the real form of the newer social service structures that are being created. In addition it is uncertain how decentralized services are supposed to be "better" than those they replaced.

Integration: Integration of social services (and

health services in some situations) implies the organization of similar and related social services within one structure. Integration can be achieved at one administrative level in such a structure but not at others; for example,

62



there are several government departments of health and social services that are integrated at the level of Minister and Deputy Minister, but are essentially independent organizations at the service delivery level. However, in the context of recent social service delivery re-organizations, the intention is to pursue integration to the service delivery level. The idea of integration is also related to that of 'co-ordination'. Both are addressed to the problem of how related services can best be articulated with each other. Integration is the more radical response and is now being widely entertained because of the apparent failure of 'co-ordination' to produce co-operation between related services.

At an ideological level, the idea of integrated services is related to the long term quest within social policy for universal rather than selective service patterns. The Seebohm Report3 states the case for social service re-organization as follows:

"111. We see a strong case for re- organization so that services may:

a) meet needs on the basis of the overall requirements of the individual or family rather than on the basis of a limited set of symptoms

b) provide a clear and comprehensive pattern of responsibility and accountability over the whole field,

i) be more accessible and com- prehensible to those who need to use them."

The newer integrated pattern is pro- moted because it is more universal in its

3"Report of the Committee on Local Authority and Allied Personal Social Service" London H.M.S.O. Cmmd 3703 p.37

coverage, accountability, and access than the separate services it replaces. This is the same basic idea that Wilensky and Lebaux4 pursue in their distinction between residual and institutional services - with the clear implication that institutional services are more appropriate for industrialized sQciety. A similar idea is also present in A. Kahn's writing particularly in his identification of "social utilities" as being a desirable organizing concept for social services.5 The central thrust of this quest is related to the desirability of providing service without creating special, usually stigmatized, identities.

Thus the pursuit of universality and hence integration is related to the sociological literature in that it is seen as resisting the tendency of our service systems to create alienated statuses through identifying individuals with social problems. Integration resists this tendency in two ways. First it serves to provide service within a broad frame- work that emphasizes the fact that all people need help at some points in their lives, that receiving help is normal, and hence not a particular product of the individual circumstances of alcoholics, neglected children, the depressed, etc. Second, integration provides a comprehensive service responsibility and authority. This comprehensive authority should avoid the subdivision of families, persons, and problems between agencies, and also avoid leaving some needs and problems unattended because no jurisdiction is responsible. Integration of service delivery is seen as providing the context for more holistic services to both individuals and com-

4Wilensky and Lebaux "Industrial Society and Social Welfare" p. 138

5Kahn, Alfred "Social Policy and Social Services" Random House, N.Y. 1973, p. 76

63



munities. Empirically this concern has been studied in the several descriptive and experimental studies that have examined the delivery of social services to multi-problem families.

To these ideological and sociological arguments favouring integration, there are planning and administrative ad- vantages that are alleged for integrated service patterns. The widened context for planning and administration result- ing from service integration is seen as making for more rational planning and for a more unified, and hence rational, administrative structure. In other words, integration leads towards larger organizations and longer chains of authority-subordinate, relationships - the very trends that decentralization reacts against.

Finally there is some attempt to identify the ways in which integration will lead to better and more efficient social services. The services are seen as being better because it is expected that they will be more holistic in their response to communities and individuals. The services are seen as being more efficient because the process of allocating resources between a variety of ends will be more rational.

So far in this discussion integration has been treated as an abstract idea. In practice, one must contend with the question of what services are to be integrated and how they can be integrated. Because the arguments identified above are general to the human services, they are not that useful in answering such practical dilemmas as whether it is desirable to integrate health and social services, social services and criminal justice services, social services and income services, etc. These practical questions tend to be addressed by a second level of ad hoc arguments, special plead- ing and politics. Similarly, the question

of "how" integration is to be achieved requires an appreciation of the immediate politics and consequences of actions.

Thus, although there are powerful arguments and interests favouring integration at theoretical level, there are a host of practical questions bearing upon the scope and implementation of integration that are formative upon the final product and which can lead to very different types of integration oc- curring.

Legislation in Quebec and Manitoba and administrative experiments in Al- berta and British Columbia are in the direction of integrating the various personal social services with each other and with community health services. The criminal justice system remains separate but there are important questions affecting the organization of services for juveniles, i.e. should they be part of the personal social services or should they be part of the criminal justice system. The future status of social allowance income programmes remains unclear. Administratively several provinces have tried to separate their income services from their personal social services. However, the line between the two is not easily drawn, partly because some persons needing income services also need personal social services and, conversely, some of the need for personal social services is related to an inability to purchase service at market prices. Thus, the relationship of re-organized personal social services to income services remains unclear. The changes that have been made have considerable implica- tions for social work practice and social work education. They increase consi- derably the range of personal problems that individual social workers in direct contact with clients will encounter, and hence the range of interventive ap- proaches and knowledge necessary. The

64



changes emphasize the need for inter- disciplinary collaboration at the direct practice level. The changes immerse social work in much more complex organizational forms in which social workers are not necessarily the dominant or most numerous professionals; and in which position of organizational leadership are not necessarily going to be held by social workers. The changes keep open the long-term, and some- times uncomfortable debate, concern- ing the form and substance of social work expertise and the ways it dis- tinguishes its expertise from that of other professions.

Citizen Participation: Community participation in the so-

cial services is scarcely a new idea. The older forms of social service organization originated from mutual support and citizen participation. R. Lubove6 indicates how the development of social work as a profession resulted in the displacement of citizens from positions of professional judgment and administration to positions of subordinate vol- unteer roles and Board level sponsorship activities. Nevertheless, these activities remain a significant part of the social services as organized through such bodies as a Chartered Children's Aid Society, United Way member agencies, etc. It was only in the government section of the social services that citizen participation was often absent.

More recently, during the 1960's and 'War on Poverty', the idea of service consumers having an influence upon the agencies and professions that worked with them received support. The history of the various community action programmes, welfare rights groups and community development activities dur-

6Roy Lubove "The Professional Altruist", Harvard, 1965

ing the American and Canadian 'wars on poverty' served to demonstrate that consumers could make a contribution to personal social service policy development, administration, and practice, but that it was difficult to provide continuity of sponsorship and funding.

Here again there are important ideological elements in the social policy and administration literature that favour community participation. Foremost of these is the commitment to democratic forms of social institution and to the idea that the individual or group should be heard in any matter affecting its welfare. Again, one could trace connec- tions between these ideas and the sociological literature that associates power- lessness with alienation7 and views participation as a response to these issues of our society.

To these general concerns regarding social institutions and favouring citizen participation one must add a more direct and tangible problem for the social services - how to obtain a measure of the "demand" for services. The traditional approach to understanding social service "demand" has relied prin- cipally on the estimate of professionals that these were "n" clients, or potential clients, and that this called for "x" units of service in order to provide treatment, amelioration, support, etc. This approach to "demand" has come under criticism from several viewpoints. First, it has been observed that the professionals who produce such measures of "demand" are not disinterested parties. They are usually the ones that provide the service and stand to gain in power, influence, and salary through the ex- pansion of the services of which they are a part. Second, it has been noted that consumers and professionals may have

7M. Rein. "Social Policy", Random House, N.Y., 1970, pp. 430-431.

65



different views of the general direction of social policy and that a professionally based measure of "demand" only provides expression to one view. Finally, there is a particular problem for the social services that derives from their non-market, usually charge-less, form of distribution and consumption. When the charge for a service is zero, consumers tend to express their demand at the "satiety" level. Since no society can meet all needs at the satiety level, there is no good reason to think that social services should ideally be free from the need for a realistic demand and rationing mechanism. The development of Community Resource Boards is an approach to the solution of this problem. In essence the Resource Board becomes a community rationing mechanism for scarce social service resources - money, professional personnel, etc. "Demand" can be expressed by consumers, professions, and citizens but it is up to the Board to legitimize the demand and make allocative decisions between different groups.

The role of citizen participation is thus not related to any idea of providing "more" services for given resources. Instead it is related to the idea of providing "better" service - "better" being defined in terms of service that is validated by local community participation in priority determination.

Such decisions require a form of community participation that can be viewed as representative of the community as a whole. It is for this reason that the largely self-appointed, and self- perpetuating, Boards of Directors of private agencies were considered to be unsuitable mechanisms for community participation. Instead, the newer mechanisms aim at breadth of community participation either by local elections or by appointment by provin-

cial governments. The local elective route to citizen participation is accom- panied by particular hazards. Muni- cipal politicians are not likely to view the development of new and separate local elective structures with anything but suspicion. Municipal opposition was the major reason given by the B.C. Social Credit governments for dis- mantling the elected boards that the previous N.D.P. government had begun in Victoria and Vancouver.

More broadly, although substantial ideological, sociological and economic arguments can be made favouring citizen participation, the translation of these ideas into structure and organization remains experimental and unestablished. Community practice remains the form of social work intervention in which the practitioner is most likely to lose his own shirt!

Conclusion: This exploration of recent changes in

social service organizational patterns leads towards the following general conclusions. One group of ideas favouring the changes appear to be ideological and sociological. Alienation and the means of serving people that minimize alienation are important considerations in the re-shaping of social service patterns. A second group of arguments affecting the changes are basically economic in form. They deal with the delivery of more or better service from limited resources and are attentive to measures of demand and effectiveness. This second group of arguments will probably be more significant than the first because of the general situation of scarcity and restraint within which the social services now have to operate.

Of the three major concepts, integration of services appears to be the

66



most significant in its total effect upon service patterns. Decentralization is certainly not a new departure; can conflict with integration; and seems to be diminishing rather than increasing. Its impact upon services is also unclear. Community participation remains a general objective of service re-organization, but the political and professional means to its achievement remain experimental. Because of the scope of these changes, "summative" research is

not likely to be productive. On the other hand, a "formative" approach to evaluation and development is, or should be, an essential component in social service re-organization.

The overall significance of these changes should not be minimized. They are having a considerable effect upon social work practice and should have a direct effect upon preparation for social work practice.

67



an analysis of social service delivery re-organization

Documents