Issues in Human Service Delivery (Social Sciences Essay)

Human Service Delivery can come in many forms, and for the next 4 weeks you will focus on four different topics making an application to your focal agency. Be sure to refer to the course readings.
Read the mini-lecture contrasting "power over" clients and "power with" clients.
What is the nature of the client/agency relationship? "Power Over" or Altruism "Power With"? How does empowerment play out in your focal agency?
Post your initial comment which must be 2-3 short paragraphs citing the course readings. Then enter the discussion area at least 2 more times to read each of your fellow students' comments, and make appropriate suggestions for how their agency might improve its performance in this area. Provide them with any helpful ideas about what are best practices that you have read about or noted in your focal agency. These comments should be made during the discussion week.
My course book:
Reference
Halley, A. A., Kopp, J., & Austin, M. J. (1998). Delivering Human Services: A Learning Approach to Practice (4th Edition) (4th ed.). Pearson.
Lecture below:
Historically there have been two views of the relationship between human services agencies and their clients, I have chosen to call them "power over" versus "power with".
The original stance of government, dating back to the Elizabethan Poor Laws probably can best be described as "power over" those in need of assistance, including the poor and those suffering from a wide variety of physical, emotional, and intellectual challenges. This stance undoubtedly is rooted in an aristocratic view of society in which the "privileged" classes were expected to take care of those "beneath" them in social status. This expectation of care was a product of both a philosophical tradition dating back to the days of Plato and Aristotle that assigned responsibility to the aristos or aristocracy and a long biblical tradition in Western Europe rooted in Judeo-Christian values emphasizing love of neighbor and the virtue of caring for the less fortunate.
At the time the Elizabethan Poor Laws were enacted in the early 1600's, the English government was in the hands of the landed aristocracy who also paid the vast majority of taxes. Since tax on land paid for social services, it made sense that those who paid the taxes should set policies for their distribution. "Counts" were primarily in charge of the new approach to meeting the needs of the poor. Hence, the assignment of social welfare administration to "counties", a practice that continues to this day in the US.
Veteran speaks about denial of benefits
Victims of Battle . . . or Wimps?
Tyler Einarson, 28, of Homestead, Minn., describes how he was wounded in combat and his subsequent fight to receive disability benefits, during a news conference at the National Press Club in Washington, Monday, January 25, 2010. Einarson and representatives from the National Veterans Legal Services Program discussed developments in a class action lawsuit by Iraq and Afghanistan war veterans claiming denial of benefits for post-traumatic stress disorder. (AP Photo/J. Scott Applewhite)
In addition to the "county" system of social service administration, we have inherited the Elizabethan model for determining whether persons are "worthy" of receiving help. Human services still relies heavily on three categories: persons who deserve care because they are unable to help themselves (including, for example, the physically ill, the mentally ill, and the developmentally disabled and/or intellectually challenged); those who are unable to care for themselves because of their age or stage of life (children and the elderly); and those who "should" be able to work and care for themselves, the "able-bodied" poor. For most of social welfare history, the first two categories have met with at least some public sympathy. The "able bodied", on the other hand, have usually been labeled "paupers", "afflicted by a 'culture of poverty,'" or just plain "lazy".
While it certainly can be argued that systematically providing for the poor is better than providing sporadic care, no care at all, or outright persecution, the problem with the aristocratic model is that it presumes that one party is the "provider" and the other the "receiver" of services. This, in turn, sets up an automatic imbalance of power with the logical consequence that the "provider" assumes "power over" the recipient. The "provider" sets the rules and determines who will receive help, the amount of help that will be received, and criteria for denial of help.
The decision to give help and whether it is made from a stance of "power over" the recipient or "power with" the recipient is made on several policy levels. At the level of social values, it is based on an uneasy balance between the high value placed on individualism and individual responsibility and the responsibility of persons to band together to support one another in an implied or explicit "social contract". Moreover, social values still tend to mirror those of Elizabethan days. Those in need are implicitly and explicitly divided into those who "deserve" compassion and those who are perceived to be to blame for their own circumstances.
The tension between these major social values is, in turn, reflected in the social policies of the two major political parties. Republicans, at least in the present day, emphasize individualism especially as it is manifested in capitalism. Their emphasis is on the responsibility of individuals, families, and private charities to care for those in need. Those who are deemed "capable of work" are expected to fend for themselves. Democrats emphasize the "social contract" and, therefore, the responsibility of government to provide its citizens with the basics of a decent quality of life.
The differences between the two parties filter into what political scientists call "sectoral policies" or broad areas of the human services system impacting laws and funding for mental health, developmental disabilities, drug and alcohol services, the aging, child care, children, youth, and families, income maintenance and a myriad of sub-categories of each. Republicans tend to lay responsibility for these services on individuals, families, private charities, county governments, and the states in approximately that order. Democrats do not deny private responsibility, but, at least since President Franklin Roosevelt, have asserted that the national government has a responsibility to use federal tax money to ameliorate suffering.
At the national level, laws are passed giving permission for the national government to be engaged in service delivery and other national laws are required to allocate funds to pay for services. Each of these laws defines the agency or agencies responsible for oversight of programs and distribution of resources. Thus, salaried employees within the national, state, and county bureaucracies are given the responsibility of developing regulations that define how services will be delivered and how the funds to pay for them will be allocated. Regulatory agencies have a great deal of authority in human services. The jurisdictional policies and reporting procedures that they create largely define what agencies receiving any kind of government funding can or cannot do. In general, regulatory agencies seem to operate from the "power over" model. Since shortly after the failure of the War on Poverty in the 1960's the policies and procedures of regulatory bodies have been become more and more restrictive. Rules and reporting requirements have increased, funding has been tightened, and agencies have been left with hard decisions.
At the organizational (or agency) level, program policies, daily practices, record keeping, and funding levels are determined largely in light of policies set by the regulatory and legislative bodies discussed above. In addition, the basic values of the agency's governing board and its chief executive officer are important determinants of how clients will be treated and the rules that will be developed. Some governing boards, executive directors and other administrative staff view clients as "deserving" or "don-deserving" or "compliant" and "don-compliant". Clients (and sometimes lower level staff) of such agencies may be heard to remark "They act as if they are taking the money out of their own pocket" and, indeed, leaders with such a value system do feel that they are dispensing services that somehow must be "earned", operating out of the "power over" value system. In many other cases agency leaders feel an obligation to serve humankind or at least a particular target population. These people tend to develop policies and procedures in light of helping as many people as possible as effectively as possible within the constraints of time, staff, and funding. These agencies operate from a "power with" perspective.
While all of the above are important determinants of social and agency policy, human services are really delivered at the "street level" by case managers and other direct service workers. Conflicting values show up at the "street level" too. Some direct services workers implicitly or explicitly base service delivery on whether or not they believe a particular client to be "worthy" or "unworthy" of services based on the worker's own values. For those who implicitly use their own moral and ethical values to judge others, a "worthy" client is often one who is compliant with requests, who provides necessary information in a timely way, is polite, is reasonably clean, is "moral" and seems motivated to try to improve. On the other hand, an "unworthy" client is non-compliant, misses appointments, is impolite or downright nasty, smells bad, lives an "immoral" life (as defined by the caregiver) and is perceived to be lazy or unmotivated. While most human services' workers would probably deny (even to ourselves) that we are motivated by our implicit categories, most human services' clients would probably tell us that they often experience judgmental attitudes from direct services workers. When worker values get in the way of service provision, the worker is exercising "power over" the client. On the other hand, many human services' workers are fair-minded and non-judgmental. They listen carefully and empathetically to their clients. They are culturally competent, actively attempting to understand their client's world. They empower their clients by actively teaching problem solving skills, activating positive supports for client well-being, and working to eliminate barriers. When such practices prevail, the worker is exercising "power with" the client.
This course emphasizes the value of exercising "power with" rather than "power over" clients and is based explicitly on the ethical guidelines of both the human services and social work professions. However, in the rough and tumble world of human service delivery both value frameworks exist simultaneously. It is important that you are able to recognize these different approaches to power within agency/worker/client relationships, and to make wise ethical decisions regarding the role of power in your practice.

Joyce S. McKnight (c) 2007