The Privatization of Human Services: Policy and Practice Issues Volume I

275 Pages·1998·7.111 MB·English

by  Margaret Gibelman (auth.), Margaret Gibelman DSW, Harold W. Demone Jr. PhD (eds.)

Springer Series on Social Work
Albert R. Roberts, D.S.W., Series Editor
Graduate School of Social Work, Rutgers, The State University of New Jersey
Advisory Board: Gloria Bonilla-Santiago, Ph.D., Sheldon R. Gelman, Ph.D.,
Gilbert]. Greene, Ph.D.,Jesse Harris, D.S.W., Michael]. Smith, D.S.W.,
Barbara Berkman, Ph.D., and Elaine P. Congress, D.S.W.
1984 Battered Women and Their Families: Intervention Strategies and
Treatment Programs, Albert R. Roberts, D.S. W
1984 Clinical Social Work in Health Settings: A Guide to Professional
Practice with Exemplars, Thomas Owen Carlton, D.S. W
1987 Information and Referral Networks: Doorways to Human Services,
Risha W Levinson, D.S. W
1988 Social Work in the Workplace: Practice and Principles,
Gary M. Gould, Ph.D., and Michael Lane Smith, Ph.D.
1990 Social Work Practice in Maternal and Child Health
Terri Combs-Orme, Ph.D.
1990 Program Evaluation in the Human Services Michael]. Smith, D.S. W
1990 Evaluating Your Practice: A Guide to Self-Assessment,
Catherine Alter, Ph.D., and Wayne Evens, M.S. W
1990 Violence Hits Home: Comprehensive Treatment Approaches to
Domestic Violence, Sandra M. Stith, Ph.D.,
Mary Beth Williams, L.C.S. W, and Karen Rosen, M.S.
1991 Breast Cancer in the Life Course: Women's Experiences,
Julianne S. Oktay, Ph.D., and Carolyn Ambler Walter, Ph.D.
1991 Victimization and Survivor Services: A Guide to Victim Assistance,
Arlene Bowers Andrews, Ph.D.
1992 The Family Functioning Scale: A Guide to Research and Practice,
Ludwig L. Geismar; Ph.D., and Michael Camasso, Ph.D.
1994 Dilemmas in Human Services Management: Illustrative Case Studies,
Raymond Sanchez Mayers, Ph.D., Federico Souflee,Jr., Ph.D., and
Dick]. Schoeck, Ph.D.
1994 Managing Work and Family Life,
Viola M. Lechner; D.S. W, and Michael A. Creedon, D.S. W
1996 Total Quality Management in Human Service Organizations,
john]. Gunther, D.S. W, and Frank Hawkins, D.S. W
1997 Multicultural Perspectives in Working with Families,
Elaine P Congress, D.S. W
1997 Research Methods for Clinical Social Workers: Empirical Practice,
john S. Wodarski, Ph.D.
1997 Elder Abuse and Neglect: Causes, Diagnosis, and Intervention
Strategies, 2nd Edition Mary joy Quinn, R.N., M.A.,
and Susan Tomita, M.S. W, Ph.D.
1998 The Privatization of Human Services
Volume 1: Policy and Practice Issues
Volume 2: Cases in the Purchase of Services
Margaret Gibelman, D.S. W, and Harold W Demone, Jr., Ph.D.
Margaret Gibelman, DSW, is Professor and
Director of the Doctoral Program at the
Wurzweiler School of Social Work, Yeshiva
University, in New York. She teaches in the
areas of social welfare policy, manage
ment, and child welfare. She has also taught
at Rutgers University and The Catholic
University of America.
Dr. Gibelman has worked in the human
services as a clinician, supervisor, educator,
and manager. In the latter category, she has
served as Executive Director of the National
Association of School Psychologists and the
Lupus Foundation of America. She was also Associate Executive Director
of the Council on Social Work Education, the accrediting body for social
work education programs in the United States. She is a frequently con
tributor to scholarly journals on nonprofit management, privatization,
professional education, women's issues, and service delivery systems.
Harold W. Demone Jr., PhD, is currently a
Visiting Scholar at Florence Heller School
for Advanced Studies in Social Welfare,
Brandies University and an Emeritus Profes
sor II in Social Work and Sociology and for
mer dean of the School of Social Work at
Rutgers University. His publications on the
human services exceed 120 in number.
With a professional career spanning more
than 40 years, about equally divided between
the practice and academic arenas, Dr.
Demone has had frequent opportunities to
both practice and observe many of the facets
of privatization, even long before it was known as such. Dr. Gibelman and
Dr. Demone have teamed on several articles on the subject of privatiza
tion and co-edited Services for Sale: Purchasing Health and Human Services
(Rutgers University Press, 1989).
The
Privatization of
Human Services
Policy and Practice Issues
Volume I
Margaret Gibelman, DSW
Harold W. Demone, Jr., PhD
Editors
~~~
Springer Science+B usiness Media, LLC
Copyright© 1998 by Springer Science+B usiness Media New York
Originally published by Springer Publishing Company, Inc inl998
Softcover reprint of the hardcover 1st edition 1998
All rights Reserved
No part of this publication may be reproduced, stored in a retrieval sys
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Library of Congress Cataloging-in-Publication Data
The privatization of human services : policy and practice issues I
Margaret Gibelman, Harold W. Demone, Jr., editors.
p. cm.-(Springer series on social work: 28)
Includes index.
ISBN 978-0-8261-9870-9 ISBN 978-3-662-30309-2 (eBook)
DOI 10.1007/978-3-662-30309-2
1. Human services-Contracting out-United States.
2. Social work administration-United States.
3. Privatization-United States. I. Gibelman, Margaret.
II. Demone, Harold W. III. Series.
HV95.P737 1997
361.973-dc21 97-28506
CIP
Contents
Foreword by Alfred J Kahn vzz
Preface xz
Contributors xxzzz
Chapter 1. Theory, Practice, and Experience
in the Purchase of Services 1
Margaret Gibelman
Chapter 2. Evaluating State Mental Health
Care Reform: The Case of
Privatization of State Mental
Services in Massachusetts 53
Dow A. Wieman and Robert A. Dorwart
Chapter 3. Purchase of Service and
Fostered Failure:
A Massachusetts Case Study 79
Paul S. Regan
Chapter 4. Contracting for Alcohol and
Drug Treatment: Implications
for Public Management 97
Steven Rathgeb Smith
Chapter 5. Church, State, and Social
Welfare: Purchase of Service
and the Sectarian Agency 117
Eric M. Levine
v
vi Contents
Chapter 6. Fears Betrayed: Initial Impressions of
Contracting for United Kingdom
Social Services 155
James Richardson and Richard Gutch
Chapter 7. Accountability in Purchase-of-Service
Contracting 183
Peter Kettner and Lawrence Martin
Chapter 8. The Political Future of Privatization 205
Harold W. Demone, Jr.
Index 245
Foreword
No reader of professional journals, agency reports, or the daily press needs
to be told that Professors Gibelman and Demone have assembled a vol
ume of contributions to a very lively debate. The two words highlighted,
"privatization" and "contracting," sum up the prescriptions of many for
social service reform and the anxieties of others who question the new
strategies.
The pace and scale of developments over the past 2 decades sometimes
allows us to forget that the subject has a long history. Privatization may be
thought of as involving public turnover to the private sector of responsi
bility for services it has been delivering. Or it may be the public sector
arranging for the private sector to take on new services that the public
wishes to encourage or for which it accepts responsibility. The transaction
usually involves public funds.
The historical story, however, is not one of public temporal primacy.
One can go back to the ancient world for early examples of simultaneous
public and private contributions to what would today be thought of as wel
fare services. The private component was either individual charity or was
usually based in religious institutions. Or, one can begin with the break
up of feudalism and the transition to mercantilism. The evolving state
needed to develop new provisions (through poor law) where church insti
tutions, mutual aid, and charitable individuals had once sufficed. As it
matured, poor law eventually involved intertwined local government and
the local private sector, with some public subsidy of the latter. The process
was more strongly delineated by the 19th century, when the "require
ments" of the developing wage system created a new, more limited and
punitive poor law; an expanded middle-class humanitarianism provided
a much-needed safety valve (sometimes with and often without govern
ment financial support). Now there were programs for the "deserving"
vzz
viii Foreword
and for the others. Private agencies were to become "more" eligible, less
stigmatizing.
Modern social services and modern social work developed from the
Progressive Era, but the scale and nature of the social welfare enterprise
changed with the entry of the federal government, a result of the New
Deal. The process gathered momentum in the public and private social
services and mental health after World War 11-but especially during the
Great Society. It was the expansion of scale and scope from the mid-1960s
to the 1980s that encouraged and supported the large, publicly assisted,
voluntary service expansion, some of it associated with successive thrusts
of public welfare "reform" and much of it categorically organized around
social problems or troublesome symptoms. All of it remains with us today
and the process continues.
The backdrop for social service developments of the last 2 decades is
the "liberal" turn in economic thinking in capitalist welfare states, exem
plified and led by the Thatcher era in Britain and the Bush-Reagan terms
in the United States. (Reference here is to liberal economic policy in the
European meaning, with the resultant emphasis on deregulation, gov
ernment downsizing, privatization, and the insistence on the use of mar
ket devices, whenever possible, as vehicles for efficiency.) As of this writing,
most of the leading industrialized societies (as represented by the
European Union [EU], the Organization for Economic Cooperation and
Development [OECD], the World Bank, and the International Monetary
Fund) are preaching, enforcing, and exporting a process of governmen
tal downsizing, free trade, and privatization, which, despite some resis
tance and recent challenges, continues to dominate.
But it is one thing to privatize armament manufacture, telecommuni
cations, transport, or even garbage collection, fire fighting, and road main
tenance. The products or services are or can be standardized, units can
be counted, costs and cost-benefits can be computed. The terms of the
debate and the nature of the policy choices can be arrived at (and there
is by now an extensive body of empirical literature as a result). What of
the social services, whether narrowly or broadly defined? What is a stan
dard expected unit of child protection, family support, child guidance
intervention, and how does one describe standard expected impact? The
social services, nonetheless, are part of the general culture so that,
inevitably, public leaders, legislators, and the media expect them to behave
as do all institutions, and the ideologies that motivate public policy in
other domains are applied to them as well. This is indeed a time of change.
But how does it work? And does it work? What.are the processes and
Foreword ix
mechanisms that will create effective systems? How has privatization and
contracting evolved in a political culture which has cut funding for social
services significantly since the Reagan years and has recently decentral
ized some major functions to the states"? Surprisingly, little is known. The
answers must be sought "on the ground."
Contracting, or purchase of service, has been the most prevalent pri
vatization mechanism in the social services in recent decades. The gen
eral arguments offered-economy, efficiency-are similar to the general
arguments for all privatization, but the empirical case is weak if one
demands standard research. If one cannot standardize inputs and out
puts, how does one measure? Is progress being made in these regards?
Further, there are also hints of other arguments and rationales beyond
economy and efficiency that deserve attention and testing: quality, diver
sity, innovation.
For now, we must return to the immediate questions: What do we know?
What is the experience? What is the case for privatization/ contracting?
What are the choices? What are the mechanisms? Gibelman and Demone
have assessed the state of affairs very well. They know that we need case
materials, records of experience, fresh and sharp thinking, and a vehicle
for debates. This timely book, and its companion volume, will be welcome
and used.
J.
ALFRED KAHN
Professor Emeritus
Columbia University
School of Social Work
NewYork, NY