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Jane Addams, A Great American Hero

JaneAddamsPortrait

On our trip to Chicago, my wife and I visited Hull House, one of the first Settlement Houses in the United States and home to Jane Addams. It is now a museum located in the middle of the University of Illinois, but 130 years ago it stood in the middle of the worst immigrant slums in Chicago.

Addams was born into privilege, yet in 1889 she and her friend, Ellen Gates Starr, decided to moved into a house in the heart of the immigrant slums of Chicago. Their initial idea was to providing daycare for children living in poverty. In the process they came face to face with the great hardships and disadvantages or poor immigrants all around them. The focus or their mission kept growing to meet the endless needs. Daycare was supplemented with preschool and educational services. They opened the first playground in Chicago. She saw that child labor practices prevented theses children from having a full childhood, so she advocated for laws against child labor. Her mission grew to serve the parents and others adults.

Addams recognized that there were community and systemic issues that prevented the poor from improving their lives, things beyond their control. For example, the stench of garbage filled the streets and created unsanitary conditions. People were getting sick because the city wouldn’t regularly pick up the garbage in their neighborhood. She fought the city and won regular trash pick-up. When she learned that there were only 5 bathtubs in the whole community, she built a pubic bath beside the Hull House where hundreds of people came every week.

Intervening to help the poor and to lift their burdens on multiple social levels became her pattern. She took in homeless families, listened to their stories, helped them find housing and then advocated for better housing. She sheltered woman who were abuse by their spouse, listened to their stories, helped them get on their feet and used what she was learning to advocate for social change. Moreover, the work of Addams and Starr at Hull House attracted some of the best and brightest woman of the day to study the conditions of the poor and and disenfranchised, and to organize social movements for social change.

Addams became a prolific writer and prominent national spokesperson for social change in the 1930’s and 1940’s. The data she and other collected on the social issues of the poor, and social research at Hull House, helped inform her writings. Her advocacy and social ideas got her labeled as the most dangerous woman in America by none other than the Daughters of the American Revolution. Herbert Hoover’s FBI compiled lengthy files on her anti-war activities during WW I. Still she persisted.

Jane Addams was among the early pioneers of an effective method for improving peoples lives. It includes:

Meeting the immediate needs of a person in need


– Listening to their stories face to face


-Empowering them to get back on their feet through their own efforts whenever possible


– Collecting data on the problems and issues they presented


-Making observations about the local circumstances and social barriers that contributed to their problems, and


– Using that information to advocate for broader changes in laws, policies, funding and greater  social awareness 

This intervention methodology is the foundation for the profession of Social Work. This is the mission of social work and what sets it apart from psychology and other helping professions.

In 1931 Jane Addams became the first American woman to win the Nobel Peace Prize for her work at Hull House.

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Of Poverty and Proverbs – An Excuse to Blame the Poor

by Brian T. Lynch, MSW

“Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

There is some wisdom in this old English proverb. It seems obvious that our survival instinct compels us to use our skills to meet our basic needs. The point being made by this proverb is that It’s more worthwhile to teach someone to do something for themselves than to do it for them.

As a nugget of wisdom, however, the expression is also insufficient. It assumes that resource and circumstances are otherwise favorable for the fisherman. The proverb shouldn’t be taken too literally or applied too broadly, but it often is. This is especially the case when it is applied to social welfare.

Specifically, it becomes a problem when policy makers believe that all you have to do is give someone the skills they need they can do the rest on their own. It’s the notion that skills plus self-determination are sufficient for success. This reductive thinking forms the rationale behind the conservative politics of poverty. It’s destructive corollary is a belief that when skills have been properly transferred, yet success remains elusive, the fault lies within the character of the person. It is a belief that fails to consider scarce resources or other barriers beyond a person’s control.

To make this point, take the proverbial fisherman as an example and ask yourself the following question: What else, other than skills, might be required for the fisherman to catch his daily meal?

You won’t get very far down your list before you see the point here. The fisherman’s success still requires the right conditions, many of which are beyond his personal control. And some of the conditions are dependent on social factors, or environmental factors over which we have societal influence. Examples of these include having clean water, allowing public access, or requiring a fishing license.

The devil is always in the details. There are no simple formulaic ways to think about poverty. There is only the need to critically evaluate the impact of policies that influence everyone’s well being, and to seek out, and overcome the barriers people face every day to putting food on their table. Do that and every able bodied person will act with self-determination.

Declaring War on the Poor

by Brian T. Lynch, MSW

Thom Tillis is now Senator elect from North Carolina, having beaten Democratic incumbent Kay Hagan in the 2014 election. During his campaign Tillis berated the poor and suggested that those people who can’t help being poor, like the truly disabled, should rise up and opposed welfare for the unworthy poor. What he actually said was:

“What we have to do is find a way to divide and conquer the people who are on assistance,” 

North Carolina has 1.1 million poor. That’s 13.1% of its population. If these folks voted it would be hard to imagine Tillis getting elected, but Hagan and the Democrats have abandoned the poor and working class in this country as well. Now the poor are under attacks like this:

“We have to show respect for that woman who has cerebral palsy and had no choice, in her condition, that needs help and that we should help. And we need to get those folks to look down at these people who choose to get into a condition that makes them dependent on the government and say at some point, ‘You’re on your own. We may end up taking care of those babies, but we’re not going to take care of you.’ And we’ve got to start having that serious discussion.” – Thom Tillis

Watch for the U.S. Senate to put Tillis on the Health, Education, Labor and Pensions Committee to replace Kay Hagan. He is destine to become the chair of the Children and Families Sub-committee with his attitudes. His appointment would amount to a declaration of war on the poor.

So how should sensible people respond to divisive attacks like this on the poor and vulnerable? Should we begin making similar distinctions between the worthy and unworthy rich? Should we affirm those who earned their great wealth and provide social benefit but rescind all advantages given to those who use their inherited wealth to squeeze the people and their government for still more?

How we respond to these questions will define who we are as a nation.

Snippets: Toxic Stress and New Ways to Combat the Impact of Child Abuse and Neglect

What follows is a snip-it of an excellent article from the Opinionator section of the New York Times by David Bornstein. Within the article are hyperlinks to excellent source material on childhood toxic stress, its impact on children and new methods to prevent harm or treat children who are exposed to toxic stress. I have taken snippets of each of these hyperlinks to create an annotated index to the sources from Mr. Bornstein’s article. I hope that this will encourage further reading and understanding on this topic. Having spend 31 years as a social worker in child protective services it has been my experience that chronic and repetitive stress on children is both pervasive and incredibly damaging. It takes new protective service workers years of experience to recognize toxic stress and fully appreciate how damaging it truly is. The whole field of protective services is more oriented towards responding to physical abuse and acute safety risks than it is to chronic neglect or repetitive lower level trauma. – Brian T. Lynch, MSW

Protecting Children From Toxic Stress

By DAVID BORNSTEIN

New York Times – October 30, 2013

Imagine if scientists discovered a toxic substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risks for smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression — and simultaneously reduced the chances of succeeding in school, performing well on a job and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it and keep it far away from children. Right?

Well, there is such a thing, but it’s not a substance. It’s been called “toxic stress.” For more than a decade, researchers have understood that frequent or continual stress on young children who lack adequate protection and support from adults, is strongly associated with increases in the risks of lifelong health and social problems, including all those listed above.

[read more: http://opinionator.blogs.nytimes.com/2013/10/30/protecting-children-from-toxic-stress/?_r=0 ]

Toxic stress response: Occurs when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.
When toxic stress response occurs continually, or is triggered by multiple sources, it can have a cumulative toll on an individual’s physical and mental health—for a lifetime. The more adverse experiences in childhood, the greater the likelihood of developmental delays and later health problems, including heart disease, diabetes, substance abuse, and depression. Research also indicates that supportive, responsive relationships with caring adults as early in life as possible can prevent or reverse the damaging effects of toxic stress response.

[read more: http://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/ ]

Centers For Disease Control and Prevention

http://www.cdc.gov/ace/index.htm

Survey shows 1 in 5 Iowans have 3 or more adverse childhood experiences

October 14, 2013By Jane Ellen Stevensin 

Iowa’s 2012 ACE survey found that 55 percent of Iowans have at least one adverse childhood experience, while one in five of the state’s residents have an ACE score of 3 or higher.

In the Iowa study, there was more emotional abuse than physical and sexual abuse, while adult substance abuse was higher than other household dysfunctions.

This survey echoed the original CDC ACE Study in that as the number of types of adverse childhood experiences increase, the risk of chronic health problems — such as diabetes, depression, heart disease and cancer — increases. So does violence, becoming a victim of violence, and missing work days.

[read more: http://acestoohigh.com/2013/10/14/survey-shows-1-in-5-iowans-have-3-or-more-adverse-childhood-experiences/ ]

From the American Academy of Pediatrics

Technical Report

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

  1. 1.       Benjamin S. Siegel, MD, 
  2. 2.       Mary I. Dobbins, MD, 
  3. 3.       Marian F. Earls, MD,
  4. 4.       Andrew S. Garner, MD, PhD, 
  5. 5.       Laura McGuinn, MD, 
  6. 6.       John Pascoe, MD, MPH, and 
  7. 7.       David L. Wood, MD

 

ABSTRACT

Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. [snip]

[read more: http://pediatrics.aappublications.org/content/129/1/e232.full ]

WORKING PAPER #3

Excessive Stress Disrupts the Architecture of the Developing Brain

New research suggests that exceptionally stressful experiences early in life may have long-term consequences for a child’s learning, behavior, and both physical and mental health. Some types of “positive stress” in a child’s life—overcoming the challenges and frustrations of learning a new, difficult task, for instance—can be beneficial. Severe, uncontrollable, chronic adversity—what this report defines as “toxic stress”—on the other hand, can produce detrimental effects on developing brain architecture as well as on the chemical and physiological systems that help an individual adapt to stressful events. This has implications for many policy issues, including family and medical leave, child care quality and availability, mental health services, and family support programs. This report from the National Scientific Council on the Developing Child explains how significant adversity early in life can alter—in a lasting way—a child’s capacity to learn and to adapt to stressful situations, how sensitive and responsive caregiving can buffer the effects of such stress, and how policies could be shaped to minimize the disruptive impacts of toxic stress on young children.

Suggested citation: National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Retrieved from http://www.developingchild.harvard.edu

Download PDF >>

Strengthening Adult Capacities to Improve Child Outcomes: A New Strategy for Reducing Integenerational Poverty

Jack P. Shonkoff, Harvard University – Posted April 22, 2012

[snip]
It’s clear that high-quality early childhood programs can make a measurable difference for children in poverty, but we must do more. Advances in neuroscience, molecular biology, and the behavioral sciences provide the evidence needed to build on best practices and to forge new ideas that can address the factors that contribute to intergenerational poverty. One promising path is to focus on fostering the skills in adults that allow them to be both better parents and better employees.

Science tells us that children who experience significant adversity without the buffering protection of supportive adults can suffer serious lifelong consequences. Such “toxic stress” in the early years can disrupt developing brain architecture and other maturing biological systems in a way that leads to poor outcomes in learning, behavior, and health. [snip] …[T]he goal is to prevent or mitigate the consequences of toxic stress by buffering young children from abuse or neglect, exposure to violence, parental mental illness or substance abuse, and other serious threats to their well-being.

Success in this area requires adults and communities to provide sufficient protection and supports that will help young children develop strong, adaptive capacities. Since many caregivers with limited education and low income have underdeveloped adaptive skills of their own, interventions that focus on adult capacity-building offer promising opportunities for greater impacts on children.

One area of development that appears to be particularly ripe for innovation is the domain of executive functioning. These skills include the ability to focus and sustain attention, set goals and make plans, follow rules, solve problems, monitor actions, delay gratification, and control impulses.[snip]

[ See more at: http://www.spotlightonpoverty.org/ExclusiveCommentary.aspx?id=7a0f1142-f33b-40b8-82eb-73306f86fb74#sthash.4XsuGXPI.dpuf ]

Stress reactivity and attachment security.

Gunnar MRBrodersen LNachmias MBuss KRigatuso J.

Source

Institute of Child Development, University of Minnesota, Minneapolis 55455, USA.

Abstract

Seventy-three 18-month-olds were tested in the Ainsworth Strange Situation. These children were a subset of 83 infants tested at 2, 4, 6, and 15 months during their well-baby examinations with inoculations. Salivary cortisol, behavioral distress, and maternal responsiveness measures obtained during these clinic visits were examined in relation to attachment classifications. In addition, parental report measures of the children’s social fearfulness in the 2nd year of life were used to classify the children into high-fearful versus average- to low-fearful groups. In the 2nd year, the combination of high fearfulness and insecure versus secure attachment was associated with higher cortisol responses to both the clinic exam-inoculation situation and the Strange Situation. Thus, attachment security moderates the physiological consequences of fearful, inhibited temperament. Regarding the 2-, 4-, and 6-month data, later attachment security was related to greater maternal responsiveness and lower cortisol baselines. Neither cortisol nor behavioral reactivity to the inoculations predicted later attachment classifications. There was some suggestion, however, that at their 2-month checkup, infants who would later be classified as insecurely attached exhibited larger dissociations between the magnitude of their behavioral and hormonal response to the inoculations. Greater differences between internal (hormonal) and external (crying) responses were also negatively correlated with maternal responsiveness and positively correlated with pretest cortisol levels during these early months of life.

[read more: http://www.ncbi.nlm.nih.gov/pubmed/8666128 ]

Child FIRST

HIGHLIGHTS
  • Intervention: A home visitation program for low-income families with young children at high risk of emotional, behavioral, or developmental problems, or child maltreatment.
  • Evaluation Methods: A well-conducted randomized controlled trial.
  • Key Findings: At the three-year follow-up, a 33% reduction in families’ involvement with child protective services (CPS) for possible child maltreatment. At the one-year follow-up, 40-70% reductions in serious levels of (i) child conduct and language development problems, and (ii) mothers’ psychological distress.
  • Other: A study limitation is that its sample was geographically concentrated in Bridgeport, Connecticut.  Replication of these findings in a second trial, in another setting, would be desirable to confirm the initial results and establish that they generalize to other settings where the intervention might be implemented.

Download a printable version of this evidence summary (pdf, 4 pages)

Effects of Child FIRST one year after random assignment:

Compared to the control group, children in the Child FIRST group were –

  • 68% less likely to have clinically-concerning language development problems, as measured by a trained assessor (10.5% of Child FIRST children had such problems versus 33.3% of control group children).
  • 42% less likely to have clinically-concerning externalizing behaviors, such as aggression or impulsiveness, as reported by their mothers (17.0% of Child FIRST children versus 29.1% of control group children).

Compared to the control group, mothers in the Child FIRST group were –

  • 64% less likely to have clinically-concerning levels of psychological distress, based on self-reports (14.0% of Child FIRST mothers versus 39.0% of the control group mothers).
  • The study did not find statistically-significant effects on (i) the percent of children with clinically-concerning internalizing behaviors (e.g., depression or anxiety); (ii) the percent of children with clinically-concerning dysregulation (e.g., sleep or eating problems); (iii) the percent of mothers with clinically-concerning parenting stress; or (iv) the percent of mothers with clinically-concerning depression.3

[read more: http://toptierevidence.org/programs-reviewed/child-first ]

Research Finds a High Rate of Expulsions in Preschool

By TAMAR LEWIN

New York Times – Published: May 17, 2005

So what if typical 3-year-olds are just out of diapers, still take a daily nap and can’t tie their shoes? They are plenty old enough to be expelled, the first national study of expulsion rates in prekindergarten programs has found.

In fact, preschool children are three times as likely to be expelled as children in kindergarten through 12th grade, according to the new study, by researchers from the Yale Child Study Center.

[read more: http://www.nytimes.com/2005/05/17/education/17expel.html?_r=0 ]

Preschool and child care expulsion and suspension: Rates and predictors in one state.

Gilliam, Walter S.; Shahar, Golan

Infants & Young Children, Vol 19(3), Jul-Sep 2006, 228-245. doi: 10.1097/00001163-200607000-00007

ABSTRACT : Rates and predictors of preschool expulsion and suspension were examined in a randomly selected sample of Massachusetts preschool teachers (N = 119). During a 12-month period, 39% of teachers reported expelling at least one child, and 15% reported suspending. The preschool expulsion rate was 27.42 per 1000 enrollees, more than 34 times the Massachusetts K-12 rate and more than 13 times the national K-12 rate. Suspension rates for preschoolers were less than that for K-12. Larger classes, higher proportion of 3-year-olds in the class, and elevated teacher job stress predicted increased likelihood of expulsion.  [snip]

[read more: http://psycnet.apa.org/psycinfo/2009-04570-007 ]

Traumatic and stressful events in early childhood: Can treatment help those at highest risk?

Chandra Ghosh Ippen, William W. Harris, Patricia Van HornAlicia F. Lieberman

ABSTRACT: This study involves a reanalysis of data from a randomized controlled trial to examine whether child–parent psychotherapy (CPP), an empirically based treatment focusing on the parent–child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs)

[read more: http://www.sciencedirect.com/science/article/pii/S0145213411001499 ]

Listening to a Baby’s Brain: Changing the Pediatric Checkup to Reduce Toxic Stress

Listening to a baby’s heartbeat. Examining a toddler’s ears. Testing a preschooler for exposure to lead. These critical screenings have long been the hallmarks of early childhood checkups. Now, leading pediatricians are recommending major changes to the checkups of the future. The American Academy of Pediatrics (AAP) wants primary care doctors to screen their youngest patients for social and emotional difficulties that could be early signs of toxic stress. Read more >>

[read more: http://developingchild.harvard.edu/resources/stories_from_the_field/tackling_toxic_stress/ ]

From the American Academy of Pediatrics

Policy Statement

Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health

Andrew S. Garner, MD, PhD, Jack P. Shonkoff, MD, Benjamin S. Siegel, MD, Mary I. Dobbins, MD, Marian F. Earls, MD, Andrew S. Garner, MD, PhD, Laura McGuinn, MD, John Pascoe, MD, MPH, David L. Wood, MD

ABSTRACT : [snip] To this end, AAP endorses a developing leadership role for the entire pediatric community—one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters—to catalyze fundamental change in early childhood policy and services. AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span.

[read more: http://pediatrics.aappublications.org/content/129/1/e224.full.html ]

Top of Form

aces connection

HEALTHY, HAPPY KIDS GROW UP TO CREATE A HEALTHY, HAPPY WORLD.

This is a community of practice network. We use trauma-informed practices to prevent ACEs & further trauma, and to increase resilience.

[read more: http://acesconnection.com/ ]

ABOUT DAVID BORNSTEIN:

David Bornstein is the author of “How to Change the World,” which has been published in 20 languages, and “The Price of a Dream: The Story of the Grameen Bank,” and is co-author of “Social Entrepreneurship: What Everyone Needs to Know.” He is a co-founder of theSolutions Journalism Network, which supports rigorous reporting about responses to social problems.

Does Philanthropy End Up Hurting the Poor and Vulnerable?

What follows is my response to an open discussion about the role and social value of philanthropic  foundations.  It is my response to the lead article by Dr. Rob Reich, which can be read in its entirity at the URL below.

BOSTON REVIEW

http://www.bostonreview.net/BR38.2/ndf_rob_reich_foundations_philanthropy_democracy.php#c5t_form

MARCH/APRIL 2013

Lead Essay:
What Are Foundations For?

Rob Reich

This article leads off our debate on philanthropy, with responses from Stanley Katz, Diane Ravitch, Larry Kramer, and others.

Graham Smith

Judge Richard Posner, one of the foremost American jurists outside the Supreme Court, once observed, “A perpetual charitable foundation . . . is a completely irresponsible institution, answerable to nobody. It competes neither in capital markets nor in product markets . . . and, unlike a hereditary monarch whom such a foundation otherwise resembles, it is subject to no political controls either.” Why, he wondered, don’t we think of these foundations as “total scandals”?

If foundations are total scandals, then we have a massive problem on our hands. We are now living through the second golden age of American philanthropy. What Andrew Carnegie and John D. Rockefeller were to the early twentieth century, Bill Gates and Warren Buffett are to the early twenty-first century.

The last decade of the twentieth century witnessed the creation of unprecedentedly large foundations, such as Gates’s. The assets of the Gates Foundation and a separate Gates Trust, which holds wealth donated by the Gates family and Buffett, together total more than $65 Billion. If the combined entities were a nation, it would be 65th on the world GDP list. And it’s not just billionaires and their mega-foundations that command attention. Record wealth inequalities might be a foe to civic comity, but they are good for philanthropy. The boom in millionaires has fueled unprecedented growth in the number and assets of small foundations as well.

So foundations have seen explosive growth. But why are they a scandal?  Read the Full Article.  http://www.bostonreview.net/BR38.2/ndf_rob_reich_foundations_philanthropy_democracy.php#c5t_form

My Comments:

In setting up his essay on philanthropic foundation in this “second golden age”, Reich offered the following:  “Let us dismiss quickly one common and intuitive thought: that foundations exist because they are remedial or redistributive, responsive to the needs of the poor or disadvantaged.”

He goes on to identify public goods this way: “It has long been understood that the commercial marketplace does not do well at providing what economists call public goods. These are goods that, like a well-lit harbor, are available to everyone if they are available to anyone; and that, like clean air, do not cost more when they are consumed by more people. “

After three decades in the field of child welfare, this was a startling and insightful dismissal.  In debating whether America’s philanthropic foundations are worthy of the tax exempt status conferred on them in 1937, Reich excludes consideration of their value relative to public services that reduce human misery but carry a cost per use.  In other words Reich’s definition of public goods includes only passive public services, like street lights, but not active public services, including child welfare.  This certainly explains why foundational giving for public needs is so small a percentage of their activity.  Yet we are asked to judge whether their social contribution is worth their $53 billion in tax exemptions each year?  How much good could that revenue do to support and strengthen our most vulnerable citizens?  Don’t ask!

To characterize social services as remedial “or redistributive” of wealth, is offensive to me.  When used to characterize government spending on the general welfare, “redistribution” is a code word to frame partisan arguments in our muffled debate over distributive justice.  Taxing the more successful citizens to promote the general welfare, except for military spending, is considered an unfair redistribution of wealth, yet any discussion on  the fair distribution of profits between workers and business owners is considered out of bounds.

The context for this discussion on foundations is the social value of philanthropy at a time when wealth disparity has never been greater.  When a growing number of wealthy foundations are extracting ever more revenue from an already dwindling federal revenue stream,  excluding consideration of their impact on public services makes this discussion itself a plutocratic exercise.

The pros and cons of whether foundations generate valuable diversity and innovation were well explored by the forum’s other contributors, but none of their essays addressed underlying assumptions.  Foundations actually do play an outsized and often deterious  role in how community social services are structured, funded and distributed. None of the contributors picked the scab off  this wound to consider the broader picture.  Financially speaking, foundations are in direct competition with public social services and the vulnerable populations served. I was disappointed.

Time to Cap the Debate on Social Security and Medicare

Social Security and Medicare are in serious financial trouble in the future because they have been under attack for so long that how we thing of them has been changed by those who wish to kill these programs.  Regardless of whose figures you believe when discussing the financial health of these programs, it could all be fixed by scraping the income cut off cap for contributions.  Right now income payroll deduction collect a fixed percent of incomes up to around the first $107,000.  This was just raised to this amount this year.  All income over that amount is not considered.

I am a reluctant proponent of eliminating the Social Security and Medicare income contribution caps.  In the short run this improve the income projects for both programs for some time to come, but it would also plant the seeds of distruction for these programs.  It is helpful to understand why there are these caps to understanding my point.

Social Security and Medicare are government run insurance programs.  Payroll deductions are really premiums to pay for them.  Only those who pay their premiums over the years will be eligible for benefits in the future.  These premiums, collected though payroll deductions, are not income taxes in the sense that they do not fund the federal budget. These programs are not the cause of our federal spending deficits or our national debt (two terms often tossed about as if they meant the same thing).  Both Medicare and Social Security are currently solvent.  They are collecting enough in premiums to cover current expenses.
Because Social Security and Medicare are insurance programs, the premiums have a cap so that the revenues collected are just enough to pay expenses for current recipients.  There is no massive bank account where your money is held until you retire. What we pay in annual premiums, in other words, pays for the benefits received by current recipients.  The cap on income contributions is the means to adjust annual collections to meet current needs.  It is like the volume control, or the valve of a faucet or a dial on a dimmer switch.  The actual percentage of our income that we pay in premiums is fixed.  It is not indexed to inflation.  So even if there weren’t more seniors collecting benefits, the income cap would need to be periodically raised to adjust for inflation.  Raising the cap is how we increase premium revenues without having to change the percentage of money taken out of our salaries.  It is designed to raise the “volume” of cash flow by collecting a little more from just the wealthiest  group of contributors.
But these government insurance programs have always had their critics who, over the years, have attacked these social programs and changed the language used to describe these social insurance programs.  They alter the language in order to frame their debate and change how we think about the programs.  Premiums became” taxes,” “wage garnishment” or “big government spending.”  Benefits became “entitlements,” or “government handouts” and so forth.  As a result, increasing the income cap is, “a big government tax increase,” on the “successful” who are “job creators,” the “makers,” so that our out of control government can give even more money to the “takers”.  We all know the rhetoric on the right.
It is true that premium revenue needs to be raised and it is always true that we need to find more efficiencies in delivering services.  But the opponents of these programs scare the hell out of everyone by conflating current debt and deficits with the potential of future insolvency for these programs if income caps are not adjusted.  So we should either raise the income cap to increase revenue as originally intended or we scrap the cap and make everyone pay a flat percentage of their salary.  This method would still require periodic adjustsments for future inflation and shifting service needs, but raising premium rates would be a much harder thing to do politically since it would affect everyone and not just a handful of people who are well off and won’t hardly notice the change.

“Free Market” Social Services Fail to Deliver

Where do you turn when your aging mother can’t be by herself anymore or you notice your baby seems a little delayed?  Imagine that your teenager start  skipping school and staying out all night or imagine you are suddenly diagnosed with a serious illness or disabled in an accident.  Where do you go for help?

Sooner or later we all knock on the door of our community’s social service network.  What greets us may be far less than we expect.  And sadly, the help available to us will depend a lot on where we live and how much money we make.   The confusing patchwork of private, public and non-profit social service agencies through which we must navigate is the natural, unintended consequence of the free market model we’ve created to deliver social services.

We are all only temporarily able bodied.  We don’t give much thought social services.   We are content knowing that free market competition is efficiently keeping down the cost of publicly financed services for the needy.

It isn’t until we seek help ourselves that we encounter a labyrinth of agencies with confusing components and cutesy sounding acronyms for their names.  Agencies often list the types of services they offer (counseling, for example) without listing the types of problems they serve (such as adolescent issues).   Consumers are expected to know which services work best for their problems.  Some agencies over promise results in their marketing or take on people with problems that would be bettered resolved elsewhere.   Access to services are often restricted by bewildering eligibility requirements based on age, gender, geography, diagnosis, income, insurance provider, religion, ethnicity, funding source or hours of operation.

If your family has one or two very common problems, chances are you will find the help you need.  But if your problems are uncommon or complex, your search will not go smoothly. And if you also happen to be poor, live in an under served community or don’t have transportation, the prospects for getting effective help are slim.

This is the character of our social service networks today.  They are not based on matching service availability and capacity to the needs of local communities.  They are loosely coordinated networks created by free market forces and competition between private or non-profit agencies scrambling for dollars.

For over thirty years we have been privatizing public social services in the belief that free markets are more efficient than government in providing the best services at the lowest cost.  Little attention is given to the inescapable fact that market driven systems create uneven results by their very nature.  This is true in commerce but especially true in public social welfare.  Larger agencies are more politically connected and better positioned to compete for public dollars.  Wealthier communities have a higher profit potential so they attract more and better competitors.   Smaller agencies and program models that incorporate innovative ideas are less able to compete for government money.

Innovative approaches to helping people are usually funded in small trials by private foundations.  Even when these trials prove successful, bringing them up to scale is almost impossible.  Agency competition actually works against it because social service providers are competing on an artificial playing field.

Governments create the playing field on which agencies compete, but the government departments responsible for developing and funding social service contracts are often under staffed and ill equipped to monitor service outcomes.  They also lack the personnel and special expertise it takes to design better programs.  The time and effort involved in researching literature, writing contract proposals, putting contracts out for bid and guiding the implementation of new programs is enormous .  Politicians don’t want to spend what it would cost to create real free market competition for high quality services.

To overcome the uneven distribution of services problem,  governments develop specially targeted service contracts with extra financial incentives to serve specific areas.  But these initiatives are expensive and tax revenues are declining.  Targeted service contracts are usually limited in size and scope because of their higher costs.

We have come to the point where the availability and quality of essential services, to treat an abused child for example,  becomes an accident of birth.  How often have I seen children getting excellent services in one county while children with identical needs have no such services in another.

Commercial markets are efficient in distributing products according to demand when profits are distributed according to merit.   This method breaks down when applied to funding social services.  Competition discourages inter-agency coordination and inadequate  funding increases agency competition in more profitable locations while discouraging them from entering less profitable communities.  This causes unacceptable inequalities in meeting the basic human needs of our people.

There are many pressing issues that demand attention.  How we fund social services is rarely among them, yet the wisdom of distributing social services through artificially created free markets cries out for public debate.