Effective Services for Children and Families: Lessons from the Past and Strategies for the Future

Peter B. Edelman

Georgetown University Law Center

and

Beryl A. Radin

Washington Public Affairs Center

University of Southern California

For three decades Americans have debated the difficult question of how to structure human service delivery systems. Despite the dramatic political, economic, and social changes that have taken place in the United States over the past 30 years, this question has continued to plague social policy analysts and advocates. A number of factors coalesced in the 1960s to define the problems in terms that are with us today.

Thirty years ago a national interest in assisting the poor and minorities with services funded by tax dollars appeared for the first time in a noncrisis context. These efforts combined with the programs of the New Deal to create a social program fabric that was not dissimilar to that of some of the European welfare states. The agreed-upon clientele for services expanded, and the federal government came into the picture as a significant ongoing funding source. The recognized agenda of needs broadened as well. Problems previously ignored became legitimate targets to be addressed. The nation discovered that the poor had legal problems, health problems, and family problems of which it had previously been unaware. Many assumed that the crazy quilt of human services that emerged reflected an acceptance of an active and innovative role at the federal level that, they thought, would in turn bring about rationalization in a coordinated system as time went on.

Questions arose in rapid-fire order about the performance of virtually everyone who had some role in the past. Government at all levels was suspect: old-line federal agencies and states and local governments across the board. State governments were seen as especially moribund. Professionals of all kinds came under attack, from social workers to teachers, doctors, lawyers, and bureaucrats. Institutions, particularly residential ones, that were supposed



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Effective Services for Young Children: Report of a Workshop Effective Services for Children and Families: Lessons from the Past and Strategies for the Future Peter B. Edelman Georgetown University Law Center and Beryl A. Radin Washington Public Affairs Center University of Southern California For three decades Americans have debated the difficult question of how to structure human service delivery systems. Despite the dramatic political, economic, and social changes that have taken place in the United States over the past 30 years, this question has continued to plague social policy analysts and advocates. A number of factors coalesced in the 1960s to define the problems in terms that are with us today. Thirty years ago a national interest in assisting the poor and minorities with services funded by tax dollars appeared for the first time in a noncrisis context. These efforts combined with the programs of the New Deal to create a social program fabric that was not dissimilar to that of some of the European welfare states. The agreed-upon clientele for services expanded, and the federal government came into the picture as a significant ongoing funding source. The recognized agenda of needs broadened as well. Problems previously ignored became legitimate targets to be addressed. The nation discovered that the poor had legal problems, health problems, and family problems of which it had previously been unaware. Many assumed that the crazy quilt of human services that emerged reflected an acceptance of an active and innovative role at the federal level that, they thought, would in turn bring about rationalization in a coordinated system as time went on. Questions arose in rapid-fire order about the performance of virtually everyone who had some role in the past. Government at all levels was suspect: old-line federal agencies and states and local governments across the board. State governments were seen as especially moribund. Professionals of all kinds came under attack, from social workers to teachers, doctors, lawyers, and bureaucrats. Institutions, particularly residential ones, that were supposed

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Effective Services for Young Children: Report of a Workshop to deliver services were targets, too, whether they were mental hospitals, schools for the retarded, acute-care hospitals, or jails or even educational institutions, corporations, trade unions, churches, or foundations. Each of these developments—the broadened definition of clients and service needs, the arrival of noncyclically related federal funding, and the questioning of governmental, professional, and institutional performance—played a role in framing the debate over how to deliver services most effectively that has continued on and off ever since. The questions that were asked in the 1960s have never been fully answered. For the last decade they were seldom even asked. As the 1990s begin, there is some indication that they are back on the table. So it is time to query: What have we learned? What should we do differently if we get the chance to do something? THE 1960S: SUCCESSES OR FAILURES? In many ways, the experiences of the 1960s have become a Rorschach test for the society. People react reflexively to the mention of the 1960s and see what they want to see, for good or ill. Because the debate over this experience is often waged on so many levels, it is difficult to present a balanced picture of its contributions and limitations. To begin with, the picture for the poor and minorities in the society is improved in many respects over what it was in 1960. Despite the many problems that remain to be solved and complications that have emerged since that time, some things did get better. At the same time, it is not at all clear how well we have institutionalized these changes. We know that millions of people did escape poverty, especially during the period between 1960 and 1973, but current data suggest that the improvements are fragile at best. Much of what was gained during the civil rights revolution is still largely intact, in legal if not in economic terms. Legal services for the poor are recognized as important even if resources for that activity are significantly lower than during the 1960s. While a revolution for the rights of women came into its own, it too has had difficulty dealing with economic rather than legal rights. Health care for the elderly is vastly improved, despite the current attacks on Medicare funding. Health care for the poor, with all its limitations, is better than it used to be. Services for the mentally retarded and the developmentally disabled have been revolutionized, and the disabled in general have come a long way. The society has acknowledged that early childhood development programs for disadvantaged children are important, as is the need for special nutritional attention for low-income pregnant mothers and young children. These are not trivial advances, and most of them originated in initiatives that began in the 1960s. Despite this, the 1960s have a bad name, even

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Effective Services for Young Children: Report of a Workshop among many sophisticated people. The debate over these issues—particularly over program structures and strategies—is so entangled with other political battles of the period that it evokes great controversy. For some, the scary and even scarring memories of the period are a barrier to finetuned discussion. For others, a broadside attack on the period (or a blanket defense, for that matter) is a way of avoiding an extremely difficult policy question: What is the standard that we want to use to evaluate the programs created then? Were they meant to eliminate all problems (as the rhetoric of promises suggested), or were they meant to be incremental changes constituting an acknowledgment that these problems do exist and a commitment to further increments that would over time evolve into a solid system? Much of the debate over the contribution of the 1960s revolves around the Community Action Program and the Model Cities Program—the two most conceptually radical attempts to deal with service delivery problems. Both attempted to create new structures that would perform planning and coordination functions at the grass-roots level, providing mechanisms to deliver services to the unserved or underserved more effectively than existing institutions. Community Action Programs Under the Community Action Program (CAP), which was a key part of the war on poverty, some 500 community action agencies were set up around the country. CAP was not a program in itself. It was meant to be ''a process for mobilizing resources and coordinating other programs,'' as cited in Freiden and Kaplan, The Politics of Neglect: Urban Aid from Model Cities to Revenue Sharing (MIT Press, 1977). The Economic Opportunity Act created quite a long list of programs: Head Start, Neighborhood Legal Services, Neighborhood Health Centers, Foster Grandparents, Job Corps, VISTA, and various job training programs to be run through the Department of Labor. The idea was that, for those programs that were to be delivered at the local level, the CAP agency would be the umbrella coordinating agency and might run some of the services itself but not necessarily. This sounds innocuous enough. There were, however, three key features that made the initiative far from innocuous. First, the CAP agencies were set up outside the political system and were not accountable to the mayors or any other local elected or appointed officials. Second, they were to involve the "maximum feasible participation of the poor," which was widely understood to mean that they were to be controlled, in terms of how their boards would be structured, by the people they were intended to serve. Third, their funding came directly from the federal government, not through any intermediate governmental filter.

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Effective Services for Young Children: Report of a Workshop What happened next was predictable and, it is generally agreed, intended. The CAP agencies began to march on City Hall. They didn't just sue (although they did that, too); they used federal money to rent buses and make signs so they could make demands on city government. They were not beholden to City Hall for anything, and few of them were advised by professionals who might have warned them of the risks of being confrontational. So Mayor Daley of Chicago came to Congress and got Congress woman Edith Green to amend the law to thwart the CAP agencies' autonomy. The CAP agencies receded into being small social delivery agencies, basically outside the organized social service delivery system. (That is where many, if not most, of those that survived are today). They still have a small assured source of federal funding via the block grant administered by the Community Services Administration. So they can continue to go it alone if they choose to, although a good number of them have become integrated into local service delivery networks if for no other reason than to get United Way, local foundation, or local government (including Title XX) funding. Is this a sad story? Absolutely not. Most of the "mini-categorical" programs which the CAP agencies were supposed to coordinate have survived. Some, like Head Start, have made it to the hall of fame of successful social programs. All were transferred to other federal agencies: It is not surprising that parallel programs set up in parallel agencies could not survive in that form. They were conceived as independent efforts so as to escape stultification in a traditional bureaucracy. They were meant to serve as a yardstick against which to measure the performance of existing programs and as a goad to push old-line agencies to do better. This is not a situation that could be expected to last. The programs originally assigned to the Office of Economic Opportunity largely did what they were intended to do in waking up other bureaucracies. This strategy is not something to be done only once in history. It is entirely appropriate to contemplate a cycle of parallel programs in a parallel agency or agencies every generation or so. While the specifics may be different, it may well be time for another such strategic initiative. The CAP agencies themselves also made a contribution. During their brief heyday they gave a generation of poor people a taste of having a sense of control over their own lives. They did actually contribute to changing the behavior of some elected officials. And they left behind a group of people who were nurtured there, learned how to use the system, and went on to community leadership in many instances. They also learned how difficult it is to use public money to set up an alternative politics. Using federal money to fund litigation against governments has been controversial and has barely survived. Political advocacy

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Effective Services for Young Children: Report of a Workshop funded with tax dollars is inherently problematic because the targets of advocacy will fight back. They learned, too, that direct federal funding of a locally untethered set of service delivery agencies runs a particular risk that such agencies will not become part of a local service delivery network. For the long run, local service delivery agencies and entities which are accountable to or connected to local governmental or philanthropic institutions or networks are going to be more effective than those that are not. Model Cities Programs As the Office of Economic Opportunity was getting launched, planners for the new Department of Housing and Urban Development were working on an initiative based on premises somewhat similar to community action. They, too, envisioned a process that would pull together existing categorical programs at the local level to make them more responsive to the needs of the poor. It was widely felt that the urban renewal efforts of the 1950s had failed to help the poor, and in many cases had hurt them by destroying their housing and not providing anything to replace it. The Task Force planning that turned out to be Model Cities believed that physical renewal was not enough, that housing construction and rehabilitation had to be combined with education, health, and social services. Their report called for a massive housing program, a total approach, and flexibility regarding local building codes, federal bureaucratic rules, and categorical boundaries. It said three principles should govern: concentration of resources, coordination of talent and programs, and mobilization of local leadership. The idea was that, if new money for housing was added to access to existing federal programs in other areas, enough in the way of resources would be available to stimulate a successful local process to coordinate and build linkages among programs. The bill finally enacted as Model Cities fell far short of what had been recommended. The Vietnam War robbed it of funds; its implementers were not given the authority that had been sought to pull in funds from other departments. The expediters who were to have been installed to package initiatives for each city were not created. And, on top of everything else, what was originally to have been a small number of concentrated demonstrations was dissipated into some 66 cities. Even without the Vietnam War it is doubtful that enough money would have ever flowed anywhere to demonstrate anything. Lacking either the new money or any way to command access to the existing money, there was no glue to cause people at the local level to take the Model Cities planning process seriously. There is nothing particularly wrong with the original design of Model Cities. The problem is, it was not enacted into law. One possible lesson is

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Effective Services for Young Children: Report of a Workshop that, if there is a desire to demonstrate what can be done in one neighborhood on a concentrated basis, enough resources had better be made available to make a difference. Model Cities is, if nothing else, a lesson in dissipation of limited resources. By the end of the 1960s, the scars from the decade pulled strategists away from the community level to focus on coordination and planning at the national level. The initiatives of the 1970s were much more modest in scale. In the early 1970s the programs advanced within the Department of Health, Education, and Welfare (HEW) aimed at coordinating the array of categorical programs that had been created over the years. Policy planners believed that by developing opportunities for consolidation at the national level, state and local agencies would be able to rationalize the system and create new structures that were more effective deliverers of services. HEW funded a number of demonstration programs aimed at the integration of services at the local level but was never able to obtain congressional approval for large-scale reform efforts. During the late 1970s, attempts were also made to foster partnerships of city, state, and federal agencies, but they too remained small-scale programs that were eventually replaced by Reagan administration block grants. THIRTY YEARS OF EXPERIENCE: THESIS, ANTITHESIS, AND SYNTHESIS Much of what the society believes about the programs of the 1960s is colored by the way these efforts were portrayed—even caricatured—in the 1980s. The debate about effective services became a polemical contest centered around three issues: the role of the federal government; money as a lever for change; and the search for a panacea solution. Our thinking about each of these issues was clouded by a battle of myths: the efforts of the 1960s were reduced to slogans and replaced by mirror like, opposite slogans in the 1980s. We believe that it is time to go beyond these slogans and to create a discussion in the 1990s that addresses the substance of these issues and not simply to rest on the rhetoric. That is our synthesis. The Role of the Federal Government The mythology about the 1960s is that people believed that federal programs alone could solve the country's social problems. Although there was a tendency in many programs of the 1960s to believe that the essential lever for change came from Washington, there were some other efforts that recognized the contribution of other institutional actors. But the lack of experience within the country about these issues (and the relative naivete of program designers) did contribute to a simplistic approach. There

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Effective Services for Young Children: Report of a Workshop is no question that President Johnson did oversell programs. His exaggerated style did lead to an unreasonable increase in people's expectations. When the problems weren't solved (and new problems such as Vietnam and Watergate emerged), some people became disillusioned and turned away from government. Given this disillusionment, it is not surprising that the mirror-image myth of the 1980s was that the national government is useless in dealing with domestic social problems and thus has no role to play at all in this effort. Rather than governmental action, we were told that the private sector through voluntary action alone is the appropriate institution and mode of intervention. After eight years of Ronald Reagan's antigovernment government (except in defense), we now have George Bush's kinder, gentler version of the same thing. The synthesis for the 1990s must be that, although government has a role at all levels, even with the full participation of state and local government, it cannot do the job by itself. These problems will not be solved without the participation of all of us, as individuals and as institutions of which we are a part—our churches, our companies, our unions, the United Way. And the people who need help have an obligation too—to take responsibility for themselves to make the maximum use of the help to achieve self-sufficiency. The particular role that government should play constitutes a key question. The federal government's role is relatively easy, apart from debates over how much money it will put in. Other than Social Security, activities of the Veterans Administration, certain agricultural matters, the federal prisons, and services for the military and their families, the federal government does not deliver services directly. It pays for them, and in recent years it has moved away from extensive use of tiny categorical programs that tie up state and local governments and private providers in multiple reporting, overlapping and even inconsistent regulations, and multiple planning requirements and grant applications. There is still a large debate over the degree and form of regulation that should accompany federal funding, but at least there are far fewer tiny categorical aid programs to cloud the picture. Even so, the number of funding streams that confront one trying to organize comprehensive or multiple services from a neighborhood or community perspective is overwhelming and raises important questions about the role of state and local government. To what extent can or should there be a coordinating or packaging function, particularly for local government, at either the neighborhood or municipal level? A related question is the "make or buy" issue—the extent to which government, either state or local, should deliver services itself through its own employees, and the extent to which it should contract or use grants to accomplish its purposes. One theme governing the answers to these questions should be the idea

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Effective Services for Young Children: Report of a Workshop of community. We seem to have lost the idea that a significant social policy aim is embodied in the notion of community, of a social infrastructure that embodies stability and security and shared values. For many today, individual opportunity is nullified because there is no community around them. No matter how strong their family, the street is a jungle with unsavory and often fatal attractions, pressures, and perils. Surely one role of government is to help rediscover and rebuild the sense of community that we have lost in too many places. Pursuit of this theme should guide new service initiatives as well as efforts to deal with the way services are organized. Money as the Lever for Change The 1960s have been portrayed as an era in which people thought that all that was necessary was to throw money at problems and the problems would disappear. While it was true that people during that era had more confidence in the ability of money to evoke institutional change, the resources for this task were never made available even at the level authorized by Congress, let alone at the scale required to make real change. Viewed in the context of the 1990 budget, it is clear that President Johnson was a big talker, but he was in fact not a big spender. The average annual deficit during his presidency was less than $6 billion, and that includes the years of paying for the Vietnam War. The 1980s counterpoint to this position was that we can solve social problems without any federal money at all. Somehow, magically, a groundswell from the society would create a climate in which all the needed soup kitchens and homeless shelters would emerge, inspired and guided by a lot of tough talk from Washington. If government funds were required, they would come from the local community or from the state. The 1990s synthesis has to be that we cannot solve the problems without money, but that money alone will not solve the problems. We have to confront deeper structural failings. School bureaucracies are stultified, and principals and teachers are blocked from taking initiatives that would benefit their students. Public housing units in many major cities stand unoccupied for lack of maintenance, not just lack of funds. Our health-care system is still excessively hospital-based and not sufficiently preventive. That there is a major structural agenda is particularly worth bearing in mind in talking about effective services. Measures to make services comprehensive, accessible, and better coordinated are structural to be sure, but they will miss their mark unless they are accompanied not only by adequate funding but also by a long list of other structural changes, including better education and training of those delivering the services and changes in public personnel policies that create sanctions against unproductive workers and rewards for those who are productive.

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Effective Services for Young Children: Report of a Workshop The Search for the Panacea Solution The third myth about the 1960s is that people believed there was a silver bullet, a single magic program that—if we could just find it—would solve all our ills. And in fact people have jumped from one quick fix and one panacea to another over the years. Even when an initiative was overly simplistic, we have not stayed with it long enough to see whether it would make a difference, and we have not taken the time to correct the flaws in the initial version to see whether it would work better when improved or redesigned. The reactive myth of the 1980s—that nothing works, so why bother to try—is particularly understandable given the persistent naive faith that magic solutions exist and the massive unwillingness to stay with anything long enough to give it time to do any good. There is a slightly more sophisticated version of these myths that deserves mention as well. This is represented by Senator Daniel Patrick Moynihan, who has said that the 1960s were "most successful . . . where we simply transferred income and services to a stable, settled group like the elderly. It had little success—if you like, it failed—where poverty stemmed from social behavior." This is a vast oversimplification. If Senator Moynihan is saying that primary prevention is more successful than interventions with populations already manifesting social pathology, his observation is unremarkable, indeed obvious. But he seems also to be saying that there is no point in even trying to help those people whose need for services is so complex that it is difficult to ensure that the help will be effective. He seems to be questioning the value of crisis services and, for that matter, services of any kind to poor people who already have problems beyond their lack of income. He seems to write off vast groups of people: teenagers who get into trouble with the law or have babies, drug and alcohol abusers, many of the homeless, and others. Our synthesis for the 1990s, Senator Moynihan notwithstanding, should be that, although there is no silver bullet, there are many interventions and many programs that do help, including many that demonstrably help multiproblem families. Nonetheless, while some families and some individuals within families can be helped by individual programs, broad progress depends on employing our endeavors in tandem. We have learned that the problems of many of the poor, and of high-poverty neighborhoods as a whole, are interrelated and difficult to separate. We cannot eliminate teenage pregnancy without dealing with education, health care, broader family issues, and employment opportunities. To promote individual self-sufficiency we need better schools, child care so parents can take jobs, and health

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Effective Services for Young Children: Report of a Workshop coverage so people will not be tempted to stay on welfare in order to keep Medicaid. And again, to emphasize a key aspect of the point, many of the interventions that we know are effective are on behalf of people for whom "poverty stemmed from social behavior." WHAT HAVE WE LEARNED? We know government has a role, but so do all of us. We know there are serious structural problems in the functioning of government and institutions that must be attended to. We know there are interventions that work but it must become possible to use them in combination and with sensitivity to specific locations. And we know we must act because we will be worse off if we do not. In that context the question arises, how can we deliver more effective services? It is critically important to bear in mind that there are built-in severe barriers to change. Legislative bodies at all levels of government take both budgeting and substantive action in relatively small increments. It is difficult to get the political decision making system to act in comprehensive terms. This situation is reinforced by the way interest groups relate to the political system. There are few multiservice interest groups. Most interest groups organize themselves according to their own field or discipline and have carved out counterpart power bases in legislative committees and executive agencies. Professionals want to maintain separate identities and power bases. They and their client groups lobby for their claim on scarce resources and do not want to share the limited pie. Whether consciously or not, legislators and administrators alike act to maintain fragmentation as a way of dealing with scarce resources, because fragmentation rations use. If access points are unclear, fewer people will use the services and less money will be spent. In fact, from a totally cynical point of view, fragmentation at the delivery end and block grants at the funding end are a perfect combination. Fragmentation reduces use, and block grants weaken constituency support for funding because no single constituency can be sure it will benefit from an increase in funding for the block. Recipient accountability is reduced by the use of block grants because there is no articulated set of standards against which to judge grantee performance. Congress does not easily see the successes that may have transpired at the local level with block grant money after it was handed out by the state (and it is hard for advocates and program administrators to amass the evidence), so it is more difficult to create momentum for increases in (or even to maintain) appropriations for the block.

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Effective Services for Young Children: Report of a Workshop SEARCHING FOR MODELS Buried in the inheritance from the past 30 years are a number of models of service and access that are worthy of mention as possible guides for effective services for children and families in the 1990s. Some of these efforts were stimulated by direct federal activity, others by indirect means; some came about because of state or local action; still others resulted from innovations within the voluntary sector. In some communities these efforts have been quite successful, while in other settings they have not produced desired effects. They are not large-scale, grand schemes; rather, they are modest efforts that are worthy of consideration for those concerned about future change. These models focus on three different issues in the service process. Some of them intervene at the service delivery point, with multiservice and coordinated efforts at the point at which the client comes into the system. These efforts attempt to respond to clients' confusion when they confront a fragmented process and a bureaucratic maze that requires them to move from one service location to another. A second variety focuses on the planning and resource allocation process and seeks to intervene at the point at which budgets are made and top officials make determinations about service priorities. A third concerns place specificity: the design of services particularly aimed at defined geographic areas. Service Delivery and Access Models Multiservice Centers and Settlement Houses There was never a federal program specifically designed to fund multiservice centers, but a number—the Roxbury Multi-Service Center in Boston is a typical example—were funded or stimulated by federal activity in the 1960s. The Door in New York City is an example of a multiservice center directed specifically at high-risk teenagers. The Beethoven Project in Chicago and the Casey Foundation initiatives are current examples directed at families in various ways. An older model, reformed and refurbished in the 1960s and 1970s in many cities, is the settlement house, which, properly led and administered, is a multiservice center by another name (or vice versa). A newer model, still more often a suggestion than a reality, is to colocate services in schools. The community schools movement and the Cities in Schools program, nongovernmental initiatives that began in the 1970s, have pursued this strategy with mixed results having more to do with the particular people involved in the individual cities than with the validity of the concept.

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Effective Services for Young Children: Report of a Workshop While every service a family might need cannot be located under one roof, these experiences indicate that it is possible to have a basic intake function as a core, and to have colocated on the premises such services as family counseling, legal services, primary health and mental health services, educational supplementation, child care, and recreational and community activities. Cities and counties could find it possible to locate an office to do eligibility for public assistance, food stamps, nutrition, and other relevant programs. All of this is far from simple, but it is possible. This approach is different from the decentralization movement of the 1960s and 1970s. During that time there was a proliferation of neighborhood centers for separate programs: health centers, community mental health centers, and legal services offices. Each reflected a separate federal funding stream. In addition, there were separate state, county, and/or municipal social services offices and public health clinics and separate groups of job training and drug treatment programs, as well as nonprofit agencies offering a variety of specialized services, funded by combinations of United Way and public dollars and perhaps other local philanthropy. In most cities, especially the large ones, it was difficult to rationalize these overlapping and uncoordinated centers. Each was naturally jealous of its own sovereignty, and most had vertical relationships with bureaucracies and funding sources that were in turn protective of their own sovereignty. While many of these centers are now defunct because of budget cuts, the underlying turf boundaries are problems that have not disappeared with the passage of time. A related problem is that nongovernmental entities that seek to cut across categorical lines have an exceptionally difficult time getting the funds they need. Given that there is no multiservice center or settlement house "program," they must constantly hustle for public grants and contracts. At any one time they may have employment and training, drug treatment, teenage pregnancy prevention, Title XX, or any of a dozen other kinds of money. Often their current mix of activities is skewed by the kind of money that is available. An especially pernicious problem is the timing of payment under grants and contracts. Typically, the city or county, whether under its own rules or federal or state rules, pays after the service is performed, so the private agency has to somehow front the money. Worse, payment is often unconscionably late. More than a few nongovernmental agencies have been driven out of business by this difficulty. Little City Halls A few cities—New York and Boston come to mind—experimented with decentralized outposts of city government in the late 1960s and early 1970s.

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Effective Services for Young Children: Report of a Workshop Regardless of the name used, these public outposts—when and if competently staffed—could be revived as an access and referral point for services for children and families, cross-cutting the various public departments that offer services relevant to this clientele. Planning and Resource Allocation Models The Youth Bureau Model If someone in the city or county mapped all of the services relevant to a particular clientele and sought, to the extent resources are available, to fill the gaps that show up, a better array of services should eventuate. If all of those in the area who were represented on the map had a copy of it when it was completed, better referral patterns should result. In the field of youth services a number of states—New York is one—have adopted a system like the one described. Each county has a youth bureau that annually makes a youth services plan for the county. The state reviews the plan and occasionally rejects portions of it or asks for modifications. When the plan is approved the county is entitled to a certain amount of state funds to implement it, on a 50 percent matching basis. In New York State, at least, private providers are eligible for funding, and in some counties United Way supplies much of the local match. The funding is far from sufficient to cover all service needs for adolescents, but it is enough to cause every county to participate. The result is that services are typically more complete and referral patterns more clear than would otherwise be the case. Offices for Children In the largest states it is difficult to contemplate the creation of an operating agency that would have under its jurisdiction all services for children and families if by that phrase one would mean to include public assistance, food stamps, social services, child welfare protective services, mental health, mental retardation, and juvenile justice. Smaller states have created such ''super'' agencies with mixed results, but in the biggest states such an agency would be extremely unwieldy (unless it was such a loose confederation as to be not a very meaningful consolidation). What some states (and some local governments) have done, therefore, is to create an office for children as a part of the office of the chief executive. This office generally acquires the planning and legislative relations function for the relevant issues, at least with regard to major initiatives of the chief executive, and often has responsibility for the handling of particularly difficult individual cases of multiproblem (and therefore multiagency) children and families who might otherwise be shunted from agency to agency.

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Effective Services for Young Children: Report of a Workshop These offices cannot be a substitute for real services, however. In some cases, the efficacy of the offices for children has been overstated by elected officials seeking to claim they have done something for children when they either have insufficient resources to spend on needed programs or, even worse, have no wish to tackle problems directly on their merits. Place-Specific Models A few of the past efforts were constructed on the concept of place specificity. This is especially relevant to areas in which there is a high concentration of poverty. Elsewhere, multidisciplinary access points and colocated services will improve accessibility and go some of the way toward improving quality. In areas of intense poverty, however, a sense of place in the design of services can play an even more fundamental role, as a part of a strategy to rebuild a feeling of neighborhood and community. A key lesson to be drawn from the CAP, the Model Cities, and the multiservice center experiences is that, apart from a few individual multiservice centers and settlement houses, a fully funded, highly targeted, comprehensive approach in an area of great poverty has never really been tried. One possible challenge to pursue for the 1990s would be a few such comprehensive approaches in areas of concentrated poverty. The desperate, multiproblem, multicrisis straits of such areas counsel a broad definition of comprehensiveness—one that goes beyond a single multiservice initiative, no matter how comprehensive that is in its work. We should know by now that services alone will not cure poverty or rebuild a sense of community. A low-income family seeking help to find housing will not be helped by services if no housing is available at a price they can afford. Job training does not help when there are no jobs. Drug treatment is a drop in the ocean when there is a tidal wave of drugs in the street. Tutoring services will not make up for schools that do not teach. The problems of the street will engulf even the most sophisticated multiservice center if that initiative is taken in isolation. For the 1990s a comprehensive approach in a single neighborhood of concentrated poverty must to the maximum possible extent go beyond services if it is to offer any hope of making a difference in the life of that area. Attention to housing, the schools, public safety and law enforcement, and economic development should be a part of a coordinated effort. This means that any such effort cannot be undertaken by the private sector by itself but must involve city government as well and state and federal funding for some portions of the endeavor. A part of such a comprehensive approach in an area of intense poverty might be the rediscovery or reinvention of the settlement house in a contemporary form. This is a very complex task in itself. We cannot expect

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Effective Services for Young Children: Report of a Workshop the model from the turn of the century to meet today's needs or surmount the built-in barriers to comprehensiveness in terms of government and politics and professional identities. A long list of problems must be addressed with the greatest of care. Today, for example, intake workers in such a place would have to have a renaissance knowledge of human problems and the corresponding services to which one might make a referral. Professionals and other staff delivering services would have to be highly committed, able, and willing to accept the salaries ordinarily associated with such positions. And even a large investment in the settlement house itself would not create the myriad of necessary referral places or ensure their responsiveness to a telephone call seeking to make an appointment. In order to minimize all of these problems, it is important that each service offered in such a center that is also a natural part of some larger agency and disciplinary world, whether it be health, mental health, or family services, be created with a relationship to the larger professional world of which it is a part. This is important for purposes of future funding, for coordination, and for the development of referral patterns. The project should not be undertaken without a careful mapping of local perceptions of neighborhood and community needs for service and community participation in the design and policy direction of the services. Success in the 1990s requires a balancing of professional community involvement that eluded reformers in the 1960s. Patience is a critical virtue, too. Each service may require a different license—the penetration in each case of yet another bureaucracy. Patience requires forbearance in the proclamation of success as well. The last thing we need is another round of prematurely raised expectations. No one should run off to advocate a government program to replicate the initiative until it has been in place long enough to prove its worth and has undergone rigorous evaluation. A PERSPECTIVE FOR THE 1990S As this discussion has indicated, much has changed in the past 30 years. We have swung between strategies of extremes. We have moved from an environment of hope and possibility to one of limitations and despair. The fires of change of the 1960s have been dampened by the rains of fear, complexity, and cynicism. As the pendulum appears to be moving toward a new sense of activism and social responsibility, we must acknowledge that there are lessons to be learned from the experience of the past three decades. We offer five lessons for the future. Modesty and Humility. We have learned that the social change we have attempted (and want to attempt in the future) is extremely difficult to

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Effective Services for Young Children: Report of a Workshop achieve. We are still far from knowing enough about what actually works and what does not, even though we know much more than we did in 1960 (and if we had the political will to fund fully the things that we know are successful, we would be far better off than we are now). While we want a society in which all citizens have hope for the future, we cannot raise expectations beyond some point of real possibility. Thus, even though we may seek to intervene in a few places in as massive a way as possible, we must at the same time do so cautiously, without grand promises and with the knowledge that we have embarked on a somewhat risky path. Panacea solutions of any kind are likely to fail. Limited Resources. Few have to be reminded that programs for children and families are expensive, and it is extremely difficult to obtain funding for them in this era of budget limitation. While we know this, we sometimes have to be reminded that we have other resource limitations. Some of these limitations are of our own making and could be addressed. We do not have adequate expertise to guide our action. It has often been difficult to obtain support for program evaluation efforts and other data collection and monitoring schemes that provide program managers with information to use to modify ongoing programs. And we have found that time is also a scarce resource. Even small demonstration programs take much more time to put into operation than we usually give them. Frequently, the political system is not willing to wait for programs to develop before assessing their impact. Diversity. Over the past 30 years we have learned a lot about the diversity of situations and populations around the country. We have been forced to acknowledge that the idiosyncracies of a state, locality, or even a neighborhood can determine the effectiveness of a particular program. We have recognized the importance of beginning programs or projects with a mapping of local perceptions of needs and finding ways to ensure a sense of participation and ownership by those who are the recipients of the services. At the same time, we have learned that change requires partnerships between many different actors: the professionals who actually deliver the services; the elected officials who must provide the resources for them, at least when they come to be replicated on a broad scale; the citizens who are the consumers of the services; and the administrators and managers at national, state, and local levels. Complexity. Much of the negative perception about past programs stems from the unintended consequences that emerged from them. Seemingly simple strategies for change opened up numerous Pandora's boxes and created problems that seemed neverending. For example, a decision by a community to open up a multiservice center may confront an array of licensing and other bureaucratic requirements that effectively kills the effort. Similarly, schemes to address one set of problems may create other problems, particularly when eligibility requirements are affected.

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Effective Services for Young Children: Report of a Workshop Synergy. We know that the problems faced by children and families are interrelated and interdependent. While public safety, available jobs, school improvement, and affordable housing are separate problems, they are also closely related when we are talking about areas of concentrated poverty. Although for many families, even in such areas, there are single interventions that may have great impact, we have learned that others need multiple service interventions and still others need the benefit that comes from efforts to restore the basic institutions that make up a community. As we devise new schemes for the future, we are challenged to find ways to construct programs that have the ability to build on one another and operate in a related way. We are well aware that these lessons pose a major dilemma. On one hand, the lessons of humility, complexity, and resource limitations counsel efforts at modest, incremental approaches to change. On the other, at least insofar as the problem of concentrated, intense, highly impacted poverty areas is concerned, it is time to seek a few demonstrations that are comprehensive on a synergistic scale never before attempted. Although we know that there are no panacea solutions, we must find ways to create initiatives that demonstrate some level of visible effectiveness. These may be a few highly concentrated efforts in a small number of high-poverty neighborhoods, or new attempts to ease client access to services, or new endeavors to rationalize government funding streams and regulatory strictures, or new programs that respond to specific community based needs in areas in which single initiatives have promise of making a sufficient difference to be cost-effective. We can only hope that this is the beginning of a new public policy breakthrough that will bring us to a new era of public responsibility and compassion.