17 The Need For Change

The Commonwealth of Pennsylvania has 2.8 million young people under the age of eighteen. Some of these children are having problems in living although it is difficult to identify the specifics of either the problem OR the solutions. The Bureau of Special Education¹ says that there are approximately 200,000 children with disabilities and identifies slightly more than 16,00 with emotional disturbance, while the Office of Mental Health Children’s Bureau² indicates that 192,000 children are likely to have mental health problems, 83,000 of those are likely to be severe, although the system plans to serve only about 51,000 of the total and 15,000 of those with severe difficulties during the coming year. The Pennsylvania KIDS COUNT³ indicates that there has been a 14 year increase in the rate of births to single teens under the age of twenty, the rate of births with late or no prenatal care increased in urban counties by 46.8%, although the rate of infant mortality and child deaths decreased over the same period, including violent deaths despite the continued media message that children are out of control.

At the same time the placement rate of Child Welfare and Juvenile Court increased, as did secondary school dropouts. The economic indicators of single-parent homes, children receiving AFDC and children in poverty all increased during the period as well. The Pennsylvania Partnership for Children and Philadelphia Citizens for Children and Youth⁴ add that 448,000 children live in poverty. The report card for children in Pennsylvania as indicated by these combined reports remains quite vague, although certainly not good. 16% of our children appear to be living in poverty and about 14% have or are projected to have specific disabilities. The relationship between these two cohorts is inferred, but not documented. Regardless of the configuration, the statistics indicate some real problems. The level of poverty and disability is higher than an enlightened society might desire. Somewhere between 16% and 30% of the children in the Commonwealth are potentially not living any where near a quality life. Of even more concern is the indication that things are getting worse, not better; from which one could easily infer that present technologies are ineffective. And the most ineffective of all of the interventions are those that attempt to control the child’s behavior.

There is currently a public debate over the appropriate role of government [the allocation of resources and the implementation of social strategies] in assuring that each of these children achieves and maintains an optimal level of physical and psychological fitness and lives in a safe and secure environment. While many people see such debate as a threat to the survival of the Commonwealth’s most vulnerable children; such a debate might properly be also be viewed as an opportunity. The professional literature is unfortunately replete⁵ with evidence of the failure of present human service efforts to provide adequately for children with emotional and behavioral disabilities and worse yet, failure to be effective with those for whom it does provide. Those who believe that what we are doing is the right thing and that all we need is more money to do the job right seem to miss the point. If we continue to do what we have been doing, we will continue to get what we’ve got, and the record shows that that is not even close to satisfactory.

Whether we spend more or less money on children in the coming years is not the appropriate point of the debate. If we can agree on the goal of adequately providing for all children; then the truly moot points are the development of effective [quality outcomes] and efficient [prudent expenditures] strategies. Even if such strategies are more expensive in the short term, positive outcome would make them less expensive in the long term since increasing numbers of children with problems in living would become contributing citizens as adults and the numbers of children with such difficulties would diminish over time. An ounce of prevention might well be worth a pound of cure; but the prevention must work in order to make this so.

The real fear for many of us is that the economic stress and desire to cut the budget will cause both short term and long-term loss, in that we will cut current spending while continuing the current ineffective strategies thus getting the worst of both actions. Unfortunately those who oppose the budgetary cuts continue to propagate the faith in present activities, which makes the likely compromise to be the continuation of failed technology, but with reduced resources. This position in light of the continued failure seems to be a survivalist position instead of a strategic position. It indicates a greater desire to maintain the system and its employees than to provide the best technology for children.

An ideal outcome, it would seem, would be to identify very different strategies that are both effective and less costly. It is to this end, that recommendations for dramatic change are made regarding one aspect of the overall strategy to improve the lives of children. This recommendation is in the development technologies that have been proven in research and the market place over the past twenty years, although they have been unable to gain a solid share of the market because of the pre-eminence of the present advocates. This technology of psychological fitness is based on learning theory and is built around cognitive/behavioral skill building. The term “psychological fitness” is used as much to indicate change as to be more accurate than the present term, “mental illness”.

The ‘survivalist’ do have something to worry about. It is unquestionably true that human services need to be retooled in the same manner as other parts of our economy have been and it seems inevitable that there will be a changing of the guard. In fact, those most imbued with the present system are likely to be the first let go. Their continued need to have people “feel good” rather than achieve; their continued view that people “cannot help themselves”; their continued need to “protect” their clients, the public and themselves from a fear that is self created makes it unlikely that they will ever be able to perform in a more positive and enlightened technology. Further, the arena for this technology should be in valued settings in which all children participate; home, school and community.

What is being suggested then is a strategy that would provide to the child, the family and the community the skills, services and supports which are necessary to create an environment for psychological fitness. In addition, it is expected that such involvements would cost less than the present strategies while having more impact through positive outcome and, at the same time, support personal responsibility and rights of the individual. If this seems too good to be true, it should be indicated that the strategy is less well demonstrated in regard to the remedial impact than it is for the therapeutic and preventative aspect. This is not to indicate that its effect on children who have accumulated severe emotional problems within the present environment and helping system is not effective, only that it has not been demonstrated by many people over time because it has not been tried. If we are to be consistent, we must expect that the new technology, whatever it is, can demonstrate quality outcomes across many children and families over time. The present technology has had substantial opportunity to demonstrate its effectiveness, and by every indicator, has failed. There is every confidence that the experimental evidence of effectiveness of the cognitive/behavioral technology in remedial situations will be supported in the applied world. And if it does not, we will find something better.

The system of human service delivery must be retooled in regard to technology, personnel, location and distribution, and structure. The structure must be built as a learning system so that we do not duplicate the continued failures of the last half-century through the establishment of a status group of experts who, although continuing to fail, go unchallenged. The system must be built along continuous quality improvement lines so that the focus on material outcomes that affect the quality of life is constantly and consistently identified, sought, measured and improved. No longer can we tolerate a system that defines a limitation of negative outcomes as its goal and then, despite continued failure to even achieve this limited goal blames it on the lack of funds.

The system must be built on a basic trust in human beings to do the right things, not on the belief that people are defective and deficient. The Theory X of Douglas McGregor suggests that people are naturally lazy, hate work, shirk responsibility, have to be controlled and coerced into exerting effort on behalf of organizational goals, and are concerned primarily with security. In contrast, his Theory Y holds that work is as natural as play or rest, that people can learn to accept responsibility and to be resourceful, creative and imaginative at work, that workers exert great efforts to achieve goals to which they are committed, particularly when attaining those goals leads to a sense of ego fulfillment and self-actualization, and that current organizational arrangements engage only a small part of their members’ productive potential.

History suggests is that human services apply Theory X not only to their own staff, but the people they serve. It is time for Theory Y.