In Pennsylvania the Office of Medical Assistance [Medicaid] has developed the use of managed care organizations in an attempt to save money. This article explores suggestions as to how to bring a very fragmented system of child services together in creative ways to enable children with problems in living to improve social performance. Behavioral health is the current metaphor for ‘mental illness’ a metaphor for problems in living that makes the person appear to be bizarre.

This article examines ways that schools can develop services and support for students with problems in living as a means of enhancing social competence.

In making the shift from traditional models of serving people with problems in living to a transitional model dedicated to the use of cognitive behavioral management, one is required to look at the full range of organizational elements which have been identified by Robert B. Waterman, Jr., Thomas J. Peters and Julian Phillips in a 1990 article called Structure Is Not Organization.

Managing people in an organization has certain congruence with managing people with problems in living. In both cases, there is a requirement to get the personal preferences of the individuals involved compatible with a specific, defined set of assumptions which the manager believes will be beneficial to both the individual and the organization or society. And in both cases, the critical assumption underlying the need for change is that the learning environment [culture] has somehow created and maintained thoughts that are now considered to be incompatible with the desired culture.

Human service managers today are intrigued by outcomes. It is a fad that is given a great deal of “lip service” but often without merit. The reason for this is that we so often measure outcomes without a standard. “I want to do what’s best for kids.” What a wonderful thought. Shouldn’t we all be this caring? However, people who use this as a mantra often believe that ‘what is best for kids is’ something that people who believe in social learning theory would feel is very negative for kids. Until we decide what is best for kids, we have no means of measuring outcome nor making decisions about management performance.

Planning is essentially a process of collecting information which will enable one to make decision about some future point or goal. When one talks about planning in the context of human services one needs to collect a great deal of information from diverse fields; reach consensus about the relevance of that information to groups and individuals; and make decisions about various components of systems regarding the best possible strategies and tactics to meet an agreed upon mission.

Managers often look askance at philosophy as though it were a “frill” and not an essential. They feel, perhaps, that results oriented people are pragmatic, not philosophical. Unfortunately, no organization can reach right results without a clear definition of its own summum bonum, (life’s greatest good). This process is important, not only to the field of human services, but also to the process by which people with problems in living seek coherence.

We will examine coherence as it applies to the development of a systematic connectedness based on the development and implementation of social policy in regard to the management of the delivery of human services. It is our hypothesis that the inability of government to steer [set precise goals both for direction and measurement of accomplishment]; and to learn [identify discrepancies between goals and outcomes and design new alternatives to more optimally meet those goals] has left our society with a human services network which marches toward oblivion with very good intentions. We further suggest that the conflict of explicit [that which is stated] and implicit [that which is intended] social policy along with the fallout lack of consistent patterns of values and incongruous sets of ideological principles, results in real harm being done to people with problems in living.

Values are held at three levels: as ideals which may never be reached but are what is what we hope for; as goals which we will work towards with the expectation that some day we will get there, and as commitments which means that every person is working on these values NOW! Often values are not held as commitments by staff even though they are held as commitments by organizations. This is sometimes due to the vague manner in which they are articulated.

Changing a human service system is a process of developing clarity between beginning points and outcomes and developing new problem solving solutions to bridge the gap between the two. The intent here is not to develop all of the specific steps of that solution process, but rather to identify some of the salient components of a transformational system. The most single characteristic of a human service delivery system is the quality of its personnel.