SOCW 6351: Social Policy, Welfare, and Change Week 11

Discussion 1: Policy Analysis and Application

According to the NASW Code of Ethics section 6.04 (NASW, 2021), social workers are ethically bound to work for policies that support the healthy development of individuals, guarantee equal access to services, and promote social and economic justice.

For this Discussion, review this week’s resources, including Working with Survivors of Sexual Abuse and Trauma: The Case of Rita and “The Johnson Family”. Consider what change you might make to the policies that affect the client in the case you chose. Finally, think about how you might evaluate the success of the policy changes.

By Day 11/09/21

Post an explanation of one change you might make to the policies that affect the client in the case. Be sure to reference the case you selected in your post. Finally, explain how you might evaluate the success of the policy changes.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

Discussion 2: The Social Work Advocate in Politics

Social workers often have commitments to specific policies, laws, or funding of programs that are vital to the population they serve or an issue that they strongly support. Such commitments often lead social workers to become involved in political issues and the campaigns of specific candidates. Being a social worker, such campaign experiences, the outcomes of your efforts, and how effective you felt you were may affect your view of the political process and the likelihood of becoming involved in similar campaigns in the future.

For this Discussion, reflect on your experiences if you have ever participated in a political campaign. What was the outcome of your participation? If you have not participated in a campaign, choose a campaign topic you support or oppose and consider the ways you might like to participate in that campaign. Likewise, think about your experiences if you have ever lobbied on a topic. If you have not, choose a topic for which you might like to lobby in favor or against. Finally, consider how you think social workers might have a powerful and positive effect as elected officials.

By Day 11/10/21

Post an explanation of the role of lobbying and campaigning in social work practice. Then, explain how you think social workers might have a powerful and positive effect as elected officials. Finally, explain of the impact, if any, the experiences and opinions of your colleagues have had on your own experiences and opinions.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

Follow Rubric

Responsiveness to Directions

27 (27%) – 30 (30%) posting fully addresses all instruction prompts, including responding to the required number of peer posts.

Discussion Posting Content

27 (27%) – 30 (30%) Discussion posting demonstrates an excellent understanding of all of the concepts and key points presented in the text(s) and Learning Resources. Posting provides significant detail including multiple relevant examples, evidence from the readings and other scholarly sources, and discerning ideas.

Peer Feedback and Interaction

22.5 (22.5%) – 25 (25%) The feedback postings and responses to questions are excellent and fully contribute to the quality of interaction by offering constructive critique, suggestions, in-depth questions, additional resources, and stimulating thoughts and/or probes.

Writing

13.5 (13.5%) – 15 (15%)

Postings are well organized, use scholarly tone, contain original writing and proper paraphrasing, follow APA style, contain very few or no writing and/or spelling errors, and are fully consistent with graduate level writing style.

Required Readings

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

• “Working With Survivors of      Sexual Abuse and Trauma: The Case of Rita” (pp. 81–83)

Working With Survivors of Sexual Abuse and Trauma: The Case of Rita

Rita is a 22-year-old, heterosexual, Latina female working in the hospitality industry at a resort. She is the youngest of five children and lives at home with her parents. Rita has dated in the past but never developed a serious relationship. She is close to her immediate and extended family as well as to her female friends in the Latino community. Although her parents and three of her siblings were born in the Dominican Republic, Rita was born in the United States.

A year ago, Rita was sexually assaulted by an acquaintance of a male coworker. Rita and a female coworker met Juan and Bob after work at a local bar for a light meal and a few drinks. Because Rita had to get up early to work her shift the next day, Bob offered to drive her home. Instead of taking Rita directly home, however, he drove to a desolate spot nearby and assaulted her. Afterward, Bob threatened to harm her family if she did not remain silent and proceeded to drive her home. Although Rita did not tell her family what happened, she did call our agency hotline the next day to discuss her options. Because Rita’s assault occurred within the 5-day window for forensic evidence collection of this kind, Rita consented to activation of the county’s sexual assault response team (SART). Although she agreed to have an advocate and the sexual assault nurse examiner (SANE) meet her at the hospital, Rita tearfully stated that she did not want to file a police report at that time because she did not want to upset her family. The nurse examiner interviewed Rita, collected evidence, recorded any injuries, administered antibiotics for possible sexually transmitted infections, and gave Rita emergency contraception in case of pregnancy. The advocate stayed with Rita during the procedure, supporting her and validating her experience, and gave her a referral for individual crisis counseling at our agency.

My treatment goals for Rita included alleviation of rape trauma syndrome symptoms that included shame and self-blame, validation of self-worth and empowerment, and processing how it would feel to disclose to others when the time felt right. In addition, Rita would receive important information regarding state policy and procedure for victims of sexual assault that would assist her in deciding when and how to report the crime if she chose to do so.

My treatment involved crisis intervention and stabilization along with emotional support and validation surrounding her experience. Managing her trauma and acute stress symptoms were key to her recovery. Those symptoms included guilt, shame, emotional shock, powerlessness, anxiety, fear, anger, and doubting her judgment. We processed Rita’s emotional dysregulation and sense of outrage over what happened. Over the weeks that followed, we also explored Rita’s relationship to her immediate and extended family and how they had high expectations for her and her future. Rita’s shame over the assault prevented her from telling her family for fear they would also be shamed and judge her for accepting a ride from someone she did not know well. We discussed the policy for reporting a sexual assault to the police in our state and how Rita only had a 90-day window to report the crime after her forensic evidence was obtained. After 90 days, the forensic kit would be destroyed.

The problem with the current 90-day hold policy in our state for victims like Rita is that a person in crisis experiences strong and conflicting emotions and is faced with an acute sense of disequilibrium and disorientation. This, in turn, affects her or his ability to retain information and make decisions. The person, therefore, has barely enough time to make sense of what happened to her or him, let alone decide what to do about it. The 90-day hold policy may not afford a traumatized victim of sexual assault enough time to make a decision to report to law enforcement.

I utilized a strengths-based model in my treatment with Rita to help her address the decision to report the crime. A strengths-based framework is client-led with a focus on future outcomes and strengths that the client brings to a problem or crisis. It is an effective helping strategy that builds on a person’s resiliency and ego strength. An integrative strengths-based intervention can contribute to the development of a positive outcome for clients in crisis.

I counseled Rita for 6 months. After 5 months, Rita felt strong enough to disclose to her family and file a report with the police. However, because the 90-day window had closed by the time she was stabilized and emotionally ready to file, her forensic evidence was unavailable.

Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

• Part 1, “The Johnson      Family” (pp. 11–13)

The Johnson Family

Talia is a 19-year-old heterosexual Caucasian female, who is a junior majoring in psychology and minoring in English. She has a GPA of 3.89 and has been on the dean’s list several times over the last 3 years. She has written a couple of short articles for the university’s newspaper on current events around campus and is active in her sorority, Kappa Delta. She works part time (10–15 hours a week) at an accessory store. Talia recently moved off campus to an apartment with two close friends from her sorority. She is physically active and runs approximately three miles a day. She also goes to the university’s gym a couple of days a week for strength training. Talia does not use drugs, although she has smoked marijuana a few times in her life. She drinks a few times a week, often going out with friends one day during the week and then again on Friday and Saturday nights. When she is out with friends, Talia usually has about four to six drinks. She prefers to drink beer over hard liquor or wine, but will occasionally have a mixed drink.

Talia has no criminal history. She reports a history of anxiety in her family (on her mother’s side), and on a few occasions has experienced heart palpitations, which her mother told her was due to nervousness. This happened only a handful of times in the past and usually when Talia was “very stressed out,” so Talia had never felt the need to go to the doctor or talk to someone about it until now. Talia is currently not dating anyone. She was in a relationship for years, but it ended a few months ago. She had since been “hooking up” with a guy in one of her English classes, but does not feel it will turn into anything serious and has not seen him in several weeks.

Talia’s parents, Erin (40) and Dave (43), and her siblings, Lila (16) and Nathan (14), live 2 hours away from the university. Erin works at a salon as a hairdresser, and Dave is retired military and works for a home security company. Erin is on a low-dose antidepressant for anxiety, something she has been treated for all of her life.

Talia came to see me at the Rape Counseling Center (RCC) on campus for services after she was sexually assaulted at a fraternity party 3 weeks prior. She told me she had thought she could handle her feelings after the assault, but she had since experienced a number of emotions and behaviors she could no longer ignore. She was not sleeping, she felt sad most days, she had stopped going out with friends, and she had been unable to concentrate on schoolwork. Talia stated that the most significant issues she had faced since the assault had been recurrent anxiety attacks.

Talia learned about the RCC when she went to the hospital after the sexual assault. She went to the hospital to request that a rape kit be completed and also requested the morning-after pill and the HIV prevention protocol (Post-Exposure Prophylaxis, or PEP). At that time, a nurse contacted me through the Sexual Assault Response Team (SART) to provide Talia with support and resources. I spent several hours with Talia at the hospital while she went through the examination process. Talia shared bits and pieces of the evening with me, although she said most of the night was a blur. She said a good-looking guy named Eric was flirting with her all night and bringing her drinks. She did not want to seem ungrateful and enjoyed his company, so she drank. She also mentioned that the drinks were made with hard liquor, something that tends to make her drunk faster than beer. She said that at one point she blacked out and has no idea what happened. She woke up naked in a room alone the next morning, and she went straight to the hospital. Once Talia was done at the hospital, I gave her the contact information for RCC. I encouraged her to call if she had any questions or needed to talk with someone.

During our first meeting at the RCC, I provided basic information about our services. I let her know that everything was confidential and that I wanted to help create a safe space for her to talk. I told her that we would move along at a pace that was comfortable for her and that this was her time and we could use it as she felt best. We talked briefly about her experience at the hospital, which she described as cold and demeaning. She told me several times how thankful she was that I had been there. She said one of the reasons she called the RCC was because she felt I supported and believed her. I used the opportunity to validate her feelings and remind her that I did, in fact, believe her and that the assault was not her fault.

We talked briefly about how Talia had been feeling over the last 3 weeks. She was very concerned about her classes because she had missed a couple of assignment deadlines and was fearful of failing. She told me several times this was not like her and she was normally a very good student. I told her I could contact the professors and advocate for extensions without disclosing the specific reason Talia was receiving counseling services and would need additional time to complete her assignments. Talia thanked me and agreed that would be best. I introduced the topic of safety and explained that she might possibly see Eric on campus, something that might cause her emotional distress. We talked about strategies she could use to protect herself, and she agreed to walk with a friend while on campus for the time being. She also agreed she would avoid the gym where she had seen Eric before.

The Johnson Family

Erin Johnson: mother, 40

Dave Johnson: father, 43

Talia Johnson: daughter, 19

Lila Johnson: daughter, 16

Nathan Johnson: son, 14

During our second meeting, Talia seemed very anxious. We talked about how she had been feeling over the last week, and she indicated she was still not sleeping well at night and that she was taking long naps during the day. She had missed days at work, something she had never done before, and was in jeopardy of losing her job. Talia reported experiencing several anxiety attacks as well. She described the attack symptoms as feeling unable to breathe, accompanied by a swelling in her chest, and an overwhelming feeling that she was going to die. She said that this was happening several times a day, although mostly at night. I provided some education about trauma responses to sexual assault and the signs and symptoms of post-traumatic stress disorder (PTSD). We went over a workbook on trauma reactions to sexual assault and reviewed the signs and symptoms checklist, identifying several that she was experiencing. We practiced breathing exercises to use when she felt anxious, and she reported feeling better. I told her it was important to identify the triggers to her anxiety so that we could find out what exactly was causing her to be anxious in a given moment. I explained that while the assault itself had brought the attacks on, it would be helpful to see what specific things (such as memories, certain times of the day, particular smells, etc.) caused her to have anxiety attacks. I gave Talia an empty journal and asked her to record the times of the episodes over the next week as well as what happened right before them. She agreed.

We met over several sessions and continued to address Talia’s anxiety symptoms and feelings of sadness. She told me she was unable to talk about what happened on the night of the rape because she felt ashamed. She said that it was too difficult for her to verbalize what happened and that the words coming out of her mouth would hurt too much. I reassured her that we would go at her pace and that she could talk about what happened when she felt comfortable. We practiced breathing and reviewed her journal log each week.

It had become clear that the evenings seemed to be the peak time for her anxiety, which I told her made sense as her assault had occurred at night. I described how sleep is often difficult for survivors of sexual assault because they fear having nightmares about what happened. She looked surprised and said she had not mentioned it, but she kept having dreams about Eric in which he was talking to her at the party. The dreams ended with him holding her hand and walking her away. She said she also thought about this during the day and could actually see it happening in her mind. We talked about the intrusive thoughts that often occur after trauma, and I tried to normalize her experience. I told her that often people try to avoid these intrusions, and I wondered if she felt she was doing anything to avoid them. She told me she had started taking a sleep aid at night. When I asked about her exercise habits, she said that right after the assault she had stopped running and going to the gym. We set a goal that she would run one to two times a week to help her with anxiety and sleeping. I also suggested that now would be a good time to start writing her feelings down because journaling is a very useful way to express feelings when it is difficult to verbalize them. Talia mentioned that she had decided not to go to the police about the sexual assault because she did not want to go through the process. I informed her that if she wanted to, she could address the assault in another way, by bringing it to the campus judicial system. She said she would think about this option.

During another session weeks later, Talia came in distraught. She said she had been feeling better overall since working on her breathing and doing the journaling, but that a few things had happened that were making her more and more anxious and that her attacks were increasing again. Talia said her parents were pushing her to drop out of school and to come home. She said they had been calling and texting her often, something she found annoying but understandable. They were very upset about what had happened, although they were more upset with her that she had waited for weeks to tell them about “it.” Her father threatened to come and beat the guy up, and her mother cried. She avoided talking with them, but they had become relentless with the calls. Her mother had shown up with her sister unannounced the previous weekend and had treated Talia like she had a cold—making chicken soup and rubbing Talia’s feet. The pressure from her parents was weighing on her and upsetting her. Talia was also distressed by a friend who kept pushing her to talk about what happened. When Talia finally relented, her friend asked her why she had gone upstairs with him. Talia said this made her feel terrible, and she started to cry. This friend also told her that Eric had heard she had gone to the hospital and was telling people that she had wanted to have sex. Eric had been telling people she was “all over him” and that she had taken her own pants off. This made Talia very angry and upset.

Key to Acronyms

HIV: Human Immunodeficiency Virus Infection

PEP: Post-Exposure Prophylaxis

PTSD: Post-Traumatic Stress Disorder

RCC: Rape Counseling Center

SART: Sexual Assault Response Team

We talked about how there are certain myths in society around sexual assault and that the victim is often blamed. We also talked about how the perpetrator often blames his or her victim to make himself or herself feel better. Talia said she has felt some sense of blame for what happened and that she should not have drunk so much. She started to cry. I gently reminded her that she was not at fault for Eric’s actions, and her drinking was not an invitation to have sex. I reminded her that he should have seen how incapacitated she was and that she could not have consented to sex. Talia continued to cry. She clearly had a number of emotions she wanted to express but was having difficulty sharing them, so I offered her some clay and asked her to use it to mold representations of different areas in her life and how she felt about them. We spent the rest of the session talking about the shapes she made and how she felt. Toward the end of the session she told me she had decided to put in a complaint with the campus judicial system about the assault. She worried that Eric would assault another woman and she would feel responsible if she did not alert the university. I offered my support and told her I would be there for her through the process.

Popple, P. R., & Leighninger, L. (2019). The policy-based profession: An introduction to social welfare policy analysis for social workers (7th ed.). Upper Saddle River, NJ: Pearson Education.

• Chapter      13, “Taking Action: Policy Practice for Social Workers” (pp. 285-306)
• Chapter      13, “Conclusion” (pp. 307-312)

Conclusion

Lessons From Policy Analysis

When in graduate school, one of the authors had a favorite economics professor who was fond of saying that the key to understanding economics is the realization that everything is related to everything else—in at least two ways. This is also a useful observation for social welfare policy. All parts of policy are infinitely complex and interrelated in a seemingly endless variety of ways. This same professor also used to say that if you took all the economists in the world and laid them end to end, they would never reach a conclusion. Although a cynic might also say this about social welfare policy analysts, we do not want to end this book on such a note. We think several broad, general conclusions can be drawn from the analyses we have presented, and we will identify these in the following sections.

Thoughts for Social Work Practice

Social workers are often asked to address groups of influential citizens, such as Rotary Clubs, on issues of social welfare policy. Realizing that policies such as financial assistance to the poor are not popular, how might a social worker ­giving an address to a civic group use the concept of partisan policy analysis to present financial assistance policy in a manner that might result in increased support?

The Bottom Line Is the Bottom Line

The primary issue in practically every area of social welfare policy is cost. Put another way, social welfare policy is always subservient to economic policy. Every policy reform we have discussed has as its driving goal the reduction of expenditures, or else a fear that costs will get out of control. The 1996 welfare reform legislation has as its centerpiece requirements that recipients become employed, with time limits for this to happen. The argument is that we are spending too much and that work requirements will reduce costs. The main argument for family preservation is that by intervening in a family quickly and intensively, we can avoid foster care and thus reduce total long-range cost. Most proposals for reform of Social Security are based on assumptions that the system will go broke at some future date unless costs are reined in. The current debate about reform of the Affordable Care Act is largely about cost. Issues of humanitarianism, quality of life, promoting a good society, and mutual responsibility are all secondary to doing it cheaper.

As social workers, we have often been pulled into the cost game and we have sold policies we wished to pursue based on promised cost reductions. Lindblom’s notion of partisan policy analysis is why we do this. (If you will remember from Chapter 3, ­Lindblom is the political scientist who argues that people perform policy analyses directed toward the goals of those they wish to influence.) Realizing that policymakers are greatly concerned with cost, social workers try to sell policies based on cost reduction. Social workers did this in 1962 when we convinced Congress that providing social services to welfare recipients would help them solve the problems leading to their dependency, get them off welfare, and thus save costs. We did this again in 1993 with arguments advocating for the Family Preservation and Support Program. Legislators quickly soured on the 1962 Social Service Amendments when they did not produce the expected cost savings. Now that family preservation is firmly in place and foster care placement rates—hence costs—are continuing to rise, it is highly likely that Congress will also sour on this, even if it can be demonstrated that by other criteria the concept is a success.

Compassion and Protection: Dual Motivations for Social Welfare Policy

Our review of current social welfare policies has confirmed Ralph Pumphrey’s (1959) historical review of social welfare in the United States. He argued that all social welfare is driven by two more or less compatible motives. On the one side is the desire of people to make the lives of others better. “This aspect of philanthropy may be designated as compassion: the effort to alleviate present suffering, deprivation, or other undesirable conditions to which a segment of the population, but not the benefactor, is exposed.” On the other side are aspects of policies that are designed for the benefit of their promoters and of the community at large. Pumphrey (1959) called this motivation protection and stated, “It may result either from fear of change or from fear of what may happen if existing conditions are not changed.” Pumphrey (1959) concludes by offering the hypothesis that social welfare policies that have proved effective have been characterized by a balance between compassion and protection.

A policy that seeks to keep mental patients on their medications, but only results in extending their compliance time by a few weeks will be judged by many people to be a failure. However, perhaps an average of few weeks of extra compliance is actually a very significant accomplishment.

val lawless/Shutterstock

Aspects of compassion and protection have been evident in all the policies we have analyzed. Public welfare policy is concerned with helping poor people (actually the children of poor people) but is also concerned with protecting society against the threat of dependent adults; family preservation policy seeks to help keep families together but also seeks to protect society from the excessive costs of an escalating foster care population; Social Security is designed to assure that the elderly are afforded a reasonably comfortable retirement, but it also protects families from having to assume responsibility for the care and support of aging relatives.

Ideology Drives Out Data in Social Welfare Policymaking

Social welfare policies are influenced much more by social values than they are by data from empirical research. It causes policy analysts no end of frustration to see situations such as the welfare reform debate. Even though masses of data have been presented to Congress demonstrating that many poor people can’t work and that there are not jobs for a majority of those who can, Congress continues to pass reform packages that feature time limits on assistance (“Testimony of Sheldon Danziger,” 1996). These time limits are based on the work ethic and confidence that America is the land of opportunity, which often results in the belief that work can be found by anyone who tries hard enough. As empiricists and social scientists, we express outrage, sometimes amusement, at what we view as antiscientific, anti-­intellectual behavior.

Is this tendency to promote values over data really so difficult to understand? We don’t think that it is. Even social workers and allied social scientists find it hard to accept data that contradict deeply held values. For example, we are finding the research that casts doubt on the effectiveness of family preservation programs difficult to deal with because these programs are embodiments of some of our most cherished values. When Richard Herrnstein and Charles Murray (1996) published The Bell Curve: Intelligence and Class Structure in American Life, social workers immediately rejected the book’s main theses, in most cases never having bothered to read the book. We have read the book and found ample grounds on which to reject Herrnstein and Murray’s assertions empirically. However, and this is our point, many of our colleagues rejected it without objectively assessing the arguments because these were so out of line with social work values.

Although we understand the tendency for ideology to drive out data in policy­making, we do not excuse it. One of the ongoing challenges to policymakers will always be to make the process more rational and data based. This is the only way we will ever bring about meaningful social change and a more just society.

Policymakers Are Generally More Sophisticated Than They Appear Our Expectations

Political scientists Theodore Marmor, Jerry Mashaw, and Philip Harvey (1990) argue that the central feature of social welfare policy is misinformation. They say,

A quite remarkable proportion of what is written and spoken about social welfare policy in the United States is, to put it charitably, mistaken. These mistakes are repeated by popular media addicted to the current and the quotable. Misconceptions thus insinuate themselves into the national consciousness; they can easily become the conventional wisdom.

However, policymakers themselves generally know better. With the legion of consultants, expert staff members, and social scientists providing testimony before committees and all of the data and expertise available from government bureaus and private think tanks, all at the beck and call of legislators, they usually have a pretty good grasp on the reality of social welfare problems. Also, some policymakers, for example, the late Daniel Patrick Moynihan, were experts in social welfare-related areas before they were elected to office. Others specialize in one or two areas of policy after election and quickly become quite expert.

With popular misconceptions about social welfare so strongly entrenched, how can legislators make policy in this area and hope to remain in office? Marmor, Mashaw, and Harvey present three options. They can try to correct the conventional wisdom, they can act as if the conventional wisdom is true, “or they can speak in terms that reflect popular understanding but attempt to govern on the basis of their quite different conception of the facts.” The first option is a sure road to political death; the second is generally too cynical even for career politicians. So most see “dissembling as the only path available to policy reform combined with political success” (Marmor, Mashaw, & Harvey, 1990). Marmor, Mashaw, and Harvey were writing in 1990, perhaps a more reasonable time. We fear that, in 2017, acting as if the conventional wisdom is true (for example, the belief that the coal industry can be revived in West Virginia) is no longer too cynical for many career politicians.

These observations explain why reforms of social welfare policy have such a high failure rate. If reforms are marketed in terms of dominant misconceptions, they are destined to fail. As we saw in the chapter on welfare reform, nearly every politician is currently on the bandwagon supporting the five-year time limit on welfare benefits. However, all except for perhaps the most dense have seen the data that, having now passed five years, there are large numbers of welfare recipients for whom there simply is no work, or who, for various reasons, are unable to work. They further realize that taking the steps necessary to guarantee work will result in a more, rather than a less, expensive welfare program. Thus, because social welfare policies are designed and marketed in a way that virtually assures eventual failure, reform will always be a key feature, perhaps even focus, of the system.

Our Expectations for Social Welfare Policy Are Unrealistic

The common denominator of all the policies we have analyzed, with perhaps the exception of Social Security, is that, for some of the reasons already mentioned, they have had disappointing outcomes. In an interesting analytical twist, the prominent sociologist Amitai Etzioni (1994) argues that the problem may well be not that the policies are failures, but rather that people expect too much from them. He argues that human behavior is extremely difficult to change and that the very act of attempting to do so is a tremendous challenge. He says, “We all know how difficult changing human behavior is, but this knowledge has not changed our basic optimistic predisposition. Once we truly accept that human behavior is surprisingly resistant to improvement, however, some rather positive, constructive lessons follow.” These lessons are summarized below.

Lower Your Expectations—Expect Change to Cost Much More than Predicted

Because behavior change is so difficult to accomplish, we should be happy with any positive results at all. Viewed from this perspective, we should celebrate the fact that family preservation programs are successful in reaching and helping a few families, that a welfare-to-work program places 10 or 15 percent of participants in jobs, that boot camps for young offenders have a 50 percent graduation rate. Regarding this last example, ­Etzioni (1994) observes, “We must acknowledge that hoping to assimilate people raised for twenty years in one subculture (say, the inner city, as a gang member) into a different subculture (of work and social responsibility) in only a few months is laughably ambitious” (p. 16).

Creaming Is Okay

Social programs are often criticized for concentrating on the part of the target population with the fewest problems. For example, welfare-to-work programs often admit recipients with a comparatively high level of education, few problems, and recent work experience because they are easy to place in jobs and make the program look effective. As we saw in the review of family preservation, that policy is currently under criticism because the clients selected for services are not the most serious cases. Researchers have concluded that most of family preservation’s clients were never in danger of having the children removed in the first place. Critics say that the practice of creaming is undesirable because it directs services to people who may not even need them and it avoids dealing with the really tough problems. Etzioni disagrees, arguing that we never have enough money to help everyone and so it only makes sense to concentrate our efforts on those most likely to benefit. “The resources saved this way can then be applied to some of the more difficult cases. Policymakers should, though, recognize the fact that the going will get tougher and tougher” (Etzioni, 1994, p. 16).

Don’t Expect to Scrape the Bottom of the Barrel

We must recognize that even with concentrated and persistent effort, no social welfare policy will ever be able to reach everyone and every social problem. In a situation analogous to a medical patient with an illness too severe to cure, there are some people who will never be adequate parents, some welfare recipients who will never be able to get a job, some criminals who will never be “rehabilitated,” and some social problems, such as poverty, that will never be completely eradicated.

Thoughts for Social Work Practice

The sociologist Amitai Etzioni argues that we should consider the practice of creaming to be okay. Do you think that you, as a professional social worker, can do this within the strictures of the National Association of Social Workers (NASW) Code of Ethics?

Don’t Allow the Best to Defeat the Good

We generally tend to evaluate social welfare policies relative to the original promises of their sponsors rather than to some reasonable level of achievement. Because of the nature of the political process, policies are almost always oversold initially in order to get enough support to be enacted. Because, as we have noted again and again, social welfare policies rarely exhibit spectacular success, they should be measured against other policies rather than against some ideal standard. For example, a welfare-to-work program that increases the level of paid employment by nine hours a month will be considered a failure if measured against the standard that all participants should find full-time jobs. However, if compared with other programs that increased work by only five hours per month, this program could look very good. “As long as the social goal at hand must be served, we must settle for the comparative best (which is often not so hot), rather than chase elusive perfection” (Etzioni, 1994, p. 16).

Be Multifaceted but Not Holistic

In social work school, we teach students to utilize a systems approach. This approach illustrates how the various aspects of a person’s life and problems are related and that anything affecting one aspect of a system will reverberate throughout the whole system. This approach also illustrates that policies must address a number of facets of a person’s life to be truly effective. Probably the best example in this book is child welfare policy. It is now quite fashionable to point out that it is impossible to address child abuse and neglect effectively without at the same time addressing poverty. Etzioni accepts this but argues that a holistic approach would cost so much and be so complex that it would never be practical for the large number of people who need help. We must search for policies that recognize the systems aspect of problems but are less exacting than a holistic approach. Thus, while we recognize that poverty is the major factor leading to child neglect, we can still provide therapeutic day care programs that address only a few targeted aspects of the neglect and by doing so make some children’s lives better. As Etzioni (1994) concludes,

It’s no use pretending that poverty or welfare will be abolished, AIDS or cancer cured in this century, drug abuse or teen pregnancy sharply reduced. Let’s instead dedicate our efforts to effective but clearly delineated projects in each of these areas. This humbler approach is likely to have a very attractive side effect: it may enhance public willingness to pay for such projects and may also restore public trust in our leaders and institutions. (p. 16)

There are slight indications that Etzioni’s advice about lowering expectations is beginning to sink in, for program evaluators at least. In their meta-analysis of scientifically adequate evaluations of family support programs, Dagenais, Begin, Bouchard, and ­Fortin (2004) found evidence of only very slight effects by the twenty-seven programs evaluated. After discussing the disappointing data, they surprisingly conclude, “Investigators would, therefore be wise to give up on obtaining spectacular results and content themselves with more modest program gains. Not even a small change in a family should be taken lightly, however.”