Sabbatical Awards 2005-2006  

Sabbatical Report:  Garry Oldham

The Donut or the Hole:  New Perspectives on Delivering Human Services

What are human services? In general, human services assist people with problems in living, and tries to help people achieve their highest level of self-sufficiency.  Traditionally, human services have had three distinct functions: social care, social control and rehabilitation.  Social care is assisting clients in meeting their social needs with a focus on those who cannot care for themselves, our most vulnerable citizens such as children, the elderly, people with disabilities or mental illness, and victims of crime, disasters or crises.  Social control differs from social care in that the recipients are capable of caring for themselves but have failed to do so, or have done so in a manner that violates social norms or laws.  Examples of social control programs are child protective services, and programs within the criminal justice system.  Rehabilitation has the goal of returning someone to a prior level of functioning.  The inability to function can be related to an illness, physical or psychological, or a set of circumstances.  Soldiers returning from war, victims of child abuse, or people who have found themselves out of work or on the streets – all may need services to help them return to a higher level of functioning.  In practice, these three functions are not really separate from each other.  Many clients have multiple problems that may require some mix of goals associated with social care, social control and rehabilitation.

To best understand current practices in delivering human services, it is useful to know a bit about the history of helping and the attitudes and beliefs that impacted the manner in which less fortunate people were helped in Europe. For example, until the middle ages, people believed that those suffering from mental illness were possessed by evil spirits and treatment focused on ridding the body of such spirits.  The mentally ill had holes drilled in their skulls to let out the evil spirits, and they were often beaten, starved, chained, and exorcised. Persons suffering from physical and or psychological problems were frequently “set free” in the forest to meet their demise hungry, cold, and alone.  During the middle ages, caring for those in need was the responsibility of the community, the feudal lord, and extended family.  And, until the 1500s, the Catholic Church was the institution that largely provided services to people in need.   The church viewed deviant behavior as a product of sickness, and responded accordingly, and for humanitarian motives.

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As the feudal system disintegrated, and people moved away from a rural, agriculturally based society, into cities, nuclear families replaced extended families.  With urbanization and industrialization came extreme poverty, as well as poor working conditions that prevented the caretaking of needy family members.  During the latter part of the sixteenth century, London had so many beggars on the streets that the government decided to collect taxes to deal with the problem of poverty.  At this time, the poor were often not even viewed as human beings.  In 1601 the first Elizabethan Poor Law was enacted.  This law categorized those in need into two groups: the worthy poor who where deemed poor due to no fault of their own; and the unworthy poor who were seen as able bodied, and capable of work, regardless of their age.  The law reflected both humanitarian as well as social control concerns.  The worthy poor were typically housed in large institutions - poor houses - that often housed all sorts of people including criminals, the mentally ill, the physically fragile, and very young children.  While the motive was humanitarian, the reality was less than humanitarian.  The unworthy poor were sent to workhouses.  This law was in effect in England for 250 years and became the basis of our social welfare policies in this country starting in Plymouth and Jamestown.  Through the 19th and 20th centuries, large generic institutions gave way to specialized institutions such as prisons, orphanages and hospitals.

Social welfare policy reflects a particular view about the role of government in meeting people’s needs. Issues about the worthiness of recipients continue to be debated as social policies are enacted.  Values and perceptions about children and the elderly have changed during the last century.  Eighty years ago, many children who had no parents to care for them, were put on trains, sent west to farm families to be raised.  Often these children were really no more than indentured slaves. Sixty years ago, youth who committed misdemeanors could end up spending years in prison for offenses that an adult might pay a fine for or serve a few days in jail. Changes in the public’s knowledge, and attitudes about problems led to new legislation to protect our most vulnerable citizens. The first child protective services opened its doors in the 1960’s.  The 1960’s also introduced Medicare, Medicaid and changes in the social security act that moved millions of senior citizens out of poverty. The Human rights movement of the 1960’s influenced the way Americans perceived people’s needs and rights.  During the 60’s and 70’s, we saw the emergence of many programs aimed at assisting people with physical and mental disabilities, youth, drug addiction, and victims of domestic and other types of violence.  In response to these identified needs, human service work have most frequently focused on human weaknesses and problems.

The importance of social justice, and recognizing each individual’s dignity has always been a basic value of the human service profession.  However, when the helping professions focus exclusively on an individual’s deficits, or problems, we fail to see the whole person.  Labeling, or naming a problem, fails to really tell us much about a person’s struggles, and doesn’t encourage people to use their own resources and strengths to improve their lives.  In fact, some clients end up totally buying into our labels, and can’t see that they have any resources or strengths beyond their labels.  About ten years ago, the helping professions really began experimenting with a different approach to working with people. This approach is known as the strengths perspective. The strengths perspective is growth-oriented; its emphasis is placed on identifying, affirming and enhancing the knowledge, abilities, resources, aspirations and hopes of people.  It recognizes that the client is more than his or her problem; that people have had successes in their lives in the past that can help them deal with, and see beyond their current problems.  Let me give you an example: a man suffering from schizophrenia saw a mental health worker who used a strengths perspective in her work.  This man was a part time dishwasher but prior to his illness he had loved to travel and he still loved aviation.  The mental health worker helped this client set up a plan to deal with potential crises resulting from his mental illness, which are typically part of this chronic disorder.  She then focused on learning about his interests, and encouraged him to pursue activities that would increase his satisfaction with his life.  As a result, he got a job as a dishwasher at the airport.  This job led to a job out on the tarmac. This is a good example of helping a client find the path beyond his illness or problem; helping him look to his possibilities.

The basic, underlying premise of the strengths perspective is that people’s strengths and resources, and the resources within their environments should be the central focus of the helping profession.  This is accomplished by asking clients questions that help them see their own resilience, strengths, and talents. This is a fundamental shift in the way human service workers have practiced.

The goal of my sabbatical was to assess the profession’s status with regards to implementing the strengths perspective.  In addition to reading about the strengths perspective, I visited with agency staff as well as educators in human service programs. What I learned was that, in general, people knew about, supported and liked the strengths perspective approach.  However, I learned that the implementation of this approach fell short of its ideal goal – making strengths the focal point. Still, agencies are doing things reflect that philosophy, and principles of the strengths perspective.  Agencies talk about empowering clients, through offering information, education and encouraging people to make their own choices and decisions.  One local agency tore down their walled nurses’ station to lessen the power differential between staff and clients. In residential programs, clients are setting their own rules.  Agencies are collaborating with each other to create more opportunities for clients.  Agencies are talking with clients about their strengths, and state administrative rules mandate that clients be asked about their culture as well as the strengths they bring into the situation. Unfortunately, helping people, who feel downtrodden, uncover their strengths often takes time and most agencies are limited in the time they have with clients.  And once strengths are identified, they need to be included in the treatment plan, in a meaningful way.  It appears that all too often, discussion, and use of strengths is superficial and not really employed in a manner that truly supports hope and possibilities.  The literature is really clear; if you want to operationalize a strength-based approach, the initial assessment with a client must predominantly focus on strengths, not problems.  This doesn’t appear to be happening.  Reimbursement for services requires documentation of problems, and a treatment plan that responses to those problems.  Additionally, we are a problem-oriented society; we like talking about problems, solving problems, and the language we use in the field still supports this problem orientation.

Educators in the human service field appear to strongly support the strengths perspective and are teaching some classes that specifically reflect this philosophy and teach people how to conduct strength-oriented assessments and counseling sessions. They also discuss concepts from this perspective in other classes. However, faculty faces a dilemma; we can teach strength-based assessment and treatment planning but our students, for the most part, will work in agencies that are still problem oriented.

This sabbatical provided me with an opportunity to better grasp this new paradigm, and has encouraged me to create ways to better educate my students in the strengths perspective, and to challenge their perceptions to seeing clients as having holes.  My goal is to have students perceive clients as whole human beings, facing temporary setbacks, and capable of unknown possibilities.