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If the human service system is really a system, what are its goals and outcome expectations and how are they measured. This examines some of the pitfalls of the traditional system of providing services to people with problems in living. The implications of the title at the top of the page are:
Who is to be served? While it is normally assumed that the purpose of human service systems and agencies is to serve some target population of people with problems in living, this is not inherently clear by the functional behaviors of the system. It is interesting to note, for example, that the verb serve is more often than not being transformed in common professional language into service. When service is used as a verb, it provides a very different connotation. Historically, it was probably first used in this manner in relation to the construct of prostitutes "servicing" Johns; but its most familiar use is in the context of servicing a mechanical object , such as a car. To suggest that a human service worker services a client has a quite different conceptual texture, than to say that that same person serves a client. On the other hand, professionals seem to be able to talk about themselves as being public servants, which would imply that they serve the public at large, in the manner of politicians and bureaucrats. But to serve the public is often a significantly different matter than serving a target population. The public has interest groups that may conflict with a target group. If this were to happen, the question of who you serve becomes a significant issue. Again, the professional language provides clues as to the identification of the real intentions of the helping professions. Professional helpers and their literature often make reference to noncompliance. To comply is to obey. It is not normally expected that the person being served obey the servant. Therefore, logically, no client can be noncompliant and be served. Other terms such as incorrigible, hardcore, multi-problem, or the role assignments such as patient, recipient, etc., all seem to suggest that the intention is not to serve the person with problems in living at all. What is the goal to be reached? If the helping professionals are really in the business of serving the public, what is the public will? Without some articulation of public will it is impossible to determine how to organize ourselves to reach a goal. One could argue that the government organized "human service systems" and their combined legal and regulatory opinions represent the public will. If that is the case, there seems to be a very mixed message indeed. Clearly the public will is in a state of flux, having been strongly in favor of the removal and/or control of people with problems in living, and now articulating the construct that such people really are in control - while continuing the functions of a control agent through archaic regulation which protects "expert" guilds and fails to identify clearly intended outcomes. The failure to separate the system outcomes from the personal outcomes of people with problems in living and to weigh the merits of each when they conflict is an abomination of the public will. What are the set of elements or parts that need to be organized? If one were simply to count the number of people with problems in living who are either living in places that they do not value, one can see that the elements being organized to help them is quite elaborate. If one reviews regulations of such human service systems, we find that a significant element of the organization is the assurance that certain "experts" is an important factor. Thus elements of people and facilities are important despite the fact that neither of these elements are of the significance to the people with problems in living. Another very important element is categories [labels] and categorical spending, which seems to imply that if we organize in a manner which expends money on people with labels Again, these elements are organized primarily to assure that people with problems in living comply with the public will, not that they learn to behave in ways that reduces their problems in living and choose therefore to behave in ways that identify them more with the public than with any problem as identified by themselves or others. How will we know that we have been useful? Since the public will has not been clearly defined or if defined, is not being addressed, and the people with problems in living are not the people being served, how do we know when we have been "useful". The Oxford Dictionary defines useful as of use, serviceable, suitable for use, advantageous, or profitable. The definition itself seems to be of little use. The definition of useless, however, may be more helpful. Serving no useful purpose, unavailing; of inadequate or insufficient capacity, inefficient. The general public seems to articulate these terms quite often. The actual people who use the systems are often ambivalent: some picket the helpers while others find comfort in just being there. Few however, seem to diminish their problems in living, however. Very little data [except perhaps in the physical health system], other than a few anecdotes, are available in health, education and welfare systems that indicates that the person with problems in living no longer has such problems. Education may be able to point to scholars, but few of those have been helped to overcome problems in living to achieve such scholarship . People may have learned to live with their problems or come to recognize that they have no responsibility for them. They may find the services and supports comforting rather than intrusive. It is perhaps significant that most human service organizations emphasize how much service they provide rather than market their effective outcomes. The best human service agencies are the largest and are servicing the most people. The exponential expansion of the Diagnostic & Statistical Manual - Fourth Edition , which is Bible for psychiatric "illnesses" seems indicative of the need to service more people. Commentary It would seem that there are a few basics for human service systems to consider: o Determine who they intend to serve. |
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