By Jule M. Sugarman, Chairman, Center on Effective Services for Children
(This article is based on a forthcoming book by the author entitled Building Local Strategies for Young Children and Their Families.)
A Decade of Change
The last ten years have seen a growing demand for radical change in the delivery of human services for young children and their families. The operative words have become system change, cooperation, coordination, and - most popular of all - collaboration. Other phrases, such as locally managed, family-focused, age-appropriate, blended funding, and seamless services, have become part of the lexicon of academics, planners, and a surprising number of practitioners.
Many state officials are considering shifting their focus from rigid systems based on tight regulations and prior approval to new approaches that prospectively would emphasize flexible standards with training and technical assistance provided by the state. Similarly, there is growing interest in accountability and evaluation by state agencies. Collaboration among state agencies is being nurtured by Children's Cabinets in some states, by offices for children in others, and by a variety of other arrangements.
The concept of child development as embracing the years from the prenatal period through the third grade is now widely accepted. Thus, new ties become necessary between schools and programs that serve younger children.
Programs are now being conceived as child care and development programs. The distinctions between the two have become archaic. Most professionals now believe that child development programs must find ways to meet family needs for child care. Similarly, a growing consensus holds that all forms of child care ought to incorporate child development activities.
Families increasingly are being seen as critical to the success of working with children. The term "families" is often used in lieu of "parents," because the nurturing of children involves a variety of arrangements. Grandparents, siblings, other relatives, friends, new partners, foster parents, and others are frequently living in the home; foster parents and others are frequently the principle source of support for the child. Multidimensional efforts now speak to educating families in parenting skills, consciously involving families in working with their children at home, and involving families in classrooms. Many programs now seek seriously to involve families in the management of programs.
The holistic approach emphasizes the need to address child and family problems and opportunities on a multi-institutional, multiprofessional basis. Thus, we find increasing interest in facilitating interaction among health, mental health, education, nutrition, family support, and social services personnel. Staffs with different backgrounds are operating in organizations outside of their traditional bases. For example, schools are seen by some as a logical base for providing health services. Mental health personnel and social workers are now found in many schools. Public health personnel are moving beyond traditional concerns for well baby care to a much more comprehensive approach to meeting the entire range of health care needs for children and their families. Family participation is becoming an ingredient of all types of service programs. The growing complexity of these arrangements is creating new demands for effective case management in a variety of forms.
One also must note a distinct shift in political concern about children at both the national and state levels. New laws have been enacted within the last ten years. Appropriation levels at both state and federal levels, while still unsatisfactory, are growing faster than most other public programs. The growth has been most encouraging in areas such as health care, through the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT) within the Medicaid program; nutrition through the Women, Infants, and Children (WIC) supplemental feeding program for pregnant women and infants, child care and school nutrition programs, and increased support for food stamps; child development activities through Head Start; a variety of child care programs, including JOBS, transition and at-risk care as well as a new Child Care and Development Block Grant Act, which went into effect in 1991; efforts to increase child support collections; and foster care and adoption, as well as child protective services.
Changes for the Next Decade
Unfortunately, many of the changes described above are goals rather than realities. Today's systems look very much like those of a decade ago. Examples of real cooperation, coordination, and collaboration are still very much the exception. Interdisciplinary professional training and cross-program careers are scarce. Effective case management, sharing of information, common databases, and shared funding are rare. Very few locations are making a real effort to plan on a multiprogram basis.
As in the past, no single organization and no single official has responsibility for services to children and families. While governors have a great deal of authority, education systems are substantially insulated from their influence. Both state and local boards of health often operate independent of the governor. Federal regulations sharply delimit what a governor can and cannot do.
Consolidating authority in a single agency for children and families has often been discussed. Frankly, we do not think that such an agency will ever be created. Too many programs and professions wish to retain their independence, and there are too many legislators in Congress and the states, legislative staffs, national advocacy groups, and parent groups to permit extensive consolidation of programs.
Furthermore, the record of consolidating programs under the supervision of large bureaucracies is less than satisfactory. Indeed, current thinking tends to favor decentralization. School-based management is a prime example, but the urge toward decentralization affects other areas as well.
We believe that progress requires constructing voluntary systems of collaboration that are seen as mutually advantageous to all of the participants. Collaboration needs to be encouraged by federal and state policies, but the real action is at the local level. In my forthcoming book, I make the following point:
"The importance of local communities is that they are where services are actually delivered. It is local practice that will determine whether programs are effectively operated; staffed with highly competent people, working in harmony with one another; welcoming families as active partners; assuring that seriously at-risk children and families are identified and their needs responded to; forging collaborative partnerships among education, child care and development, health, mental health, family support, protective, social services and financial assistance programs; and establishing systems for evaluation and accountability."
In my view, the principal obstacle to creating voluntary collaboration among local programs is the belief that federal and state policies will not permit it. One can argue that this impression is not true, but the reality is that most people and, I suspect, many federal and state officials believe that it is true. In order to create a different attitude at all levels of government, I am proposing the use of consolidated state plans. Under this concept, a state would propose a plan for federal approval covering some 39 federal programs. The state plan would make clear that local communities have authority to:
In effect, the consolidated plan approach allows local communities to establish practical and effective systems of collaboration and thereby to improve the delivery of services. The states of Indiana and West Virginia will be working with our Center on Effective Services for Children to develop a consolidated state plan tailored to their individual needs as well as to prepare state versions of our book on Building Local Strategies for Young Children and Their Families.
Posted on March 23, 1995
URL: http://www.ncrel.org/sdrs/areas/issues/envrnmnt/go/93-3gc1.htm