Here is chapter 9 .
You may have gathered by now that the human services field is quite complex.
Complete agreement regarding philosophies, methods, goals, services, funding,
or anything else just does not exist nor, from our point of view, should it.
There are times when controversies and differences are stimulating, healthy,
and valid and lead to creative solutions. At other times, they are repetitious,
meaningless, and destructive. Too frequently they consume time, energy, and
resources that might better be used providing needed services. To this end, we
highly recommend that students become familiar with the books in the Opposing
Viewpoints series, published by the Greenhaven Press, that deal with issues
of concern to human services workers.
The purpose of this chapter is to present a sampling of basic controversies
and issues in the field of human services that have not yet been resolved
and may never be resolved to everyone's satisfaction. The questions raised in
this chapter influence all human services workers. Some issues affect the
human services worker more directly than others, but they all impact on the
worker and the services provided. Prior knowledge of these and other controversies
helps workers know what they might expect from colleagues,
politicians, consumers of human services, and the general public. This
knowledge can be instrumental in helping the worker provide more effective
We do not attempt to resolve these issues here. Our views are often
implied by the way we present issues. Furthermore, we do not expect you to
come to any specific conclusions or agree with any particular point of view.
Whereas issues change, conditions change, and people change, many old issues
reemerge that give the appearance of new issues. These so-called new issues
have in all probability been with us in one way or another, to one degree or
another, for as long as the human services profession has existed. Some examples
are discussed in this chapter. The idea is to examine them and understand
their significance to human services workers and to the provision of human
services, for they very frequently raise questions regarding one's personal and
professional values and ethics.
THE CLASH OF VALUES IN SOCIAL POLICIES
At the outset, it is worth repeating that complete agreement about social policies
in the human services rarely occurs. Social policies are supposedly based
on morals and values; however, there is no consensus about what is morally
right. Jansson (1988) identifies five moral issues involved with social welfare
policies. In discussing them, it will become quite clear that they are all closely
related and overlap each other in many ways. Following are the issues and
some of the questions they raise.
current controversies and issues 325
Human Services in Comtemporary America COPYRIGHT© 2004 Brooks/Cole, a division of Thomson Learning
326 chapter nine
1. Morality of social services. Who shall receive services and on what terms?
Questions: Shall services be given to only those who are unable to
work? What about (a) those who cannot find work or (b) those who cannot
earn enough to stay above the poverty line? Should those who receive
benefits be required to work in the community? Should those on welfare
not receive increased benefits for additional children?
2. Nature of social obligations. For what needs and problems is society
responsible and which shall receive priority? (p. 5)
Questions: Are we our brothers' keepers? Is society responsible for
providing for all who cannot care for themselves? Should society provide
for only food, shelter, clothing, and medical care? What about education,
cultural enrichment, and economic needs?
3. Preferred interventions. What kind of policy remedies should be chosen to
address specific social problems? (p. 5)
Questions: Should drug abusers be jailed, or should drugs be legalized?
Should society emphasize treatment and prevention of drug abuse,
or should the focus primarily be on keeping drugs from entering the country
and on enforcement of antidrug laws? Should society prohibit abortions
or continue to allow them, and on what terms? Should there be gun
control, and on what terms? Should society force the homeless into shelters
or hospitals, or jail them if they refuse to go to either?
4. Compensatory strategies. Should society give preferential assistance or
treatment to members of specific groups that lag behind the rest of the
population in economic and other conditions? (p. 5)
Questions: Does not society do this through welfare, and other programs?
The real question is, to what extent and when does society provide
assistance and treatment? Should society guarantee basic health care
for those who cannot afford such care? Should affirmative action programs,
which seek to guarantee jobs, education placements, and contract
work to members of minorities, take precedence over equal opportunity
5. Magnitude of federal policy roles. What policy powers should federal
authorities possess, and what should be the magnitude of federal social
spending? (p. 5)
Questions: Is the federal government too large? Are state and local
governments better able to know and understand the needs of their people?
Should the federal government step in to meet the needs of its citizens
if state and local governments cannot? Does the federal government,
through its policies and funding power, wield too much influence on state
and local policies and practices? Should federal social spending be limited
to maintaining a balanced budget or until additional taxes are needed?
The various interest groups continue to disagree in their answers to these
and many other questions. A brief look, however, at just two specific issues
dealing with welfare, life, and death will further exemplify the problem.
The proposals being considered by states to deny benefits to single mothers on
welfare who then have additional children raise many moral issues. Conservatives
feel that such benefits reward welfare mothers for having more children
and so provide an incentive for them to become welfare dependent. They
believe that it is basically irresponsible to bring children into the world if one
cannot adequately provide for them. Should society support this perceived
irresponsible behavior? Liberals argue that society has an obligation to take
care of those in need and that children should not be punished for the behavior
of their parents. They also question the assertion that denial of benefits for
additional children is an effective way to help the mothers become more independent.
They question whether the proposed cuts would really discourage
these women from having additional children. Could not society find better
ways of helping welfare mothers become independent of the welfare system?
Better yet, cannot society find a way to end poverty?
The issue of euthanasia was revived suddenly and sharply when a doctor
helped a woman suffering with Alzheimer's disease commit suicide. The doctor
was charged with murder, but the case was dismissed because there was no
state law that prohibited assisted suicides. The same doctor, through the use of
devices he developed, assisted two other women to commit suicide ("Two
Doctor-Assisted Suicides," 1991). In both instances, the doctor provided the
means and the women committed the act. There was no doubt that the women
wanted to die; however, several disturbing ethical questions remain. Should
assisted suicides be allowed? If so, other questions need answering. Who is to
assist, and under what circumstances? Should these decisions be made by the
patient, family, doctor, community, all, or a combination of some of these?
What criteria should be used to justify active (assisted) or even passive (unassisted)
euthanasia? Should the criteria be age, finances, quality of life, life
expectancy, health, or any other condition? Should euthanasia be legalized?
Should the federal government attempt to overide the decision of the voters of
a state to legalize euthanasia? The Hemlock Society, a group that supports suicide
and assisted suicide for the dying, strongly endorses the right to die and
the legalization of euthanasia (Humphry, 1991).
Let us take a closer look at how the clash of values creates problems that
directly affect human services workers, consumers, and people in general. In
presidential campaigns and budget or legislative battles, past and present, one
constantly heard contestants speak of American values or what is right. Are
the American values of conservatives more valid than those of liberals? Who
decides what values are American values? Do liberals know more about what
is right than do conservatives? What about individuals, schools, churches and
synagogues, or any other institutional perceptions of American values or of
what is right or moral? How one resolves these questions is essential, for it is
current controversies and issues 327
their attempted resolution that allows us to struggle somewhat successfully
as a democratic society. Some issues that highlight this struggle, which were
touched upon in previous chapters, follow.
For example, is it an American value or morally right both to perpetuate
corporate welfare and significantly limit welfare to the poor? Some claim that
each is an American value and morally right because it helps the poor get off
welfare and helps the economy and the effort to balance the budget. Others
claim that corporate welfare should be cut because it is too costly and helps
corporations and businesses rather than the individuals in need. Is it an American
value or morally right to maintain a minimum wage that does not provide
enough income to raise individuals and families above the poverty level?
Some still claim that to raise the minimum wage any higher will create inflation
and cause the loss of jobs; therefore, it is better not to increase it. Completing
the exercise "Ranking American Values" at the end of this chapter
might help clarify the many differences and issues regarding the use and frequent
overuse, most often by political candidates and their supporters, of the
concept of American values.
Aside from these being significant moral issues and sources of controversy
in our society, they are perfect examples of how social policies are influenced
through the interpretation of policies and laws (discussed in Chapter 7).
GOVERNMENT: HOW MUCH SUPPORT
FOR THE NEEDY?
In recent years, the annual struggle over the federal budget has highlighted a
major controversy affecting human services workers and programs. The Reagan
and Bush administrations and Congress have significantly reduced funding
for some programs that provide a safety net to help the truly needy. Even
in the 1960s, at the height of President Johnson's Great Society when the Democrats
were in the majority in both houses, there was tremendous pressure to
reduce domestic spending (Califano, 1994). The pressure was focused primarily
on programs serving those in need. According to many liberals, there seems
to be a pattern of primarily reducing domestic spending for the needy over
defense or other needs whenever there is pressure to reduce spending. One
needs only to look at the proposed and actual cuts in budgets over the years
to see how direct support and indirect support for those most in need are targeted
for reduced aid.
The proposed cuts and reduced rate in spending for social programs starting
in 1995 in an effort to achieve a balanced budget in 2002 were successful.
That there will be reductions in the rate of domestic spending is a certainty;
however, what specifically will be cut and by how much are examples of a
clash of values between conservatives and liberals. The question raised in the
title of this section (that is, how much support for the needy?) provokes further
discord regarding values and morality. One might say that there is never
328 chapter nine
enough support as long as over 39 million people live in poverty, over 40 million
have no health insurance, and so on. Other conservatives and liberals
point out that we cannot afford to help everyone. Although there is agreement
in this regard, there is little agreement on how much we can afford, who
should be helped, and by what means. We do know, however, that too many
need health care, jobs, nutrition, shelter, vaccines, treatment for mental illness,
and welfare, among many other necessities.
The changes in the budgets of social programs raise key questions regarding
the role of government in providing services. Who has the major and/or
ultimate responsibility for the welfare of those in need? Is it the local, state, or
federal government? Does government have responsibility for the welfare of
only those who are poor? These and other questions will always be raised as
long as there are people in need, funds are limited, and those in power make
decisions that reflect their values and philosophies. A look at some of those
who seek support and the issues they face will help identify the problems one
must deal with as a human services worker.
TARGET POPULATIONS: THE STRUGGLE
The struggle for support takes place on two major fronts. One is the struggle
to gain the moral support of the public, the media, and professionals.
That generally involves convincing others that your goals are just and good.
The second front, closely related to the first, is the struggle to gain financial
Throughout the late 1990s, three populations have frequently made the
headlines: welfare recipients, AIDS patients, and the homeless. The reason
they are so often in the news is that we as a society are desperately trying to
provide additional and more effective programs to help and to cope with these
people. One major problem in trying to develop more successful programs for
these groups is how they are perceived by others. Much of the public, much of
the media, and many politicians, legislators, officials, and, yes, human services
workers have a negative attitude toward these people (Dye, 1987; Marin,
1987). Richardson (1998) reports that frustration and fear of AIDS have given
rise to the passage of a series of laws intended to protect the public from people
infected with HIV. For the homeless and welfare recipients, the myths
about these populations contribute to the public's negative attitudes. These
issues will be discussed further later in the chapter.
Although many others have very positive attitudes and do whatever they
can to help these groups, effective programs are difficult to develop without
significant public, media, and professional support. A second major problem
that makes the development of more successful programs very difficult is the
diversity of values and points of view regarding the most effective ways of
dealing with these groups. These two factors lead to the third problem, namely
current controversies and issues 329
that of funding programs for these and other needy populations. The variety
of possible solutions given by the professionals involved with developing programs,
as well as those offered by the public and the media, reflects the different
and often conflicting philosophies and values that create problems in
shaping effective policies and programs. The first group to be considered here
will be people with AIDS.
The AIDS Epidemic
The question of priorities in the funding of treatment and research programs
of various social and medical problems has become quite controversial.
Because a limited amount of funds is provided for these programs, if funds are
increased for one program, must they be reduced in another program? Such a
conflict over delegation of funds has now become quite heated in the fight
against AIDS. The powerful AIDS lobby has been fighting for and demanding
significant increases in funding for treatment and research for their constituents.
However, significant controversy persists about the level of funding
that should be supplied for various diseases. According to Califano (1994), the
federal government reported that under 800,000 deaths were due to heart
disease and over 500,000 were due to cancer in 1993, but 25,000 people died
Over the years, funding of approximately $1-1.5 billion or more was provided
for the fight against each of these diseases. In spite of the difference in
the number of fatalities, which has been fairly consistent in recent years,
Edmondson (1990) urges that the fight against AIDS should be funded at a
much higher level than before for two reasons. First, two-thirds of those who
die of cancer are over 65 years of age, and over half of those who die of heart
disease are over 75 years of age. By comparison, most people who die of AIDS
are under 40 years old. Therefore, the lives of AIDS patients were cut short
often before their real contributions to society could be made. Those who died
at later ages had made their contribution and had lived fuller lives. The second
reason given by Edmondson for increased funding for the fight against AIDS
was that AIDS is infectious. What would you decide if it were in your power
and you had to make such a decision?
There are two additional controversial practices regarding the AIDS issue,
both aimed at reducing the spread of the virus: (a) exchanging dirty needles for
clean ones for drug users and (b) distributing condoms to high school students.
There was no guarantee, according to the critics, that the exchanged needles
would not be shared among users. The feeling was that such a program also
encouraged drug use. Meanwhile, the New Haven program of exchange,
authorized by the Connecticut state legislature, provided evidence that such
programs could be successful.
The distribution of condoms in high schools under specific conditions has
been approved in Philadelphia, San Francisco, Los Angeles, and New York
City, among other jurisdictions. The approval in each case was not attained
330 chapter nine
without controversy and struggle. In New York City, for example, it was
approved only after a long-and still continuing-struggle against the program
by many parents, religious organizations, and others. Opponents of the
program claim that none of the demonstration programs were actually proven
effective and there was no guarantee that the condoms provided would actually
be used. Such programs, it was felt, encouraged young people to engage
in sexual intercourse.
These issues regarding funding and how best to develop programs to prevent
the spread of AIDS have led to a great deal of frustration and struggle.
The attempt by some infected individuals to purposely infect others has created
additional fears. These problems have given rise to a series of laws to protect
the public. Some of them overrule previous privacy protection. Some
require notification of partners of an infected individual. Others demand testing
of segments of the population, and many states make it a crime to purposely
and knowingly infect someone (Richardson, 1998).
What else can one, should one, do to help prevent the spread of AIDS?
school or day care centers?
of needles and thus the spread of the virus?
form of prevention of the spread of AIDS?
When one looks at the problems of the homeless, one finds many different
attitudes and approaches to solving them. A conservative candidate in the
1992 presidential race recommended that the homeless be forcibly taken to
shelters or jailed if they resisted and tried to sleep on the streets. Other candidates
did not appear to feel that homelessness was an election-year issue,
even though the problem seemed to be increasing. Advocates for the homeless,
however, strongly urge an increase in low-income subsidized housing.
Others believe that deinstitutionalization is a major cause of homelessness
and that mental patients make up the majority of the homeless. Mental illness,
however, is not a major cause of homelessness. According to the
National Law Center on Homelessness and Poverty, about 25% of the homeless
are mentally ill. Truly major causes of homelessness are unemployment,
underemployment and the lack of affordable rental housing. A survey by the
U.S. Conference of Mayors, 1998, found that about 27% of the homeless
population work and are still without a home. Nevertheless, in some jurisdictions
the mentally ill become a political football. If, for example, most of
current controversies and issues 331
the homeless are considered mentally ill, they become a state problem; if they
are not, they are a local problem. Kozol (1988) and Johnson (1990) both
make the point that poverty, not mental illness, is the major cause of homelessness,
even though some homeless people do need psychological treatment.
Income and subsidized housing, they believe, would resolve the issue.
For the homeless, should we and can we:
The third group, welfare recipients, is also of major concern to society. Many
taxpayers resent having to pay taxes to support welfare recipients who are
all too frequently stigmatized and stereotyped as being lazy, cheats, and
welfare-dependent. However, few of these very same taxpayers and others
realize how many people receive benefits from government in one way or
another (Abramovitz, 1983). For example, tobacco, sugar, and dairy farmers,
among others, are paid billions of tax dollars each year to limit production and
to maintain price levels that assure profits. Are they the truly needy? What
about all those who are able to take deductions on income taxes for health
costs, interest on mortgages, entertainment for business, and other items?
Although the government does not actually pay cash to these more affluent
people, it is, in effect, telling them that they can keep the money they would
have to pay were the deductions not allowed. These deductions total billions
each year. Actually, it turns out that the more money one makes, the more benefits
one may get through increased deductions (Abramovitz, 1991). What
about community and state college students who obtain federal and state aid?
Tax monies are supporting them in obtaining an education even if they are paying
the full tuition. Do they and all the others mentioned really see themselves
as "welfare recipients"? Clearly, we taxpayers have less problem with government
aid dispensed to "us" rather than to "them," especially when the "others"
are poor and in need of food, clothing, and shelter. The question really is,
why are these benefits acceptable and those for the truly needy less so?
For welfare recipients, is it moral to:
332 chapter nine
exchange for some of their benefits?
subsidized by state and local tax monies) pay the actual cost of their
The many questions raised with each group are controversial enough in
their own right. Additional questions arise that may be of particular concern
to human services workers. One question has to do with the problem of individual
rights versus rights of the public. Another question has to do with the
apparent effort to control these target populations in some fashion. Are we not
really attempting to devise behavioral and social controls for people who for
the most part are victims of situations beyond their control, and who for the
most part have not broken any laws? Other controversies in the human services
center around the effects of a conservative government and/or a recession
on social programs. The basic question is, whose benefits shall be cut?
Regardless of who has control of the purse strings, be they liberals or conservatives,
there will always be a limited amount of funds made available for
social programs. This is clearly a political decision. The general trend has been
that in times of prosperity and/or when liberals are in power, social programs
are funded more generously. When conservatives are in power, support for
social programs is usually significantly reduced. The major questions then
become: Which programs shall be reduced or eliminated? Shall it be programs
serving the elderly, or school lunch programs, or programs for people with disabilities?
What about programs for the homeless, the mentally ill and retarded,
or the poor? Who shall make the decisions? What criteria would you use in
making these choices? These kinds of questions and their answers create all
kinds of tensions in the human services field. Peirce (1982) perhaps answered
some of these questions when discussing budget cuts made by the local, state,
and federal government. He points out that "the stark fact is that the budget
cuts it makes are far deeper in subsidized housing, in job training, in welfare
and education programs of primary benefit to poor people than to programs
the middle class utilizes most-social security, Medicare, civil service, and military
pension levels" (p. 14).
Although it is generally acknowledged that all of the groups receiving support
have a legitimate claim to that support, it becomes clear that some programs
will lose funding. Several things happen in situations like this. First, the
agencies serving the different target populations, and the members of those
populations, start competing strenuously with one another for available funds.
The most articulate and organized of the various target populations, the ones
with the most political influence, generally are more successful in gaining support
and funds. As an example, the outcry some time ago by the recipients of
social security about the threat of reduced benefits tempered efforts in benefit
current controversies and issues 333
When funds are cut and staff reductions occur, caseloads tend to increase.
This then requires a screening process that assures that those in most need get
service, while others are turned away. The increased caseload puts additional
pressure on the workers, and services to the needy often suffer. Competition
and struggle for existence shift the focus, energies, and resources away from a
unified effort by target populations and the human services field to increase
overall funding for social programs. This kind of competition seems to
demand that the strong shall survive and the weak shall perish.
PROFESSIONALISM IN THE HUMAN SERVICES
Two major and muted struggles have developed among human services workers
in the last two decades. Both struggles involve money, status, and levels of
responsibility. One conflict occurs between generalist human services workers
and traditional professional human services workers. The other conflict occurs
among traditional professional human services workers. Fortunately, these
quarrels have not had significant ill effects on the direct services provided by
the human services workers themselves. It is nonetheless important to know
and understand the different points of view of the various contestants, as well
as to recognize that all is not sweetness and light in the helping professions. A
brief description of the issues follows.
Since the introduction of indigenous community leaders as paraprofessionals
in the War on Poverty of the 1960s, the number of workers in the
human services has grown steadily and rapidly. In addition, the responsibilities,
knowledge, training, and competence of generalist human services workers
have, from their point of view, increased to a level comparable to that of
traditional professional human services workers. Furthermore, large numbers
of generalist human services workers and some traditional professional human
services workers believe strongly that many generalists outperform traditional
professional workers. A trainer of generalist human services workers cited by
Sobey (1970) states that such workers are often superior to traditional professionals.
These convictions on the part of generalist human services workers are
the basis for strong feelings about the differences in pay, status, responsibilities,
and opportunities for advancement between generalists and traditional
professional human services workers.
Many educators believe that graduates of recognized undergraduate human
services programs should be considered professionals. Generalist human services
workers assert that, although they do not have graduate degrees, the combination
of their life experiences and limited formal education are "credentials"
equal to those obtained through advanced formal education.
Many human services educators are convinced that human services is a
profession (Clubok, 1984) and that graduates of recognized college human
services programs should be considered professionals. In addition, some feel
that human services is an evolving profession (Feringer & Jacobs, 1987).
334 chapter nine
These and other human services educators assert that most criteria needed for
the establishment of the traditional human services professions have been met
in regard to the human services. These criteria include, among others, a professional
membership organization, regional and nationwide annual professional
conferences, journals, standards for approval of college human services
curricula, and an organization to approve college programs (for example, the
Council for Standards in Human Services Education). Furthermore, according
to other human services workers and educators, the growth of graduate
degree programs in human services is further proof of professionalism in the
human services. On the other hand, human services workers with advanced
degrees feel that their advanced intensive training provides them with greater
knowledge and skill in providing specific services and enables them to function
at a significantly higher level than can generalist human services workers.
Professionalism, they assert, is based on the attainment of a specific body
of knowledge unique to that field and gained only through traditional professional
schools. Much of the knowledge and skill referred to by traditional
professionals deals with clinical functions in addition to supervisory and educational
responsibilities directly related to their specific profession. These
professions might include psychology, occupational therapy, social work, and
others described in Chapter 6.
In addition, these professionals feel strongly that until college human services
programs are accredited by an organization sanctioned by the Council on
Post Secondary Accreditation the human services is not yet a profession. The
council is the only organization sanctioned by the U.S. Department of Education
to allow specific groups to provide recognized accreditation. These people
also believe that until human services is recognized and incorporated into
the Civil Service Systems as a profession, it is not to be considered a profession.
The struggle goes on, and you will be faced with this issue in one way or
another, to one degree or another, as a human services worker.
Generalist human services workers' efforts to gain recognition and parity
with traditional professionals are duplicated among the traditional professionals
themselves. The issue centers around which traditional professionals
shall be eligible for third-party payment without the need of being supervised
by those with higher standing or credentials. Third-party payment is payment
to the traditional professional by an insurance company, such as Blue Cross or
Medicare, for services provided to the client. Third-party payment permits
many more individuals to obtain help that they otherwise could not afford.
Third-party payment also significantly increases the amount of income for
agencies and traditional professionals who provide services to the needy.
Who, then, among the traditional professionals is eligible to receive these
third-party payments? Most traditional human services professionals, particularly
those in private practice, are eager to be included in these programs.
Medical doctors and psychiatrists are included in all such programs. In some
jurisdictions psychologists are included, and in others they are not. Social
workers and other traditional human services professionals are also not
current controversies and issues 335
included everywhere. In certain situations, some traditional professionals are
included in these programs only if they are supervised by a traditional professional
of another discipline. For example, a psychiatrist might supervise a psychologist
or social worker. It goes without saying that professionals in one
discipline object strenuously to being supervised by those in other disciplines.
A more recent issue centers on the armed forces' permitting psychologists to
prescribe psychotropic medication. Should this practice be permitted for all
trained psychologists? Will other professions seek the same or other privileges?
Is the practice helpful to clients? These and other questions arise as competition
between and among human services workers exists.
Competition for jobs has increased in recent years as a result of the growing
number of professionals and cuts in programs and services. Unfortunately,
little if any positive changes have occurred regarding these professional issues
Acceptance into these insurance programs is achieved for the most part
through legislative action at local, state, or national levels. Therefore, the professional
organizations representing the different disciplines lobby to have their
members included in these programs. Professional groups already included in
the plans often oppose the inclusion of new groups, claiming that they are only
trying to protect the public. Some think that there is enough to go around for
everyone and that the constant competition for high status, recognition, and
control does little for the image and dignity of human services workers.
Another professional issue that is being raised among many social workers
involves whom social workers serve. Specht and Courtney (1994) state the
issue clearly: Today, a significant proportion of social workers are practicing
psychotherapy, and doing so privately, with a primarily middle-class, professional,
Caucasian clientele in the 20- to 40-year age group. The poor have not
gone away; there are more of them now than at any time in recent memory.
Certainly many professional social workers are still committed to the public
social services, to helping poor people and dealing with social problems, but a
large part of the profession is "adrift in the psychiatric seas" (p. x). They further
claim that it is the former kinds of students and practitioners "that the
profession needs if it is to realize its original mission" (p. x). Jacobson (2001)
supports this view asserting that what has been destructive to this mission
". . . has been the encroachment of therapuetic practice on the field as a
whole" pp. 51-61. There is little doubt from our point of view that we are in
desperate need of such human services workers. Huff and Johnson (1993) recognized
this issue when they wrote:
Since its birth, social work has been in the vanguard of many national reforms,
often speaking on behalf of populations who are too beleaguered to forcefully represent
themselves. Of late, too many social workers have abandoned the traditional
mission as advocates for social justice. Social workers must rededicate
themselves to leading a new reform movement dedicated to a more equitable redistribution
of America's wealth. (p. 315)
We feel the same might be said regarding many other human services workers.
336 chapter nine
THE ROLE OF HUMAN SERVICES WORKERS
Is the role of the human services worker to help individuals solve their interpersonal
problems? Is it to help them cope with the stress brought on by financial
difficulties, physical disabilities, or other outside pressures? Or is it to try
to help change those conditions that create the problems in the first place?
During the War on Poverty in the latter part of the 1960s, agencies were
formed to fight poverty, racism, and crime, among other problems. Federal, state,
and local governments, as well as some private foundations, funded these agencies.
The workers in an agency located in a high poverty and crime area helped
local residents learn their rights in the courts. The workers went to court with
their clients to protest against police brutality when it occurred. They taught
them how to organize and conduct rent strikes when the tenants were not getting
service. They also defended people who were on welfare whenever they needed
help (Krozney, 1966). The focus of human services workers during those years
was mainly on helping people cope with injustice (Morales & Sheafor, 1980).
The main concept was gaining and using power, and people did protest and fight
against injustice. However, in one case, the protests and struggles aroused those
who were threatened by these actions and who in turn brought pressure on those
in power to curtail the funding for such projects. This, in effect, changed the
nature of the role of the workers. No longer able to use government funds to fight
"the Establishment"-government agencies and supporters-human services
workers shifted their focus to helping clients adjust to their situation.
There are still many human services workers who feel that helping people
adjust to their problems is not a very useful activity. To adjust to poverty,
racism, crime, mental illness, and similar problems rather than to make every
effort to combat or prevent these problems is seen by many as a losing battle.
Poverty still exists, and the gap between the wealthy and the poor continues
to grow. The number of people in need of mental health services has increased,
even though mental hospitals have released large numbers of patients. Child
abuse and wife abuse have increased. Treatment and living conditions of the
elderly leave much to be desired. All this has occurred in spite of the efforts of
human services programs to date.
What else, then, can a human services worker do? "Become more of an
activist," urge the activists. "But activists are seen as radicals by the public,
government officials, and other human services workers" is often the reply. It
is true that activists in the human services do not often win a lot of friends.
The activist role usually stirs controversy and involves some risk. A worker
some years ago prevented clients from entering an unlicensed nursing home
and was reprimanded by his agency. The worker, with the help of his union,
not only had the reprimand withdrawn but initiated action on a state level to
change the rules regarding placing people in unlicensed nursing homes. The
worker was successful in that instance. Activists, unfortunately, are not always
successful; but if there is to be any chance for success in eliminating injustice,
there must be activists. Today, however, the practice of advocacy is growing
and accepted in the human services professions. (See Chapter 6 for details.)
current controversies and issues 337
WHOM DO HUMAN SERVICES WORKERS SERVE?
The answer to this question seems obvious and simple. In theory, it might be.
However, in practice, significant issues arise. For example, suppose you are a
human services worker in a mental hospital. The policy is to discharge patients
as quickly as possible. One of your patients has been selected for discharge and
you are asked to follow through, but you are convinced that the patient is not
able to function outside the institution. He is generally stabilized in the institution,
however, and has been there for over 6 months without creating trouble,
so "get him out" is the word. What do you do? You are working for the
hospital, and it is under pressure to discharge as many patients as possible in
the shortest time possible. You are also responsible for the patient's well-being.
What happens if you do not discharge the patient? What happens if you do
discharge the patient? This situation has actually occurred, not once but many
times, in state institutions.
There are several possible answers to the question, "Whom do human services
workers serve?" They include the client, the agency for which one works,
the government, society in general, and themselves. Some workers would
claim that it is possible to serve all of these but not at the same time or to the
same degree. In any case, human services workers might soon be required to
make difficult choices regarding whom they serve.
An even more complicated situation arises if and when workers who are
paid by third parties such as insurance companies or Medicare must give
detailed reports of service to the companies. These reports identify not only
the individuals but also the nature of the problem and the course of treatment.
In effect, this is a break of confidentiality and a way of influencing the treatment
provided. The insurance companies and managed care organizations
often may attempt to limit or control the course of treatment. Do you as a
human services worker go along with this kind of program, thus serving yourself
with regard to payment and future patients? Do you refuse such a program
and patients enrolled in those programs? Do you work with the patient anyway,
even though payment might be reduced? Whom do you really serve-
yourself, the insurance company, the client, or all three?
What about the situation in which you might be serving the taxpayer?
Such a situation came up when eligibility criteria for disability payments were
revised and thousands of disabled persons were denied payments. The object
here was to save the taxpayers money and to cut costs to help reduce the federal
deficit. What do you do when asked to administer such a program? Where
do your human services responsibilities lie? Do they override your fiscal or
The last example involves a much broader issue. It raises the question of
not only whom do we serve, but when do we serve them and at what cost. As
stated previously, all the present efforts of human services have not been able
to provide services for all those in need. Choices must be made. How do you,
the human services worker, make them? Furthermore, if one chooses to become
an activist or to work in prevention programs, those in need of specific help
are denied your services. These kinds of choices affect those in need, other
human services workers, professional organizations, legislators, and the public
Without further description or comment, many other controversial issues
in the following list and those already described should provide you with more
than enough material to ponder at this point.
All this may be confusing, but it can also be stimulating and exciting to struggle
with these issues and discover your own way as a competent human services
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