a working system for social service delivery

PROCEEDINGS OF THE IEEE, VOL. 63, NO. 3, MARCH 1975

Let us rank the most practical solutions on four different criteria. To minimize risk, it would appear the ranking should be as follows:

1) microrevitalization; 2) parasite town; 3) NTIT; 4) FSNC.

To optimize return to the entrepreneurial developer, the ranking is as follows:

1) parasite town; 2) NTIT; 3) FSNC; 4) microrevitalization.

To maximize immediate positive impact on existing cities, the ranking is as follows:

1) NTIT; 2) microrevitalization.

To maximize long-run positive impact on nation, the ranking is as follows:

1) FSNC; 2) NTIT.

451

A system analysis concept developed by NASA to help it decide among the myriad of possible follow-ons to the Apollo Project is the idea of the “pacing mission.” The pacing mission is defined as that mission which is barely within existing capacity and which will return the maximum of benefits. The pacing mission by definition will result in the development of pacing methodology, that is, technology with which to solve lessdemanding and rewarding problems. In exactly this sense,

free-standing new city appears to be the pacing mission for urban revitalization of the nation.

REFERENCES

The Douglas Commission Report, Building rhe American City (Rep. Nat. Comm. Urban Probl., House Doc. 91-34). Washington, D.C.: U. S. Gov. Printing Office, 1968. J . V. Lindsay, The City. New York: Morton, 1968. D. P. Movnihan. “The schism in black America.” Public Interest. ~ ~ ~~~ - ~~

no. 27, pp. 3-24; Spring 1972. D. Nelkin, The Politics of Housing Innovation. Ithaca, N.Y.: Cornell Univ. Press, 1971. D. Canty, Ed., The New City, Report of rhe National Commitfee on Urban Growrh Policy (A. Rains, Chr.). New York: Praeger, 1969. G. Breckenfeld, Columbia and rhe New Cities. New York: Ives Washburn, Inc., 1971, p. 187. J . E. Gibson, “Why design a new city?” IEEE Trans Sysr., Man, Cybern., vol. SMC-3, Jan. 1973.

A Working System for Social Service Delivery

JAMES D. PALMER,sENIoR MEMBER, IEEE

Absrmcr-The design of a systen to provide for delivery of social senices to clients and accountability to the state is presented. An inlmduction to actual s y s t e n s problems in sod services deli- is provided together with the human interrction 7 ne- to bring successfully the systems approach to social semce delnery. An analysis of case histories has been accomplished to detamine common characteristics among actual cases which leads to a dassifhtion system for multiproblem familiar relative to family functioning. A detailed description of the system and the flow diagmms of infomation, decision, and activity (IDA) points is given. m e system is m and working in Lynchburg, Va. and is to be installed and completed in Chesapeake, Va., by the end of 1974. Typical displays of the information system outputs as provided to ase workas and supmitors 1 ~ e shown.

Manuscript received March 2, 1974; revised October 2, 1974. The author is with the Metropolitan State College, Denver, Colo.

80204.

INTRODUCTION OCIAL SERVICES comprise a major portion of the total welfare program of this country amounting to more than $11 billion annually and growing at a rate equal to ap-

propriations growth with no limit in sight except as individual states and localities establish arbitrary limits to spending. The delivery of social services; e.g., housing, prenatal care, job training, medica$ services, counseling, etc., is generally frag- mented at the agency level and throughout state government. It is not unusual to find several state-wide agencies providing the same or similar services or for local agencies to be in com- petition with other local agencies or be unaware of private agencies providing the same services to the same clients. An examination of this complex situation from the systems point of view using the terminal objective of delivering a needed

452 PROCEEDINGS OF THE IEEE, MARCH 1975

service to a client has resulted in a generic system for social service delivery which has been implemented in two agencies. The features of the generic system include immediate emergency service, community and state resource appraisal and evaluation, assessment of client needs. and evaluation of the outcomes in behavioral terms. This system is unique in that it retains the human interaction between caseworker and client, while holding up for accountability the use of resources.

The systems approach taken is supported by a management information system which provides complete data on any of the system components to the agency supervisors and directors. Through case-load assignments and queing all clients are assigned to a case worker or are reviewed periodically. This process eliminates case carrying and assures an equitable load distribution for all case workers and most importantly assures each client of service on a regular or periodic basis. Through the assessment of client situation, goals are established for services. Following the development of a service plan prepared by the case worker in consultation with the client, a service delivery package is determined and services made available to the client as appropriate. Evaluation of the effectiveness of the service plan and the services provided is performed at agreed to dates following the service delivery. Actual time may range from a few days for housing, to several months for counseling. The evaluation, as the assessment, provides for establishing client progress or need in behavioral terms so that changes may be determined.

Information concerning existing needs are readily available and a measure of change in clients attributable to the delivery of services becomes a reality. For both state and federal government the ability to assess the efficacy of social services is possible for the first time. The capability to plan for and allocate resources to an agency and measure the outcomes in client movement as well as determine cost is now possible. The prime benefactors are the clients to be served through a planned set of services and the taxpayer who for the first time will have the ability to hold the social service delivery system accountable.

The discussion which follows covers the necessary process aspects of developing a social service delivery system, the development of the generic model of the clientlcase worker interface activity and the resulting system including samples of the input to and output from the management information system. The system is in full operation in the Lynchburg, Va., and by December 1974 in the Chesapeake, Va., welfare agencies and covers approximately 500 and 7500 welfare cases, respectively.

SOCIAL SERVICE BACKGROUND Social services, as used in this paper, refers to any service

provided to a client of a local social service (or welfare) department, where the services are partially or wholly paid for by federal funds channeled through the Division of General Welfare of Virginia’s Department of Welfare and Institutions. Social services range from so-called “hard” services such as the provision of assistance in finding adequate housing to “soft” services such as counseling of clients to assist them in achieving greater self-sufficiency in managing their own lives.

The federal enabling legislation, the Social Security Act of 1933, did not explicitly allow for the provision of social services. It provided funds for financial assistance payments only. However, in addition to their primary task of determining eligibility for assistance payments, in a series of gradual steps

over the years social workers began providing a wide variety of social services.

The assumption and/or assertion of the professionals in the field was that social services were a necessary adjunct to money payments in order to move clients to a greater degree of self- sufficiency and, on the average, to reduce their dependency on monetary assistance. But, throughout the life of the program, there has been little clear-cut evidence that these claims have validity. There has not even been consensus among profes- sional social workers as to the criteria by which “self- sufficiency” should be measured. In the face of what seems to be overwhelming negative evidence (i.e., the more money spent on social services, the greater the claims for monetary assistance), there has been a growing clamor for the elimination or at least severe reduction in social services offered. Public officials, strongly affected by growing public clamor, have raised serious questions about the value of social services. Also, client groups, viewing some types of social services as attempts to maintain the welfare recipient in a dependent and subservient role, have demanded the elimination of all social services except those defined as “hard” (where “hard” means a service which could be purchased by the client if only he had enough money).

Social Services Delivery Objectives The original objective in this project was to develop a set of

criteriu for evaluating the effectiveness of social services in moving the client to a greater degree of self-sufficiency. This was expanded to include the development of a methodology for evaluating all social services. This latter required the entire system of delivering and of managing the delivery of social services to be reoriented, reorganized, and redesigned which would result in improved efficiency and effectiveness in meeting the goal of the Department. For purposes of conceptual- ization and management, the Social Services System is addressed as three subsystems.

Management subsystem. Information subsystem. Delivery subsystem.

The delivery subsystem covers all activities of the service worker as he/she is directly or indirectly engaged in interaction with the client. The delivery subsystem includes the capture of all raw data needed for case management, program management, and “agency” management (at local, state, and federal levels). %

The information subsystem processes the raw data captured in the delivery subsystem and stores it for use as management needs for information are established.

The management subsystem has to do with all aspects of local, regional, and statewide managerial and executive functions associated with the delivery of services and general welfare.

A management study of all major divisions of state government conducted in 1969 clearly showed the need for accountability in all areas of general welfare, particularly in the programs of categorical aid and payments. The study also identified one specific area in which no control, evaluation or accountability was to be found-this area was social services. The response by the Department of Welfare was to develop Virginia uniform welfare reporting system (VUWRS) which was to provide all systems necessary for management and accountability of the welfare programs. VUWRS worked

PALMER: SOCIAL SERVICE DELIVERY 453

reasonably well in the areas of payments and categorical aid, but did not function in the area of social services and did not recognize that this was a total systems problem.

PROBLEM STATEMENT In the words of Russell Ackoff the delivery of social services

viewed as a system was in fact a MESS. There was no way to approach the situation from the traditional point of view and reduce it to a series of manageable parts. At the outset it was clear that to develop a system it would be necessary to make explicit the process involved, the problems and the goals. The major problem lies in the delivery of needed social services, as available, to clients in the best possible manner leading the client toward “self-sufficiency.” Complicating this was the need for complete human interaction between client and case worker. The major problems were defined as follows.

1) The process of delivery of social services was not functioning in a deliberate controlled manner.

2) The welfare client was not well served by the delivery of social services.

3) Accountability was completely missing, due in part to a confusion of funding sources and in part as to what constituted a completed service.

4) Evaluation was not being done. 5) Any system developed to achieve accountability and

evaluation must have the support of the clients and case workers as well as management at all levels.

6 ) Costs associated with social services were accelerating at a rate which would consume the entire annual tax base of the Commonwealth of Virginia within ten years. 7) There existed no “case analysis” information from which

to judge whether the services provided assisted the client toward self-sufficiency.

8) No resource appraisal or accessibility was available to workers and most resources were not known to clients.

9) Management functigns were not being performed.

Systems Approach From the outset, the needs were recognized for a fast access

data base/management information system to support the delivery of social services. In addition, it was necessary to provide for the management of resources and to respond to questions from all levels of management including the governor and legislature.

In practice the concept of service delivery was individualized to the extreme. As a consequence, management was in essence coping with the day-today case worker/client problems and control was largely achieved through maintenance of a “full” schedule of clients otherwise termed “case carrying.”

In order to bring about changes in the delivery of social services there existed a need for all involved to participate in the development of any such system or social service delivery program. An additional complication that had considerable force influencing case workers was the necessity to continue to serve existing case loads and to meet existing reporting requirements both at state and federal levels.

The approach taken was one of total involvement in an open environment leading to the “bottoms-up”. or worker/client action interface concept. The “opening” of the Agency caused a great many internal questions, challenges and trauma that moved to the very essence of the social service delivery program, i.e., why are social services to be provided. Once it became possible to discuss service delivery and management style,

it became possible to make explicit the goals for service delivery. What evolved was the development of a dynamic adaptive system for service delivery and the explicit statement of short and long term client goals.

In formation-Decision-Activity Analysis The systems analysis was initiated in the Lynchburg Agency

with the on-site development of an informationdecision- activity (IDA) analysis of all worker/client action interface functions. The process was one of making explicit each function, each point where a decision must be made, each time a resource was called for and each place where information was either generated or required. From this, it became apparent that the workers employed a sophisticated pattern recognit!on function in establishing service plans for the client.

Pattern recognition was assumed to be a basic underlying principal which, if made explicit, would lead to the fuller definition and understanding of service delivery.

The basic vehicle of involvement, pattern recognition, adaptivelresponsive design and bottoms-up approach was the IDA analysis work over time. The initial outcomes of the IDA analysis resulted in the clear understanding of the manner in which the Lynchburg Agency provided social services. The IDA maps provided three basic components:

1) the decisions made by the various staff within a particular

2) the information used or needed to make a particular

3) the activity caused by the decision made.

service sequence;

decision;

The service sequences examined for the IDA maps were as follows.

1) Child welfare services to unwed mothers. 2) A.D.C. services-medicaid services. 3) Adult services. 4) Adoptions (parent approval process). 5) Adoptions (child selection process and placement). 6 ) Foster care. 7) Service only. 8) Infant and older child adoptions.

Following this initial identification of the service sequence IDA’S, the next step was to assemble these functions into service delivery modules which would identify and separate generic functions from agency style. It is important to note that the entire process was undertaken through involvement of the case workers. This has been done in a manner which in- sures the continuing participation of the case worker in a system of his/her design which in turn has insured the emergency of a design that is implementable at the case worker/client action interface.

Simultaneously with the IDA process, a full inventory of the community resources was established to satisfy the need of the case worker for this information and to outline agency, region and state information requirements in this area.

An example of the outcomes of the IDA process in the area of adult services is shown in Fig. 1.

CASE ANALYSIS

The 1963 Federal Guidelines for evaluation and assessment of the effectiveness of the delivery of social services had as a basic requirement, the development of base-line information. The underlying assumption stated succinctly was that unless a


Supv. Review

Assign

Intake Supervisor

- Screening - Detern ine appropr ia te - Reviw and a s s i g n a l l new

ca tegor i ca l program o r cases .

s e rv i ce on ly Way be m i t t e d on d i r e c t

worker. See 1-B.) s e r v i c e c o n t r a c t t o

I Refe r ra l Sheet

C l i e n t may request s p e c i f i c s e r v i c e s . Hay f lag case shoving a s e rv i ce need based on supervisor review.

A l l a d u l t c a s e s r e q u i r e home v i s i t s . 0' ec i s ion

from Phon

- C Y judgment based on c l i e n t

- OAA, APTD, AB e l i g i b i l i t y i n f o r r a t i o n

r e q u i r m e n t s . Manual o f p o l i c i e s and procedures. - May involve supv. input vhen CY f e e l s i t is

- G a t h e r e l i g i b i l i t y i n f o r - necessary.

mation and send on to In take Superv isor for dec i s ion .

0 Assessment

M u l t Case Worker

- Detern ine p roblca . Serv ice fo lde r . Refe r ra l shee t . Home v i s i t s ' C O M U l U l t i O M v i t h

f r i e n d s , e t c . - Determine service and method

' C l i e n t c m p e t a n c e * Resources '

P r o t e c t i v e s e r v i c e s required - consul t u i th supe rv i so r - Personal judgment of

- See ADC s t e p 4 worker

@$ g ecoed

Requirement

- Provis ion of adu l t p r o t e c t i v e s e r v i c e s Bu l l e t in t 5 2 0

-4-

- Serv ice co r rec t - Cooperation - P r i e c d s , r e l a t i v e s a v a i l a b l e - See AM: s e r v i c e s t e p 4

Service

- C e r t i f i c a t e o f p a t i e n t

W-121-6/69 s ta tus (p lacement )

c l e r i c a l c o n t r o l work - I n t e r m e d i a t e c a r e f a c i l i t y

- See ADC s t e p 4 - Need corn . resource da ta . Ex. r e l a t i v e s , n u r s i n g homes, homes for aged, h e a l t h c l i n i c , s e n i o r c i t i z e n homes

Fig. 1. Adult services-information decision activity.

determination of some index of family functioning was available there would be no ability to measure change as a consequence of receipt of services.

To meet this need and fulfii the basic requirements for evaluation and assessment of the delivery of social services a major effort was undertaken simultaneously with the systems design to develop a set of criteria through which case classification could be established. The program was initiated by requesting of each case worker the analysis of four cases in response to a common questionnaire. Some 3200 cases were analyzed on the basis of the questionnaire.

The major goal of the case analysis project was to isolate and describe discrete characteristics of family functioning from among families receiving social services. A statistical typology of social service recipient families was derived with 16 major groupings identified and characterized by a profile of family functioning difficulties ranging from adult behavior problems to unmet housing needs. The group profiles thus derived provide a statistical mapping of the social service caseload. In order to be useful and used, the typology was reduced to a size and complexity manageable by the case workers on a day- today basis. This analysis of family typology showed that nearly all the important problem combinations could be re- lated one to the other in a way which enabled classification of families with virtually no overlap. From this study, four summary measures of family functioning emerged: 1) adult behavior; 2) child behavior; 3 ) health; and 4) unemployment due to lack of skills. These are the key to the classification scheme of recipient families. The process involves only nine categories and requires no complicated statistical calculation from the social worker, rather only the presenceor absence of a particular problem in each area. Table I shows the summary of the major variable combinations and Table I1 shows the frequency

TABLE I

-5-

Continue

- Service complete . Kore problems . Addit ional requests . Current problem s t i l l e x i s t s

- Judgment of CW

Terminate

- Clien t reques t - No more need - Cl ien t exp i r e s - &fore c los ing ,

supv. is consul ted

Requirement

Adul t p ro tec t ive se rv ices , Bu l l e t in 1520

MAJOR SUMMARY VARIABLE COMBINATIONS Met Behavior B u l t l Onufplqm+nt Dne ChLlC Behavior

R'obler Pmbh h Lack o f Skills P r o b l u

L

4.5 ¶

X 10.6 8

x X 12.9 7

x X x 4.0 6

x X 4.6 5

x x X 4.0 b

x x 6.6 J

x X X B . 8 2

x x x x 20.2%

TABLE Il FREQUENCY OF OCCURRENCE OF SUMMARY VARIABLE' COMBINATIONS

IN EACH MAJOR GROUPING o? OccmUeLlce In -

a-TIoY A B C mXIrnT GRXR) t b S P r GRXR) ( ~ S I W X T

1

2 - - 27.5

3 7.5 - 1.3 - 7.5

4 1.6 10.0 7.5

I 3.4 6.7 1.5

6 s.1 - - - 6.7

7 21 .a - 1.7

8 17.1 - 1.7 9 6.7 - -

- 7.3% - 40.2% - 35.8%

- 10.9 40.2

- - -

-

PALMER: SOCIAL SERVICE DELIVERY

I I 1

TABLE IV PROFILES OF FAMILY FUNCTIONING AMONG CROUPS B4 AND c4

I t

I

808

93

898

yo m

44 53

33

m

56 93

Ilf

7

U 40

s6 67

22

m YLJ

44 53

"lu TABLE V

CLASSIFICATION OF CROUPS B4 AND c 4

c4 1 of occurrence as determined from the analysis of 3200 cases. From Table I1 it can be seen that variable combinations 7, 8, and 9 allows the classification of three subgroups and will account for nearly onequarter of all families with children.

What remains are the combinations 1-6. As an example to understand the process, consider two subgroups (B4 and C4) which have the same variable combination. Each of these exhibit problems in the area of adult behavior and health. They both &=family members unemployed due to lack of skills, but neither have child behavior problems.

While the two subgroups have the same summary values, it can be shown that there are important individual differences. For example, while almost all the families in B4 have money management problems, only one third of the families in C4 do.

455

Similarly, a family in B4 is almost twice as likely to have an adult with a functional health problem. The question for the case worker is not a proportional value, but the presence or absence of a problem. Certain combinations are much more likely to occur in B4 families than in C4 families. Thus a family with a serious money management difficulties and an adult with a functional health problem has a very good chance of being classified as a member of group B4. One way to esti- mate these chances might be as follows.

If we assume the presence of money management problems and adults with health problems to be statistically independent, the proportion of B4 families with both will be 87 percent (0.93 X 0.93). Similarly, C4 families will have this combination only 19 percent (0.33 X 0.56) of the time. In other words B4 families will be over 4 times as likely to have both problems.

This process has been applied to each of the various combinations. A partial summary of the results is shown in Tables 111-V to give an indication of the power of this methodology in establishing base-he information on family functioning from which to base a measure of change as a consequence of receipt of social service.

SOCIAL SERVICE DELIVERY SYSTEM GENERIC DESIGN CUSTOMIZED STYLE

The design is based upon generic functions common to all service industries and is structured according to the general information, decision, and activities inherent in any service delivery program. It is elastic in scope and flexible in focus and is adaptable to the characteristic style of any human resources project.

OPERATIONAL VISIBILITY-BUDGET ACCOUNTABILITY The people who work to delivery social services want their

working activity to be seen. They want to display what they are doing, what they accomplish, and the resources they have to use. Those who pay for the delivery of social services want to know how the funds they allocate are used and what results are obtained and they want to be able to decide if the results are worth the cost. The system design satisfies both sets of requirements. It takes advantage of the desire for operational visibility and provides a basis for budget accountability. The focus on the need for information of the persons working to deliver services provides evaluative and p-g information generated as a byproduct which satisfied the requirements of the management functions which support the delivery process.

STANDARD DATA DESCRIPTION: CLIENT, OPERATIONS, AND RESOURCES

The system design provides for the systematic collection of standard data to describe the characteristics of the clients using the system, the operations performed to deliver services to these clients, and the resources required and used for delivery. This data is processed as needed to gain information to make decisions for the control and support of service delivery activities.

MODULAR DESIGN: EIGHT BMIC SYSTEM FUNCTION (EIGHT DESIGN MODULES)

The design is conceptually organized into eight modules which represent major functions of the service delivery process. Each acts as a convenient focus for organizing the clusters of decisions and activities needed to meet specific intermediate


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Interview

Assignmt

I (IIP1) Intake Infomatian Packet 1

A s s e s s m t

(ESIP) h r g e n c y Services

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Select Case for

Assignment

(Una) Uorker Ca6eload Report

Priority & N - O Experience N d 0 Training

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i

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system objectives. The eight modules are as follows. 1) Intake. 2) Case assignment. 3) Assessment. 4) Service selection. 5) Resource appraisal. 6) Service delivery. 7) Service impact evaluation. 8) Case disposition. The name of each module is intended as a brief description

of the major function performed in its operation. No hard and fast sequence of operation is implied other than what is obvi- ous to common sense. Various mixes of function can occur and concurrent operation is natural to several of the modules. For example, assessment might continue during service delivery, etc. The system is “soft shouldered,” in that it is designed to adapt to the requirements of individual service delivery situations.

INTAKE The purpose of the intake module (Fig. 2) is to facilitate the

client’s initial use of the service delivery system and establish a priority for that use. One of the unique characteristics of the system design is its explicit concern with priority in the use of resources. This concern starts as the client enters the system. Programmed, concentrated attention is given first to the de- tection of emergency problems in the client’s situation.

Intake Functions 1) Client enters system. 2) Collect case information. 3) Inform client. 4) Detect emergencies. 5) Establish case priority. 6) Refer client. 7) Document client entry. At intake, the client is introduced to the service delivery

system. The information needed to perform this introduction is collected and the client is informed of the services that he may expect to obtain by using the system and how they are delivered. He is given the opportunity to accept or decline these services. If the client elects to receive service, a preliminary assessment of his situation is conducted. The purpose of preliminary assessment is to establish a priority for the client’s use of the system and is expressed in terms of the urgency of the client’s need for the resources of the system. Preliminary assessment involves the client in identifying his service needs whenever feasible. Documentation of the client’s entry into the service delivery system at intake forms the basis for tracking the client’s subsequent use of service resources and for managing the activities coincident with that use.

CASE A~SIGNMENT

The purpose of the case assignment module (Fig. 3) is to provide a systematic and visible way to manage the caseload of both individual case managers and the social service agencies which support them. The explicit concern with priorities for resource usage is apparent. Case assignment is a process based upon a designated priority for a client’s assess to service resources which serves as a basis for assignment of a social service case manager to each client who wishes to use the service delivery system.

Case Assignment Queue

or queued for assignment. 1) A social service case is either assigned to a case manager

2) Highest priority cases are always assigned first. 3) Where the agency caseload exceeds its case management

capacity, its lowest priority cases reside in the case assignment queue.

The system design features a unique computer assisted proce- dure which enhances social service caseload management capability: the case assignment queue. A client whose case is queued for assignment is under the recognizance of the social service agency. While a case is queued, case visibility is main- tained through a systematic and periodic scanning process. Client access to the agency is always available and the client is informed that his case is in queue.

Case Assignment Functions 1) Assign case. 2) Transfer case to queue. 3) Maintain caseload balance. 4) Monitor queued caseload. 5 ) Allocate casework skills. 6) Respond to case status change. The system design provides the capability to perform these

functions. To support this capability, reports are generated which display the information necessary for caseload visibility. The status and activity history of any case in the agency caseload is kept up-to-date and is available for immediate use.

ASSESSMENT

The purpose of the assessment module ( F i g . 4) is to develop data which describes the patterns of characteristics in a client’s situation that depict ~ needs for specific social services. The design of this module promotes the setting of information objectives by the case manager for the direction of efforts to assess the client’s situation. It provides for the evaluation of assessment contact based upon the extent to which these objectives are met and allows modification or reformulation of objectives as new information requirements emerge. It enables management and control of assessment contact.

Assessment Functions 1) Set information objectives. 2) Contact information sources. 3) Record contact results. 4) Evaluate contact results. 5 ) Search for diagnostic pattern. 6) Evaluate emergent pattern. 7) Establish baseline assessment. 8) Provide assessment visibility. Another of the unique aspects of the system design is the

replacement of case dictation as a function of case assessment. The technique that enables this replacement is based upon a battery of standard data elements for use in recording the results of assessment. Each element is in the form of an assessment question with multiple answers. To record a particular assessed characteristic, the appropriate data element is refer- enced and its value specified using a simple coding technique. It is then entered as input to the computer which supports the system. Display of assessment results is accomplished with computer assistance in the form of an English language statement which describes the assessed characteristic.


c N

+ F

j .

+ @

Ftg. 4. Assessment module.

SERVICE SELECTION The purpose of the service selection module (Fig. 5 ) is to

formulate explicit service delivery objectives based upon the results of assessment and to specify the services which would enable fulfillment of these objectives. The result of service selection is in effect the statement of' a service hypothesis. It predicts in behavioral terms the change to be expected in particular characteristics of the client's situation as a result of the delivery of specified services, providing effective social service resources can be used.

Senice Selection Functions 1) Formulate service delivery objectives. 2) Specify services for delivery. 3) Specify service delivery sequence. 4) Document service hypothesis.

The formulation of service delivery objectives is directly based on the results of assessment. Characteristics of the client situation, recognized in the assessment process as making up a problem pattern, are used to defiie service targets. This definition is expressed as the modification or maintenance of the assessed value of the specific characteristic.

The set of service targets to be reached through the delivery of particular social service constitutes a service objective. All service objectives established for a single service case express a service delivery hypothesis. It remains, then, to join this hypothesis to social service resources that can be used to deliver the specified services, in order to express a service plan.

RESOURCE APPRAISAL

The purpose of the resource appraisal module (Fig. 6) is to identify the social service resources needed in order to deliver selected services and to appraise those resources that can be


Fig. 5. Senice selection module.

Y A

Fig. 6. Resource appraisal module.


I

C o l T A C T CUTSIDE

4

t

4 "

i

t

Fig. 7 . Service delivery module.

used to meet these needs. The resource identification process consists simply of selecting standard resource categories. There is a two-fold result of the resource appraisal process. First, the gap between service resource needs and effective resources that can be used to meet these needs is explicated. Second, a service plan for the client is completed which specifies the actual social service resources to be used to reach clearly stated service delivery objectives.

Resource Appraisal Functions 1 ) Identify resource requirements. 2) Analyze resource context. 3) Select actual resources. 4) Specify service activities. 5 ) Document service plan. When the actual resources to be used in achieving a specified

service delivery objective have been selected, service activities necessary to initiate and maintain the client-resource contact, are explicitly identified, these activities, (for example, referral, transportation, facilitation, etc.) constitute the units of work that must be acquired or supplied by the case manager in order to carry on service delivery. Those service activities which are supplied or purchased represent the direct costs of social service.

After execution of the resource appraisal process, the client's service plan, made up of a service hypothesis plus a statement of resources and service activities is ready for implementation.

Community Resource Component 1) Social service resource inventory. 2) Development and update. 3) Usage and evaluation.

To support the primary service delivery activities of the system, the design includes a specialized community resource component. Its function is centered around a community social services resource inventory which is continuously up- dated to reflect a current community resource context. Where there are neeas for new resources or for expansion or upgrad- ing of existing resources, the necessary development is performed by this function.

Identification of these needs is based upon usage and evaluative data which is posted against the resources which make up the inventory. This data, which reflects service delivery experience with the community resource context, is generated out of the resource appraisal and service impact evaluation activities of the system.

SERVICE DELIVERY The purpose of the service delivery module (Fig. 7) is to

implement the client's service plan by providing the service activities necessary to enable client contact with selected social service resources and to maintain that contact for the duration of its effective use. Concrete action which joins the client with community social service operations constitutes the service delivery process. It is in this process that the practical exigen- cies involved in the use of community resources are met. It is here that the myriad and sundry activities take place which facilitate the client's movement toward specified service objectives. The process includes the adaptation of the service plan to accommodate the short-term conditions that block the use of resources, the minor catastrophes that abort carefully developed service sequences, and the changes in the client's situation that make service objectives irrelevant of inappropri- ate. Service delivery is a dynamic process in continuous inter-


action with the processes of assessment, service selection, and resource appraisal to maintain an optimum response to client needs.

Service Delivery Functions 1) Enable client-resource contact. 2) Monitor service delivery sequences. 3 ) Document service delivery contacts. Each significant contact that occurs between the case manager

and the client or a community resource agency is recorded. Contact documentation reflects case-member identification and date of contact in conjunction with the service delivered, the resource agency involved, and the service activity expanded. It includes a record of the a p p r o d a t e time used for tho contact and an indication of its effectiveness. Contact information is collected throughout the period of service delivery in order to track the client's use of community resources and make the service activities of the case manager visible.

SERVICE IMPACT EVALUATION The purpose of the service impact evaluation module ( F i g . 8)

is to follow up the client's use of service resources to determine the results of that use, and to evaluate the impact of the client's situation. The service impact evaluation is carried on in three discrete phases. A critique of the results of resource usage is made by the resource agency performing service, the client receiving the service, and the case manager who arranged the service. This information is fed-back for use by the community resources component of the system.

The characteristics of the client's situation which enter into case classification are reassessed according to established case analysis sampling requirements. This information is used for statistical measurement of case movement. The characteristics of the client situation which were used in formulating service

objectives for the client are reassessed to determine the effectiveness of the service plan and the resources used for its implementation.

Service Impact Evaluation Functions 1) Perform "delivery results" follow up. 2) Measure case movement. 3) Evaluate attainment of objectives. 4) Recommend case disposition. 5 ) Document service impact. The results of service impact evaluation provide basic intelli-

gence covering the effectiveness of the social service client's interaction with his community resource context. This intelligence includes coverage of case management and other service activity expended to enable the client's use of these resources. Analysis based upon service impact intelligence can be trans- lated into estimates of social benefit. These estimates coupled with cost data derived from statistical analysis of the characteristics of service activity and case management will produce the accountability which is one of the primary objectives of the system.

CASE DISPOSITION The purpose of the case disposition module is to determine

how to accommodate a social service case that has been re- leased from caseload of a case manager, transfemed from another social service agency, reopened at the request of a client, or is in a transition phase following a completed service delivery sequence.

CONCLUSION The generic system described has been installed and is now

functioning in Lynchburg, Va., and will be by December 1974 in Chesapeake, Va. The systems are supported by computers


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in the locales and are provided backup through the central ADP agency of the state located in Richmond, Va. To assure full use of the system in its intended operating mode extensive documentation and development of forms was required. A program of case analysis was carried out to determine if it would be feasible to develop base-line information on each client and to establish patterns for aiU in developing service programs for clients. A resource bank was developed which would be able to provide for each worker the knowledge relative to the availability of any service, the quality and costs

of that service and location to which the client must go to receive the service. The information provided to the case worker and supervisory person is derived froin the support system and examples of the type and format of this information is given in Figs. 9 and 10.

Procedures manuals have been developed and are being used by case workers and supervisors participating in each phase of the system. A fully developed service resource document has been established which provides access to each service including the cost, availability, quality and location.

PROCEEDINGS OF THE IEEE, VOL. 63, NO. 3, MARCH 1975

The Social Service Delivery System in its present form supports all of the functions of the Lynchburg Agency except financial assistance. This system is being used as the model for state-wide implementation and also as the model for a one-stop broker-advocate human services delivery system. The impor- tance of this system to all levels of social service delivery is several fold. From the point of view of the client immediate access is gained to all services for which that person is eligible. Through the process of intake and assessment the client is in a better position to recognize and try to cope with basic problems. For the case worker, organization comes to what in the past has been a chaotic mess. From assessment through case disposition the worker is in a position to provide for the client from a position of strength gained through knowledge. Emer- gency situations are determined and met. Service plans are established through cooperative interaction with the client. Evaluation of the effectiveness of the services delivered is provided through the service impact evaluation. The supervisors are provided the opportunity of managing the agency. The concept of case carrying is eliminated.

The major innovation provided by the Social Services De- livery System is in the area of management at the local and state levels. For the first time information is available in a timely fashion and in a form useful to the management function to be performed. Real cost in terms of personnel and services is available. Forecasts of the implications of new policies on both personnel and resource costs can be made. Evaluation of the effectiveness of service as delivered both in terms of the impact on the client and of the effectiveness of

463

service as delivered both in terms of the impact on the client and of the effectiveness of workers is available. It is feasible to discuss cost effectiveness in real terms and provide funding requirements based on assessment of impact of present or new programs.

REFERENCES

C. Argyris, Management and Organizational Dcvelopment. New York: McGraw-Hill, 1971. HEW, Social Worker Manual, 1963. W. M. McFeely, “Organization change: Perceptive and realities,” Conf. Board, New York, N.Y., Rep. 561, 1972. A. H. Maslow, “A theory of human motivation,”in Orgunization Theories. Columbus, Ohio: Memll, 1970.

systems,” presented at MassachusettsConf. Soda1 Welfare, Boston, J . D. Palmer, “Developing evaluation criteria for service delivery

Mass., Dec. 1971. J . D. Palmer and J . Deloyht, “A management information system for Virginia,” in Proc. SMCNat. Conf, Nov. 1973. H. M. Runyan, “Introduction to transition management,” Sys- tems Research Co., Boston, Mass., 1973. The Management Group (TMG), “Computerized service (welfare) delivery systems in Maine,” Waltham, Me., 1970.

economic Evaluation? Garden City, N.Y.: Doubleday-Anchor, R . Thoobald, Ed., The Guaranteed Income, Next Step in Socio-

A. Toffler, Future Shock. New York: Bantam 1971. Touche-Ross (T-R), “Use of Computers in Welfare Systems in Washington, Michigan and Virginia,” Washington, D.C., 1971.

Inst., Columbus, Ohio, Monogr. 3, Apr. 1973. J . N. Warfield, “An assault on complexity,” Battelle Memorial

Columbus, Ohio, Monogr. 4 , Apr. 1974 (many excellent , “Structuring complex systems,” Battelle Memorial Inst.,

references). A. K. C. Wong and T. Au, “Regional planning of health care facilities,” ZEEE Trans. Syst., Man., Cybern., vol. SMC-3, Sept. 197 3.

1967.

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Community Dialog Technology

Absmct-For the past three years, the M.I.T. Community Dialog Project has facilitated approximately 200 group meetings, settings ranging from high schods and universities to political and industrial organizations, from senior citizens groups and rotary clubs to state and national assemblies of government officiais, scientists and businessmen. Using electronic voting technology and specially designed meeting procedures, every participant is enabled to make an anonymous coded response to questions posed by the moderator or another participant, and to observe instantaneously a tally of how many people voted in what category. The purpose is to get a rapid appraisal of where there is consensus and where there is controversy, to allow participants to meal their ignorance, to deal with controversial questions without intimidation, and generally to make the discussion more responsive to

work was supported by the Division of Social Systems and Human Manuscript received June 1, 1974; revised October 8, 1974. This

Resources, National Science Foundation, under Grant GI 34900. The author is with the Department of Mechanical Enpneering, Massa-

chussetts Institute of Technology, Cambridge, Mass. 02139.

real interests and needs of the group. In special crses, quantitative procedures are used to rate alternatives against criteria and find group utilities, but mostly these procedures are reguded as an au@nentation of normal free discussion and idea formulation, not a means for com- mitment to final decision. The paper evaluates the usefulness of these techniques as a function of the type of topic and questions used, the pedty and experience of participants, the style of the moderrtor, and other factors. It poses fundamental questions reeuding the d e m e cntic p- especinny in view of rapidly i n d g capabiities for large scale community communication, such as are provided by two- way cable TV.

INTRODUCTION

Y OU ARE asked by the pollster, “Do you approve of the way the President is handling his job?” Kindly respond “Yes,” “No,” “Undecided.” There is no opportunity to

modify the question, to qualify the response, to make a different response, or to register an objection to the process.

a working system for social service delivery

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