NCSW Part 3: A Century of Concern 1873-1973: Problems of Effective Functioning

Problems  of  Effective  Functioning

by James K. Whittaker Associate Professor, School of Social  Work Chairman, Human  Services Sequences University of Washington, Seattle, Washington

Attempts  to  define the remedial field often  lose more than  they gain in elaboration. Once stripped  of  the  categories  – “mental health,” “corrections,” “retardation;” unen­cumbered   by  the  labels  – “multi-problem  family,”   “emotionally  disturbed   child,” “juvenile  offender;”  and liberated  from  the technical jargon – “psycho-social diagnosis,” “therapeutic intervention,” the remedial field may be seen in its essence: which is, quite simply, people helping people.

It is of course true that we now know a good deal more about the kinds of problems people have and, hopefully,  more about how to be of help to them. But quite apart from the  techniques,  at  the  heart  of  every  true  remedial  effort  lies  a  personal  encounter between  two people attempting  to share in each other’s humanity  with the ultimate goal, in the words of Jane Addams, of “raising life to its highest value.” This concern for  the worth  of individual life – from Mary Richmond’s  exhortations to respect the dignity of clients,  to  present  efforts  directed  at  humanizing  social work  practice  – emerges as a central point in the last century’s history of remedial efforts in the field of social welfare.

At present, the problems facing the remedial field are legion: internecine quarrels over which “technology” of helping works best and when and how it should be delivered; problems  of  financial  support,   particularly  among  the  voluntary  agencies; mounting volumes of research which question  the efficacy of present methods of social treatment; and larger issues raised (again) by the social actionists and (anew) by the environmentalists which at times question  the wisdom of financing any ameliorative efforts when what are so clearly needed are massive programs of prevention and protection. Of course there have always been strains within  the helping professions and pressures from without,  but at almost no time were they as divisive and intense as at present.

In all quarters  of the remedial field one may hear the rumblings of dissension and view the bitter  fruits  of an effort  plagued always with two  few  resources and often launched too late to provide anything but the most superficial of care.

In  the  children’s  field,  while the  numbers  of  dependent  children  in institutions has dropped  sharply  over  the last fifty  years, the  number needing some form of help with emotional  problems has risen to the point where the President’s Joint Commission on the Mental Health  of Children  estimated  that  we are currently  providing care for  roughly one-third  of  the  children  in need. The  inadequacy  of  our institutions  to deal with the problems of  juvenile offenders,  indeed the inadequacy  of our system of juvenile justice which still sees young  children placed in detention  whose only “crime” was that  they were the victims of crisis or neglect, is still evident despite numerous attempts  at reform. Programs in specialized problem  areas like  juvenile drug abuse still fall far short  of the mark of adequacy and conditions in some institutions for the mentally retarded child give the lie to the belief that this nation has adopted the admonition  of Dewey that “What the best and wisest parent wants for his own child, that  must the community  want for all of its children.”

In  the  field  of corrections  the  inability  of  present  programs and  resources  to meet current  problems  are visible like so many  open  wounds  throughout the land. The rare adult  offender  who  does survive his period  of incarceration  unscathed  is likely  to  be released to a community  suspicious of his presence and offering few of the supports  he needs to readjust to the demands of productive social life.

The crisis in health care touches virtually all in the society and beyond the obvious and acute  manifestations  of  physical  trauma  and  disease, lie the  more subtle  but  equally painful symptoms  of emotional  suffering and neglect. Family disorganization and break­ down,  personal  despair and  anxiety,  depression  fueled  by an inability  to  deal with systems grown too large, alienation  and anomie among the young and a yearning for a sense of fulfillment  and  meaning on  the  part  of  many,  capture  but  a few of the conditions deserving of remedial help, yet they often go unaided because of insufficient programs or inadequate funding.

The targets for healing span all age groups- from preschooler to aged pensioner – and all classes,  though many wear the double  yoke  of  poverty  and  dysfunction.  With so sweeping an agenda for change and so loud a call for help, one wonders at times if any degree of progress has been made or will be forthcoming. On reflection, it would take all but  the  most  biased reading of  the last century’s  remedial efforts  in the field of social welfare to  fail to  admit  that  many  advances had  been made:  in child health  and pro­tection, in community  programs for delinquents, in family counseling and mental hygiene: progress to  be sure,  but  so much  needing to be done.  Equally difficult  to assess is the reason for the insufficient action:  professional in-fighting, lack of financial resources, embryonic  technologies  of  helping  – all  may  share  some  culpability  as contributing causes. But  perhaps  in  some later  analysis the  real impediment  will be seen less as a shortcoming  in finance or technology and more as a failure of will: a  conclusion  waxing more plausible with each commission report,  senate hearing, or social outcry  adding to the seemingly endless litany  of voices proclaiming  what  needs  to  be done.  All of this makes extremely  difficult  the  task  of predicting where the remedial field is headed:  so numerous are the variables, so considerable the unknowns.

But while no one can be sure precisely where the helping field is going- one reading would see several vectors rather than a single direction – perhaps some sense of where we are going may be garnered from a careful analysis of where we have been.

Past Influences

The remedial field has always been marked by gulfs and divisions. Presently  they are philosophical and technological; previously they  were geographical. Indeed,  the bridging of distances – between  cities, states  and  regions – and  the  emerging recognition of a common  community  of interest  were central  to the development of helping services in the final quarter  of the last century.  The period was also marked by a certain optimism and a special enthusiasm, almost as if the discovery of common problems and mutual interests,  as well as the conquest  of physical boundaries, portended  solutions soon to be found.

If  some  differences  of  opinion  existed  about  causation  of  problems  – from  moral turpitude   to  social influence,  to  characterological  defect  – relatively little  dissension could  be  found  regarding  what  needed  to  be  done.  Families needed  adequate  food, clothing,  shelter  and  medical  care.  Children  deserved a  wholesome  environment  for growth  and  development.  Those  special  children  deprived  of  natural  parents  through death or desertion  required devoted and loving foster families, or as a last resort, home­ like institutions for care. Nearly all remedial efforts involved some form of environmental manipulation:  removing the waif from the city streets; finding a flat for a newly arrived immigrant family; converting  the child care institution  from barracks to cottage; placing the  mental   patient   in  uplifting  surroundings;  and  removing  the  delinquent  from  his criminal associations. All of these efforts  were based on a view of individual problems as greatly influenced (if not created) by social conditions.

It was natural  then  that  along with individual “case  work,”  there  was a need for a more general societal effort  directed at the root causes of the specific problems. Poverty, inferior  housing,  overcrowded  cities,  poor  health  care – all required an attack  along a much broader  front.  What Mary Richmond called the “interdependence of individual and mass betterment” was a cornerstone  of  the emerging social welfare profession and was very much in evidence at professional conferences and symposia. Reform and remediation went hand in hand into  the new century  with the belief that  both  were needed if  truly efficacious  solutions  were  to  be- realized.  Much  happened  between  then  and  now  – currents  occurred  which at  times caused deep rifts between  the two movements – and only recently has the old alliance been revitalized.

In  the  intervening  years social work  and  the  remedial  field got organized and went professional. Summer  training institutes  were replaced by graduate  professionals schools of social work; loosely knit federations  of friendly visitors became social welfare bureau­cracies; common  sense and dedication  in  charity  workers  were supplemented  by a professional  technology;  problems – once simply  defined in social or moral terms – were seen as vastly more complex entities requiring sophisticated forms of intervention.  By the late 1920s and over the vehement protestations of many of the older social actionists, the shift had been made from “cause” to “function.” Indeed, Porter Lee’s 1929 presidential address couldn’t  have more accurately described the differences between the new helping professionals and their earlier counterparts: “an embattled host for the cause, an efficient personnel for the function.”

Well before Lee’s address, growing numbers of new professionals — heeding the criteria for professional advancement  suggested by Abraham Flexner at the 1915  National Conference  of Charities  and  Correction (Ed.note: read: Is Social Work a Profession?)  – were hard at the task of defining the new orien­tation  to  helping.  And  so  much  needed  to  be  done.  Educational  requirements  were stiffened  and the two-year master’s degree program became the entry point to the new profession.  National  organizations  were  formed  to  accommodate   to  the  varying pro­fessional needs  of medical,  psychiatric  and  family social workers. Casework and group work emerged as distinct  methods  of helping and various theoretical  positions gathered their  ardent  supporters.  Chief among  these was the new dynamic  Freudian  psychology which  tended  to  view difficulties  as more internal  and emotional  and less external  and social. The treatment  of choice shifted considerably from environmental manipulation  to insight- producing counseling. No matter that the actual number of psychoanalytically trained  practitioners  remained small: theirs was still the model to be followed. In time, the  majority  of  professional  schools of  social work would adopt  an essentially psycho­ dynamic orientation  to human  development as well as to practice. This new emphasis on the  insight-focused  interview  conducted  in an office, coupled  with the growing bureau­cratization  of social welfare agencies – with the concomitant  separation of function  and division of labor – tended to remove individual workers at least one step from the earthly engagement between family and friendly visitor that had characterized earlier times.

A great  deal of  attention   was paid  to  developing the  new technology  of helping – psycho-social diagnosis, case planning, treatment  intervention  – as well as to delineating a whole new taxonomy  for human problems. The “illness-treatment” model gradually grew in  prominence  and adjustment  to (rather  than changes in) social conditions  became the watchword.

The  mental  hygiene movement,  by  the  late  1920s  heavily psychoanalytically  domi­nated,  offered, in addition to a new technology of helping, a ready-made structure  for the new professional  social worker  to  operate  within:  the psychiatric  team. Basking in the glow of reflected  status from psychiatry, the “psychiatric  social workers” became, as one writer notes,  the “Brahmins” of the new profession. Specifying the social worker’s “role” and function  – on the psychiatric  team, on the hospital ward, in the community  agency became  a  preoccupying  issue for  the  profession.  Again the  new  professionals  were moving further  from  direct contact  with the totality  of the individual or family problem. Precise role definitions  and specification  of function  read well on the organization  chart, but often ill-matched the multiple real life problems of clients.

Whatever else one could  say about  the  remedial segment  of  the social welfare field from  roughly  the  end  of  World War I until  relatively  recently,  it  is certainly  fair  to characterize  it as having undergone  a great turning inward upon  itself: a turning inward that  had its  salutary  features  to be sure – the development  of professional standards,  a greatly  improved  technology   of  helping  – but  which  also  spawned  a  kind  of  social myopia for which the profession was to be called accountable in later years.

Present Influences

The  remedial  field  today  exists  in  a state  of siege. So ubiquitous  is the conflict,  so intense  the battle,  that  all but the loudest  of salvos and the sharpest  attacks  go virtually unnoticed.  The quest for professional  normalcy  has become the struggle for professional survival.

From  without,  the  remedial  field – in  particular,  the  social work  profession – has been called to task by numerous client groups for being unresponsive  to  their needs and problems.  Racial and  ethnic  minorities  among  others  have challenged  the  helping pro­fessions to become more socially active on their behalf, to become far less ignorant of the culture  and values of the groups they  work with and, above all, to direct change efforts not at individual pathology, but at the pathological social conditions in which clients — particularly  if  they  are  poor,  or  a member of a minority  group — must live. Especially telling is the  charge that  the very agencies and institutions – now often  grown to huge bureaucracies – once designed to alleviate human  misery, are now serving to perpetuate it. Clients are demanding  more humane  and relevant programs, more active participation in the helping process and more control  over the provision of services. Laudable aims to be sure:  but how to incorporate  them into that now firmly ensconced “professional  role” so long in the forging?

Other  attacks come from the sources of support- public and private funding agencies. Disenchanted  by promises never kept, by expectations  never realized, and faced with increasingly insufficient  revenues to meet growing service needs, the funding agencies are turning from  the helping professions to other quarters for aid in solving human problems. “Accountability” and “cost  effectiveness” are the by-words of the new managerial orientation  to  human  social problems.  In  particularly  dire straits  are the private agencies – long  accustomed   to  viewing  themselves  as  the  arbiters  of innovative  practice  – now struggling mightily  to retain  their autonomy  and leadership and fearful of encroachment from the  public sector. Even more generally, the entire remedial field suffers to an extent from  a kind of “post  Poverty Program hangover”  on the part of the public, causing — as the president  of the National  Association of Social Workers recently  noted — the lowest degree of acceptance  for  social welfare programs  and social work professionals that  he could remember.

As if the wave of anti-professionalism,  disenchantment of the public, severe shortages in funding, and client demands were not enough, other tremors emanate from within the remedial field itself and from several sources. Some urge the almost total abandonment of palliative services in favor  of action-oriented, system-focused  strategies  directed  at  the root causes of individual problems. Poverty, racism, inequality and urban blight should become the major targets for the helping professions the argument goes: to do otherwise is to offer a soporific when what is needed is major surgery. This particular thrust  really a whole series of  separate  pressure points  within the field – multiplies considerably  the range of possible targets wherein already scant resources must be directed.

The plea to redirect resources to larger targets appears to be supported  by a growing litany  of  research reports  all questioning  the effectiveness of case-by-case intervention. While some results can properly  be attributed to faulty  research design, the point seems to have been made that , by and large, individual attempts  at remediation  have not been successful to any appreciable extent.  In the beginning, such studies served only to create spirited  discussion in the professional literature;  now they provide damaging evidence to those management-focused public officials seeking more cost effective solutions to in­dividual problems.

Partially  as a result of these discouraging research reports,  professional orthodoxy particularly  adherence  to  psycho-dynamic  theory  has been  replaced  by  a theoretical pluralism unparalleled  in  the  remedial field.  Far  removed from any kind of systematic eclecticism, the knowledge base of remedial practice today resembles a collage of bits and pieces of theory,practice research , isolated techniques and highly personalized approaches strung  together  by  the  flimsiest  thread  of adherence  to  professional ethics.  Whatever common  core  of  knowledge  could  have  been  assumed in  the  the  past has shrunk  to minuscule  proportions,  as social welfare practitioners,  theoreticians  and students  battle with each other  over who possesses the “truth.” Perhaps most troubling in what could be a healthy  ferment  of new ideas is the social fervor with which many are pursued. One would  have  thought   that  after  the  remedial  field’s  almost  total  acceptance  and later disenchantment  with  Freudian  theory  the profession would be more cautious  as one writer states about  “granting the status of an axiom” only to snatch it away again at a later time.

Along  with  internal  and  external  forces,  the  remedial scene has  been substantially altered in recent years by changing values and attitudes  of the public at large. More liberal acceptance  of out-of-wedlock  pregnancy and single parenthood  has forced many mater­nity  agencies to  radically alter  their  programs or go out  of existence.  I n juvenile cor­rections and mental  health,  the trend  toward more community-based forms of treatment signals major  changes in the  service structure   a bitter  pill for some segments of the remedial field  who for  years  have been arguing for “more  of  the  same”  facilities and programs.

New populations  of clients,  like  the  young  drug user,  and new forms of service de­livery, like the crisis clinic, have given rise to a whole spate of new agencies and programs, often  staffed  by  non-professionals  and  operating  outside  of  traditional  social welfare agencies. Even  private  industry   is  now  making  inroads  into  the  social  welfare field : franchising  service programs,  training  staff,  and  offering  consultation   to  government. Little  wonder that  some of the members of the old coalition- private agency executives, professional social workers and public welfare personnel feel at times as if events have passed them by and what was once solidly their “turf” must now be shared with consider­ able numbers  of others.  Faced  with  such formidable  and  diverse challenges, it is little wonder  that  some would  yearn  longingly for  the days of theoretical  orthodoxy , client acceptance,  and  public  support.  Some,  indeed,  would  view the current  crisis in the re­ medial field as merely transitory  the result of , say , a hostile administration, or econo­mic recession, or “flash-in-the-pan” new programs.

It is difficult  to accept  this position in light of what is now occurring in the remedial field.  Basic structural   revision, rather  than  superficial change would  appear  to  be  the logical  outcome  of  present   trends.   The  critical   question  is,  of  course,  what  will  the remedial field of the future  resemble?

Future Directions

If one  rejects  out  of hand  the  notion  that  things will remain exactly  as they are in the helping field, or revert to some prior state  of relative tranquility , then also to be discarded is the  view that  we are now witnessing the death  of the entire  remedial field. Two factors would  seem to  argue against  this latter  course.  First, even with a totally  new set of social institutions- as many  actionists would  argue for- there will still be a need for remedial services.  Who  will  presume   to  suggest,  for  example,   that  new  institutions will  not  in themselves  create  new problems  of adjustment for  individuals,  requiring  new methods of remediation? In  truth, the problem  with  the whole “remediation-reform” question is that goals and means have become misplaced:  needed  changes in present social institutions will not   be  brought   about   by  remedial  services,  nor  will  the  eventual  realization   of  those systematic changes  do away completely with the need for ameliorative  programs. Clearly , both  reform  and  remediation must  proceed  together  in a manner  similar to that  envision­ ed  by  the  social  welfare   pioneers   of  the  early  part  of  this  century . While surely  no solution   – to  a social  welfare  organization, or  social  agency  or  individual  practitioner faced  with  scant   resources  of  time  and  money   – it  at  very  least  helps  to  focus  the problem  squarely  in “both/and” terms  rather  than  in the  “either/or” logic some  would prefer.

A second  factor  which  seemingly  will insure  the  continuance of the  remedial  field in some  form  is the  increasing  demand  for  more  services of all kinds  by a public  that  finds itself  with  the leisure  time  to  become  increasingly  concerned with individual  betterment and  overall quality  of life. The  demand  for more family life education and the encounter group  movement  provide  two  fairly  recent examples  of where public demand  has created new services. Assuming,  then,  the  continuance of  the  remedial  field in some form;  what will it  resemble?  Cognizant  of the  risks inherent  in hard-nosed  predictions, it is perhaps more  productive   to  speculate  on what  might be true  in the  remedial  field if a common effort  were made to shape the casting of the future  mold.

First  among  priorities  would  be a total  rethinking of the values and ethos  that inform the field  of interpersonal helping What is needed  is a value set that is in keeping with the principles  of a sound  ecology  and  that  stresses  the highest and best quality  of individual, group  and  community life. Specifically, this would entail  an orientation to remediation – whether   in  corrections, health, or  welfare,  which  stressed  “growth and  development” rather   than  “illness  and  treatment,” and  sought   to  diminish  rather   than  highlight  the differences between  the helpers and the helped. The recognition of the fullest  potential ­ for  any  client,  whatever  his diagnostic  label – should  be the primary  goal of all remedia­tion.  This  cannot and  should  not  mean  merely  the  readjustment of an individual  to an essentially  unhealthy social condition.

Further suggested  is that  all remedial  efforts redirect  themselves  at  real life problems of  people  in  need  and  not   at  preconceived   and  method-defined notions   of  what  the difficulty  is. In  short,  all attempts should  be made to lay renewed emphasis  on the social aspects  of  remedial  practice  and  make  the  method   of  helping  conform   to  the  client’s problem  and  not  vice-versa. Central  to the remedial process should  be the joint efforts  of helper  and  helped  pooling  their  resources  in a voluntary  relationship to achieve a com­monly  agreed-upon   goal.  This  means  that  involuntary  treatment , coercive  practices,  or anything  less  than  a full  sharing  of  confidence between  client  and  worker  will not  be acceptable.

The problem of competing  theories of change should be squarely faced in the full recognition  that  we  remain  far  distant  from  anything  resembling a unified  theory  of human  behavior, or a highly reliable solution  to any of the multitude  of problems with which we deal. Experimentation and eclecticism should  be encouraged in social agencies and in professional training. Differences of opinion,  or theoretical persuasion should not assume the  “thou-shalt-believe-all-or-nothing”  quality  they  have in the past, but rather the attempt  should be to build bridges rather than to shout across the chasm. Along with the eclectic approach  to practice should go a thorough program of evaluative research to try  to  provide answers to  the  question, “What works best?” On this point it would be wise not  to “oversell”  whatever we have to offer. No single attempt  at remediation  will “cure” delinquency,  or completely solve a community’s drug problems, or minister to the total mental health needs of an area. Honesty and tempered optimism at the outset are probably the best antidotes to public distrust of professional intervention.

The area of service delivery is yet another  quarter  where  rather  major  changes  will need to be made. First, and perhaps most troublesome, are the whole spate of categorical programs  that  have developed over the years, each with its own definition  of problems and array of services. The hard question to be answered is whether our present method of defining  problems  makes sense any more given what we now know about  the interlink­ ages between human difficulties? A.J. Kahn has pointed out that most categorical defini­tions of problems represented social advances when first promulgated: “orphan  asylum” signified  that  homeless  children  would  no  longer  be  indiscriminately  placed  in  alms houses  and  “mental   illness”  signaled a  trend  away  from  viewing certain  behavior as morally reprehensible or subject to criminal penalty. The dilemma at present is that the remedial  field  is  now  made  up  of a whole array  of  services clustered  around  certain problem  definitions,  usually with specific assumptions about  etiology and amelioration. We must attempt  to answer the question – in light of what we now know about human behavior and in  terms  of an  orientation  to growth and development  rather  than illness and  treatment   – of whether  these categories,  these  problem  definitions  and  these  assumptions  make sense any more. If they do not, then what better way can be constructed for dealing with problems of children and adolescents,  or families in crisis, or the aged? These are extremely difficult  questions  to answer and the more so because of the enor­mous investment of the present _remedial establishment in the way it now views itself. The temptation,  always,  is  to  say, simply,  that  what  we need is more  of  the  same:  more professionally trained social workers, more community  mental health  clinics, more insti­tutions for delinquents. This approach – in the short view, uncritical- could ultimately leave the social welfare profession mired in its cherished programs while the remedial field moves on to new modes of service delivery.

Another  factor  in the service delivery area concerns the continued  existence of some of  the  old  dichotomies:  “public/private,” “community/institutional.” The  era of  the totally  self-sustaining, voluntary  agency appears  to  be drawing  to a close. Rather  than guard against the inevitable merger with the public sector:  at times to fill needed service gaps and to engage in joint attempts  at service delivery. To those convinced that  such a course would amount  to  the ruination  of the voluntary agency, the question increasingly becomes “Which is of greater import – exclusivity or existence?”  Finally, both voluntary and public agencies should prepare for the entrance of private industry and other vendors into  the  remedial field in the coming years. With this, as with the introduction of cost effectiveness  procedures  and a new emphasis on accountability, the remedial field must choose between an essentially proactive or reactive position.

As with  the “public/private” dichotomy,  the  traditional  distinctions  between  com­munity-based  and institutional  agencies – in mental health and corrections- should give way to a single conception  of an agency offering a whole continuum  of services ranging from  totally  institutional   to  totally  community-based  with  all variations in  between . Diversification of services should  be  the  watchword  for  those agencies concerned going the  route  of  singe purpose  organizations  or agencies (like  maternity  homes  for unwed mothers).

Lastly, the remedial field might do well to think some of restructuring services bearing in mind only the factors of access and egress: How easy is it to obtain the needed service? How  difficult  to  terminate?  Looked  at  in this manner,  some services – for  example, maternal and infant  care, suicide prevention and food programs for the elderly- should be structured  in such a way that it becomes extremely  simple to get in and out of the service network as the need arises. Others, like juvenile detention  or involuntary hospitali­zation,  might be set up in a way that  provided for difficult  access and easy egress along the way.

A  final  concern  that  needs  to  be  addressed  involves the  whole question  of client advocacy. In a general sense, the definition of the remedial helping role must be expanded to weigh equally those actions taken on the client’s behalf, as well as those taken directly with him in the helping encounter.  In a sense, this means no more than a return  to the kind  of  collateral  helping  advocated  by  Mary Richmond at  the  turn  of  the  century: helping the client negotiate a vast agency of government, providing assistance in an employment  search, negotiating with the courts over a custody problem, or working with a teacher to insure a better  home-school relationship. All things that social welfare pro­fessionals have always held important, but which were treated with somewhat diminished attention  during the long infatuation  with individual treatment.  More specifically, to the issue of advocacy where clients’ rights are infringed through inhumane practices or puni­tive regulations, sufficient mechanisms should be developed through national professional organizations to provide the necessary support  to both the aggrieved client and his work­ er.

In sum,  the  remedial field is likely  to  turn  in several rather  than a single direction toward greater emphasis on cost effectiveness and accountability;  toward a gradual blur­ ring of distinction  between public/private and community/institutional programs; toward an orientation  based on human  potential  and growth and development rather  than on a narrow conception  of illness and treatment; toward greater participation  of consumers in remedial programs at all levels; toward a more systematic eclecticism in theory  orienta­tion  underpinned  with  a substantial  research endeavor; toward  greater  involvement  of new vendors in the remedial field including private industry and consumer groups; toward a rethinking  of present  problem  categories and  accompanying service systems with the goal of providing an inclusive service net with little or no stigma attached  to the recipients and, finally,  toward  a renewed social consciousness on the part of agencies and helping professionals which places client advocacy at the heart  of the remedial relationship. This could well be the form of the remedial field of the future.

How curious it  would all appear  to  those  pioneers who journeyed  to New York in 1874  to  pool  their  ideas to  provide better  services to  those  in need,  or later  to Mary Richmond and others like her who knew of the importance of such things as proper food budgeting and  where to  assist families in getting a load for fuel for cold winter nights; how strange indeed to talk in such obscure language of “cost accountability” and “service networks”  when it was abundantly  clear what needed to be done:  families to be housed and made sufficient; children to be cared for in physical and mental health; offenders to be worked with and returned  to society – and no talk here of divisiveness: broad social reforms must of course be mounted and remedial programs as well, to aid those who have already felt pain.