Privatization, Welfare Reform and the New Business in Foster Care: An Examination of Market-Oriented Discourse in Current Child Welfare
Arturo Biaocchi and Teresa Swartz
This exploratory project sought to examine the potential of investigating trends in foster care, and child welfare and social services in general, from different theoretical and empirical perspectives. In the form of open-ended interviews we wanted to explore recent trends in child welfare related to privatization, manage-care and marketization, and elucidate the context in which social workers, agency directors and county workers view these changes.
At this point we are still reviewing the data gathered in these interviews and analyzing the ways in which social workers frame the work they do, and the institutional arrangements that define contracts between county and private providers. We are also conceptualizing how the interviews speak to the implications elucidated in the Medical Anthropology literature related to managed care and social services. We hope to flesh out this analysis in the form of an exploratory paper to publish. Below are some of the key points of our findings.
A) There are clear signs that economic and social markets have continued to merge since the era of welfare reform. The idea that interventions in child welfare will benefit from the overt medicalization and marketizaltion of services seem embedded in the social worker discourse for improving the effectiveness of such services. The dynamics of manage care seem significant in this regard.
B) Agency directors are aware of interagency competition for county contracts and consequently "market" themselves by advertising their use of "program performance data" to ensure "efficiency." This discourse is grounded in the broader context for a drive toward evidence-based practices intertwined with market structures in the field. A sub-market for evidence-based consulting has evolved in the wake of agencies seeking evidence-based certification, as such certification is a marketable asset.
C) County representatives and agency directors had interesting interpretations regarding the issue and significance of collecting performance data. Certainly, collecting performance measures "seems to be the way things are going," though it is unclear what actual significance agencies ascribe to this data. It is also interesting that agency directors could give examples of how performance goals may not always be aligned with client well-being, though they nonetheless feel the need to measure their work in this fashion.
D) Despite our concerns, there are clear positives for using Medicaid funds to support child welfare. As agency directors shared with us, such funds have allowed for creative and flexible interventions to use with
families. Also, the use of Medicaid pays credence to a universalism for preventative service provision. Children and families covered by Medicaid are eligible for preventative support services that they would otherwise no receive, unless serious abuse had been discovered (which many social workers feel is a stage when things have already gone too far). Nonetheless, using Medicaid services may re-orient the way such services are administered and practiced.