Trends that began in the 1950s and 1960s intensified in the following decades. Advances in psychiatric treatment, new behavioral healthcare models, and the advent of psychotropic drugs were combined with budget constraints and a public outcry over the custodial nature of mental institutions and orphanages.
The Joint Commission on Mental Illness and Health recommended community-based treatment, and the Community Mental Health Centers Act of 1963 promised federal support. The latter fell far short amid rising Vietnam War expenditures and economic recession, but outpatient facilities, clinics, employment training, and other community-based services continued to grow.
State asylums and group homes were virtually emptied, and residents were moved to less expensive outpatient care, foster care, and community-based services. Both adult and children’s institutional facilities saw a radical shift in population.
“Residential programs became the placement of last resort,” says Jim Campbell, former executive at Leake & Watts Services. Campbell also served on the boards of the National Association of Homes and Services for Children (NAHSC) and the Alliance for Children and Families. “Institutions that cared for the mentally ill were being closed, so there were fewer psychiatric hospitals for children. The kids coming into residential care were increasingly more severe, far more damaged. People were arguing that these kids were being neglected by being put into residential care. Others said if it weren’t for residential care, these kids would be dead on the street.”
President Richard Nixon came into office on the promise to end the Vietnam War and reduce government services—particularly the welfare programs earlier administrations had created. He said he would eradicate the Great Society and liberal “big spenders.” Social workers were a particular target—he vowed to “make sure social workers would be looking for honest work.”
The unpredictable Nixon, in fact, signed legislation that provided federal block grants to local communities for social services; expanded social security benefits and the food stamp program; and provided funding for job training, rehabilitation, occupational health and safety. Nixon even proposed comprehensive health insurance for every American.
Although the National Institute of Mental Health increasingly focused on research, there was little effort to identify and eradicate the causes of social and economic dysfunction. Conservative backlash against the swelling welfare rolls and rising out of wedlock births to African American women effected a return to the thinking of a much earlier era: Poverty represented a moral defect or other problem within the individual. Hard work and sound moral character were the solution. Legislation reflected this public attitude.
The economic crises of the next two administrations cut funding for welfare and social service programs. President Jimmy Carter’s expansion of mental healthcare policy was immediately rescinded by President Ronald Reagan, who escalated defense spending, slashed spending on social welfare programs, and transferred responsibility for most social welfare to the states.
National Association of Homes and Services for Children is Founded
It was within this climate that the National Association of Homes for Children (NAHC), which was later renamed National Association of Homes and Services for Children (NAHSC), was founded in 1975.
“NAHC was organized because of a threat,” says Arlin Ness, former president of Starr Commonwealth in Albion, Mich., NAHC president from 1987–1989, and currently president emeritus of Starr Commonwealth. Starr Commonwealth and its president at the time, Larry Brendtro, who was NAHC president in 1979 and 1980, played a key role in developing NAHC. Other pivotal partners were the Florida Sheriffs Boys Ranch, Greer-Woodycrest Children’s Services, Baptist Children’s Village, Buckner Baptist Benevolences, St. Francis Boy’s Homes, Richmond Home for Boys, Camp Oakland Youth Programs, the Duke Endowment, Presbyterian Homes, and Episcopal Child Care Services.
Ness cites three elements that came together to challenge the residential care field:
- The accusation that residential treatment facilities were becoming irrelevant, that they weren’t tied into the child’s original home and into the larger community.
- The federal government’s increasing focus on deinstitutionalization and talk of rewriting accreditation and licensing standards that challenged residential care.
- Publication of Weeping in the Playtime of Others by Kenneth Woodin, a shocking expose of juvenile justice institutions that fueled widespread public misunderstanding of residential care and ignited the deinstitutionalization movement.
Said Brendtro in the fall 1995 issue of the NAHC magazine Caring, “The field was put on the defensive. We were all tarred with the same brush. We had to recapture our position as child advocates.”
“The deinstitutionalization movement was intended to place children in more normalized and less restrictive environments. It also resulted in less costs per child,” explains Curtis Mooney, former president of the Kentucky Baptist Homes for Children and NAHC president from 1994–1995. “Unfortunately, for many children the use of family foster care has resulted in children making many moves and having to adjust to many different placements. The trauma of each placement move has been detrimental to these children.”
He continues, “NAHC grew out of this whole deinstitutionalization movement. It was a reaction to this movement against residential child care. In banding together, these organizations were large enough to be heard and to influence policy decisions in the best interests of children.”
By its second year, NAHC had more than 400 member agencies. Ian Morrison, then president of Greer-Woodycrest and NAHC president from 1977–1979, testified on foster care before joint Senate and House committees. His testimony became NAHC’s first position paper, “Foster Care in the United States,” released in 1976. NAHC worked to educate legislators at the regional, state, and national levels. Advocates who had lived in children’s homes and now were in government leadership positions testified on behalf of the best interests of children. They agreed that foster care was an important service. They agreed that children should be kept in their own homes whenever possible. But they advocated that above all, children needed to be protected and provided with a stable environment. Not every child’s home or every foster home provided such an environment.
NAHC adopted a code of ethics and professional standards, leading to an accreditation program for children’s residential group care facilities in 1978. The accreditation program helped establish NAHC as a credible, viable national voice in the child care field. Brenda Russell Nordlinger, who had 10 years experience as a Congressional liaison and extensive experience as a social worker, was hired as executive director. Ultimately, an office was established in Washington, D.C.
“The NAHC accreditation standards had a profound impact on the field,” says C.T. O’Donnell, who was on the NAHC Executive Committee and then served as interim CEO. O’Donnell has served as executive at several child welfare agencies and was on the board of the Council on Accreditation. “NAHC trained peer reviewers from across the country who could objectively evaluate each other’s programs. You can imagine all the different practices around the country at the time—for example, some places still believed in spanking. The NAHC standards defined what the field thought of as appropriate care for children and shared best practices. A cadre of peer reviewers developed, so that I, as a CEO at Florence Crittenton Homes, could ask someone to do a peer review of my agency. Knowledge proliferated. Overall, national quality of care dramatically improved.”
NAHC achieved success in both the legislature and public opinion surveys. The Adoption Assistance and Child Welfare Act of 1980, however, fundamentally changed the face of residential child care. The legislation mandated that child care should be in the “least restrictive” setting. Deep into recession, the federal government did not supply the funding to implement these requirements. It fell to child care agencies to comply. Morrison said in the fall 1995 issue of Caring, “Some agencies folded as a result. Others changed and diversified. Those that survived were adept enough and smart enough to expand into other fields.”
Some NAHC members still were traditional long-term custodial care facilities. Others, like Starr Commonwealth, had evolved to short-term residential treatment. Foster care, too, had added treatment foster care. Community-based programs provided preventive care and support services to help children transition back home.
A Revolution Arrives: Privatization
Amendments and expansions to the Social Security Act in the 1960s and 1970s increased government contracting to the private sector. “There was a great deal of new investment in human service organizations by the government,” says David Campbell, a faculty member in public administration at Binghamton University, and a former administrator at Center for Families and Children in Cleveland and Community Service Society of New York.
Privatization of government social services has, in fact, increased at major watershed points in the history of social policy (the progressive era in the late 19th century, New Deal, Great Society, and Reagan years). Interestingly, it is prevalent both at times of expansion and during contraction of government services. For example, during the 1970s, federal funding for social services increased greatly under Title XX of the Social Security Act, and for human development and employment services under the Economic Opportunity Act and the Comprehensive Employment and Training Act. Nonprofit organizations and for-profit businesses both emerged to fill the need for government contracted service providers. In contrast, during the early 1980s when federal funding for social programs was dramatically reduced, there were also some increases in contracting out services (in some locales) as one way to reduce unit costs and gain efficiencies despite reduced overall funding. (Governmental Responsibility and Privatization: Examples for Four Social Services, Arnold Gurin, Privatization and the Welfare State, edited by Sheila B. Kamerman and Alfred J. Kahn, Princeton University Press, Princeton, N.J., 1989)
Throughout the 1970s and 1980s, voluntary agencies faced an ever-tighter funding environment and growing recognition that financial resources must be attained outside of United Way. This realization irreversibly altered agency administration. If agencies had to raise money on their own, they would have to develop a business model. It also fundamentally altered the role of the board of directors, who would have to be fundraisers and capacity builders.
As government funding increased, United Way funding—the traditional mainstay of human service organizations—decreased. Agencies moved from being largely United Way supported to increasing support from many levels of government. Foundation support also became an important source of funding. “There was now so much multiple funding, United Way was no longer the monopoly it had been,” explains former Family Service Association of America (FSAA) staff member Bob Rice. “That hurt United Way funding across the country. People thought, ‘If my tax dollars are going to support these agencies, then why should I contribute to United Way?’ ”
The world had changed, and FSAA had to change with it. With government responsible for the bulk of social welfare funding, FSAA and member agencies realized anew that it was vital to have a strong voice at the table when policy and funding decisions were being made. FSAA made a concerted decision to strengthen its influence and liaison with government agencies. In 1975, it formed the new Division of Policy Analysis and Development to advance this effort. A full-time director was housed in the FSAA headquarters. “We knew that we would have to project a visibility and credibility based upon what we had accomplished as well as upon what we were currently trying to accomplish,” said an association report.
By the end of the decade, FSAA had established the Washington D.C. Office for Governmental Affairs. Today, the public policy office continues to represent the child and family service movement from its office in Washington D.C., closely monitoring developments that impact children, families, and communities.
Formation of the Council on Accreditation
To be a credible voice for children and families, FSAA, the Child Welfare League of America (CWLA), NAHC, and other organizations understood that their members must meet high performance standards. Thus, they independently developed accreditation standards.
For decades, FSAA had focused on field service to help member agencies evaluate and improve program operations, management, and governance to meet and exceed accreditation standards. This was a central benefit of membership. The same was true of CWLA.
But by the 1970s, government contracts and other funding sources increasingly called upon human service organizations to demonstrate quality standards. It was apparent that there were too many different organizations offering too many accreditation standards for too many different programs. FSAA and CWLA worked together to create the Council on Accreditation (COA) in 1977, each giving up its independent accreditation program.
“Both organizations recognized a real conflict of interest: they were accrediting the dues-paying members, and there was no arms-length relationship between the organization and the member agency,” says Reed Henderson, who was an executive at several family service agencies. “To what extent are you giving an agency slack because if you don’t accredit them, you’re out a member? COA was an effort to create a truly independent certifying body for membership organizations.”
Today, COA accredits more than 45 service areas for private social service and behavioral health care organizations. Accreditation is viewed as a catalyst for change, building on organizational strengths to achieve ever-greater performance.
After COA was developed, the work of FSAA changed dramatically. Field consultation with member agencies moved to a focus on education and training, best practices, and sharing information among member agencies.
Goal of Holding White House Conference on Families Achieved
In 1979, a long-held FSAA goal came to fruition: the establishment of an Office for Families in the federal government’s Administration for Children, Youth and Families. Its intent was to identify and eliminate governmental policies that adversely affect families.
FSAA also had long advocated for a White House Conference on Families to air the needs and aspirations of American families and to draw national attention to the influence of government and other forces on family life.
FSAA provided volunteer and staff leadership to a voluntary coalition that was pivotal in creation of the White House Conference on Families. Bob Rice, who at the time was FSAA director of policy analysis and development, headed a coalition of large voluntary agencies to persuade President Jimmy Carter to establish the conference. Rice then served on the conference advisory board. Carter ultimately approved the conference, but President Ronald Reagan had taken office by the time it occurred.
Unlike other White House Conferences, which were a one-time event held in the nation’s capitol, the Conference on Families occurred over a period of several years at several different times and locations. The conference held hearings throughout the country, soliciting testimony from thousands of families and other stakeholders. Together, they struggled to answer fundamental questions: What is a family? What is its future? What role should government play in determining policies designed to support the family unit? The final conference report and recommendations were submitted in late 1980.
“It was a contentious, highly politicized, wild, and wonderful thing,” says Rice. His recollections include:
During the 1970s, there was a gap between what people thought families were like and the reality we were seeing in our caseload. People pictured the standard nuclear family, where the father worked and the mother took care of the kids. Our practice saw people who were not married and raising kids. Single parent families. Families headed by gay parents. Agencies saw this great variation in families, all of which we are familiar with today.
So leading into the White House Conference on Families, we wanted to be clear on a definition of what we thought a family was, based on what we were seeing. We believed that people who constructed themselves as a family should be regarded as such. We were not trying to establish a standard structure for families; we only said that our job is to help families as they actually exist.
It became a highly adversarial process. The American Home Economics Association stood up with FSAA and said look, family life isn’t really like that idealized assumption everyone has, and if we’re going to help families, we have to pay attention to how and what they really are. Catholic Charities also was vital to the development of the coalition and the White House Conference. These two national organizations understood that families weren’t always traditional in form. Theirs was an important voice because they represented educational and conservative and religious sectors.
The religious right cut its teeth on the White House Conference on Families. They came in droves, arguing against any government activity concerning families. They believed that government might intervene in defining marriage and family, something they saw as defined by unchanging Christian principles. This meant that concern for less traditional family forms was tantamount to official approval. The “nuclear family,” with a stay-at-home mom, children, and a breadwinning dad was to be fortified, not the more varied groupings that were increasing throughout the country. In direct contrast, newly militant feminists were looking for more freedom for women to move beyond marriage and the nuclear family and move into the workplace. Contained within this was also the whole subject of homosexual people. Were they families too?
It was all right out there, and FSAA, family service agencies and other national organizations were right in the middle of it. Our hopes for discussing a rational policy about the kinds of services families needed went out the window.
But the White House Conference on Families was an absolutely fantastic development. It accomplished a lot of things. As we traveled around the country listening to families, I think we were surprised to find that families and communities varied far more than we expected. We thought we understood families, but here were concerns and behaviors we’d never heard before. I think a lot of us realized we had been too removed from the community. The experience made family service agencies much more community-minded than they had been before. There were many categorical programs, but there was no recognition that families were at the center of many of the social issues that concerned these programs. Ever since the conference, you hear politicians talking about what families need and how things affect families. There is a far greater orientation to families.
The 1980 FSAA Annual Report includes this record: “The involvement of FSAA in the White House Conference on Families was deep and rewarding. We shared responsibility for giving families a long overdue hearing and contributed to the development of a realistic agenda for action on behalf of the nation’s family. The testimony of families across the country confirmed what FSAA and its member agencies already believed: American families, although diverse, share many common concerns … families are under severe economic and social pressures … families feel that big government and other big institutions need to pay more attention to their needs … families have a strong instinct for self-preservation and self-help.”
Read the next chapter from A Century of Service.