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The End of Social Work: The Neoliberalization of Doing Good

By Sanford F. Schram and Basha Silverman

Graduate School of Social Work and Social Research Bryn Mawr College

Over the last few decades, the social work profession has been transformed, not just in the U.S., its country of origin, but increasingly in other developed societies where pressure grows to emulate the U.S. in a globalizing world (Ferguson and Lavallette 2006). This transformation is also not limited to a select set of specialties or modalities of treatment. The transformation covers various fields and multiple areas of practice. Further, the animating forces behind this transformation lie outside social work but have engulfed it as part of a broader effort to remake the helping professions more generallymedicine, nursing, psychological counseling, education, and corrections, etc. Social work is being neoliberalized along with just about everything else in our changing society. Neoliberalization is the process by which institutions and their operations are restructured to operate more consonant with market principles (Brown 2003). It is more than privatization; it is marketization. Marketization is where market logic is made central to how an organization works and how its personnel complete their assigned responsibilities. Marketization also changes how outcomes are assessed, including giving greater stress to achieving outcomes more efficiently and giving priority to economic indicators, such as enhancing human capital, increasing employability, improving financial assets, or other gains in economic inputs and outputs. The road to a marketized society is through a disciplinary regime of rewards and penalties to enforce market compliant behavior. The ascendency of market logic is today all pervasive. We read about how parents incentivize children, doctors incentivize patients, insurance companies incentivize doctors, governments incentivize citizens, and all use penalties as a counter when incentives fail (for various examples, see Thaler and Sunstein 2009; Fisher

2009; and Peck and Theodore 2010). Disciplinary regimes encourage the internalization of market logic to create the marketized society. Whether it is time-limited therapy or time limits on housing assistance, reductions in supportive services is a commonly cited dimension of the neoliberalization of social work. Yet, the neoliberalization of social work is not just about reductions in service. It involves more than cost-shifting from the national to state and local governments, or load-shedding from the public to the private sector. The shift is more about replacing the repudiated old social work approach to helping clients, whether in drug treatment or welfare-to-work programs, with what is commonly called the business model. Neoliberal disciplinary regimes pressure social workers to do more with less while insisting more on clients accepting responsibility for their problems. It includes enlisting communities to discipline themselves, recruiting community members as case workers who monitor and discipline other community members who are the clients. This is what Cathy Cohen (1999) calls advanced marginalization and it is perhaps the extreme form of devolution. This extreme devolution is designed to get clients from the community to discipline themselves which is in many ways the ultimate form of privatization. With the radically devolved and privatized system what was previously seen as a social or public problem is now often increasingly seen as a matter of local and personal responsibility. The increasingly popular solution under this sort of devolved and privatized system of neoliberal social work is to use incentives and penalties to get clients to conform to behavioral standards. Yet time and again, we can see that sanctions actually loom larger than incentives since they save money. Whether it is sanctionsi.e., financial penaltiesfor failure to comply with welfare-to-work rules or evictions from public housing due to violations of zero-tolerance

policies regarding tenant behavioral requirements, a more disciplining regime is part and parcel of the neoliberalization of social work. Across the disparate areas of social work practice, the disciplinary approach encourages reducing social problems to personal troubles in ways that make them amenable to medicalized treatment. Extended reliance on cash assistance, or even housing assistance for that matter, is seen as a dependency subject to medicalized treatments that instruct clients in how to respond to disciplinary incentives and penalties so that they become more personally responsible for managing their personal deficiencies. An economistic-therapeutic-managerial (ETM) discourse re-describes the problems most fundamentally associated with poverty as problems of personal deficiency that are to be solved by disciplining clients to learn to be more personally responsible in cost-efficient ways and to manage their needs by learning to be more effective market participants (Schram 1995). The neoliberal disciplinary regime relies on new organizational forms, managerial tools and staffing patterns. Social work has always been practiced in diverse organizational settings; and in the United States there has always been a mixed system of social provision, with both public and private agencies providing services and treating clients. Further, in these diverse settings, social work has often been practiced by many different people, including some without graduate degrees in social work. In recent years, however, under the banner of the new public management, there has been a decided shift toward privatization with governments increasingly relying on private, often for-profit contractors to deliver social services and treat clients (Kettl 2002). And these contractors often rely on non-professionals for delivering services in a costefficient manner. Whether it is welfare-to-work, drug treatment, housing assistance, child welfare, domestic violence treatment, programs to assist the elderly, residences for the homeless,

the disabled, mentally or physically, and most especially various forms of counseling for what is now called behavioral health, more and more people practicing what had previously been recognized as the craft of social work in privatized agency settings where criteria for good performance are more determined by contractual obligations and performance management systems than professional standards. While privatized agencies have certain advantages, including being able to operate more flexibly than public agencies that are bound by government regulations and civil service laws, these agencies are much more likely to emphasize the economic bottom-line and will pursue cost efficiencies to the point of reducing the quality of care concerning their treatment of their clients. Through it all, frontline workers increasingly are likely to think of themselves as more employees for a corporation than social work professionals who are committed to serving the community. Privatized agencies where social work gets practiced increasingly are in competition with each other for public and private sources of contract funding. While often grants require community collaboration, agencies recognize they are competing for scarce dollars. Under these conditions, innovations get treated more like industrial trade secrets than community resources. The neoliberalized workspace of the privatized agency poses further risk for social workers to serve the ends of social justice on behalf of the community. Social work is increasingly an epithet used to repudiate as outdated practices that are seen as coddling clients while the business model is the term characterizing the new approach that encourages running agencies more to enforce accountability for costs, measure performance, and discipline clients so that they accept personal responsibility so as to reduce the financial burden they impose on society and increase becoming productive citizens in our society.

In addition to the changed organizational context that is neoliberalizing social work, a new set of managerial tools are contributing to the end of the old social work as we knew it. Evidence-based practice requires frontline workers to use only techniques proven by research to be effective (Floersch 2002; Webb 2001). The idea of evidence-based practice predated more recent efforts at marketizing social work activities, but it has come to be assimilated to the neoliberalization project, where it has played a critical role in reducing treatment options to only those that have proven to produce results in cost-efficient ways. Performance management systems measure outcomes to ensure workers are producing desired result with clients (Moynihan 2008).The growing interest in outcomes measurement however can lead to more and more of social work confronting the similar problems to teachers who increasingly see their remuneration as well as reappointment made contingent upon how well they teach to the test under the neoliberal regime put in place by No Child Left Behind (Whoriskey 2006). While there is nothing in theory that is wrong with using the new analytic tools for achieving most cost-efficient operations, a problem arises in the context of an ongoing neoliberalization that makes market compliance the overriding goal. Then, efforts to achieve other equally or even more important goals, such as ensuring compassionate care, or promoting social justice, equity, community and solidarity, fall by the wayside. The new analytical techniques put in place a bottom-line mentality, where cutting costs by disciplining clients becomes king. Therefore, changing organizational forms coupled with new managerial tools are radically revising how social work is practiced across a wide number of specialties with direct effect on diverse client populations. Yet, these are but the medium through which neoliberalization is realized. The form has changed but so has the function. Social work has

always had to struggle with a number of devilish dichotomies concerning client treatment. From the criticisms of Jane Addams on (1902), social work has always been vulnerable to charges of paternalistically telling clients how they ought to conform to societal standards for right conduct rather than listening to clients to better give them what they say they need (Schram 2002). The profession has had to struggle with the tension between disciplining clients and empowering them. Relatedly, this tension has often highlighted another between changing the clients behavior rather than working to restructure society. A related tension is between working for long-run change to realize a more socially just society versus helping clients in the short run fit into the existing society. Neoliberal social work practice has reduced these tensions in favor of the latter. Today, neoliberal social work is decidedly more about disciplining clients to be able to function in the existing society on its terms, rather than empowering them to be able to work for change to a more socially just society. We work now for client compliance more than trying to change social structures to better include and accommodate clients. And we are more likely to demand compliance in spite of the differences clients present that make them look as if they are noncompliant, nonconforming, difficult or just plain different people who violate basic social norms. Nonetheless, neoliberal social work talks incessantly about empowerment. Yet, it is as if this is a sign that neoliberal social work in Shakespearean terms doth protest too much, highlighting how it wants its disciplinary practices to be seen as forms of empowering clients (Cruikshank 1999). Empowerment to become included in a society that still slots you at the bottom and pushes you to the margin as less than a full citizen, less deserving of respect or even entitlement, is the ultimate example of Giorgio Agamben (1998) calls the paradox of inclusion (also see Handler 2004).

Social work today comes to be but a handmaiden to enforcing this paradox of inclusion in the neoliberal society. Much of social work practice today is focused on behavioral management designed to help clients fit into the existing order but perhaps only marginally or tentatively, whether it is by virtue of limited counseling sessions with pharmacological solutions added on, questionable housing placements to return patients to the community, shelters but not permanent housing for the homeless, low-wage work for the poor, or marginal life skills, like the ones that can be gained from financial literacy classes. Should clients require too much attention and expense they become vulnerable to being left out under the new slogan of reducing bad best and removing bad apples (Schuck and Zeckhauser 2010). The neoliberal disciplinary regime seeks to discipline clients that can be cost-efficiently included in the social order even if their inclusion is at best marginal. Again and again, we can see this trend whether it is in mental health, housing, employment or many other areas where social work is practiced with clients who confront significant personal challenges often not entirely of their own making. The disciplinary turn wrought by the neoliberalization of social work represents nothing less than the end of social work as a profession dedicated to achieving social justice for its clients. The end of social work implies both its terminus and its animating purpose. The end to the old social work way of doing things is to suggest the beginning of a new social work grounded on the business model. If the old social work is ending, a new social work is beginning. Its animating purpose, increasingly seen in a wide number of practices and across a number of areas of treatment for diverse populations, is then to enforce market compliance, promote market logic, discipline providers and their clients alike to be competent market actors, all in the name of fulfilling the ideological ends of neoliberalism as the reigning philosophy for championing a market-centered society. Social work is but one casualty in the neoliberal firestorm overtaking

organized society. Yet it is a poignant one that demonstrates how far neoliberalism can take us from concerns about social solidarity, community, compassion and care, all of which are pushed to the side in the rush to neoliberalize. The foregoing is the argument we will defend in full in a book with the same title as this paper. A sketch of the books analysis offers the following outline. After an introduction that draws heavily from this paper, we start in the second chapter with showing that social works history has proven to be fertile ground on which to marketize a helping profession that ostensibly had non-market principles at its core originating impulses (Specht and Courtney 1995). Undoubtedly, social works history made it vulnerable to neoliberalization. Historically, it has been troubled as a fragile profession, predominately practiced by women (if often dominated by men), who were often castigated as acting on the basis of emotion and without reasoned, rational, scientific foundation for their practices (McPhail 2004). Consistently, if episodically, the social work profession would fall into debates of self doubt, casting about for a scientific base or some other foundation on which to legitimate itself as a profession that has a coherent focus and distinctive but validated set of practices (Ehrenreich 1985). Such vulnerability has proven to be a most inviting environment for the infiltration of neoliberal ideas. Social work is now in the current era keen to prove its market compliance as part of its quest for professional legitimacy. Serving the ends of marketization replaces the ends of achieving a social just society. It is the end of social work as we knew it. We follow this history of social work with a third chapter that surveys changes in the education of social workers, highlighting how curricular change, including deskilling and the proliferation of alternative degrees, has both reflected and promoted neoliberalizing impulses. After surveying the neoliberalization of social work curricula, our analysis moves in the fourth

chapter to focusing on how students are changing in composition and in how they identify when going into the field (labeling themselves most often not as social workers, a trend suggestive of the neoliberalization process at work in the profession). In the fifth chapter, we begin our analysis of case studies that are designed to show the similarities associated with putting in place a neoliberal disciplinary regime across different fields of treatment and service provision. We rely on Bent Flyvbjergs (2006) idea of the critical case study for contrasting examples across different areas of social work practice. These examples are not meant to be representative but instead provide distinctive instances that highlight the key dimensions of the neoliberalization of social work practice in each area. We start at the clinical end of service provision drug treatment to demonstrate how the replacement of the old social work approach with the neoliberal business model has deleterious consequences for both counselors and clients alike. In the sixth chapter we move to wraparound services for troubled youth as an example of the medicalization of social problems by contract agencies paid to designate the medical necessity that justifies insurance reimbursement. We focus on the attendant disciplinary approach to treating these disadvantage youth that flows from medicalizing personal behavioral problems to the neglect of dealing with the social sources of their difficulties. In the seventh chapter, we examine changes in housing assistance with special attention to how an asset-building approach is illustrative of disciplining the poor to practice personal responsibility. We point to the growing emphasis on financial literacy as a tool for getting the poor to be more market savvy citizens as if this enables them to overcome financial destitution. Chapter eight examines the changes in welfare policy implementation as an example that encompasses all of the key features of the institution of the neoliberal business model: organizational forms, staffing and client treatment. We conclude with

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the beginnings of a discussion about getting beyond neoliberalization in the name of doing good for clients and communities in a post-neoliberal way. In this paper, we provide a short historical overview to inform an analysis of how a neoliberal disciplinary form of practice is overtaking the profession today. We then turn to indepth case studies from our larger project to contrast the neoliberal changes in organization and practice in drug treatment and welfare-to-work. We choose drug treatment from chapter five and welfare-to-work from chapter eight to highlight how the neoliberal wave is washing over highly disparate forms of social work practice located at polar ends of the service continuum. In this way, we suggest the wide reach of the neoliberal disciplinary approach. In the process, we show how neoliberalization involves a circuitry where welfare policy gets medicalized and drug treatment programs get welfarized. The poles of social work practice operate as relays sparking change across the profession to intensify the disciplinary dimensions of practice in each area to focus on the promotion of personal responsibility as the key to solving social problems. We conclude by discussing the ways in which neoliberalisms paternalism has become the latest way of blaming the victim for his or her problems. THE PRINCIPLE OF SUBSIDIARITY: THE PALL OF THE CHURCH Father David Bosnich, a priest in the Byzantine Catholic Church, wrote in the magazine Religion & Liberty in 1996: One of the key principles of Catholic social thought is known as the principle of subsidiarity. This tenet holds that nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization. In other words, any activity which can be performed by a more decentralized entity should be. This principle is a bulwark of limited

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government and personal freedom. It conflicts with the passion for centralization and bureaucracy characteristic of the Welfare State. This is why Pope John Paul II took the social assistance state to task in his 1991 encyclical Centesimus Annus. The Pontiff wrote that the Welfare State was contradicting the principle of subsidiarity by intervening directly and depriving society of its responsibility. This leads to a loss of human energies and an inordinate increase of public agencies which are dominated more by bureaucratic ways of thinking than by concern for serving their clients and which are accompanied by an enormous increase in spending (p. 9). While we might be tempted to unreflectively accept the popular idea that social workers are leftists who unquestioningly embrace the need for a social welfare state, the history of social work suggests a more complicated story. In fact, social works own origins in the church suggest that contemporary applications of the principle of subsidiarity have relevance to understanding how the history of social work makes it distinctly vulnerable to neoliberalization. The priests of medieval Europe ministered to both the body and the soul of the poor with an eye on realizing the moral person (Illich 1982). The early friendly visitors of the often-church affiliated Charitable Organization Society chapters in U.S. cities and towns of late 19th Century America were perhaps more keen to paternalistically teach moral principles to impoverished immigrants than they were to provide material aid (Addams 1902). The early 20th Century debates between COS leaders and people like Jane Addams from the settlement house movement put the tensions in the field in stark perspective. While the settlement house approach was more grounded working with the community rather than imposing values from the outside, both COS and

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settlement house leaders were interested in improving the poor (Katz 1997) by teaching them better ways of living (Boyer 1992). In other words, social work has from its inception embraced the principle of subsidiarity: it is better to get clients to be self-sufficient than to make them wards of the state. Social works history includes the longstanding preoccupation with distinguishing the deserving from the undeserving poor and social workers continue to be caught up in practices that slot people into categories that determine whether they deserve treatment that is designed to ensure they will practice the personal responsibility that makes them deserving. Moral instruction of a paternalistic sort has cast a long pall over the profession that continues today in a neoliberal guise. Periodic campaigns to rid the profession of its moralistic roots dot its history and continue today whether it is in the strengths perspective (Rapp 2007) that emphasizes clients strengths rather than personal deficiencies as the focus for treatment or the stress today on culturally competent social work practice that resists paternalistically imposing the professionals values on clients from diverse backgrounds (McPhatter 1999). Yet, these waves of reform of social work practice have proven necessary because the profession s bedrock remains categorizing clients, separating the good from the bad, and no more than previously, investing time in primarily in the clients who can be treated cost-efficiently. These enduring preoccupations reflect a legacy of paternalism wrought from the principle of subsidiarity. As social work organized into professional associations in the early 20th Century, it was decreasingly associated with the church, but not necessarily more associated with the state. Instead, its leaders were more interested in establishing professional legitimacy by showing it was a profession founded on explicit organizing principles, a distinctive knowledge base, and a unitary form of practice that all social workers were trained to enact regardless where they

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practiced (Ehrenreich 1985). And the result was an orientation that suggested social work was more about changing individuals to fit into society than the other way around. The COS approach won more of the battle while settlement houses lost most of it. Casework with individual clients and families increasingly won out over community organizing of the settlement house movement and in many ways it came to be seen as the core practice of social work. Casework, especially when informed by psychology, or even psychotherapy, was often seen as the more professional form of social work practice. The settlement house approaches lived on with the professionalization of social work but, other than a resurgence for community organizing in the 1960s, it has remained the marginal side of the profession (even if President Barak Obama himself was a community organizer) (Specht and Courtney 1995). Social work historically has been vulnerable to proving it is a profession that can help the disadvantaged and marginalized get integrated into the existing society more so than by showing it has the tools to change that society (Cloward and Piven 1975). By the mid-20th Century, social workers were disproportionately women, adding further pressure to prove that they were not just acting on emotion out of compassion for the disadvantaged and marginalized (McPhail 2004). The gendered nature of the profession has intensified interest among its members in demonstrating that it has an objective scientific base for dispassionate, reasoned practice. The profession inevitably turned in that direction. Evidencebased practice is the idea that practice in any profession ought to be grounded in the best available research that indicates the effectiveness of any particular treatment, intervention, service, etc. (Floersch 2002; Webb 2001). Evidence-based practice has its origins in medicine but over the last several decades has spread to other allied helping professions, including social work. The literature on the strengths

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and limitations of evidence-based practice in social work is legion. The idea of evidence-based practice persists in medicine, however, where more ominous neoliberal research is now emerging (Elliot 2011). Marketized research is the new frontier. The merging of marketing and research is something that is only now beginning to be discussed in medicine (Fisher 2009). Seeding trials pay doctors to recruit patients as subjects for drug tests, serving to market the drug to doctors. The mixing of marketing and research often is done to the detriment of the latter. This bad research can often have adverse effects for patients who get recruited to the trials because they are interested in accessing free medicine when they lack insurance coverage (Yearby 2011). Even the institutional review boards relied on to authorize these trials as consistent with federal requirements for ethical research are increasingly for-profit contract agencies that cannot be seen as too strict or drug companies will seek out competitors to gain authorization. These developments raise the possibility of the neoliberalization of research itself as part of the threat associated with the marketization of the helping professions writ large. While market-driven research still lies ahead on the horizon for neoliberal social work, we already can see that research, not contaminated entirely by marketing considerations, is now the touchstone of a social work profession that is now heavily dependent on outside funding. Research undoubtedly has the potential to be helpful in improving the knowledge base for various forms of social work practice; and it can contribute to needed perspective that is not limited to narrow focus on cost efficiency achieved by disciplining clients to accept more responsibility for their failure to be productive members of society. Yet, this narrow focus predominates today. Managed care is but a symptom then of an underlying impulse to neoliberalize the helping professions by getting them to monitor and discipline clients in cost-efficient ways so that those clients not only become less of burden for the rest of society but then can better integrate into the

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existing society, including the market. Proponents of this orientation suggest it not only promotes program integrity but does so in a way that will resonate with the cost-conscious taxpayers. Research is increasingly used to promote savings in ways that involve triaging clients. As Shuck and Zeckhauser (2010) insist, good public policy involves not wasting money by avoiding bad bets [and] removing bad apples. Yet, there is no gainsaying the fact that, in spite of all the travails of evidence-based practice in medicine, the social work professions leaders are interested in demonstrating that social work practitioners are themselves just as much as doctors practicing evidence-based social work. Evidence-based practice is being used in part to repudiate the idea that the profession is a collection of bleeding heart liberal women who operate on the basis of emotion out of blind compassion for their clients, irrespective of the proven effectiveness of their practices. Evidencebased social work today serves other important legitimating functions. As social work has lost much of its energy in working for broader structural change, more and more social workers are hired to treat clients, often with various forms of cognitive and behavioral therapies. Social workers have not just moved away from working in community agencies designed to change the structure of power and reallocate resources. They have shifted to being frontline workers whose main goal is to help individuals overcome personal deficits so they can better function in society (Wakefield 1988). Clinical social workers engaged in this sort of client treatment are providing counseling services funded through third-party reimbursements from health insurance providers, including the governments Medicaid program for the poor. Whether it is managed care agencies that decide whether the treatment qualifies for private health insurance reimbursement or other decision-makers associated with government or foundation funding, evidence-based practices are what is likely to be funded and only to the extent to which the decision-makers think it is cost-

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effective. Time-limited therapy is but the most widely cited example of this approach to grounding practice in research in the neoliberal era (Harris 2011). Insisting on research-based efficiencies is but the beginning of the neoliberalization. Moving beyond cost shifting from the federal to the state and local governments, and beyond load-shedding from the public to the private sector, focus turns to using rewards and penalties to incentivize behavior (Thaler and Sunstein 2009). The neoliberalization of social work most fundamentally involves the shift to a business model that puts in place a bottom-line orientation within an agency that ultimately relies on rewards and penalties to impose a disciplinary regime for client treatment. The business model increases pressure to engage in creaming by focusing on working with clients who will succeed while ignoring those who will fail (ala avoiding bad bets, removing bad apples. By discipline, we mean not simply punishment but the calculated use of rewards as well as penalties to incentivize market favorable behaviors. There are therefore two significant dimensions to this shift: (1) growing reliance on disciplinary practices; and (2) the increased use of them to cost-efficiently promote market consistent behaviors. Both dimensions represent a significant shift away from more supportive form of social assistance that social work has historically tried to justify, if in ways that laid the groundwork for its ultimate neoliberalization. The principle of subsidiarity evidently has cast a long pall over social work extending well beyond its time when it is originally rooted in the church. Today, whether it is the elaborate behavioral rules in a homeless shelter or a drug treatment program, or even group therapy for drug treatment in a homeless shelter, or, for that matter, any number of other areas of social work practice, the disciplinary regime of neoliberalism is a visible feature of that practice venue. And it is less than ironic that faith-based treatment programs that impose behavioral standards in mantra-like fashion on their clients have

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been evaluated favorably in the evidence-based literature (Hodge and Pittman 2003); and the disciplinary approach of those faith-based programs has become a standard for other drug treatment programs (Gowan and Whetstone 2011). To choose but one poignant example, the continuing popularity of recovery houses where addicts go upon release from prison is perhaps the extreme version of the neoliberal disciplinary regime in action today (Fairbanks 2009). Recovery houses demonstrate the lasting influence of the principle of subsidiarity. These houses are most often private homes converted to house multiple ex-felons to have a place to live while in treatment as a condition of their probation. The residents give their welfare checks and food stamps to the manager (often a recovering addict him- or her-self) in exchange for living in the residence. Recovery houses became popular as the public welfare state eroded, welfare benefits declined and group homes and other state-supported services declined. With few funds, recovery houses fall back on a strict disciplinary rule-bound regime for residents, including a tightly scheduled day starting from time-limited early breakfast to strict lights-out requirements at the end. The rule bound regime is designed to instill discipline and keep residents on the road to recovery by focusing on the need to develop personal responsibility. In the shadow of a vanishing public welfare state, a neoliberal, privatized network of unregulated recovery houses emerges to fill the void. In the face of dwindling public services a disciplinary regime of personal responsibility rises like the Phoenix from the ashes. Neoliberal marketized disciplinary service provision grows not so much because it preferable but as the last standing alternative to the waning of the welfare state. Today, in the neoliberal era, it is distinctly possible that we honor the principle of subsidiary by default more so than religious fervor, giving new meaning to the idea of faith-based services. Yet, it might take more than hope before neoliberal social work becomes a socially meaningful practice. In the interim, it might just mean

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the end of social work as we knew it and the beginning of a new kind of social work that has more market-oriented goals as its implied ends. NEOLIBERALIZING DRUG TREATMENT While a neoliberal disciplinary regime rises with the recovery houses that have popped up given the erosion of the welfare state, the drug treatment programs serving the ex-offenders living in those recovery houses and others have undergone their own neoliberalization along with other areas of what has been conventionally venues for social work practice. These programs are now privatized and focused on disciplining clients in a cost-efficient manner so that they become compliant workers on the bottom of the occupational structure. In the process, the disciplinary regime that has helped medicalize issues like poverty and welfare dependency and it has in turned helped welfarize areas of clinical practice such as drug treatment. The seemingly polar ends of the social work continuum, the clinical that aims to frame social problems as personal troubles and the social end that seeks to create economic opportunities for the poor, now increasingly share a similar focus. Medicalization from one end and welfarization from the other meet in the neoliberal disciplinary regime that emphasizes cost-efficiently making clients accept more personal responsibility for their plight. By medicalization, we mean the process by which a problem is characterized as a pathological condition that requires medical treatment, such as when welfare dependency is treated as analogous to other dependencies such as a chemical dependency (Conrad 2007). By welfarization, we mean the process by which a program comes to be focused on disciplining clients to accept their personal responsibility to achieve selfsufficiency such as when welfare is reformed to be welfare-to-work program that includes incentives and penalties to move recipients from welfare to work (Soss, Fording and Schram 2011). By examining changes in the organization, management, staffing and practice of both

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drug treatment and welfare-to-work, we will provide evidence that they are neoliberalized in similar ways with troubling consequences for practitioners and clients alike. We start with drug treatment by examining what is happening in one state, Delaware. In the United States, substance abuse treatment provider organizations are typically licensed, funded, and monitored by a state agency. In Delaware, it is a single state agency within the Delaware Department of Health and Social Services (DHSS) known as the Division of Substance Abuse and Mental Health (DSAMH). DSAMH, like similar state agencies, is subject to federal mandates that funds be used efficiently. DSAMH and other states drug treatment units, manage those federal funds while being responsible for training, technical assistance and outcome oversight of contracted providers. The Federal Government has been active in the dissemination of guidelines and reports insisting on the utilization of measurable evidence-based practices (EBPs) and scientifically based treatments, it is the responsibility of each state to ensure that these recommendations are implemented and measured. In 1999, NIDA (National Institute on Drug Abuse) published a guide Principles of Drug Addiction Treatment describing 12 efficacious scientifically based treatment approaches. In 2006, The Institute of Medicines (IOM) Report, Improving the Quality of Health Care for Mental and Substance-Use Conditions identified a critical need for quality and measurement improvement of healthcare provisions within both mental health and substance abuse treatment (IOM 2006). As a result, performance measurement contracts have become commonplace. These models are used to enhance the quality of substance abuse treatment services, with a specific neoliberal focus on the use of incentives or rewards. 1

Some example of neoliberal models of service delivery from outside substance abuse treatment include: (1) the Local Initiative Rewarding Results project uses health plan provider and member performance incentives to increase participation in well care and improve related health

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Drug treatments relationship to the health insurance system has undoubtedly provided a conduit for innovations in medicine to seep into its practices. The broader medical field has in fact adopted similar practices, such as Medicaid programs incentivizing primary care providers who assist their patients in illness management by awarding end of year bonuses when costs (even projected) of expensive chronic illnesses such as diabetes can be reduced. This system of reinforcement has been referred to as provider contingencies (McLellan, Kemp, Brooks and Carise 2008). The use of incentives and rewards is not new to the field. It has been used effectively to change individual client behavior. According to Higgins and Petry (1991), contingency management, a treatment model where patients receive rewards based on their behavior, such as adherence to program rules and achieving treatment goals that are reinforced with incentives and sometimes even punished for non-compliance, has become one of the most effective treatment strategies applied in drug treatment. What is new is its application to treatment providers, where funding sources are now using this system of behavior modification on the agencies they contract with to perform the services. The neoliberalization process extends contingency management to incentivizing providers to act more like private for-profit agencies in competition with each other. More broadly referred to as purchasing levers, incentives are viewed as successful delivery strategies for value-based financing of drug treatment that maximizes the states

outcomes; (2) a Community Health Network of Connecticut initiative to improve Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program participation rates is using friendly competition and weekly prizes for overall staff effort; and (3) a Partnership Health Plan initiative to ensure appropriate asthma medication usage among members uses physician/staff training on asthma education, personalized beta-agonist reports for physician practices, and recognition in quarterly newsletters (Maron, Daigle and Gueronniere 2005).

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purchasing power to ensure high quality services (Marton, Daigle and de la Gueronniere 2005). While there are several types of purchasing levers used to ensure accountability, service coordination and improved outcomes, there are only a few most commonly adopted to also encourage the implementation of evidence-based practice (EBP) in the field of substance abuse treatment (Marton et al. 2005). Many states have indicated the use of performance incentives to improve service provider behavior in general; however, only a few states report using financial incentives (Marton et al. 2005). These commonly used purchasing-lever strategies include policies that mandate the utilization of EBPs, policies that mandate the utilization of a specific EBP as a contracted requirement, or financial performance incentives (Marton et al. 2005). According to a report produced in 2003 by Join Together, a policy panel at the University of Boston School of Public Health, the panels primary recommendation is that purchasers of treatment services should reward results - an idea that is very consistent with other leading edge efforts to improve the quality of health care for other diseases (Join Together Policy Panel 2006). In this context, Delaware represents a leading-edge state to neoliberalize drug treatment. In response to the federal pressures to attain fiscal accountability and improved clinical management, Delawares DSAMH took a cue from other local government agencies that provide fiscal oversight to contracted private providers. DSAMH looked to the Department of Transportation whose contracts included provisions for payment incentives and financial rewards for contracted work completed ahead of schedule as well as penalties for failing to meet contracted deadlines. Additionally, while those contracts did include specific standards, they also allowed the contracted provider to determine the methods actually used to complete the

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work, thus fostering creativity and ingenuity. That same thinking was applied to the purchase of the addiction treatment services in Delaware (McLellan et al. 2008). In Delaware prior to 2001, all substance abuse treatment provider contracts had been based on cost-reimbursement or fee-for-service. All costs were calculated based on the costs associated with the specified level of treatment (outpatient, inpatient, etc.). These contracts did not include reward or penalty provisions. Additionally, DSAMH was committed to the adoption and implementation of EBP. Even though DSAMH held several trainings on a variety of different EBPs to help encourage widespread practice among providers, there was no way to enforce their implementation or hold providers accountable for improving client outcomes. In 2001, Delaware changed their payment process; an experiment with their outpatient treatment providers by creating performance based contracts (McLellan et al. 2008). Outpatient substance abuse providers became eligible for positive incentives such as additional dollars, and penalties such as loss of dollars. According to Jack Kemp, a leader in neoliberalizing drug treatment administration in Delaware, this approach was adopted to test whether or not financial incentives for better program performance might offer the conditions under which the adoption of new evidencebased therapies might be feasible and indeed a good business investment (McLellan et al. 2008; Stewart 2009). Only two states have used incentives-based payments in addiction treatment, Maine and Delaware. In Maine, from 1992 through 1995, the Office of Substance Abuse changed its feefor-service contracting procedure to include penalties for not meeting the contracted measures such as improved employment levels, decreased arrests, and increased abstinence. This effort was aimed at identifying and motivating programs that were performing poorly. By 2002,

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Delawares contracts included significant financial incentives for meeting or exceeding target areas and financial penalties for failing to meet them (see McLellan et al. 2008). DSAMHs effort to improve accountability and effectiveness included behavioral contingencies in the performance contracts between the DSAMH and outpatient drug treatment providers. These contingencies were based on the providers ability to attract, retain, and graduate outpatient drug treatment patients. Additionally, these contracts included requirements for the provider to use evidence based models. These performance contracts did allow some flexibility for the contracted provider to select an EBP but enforced a prescription of shared goals. The funds would then be tied to the agreed upon indicators (McLellan et al. 2008). Within this neoliberalized contracting system, Delaware became a leading-edge state that moved to a performance management accountability system. Recommendations made in the 2006 IOM Report, Improving the Quality of Health Care for Mental and Substance-Use Conditions, acknowledged the importance of permitting states to redesign their original grantbased financing systems but that they do so incrementally. This would include adding specific goal oriented performance measures (IOM 2006). By 2006, in Delaware, a new set of managerial tools had not only been suggested but also required in the provider contracts to mandate the implementation of performance measurement and evidence based practices. These new conditions led to innovations being treated more like trade secrets of the forprofit business model than just use of community resources. In Delaware, it was imperative that the new performance measurement system designed to alter the managerial practices of providers was rolled out with providers who had the infrastructure to support such changes and requirements. The goals: 1) improve performance; 2) monitor performance; and 3) improve outcomes. While there was flexibility for the programs, the tenets outlined to ensure success

24

included time limited and measureable treatment, appropriate level of care also referred to as treatment dosage and the use of evidence based techniques (McLellan et al. 2008). Programs were rewarded for achieving three goals. (1) Engagement and Utilization: demonstrate increased client admission and engagement. If the program met 90% of their utilization goal, they were rewarded 100% of the contract amount. If less than 90% was achieved, deductions to the contract amount were made accordingly. (2) Active participation: required attendance is dictated by the specified number of sessions in the EBP and varies based on the stage of treatment. Incentive payments or bonuses were made for exceeded this goal with a maximum of 5% over target. (3) Program Completion which includes graduation, abstinence and achievement of treatment goals. An additional financial incentive was paid for each graduation with a maximum limit in each contract (McLellan et al. 2008). The neoliberalization process was furthered by private funding. From 2006-2009, the State of Delaware took part in the Robert Wood Johnson Foundation's (RWJF) Advancing Recovery: State/Provider Partnerships for Quality Addiction Care national initiative (http://www.advancingrecovery.net/Home/Home.aspx). This initiative represents cooperation among the Network for the Improvement of Addiction Treatment (NIATx), the Treatment Research Institute (TRI) and the Robert Woods Johnson Foundation (RWJF). The goal was to restructure existing administrative and clinical systems for drug treatment to produce more successful outcomes. Delaware was one of six state-provider partnerships that participated in a learning network that provided tools to improve the delivery of addiction treatment. This initiative provided funding opportunities for local programs to receive technical assistance to improve their systems to remove barriers to treatment entry and retention. The project promoted the use of evidence-based clinical practices through innovative partnerships between substance

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abuse treatment provider organizations that deliver care and single state agencies. This group of technical assistance providers brought strategies from the business model for making changes at both the state and addiction treatment service providers to implement evidence based practices. These external changes led to obvious internal modifications to traditional service delivery. With increased pressure from funding agencies for greater accountability and effectiveness of prevention and intervention programs, there is a rising demand for program quality, and evidence of that quality; demanding the use of EBPs. There is a new pressure to adhere to specific methods and techniques and demonstrate professional competency as measured by achieving performance management outcomes since funding is now tied to performance measures. As a result, working with clients has changed to emphasize achieving the specific outcomes related to performance measures. While drug treatment clients have always been held personally accountable for their choices, even once addiction was determined a chronic disease, there is now pressure on the agencies and their staff to enforce such contracts on clients. With competition for funding ever rising, it is imperative that drug treatment providers are continuously learning the newest EBPs, using all the right jargon, and training their workforce in the next greatest life changing model being popularized at any one time, as new models are introduced every few years. Applicant providers must demonstrate they have the capacity and knowledge to implement the proposed model. This includes the mention of the latest buzzwords related to the empirical research support and assurance that their agency personnel have been appropriately trained. This can lead to funding awards and contracts that pigeon hole the agency and the staff into using the one specified EBP they proposed to do.

26

This is extremely problematic for several reasons. With the threat of losing money, suffering penalties for not performing, there is intense pressure to train employees in the new model. First, agency personnel are forced to attend training resulting in lost time necessary to manage high client caseloads. Second, trainings often cover only the basics leaving out the details necessary to effectively apply the models to practice. Third, the training itself is very expensive and often offered only one time over only one or two days. Finally, very little money is ever invested in follow up training, including training for key issues like supervision, to ensure the EBP is properly implemented. When an agency is pressured to show they are using the EBP, this inevitably puts pressure and anxiety on personnel who are then forced to implement it regardless of their preparation to do so. Government involvement in the provision of drug treatment to ensure that local providers are using the most cost-effective interventions is a development that has reduced needed flexibility in the treatment of clients. Drug treatment counselors are handcuffed to the prescribed intervention models, their time is measured, their notes are audited and their client sessions are nearly scripted. When treatment providers propose to implement a specific EBP they are then required to apply the associated prescriptions and proscriptions (time limits, scripts, etc,) universally as the course of treatment for all of the individuals served within a given program. This practice robs the social workers from using their professional discretion and forces them to work within the limits of their power and control, which has already been established by the funder. When an agency selects new EBPs, there are changes in service delivery patterns, program designs and paperwork that inevitably reflect the focus on the next great thing. This creates a great deal of confusion and anxiety among the staff. On the one hand, they are taught to

27

be client centered and treat each client individually while simultaneously being expected to deliver the one intervention (as if it is one size fits all) to all clients. This could have obvious devastating effects on the client. Alternatively, when a clinician becomes totally entrenched in one model, he or she begins to always apply it and when it does not work they are at increased risk of blaming the client calling the client non-compliant or resistant to treatment (see Gowan and Whetstone 2011). An alternative but equally problematic result can have negative consequences for the clinician. When and if a clinician realizes that the one size (meant) to fit all EBP will not work for a particular client they become concerned that they will be penalized for not utilizing the EBP leading to anxiety or even falsifying of records, forcing an outcome or at least documenting one when it is not really there. Even if the counselors wanted to explore more of their clients environmental obstacles, there is no time in the session to do this when the sessions are designed to include clinical talk therapy only. Today, drug treatment providers are faced with a myriad of workforce issues in general such as an insufficient workforce to meet the increasing demands for drug treatment, an increased utilization of medically assisted therapies such as Suboxone, Naltrexone, and Vivitrol in addition to methadone, on-going challenges related to stigma associated with drug addiction, and the shift to mostly public funding for drug treatment. Yet, the most pressing issue has been highlighted by the Mid Atlantic Addiction Technology Transfer Center, funded by SAMHSA, in their 2010 report titled Addressing Workforce issues: the pressure to use performance and patient outcome measures and the use of EBPS. In addition to the enormous burden on the staff to operate within the new financial constraints associated with a system of rewards and penalties that creates an overwhelming burden without sufficient resources to manage the ever increasing

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demand for treatment as mentioned, there is equal pressure on the provider to hire and train qualified staff while still saving money. When agencies are under pressure to perform with limited resources, they respond like all businesses do. How can they get more for less? How can they get the most bang for their buck? While the delivery of life saving interventions such as evidence based drug treatment would seem like something worth investing not only dollars but the time and resources to support the most qualified clinicians, an agency under economic pressure must make tough decisions. When it makes the best sense to get the most highly trained from the best schools with the most experience but it costs less to get a lesser credentialed or newly minted clinician the decision is made. As long as they have the minimum credentials necessary for billing, they are hired. This practice of skimping on workforce quality can have devastating effects on client care, staff morale, and agency practices. In addition to the economic burdens and challenges associated with serving the chemically dependent, there are additional stressors on the field in general. There is a great deal of emphasis on treating clients with what is referred to as co-occurring disorders. Over the last decade, there has been greater awareness and understanding, albeit many questions still exist, around the idea that individuals suffering from chemical addiction are often simultaneously challenged with other mental illness such as anxiety and depression. This is now referred to as co-occurring or dual diagnosis. Given the complexity of client problems, it remains troubling that the majority of professionals who work in drug treatment are counselors with associate or bachelors degrees in counseling or human services. The majority have certifications in the field accredited by their local state addictions certification board. There are often very few licensed folks or social workers with masters degrees. Directors and managers are typically folks

29

who climbed the career ladder while working in the field, moving from counselors to supervisors. Very few treatment programs have full time doctors, nurses, psychiatrists and psychologists. Neoliberalization has intensified the challenges in staffing by simultaneously routinizing the casework and insisting that counselors be skilled in the latest EBPs. The complexities of staffing with neoliberalized drug treatment are demonstrated in the case of the movement to behavioral health. In an effort to compete for limited public resources and at the same time remain eligible for a wider variety of grants and funding sources, the drug treatment field has begun to pay closer attention to how it is perceived. Rather than fighting stigma, drug treatment has taken an alternative position by re-branding itself as behavioral health. This term is strategically used by drug treatment providers to position their eligibility for funding from the state and reimbursement by Medicaid and private insurers. More and more provider administrators are working hard to identify and repackage themselves as behavioral health providers with marketing efforts similar to those used in big business to shed their old reputations that limited their options as the field makes way and prepares itself for health care reform. Morphing the name and the services is suggested necessary to stay in business. With health care reform and parity for mental health and substance abuse treatment there will be increased pressure to employ more qualified and well-trained behavioral health staff. With the emphasis placed on qualifying as experts on behavioral health drug treatment agencies are laboring to make it appear as if they are treating clients more holistically, offering more services in one place, and hiring more qualified staff. Staffing challenges reflect the history of drug treatment. It began as a self-help campaign, born out of the 12-step movement and theory that there is great value and efficacy in one alcoholic helping another (Alcoholics Anonymous 1953). Former users began working in the

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field as drug counselors with very little training only life experience. Academia still lacks this formal training; one cannot major or graduate with a degree in addictions counseling. Instead, majors such as psychology, counseling, human services, and social work often include one class on the subject or even worse one course that only covers one week of addiction specific material. While researchers continued to try and explain addiction and find a cure (treatment) by looking at medications to curb heroin cravings or satisfy/reverse ones desire for alcohol, the personnel in the field today are often under qualified to meet the expectations of the outcomes-oriented neoliberal regime. They are often without the tools and resources to meet the real needs of their clients while trying to game the system to get the level of care/treatment dosages that are reimbursable according to contract requirements and insurance standards. The behavioral health approach intensifies these tensions especially given the complexity of problems confronting clients. As these once-were drug treatment centers grow and change as they follow the money trail, all in the name of providing more services to help their clients and provide more holistic services, they are adding more and more in-house programs. These programs can include vocational rehabilitation, primary care, gynecology and family planning, dental services, and art therapy. On its face this seems to be the answer to removing obstacles to improved health outcomes but it could also be dangerous to the clients as well. By offering all services under one roof, there is a risk of sending unwarranted messages to the client, such as this treatment center is the only place where they belong. This type of practice and messaging only affirms stigma, notions of the other, and deviance. All the while, contract agency personnel are stretched ever further beyond the breaking point. In the non-profit sector, this type of cherry picking happens but very differently. Clients are rarely denied treatment. In fact, waiting lists are discouraged when clients do not have

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insurance because the state pays for them in full. In other words, drug treatment administrators are likely to ensure easy access and admission for the uninsured. Additionally, drug treatment administrators may also deny their capacity to do more with less, rather than accommodate a growing demand, because this could send a message to the community and the funding agencies that there is no need for more resources. Meeting the bottom line is the driving force for drug treatment today. Service providers are guilty of creating categories that determine whether or not someone deserves treatment that are based on the bottom line. Administrators determine who is eligible for services based on their ability to be reimbursed for service. For-profit drug treatment agencies are often most interested in the retention of those clients who are privately insured. For example, if a client has a particular private health insurance and this third party payer is known to authorize a longer stay in treatment, the treatment provider may adjust its practices to best accommodate that client. This could include kinder treatment and relaxed or non-enforcement of the rules such as, no punitive consequences for missing group therapy, in an effort to keep the client happy and less likely to leave treatment. There is great financial interest in retaining those clients for the duration of their recommended length of stay. This type of discursive practice also exists in the reverse; when a client is denied coverage they are discharged immediately regardless of whether or not their symptoms persist. Three examples from Delaware underscore these tensions in neoliberal drug treatment today. The first is the movement to drug courts (Gowan and Whetstone 2011). Teresa Gowan and Sarah Whetstone have convincingly demonstrated in their study of a treatment program related to drug courts in Minnesota that this progressive innovation has unfortunately come to include a highly disciplinary form of treatment that has profound stigmatizing consequences.

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Gowan and Whetstone show in stark terms that social work counselors in drug-court treatment programs can be very vulnerable to using the threat of incarceration for clients who are reluctant to accept the disciplinary regimes step-by-step approach to internalizing responsibility for their plight by focusing on becoming compliant citizens who are prepared to take any job even if it leaves them poor. That most clients in the program are black only serves to create more opportunities to blame the victim all over again in racialized ways. Our analysis of the drug court innovation in Delaware adds to this understanding by highlighting how the pressures associated with a neoliberal organizational and managerial context intensify the focus on disciplining clients in the name of demonstrating performance outcomes. Over the years, social work has at times exhibited a striking tendency to problematically reflect the organizational and managerial context in which it is practiced (Ehrenreich 1985). Our examination of the process of arranging drug court-related treatment in Delaware reinforces that perspective. As with other areas of drug treatment innovation, Delaware today is a leader in using drug courts as an alternative to adjudicating people charged with drug offenses. Although drug courts are widely heralded as a progressive alternative to traditional adjudication, in the costsaving, performance pressure context of the neoliberal disciplinary regime, it has become a place for problematic triaging of clients. A key part of the process for deciding the most appropriate course of treatment for drug court clients is an assessment tool called the RANT (Risk and Needs Triage) created by the Treatment Research Institute (TRI http://www.tresearch.org/) that is administered by staff specifically trained to use this diagnostic tool. The staff are located in the Treatment Access Center (TASC) an office within DSAMH (http://www.dhss.delaware.gov/si06/drgcourt.html). The workers assess risk and need to identify

33

appropriate referrals for drug offenders in drug court. This RANT employs a four quadrant matrix divided into High and Low and Risk and Need. When used as directed, the respondent's answers to approximately15 minutes of questioning are aggregated by computer software that determines where an individual falls on a 2 x 2 matrix of Need and Risk (see figure 1). The score is then used to determine the most appropriate level of care or services that should be offered and then provided by a contracted substance abuse/mental health treatment provider. The TASC workers, similar to case managers, also act as the case liaison between the court-ordered drug treatment provider and the courts. They monitor the progress of the clients and provide feedback to the judges and other related criminal justice personnel including the prosecuters, public defenders and probation officers. While TASC workers are trained specifically in this diagnostic and assessment procedure, they often hold only an associate or bachelor's level degree in fields such as criminal justice and human services with limited experience and formal training in clinical assessment and care. As a result, TASC workers assume important responsibilities with limited professional background. They represent an extreme form of neoliberal deskilling. They must assess and refer to treatment while also bearing the burden of providing case management to the clients, who they refer to as defendants, who move through both the criminal justice and drug treatment systems. The ironies of this sort of neoliberal deskilling are striking. Interestingly, when a client is referred to a treatment center that treatment center becomes responsible for their clinical care, monitoring, and reporting treatment adherence, which includes the results of toxicology screens; however, TASC workers still have a stake in their clients outcomes. This can put the TASC worker in a precarious position; they are valued when client outcomes improve and may be considered culpable when clients recidivate. They often carry extremely high caseloads that

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require them to keep track of people who are moving in and out of various centers and systems fairly rapidly throughout the state with an obligation to report their client's successes and failures to the courts. It is in their personal best interest to control their caseloads which can lead to the manipulation of the scores for the purposes of ensuring manageability. Workers who are very familiar with the RANT tool have come to learn how to direct outcome results. For example, client answers to a RANT question that would naturally result in a low score could be manipulated to ensure that the client scores a bit higher (on risk or need) than necessary at baseline. Therefore, outcomes would appear to have improved at follow up. Another example, is when an individual might naturally score high enough to warrant a much more intensive level of treatment but since he/she is a repeat offender the worker might be so frustrated with the individual that they control the score enough to affect his/her eligibility for the program. The pressure to meet performance standards with limited skills and resources while treatment is often beyond the caseworkers control inevitably encourages gaming the measurement system. Our research indicates that since the inception and implementation of this tool, the judges and other court administrators in Delaware are pleased to have an assessment tool that will assist the system in diverting these individuals out of their courtroom and into society with the desire for them to be non-offending and productive. Court professionals recognize the revolving-door pattern that follows drug related arrests; offenders are placed on probation, then in violation of probation they end up court again cycling in and out the criminal justice system. Problemsolving courts such as drug diversion require funding and political support. Therefore, they must make good business sense if they want the support necessary to maintain their operation. Like treatment center providers, court administrators are also under pressure to prove program effectiveness and they believe this tool has the potential to be extremely helpful at reducing re-

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arrests, and violations of probation while increasing successful probation discharges. Positive changes among such indicators are useful in gaining confidence in diversion program effectiveness. Therefore, the pressure to game the system in the face of limited tools to help offenders is only intensified. With high caseloads and low job requirements, TASC caseworkers are already overworked but under trained, making them vulnerable to making subjective choices that determine the deserving versus undeserving (see Lipsky 2010). Neoliberal skimming occurs even in a progressive alternative to the mass incarceration wrought by the War on Drugs. The second example of neoliberalization in Delaware is the newly ignited emphasis on prevention programming. This is also another progressive development being subverted by neoliberal implementation. Prevention programming relies heavily on "street outreach" that has been historically implemented using a peer led approach. In fact, the most widely utilized evidence based intervention used to implement street outreach is known as the NIDA Model: The Indigenous Leader Outreach Model (NIDA 2000). In practice, drug treatment programs hire former drug users who are also from the targeted community to engage active drug users while offering opportunities and referrals for treatment entry. The theory includes the suggestion that when an individual who is ready or even contemplating change meets someone who already did and was successful then they may be more likely to say to themselves if he can do it, I can do it. This recovery model of staffing that relies on former clients has become increasingly popular and has been imported into welfare-to-work and other areas of social service provision (see next section). And while it has the potential to improve agency staff and client collaboration, it also offers the prospect to promote a more effective disciplinary regime via self-policing by target populations.

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Yet, the major problem of utilizing the indigenous leader outreach model is not so much with the theory; instead, it is with its application in a neoliberalized structure. As drug treatment is changing to meet the demands of the market (insurance companies, funders insisting on performance measures being met, etc.), the bottom line it is becoming even more important for agencies to implement best practices such as the most cost-efficient versions of the NIDA model. With more pressure to justify expenses comes a new labeling, credentialing, and even legitimating the outreach worker and forcing new qualifications that are relatively still easier to obtain than a bachelors or associates degree. The certification being emphasized today is the Certified Prevention Specialist. Delaware has taken the step of mandating that if a provider receives prevention funding, they must employ individuals with this certification. This forced certification for personnel with limited training requires staff to apply for a fee, obtain continuing education credits in a variety of areas, pass an exam, and incur recertification costs every two years to maintain the credential. This has resulted in a disgruntled group of outreach workers and needless to say this has affected their performance drastically without any evidence of improved performance. The certification requirements are further evidence that deskilling not only reduces costs of drug treatment operations, it does so in ways that require legitimating rationalizations like new superficial credentials for under-trained staff. The manner in which these requirements are being enforced only serves to undermine the whole idea of employing workers from the community. The community-based workforce becomes more reluctant partners in an effort to rationalize a more cost-efficient approach to providing treatment services. The third example is the new behavioral contracts adopted in relation to Individualized Treatment Plans for clients (ITPS). An ITP is an agreement between a caseworker and a client

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that reflects a strong parallel with the disciplinary practice to enforce personal responsibility in welfare-to-work programs through what are called Individual Responsibility Plans (see next section). In Delaware, drug treatment behavioral contracts are included in ITPs to specify an agreed upon set of practices or behaviors with clearly defined elements such as duration of time in treatment, how behavior change will be measured, and reinforcements and penalties for adhering or not adhering to the agreement. There is some research to support the notion that these contracts are effective techniques to reduce problem behavior among selected clients in drug treatment (Diaz 2010). The contract is commonly used in clinical social work practice to forge an agreement between a clinician and the client. Sometimes used to document agreed upon boundaries between the client and the clinician and other times used to outline a specific set of treatment goals. In drug treatment, clients are often required to sign contracts that stipulate the agency rules and expectations (Kerson, McCoyd and Associates 2010). The use of contracts however can undermine prior understandings in the drug treatment community to treat clients as partners working with clinicians to achieve recovery (see Gowan and Whetstone 2011). Contracts are often used to withhold privileges or even put time limits and expectations for change that are in fact not client driven, not based on the time line for behavior change that is supposed to be dictated by the client (as per the client centered EBP). These contracts are used to not only regulate the clients but produce the outcomes that are expected of the providers. In this context, the clients are empowered to act but in ways that are limiting and confining (Schram 2002, p. 19). Furthermore, the contract erroneously projects the idea that there is a shared understanding and agreed upon arrangement. This is an opportunity provided to drug treatment clients to bring their concerns to the administration. This process allows the client to have a trial to defend and appeal their position if they want to reverse a decision made by

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the clinical administration regarding a rule or expectation outlined in their contract. Yet, this process only intensifies the adversarial tensions introduced with enforcing behavioral contracts (see Gowan and Whetstone 2011). The emphasis on cost-efficiency, however, inevitably makes ITPs neither individualized nor much about treatment. They are more about enforcement. Deskilled workers, using routinized, manualized procedures to treating clients, facing excessive caseloads of over 50 drug users each, are in no position to individualize treatment effectively. One size all programming is more likely, as we have mentioned regarding several other aspects of the neoliberalization of drug treatment in Delaware. Clients end up agreeing to contract requirements they do not understand or cannot remember and counselors end up having time to enforce contracts but do little else. With this sort of treatment regime in place, we are inclined to suggest that the disciplinary neoliberal regime comes to drug treatment as much as by default as by explicit intention. DISCIPLINING THE POOR: THE NEW SOCIAL WORK IN THE NEOLIBERAL WELFARE-TO-WORK SYSTEM Our case study of the neoliberalization of welfare policy comes from an earlier study examining of the state of Floridafrequently mentioned in hearings in Congress as an innovator regarding welfare policy implementation (Soss, Fording and Schram 2011). Floridas Welfare Transition (WT) program is designed to move welfare recipients into the paid employment and is integrated into the workforce system administered by 24 Regional Workforce Boards (RWBs) under the Workforce Investment Act of 1997. We draw on field interviews with frontline case managers in 4 purposively selected regions of the state. As our Florida case suggests, U.S. welfare policy today reflects the emergence of a neoliberal-paternalist regime of poverty governance (Soss, Fording and Schram 2011). It is characterized both by neoliberal

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organizational reforms, such as devolution, privatization and performance management systems for holding accountable contract agencies, as well as by paternalist policy tools, such as sanctions, or financial penalties, used to discipline the poor to become market-compliant actors willing to take the low-wage jobs emerging in a globalizing economy. Florida combines both in a way that has made it a leader in implementing the neoliberal disciplinary regime. These changes in organization and policy were a long time in coming. From the penultimate moment of the welfare rights movement in the early-1970s, until the passage of welfare reform legislation in the mid-1990s, the welfare rolls stabilized at relatively high levels, and recipient families came to have essentially entitlement rights to assistance under the Aid to Families with Dependent Children (AFDC) program, albeit that the aid was modest and often came attached to moral censure. While opposition to growing welfare rolls built over this period, gridlock over how to address the welfare issue did not break until passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). This law formalized reforms that had been developing in the states, codifying them in the Temporary Assistance for Needy Families (TANF) program. TANF ushered in time limits for the receipt of cash aid, accompanied by work and behavioral requirements, as well as sanctions that impose financial penalties for failure to comply with these requirements. Welfare policies have long been entwined with multiple purposes, among the most important of which have been to return to the roots of social work and instill or restore morality in the poor so as to assimilate marginal groups into mainstream behaviors and institutions (Katz 1997). Further, as Frances Fox Piven and Richard Cloward (1971) contend, welfare policy has historically served to regulate the poor, effectively undermining their potential as a political or economic threat. The stigmatization of welfare recipients as undeserving people who need to be

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treated suspiciously has not only deterred many welfare recipients from applying for public assistance, but also communicated to the working poor more generally that they should do whatever they can to avoid falling into the censorious category of the welfare poor. Welfare reform in the 1990s, however, accentuated the disciplinary dimensions of welfare policy in dramatic ways. During the debates leading up to the passage of reform legislation, President Bill Clinton rather infamously touted his determination to end welfare as we know it. His success in this aim can be judged by at least three indicators. First, and most obviously, the number of welfare recipients has plummeted under reform: a 72 percent decline in the number of welfare recipients from 1996 to 2008. Second, by 2001, over half of the federal TANF block grant funding to the states paid for non-cash services, rather than for direct cash assistance to families in need (Allard 2009). Yet, the most profound changes associated with welfare reform occur at the deeper level of its underlying logic (Brown 2003). Welfare reform is much more than reducing the number of recipients and shifting expenditures from cash assistance to work support services. That is because both of these trends are reflective of a much more fundamental neoliberal-paternalist restructuring of public assistance that involves both neoliberal organizational reforms and paternalist policy tools (Schram, Fording and Soss 2008). The new organizational forms often go under the banner of the New Public Management (NPM), and involve devolution, privatization, and performance management (Kettl 2002). The new policy tools include work requirements, time limits, and the sanction schedules states have developed to penalize recipients for failing to fulfill their welfare-to work contracts, and provider agencies for failing to deliver those outcomes they have promised to the state. The combination of neoliberal organizational

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forms and paternalist policy tools has led to a considerably more disciplinary welfare regime designed to impose market discipline on the actors implementing welfare policy so that they can impose the same market discipline as clients. The primary tool for enforcing discipline on clients is the sanctions, a financial penalty for failure to comply with program rules. Sanctions under the new regime are routinely imposed on clients. This neoliberal-paternalist shift in policy and administration is not without controversy. Whether this business model approach to implementing welfare reform is working as it should is subject to intense debate. For instance, there is evidence that contract agencies confront constant pressures to meet performance benchmarks to the point that sanctions tend to be imposed disproportionately on hard-to-serve clients who are not helping providers to meet those benchmarks upon which contract renewal often depends (Cherlin, Bogen, Quane and Burton 2002). The shift to a more disciplinary approach to managing the welfare poor was facilitated by a concerted campaign by conservative political leaders to medicalize the issue of welfare receipt, replacing poverty with welfare dependency as the primary problem to be attacked (Schram 2000; Schram and Soss 2001). Welfare reform became not only about a new paternalism associated with teaching the poor what to do, but about labeling the poor as sick and in need of treatment (Mead 1997). In the run up to welfare reform, welfare dependency came to be seen as similar to a chemical or drug dependency; clients needed to be treated for their addiction and weaned from its source. At the height of the reform campaign, then-Speaker of the U.S. House of Representatives, Newt Gingrich, based his support of welfare reform on the argument that a sick society encouraged further sickness with its failed anti-poverty policies (Carroll 1995). With the medicalization of welfare reform, the importation of behavioral-health models of treatment and associated organizational and staffing patterns came to be seen as not only

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plausible but desirable. As a result, welfare reform has re-made the delivery of welfare-to-work services along lines that parallel those of addiction recovery programs. Welfare agencies have instituted services that are the social welfare policy equivalent of a 12-step program: individuals learn in the new work-first regime to be active participants in the labor force rather than passive recipients of welfare (Schram 2006). Such a view of welfare dependency has led to the importation of a recovery model into welfare reform, one aspect of which is the staffing of welfare-to-work contract agencies with recovered former welfare recipients. Several studies of welfare reform have in recent years noted that the agencies studied had about one-third of the case managers as former recipients (Ridzi 2009; Watkins-Hayes 2009). This proportion indicates numbers that go beyond the mere tokenism (Turco 2010). One of the virtues of the recovery model is that it is consistent with longstanding calls for a representative bureaucracy (RB) (Meier 1975) that can practice cultural competence (CC) concerning the unique needs of its clients (Brintnall 2008): A culturally competent bureaucracy is one having the knowledge, skills, and values to work effectively with diverse populations and to adapt institutional policies and professional practices to meet the unique needs of client populations (Satterwhite and Teng, 2007, p. 2). A representative bureaucracy that draws from the community it is serving is seen as furthering the ability of an agency to practice cultural competency in ways that are sensitive to community members distinctive concerns and problems (Carrizales 2010). In other words, RB=CC. The recovery model holds out hope that a more representative bureaucracy will be more sensitive to the ways in which its welfare clients are approaching the unique challenges that have brought them to the agencys doorstep.

43

Yet, there are ironies in this way of moving toward realizing the RB=CC formula. Former recipients, as indigenous workers from the community, under the medicalized version of welfare are seen as former addicts in recovery. If welfare is seen as a dangerously addictive substance, then the implementation of a disciplinary treatment regime is a logical next step. The decentralized service delivery systems and private providers that so characterize welfare reform are fertile ground for the importation of medical models of dependency treatment. The use of performance management systems is also entirely consistent with the need to track measureable outcomes resulting from the provision of services or the application of treatment to clients. Under this scheme, case management is a routinized and deskilled position focused largely on monitoring client adherence to program rules and disciplining them when they are out of compliance. This revised form of case management makes it possible to hire former recipients as a cost-efficient way to staff welfare-to-work programs, very much in keeping with the business model. There is, in fact, evidence that with the shift to a more decentralized, privatized system of provision, local contract agencies have gone ahead and move to a more deskilled welfare-towork case management by replacing civil servants, social workers and other professionals, with former welfare recipients (Ridzi 2009; Watkins-Hayes 2009). While this staffing pattern may at times be relied upon as a simple cost-saving measure consonant with the business model, it is also entirely consistent with a recovery model philosophy that puts forth former recipients as behavioral role models. These former recipients are frequently referred to in the literature as success stories (Schram and Soss 2001; Cherry 2007). Yet, recovery model suggests they are hired for another reason. The recovery model is grounded in the philosophy that underpins the 12-step program of Alcoholics Anonymous (AA) and it predecessors, which over time has spread to other areas of drug treatment and mental

44

health services, along with the core conviction that clients must be willing to support one another in overcoming their addictions (Repper and Perkins 2006). The recovery model therefore co-exists alongside the business model that is associated with the administrative transformation of welfare reform and both encourage the hiring of former recipients and others for deskilled, routinized forms of casework to monitor and discipline clients to be compliant with welfare-to-work rules. The importation of the recovery model into welfareto-work programs takes places within a transformed organizational and policy environment. Organization reforms associated with the new public management have been relied upon to implement the neoliberal-paternalist approach to welfare policy: devolution, privatization, and performance management (Kettl 2002). Government programs now run more like businesses and the application of the business model to welfare involves getting case managers and their clients to internalize the business ethic as well. Policy changes emphasize case managers using disciplinary techniques to get clients to move from welfare to paid employment as quickly as possible regardless of whether they and their children undergo improvements in their well-being. Floridas WT program is designed to integrate welfare recipients into the workforce. To that end, Florida has actually closed welfare offices across the state requiring applicants to signup online, using public libraries for internet access if necessary. Once approved by the Department of Children and Families (DCF), applicants must report to a local one-stop center that is run by a contract agency on behalf of a regional workforce board as part of the Floridas implementation of the Workforce Investment Act. The state has 24 workforce regions where a combination of public officials, private employers, and citizen and worker representatives sit on the local RWB to decide local policies for implementing federal and state programs including the WT welfare-to-work requirements (see figure 2). The boards most often contract with for-profit

45

providers to run one-stop centers where case managers monitor the progress of clients in moving from welfare to work. Essentially Florida has abolished welfare and integrated it into the workforce system. We interviewed program administrators and frontline workers in four of the workforce regions in the state. In the Florida WT program, local devolution and privatization emerged alongside one of the nations leading systems of performance management. Each year, a state board negotiates with each RWB to establish region-specific performance goals. Goal-adjusted performance measures are then used to determine state-level evaluations of the regions and RWB evaluations of service providers. Provider pay points are tied directly to statewide performance goals, which local contracts often specify in distinctive ways. There is wide variation among states, which have autonomy over how they arrange service provision. The Florida case is important analytically, because of the extraordinary extent to which it has elaborated contracting and performance arrangements, not because it is typical of all states. The Florida case reveals aspects of this new performance regime that may be more difficult to discern elsewhere. As case managers interviews consistently invoked a dichotomy that distinguished a repudiated old approach as social work to be replaced by a much more preferred business model. Performance in the WT program is tracked on a monthly basis and focused squarely on goals related to work promotion. Results are reported at regular intervals in a competitive format via the red and green report so called because it uses colors to indicate the rankings of the 24 regions: red for the bottom six, green for the top six, and white for the twelve in between. Rankings on the red and green report have significant material consequences. Green scores can qualify a region for substantial funding supplements, while red scores can result in the termination of a local service providers contract. Between these extremes, providers typically

46

lose pay points and draw unwanted scrutiny when their performance falls below expectations. NPM predicts that local organizations will respond to this system by innovating in ways that advance statewide goals and improve client services. Devolution will provide the freedoms they need to experiment with promising new approaches. Performance feedback will provide the evidence they need to learn from their own experiments and the best practices of others. Performance-based competition will create incentives for local organizations to make use of this information and adopt program improvements that work. Previous studies suggest several reasons why organizations may deviate from this script in rationally perverse ways. Performance indicators provide ambiguous cues that, in practice, get selected, interpreted, and used by actors in different ways consistent with their institutional interests (Moynihan 2008: 9). Positive innovations may fail to emerge because managers do not have the authority to make change, access learning forums, or devise effective strategies for reforming the organizational status quo (Moynihan 2008). Performance tunnel vision can divert attention from important-but-unmeasured operations and lead managers to innovate in ways that subvert program goals (Radin 2006). To boost their numbers, providers may engage in creaming practices, focusing their services on less-disadvantaged clients who can be moved above performance thresholds with less investment (Bell and Orr 2002). The Florida field research confirms the primacy of neoliberal preoccupation with performance outcome measurement as an organizing principle for WT implementation. Regional personnel working for private contract agencies must of necessity expect to be held accountable for their outcomes. They scrutinize performance reports and keep a close eye on other regions. Most express a strong desire to improve performance through evidence-based reforms. Indeed, local officials routinely describe performance numbers as the heart of the business model that

47

organizes service provision in the WT program. In a contract-centered system such as Floridas, where performance is exchanged for payments, performance management becomes inseparable from, and is ultimately a form of, revenue management for the for-profit and non-profit entities that invest in service provision. As one program manager put it: If we make it [the performance standard] we get paid. Then if we dont, we get zero. With state officials stressing the need for every region to make its bogey (i.e., meet its benchmarks), regional personnel rely heavily on performance measures as guides for action. Interviews with case managers indicated that performance anxiety is a pervasive feature of organizational culture in the WT program. Its effects on implementation, however, deviate considerably from the optimistic predictions of NPM. Consider, first, the double-edged nature of performance competition and its relation to trust. In theory, competition should encourage regional managers to learn from one anothers experiments. Yet it also encourages them to view other regions as competitors who have a stake in outperforming them. Our site visits quickly taught us that the latter dynamic tends to undermine the former. Policy learning and diffusion require a modicum of trust, and this trust can be undermined by highly competitive performance systems. Echoing others we spoke with, one local manager explained that regions try to maintain an edge by guarding their best ideas as trade secrets and, in the same interview, asked us not to tell other regions about new techniques being tried at her one-stop. Another explained how highstakes evaluations undermine learning by fostering suspicions of cheating: They cant tell you their best practices because their practice is cheating [to win the] competitive game. In these and other ways, competition works at cross-purposes with policy learning. It encourages local actors to distrust the numbers that other regions produce, the best practices they recommend, and the wisdom of sharing their own positive innovations.

48

Policy learning also founders on a second dynamic that flows from the discursive tensions between devolution and performance management. Statewide performance reports and efforts to publicize best practices function as parts of a discourse of generalization, suggesting that what works there can work here too. By contrast, the discourse that justifies local devolution and problem-solving trumpets the idea that communities have radically different needs, populations, and capacities. Not surprisingly, these two mindsets clash in the consciousness of the local manager. When presented with success stories from elsewhere, local officials cited a litany of traits that distinguish the region of origin from their own. Managers in rural regions often cited resource differences in this regard. The broader tension, however, is between a discourse that denigrates one size fits all ideas by celebrating local uniqueness and a discourse that treats localities as comparable and seeks to generalize innovations across them. Local officials interviewed generally rejected the practice of inter-regional performance competition, saying it did not make sense to compare different regions that operate under different circumstances. In addition to these problems, three other dynamics flow from the fact that local managers hold discretion over how to respond to performance incentives. NPM predicts that performance pressures will encourage local actors to select more effective and efficient program strategies. At the street level, however, managers often select one strategy over another for a more practical reason: from an organizational perspective, it is simply an easier path to pursue. The best-known form of this response, documented by many studies, is for organizations to count the same old things in brand new ways (Radin 2006). Efforts to improve poverty and employment outcomes are usually seen as arduous campaigns with uncertain consequences for performance numbers. In the short run, strategies of creaming suffice; it is far easier to change

49

how one counts existing conditions. Thus, local officials report that people game the numbers all the time by classifying in creative ways. To illustrate, one regional official interviewed related that a client took her pastor to church on Sunday and the case manager arranged to have the pastor say it was community service so that they could count what the client was already doing. In this environment, case managers under constant pressure to get their clients to stay in compliance with welfare-to-work rules and failing that to penalize them with sanctions that reduce their benefits until them come back into compliance. This preoccupation with monitoring clients for compliance represents a change in the role of the case manager. This role has been changed as part of the administration transformation of welfare policy implementation. From the 1910s to the 1960s, welfare caseworkers devoted much of their time to monitoring families on relief (Piven and Cloward 1971). Their intrusions into the lives of poor women and children flowed from their mandate to enforce means-tested eligibility rules and morals tests focused on family environments and virtuous behavior (Abramovitz 1988). The early Mothers Pensions were only offered to women who maintained a suitable home, and this standard was carried forward when the Social Security Board drafted its model state law for the ADC program in the 1930s: aid was to be offered only to any dependent child who is living in a suitable family home (Gordon 1994: 276). Throughout this period, case managers were charged with tasks such as carrying out home inspections, gathering character evaluations from neighbors and clergy, and enforcing policies such as the man in the house rule (Bell 1965). Morals tests served as mechanisms for denying aid to the undeserving poor, controlling sexual behaviors, and regulating gender and race relations (Gordon 1994). By pushing women off the rolls, and ensuring that their benefits could not be shared with unemployed men, they also

50

served as a means of work enforcement (Piven and Cloward 1988). For caseworkers, however, this labor-regulating function was only a secondary effect. Their job was not to enforce work requirements. It was to enforce standards of deservingness by certifying that needs were genuine, homes suitable, and behaviors morally acceptable. This era of case management came to an end in the 1960s, when welfare rights victories led to new procedural protections in AFDC administration (Davis 1995). Extending this development, the federal government moved in the early 1970s to have states separate the provision of social services and income support (Sosin 1986; Hasenfeld 2000). As a result, casework in the AFDC program became a more routinized, clerical activity focused on eligibility determinations. Caseworkers evaluated many aspects of clients lives to decide whether technical eligibility rules had been met, but they no longer managed family cases in the hands-on ways that their predecessors had. Most activities of this sort were moved to separate child welfare units and to officials who pursued cases of child abuse and neglect (Roberts 2002). The rise of neoliberal paternalism signaled yet another shift in the nature of casework, marked by the passage of federal welfare reform in 1996 (Lurie 2006). The prime directives for TANF case managers today are to convey and enforce work expectations and to advance and enable transitions to employment. Efforts to promote family and child well-being are downplayed in this frame, but they are not entirely abandoned. Under neoliberal paternalism, they are assimilated into efforts to promote work based on the idea that work first will put clients on the most reliable path toward achieving a self-sufficient, stable, and healthy family. Thus, case managers today initiate their relationships with new clients by screening them for work readiness and delivering an orientation to describe work expectations and penalties for noncompliance. In parallel with individualized drug treatment plans, welfare-to-work case

51

managers then develop individual responsibility plans or contracts of mutual responsibility to specify the steps that each client will take in order to move from welfare to a job. These rites of passage establish a relationship in which the case managers primary tasks are to facilitate, monitor, and enforce the completion of required work activities. In celebratory portrayals of the new system, case managers are described as being deeply involved in their clients development, as authority figures as well as helpmates (Mead 2004: 158). In the Florida, this ethos is expressed by the neoliberal relabeling of caseworkers as career counselors. The label evokes images of a well-trained professional who draws on diverse resources to advise and assist entrepreneurial jobseekers. In practice, however, few aspects of welfare case management today fit this template. None of the over 60 case managers we interviewed in 4 workforce regions we studied had a social work degree of any kind. Many did, however, have management degrees from Strayer, DeVry, Capella, or other vocationallyoriented schools that line the strip malls in cities around Florida (and across the country). About a third of the case managers were also former recipients who qualified for their jobs by virtue of their experience with the system more than any formal schooling or training. Under the business model of service provision, the relationship between client and case manager is rooted in an employment metaphor: the client has signed a contract to do a job and should approach the program as if it were a job. The case managers job is now to basically enforce that contract, often using the threat of sanctions to gain compliance. Case managers spend most of their time enforcing compliance to individual responsibility plans and very little time counseling clients (Schram, Soss, Houser and Fording 2010). The change is palpable. One former recipient case manager in Florida stressed in a most poignantly metaphorically way that welfare in Florida is no longer a social service. She

52

suggested it was now herding cattle instead of tending to sheep, where a shepherd takes care of the sheep, a cattle herder just runs the herd through a pen in an insensitive fashion. Under these circumstances, case management gets deskilled and routinized. And staffing reflects these changes. In Florida, as in other states, about one-third of the case managers are former recipients, working at low pay and feeling vulnerable about their improved status. Other workers are almost as marginal in their status. The case managers are less professionals counselors than compliance monitors. In the end, WT case management is reactive and clerical. It focuses primarily on documenting client activity hours and entering the results into the One Stop Service Tracking (OSST) data system. Indeed, managers at several levels argued that the data-entry fields of OSST function, in daily organizational routines, as the real policy on the ground. Interviews with the case managers indicated that the people on the frontlines see the computer screens as the policy. Whatever can or cannot be done in a straightforward way on the system, its assumed that thats the policy. Given their marginal status, either as former recipients or otherwise, case managers are less likely to risk challenging the disciplinary regime on behalf of their clients. They are likely to follow the computer as if it is a program manager. The automated nature of case workers obligations to monitor and discipline clients comes through in the interviews. When asked to describe their workday, case managers consistently report that they begin by logging on to the information system so they can address the slew of new alerts that arrives each morning. The alerts focus on two kinds of actions: documenting work participation hours for clients and pursuing disciplinary actions when such documentation is lacking. From this point forward, the daily round consists mostly of efforts to do one or the other, punctuated by face-to-face meetings with clients that often focus on the same two issues. Case managers spend most of the day either seeking documentation for work-related

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activities (a key performance indicator) or taking next steps in the sanction process such as sending out a pre-penalty warning letter, requesting a sanction, or working to bring a sanctioned client back into compliance. In short, performance and sanctioning are two sides of a single coin in the work life of the case manager and, together, they stand at the center of the job. The resulting stress felt by case managers can be traced partly to their belief that performance numbers matter for job security and trajectory. WT case managers make modest wages in a job with few guarantees, and a nontrivial number have previously received welfare themselves. They often struggle to make ends meet and, as a result, tend to view performance through the prism of their own anxieties as breadwinners. Few expect to be fired if their numbers drop. But in a system of for-profit contracting, most are keenly aware that performance numbers drive profits, and declining profits could lead their current employer to downsize the staff or even to sell the operation to another company whose retention of old employees is uncertain. At a less absolute level, most expect that if they produce weak numbers, they will be subjected to greater supervision in a way that will make their work more stressful and harder to do. Buffeted by performance pressures and lacking the tools to respond to client needs, case managers experienced their workdays as a series of frustrations and disappointments. The results of all this performance anxiety is not better outcomes for clients. The Florida study found that most clients remained poor after leaving welfare and sanctioned clients fared the worst of all (Soss, Fording and Schram 2011). To turn a phrase, the preoccupation with discipline just made the worse off worser. And these negative results were not evenly distributed across racial groups with African Americans faring the worst.

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Further, Florida might be a leader in implementing the neoliberal disciplinary regime, but that also means it leads in corruption associated with such a parceling out of the states welfare operations. Scandal has wracked the system from its inception and continues today. In July 2011 it was reported that: [Florida] Governor Rick Scott today confirmed that the U.S. Department of Labor has launched an investigation into Florida's 24 regional workforce boards to determine if they have been improperly awarding contracts to companies controlled by board members or their relatives (Klas 2011). Scott himself previously was able to propose and sign into law legislation requiring all welfare recipients to undergo drug testing (even though he came under attack for possible conflicts of interest since he had been the primary investor in the largest drug testing company in the State which was now under his wifes control). The corruptions of privatization aside, the neoliberal disciplinary welfare-to-work regime in Florida represents an elaborate shift to get the poor to accept more responsibility for their poverty without providing the necessary support for them to do anything about it. It is a new regime that imposes strict performance outcomes monitoring, deskills the case management associated with the program, routinizes the treatment of client provided by those case managers, puts their focus almost exclusively on imposing discipline on clients in the name of program compliance, and does so in ways that do not lead to improved well-being for those clients in ways that track closely by race. It represents a stark example of neoliberal failure. It is the end of social work on this end of the social work continuum. CONCLUSION Our cases studies suggest that both drug treatment and welfare-to-work have been neoliberalized. In the process, welfare policy implementation has been medicalized and drug treatment programming welfarized. Although these two domains of social work practice are

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quite different, the developments in each are strikingly similar and as a result their operations are becoming more alike. At the core of these developments are innovations that put the emphasis on routinized practices for screening, diagnosing and treating clients in ways consonant with the overriding objective of the neoliberal disciplinary regime to enforce personal responsibility costefficiently. Frontline workers in both cases are most often not professional social workers. In fact, in both cases, masters level, professionally trained social workers have never been predominate among staff. Yet, our case studies suggest social work is now being deskilled in new ways that orient work toward monitoring and disciplining clients for non-compliance with treatment plans. A new get tough form of imposing discipline lies at the core of emerging disciplinary regime. It represents the end of the old social work and the beginnings of the neoliberalization of social work as we knew it. Requirements to use specific techniques to standardize treatment, performance measurement systems to track outcomes, counselor-client contracts, the use of indigenous workers from the community, and a number of other parallels suggest the fields as diverse as drug treatment and welfare policy share being influenced by broader structural forces moving them toward a neoliberal future that focuses work with clients on cost-efficiently getting them to accept more personal responsibility for their plight. The neoliberalization of social work is an ongoing project fraught with challenges for helping clients survive in a decreasingly supportive environment.

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Figure 1. Risk and Needs Triage (RANT)

RISK
HIGH
Court supervision Status calendar Intensive drug treatment Rewards & sanctions UA monitoring

LOW
Probation supervision

Non-compliance calendar Intensive drug treatment Rewards & sanctions UA monitoring

HIGH

NEEDS
LOW

Probation supervision

Status calendar Pro-social rehabilitation Rewards & sanctions Intermediate Punishment for noncompliance

Pretrial supervision or minimal probation Non-compliance calendar Prevention / education

Source: Treatment Research Institute (TRI http://www.tresearch.org/).

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Figure 2. Floridas Workforce Regions

Source: Soss, Fording and Schram (2011).

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