As I’ve been teaching the Advanced Policies and Programs class this semester (and reviewing content for the mixed-media version next fall), it has occurred to me that I really need to be teaching a whole section on advocacy with private institutions. I thought, when I designed the syllabus, that it was pretty comprehensive. I mean, we talk about advocacy with the federal government: legislative, fiscal, regulatory, and judicial; and with the state government, and even local governments and within nonprofit agencies (which many policy classes omit).
And those entities are still undeniably important, and still where the bulk of social work advocacy is happening/needs to happen. But, especially in the age of nearly-unfettered privatization, it seems to me that we’re missing something if we don’t talk about how to advocate with private entities, including for-profit ones. After all, they now control, or at least influence, much of social service delivery: nursing homes, many health care providers (including home health), some adoption/foster care agencies, mental health care (especially in the realm of private practice), substance abuse treatment, some job training, housing providers…and probably a lot of things that I’m not even calling to mind right now.
There is a legitimate argument that, in all of these cases, there are public (governmental) agencies/institutions that retain some oversight over the private providers and their services. And that’s true, and we absolutely need to understand those relationships and figure out how to work those levers to bring the social changes we seek.
But I don’t think it’s enough. Think about it: if you have a complaint about a business where you’ve been a customer, would you receive more prompt resolution of your problem through an effective advocacy strategy directly with the powers that be at that company, or through appealing to the Better Business Bureau or the Federal Trade Commission?
I have concluded that, if we’re going to be maximally effective in our advocacy on behalf of those we serve, we absolutely MUST be prepared to bring our advocacy skills, our strategic relationships, and our persuasive power to bear on the private entities that have so much power over all of our lives. But it’s hard: not only do we not have nearly as much preparation in how to do this, but we’re in some ways dealing with apples and oranges: some of the nature of the private status of these institutions makes them more elusive advocacy targets–they aren’t subject to the same transparency rules, in many cases; they aren’t staffed by bureaucrats responsible, ultimately, to elected officials (who must be responsive to the public if they want to stay that way); they don’t have the same underlying charter to serve the public; their ultimate authority is a private set of Board members, or stockholders.
That last set of obstacles is part of the reason why I believe that the unchecked move towards privatization is, in balance, a bad thing for social work advocacy–we just don’t have the same leverage over these private entities that we do over those in the public sphere. And so, some of our advocacy within government has to address our objections to privatization, to keep those activities in public hands that, then, we’ll be able to slap (metaphorically, of course) when needed.
But, obviously, privatization has already occurred, all over the place, and neither we (as a profession) or or clients can afford for us to just throw up our hands. There are some things that we can do and learn to make us better advocates with private entities. I’ve done some literature reviews on this topic and, unfortunately, I haven’t turned up much. Much has been written, certainly, about privatization itself (much of it from right here in Kansas, regarding our privatized foster care system, the first of its kind in the country), and these are certainly helpful additions to the theoretical field–they provide some insights into the kinds of challenges that the entry of private companies into the social work ‘industry’ can create for clients and workers, which may help to point advocates in the right direction. But, in terms of how-tos or case studies or other applied research, either social work scholars aren’t writing about how to do advocacy in the age of privatization, or they’re not using the same words to talk about it that I would use.
**Here I go, crowdsourcing again–please direct me to any articles/books/etc… about advocacy amidst privatization–I’ll be forever grateful!**
In that absence, here are my initial thoughts about how social work advocates can engage effectively with the private corporations that conduct so many of the activities central to our service to society.
We need to understand contracts and the process of contracting. This means learning to read contracts the way we learn to read legislation, and understanding that much of our advocacy needs to center around the details in these contracts, since this is where oversight agencies have the greatest power to demand redress. Sometimes, problems are almost guaranteed in the structure of a contract, which may not provide enough reimbursement for quality service, or set up any kind of good grievance policy, or clearly prioritize profit over people. We need to leverage our power with the public sector to try to prevent this, in addition to learning how to deal with the fallout.
All private companies have some vulnerabilities–they are just different than the vulnerabilities of public agencies. We need to learn them so that we can plan the best advocacy strategies–are they particularly sensitive to bad press (all companies are at least somewhat concerned about bad press), or do they have some shareholders with a conscience (or can you get someone to buy shares who does), or are they about to rebid for a contract (or expand their business into another area), or can you work directly with a labor union to organize workers and put pressure on the company that way (workers+clients can be a very powerful alliance)? Sometimes, you won’t even need to use any of these tactics, but knowing which ones are more likely to yield results makes you more confident as you enter into even congenial negotiations.
We need to remember that ‘for-profit’ does not equal ‘for destruction of all things sacred and good’. There are many corporations in the business of social service provision that are trying earnestly to do a good job, that are genuinely concerned about problems encountered by consumers, and that are truly living up to their promise to be more nimble and responsive than the old government bureaucracy. We can ensure our defeat by assuming that it will be a big ugly fight, and so causing one.
Before we ever have a grievance, we need to organize service recipients so that they have real power in relation to the private service provider–they need to know and be ready to use grievance policies, have a recognized voice in company operations, have leadership, and assemble themselves into a force that can then exact needed concessions in the event of an injustice. Theoretically, since consumers can ‘vote with their feet’, private entities should be ready to deliver what they demand but, in practice, the vulnerable individuals with whom social workers work often have few other choices, and companies exploit this. To try to rectify this power imbalance, the only, only solution is to organize.
What do you think? This is an obviously incomplete list–I’m really just beginning my thinking about privatized advocacy, so to speak, and I want to hear from those who provide social work in private entities (especially for-profit ones) about what you’ve experienced and what kinds of advocacy you’ve seen (or wish you would see!). If you’ve been part of advocacy campaigns with private companies as targets (we have a lot to learn from the anti-globalization/corporate responsibility movement here, I think, but we need to find ways to translate the lessons to different contexts), what stories and tips can you share?