THE EFFECTIVENESS OF SOCIAL SERVICES IN ONTARIO: Prevalent Clients' Perceptions of Benefit and...

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THE EFFECTIVENESS OF SOCIAL SERVICES IN ONTARIO: Prevalent Clients' Perceptions of Benefit and Service Cuts Author(s): Kevin M. Gorey, Forrest C. Hansen and James Chacko Source: Canadian Social Work Review / Revue canadienne de service social, Vol. 14, No. 1 (Winter

/hiver 1997), pp. 43-53Published by: Canadian Association for Social Work Education (CASWE)Stable URL: http://www.jstor.org/stable/41669637Accessed: 22-06-2015 00:58 UTC

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THE EFFECTIVENESS OF SOCIAL

SERVICES IN ONTARIO

Prevalent Clients' Perceptions of Benefit and Service Cuts

Kevin M. Gorey Forrest C. Hansen

James Chacko

Abstract: A panel study evaluated programs offered by Windsor's Social Service Department from January 1990 to June 1996, using both quantitative and qualitative measures of client satisfaction. The survey instrument was mailed to a random sample of clients each month, and 3,162 participated. The study noted a significantly lower average score on the consumer satisfaction questionnaires returned by clients of the Income Maintenance Branch after the cuts to family benefits were put into effect in Ontario in October 1995. The prevalence of very satisfied clients decreased by approximately 30 per cent, and prevalent dissatisfaction increased more than twofold. Clients indicated increased concern for the welfare of their children in face of an increasingly punitive and less compassionate social response to their needs.

Abrégé: À l'aide de mesures qualitatives et quantitatives de la satisfaction de la clientèle, un panel a évalué les programmes offerts par le département de service social de l'Université de Windsor, de janvier 1990 à juin 1996. Chaque mois, le questionnaire a été posté à un échantillon de clients choisis au hasard. En tout, 3 162 personnes ont participé à ce sondage. On a remarqué que les scores moyens des questionnaires renvoyés par les clients de la Direction du maintien du revenu étaient beaucoup plus bas après la réduction des avantages accordés aux familles ontariennes en octobre 1995, en comparaison des scores moyens avant cette date. Le nombre de clients très satisfaits a baissé d'environ 30 % et le

Kevin M. Gorey is an assistant professor, ; Forrest C. Hansen an assodate professor ; and James Chacko a professor in the School of Sodai Work at the University of Windsor. The authors gratefully acknowledge the helpful administrative and logistic assistance provided by Dana Howe, Commissioner of Sodai Services , as well as Branch Directors Peggy Davis (Spedai Services), Susan Ellis ( Income Maintenance), and Linda Nagle (Children's Services), and Community Liaison Coordinator John Durocher, The Corporation of the City of Windsor, Sodai Services Department. The willingness of clients to volunteer their time to partidpate in this study is also gratefully acknowledged.

Canadian Social Work Review, Volume 14, Number 1 (Winter 1997) / Revue canadienne de service social, volume 14, numéro 1 (hiver 1997) Printed in Canada / Imprimé au Canada

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44 Revue canadienne de service social, volume 14 (hiver)

degré d'insatisfaction a plus que doublé. Les clients ont signalé qu'ils se sou- ciaient davantage du bien-être de leurs enfants face à l'intervention sociale de plus en plus punitive et de moins en moins compatissante à l'égard de leurs besoins.

WELFARE BENEFITS HAVE decreased markedly (by 2% to as much as 25%) in all of the provinces since 1995 (National Council of Welfare, 1995, 1997). In Ontario, for example, on one dramatic day (October 1, 1995), the typical general assistance family benefit was reduced by approximately 20 per cent. To understand fully the impact of such large systemic policy changes, we must listen to the collective voice of those most directly affected: welfare service consumers themselves. The principle of including clients' opinions in the evaluation of human service programs would certainly seem to be of unquestioned importance to most such agency administrators and practitioners. Evaluation designs which lack this critical component may be methodologically rigorous, using very precise quantitative measures, but they will be devoid of rich qualitative data based on clients' personal experiences. The significance of this principle is underscored in the publicly funded arena of social assistance because consumers of social services typically cannot express their dissatisfaction by going elsewhere to " purchase" services which will better meet their needs.

The idea for this study developed in 1988 with the mandate of the Commissioner of Social Services in Windsor, Ontario, to incorporate procedures for the collection of needed qualitative data on client satisfaction. Clients' assessments of the city's various Social Service Depart- ment programs, which have been mostly favourable, are reported elsewhere (Chandler & Osmun, 1990; Gorey, Chandler, 8c Osmun, 1996). The present panel study compares the experiences of recent service recipients (since the Ontario budget cuts) with those of clients engaged with the Social Service Department in previous years.

Client satisfaction Studies of client satisfaction have sampled predominantly from among the users of psychiatric and other allied mental health services (Burlow et al., 1987; Byalin, 1993; Kotsopoulos, Elwood, 8c Oke, 1989; Loff, Trigg, 8c Cassels, 1987; Sabourin 8c Gendreau, 1988) as well as health care services (Garber, Brenner, 8c Litwin, 1986; Hall 8c Dornan, 1990; Schwab, Smith, 8c DiNitto, 1993). Three of these studies were accomplished in Canada. Only one previous study has assessed satisfaction among the users of Canadian social services per se (Gorey, Chandler, & Osmun, 1996), though there have been many related Canadian and American studies of general social work, family service programs, and child protec- tion services (Gorey, 1996). Using an array of client or consumer satis-



Canadian Social Work Review, Volume 14 (Winter) 45

faction measures, these studies have observed consistently high satisfaction ratings across all of these service domains, ranging from 65 to 99 per cent "satisfied" or "very satisfied." While such positive reports would be encouraging to any service, they ought to be interpreted with caution for a number of reasons: 1) potential selection bias - there may be a tendency for such survey

respondents to be those with the most favourable opinions of the service (Gorey, Rice, & Brice, 1992);

2) potential information or social desirability bias - there may be a tendency for some service consumers to respond in ways which they believe are desired;

3) a lack of assured confidentiality may tend to strengthen the effects of both selection and information bias.

Our previous study in this field, by the City of Windsor Social Services Department and the University of Windsor's School of Social Work, provided some measure of control for such potential methodological problems. The present study builds on this experience.

Sample selection All branches (Income Maintenance, Special Services, and Children's Services) of Windsor's Department of Social Services served as this study's accessible population. In accordance with the commissioner's mandate, the Special Services Branch had evaluation procedures in place by January 1990, and the other two branches by January 1993. A random sample of clients was mailed the brief program evaluation questionnaire each month; in the pilot test involving 50 clients, it took less than 10 minutes to complete. Participants in programs with a termination date were sent the questionnaire during the program's last quarter. Those participating in programs without a termination date were sent the evaluation instrument three months after their files were closed, whether they completed the entire program or dropped out. A consent form, assuring them of the data's confidential use, was also enclosed with the questionnaire. The client's name and address were not used on the stamped return envelope which each was given to make it easy for clients to respond anonymously. Over the seven years of this successive cross-sectional study (1990-1996), 3,162 of the 9,060 clients in the sample returned the evaluation questionnaire, resulting in a response rate of 34.9 per cent, which is typical of similar surveys in the mental health and health care fields (Median = 38%, ranged from 28% to 95%).




Measurement of client satisfaction The client satisfaction questionnaire (CSQ-8) was used as one measure of client satisfaction with social services (Larsen et al., 1979). It is brief (eight items) and easy to administer, with known psychometric properties from previous use in mental health research (Gaston & Sabourin, 1992; Weltzien et al., 1986). These studies found it to be a highly reliable or internally consistent measure (Chronbach a = 0.93), as did ours (a = 0.92). As for its construct validity, it has been found to be essentially unassociated with social desirability (Gaston & Sabourin, 1992; Sabourin et al., 1989). On average, based on the findings of these studies, socially desirable responding may account for only one per cent of client satisfaction variability (r=0.10, r2 = 0.01, NS). Computed across its eight service assessment items (quality, appropriateness, need met, amount, refer friends, refer self, effectiveness, overall) from 1 "very dissatisfied" to 4 "very satisfied," the CSQ-8 has a theoretical score range from 8 to 32.

To balance the standardized quantitative measurement approach of the CSQ, the following three qualitative queries were presented in an open-coded format: 1 ) Name one thing that you liked most about the service. 2) Name one thing you liked least about the service. 3) Do you have any other comments or suggestions about the service

you received?

Clients' responses to these questions were analyzed for content and sum- marized according to concepts which have been hypothesized to be important predictors of service satisfaction in the related fields of health care and mental health research (Greenfield 8c Attkisson, 1989; Hsieh 8c Kagle, 1991; Russell, 1990; Swigonski, 1996). Responses were grouped by positive or negative characterization of service effectiveness, and changes over time were observed (January 1990 to September 1995 as compared with October 1995 to June 1996). The grouping variable crite- rion was chosen because it was at this time (October 1, 1995) that, due to provincial budget cuts, the typical general assistance family benefit decreased by approximately 20 per cent overnight.

Methodological strengths This study's overall response rate of 35 per cent potentially limits the validity of its findings. However, this singular limitation is balanced by a number of methodological strengths used to control for potential selection bias: a large random and anonymous sample; a satisfaction measure uncorrelated with social desirability; and specifically invited critical or negative commentary. Moreover, as the response rates did not differ significantly between the two time periods, any bias which may intrude in the longitudinal analyses will probably be relatively constant over time




and is therefore unlikely to have a potent confounding influence on the study's central findings.

Sample description The demographic profile of the client sample seems indicative of Social Services' accessibility to young adults needing employment opportuni- ties or those with young children; the majority were women (63%). The typical client has never been married (44%) and has one child (median was one child, ranging from none to six). As for socio-economic status, clients typically have some high school education, but have not gradu- ated (74%), and most of them are not currently employed (79%). The average client has received assistance from the Department of Social Services for two years (median was 24 months, ranging from 1 to 132). Female clients may generally be categorized as more socially and eco- nomically vulnerable than their male counterparts: fewer of them were married (5% of women compared with 48% of men), while more were divorced (25% compared with 8%), separated (14% compared with 5%), or widowed (10% compared with 3%). Also, fewer women were childless (27% compared with 48% of men) and, of those with children, ten times more women than men parented alone (39% as compared with 3%). (In all cases,/? <0.001.)

Client satisfaction The score distributions on the client satisfaction questionnaire (CSQ) for clients of the Income Maintenance Branch are displayed in Table 1. Categorically, Special and Children's Services Branch clients were quite satisfied with the benefits and services provided. Nearly all of them (89%) may be described as "satisfied" to "very satisfied" (scored 20 or higher on the CSQ), and their perceptions have not changed significan tly since Gorey and his colleagues (1996) first described their qualitative experiences prior to the benefit cuts (not displayed in Table 1).

Not surprisingly, all of the significant longitudinal trends were observed among Income Maintenance Branch clients, who are the exclusive focus of the following discussion. A trend was observed among them indicative of decreased satisfaction over time; their average CSQ score decreased significantly after the benefit cuts were instituted in October 1995 (AÍ = 22.9; SD = 4.9) as compared with their previous scores (M= 25.1; SD = 4.4; p< 0.001) (see Table 1). This difference between groups converts to an effect size metric of 69 per cent (Cohen's Uy 1988). The U3 statistic adds an intuitively appealing interpretation of programmatic change or practical significance. For example, in this case it means that seven of ten of the clients who received service after the cuts scored lower on the CSQ than the average client who received service before the cuts were made. It was also observed that the prevalence




of very satisfied clients (CSQ score of 26 or higher) has decreased by approximately 30 per cent over the same period of time (47% as compared with 31.4%; prevalence ratio [PR] =0.67; X 2 [1, N= 1132] = 18.72; p< 0.001) while the prevalence of dissatisfied clients (CSQ score of less than 20) has increased more than twofold (12.7% as compared with 27.3%; PR= 2.15; X 2 [1, N= 1132] = 30.28; /><0.001).

TABLE 1 Satisfaction of Income Maintenance Branch Clients:

Percentage Distributions

Percentage Distributions

Total Sample Jan. 1990 to Oct. 1995 to Client Satisfaction Sept. 1995 June 1996 (questionnaire scorea) (N= 1,132) (N=890) (N= 242) 8-13 Very dissatisfied 3.0 2.4 5.0 14-19 Dissatisfied 12.9 10.3 22.3 20-25 Satisfied 40.5 40.3 41.3 26-32 Very satisfied 43.6 47.0 31.4 Meana (standard

deviation) 24.6 (5.1) 25.1 (4.4) 22.9 (4.9) a Between-group categorical [X2 (3, N= 1132) =36.10] and mean comparisons [t (1130) =

6.32] are both statistically significant at p< 0.001 .

Qualitative evaluation

Three-quarters (75.3%) of those Income Maintenance clients who responded to the open-coded queries about their perceptions of the benefits and services they had received after the benefit cuts offered negative or critical comments. Of the cohort of prior service recipients (served before October 1995), less than half (47.1%) offered such unfavourable evaluations (X2 [1, N= 1223] =82.37; /?<0.001). Critical opinions were specific to the clients' assessment of benefits and services; their generally favourable assessments of staff and facilities have not changed significan Üy since the previous panel evaluation which was accomplished prior to the reduction in benefits (Gorey, Chandler, & Osmun, 1996).

Content analysis of clients' open-coded responses about benefits and services since October 1995 are displayed in Table 2; favourable commentary (25%), which essentially reflected their categorical expressed "gratitude for the assistance," is not displayed. Clients' most prevalent critical comment about benefits and services, mentioned by 27 per cent of the respondents, was simply some expression of their dismay with the "Harris government cuts," that their resultant substantially smaller income was unacceptable or "too small for anyone to live on with dig- nity" (see Table 2). Another quarter of the respondents (24%)




expanded on their concern with the "cuts" through expression of their concerns about how these may affect not their own welfare, but that of their children. They wondered - quite correctly based on the research literature (Hill & Sandfort, 1995; Korenman, Miller, & Sjaastad, 1995) - about how "eating lousy food" or "living in the poorest neighborhoods" will possibly handicap their children's future potential. Such prevalent concern on the part of clients about the potential deleterious effects of inadequate social service benefits on their children's health and well- being has increased nearly threefold (from 8.6% to 23.7%) since the benefit cuts were enacted (PR=2.76;X2 [1, N= 1223] = 53.65; /><0.001).

TABLE 2 Content Description of Clients' Qualitative

Assessments of Benefits and Services:3 Percentage Distribution after

September, 1995

Assessment Categories %

Unacceptable; benefit simply too small to live on 27.4 Concern for children's welfare 23.7 Stress; competing demands of basic needs 22.8 Punitive or unjust nature of the cuts 16.7 Stress; unmet other needsb 9.4

a Based on a content analysis of 514 responses from 242 clients on two queries: (1) Name one thing you liked least about the service; and (2) Do you have any other comments or suggestions about the service you received?

b Transportation, child care, dental, prescriptions, eye care, and clothing.

Another near quarter of the sample of clients (23%) emphasized the stress they experience as a result of their day-to-day struggle to meet their families' basic needs. Such comments included: "There's not enough [income] to cover rent and food, let alone anything extra, something fun for the kids." "The rent has to be paid, or we'll all be out in the cold." "I get mad and sad when we're hungry, when there's not enough to eat." "I hate giving them food I know's not nutritious." Not surprisingly, clients' categorical concern about their inability to meet their basic needs of food and shelter has also increased significantly (from 5.1% to 22.8%) since the benefits were reduced (PR=4.47; X2 [1, N= 1223] =85.16; p< 0.001). These qualitative findings are also consistent with the observed 50 per cent increase in visits to Windsor's food banks during the first year after the provincial budget cuts (Grant & Sears, 1997).




Nearly one of every six critical comments (17%) concerned the perceptions of service consumers that the cuts were punitive or unjust, and that they were being blamed for society's problems as well as for some of their own over which they had no control, such as chronic health problems or lack of access to "good paying" jobs. Many spoke of their willingness to work, but their lack of success in finding a job. Another common theme was mere survival: "This isn't life . . . it's a constant battle just to survive." Through sharing the truth of their own experience, this cohort of social service recipients convincingly debunks a number of interre- lated myths (Rank, 1994; Swigonski, 1996), for example, that such a life is easy, the option of choice for the selfish and the lazy. On the contrary, raising a family primarily with government assistance is extremely difficult, and it has recently become much more so. Such a situation is clearly the last rational option for people without alternative means to care for themselves and their families; they remain primarily concerned with the welfare of their children, even in the face of an increasingly punitive and less compassionate social response to their needs.

Discussion Before summarizing its negative findings, we ought to note that this large panel study evaluated the social services offered in a mid-sized Canadian city essentially favourably, as had a previous one with the same cohort of respondents (Gorey, Chambers, & Osmun, 1996). The vast majority of clients are still satisfied to very satisfied with the variety of benefits and services offered by the Social Services Department and with its staff members' job performance, as well as with the facilities, even after the provincial budget cuts. Not surprisingly, clients' dissatisfaction and critical commentary was specific to the benefits and services they received from the Income Maintenance Branch after September 1995. Seven of every ten such clients who received service after the cuts scored lower than the average previous client. In describing their experiences in response to the qualitative survey, clients talked about their primary concern for the welfare of their children, as well as their difficulty in meeting basic needs (food and shelter). This trend essentially seems to have mirrored the political will of the times; as some social programs have suffered much lower capital investment, consumers have taken note of the deleterious effects. In aggregate, perhaps their most consistent and compelling message to others is that life with social assistance has always been difficult, but it has recently become almost untenable. This trend may be exemplified by the qualitative findings that, even before the cuts, many clients described benefits as "only meeting their most basic needs," whereas they now more typically describe them as "not even meeting their most basic needs."




This study's sample description infers that those most likely to suffer the consequences of life on the edge brought about by the sudden change to much lower incomes are children and women. Consistent with the findings of others in the United States and Canada is the indica- tion that, though public assistance programs serve a diversity of people, the single largest clientele affected by welfare reform consists of single parents (typically mothers) and their children. In fact, when so-called less eligibility or benefit cutting strategies are employed, such cuts tend to be severest among this group (Allen-Meares 8c Roberts, 1995; Axinn & Hirsch, 1993; Crane, 1994; Jones, 1995; Norris & Thompson, 1995; Rank, 1994). As these families essentially struggle to survive, it is not difficult to imagine how the recent reduction in social assistance benefits, together with proposed cuts in other services such as rent subsidies, may ultimately diminish their chances of benefiting from such new workfare programs as Ontario Works (Corporation of the City of Windsor, 1996). If one's most basic needs are unmet, it is very likely that progress toward other hierarchical goals, such as the attainment of gainful employment, will be stifled. Conservative policies on social assistance benefits may, in fact, be structural barriers to one of the government's own centrally stated objectives - to move people from welfare to work. Unfortunately, the answer to this question must await the accumulation of experiences of real people with no other choice but to participate in this social labo- ratory.

In this era of welfare reform, the policies and programs put forth by each province (and state) may be best thought of as independent dem- onstration projects. The systematic empirical validation of each such effort would go a long way toward providing policy makers with the means of making rational, rather than merely political, decisions based on the demands of interest groups. Such rational planning is needed if we are to build a more effective (and efficient) social safety net for the next generation of North Americans. This study represents an initial step toward including the voice of welfare service consumers in such decisions, but its brief qualitative survey instrument only begins to give them the means of telling their stories. As cohorts of Ontarians and other Canadians have now had two years of experience or more with major welfare reform programs, all of us, practitioners and researchers, with a vested professional interest in the provision of effective social services, ought to do all we can to facilitate continued empowerment for the clients of social services. We believe that the national social welfare research agenda ought to include: more in-depth qualitative research, similar to the work of Edin (1993) and Rank (1994) among welfare recipients in the United States, which brings the full weight of consumers' practical experiences to the policy debate; and concomitant quantitative research which observes the economic impact (adequacy, pro-




portion below poverty line) and the impact on public health (child, familial, and social) of new policies. Ultimately, the validation of findings across methods (qualitative and quantitative) and contexts (provinces and states) will bring much wisdom, rather than mere reaction, to the next generation of welfare policy decisions.

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