Tear Down the Walls, Listen to the Community : Current large-scale social services don’t work, but the reasons for failure could all be overcome by American ingenuity.

The service programs that have made dramatic, proven differences in the lives of truly disadvantaged children are generally small and operate at the margins of large public systems. Many are run by unusual innovators, risk-takers who are willing to bend regulations and swim against the current.

If these success stories are to be transformed from the exception to the rule, then fundamental changes must be made in the methods by which health, education and social service systems pay for services, determine eligibility, set standards and maintain accountability.

The fragmented, episodic and often reluctant delivery of services that prevails today is not the result of ignorance about how to do it better. Rather, it results from the pressures of systems that push programs to:

-- Confine their activities to a single, well-defined category of problem (such as the agency that can offer only “parent education” to a family suspected of child abuse, although their acute needs include day care, safe housing and food for the children).

-- Limit eligibility to individuals who can document a narrowly circumscribed, clearly labeled deficiency (recall the New York family that couldn’t get help with their unruly teen-ager until after they were arrested for chaining their daughter to a radiator to keep her off the streets).

-- Respond only to crises rather than providing support to avert a crisis (such as the hospital that will treat the child without health insurance once he is in a diabetic coma, but will not provide the continuing care that could prevent it).

-- Dilute high-quality, intensive programs so that inadequate resources can be spread equitably (such as a home-visiting program that could not maintain its success after nurses’ case loads were doubled in response to funding cutbacks.)

In reformed systems, front-line workers would be trusted to exercise discretion and not be tethered to burdensome forms and rigid procedures. Accountability would be geared to outcomes rather than procedures (a change we’re already seeing in some public-school reforms). Professionals would be unshackled to use their best judgment, often collaborating with families to figure out what would work in a specific instance.

Training of program managers and front-line staff would equip them to exercise their new autonomy responsibly. A welcoming stance would replace one primarily aimed at keeping ineligible people away. Eligibility could be based on residence in a depleted neighborhood rather than on means tests and other individual proof of past inadequacy. Funding would be sufficient and operations flexible enough to permit intervention before disaster strikes, and to maintain high standards of quality.

If skeptical Americans are to regain confidence in the competence of government, then government must demonstrate that it can effectively tackle difficult domestic problems.

A modest start would be to ensure that, within a year, every preschool child in America will be immunized.

But American ingenuity is equal to a more ambitious task: applying the lessons of successful small-scale human service efforts to an entire threatened community. Federal, state and local governments could join with concerned citizen groups and nonprofit agencies to demonstrate, in several depleted neighborhoods, that a strategy of intense and comprehensive intervention and support will work to reverse the disintegration of family and neighborhood.

We know now that the factors implicated in persistent poverty and concentrated social dislocation are too intertwined and pervasive to respond to narrow, one-shot intervention. Comprehensive, responsive health and welfare services and schools must be combined with improved housing and public safety and expanded economic development to achieve a visible level of effectiveness.

Several national foundations are on the verge of mounting neighborhood-based cross-systems demonstrations of this kind. United Way of America has similar plans. The California Legislature has just voted to authorize six such demonstrations. With the support of both public and private sectors, these efforts would be broad and deep enough to match the magnitude of the need, and would engender confidence that this time, change is real and here to stay.

These demonstrations could persuade the public and policy-makers that earmarked funds can in fact accomplish their intended purpose and be the forerunners of the large-scale reforms that will help to strengthen families and communities throughout the nation.

Any political leader willing to take on this agenda will be listened to. My conversations with people around the country suggest that, even among Americans who are skeptical about society’s capacity to intervene, there is a yearning for better answers than abandonment of the homeless and the poor and the inner cities of the land. There is a powerful coalition waiting to be formed of those who want to help out of compassion and those who are prepared to make a hardheaded investment in America’s human capital.