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Strategies of Change

Throughout the United States, one can observe isolated examples of excellent specialized programs for the mentally retarded which have been in existence for many years, but which have not been adopted or adapted by other states or communities. A large number of professional workers, representing many disciplines, have written reports on outstanding services for the mentally retarded in other countries, and have furnished elaborate documentation through the printed word and photographs. Numerous committees and commissions in many states have reported on needs and available services for the mentally retarded, and have made sweeping recommendations for improvement. Of particular significance, of course, was the nationwide effort towards comprehensive statewide mental retardation planning which was a very important piece of the legislative program of President Kennedy enacted by Congress in 1963. Yet, with all this, progress has been slow, and has been particularly unsatisfactory in the area of residential services. Therefore, it is of great importance to search out and identify those phenomena which appear to constitute obstacles to change, and those which might facilitate it.

Obstacles to Change

The Societal Role Perception of Retardates as Deviants. The still widespread perception of the retarded person as a menace or a subhuman organism provides a particularly prominent obstacle. Fear of the mentally retarded has led community groups to protest not only the location of a workshop or a hostel for retarded young adults in a given neighborhood but even the establishment of nursery classes in public school buildings.

Usually, various role perceptions underlie use of terms and language which can be change inhibiting. A typical example is the language of the medical model so well described by Wolfensberger; this language constitutes a major obstacle to the conceptualization of a nonmedically oriented residential developmental program for those retardates whose primary needs are not in the health area.

The Momentum of the Current Service Pattern. The sheer extent, size, and monetary value, and the economic utility to certain communities, of the current physical plants, facilities, and services for the mentally retarded tend to block or delay action toward change. On the one hand, the objecting vested interests are very strong, and on the other, changes, in order to be effective, have to be of a radical, almost revoluntionary -sic- rather than evolutionary, nature.

The major professional organization in the field, the American Association on Mental Deficiency (AAMD), which could exert a powerful influence on the course of events, unfortunately has traditionally, and to a large extent to this very day, been oriented towards the conventional, institutional model. Thus, AAMD has tended towards the endorsement and strengthening of the present system rather than to a searching appraisal of the degree of its continuing usefulness and to the identification of the service areas which need restructuring. The recently introduced AAMD program for nationwide evaluation of state institutions for the mentally retarded is symptomatic of this situation. This evaluation system is oriented toward quantitative improvements in current institutional models rather than towards qualitative change through innovation. Even at that, there are no provisions for censoring or incisive reprimand for even the most undesirable, most dehumanizing practices. Indeed, the procedure of having institution superintendents evaluate each others' institutions could have resulted in little else.

Another problem develops when a state, or planning area, becomes too rigidly locked in on a long-range plan. Even when a new approach is developed, those in the system may be so involved in implementing it and in giving or developing services that there is lack of time and opportunity for thought and re-evaluation which might identify needed change. This relates to an often-observed resistance of institutions to consultations on a system level. Consultation at this systemic level can address itself to policies, basic concepts, priorities, and organization, and changes in these areas can often lead to more effective utilization of existing limited manpower, and to great improvement in services on the clinical level. Instead, less effective assistance and consultation on the clinical level alone is much more frequently sought and more readily accepted. Yet services at this level can be extremely inefficient or even futile if the basic systemic structure and process of the agency need change.

Obstacles to change are by no means to be found only in projects started long ago. Planning of recent origin can and does contain such obstacles, and the risk is particularly great when the planning includes residential facilities. For instance, Connecticut has justly received considerable accolades for pioneering a community-oriented regional system of programming for the mentally retarded. The focal point of Connecticut's regional system is the regional center. As Klaber points out in his chapter: "....in theory, a regional center could function in rented space in an office building with its director and coordinators never giving direct assistance to retarded persons." In the early stages of developing this plan, the Connecticut authorities, however, decided to structure the regional center as a building complex including a "small" residential facility accomodating -sic- up to 250 beds. The resultant problem -- the tail wagging the dog -- appears to bear out a theoretical formulation, developed by Sarason in this volume, which refers to situations where the overall purposes of a setting become secondary to the purposes of its component parts. Sociologists recognize a similar phenomenon in the conflict between latent and manifest (the real and the apparent) functions of organizations.