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Action Implications, U.S.A. Today

From: Changing Patterns in Residential Services for the Mentally Retarded
Creator: Gunnar Dybwad (author)
Date: January 10, 1969
Publisher: President's Committee on Mental Retardation, Washington, D.C.
Source: Available at selected libraries

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It should be obvious to any reader that while many program specifics may be culture-bound, many other program specifics, and above all, program principles, are very generalizable and probably even universal. Thus, the normalization principle first developed in Scandinavia appears to have universal validity. Comprehensive services, under a single administrative umbrella, for clearly defined, relatively small, geopolitical units such as cities or counties, as exemplified by Copenhagen, and by Malmohus and Essex Counties, are clearly applicable to the United States, as is apparent by the Connecticut program.

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Progress as an Obstacle to Change. While technical progress usually is change producing, it can sometimes serve to strengthen the status quo. An all-too-typical example here has been the routine dispensing of tranquilizers and similar drugs to large numbers of residents in institutions for the mentally retarded. (4) On the face of it, this seems preferable to the traditional method in poorly managed institutions of having large numbers of residents in handcuffs or straight jackets. However, the "modern" drug method permits human managers to take advantage of easily accessible and easily imposed external control, dispensed as needed medication, rather than to develop programs which place reliance on human interactions and which teach the residents internal controls.


(4) Institutions in the United States are under a barrage from drug firms whose "detail men," aided by various enticements, push for a steady increase in the use of a large variety of drugs. The situation is such as to suggest the need for a nationwide survey of the use of drugs in institutions for the retarded, and the relationship of drug usage to the promotional practices of the drug firms.

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Bureaucratic Subversion of Public Policy. Public policy is usually identified by programmatic statements emanating from top public officials or governmental commissions and by preamble statements of statutory enactments. A more realistic appraisal of "true" public policy can be achieved, however, through a comparative review of budget requests and legislative appropriations. Pursuit of the second approach will show that despite about ten years of constant emphasis on the development of nonresidential facilities in the community on the part of public officials, commissions, professional and civic groups, efforts to enlarge such programs are usually met with the greatest resistance, whereas hundreds of millions of dollars are made available for new construction (and inevitably increased maintenance costs) of residential facilities. Legislative discussion, if any, centers on how many institutions or how large an institution can be afforded, and hardly ever on a searching realistic exploration of alternatives to residential care. The phenomenon we observe here is known to sociologists as "system maintenance": bureaucratic structures develop a powerful drive for self-perpetuation and repulsion of outside influences which might be change producing. Expressed public policy raises the citizen's hopes, but then frustration sets in as the bureacracy -sic- substitutes emasculatory changes in place of the "true" public policy.

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The fact that proper attitudes are so essential to the change process may explain why a number of small states have made great progress, while some of the worst institution conditions are found in some of our largest and richest states. In a small state, a mere handful of persons in key positions need to possess good attitudes; in a large state, a hierarchy of hundreds of individuals may stand between a new idea and its implementation.

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Facilitators of Change

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From the foregoing review of obstacles to change, we now proceed to define means and ways of facilitating the change process.

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Change Orientation. First and foremost, it is important that those associated with institutions, no less than those associated with any organization or agency, attempt to make a conscientious and sincere commitment to the process of change. Change must not merely be allowed to happen, nor does it suffice to develop a vaguely favorable attitude toward it. What is needed is the adoption of conscious strategies of change, especially strategies that appear to be consistent with sociological knowledge and established experience.

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Likert and Lippitt (1953) identified certain conditions that must exist before people are ready to utilize the methods and findings of science. One of these ingredients is problem sensitivity, i.e., there must be awareness of shortcomings and problems in prevailing practices. Another ingredient is a belief that there are better ways of doing things. These two conditions are probably complementary; if one truly wants to improve things, one should first perceive and admit the existence in one's field or agency of inadequacies, archaisms and anachronisms, lack of validity of theories and procedures, and inefficient, perhaps invalid and even harmful, practices.

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