Consumer-Centered Social Work Practice: Restoring Client Self-determination

The social work profession holds the right of self-determination among its highest values. The NASW Code of Ethics states, "The social worker should make every effort to foster maximum self-determination on the part of clients" (National Association of Social Workers, 1993, p. 1). In the real world of human services, the constraints of time and limited funding are exacerbated by the demands of increasing caseloads. As a result, self-determination is frequently the first right to be violated in the name of expediency, protection, or cost containment. Freedberg (1989) suggested that "day-to-day contact with clients involves confronting an inherent dilemma in the philosophy of self-determination". It was her position that agencies and their agents (social workers) must "control" the services delivered, thus controlling the clients. Abramson (1985) referred to the conflict as an "autonomy-paternalism dilemma." A solution to the discord of paternalism and self-determination is to adopt a consumer-centered approach toward practice. This article presents a new model that emphasizes greater consumer participation in and control over the helping process. The term "consumer" is commonly used in human services systems, but the essence of the term, with its fundamental rights and responsibilities, is largely overlooked in agency operations. This is unfortunate because when consumers are encouraged to exercise their intrinsic power, positive changes can occur. Progressive social workers that serve the most vulnerable clients (such as mentally ill, frail elderly, and severely disabled clients) are finding that the consumers themselves can be their own greatest resources. Several consumer movements are currently under way and are providing solutions to long-term problems. Philosophy of Consumerism At first glance, consumerism when applied to the human services may seem like an absurd idea. How is an elderly person using in-home supportive services a consumer? Is an outpatient clinic for the mentally ill population providing consumer goods and services? What does consumerism have to do with a severely disabled person living independently? Fundamentally, clients of the human services are consumers in the same way as are customers who acquire the services and products of a grocery store. Their consumption bears an actual cost that consumers pay either directly or through third-party payers, means-tested transfers, or charitable funding. Most providers, however, do not conceptualize their services as consumer products. In addition, consumers often do not understand the rights and responsibilities they bear for the management of their own lives. The basic doctrine of consumerism within human services systems is that individuals who have direct experience with a particular life condition (for example, aging, disability, mental illness) are more knowledgeable about their own needs and interests than are their professional counterparts. When individuals redefine their role from that of patient, client, or recipient of goods and services to that of consumer, their sense of control over their own lives is elevated. The consumer rights movement is not a new phenomenon. It grew out of several complementary social movements that began to emerge in the 1960s and 1970s, including * the civil rights movement and legislation * the development of self-help organizations * demedicalization and self-care (as with terminally ill people) * deinstitutionalization of the mentally ill population * the independent living movement of physically disabled people. Ralph Nader, leader of the original consumer movement, tackled large corporations to demand consumer rights and sovereignty. The movement was based on feelings of basic and widespread mistrust of the seller and the service provider (DeJong, 1984). In the early days of the movement, President John F. …