Published in the Fall 2010 issue of SSA Magazine

Abstract: The State of Illinois is a major funder for human services across the state, providing much of the support for the Illinois social service sector. Facing the bleakest financial picture in decades, Gov. Patrick Quinn has proposed cuts to the budgets of the three overarching social service agencies for fiscal year 2011 that are both deep and wide. The impact on agencies, particularly for mental health and substance abuse oriented programs, may be devastating. Because social workers are so mission-driven in their work with clients, the stress of budget cutbacks can be particularly difficult.


The Illinois budget crisis continues to overwhelm social service agencies—and social workers—across the state

IN THE SPRING OF 2009, as Illinois Gov. Patrick Quinn attempted to plug an estimated $9.2 billion budget hole, a cloud of dread and despair hovered over a wide swath of the state’s social workers and therapists. The announcement of possible massive funding cuts caught many social service agencies off guard. Already reeling from chronically delinquent payments by the state for existing agreements, they struggled to come to terms with an even more uncertain future.

At the time, Eric Foster, A.M. ’03, was working at The South Suburban Council on Alcoholism and Substance Abuse in East Hazel Crest, Ill. He recalls the difficulty of soldiering on in his job as director of outpatient services with the prospect of losing colleagues and turning away clients looming over the organization. “While we were one of the agencies that was in better shape, there was still this general sense of dismay,” says Foster, now chief operating officer of the Illinois Alcohol and Drug Dependence Association. “There were all these rumors and speculation. People just weren’t sure if they’d walk in one day and their job would be gone.”

Foster tried to steel himself from the stress of the budget morass by plowing deeper into his work managing clients and staff. But even that took a toll. “I kind of shut down emotionally,” he says. “I didn’t sleep well at night. I didn’t do all those things that you do when you’re feeling really good. I didn’t go to the gym. I wasn’t eating right. I was always tired. But I knew I had to make the environment as comfortable as possible and relieve as much stress as I could for the staff and clients I was responsible for.”

Many American workers in this shaky economy take a head-down, nose-to-the grindstone approach at work, and that’s especially true for individuals in the human services sphere, where a deep dedication to helping the most vulnerable members of society is a prime professional motivator. “People in the human services sector are caregivers,” says Gina Guillemette, director of policy and advocacy for the Heartland Alliance for Human Needs and Human Rights. “They’re very committed to this work, and they understand resiliency, so they’re particularly adept at continuing on in the face of difficult situations.”

Following the announcement of budget cuts in 2009, thousands of protesters rallied in Springfield to convince legislators to reconsider the dramatic reductions. The result was the restoration of some funds for fiscal year 2010 to 2009 levels. But today, cuts are once again in the news, as Illinois officials have a budget deficit projected to be in the range of $13.1 billion for fiscal year 2011, according to the Center for Tax and Budget Accountability. And once again, social service providers are wondering what impact the measures will have on their clients, their agencies and themselves.

The State of Illinois is a major funder for human services across the state, providing much of the support for the Illinois social service sector, which has a workforce that is 400,000 strong. In fiscal year 2010, Illinois spent nearly $5.5 billion on social services through the state’s general fund under the umbrella of three departments: Human Services, Children and Family Services, and Aging.

Advocates say, however, that the modest increases in state social service spending that took place between 2002 and 2009—roughly $1 million a year—did not keep pace with the needs. The Illinois Department of Commerce and Economic Opportunity estimates that when new census figures are released, they will show that per capita spending on social services, when adjusted for population growth and inflation, declined by 10.5 percent.

Yet facing the bleakest financial picture in decades, Illinois Gov. Patrick Quinn has proposed cuts to the budgets of the three overarching social service agencies for fiscal year 2011 that are both deep and wide: $567 million to the Department of Human Services, $28.4 million to the Department of Aging and $34.5 million to the Department of Children and Family Services.

The impact of such cuts will be felt by agencies as large as Catholic Charities, which serves more than 1 million clients in Cook and Lake Counties and was forced to layoff close to 25 percent of its staff, and smaller nonprofits like Ada S. McKinley Community Services, Inc., an organization on the South Side that provides childcare, vocational care, mental health care and adoption training. The agency struggled through fiscal year 2010 with a $6 million hole in its budget due to nonpayment of funds owed by the state (about $3.5 million) and federal government. The agency laid off staff, borrowed into its line of credit and exhausted its reserves, but still had to slash programs.

“I’ve been in this business 37 years, and I’ve never seen anything like the last five or six years,” says George Jones, Jr., A.M. ’73, executive director of Ada S. McKinley. “We’ve had to send people home without services. It’s terrible. The need is there, but the funding isn’t there to keep programs going. It’s going to impact the entire community.”

What makes the cuts so devastating is the overwhelming dependence that most Illinois social service organizations have on state dollars. In a recent survey of nearly 500 nonprofit agencies conducted by the United Way of Illinois, nearly half of the respondents said more than half of their funding comes from the government. In some sectors, the dependence is even greater. Many Illinois health and human services agencies rely on the state for 97 percent of their funding.

The proposed cuts come on top of prolonged periods of non-payment by the State of Illinois, which is up to seven months in arrears to a variety of organizations and service providers. More than 120 groups in the state are owed as much as $1 million each, according to data collected by the Illinois Partners for Human Services. Often, contracts have been amended on the fly as state officials juggle bills and attempt to hold creditors at bay. According to a national survey of 9,000 human service organizations conducted by the Urban Institute, Illinois is the worst state in the nation for late payments to human service providers and is the third worst when it comes to changing the terms of contracts and grants midstream.

“The uncertainty of when to expect payment or if you’ll be paid what you agreed to has been most detrimental to a lot of programs,” says Samantha Aigner-Treworgy, A.M. ’10, M.P.P. ’10 (Harris), policy associate with the Ounce of Prevention Fund, an umbrella agency devoted to improving the quality of life for children born into poverty. For example, the Ounce subcontracts with a number of community-based nonprofits to provide home-visiting services to new parents. “They lost a lot of families because they just couldn’t find out from the state where they really were in terms of funding,” Aigner Treworgy says. “That makes it impossible to plan.”

At some agencies, chief executives have exhausted their lines of credit with lenders and venders, and at some small nonprofits, executive directors have even used their personal credit cards to make payroll and keep the doors open. About 54 percent of Illinois’ nonprofits have laid off staff and imposed furlough days, according to the Urban Institute report. Counselors and therapists, in turn, have often continued working full-time schedules on part-time salaries. Some are even performing their jobs on a volunteer basis, working without any pay to help the agencies stay afloat and maintain the continuity of client care.

Nancy Chertok, SSA’s director of field education, works with more than 400 agencies in a wide variety of fields across the city, giving her a wide-angle view of the impact of the state’s budget woes. “I have observed that our students are learning professional skills in more complex environments,” she says. “Some agencies are in transition; more agency staff work with the uncertainty of job cuts. We have lost some field placements because agencies have had let go of staff due to budget cuts.”

Of course, at the same time budgets are being cut, the recession has increased the need for social services. With the ranks of the unemployed swelling to nearly 10 percent nationally—close to 10.4 percent in Illinois— more individuals and families are seeking the care and counsel of the agencies whose staffs and programs are in jeopardy.

“A lot of the providers who I’ve spoken with in the Chicago area are dealing with a lot of stress,” says SSA Associate Professor Scott W. Allard, who recently completed two surveys of more than 2,000 governmental and nonprofit social service providers in seven rural and urban communities. “They’re facing the daunting challenge of having more and more people coming through the door but not knowing whether [their staff] are going to have jobs the next week, next month, next year.”

The fiscal troubles buffeting Illinois are not exactly unique, but the state does have one of the worst budget crises in the country, with longstanding structural problems that have made the financial difficulties more intractable (the state’s pension fund alone has an unfunded liability of $74 billion). The problem, according the Center for Tax and budget Accountability, is not spending. Illinois is a relatively low-spending state, ranking 42nd nationally. But for decades revenue has not kept pace with the state’s expenses, and the loss of tax income from a sputtering local economy has only made it worse.

“Illinois is really significantly behind the eight ball in relation to the rest of the country,” says Judith Gethner, coalition manager of Illinois Partners for human Services, a statewide network of social service organizations. “Other states experienced a recession in 2000, but they also experienced a recovery. Illinois never did. If we’d had a recovery like other states, we wouldn’t be where we are now.”

Allard points out that policy changes over the last decade or more have changed the impact of state budgets. “Part of it is that we simply have more people with need than we’ve seen in some time,” he says, “but it’s also that our safety net is much different now than it was during the recessions of the early 1980s when the federal [welfare reform] work requirement wasn’t in place. So much of our safety net assistance is tied to work activity today. Now, if you can’t find work, the safety net isn’t there for you. That makes the current recession very different. It has very different consequences.”

The rules have also changed for providers and those in need of services, particularly in the areas of mental health and substance abuse, the two categories of treatment that many say have been most adversely affected by the budget crisis. For substance abuse, as dollars are shrinking there is an increased demand for services due to escalating heroin and prescription drug use, particularly among youth. For mental health, in an effort to contain costs, the state has narrowed the population eligible for reimbursed services, targeting only those individuals who have particular diagnoses such as anorexia or bipolar disorder. Agencies must demonstrate that treatment of these individuals is a medical necessity, usually by documenting at least two in-patient hospitalizations, and if they can’t, they are often unable to maintain relationships with clients.

“They’re targeting a group of people for whom illness is not only severe, but persistent,” says SSA Senior lecturer Stanley McCracken, who has taught courses in adult psychopathology, mental health treatment and substance abuse. “My fear is that these individuals whose treatment is now unfunded will wind up in the criminal justice system. A lot may end up just freezing to death.”

In many cases, agencies are still able to provide service to the very poor clients who qualify for Medicaid. But individuals whose expenses are not covered are shunted aside, leaving the brunt of service cuts on the working poor. “So treatment decisions wind up being made based on eligibility for funding,” McCracken says, “rather than acuity.”

Marvin Lindsey, public policy social Worker for the Community behavioral healthcare Association of Illinois, shakes his head sorrowfully as he recounts a meeting convened in August with a coalition of executives from mental health and substance abuse agencies in Southern Illinois. “It was one of the most depressing meetings I’ve ever been to,” he says.

The proceedings started with the director of a clinic from Cairo, Ill. standing to tearfully relay the dire straits her agency was in. “She said she had 15 days of cash left,” Lindsey recalls. “She had run out of all of her ability to borrow cash, including on her personal credit cards. The bank would no longer lend her money, and she was going to have to close her facility. This is one of the poorest communities in the state, a community that really needs these services, but these are the communities where services are being cut back and cut out.”

Larger nonprofits and advocacy groups that represent human service agencies are working to get the word out about the impact of the state’s budget on clients and on agencies. But in some ways, the culture of social service work thwarts these efforts.

For instance, with so much of social service work—particularly in the areas of substance abuse, mental health and domestic violence—devoted to protecting the identities of individuals in counseling or treatment, providers are reluctant to ask clients to go public with the importance of services. “A lot of providers are rooted in the 12-step philosophy,” says Eric Foster of the Illinois Alcohol and drug dependence Association. “But when that’s your base, it’s hard to figure out how to rally the support of the community.”

Then there is the issue of providers’ devotion to clients. While shutting down services might dramatically illustrate to the public and media how dire the situation is for the state’s social service agencies, such a move is unfathomable to many providers.

“What is important to all of us is work ethic and professional responsibility,” says Jacob dancer, A.B. ’89, A.M. ’04, program supervisor at UCAN (formerly the Uhlich Children’s Advantage Network), an agency devoted to the empowerment, education and healing of youth and families who have suffered trauma, abuse or neglect. “As a clinician, you’re governed by certain ethics as part of your licensing. So even if your agency says, ‘I’m laying you off,’ your clients have to be taken care of in some form or fashion. So I inform my clients that in the event that I’m laid off, we’re still going to take care of you—off the clock if I need to.”

But such devotion masks the true nature of the crisis. “It then gets perceived by the public and the press as a false alarm,” says Ireta Gasner of the Ounce of Prevention. “As an administrator, you do everything you can to keep the funding decisions from impacting clients, but from the advocacy perspective, you need that pressure to let people to know what will happen if these services are not provided. So that’s really a moral and ethical dilemma.”

“These are people who are rooted in social work,” says Judith Gethner of Illinois Partners. “They’re mission- driven and struggle as business people to manager their limited resources, not wishing to turn away any client in need of help. Their instinct is to take care of people. The notion that we’re not going to take care of our clients even for a day is foreign to them.”

--By Charles Whitaker

By Charles Whitaker

The Illinois budget crisis continues to overwhelm social service agencies—and social workers—across the state

IN THE SPRING OF 2009, as Illinois Gov. Patrick Quinn attempted to plug an estimated $9.2 billion budget hole, a cloud of dread and despair hovered over a wide swath of the state’s social workers and therapists. The announcement of possible massive funding cuts caught many social service agencies off guard. Already reeling from chronically delinquent payments by the state for existing agreements, they struggled to come to terms with an even more uncertain future.

At the time, Eric Foster, A.M. ’03, was working at The South Suburban Council on Alcoholism and Substance Abuse in East Hazel Crest, Ill. He recalls the difficulty of soldiering on in his job as director of outpatient services with the prospect of losing colleagues and turning away clients looming over the organization. “While we were one of the agencies that was in better shape, there was still this general sense of dismay,” says Foster, now chief operating officer of the Illinois Alcohol and Drug Dependence Association. “There were all these rumors and speculation. People just weren’t sure if they’d walk in one day and their job would be gone.”

Foster tried to steel himself from the stress of the budget morass by plowing deeper into his work managing clients and staff. But even that took a toll. “I kind of shut down emotionally,” he says. “I didn’t sleep well at night. I didn’t do all those things that you do when you’re feeling really good. I didn’t go to the gym. I wasn’t eating right. I was always tired. But I knew I had to make the environment as comfortable as possible and relieve as much stress as I could for the staff and clients I was responsible for.”

Many American workers in this shaky economy take a head-down, nose-to-the grindstone approach at work, and that’s especially true for individuals in the human services sphere, where a deep dedication to helping the most vulnerable members of society is a prime professional motivator. “People in the human services sector are caregivers,” says Gina Guillemette, director of policy and advocacy for the Heartland Alliance for Human Needs and Human Rights. “They’re very committed to this work, and they understand resiliency, so they’re particularly adept at continuing on in the face of difficult situations.”

Following the announcement of budget cuts in 2009, thousands of protesters rallied in Springfield to convince legislators to reconsider the dramatic reductions. The result was the restoration of some funds for fiscal year 2010 to 2009 levels. But today, cuts are once again in the news, as Illinois officials have a budget deficit projected to be in the range of $13.1 billion for fiscal year 2011, according to the Center for Tax and Budget Accountability. And once again, social service providers are wondering what impact the measures will have on their clients, their agencies and themselves.

The State of Illinois is a major funder for human services across the state, providing much of the support for the Illinois social service sector, which has a workforce that is 400,000 strong. In fiscal year 2010, Illinois spent nearly $5.5 billion on social services through the state’s general fund under the umbrella of three departments: Human Services, Children and Family Services, and Aging.

Advocates say, however, that the modest increases in state social service spending that took place between 2002 and 2009—roughly $1 million a year—did not keep pace with the needs. The Illinois Department of Commerce and Economic Opportunity estimates that when new census figures are released, they will show that per capita spending on social services, when adjusted for population growth and inflation, declined by 10.5 percent.

Yet facing the bleakest financial picture in decades, Illinois Gov. Patrick Quinn has proposed cuts to the budgets of the three overarching social service agencies for fiscal year 2011 that are both deep and wide: $567 million to the Department of Human Services, $28.4 million to the Department of Aging and $34.5 million to the Department of Children and Family Services.

The impact of such cuts will be felt by agencies as large as Catholic Charities, which serves more than 1 million clients in Cook and Lake Counties and was forced to layoff close to 25 percent of its staff, and smaller nonprofits like Ada S. McKinley Community Services, Inc., an organization on the South Side that provides childcare, vocational care, mental health care and adoption training. The agency struggled through fiscal year 2010 with a $6 million hole in its budget due to nonpayment of funds owed by the state (about $3.5 million) and federal government. The agency laid off staff, borrowed into its line of credit and exhausted its reserves, but still had to slash programs.

“I’ve been in this business 37 years, and I’ve never seen anything like the last five or six years,” says George Jones, Jr., A.M. ’73, executive director of Ada S. McKinley. “We’ve had to send people home without services. It’s terrible. The need is there, but the funding isn’t there to keep programs going. It’s going to impact the entire community.”

What makes the cuts so devastating is the overwhelming dependence that most Illinois social service organizations have on state dollars. In a recent survey of nearly 500 nonprofit agencies conducted by the United Way of Illinois, nearly half of the respondents said more than half of their funding comes from the government. In some sectors, the dependence is even greater. Many Illinois health and human services agencies rely on the state for 97 percent of their funding.

The proposed cuts come on top of prolonged periods of non-payment by the State of Illinois, which is up to seven months in arrears to a variety of organizations and service providers. More than 120 groups in the state are owed as much as $1 million each, according to data collected by the Illinois Partners for Human Services. Often, contracts have been amended on the fly as state officials juggle bills and attempt to hold creditors at bay. According to a national survey of 9,000 human service organizations conducted by the Urban Institute, Illinois is the worst state in the nation for late payments to human service providers and is the third worst when it comes to changing the terms of contracts and grants midstream.

“The uncertainty of when to expect payment or if you’ll be paid what you agreed to has been most detrimental to a lot of programs,” says Samantha Aigner-Treworgy, A.M. ’10, M.P.P. ’10 (Harris), policy associate with the Ounce of Prevention Fund, an umbrella agency devoted to improving the quality of life for children born into poverty. For example, the Ounce subcontracts with a number of community-based nonprofits to provide home-visiting services to new parents. “They lost a lot of families because they just couldn’t find out from the state where they really were in terms of funding,” Aigner Treworgy says. “That makes it impossible to plan.”

At some agencies, chief executives have exhausted their lines of credit with lenders and venders, and at some small nonprofits, executive directors have even used their personal credit cards to make payroll and keep the doors open. About 54 percent of Illinois’ nonprofits have laid off staff and imposed furlough days, according to the Urban Institute report. Counselors and therapists, in turn, have often continued working full-time schedules on part-time salaries. Some are even performing their jobs on a volunteer basis, working without any pay to help the agencies stay afloat and maintain the continuity of client care.

Nancy Chertok, SSA’s director of field education, works with more than 400 agencies in a wide variety of fields across the city, giving her a wide-angle view of the impact of the state’s budget woes. “I have observed that our students are learning professional skills in more complex environments,” she says. “Some agencies are in transition; more agency staff work with the uncertainty of job cuts. We have lost some field placements because agencies have had let go of staff due to budget cuts.”

Of course, at the same time budgets are being cut, the recession has increased the need for social services. With the ranks of the unemployed swelling to nearly 10 percent nationally—close to 10.4 percent in Illinois— more individuals and families are seeking the care and counsel of the agencies whose staffs and programs are in jeopardy.

“A lot of the providers who I’ve spoken with in the Chicago area are dealing with a lot of stress,” says SSA Associate Professor Scott W. Allard, who recently completed two surveys of more than 2,000 governmental and nonprofit social service providers in seven rural and urban communities. “They’re facing the daunting challenge of having more and more people coming through the door but not knowing whether [their staff] are going to have jobs the next week, next month, next year.”

The fiscal troubles buffeting Illinois are not exactly unique, but the state does have one of the worst budget crises in the country, with longstanding structural problems that have made the financial difficulties more intractable (the state’s pension fund alone has an unfunded liability of $74 billion). The problem, according the Center for Tax and budget Accountability, is not spending. Illinois is a relatively low-spending state, ranking 42nd nationally. But for decades revenue has not kept pace with the state’s expenses, and the loss of tax income from a sputtering local economy has only made it worse.

“Illinois is really significantly behind the eight ball in relation to the rest of the country,” says Judith Gethner, coalition manager of Illinois Partners for human Services, a statewide network of social service organizations. “Other states experienced a recession in 2000, but they also experienced a recovery. Illinois never did. If we’d had a recovery like other states, we wouldn’t be where we are now.”

Allard points out that policy changes over the last decade or more have changed the impact of state budgets. “Part of it is that we simply have more people with need than we’ve seen in some time,” he says, “but it’s also that our safety net is much different now than it was during the recessions of the early 1980s when the federal [welfare reform] work requirement wasn’t in place. So much of our safety net assistance is tied to work activity today. Now, if you can’t find work, the safety net isn’t there for you. That makes the current recession very different. It has very different consequences.”

The rules have also changed for providers and those in need of services, particularly in the areas of mental health and substance abuse, the two categories of treatment that many say have been most adversely affected by the budget crisis. For substance abuse, as dollars are shrinking there is an increased demand for services due to escalating heroin and prescription drug use, particularly among youth. For mental health, in an effort to contain costs, the state has narrowed the population eligible for reimbursed services, targeting only those individuals who have particular diagnoses such as anorexia or bipolar disorder. Agencies must demonstrate that treatment of these individuals is a medical necessity, usually by documenting at least two in-patient hospitalizations, and if they can’t, they are often unable to maintain relationships with clients.

“They’re targeting a group of people for whom illness is not only severe, but persistent,” says SSA Senior lecturer Stanley McCracken, who has taught courses in adult psychopathology, mental health treatment and substance abuse. “My fear is that these individuals whose treatment is now unfunded will wind up in the criminal justice system. A lot may end up just freezing to death.”

In many cases, agencies are still able to provide service to the very poor clients who qualify for Medicaid. But individuals whose expenses are not covered are shunted aside, leaving the brunt of service cuts on the working poor. “So treatment decisions wind up being made based on eligibility for funding,” McCracken says, “rather than acuity.”

Marvin Lindsey, public policy social Worker for the Community behavioral healthcare Association of Illinois, shakes his head sorrowfully as he recounts a meeting convened in August with a coalition of executives from mental health and substance abuse agencies in Southern Illinois. “It was one of the most depressing meetings I’ve ever been to,” he says.

The proceedings started with the director of a clinic from Cairo, Ill. standing to tearfully relay the dire straits her agency was in. “She said she had 15 days of cash left,” Lindsey recalls. “She had run out of all of her ability to borrow cash, including on her personal credit cards. The bank would no longer lend her money, and she was going to have to close her facility. This is one of the poorest communities in the state, a community that really needs these services, but these are the communities where services are being cut back and cut out.”

Larger nonprofits and advocacy groups that represent human service agencies are working to get the word out about the impact of the state’s budget on clients and on agencies. But in some ways, the culture of social service work thwarts these efforts. 

For instance, with so much of social service work—particularly in the areas of substance abuse, mental health and domestic violence—devoted to protecting the identities of individuals in counseling or treatment, providers are reluctant to ask clients to go public with the importance of services. “A lot of providers are rooted in the 12-step philosophy,” says Eric Foster of the Illinois Alcohol and drug dependence Association. “But when that’s your base, it’s hard to figure out how to rally the support of the community.”

Then there is the issue of providers’ devotion to clients. While shutting down services might dramatically illustrate to the public and media how dire the situation is for the state’s social service agencies, such a move is unfathomable to many providers.

“What is important to all of us is work ethic and professional responsibility,” says Jacob dancer, A.B. ’89, A.M. ’04, program supervisor at UCAN (formerly the Uhlich Children’s Advantage Network), an agency devoted to the empowerment, education and healing of youth and families who have suffered trauma, abuse or neglect. “As a clinician, you’re governed by certain ethics as part of your licensing. So even if your agency says, ‘I’m laying you off,’ your clients have to be taken care of in some form or fashion. So I inform my clients that in the event that I’m laid off, we’re still going to take care of you—off the clock if I need to.”

But such devotion masks the true nature of the crisis. “It then gets perceived by the public and the press as a false alarm,” says Ireta Gasner of the Ounce of Prevention. “As an administrator, you do everything you can to keep the funding decisions from impacting clients, but from the advocacy perspective, you need that pressure to let people to know what will happen if these services are not provided. So that’s really a moral and ethical dilemma.”

“These are people who are rooted in social work,” says Judith Gethner of Illinois Partners. “They’re mission- driven and struggle as business people to manager their limited resources, not wishing to turn away any client in need of help. Their instinct is to take care of people. The notion that we’re not going to take care of our clients even for a day is foreign to them.”