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Thank you very much Bruce, I really very much appreciate the invitation from Ruth and Bruce and their colleagues to be with you today. As we were emailing back and forth, I wanted to be sure that I had something to bring to the kind of really important gathering that I knew this would be. In effect, what I asked Ruth after this invitation to speak to you on the connection between the collaboration work that we've done and the diversity issues, and the intercultural issues that you've been raising is: "are you sure you want a rapidly aging white male from Orange County to come and talk to you about these issues?" And she said yes, and so, I'm here. With those obvious attributes or whatever else they might be, I come to you in hopes that I can say something to you about these connections. Three broad streams run into the foundation -- to mix my metaphors terribly at the outset for what I want to say. The first is the work that we do in the Center. Basically we were created seven years ago with the charge to find a way that our university and colleagues around the CSU System could show how professional training in the CSU System works across disciplines; a system that sends out every single year ten thousand young people, teachers, social workers, nurses, recreation counselors and others that go to work directly with children and families. Ten thousand young people every year! If we send them out knowing how to work, ten thousand and ten thousand and ten thousand, we have an enormously greater impact than any project we can ever envision. If we send them out without those skills, and the knowledge and the attitudes and the awareness that you've been talking about -- without the skills to work with each other across interdisciplinary lines, then we arguably, are part of the problem. That concept was what really informed the creation of our Center and the work with our colleagues around virtually every CSU campus. So, that's one foundation for my remarks today. Second, I had the great honor and privilege when I came back to California -- I grew up in California, then went wandering in the East for twenty-five years working with the federal government and spent some time in politics in Connecticut. I thought the guy said: go east young man, and it took me awhile to figure that out. I finally realized that California was where I was supposed to be and have been back for ten years. When I first came back, I had the great privilege of working for California Tomorrow. This is an organization which has published, I think, more good thinking about diversity and collaboration than I will possibly be able to share with you in a half an hour or so. Funded by the Casey Foundation and several other national foundations, California Tomorrow was asked to take this idea: how do we collaborate across disciplines in a context that is full of diversity and make both the multicultural and the multi-services connect? Heddy Chang and her partners at California Tomorrow are wonderful colleagues. The experience I had working with them then and since has been a real reservoir of information on these topics. Finally, I come with a certain bias on the subject as a one-time consumer who learned probably more by being a client of the system than in any other experience in my life. For the past four years my wife and I have been initially foster parents, but now adopted parents to a brother and sister, now five and six years old. This was not, as they sometimes tend to be, completely planned. It was something that happened, that was irresistible and the logic of which was overpowering at the time and which has enriched our lives enormously. But, we went into this role supposedly as professionals, knowing how the system works. I mean I write stuff about child welfare and my wife, who has her doctorate from the USC School of Social Work, writes stuff about substance abuse. We knew what this thing was all about. In the first eighteen months that our kids were with us, we dealt with fifty-one different agencies. We were bewildered and had no idea what was happening and got a tiny taste of what it feels like to be a consumer. We stood up in court having no idea what our rights were -- no one had told us. We got referred from agency to agency and had trouble negotiating the system as supposedly educated, middle income, knowledgeable people. We got a taste of what these systems are like. So that's another piece of my own background. In dealing with those fifty-one agencies I learned something very important. Ten years ago I wrote a piece that some of you might have seen, called Failure By Fragmentation, which California Tomorrow was good enough to publish and which turns up in conference workshops from time to time. After dealing with those fifty-one agencies, I now know what I meant. In fact, it seemed so important to revisit that subject that awhile ago I started writing a ten year retrospective version of that piece, the working title of which is: Still Fragmented After All These Years. I tried to make the case that the system isn't better -- we've gotten really good at putting some of the pieces together. That's the good news. But funders and other people in the system have moved even faster to proliferate fragment and tear apart the pieces. They're doing that faster then we're putting the pieces together, so we're falling behind. As Keith Choy cautioned, we are "going so specific, that we do slices only and never see the whole." That's where some of the urgency of my remarks may come from as well. Let me start out by dismissing, if I can, the notion of the dominant culture. I think the good news is the bad news: there is no dominant culture unless you believe MTV to be a culture, and there is a powerful argument that it is. If you have daughters and if you've read Mary Pipher in Reviving Ophelia, then you know that it is appropriately called a "junk" culture. The idea that the dominant culture, this media culture that Mary Pipher calls the "junk" culture is the commercialization of sex and the use of music and media to glorify a whole host of things that are probably not good for what we used to call the dominant culture. If that's where we're coming from then we not only have to work on acculturation, assimilation, diversification, the toleration and the embracing of diversity, but we have to recognize that out there in the main stream is something some reputable people call the "junk" culture. Let's just start from that perspective rather than the notion that there is this wonderful thing that we've got to get people clued into called, the dominant culture. We need to remind ourselves of Mary Pipher's work and of others who look at the particular impact of "junk" culture on gender and on the lives of young people. I think they have some profound messages for us as we think about culture. I want to talk about how these two topics fit together and I want to lay out my premises from the start. First premise: you can't provide effective services, and thus improve outcomes, if services are not culturally sensitive. The question of what works is inseparable from the questions of what works for whom. That's an underlying theme of what a lot of people have been saying yesterday and today, and I think we take that as a given. Second premise: you can't provide effective services, and thus improve outcomes, if services are fragmented. If the way people come to us has to fit into the boxes of our disciplines, and our professions, and our programs, and our agencies. You can't get from services better outcomes through fragmented services any more than you can through culturally insensitive services. If you take those two premises as a starting point then the question becomes whether those two ideas have something to say to each other. I think they do. Again, my source for thinking about this in part, is the body of work done by California Tomorrow on diversity and collaboration. Second, I would commend to your attention the work that Lee Schorr has done in her new book, Common Purpose, which updates the work she did in 1988 titled Within Our Reach, which is about going beyond service integration to service effectiveness taken to scale. She looks at the field of children and family and neighborhood change and says the most important question we can ask is, why do we have all of these great pilot projects, almost none of which ever go to scale? She talks about the hidden ceiling on scale. I have come to believe that so profoundly. I think that what we wind up doing sometimes in the diversity arena and in the collaborative integrated services arena both is saying: well the answer to this problem is a terrific pilot project that puts the pieces together that address diversity -- what we need is a good project. Projects however are how systems inoculate themselves against change. Projects are the buffers that systems set up so that when you go to them and say: what are you doing about x, they can say we have a neat project! And a lot of the time, we fall for it. We either fall for it by either setting-up the project or we fall for the answer because the system has used the project to buffer big change with little change. And Lee says: we need to know the difference between big change and little change. That sounds incredibly obvious. The next time you go out to a neighborhood, or a community, or a school, ask yourself how much time you spend working with them and talking with them about the project versus the amount of time you spend talking about the entire school budget or all of the resources in that neighborhood: all of the people resources, the churches, and the self-help groups, and all of the government public resources as well. Have we in providing the kind of technical assistance these universities can provide, been so focused on the project and it's funding and it's re-funding that getting the project launched has been our definition of success, not improving outcomes in that neighborhood? Have we created the report card enabling us to keep track of the condition of that neighborhood or are we just reporting on whatever the people who paid for the project want us to report on? Marcel said it wonderfully this morning: measurable outcomes using case studies that get us down to the details of people's lives. When we look at those case studies, we use them in our undergraduate course, we use them in our graduate level courses on collaboration, and you use them as well. When you get to a serious case study, you find this tragic reality that each system assesses differently. Each system labels differently. Kids fall between the cracks all the time, and my friends, our dirty little secret is that most of our education still sends people out to work agencies down those narrow, vertical tracks in which we teach them the assessment tools in that discipline. We teach them to work with people who will have the same initials after their name: RN, MD, MSW, or whatever and not to work as a team. And that's where I think the diversity conversation and the collaborative services conversation come right together. The key ingredient in seeking multicultural and multi-service effectiveness is a greater measure of humility than most people in academic life possess. We need to teach students that they don't have the answer, that their culture and their profession are not the only ways to help people. At the same time, we need to teach them that putting the pieces together is the best way to serve the whole person in the whole community. The WADI, we're already doing it, syndrome is a sign of hubris, not humility. Now, lest that sound like an accusation, let me tell you my story about the lack of humility on my part, my classic hubris. If the opposite of humility is hubris, then let me tell you my hubris story. I was in Arizona where I do a lot of work with Arizona State University in Phoenix and it's environs, and was talking about how the categorical system got to be categorical. This was six or seven years ago. I explained that we have a lot of philosophical trends in American, but the only philosophical movement native to this country is pragmatism: William James and Dewey and a whole bunch of others. When you look across the history of Western philosophy you find that pragmatism is about as far as we can go in saying here is the United States of America's contribution to philosophy. I said this because we're pragmatic in our natural makeup and in our philosophical bent. We see a problem, we invent a program, we launch a project and we've solved it. Problem, program, project, case closed. I've talked about the categorical system, stemming from 800 or so acts like that, acts of good intention semi-randomly assembled into a system no one understands. No one alive understands the 800 categorical programs that are now in place between the Federal and the State government trying to help children and families and community. Nobody. It has become utterly incomprehensible. People specialize in little tiny pieces of it all their life and understand the rules in that piece of it, and that's it. But, in telling the story, in Phoenix of all places, I made the mistake of saying the only native American philosophy is pragmatism. Now I meant small N, big A! After the session, a woman with the greatest politeness, and patience, and teaching approach imaginable, came up to me and said, "you know, another way to phrase that might be to recognize that the Native American -- capital N, capital A - philosophy is holistic. It is about harmony in the individual and the community and wholeness and unity; so be very careful about using the words small N native, capital A American, side by side if you aren't aware of that. Moreover she said, I think in our tradition, in our culture and others, there is the kind of harmony and wholeness you are talking about that you have opposed in the working of the categorical system. We couldn't imagine our culture treating only the mental health of a child, or treating only their classroom problems, separate from the way they relate to their family and their community and the earth. It was a terrific lesson, and I have remembered it, as you can tell to the detail, because it reminded me that we all walk around with a certain amount of hubris. Humility is essential. But, teaching it is an art form because you have to teach students what they don't know. You have to teach the nursing students where the boundary of their confidence stops and where they have to talk to the classroom teacher, or the social worker, or the mom, or the minister, or somebody else in that kid's life. Their assessment tools, which they worked so hard to master, and you worked so hard to teach, are no longer the way to understand the life of that child. We have gotten to a point in our disciplines where layered assessment is our approach to understanding our customers or clients, the children, youth and families. We work in the juncture, my wife and I, between the child welfare system and the substance abuse system, because about 60 to 80 percent of the families whose kids are reported for abuse or neglect have serious substance abuse problems. Those two systems need to work with each other. But, try to get the child welfare risk assessment process and the drug and alcohol treatment monitoring assessment process to agree that either assessment tool -- both of which are quite lengthy; both of which can be quite obtrusive and in the clients' face; both of which take a lot of front-line worker time -- try to get those two systems to agree that either of those tools can be used to understand anything about the other problem. Then take the idea of assessment in the school system where it means something entirely different and a look at the tools that we have for family assessment and you will see that we are assessing our customers to death. Our front-line staff has become enormously skeptical when we come along saying: we have discovered a new assessment tool. "Oh no", they say, "we'll just slide it on top of the others" -- layered assessment. Screening an assessment, after assessment, after assessment. I think that's where the glue comes and where some of the diversity challenge comes in understanding how I can't help but assess you from my vantage point and therefore, I have to understand how my tool incorporates your cultural values. I have to understand enough about your life so that I don't just fit you into the mental health mold or the drug and alcohol treatment mode that my diagnostic tools force me to try to fit you into. I've got to know enough about who you are, and where you've come from, and what your culture is, to know that this assessment tool that I have used to try to squeeze you into the right boxes, and get the right reimbursement, and make sure you're eligible, is only a vague approximation of what your life is all about. I think that's where there is a dialogue between the diversity, cultural sensitivity issues and the collaborative services issues. They must come together. A surgeon who speaks three languages, but doesn't know how to work with nurses or anesthesiologists is about to commit malpractice even though she's tri-lingual. We need both those sets of tools; that will take more time. We have to send out students with skills, knowledge, and attitude without the myth of self-sufficiency. Over and over we send them out with the understanding that you now have the credential to work with other people like you, and help make peoples' lives better, all by yourselves. Instead of teaching them you can go so far, you have some wonderful skills, but they are worthless; they will be malpractice in fact, unless you can combine your skills with those of other people. The kids don't come to us; the families don't come to us in the neat packages that we've constructed around our disciplines. If you need a theoretical under-pinning for all of this, if the realities of their lives aren't enough, then pick up the current addition of the Atlantic Monthly. The cover article "Back From Chaos," is by Edward Wilson, the socio-biologist from Harvard. He makes the case for interdisciplinary thinking; for thinking across the lines, more powerfully than anything I have read in a long time. It's the kind of article you put down and you say: I've been trying to say something like that, far less elegantly, for a decade. He says that the foundations of knowledge that matter are at the boundaries. It's biochemistry, it's astrophysics, and it's special education, and mental health, and what we're learning about the brain. If you think you have mastered that subject and you send students out who think they have mastered that subject enough to mess around in people's lives, you're about to commit malpractice. You're sending out ten-thousand from our system alone each year who are about to commit malpractice unless they understand how partial these tools we give them really are, and how desperately they need to bridge to other disciplines and to the parents, and the community, and the cultures in which they work. It's also important, I think, beyond humility to learn that there are some best practices in this field and there are some worst practices as well. Trying to cram all of this into a single three-unit course is my nominee for worst practice. I have colleagues who have done this, sending around their course outlines and syllabi; proud that they have invented some new courses. I have to say when pushed up against the wall, I am much prouder when a faculty member comes to us and asks for some help with her course from our arena of stuff that we work on, than when I have a dozen students lined up for a graduate level course, or when I see 200 students getting ready for an undergraduate collaborative services seminar, because the risk of putting this in a box, and turning it into three units is, as you know well, what we often do with diversity. The conversation we've been having about infusion and the work that some of you have done is so extraordinarily impressive; the antidote to the three unit solution. That's our equivalent to the community- based project. But, we've got to get serious about going to scale. We've got to measure our work against the larger universe of need. In Kansas City last summer, fifty or so universities involved in inter-professional education -- one of the several labels that this work passes under -- talked about where we are in inter-professional education and collaborative services and graduate level professional education. The conclusion, I identified with most, was that the good news is, we have dozens of programs around the country sending out young people, and mid-career people who come back with the skills and the knowledge and the attitude we want. The bad news is that they represent less than five percent of all of our graduates. Most professional education is done the old way. We have to measure what we do, as good as we feel about it sometimes, against those larger standards. The same way that if you go into a neighborhood and launch a great project for $58,000 and in that neighborhood there are $10 million of services, and things in the neighborhood are getting worse, your project, mentality, may be part of the problem. We've got to have that sense of the larger system. We have become so much better at thinking about the pieces than about the bridges between them, or about the larger system behind them and underneath them. I also think that we have to look at some of the barriers, which you've been talking about along the way. One that we decided to spend a little time with -- with some Federal and foundation funding that we had last year -- was the degree to which accreditation, a very important issue for universities, becomes a block on working across disciplinary lines. Some of you have talked about accreditation being a block or only a partial incentive for good work in the field of intercultural, multicultural work around diversity issues. In a joint project involving the Council on Social Work Education in Washington, the USC School of Social Work and ourselves, we concluded, after looking at nursing, social work and education case studies and at some CSU accreditation visits as the evidence, that what's written down in accreditation standards is not the problem. Nobody says on an accreditation visit: see if they are doing collaborative education across disciplines and ding them if they are. It's not written that way. It is rather the Sherlock Holmes view. Sherlock Holmes who solved the case based on a dog that didn't bark. It's what isn't happening in Political Science that we have this concept of non-decisions; the things we don't made decisions about. In accreditation, it's what doesn't get said in the standards in the midst of all the talk about making sure that people from your discipline supervise your students when they go out on their field assignments. We make sure that in the discipline we get this and this and this. This builds up so high that we are silent on the message of work across the lines with other disciplines. It's accreditation by discipline, by a profession, and so the unspoken message is the other professions are important too. Since it isn't spoken, we don't work on it when we get ready for accreditation. Since we don't work on it, it becomes that less important. That's one of the places where all of this goes. Finally, I think there is a discipline that I think we leave out of the mix often that we need to bring into this conversation. It is where I think our work in the community has to be grounded and our work across disciplinary lines, and finally our work in the area of diversity as well. I think our work has to be more ethically grounded than it usually tends to be. We tend to teach ethics as privacy, confidentiality, and those kinds of issues in our field. But, I think there is a deeper question. This gets to the point Marcel made this morning in terms of measurable outcomes. It is all the work we do to make sure that interdisciplinary work and collaborative work are measured not by how hard we work, not by how many collaboratives get formed, not by projects, but by changes in the outcomes measured in the lives of the people we are trying to help. That may be an unpopular movement but, my friends, our students will live with it the rest of their professional lives. You might not like managed care and fiscal outcomes; then work harder at getting the client outcomes that can balance the dollar bottom line. Don't, as some fields have done, say what we do is immeasurable, mysterious, magic, unknowable and you cannot apply this stuff to our field when in fact, two out of three Americans that went to work this morning go to a job where their pay and their performance are connected. If we continue to argue that we are working in fields that are immeasurable and where there should be no connection, those other two-thirds of American workers are going to keep looking at us like, we want a special deal. That's already how they think about tenure. Right or wrong, why should we give them additional ammunition to think about the effects of what we do in the lives of the people that we purport to help? You see, that's the ethical core of it. We take money for helping people and what we primarily measure is what we do; not whether they got better. That is ethically questionable. So, if we are client centered, we must be collaborative because the client needs more than one service at a time. If we are client centered, we must also be outcomes driven, and community based, and family focused, and culturally centered. This is not for management reasons or for dollar reasons, but because it's better for people. For the ethical reasons I think, that inform the best practice regardless of our profession. That's hard work. It's harder than the way we do it now. The good news is, the people who try to block this, I have found in my seven years at Fullerton, retire or die. It's too bad that they've gone, but you can steer around many of them. The other good news is that the best of the young and diverse faculty you've been talking about gravitate to this. So my tips on collaboration are listen to the students, because we haven't yet spoiled them. They want to work across the disciplines. Until we tell them that you have to stay inside the wall to get promoted and to get more money, they want to work across the disciplines. Listen to the community, because they don't have the problems as neatly organized and categorized as we do. And listen to the customers, listen to the clients, listen to the moms, and the dads, and the kids that we are supposedly helping because they too don't come with these labels attached, the way we attach the labels to our work and our practice. If we listen in that way, as you've talked about listening to people of other cultures, then we will do better practices. We will have a larger impact and we need not fear the measurement of our outcomes. I see enough change in universities to be hopeful about that. I see the best young faculty coming into universities wanting to work that way, even though they're sometimes warned by their superiors to make the grade inside your discipline, than to do this collaborative stuff. Some of them happily are willing to cross that line already. I also see communities demanding from us, that if we don't work this way then -- someone said this morning the Cal State System is being dismantled, 2 billion dollars, that's some dismantling. But we will have a harder time justifying that 2 billion dollars. Hospitals in this State under Senate Bill 969 have to talk about the community benefits that they contribute to justify their non-profit status. I long for the legislation -- I may go ask my cousin Bill Leonard to introduce it some day, that will say: universities also have to annually justify their impact on the community; not with a list of 56 projects, but a coherent demonstration of their impact. Because the 56 projects makes it harder for the community to put the pieces back together. If we are part of the fragmenting influence then the failure of our fragmentation is partly our responsibility. If we are helping our students, the community, and the customers, and clients we work with to put the pieces back together, then we are part of the solution. We must be. We absolutely must be. For ethical reasons, for reasons of our financial survival, and because it's right. Thank you very much. Sid Gardner is the Director of the Center for Collaboration for Children at California State University, Fullerton.
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