Social Workers as State Agents?: How US-based Syringe Service Employees Navigate State and Non-State Service Priorities

• In Event: Health Social Work with Precarious Groups

Abstract

Human service nonprofit employees, including social workers and allied professionals occupy a unique intermediary space in the contemporary US welfare system, wherein they are tasked with mediating between state demands, participant expectations, and community concerns (Fong, 2020; Lipsky, 2010; Maynard-Moody and Masheno, 2000). In this paper, I use data from employees at syringe service programs (SSPs) in a Midwestern US state to uncover how providers in a rapidly professionalizing field negotiate the tensions working with (and against), state regulatory systems. SSPs are programs that allow intravenous drug users to obtain unused needles, as such decreasing the likelihood of bloodborne infections, and creating a support system for drug users (McLean, 2012). As syringe services began as a radical peer-led movement, (Kelley et al., 2005; Hassan, 2022), it is important to understand what happens as these organizations have obtained increasing mainstream acceptance due to their public health successes and other exogenous political factors. Using street-level bureaucracy (Lipsky, 2010) as a theoretical framework, this paper asks: how do frontline SSP employees make everyday decisions in light of their position as an intermediary?

This qualitative project includes semi-structured interviews with 26 SSP employees at 22 syringe service programs in a Midwestern US state during 2020. This particular state has seen a rapid expansion in state funding in SSPs over the past five years. Interview questions focused on definitions of harm reduction, working with state collaborators and funders, working with legislative officials, harm reduction activism, and how the SSP interacts with the community. Interviews were transcribed using NVIVO software, and thematic analysis was used when analyzing the data.

Data shows most SSP employees are supportive of the efforts that the state, particularly the state’s department of health and human services (DHHS), has put into promoting syringe services. Indeed, while the majority of respondents were satisfied with the state support they received, they described challenges that the state engendered in hindering direct service provision. Specifically, as street-level bureaucrats, some respondents described reducing their frontline work to maintain data collection and reporting necessary to receive funding, while also noting restrictions in hiring, particularly around hiring people with current or lived experience in substance use. Others described frustrations as they had to square their individual and organizational priorities with that of the state in order to access the legitimacy and material resources state collaboration provided. Nevertheless, because the state was perceived as being supportive, there was little advocacy conducted in order to engage in pushback against state dictates.

This project aids in understanding of how frontline service providers in a radical field navigate tensions engendered by state involvement. In this particular field, even as the state has outwardly been supportive through the provision and human and material resources, respondents describe difficulty in advocating against the state, and either accept conditions as is, or choose to end service provision. These research findings have implications for understanding how frontline workers engage with state actors, and how they situate their own frontline work within the confines of state structures.

References

Fong, K. (2020). Getting eyes in the home: Child protective services investigations and state surveillance of family life. American Sociological Review, 85(4), 610-638. https://doi.org/10.1177/0003122420938460

Hassan, S. (2022). Saving our own lives: A liberatory practice of harm reduction. Haymarket Books.

Lipsky, M. (2010). Street-level bureaucracy: Dilemmas of the individual in public service. Russell Sage Foundation.

Kelley, M. S., Lune, H., & Murphy, S. (2005). Doing syringe exchange: Organizational transformation and volunteer commitment. Nonprofit and Voluntary Sector Quarterly, 34(3), 362-386.

Maynard-Moody, S., & Musheno, M. (2000). State agent or citizen agent: Two narratives of discretion. Journal of public administration research and theory, 10(2), 329-358.

McLean, K. (2012). Needle exchange and the geography of survival in the South Bronx. International Journal of Drug Policy, 23(4), 295-302.

Author

• Theresa Anasti, Washington University at St. Louis