Children and Youth Services Review 38 (2014) 123–132

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Organizational responsiveness to children and families: Findings from anational survey of nonprofit child welfare agencies

Bowen McBeath a,⁎, Mónica Pérez Jolles b, Emmeline Chuang c, Alicia C. Bunger d, Crystal Collins-Camargo e

a Portland State University School of Social Work and Hatfield School of Government, PO Box 751, Portland, OR 97207, United Statesb University of North Carolina Gillings School of Global Public Health, Department of Health Policy and Management, United Statesc University of California-Los Angeles Fielding School of Public Health, Department of Health Policy and Management, United Statesd The Ohio State University College of Social Work, United Statese University of Louisville Kent School of Social Work, United States

⁎ Corresponding author.E-mail address: mcbeath@pdx.edu (B. McBeath).

0190-7409/$ – see front matter © 2014 Elsevier Ltd. All rihttp://dx.doi.org/10.1016/j.childyouth.2014.01.018

a b s t r a c t

a r t i c l e i n f o

Available online 31 January 2014

Keywords:ConsumersChildren and familiesNonprofit organizationsChild welfare agenciesInterorganizational competition

Although childwelfare practice at the frontline, organizational, and systemic levels is predicated on responsivenessto children and families, research has not determined why some child welfare agencies are more responsiveto consumers than others. This study examines the influence of children and families on agency operations(“consumer-centricity”) among a national sample of nonprofit child welfare agencies. In testing for external andinternal determinants of consumer-centricity, we find that agencies reported a high level of consumer-centricityoverall. Multivariate analyses indicate that interorganizational competition was the principal predictor ofconsumer-centricity; in contrast, internal agency attributes such as administrative infrastructural supports andaccreditation status, service technology, agency leadership, and structural characteristics were not associatedwith consumer-centricity. We propose three areas for continuing child welfare research on consumer-centricityand identify direct and indirect strategies that child welfare policymakers and practitioners may use to promoteconsumer-centricity among nonprofit child welfare agencies.

© 2014 Elsevier Ltd. All rights reserved.

1. Introduction

Attending to the needs of children and families is a central consider-ation in the design and delivery of child welfare programs. At the front-line level, case managers and clinicians are expected to tailor servicesand permanency plans to the unique needs of youth and their families(Pecora, Whittaker, Maluccio, Barth, & DePanfilis, 2009). Child welfaremanagers have been increasingly required to develop integrated data-bases and performance dashboards (Carnochan, Samples, Lawson,& Austin, 2013) and use case-based information to shape program im-provement strategies (Collins-Camargo, Sullivan, & Murphy, 2011).Child welfare agency mission statements are commonly framed aroundthe value of caring for at-risk children and attending to their safety, per-manency, andwellbeing needs. At the policy level, the Child and FamilyService Reviews are predicated on enhancing the responsiveness ofchild welfare systems to the benefit of state and federal child welfaresystems (Testa & Poertner, 2010). At each of these levels of organization,practices and routines are developed in anticipation of or in response tothe changing circumstances of children and families.

This paper investigates consumer-centricity in child welfare agencysettings, defined as the extent to which organizations act in response toor are affected by the needs, behaviors, and/or preferences of child

ghts reserved.

welfare-involved children and families. Child welfare innovationsincreasingly seek to incorporate child and family input under theassumption that consumer-centricity may enhance organizational effec-tiveness in improving child and family outcomes. Through the use ofdemonstration projects, the Children's Bureau has supported the involve-ment of youth and families in child welfare system redesign (Mitchellet al., 2012; Williamson & Gray, 2011). Attention to consumer-centricityalso reflects growing advocacy efforts by foster care alumni to expand therole of children and families in child welfare policymaking and systems(Casey Family Programs, 2008; Nybell, 2013).

These efforts are intended to enhance public accountability andsystem effectiveness by strengthening direct and indirect consumerparticipation in organizational decision-making. Indirect approachesfor incorporating consumers into agency governance involve agencydirectors, staff, and community members representing the interests ofchildren and families in board deliberations and decision-making.Direct mechanisms range from formal consumer participation onboards, panels, and workgroups to informal, often ad hoc consumerinput through surveys and frontline partnerships in service planningand delivery (Bryan, Collins-Camargo, & Jones, 2011; Collins-Camargo,Jones, & Krusich, 2009; LeRoux, 2009a).

At the program level, children and families may also be involved inservice delivery and planning. Agency leaders may elicit consumerinput in implementing and monitoring evidence-based practices(Aarons, Hurlburt, & Horwitz, 2011; Marty, Rapp, McHugo, & Whitley,2007) and in performance measurement and program evaluation

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(Hatry, 2007). Additionally, agencies may use family engagementmodels (e.g., team decision-making, family group decision meetings)to systematically increase opportunities for child and family involve-ment via family–caseworker collaboration in assessment and serviceplanning (Crea, Crampton, Knight, & Paine-Wells, 2011; Weigensberg,Barth, & Guo, 2009).

Whether focused on governance or programming, these methodssensitize agency staff and leaders to consumer perspectives for the pur-pose of enhancing service quality and promoting a learning organization-al culture (Schein, 1986). They are also premised on the expectation thatconsumers should have some control over how they are treated withinhuman service systems (Smith, 2010). As a result, consumer-centricitymay promote the development of more positive relationships betweenagency staff and consumers by operationalizing the principles of inclusiv-ity and de-stigmatization (Halvorsen, 2003; Irvin & Stansbury, 2004;Kissane, 2010); it may also improve decision-making and servicesthrough collaborative engagement in program improvement (Smith,2010; Yang & Pandey, 2011).

Yet while the field recognizes the importance of adjusting gover-nance and programming in response to consumer needs and input,reforming these structures may be difficult in practice. Whethermandated by law (as in the case of citizen review boards and panels)or initiated voluntarily, agency barriers to consumer-centricity mayinclude: lack of external incentives or pressures; policy/fiscal prohibi-tions against altering governance and management practices; insuffi-cient agency resources and staff supports; lack of leadership promotinga culture of consumer responsiveness and supporting consumer-centered initiatives; and ineffective procedures for requesting and incor-porating feedback (Bryan, Jones, Allen, & Collins-Camargo, 2007; Bryan,Jones, & Lawson, 2010; Collins-Camargo et al., 2009). In addition, chil-dren and families may have little authority over service and governancereforms. In child welfare as in other human service fields, children andfamilies are the primary consumers of childwelfare services but are rare-ly the direct payers for them and so may have little ability to negotiateservice options in the face of Medicaid regulations and other federaland state funding restrictions. Also, the services received by childrenand families may be court-ordered rather than voluntary, adding anadditional layer of complexity reflecting the authority and preferencesof family court officials in service delivery (Fluke & Oppenheim, 2010).

Thus, in making programmatic decisions, child welfare agenciesmust balance the needs of children and families with their commit-ments to other constituencies, including funders, regulatory bodies,consumer groups, community partners, and their own staff and directors(Hasenfeld, 1982; Provan &Milward, 2002). The question becomes howagencies address the needs of consumers in light of their obligations toothers. This topic becomes particularly important when child welfareagencies face competing demands from key groups, as it highlights theimportance of identifying the conditions underwhich agencies prioritizethe needs of children and families.

These challenges associated with consumer-centricity may be feltacutely by nonprofit child welfare agencies. Nonprofit agencies havegeneralized ownership structures wherein funders, agency staff, com-munity members, and program participants may claim ownership(Frumkin, 2002). The influence of these stakeholders on nonprofit agen-cies generally depends on the extent of their contribution to agencymission and fiscal sustainment. Because nonprofit child welfare agenciesare often dependent on revenues generated through service contractswith public agencies (McBeath, Collins-Camargo, & Chuang, 2012),they may face economic pressures favoring consumer-centricity whenexternal mandates and contract provisions require responsiveness tochild and family needs. However, the priorities of funders and publicchildwelfare agenciesmaynot always reflect these local concerns raisingthequestion of underwhat conditions agencies adjust their operations inresponse to consumer needs.

In general, research has described how child welfare agencies pro-mote consumer participation but not the impact of these strategies for

stimulating consumer-driven organizational change. LeRoux (2009a,2009b) found that nonprofit agencies provide greater opportunitiesfor consumer governance when funded more by public contracts as op-posed to private, charitable giving;when led by female and/or culturallydiverse directors; when board composition mirrors the overall demo-graphics of consumers and when boards include consumers; andwhen agencies are small. In contrast, there has been no empirical atten-tion to the influence of consumer feedback and needs on core interorga-nizational, programmatic, and staffing domains.

This paper uses data from the National Survey of Private Childand Family Serving Agencies (McBeath et al., 2012) to examine theperceived influence of children and families on nonprofit organizationalbehavior across the domains of initiating new services, managingexisting programming, forming interorganizational relationships, andstaff development. Multivariate models are used to identify theinfluence of external and internal factors associated with the likeli-hood of consumer-centricity in these domains of organizationaland management practice.

2. External and internal determinants of consumer-centricity

Fundamentally, adapting organizational structures and processes tobe more consumer-focused involves organizational innovation andchange. Hasenfeld (1982) suggests that organizational innovation refersto the adoption of processes, technologies, and patterns of human rela-tions previously unfamiliar to the organization whereas organizationalchange involves the redistribution of resources and power supportingagency sustainment. Because organizations generally seek to aligntheir internal operations with the demands and opportunities presentin their external environment, innovation and change that reflectconsumer input may be motivated by external and internal factors.

In particular, nonprofit childwelfare agenciesmaybecome consumer-centric in response to interorganizational competition and features of thelocal agency environment as well as internal organizational factors in-cluding administrative infrastructure and strategic attributes, the formand flexibility of agency service technology, and overall agency structure(Hasenfeld, 1982; Scott, 2008). Even when these change conditions arepresent, however, agency engagement in innovative, consumer-focusedbehavior may be shaped as much by larger institutional pressures as byintraorganizational conditions (Hasenfeld & Garrow, 2012). We reviewthe literature supporting these arguments in this section.

2.1. External factors

Interorganizational competition may create pressures and incentivesfor agencies to attend to consumers and secure other scarce andcontested resources. Literature over the past two decades suggeststhat competition is rising in the nonprofit human service sector due tothe reliance on shrinking public funding, common service technology,shared clientele, and themovement of for-profit firms and other organi-zations into markets traditionally populated by nonprofit providers(Smith, 2012; Tuckman, 1998; Young, Salamon, & Grinsfelder, 2012).At the sector level, competition has resulted in greater interactionbetween and consolidation of providers, increased efforts to securefunding from traditional and new sources, and managerial pressureto enhance overall agency performance (Garrow, 2011; LeRoux &Goerdel, 2009; Romzek, LeRoux, & Blackmar, 2012; Romzek, LeRoux,Johnston, Kempf, & Piatak, 2013).

The extent and consequences of competition among nonprofit childwelfare agencies have not yet been established, although arguments canbe made to suggest that competition can have positive and negative ef-fects on consumer-centricity. On the one hand, competition may pushnonprofit agencies to be more market-oriented and commercialized,and thus more consumer-centric. This argument, which reflects theNew Public Management orientation to privatization and managedcompetition (Meier & O'Toole, 2009) as well as population ecology

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theory (Baum & Singh, 1996), suggests that nonprofit child welfareagencies in increasingly competitive environmentsmay seek out under-served consumer populations, develop new service technologies torespond to emergent needs, and distinguish their services relative toother local providers (Young et al., 2012). Regardless of whether fosteryouth and families are able to select providers (which may not be pos-sible for involuntary populations), competition may increase organiza-tional attention to consumer engagement due to increased managerialconcern with contract procurement and fiscal risks from poor programperformance. These commercialization strategies imply a heightenedinfluence of consumers on organizational structures and processes.

On the other hand, competition and commercialization may dis-tance nonprofit agencies from their traditional roles of serving at-riskpopulations by forcing them to focus unduly on new revenue genera-tion (particularly from fee-for-service social enterprises). This suggeststhat competition may lead nonprofit child welfare agencies to restrictservices in response to consumers' ability to pay for care (Chetkovich& Frumkin, 2003; Smith, 2010, 2012). Thus, while competition may beexpected to strongly impact nonprofit child welfare agencies' relation-ship to consumers, the expected direction of its effects are unclear.

The other external force that may influence consumer-centricity isagency location and, in particular, whether the agency is located in ametropolitan area. Nonprofit agencies providing child welfare servicesin central cities must grapple with consumer demand and service coor-dination issues, often inseparably yoked, that suburban, rural, andmulti-location agencies may experience less intensely (Barth, Lloyd,Christ, Chapman, & Dickinson, 2008). First, consumer demand is likelyto be higher in urban than nonurban areas due to a combination ofgreater numbers and greater need. Given the intersection of poverty,race, and need for mental health and substance abuse treatment ser-vices in urban child welfare systems (Freisthler, Merritt, & LaScala,2006), agencies located in urban cores may be particularly challengedto respond to complex consumer needs.

Second, contract management and service coordination may bemore challenging in cities. Typically, multiple agencies are involved indelivering serviceswithin largehuman service systems, necessitating ad-ministrative coordination of contractual and sub-contractual relation-ships (Provan & Milward, 2002). Contractual relationships for servicestend to be more discretionary and cooperative in suburban and ruralareas compared to cities, which are characterized by hierarchical ties(Van Slyke, 2007). In addition to having a more formal and complexcontracted service delivery system, cities also have higher populationdensities, greater demand for services, and higher likelihood of over-use of community resources compared to nonurban regions. As a result,nonprofit agencies located in cities may face difficulty linking consumerswith services that have not been overused or depleted (Allard, 2009;Freisthler, 2013).

2.2. Internal factors

Strategic organizational attributes include administrative infrastruc-ture for performance measurement, program evaluation, and qualityimprovement. These functions, which are often expensive for fledglingnonprofit agencies, support managerial efforts to enhance services andoverall agency performance and often signify a professionalized organi-zational environment (Smith, 2012). Because accrediting bodies such asthe Council on Accreditation are increasingly rating agencies on thepresence of administrative supports (Lee, 2013), accreditation statusmay serve as an indicator of the availability of organizational resourcesfor performance measurement and program improvement. Whilethese resources may not always be put to use in the service of consumerchoice and voice, organizational innovations such as consumer-centricitydo need administrative supports to be sustained (Jaskyte, 2011). How-ever, having extensive infrastructure may also prevent agencies fromaccommodating consumer needs especially if the development ofthese supports is a response to regulations imposed by accrediting

bodies, funders, and other institutions. In this situation, agencies withmore infrastructural supports may have difficulty changing in responseto consumers, contributing to organizational inertia (D'Aunno, Succi, &Alexander, 2000).

Agency leadership may also influence the agency's ability to alteragency structures and practices in response to consumers. Consumer-centricity may be more likely to occur in agencies whose leaders haveexperiencewith agency-wide change initiatives andwhose professionalvalues promote consumer participation (Hasenfeld, 1982). Studies havefound that directors with participatory and transformational manage-ment approaches, and those with MSW degrees, are more likely toengage in agency efforts to empower consumers (Hardina, 2011;Hardina &Montana, 2011). Other research has identified service benefitsfor consumers and greater opportunities for consumer involvementwhen agencies are staffed by individuals sharing their sociodemographicbackground andwhen agency leaders and representatives are culturallydiverse (LeRoux, 2009a; Wilkins, 2007).

Childwelfare agencies are often taskedwith providing court-orderedservices that may not be desired by consumers. Tailoring agency servicetechnology to the diverse needs of children and families is the principalmeans through which nonprofit providers engage in consumer-centricity. Service tailoring at an organizational level involves ensuringthat the services provided for children and families meet their needs,wishes, cultural norms, and accessibility preferences. Nonprofit agenciestailor their services by providing a continuum of services either directlyor through subcontract with other community providers.

Changes to agency service technology may have ambiguouseffects on consumer-centricity, particularly when motivated by costsavings and program performance. For example, performance-basedcontracting and managed care approaches are commonly used bychild welfare systems to rein in treatment costs and improve perma-nency outcomes (Martin, 2005), yet their effects in these areas remainunclear (Collins-Camargo, 2012; Collins-Camargo, McBeath, & Ensign,2011).Moreover, it is questionable whethermarket-based service tech-nologies pressure nonprofit child welfare agencies into cherry-pickingstrategies and other methods of differentiating between highly reim-bursable and more costly-to-serve consumers. While these strategiesmay be based rationally on economic considerations, they may also re-duce the provision of needed services to children and families with thegreatest needs and, as a result, negate consumer-centeredorganizational efforts (McBeath & Meezan, 2010; Meezan & McBeath,2008; Smith, 2012).

Finally, structural characteristics of organizations—notably theirbureaucratization and formalization—may influence the degree towhich nonprofit agencies respond to changing child and family condi-tions. More complex agencies may benefit from economies of scaleandmay have slack resources to apply to emerging consumer demands,but may also be slower and less able to respond to environmentalchanges (D'Aunno et al., 2000; Hannan & Freeman, 1984). These struc-tural features, which are commonly proxied via organizational age andsize, may thus be used to test for organizational adaptability vs. unre-sponsiveness to external and internal pressures and opportunities(Hasenfeld, 1982; LeRoux, 2009a, 2009b).

2.3. Organizational stasis due to institutionalization

Although internal organizational factors may influence the degreeto which agencies incorporate consumer needs and input, externalforces may have a much stronger influence on nonprofit child welfareagencies' behavior. Nonprofit child welfare agencies rely heavily onresources and legitimacy from funders, regulatory bodies, and other or-ganizational partners (rather than directly from consumers). They maytherefore be particularly susceptible to external demands (Hasenfeld,1982; Selznick, 1996; Singh, House, & Tucker, 1986). Agencies may bemandated to comply with public policies, contractual requirements,and court dicta and as a result unable to alter their overall service

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approach and frontline efforts in direct alignmentwith consumer needsand feedback (Backman & Smith, 2000; Smith, 2012). For example,when agencies are required to deliver a standard treatment model (oradopt a common approach to frontline practice) to avoid furthering dis-parities in service delivery or inequities in overall service approach, staffmay not be able to tailor their service approach to the unique and di-verse needs of children and families.

Institutional pressures need not fully constrain agencies' ability todevelop and implement consumer-centered programming. But such ex-ternal forces may substantially limit the autonomy and/or discretionavailable for agencies' use in organizing their internal processes. There-fore, agencies may be committed to consumer-centricity but unable tobalance consumer needs with other fiscal and organizational priorities(Darlington, Feeney, & Rixson, 2004, 2005; Karatekin, 2013). Thissuggests that nonresponsiveness to consumers may be an adaptivebut sub-optimal response to prevailing institutional norms. Thus, largerfunding, regulatory and marketization trends may account for greatervariation in nonprofit consumer-centricity than internal differences inconsumers and organizations.

3. Methods

3.1. Study sample and data collection

All analyses were conducted using data from the National Survey ofPrivate Child and Family Serving Agencies (NSPCFSA). NSPCFSA is thefirst national survey of private child and family serving agencies acrossstate child welfare systems. The survey was developed collaborativelyin 2011 by the National Quality Improvement Center on the Privatiza-tion of Child Welfare Services, the Child Welfare League of America(CWLA), and the Alliance for Children and Families (the Alliance). TheNSPCFSA sampling frame reflected a purposive, nonprobabilistic sam-pling model that included all nonprofit and for-profit child and familyserving agencies that were members of CWLA, the Alliance, or a stateassociation involved in the National Organization of State Associationsfor Children.

To preserve the anonymity and confidentiality of agencies andtheir directors, the survey instrument was administered online and in-vitations to participate were sent through listservs controlled by thesenational and statemembership associations. A total of 446 agency direc-tors from agencies in 38 states participated in the NSPCFSA survey overMay 1–June 30, 2011. The majority of NSPCFSA agencies (64%) werelocated in large states with significant private sector involvementin child welfare service delivery and large consumer populations(e.g., California, New York, Texas). While the membership associationsprovided the authors with counts of agency membership, overlap inassociational membership could not be determined. Consequently, thesurvey had an estimated response rate of between 45 and 74%1; eventhe lower bound of this range is considered robust for studies utilizingorganizational surveys (Baruch & Holton, 2008; Jang & Feiock, 2007).Questions were asked in seven domains: interorganizational collabora-tion and competition; internal and external pressures on organizationalmaintenance; respondent characteristics; organizational demographics;funding levels; service array; and performance measurement and man-agement. More detailed information about the NSPCFSA survey isprovided elsewhere (McBeath, Collins-Camargo, & Chuang, 2011).

Given the current paper's interest in external and internal organiza-tional processes contributing to consumer-centricity among nonprofitagencies, the operational sample was restricted to agencies with non-profit tax status (comprising 89% of the overall NSPCFSA sample) aswell as those cases with full information on the dependent variables.

1 The response rate would be 45% without overlap in association membership. Howev-er, in our data, about 40% of agencies reported belonging tomore than one professional as-sociation, resulting in the reported upper bound estimate of 74% response rate.

Application of these exclusion criteria reduced the operational sampleto 366 agencies.

3.2. Measures

3.2.1. Consumer-centricityTwo outcomemeasures were used to assess the perceived influence

of consumer-centricity on the following four agency operations inthe last fiscal year: development of new programs; delivery of long-standing programs; training of frontline caseworkers; and developmentof interorganizational linkages. These two outcome measures reflectedresearch on the influence of consumer participation on agency opera-tions (Melton & Hartline, 2010; Yang & Pandey, 2011).

3.2.1.1. Influence of consumer feedback/input on agency operations.Respondents were asked to rate the perceived influence of feedback/input from families and consumers served on each of the aforemen-tioned agency operations. Likert-based response categories included“1”= “No influence at all”, “2”= “A little influence”, “3”= “Some influ-ence”, “4”= “A strong influence”, and “5”= “A very strong influence”.Scores across these operational areas were averaged to develop ameasure of the global influence of consumer feedback/input on agencyoperations (α = 0.88).

3.2.1.2. Influence of changes in needs of children/families on agencyoperations. Respondents were also asked to rate the perceived influenceof changes in the needs of children and families on each of the agencyoperations. Identical Likert-based response categories were used, andscores across the four operational areas were averaged to develop ameasure of the global influence of changes in needs of consumers onagency operations (α = 0.87).

3.2.2. External determinants of consumer-centricityInterorganizational competition was operationalized as the per-

ceived degree of agency competition with other local service providersfor: public funding (from governmental sources); private funding(e.g. from donors or fee-for-service activity); staff; and consumers.Respondents were asked to identify the extent to which their agencycompeted for these core resources using a 5-point Likert scale where“1” = “No competition”, “2” = “A little competition”, “3” = “Somecompetition”, “4” = “Frequent competition”, and “5” = “Constantcompetition”. Scores were averaged across the four areas of competi-tion (α = 0.78) to create an overall ordinal measure of interorganiza-tional competition comparable to that employed in nonprofit humanservice studies (Domanski, 2012; Garrow, 2011). Geographic location(Landsman, 2002)was operationalized as a categorical variable indicat-ing whether an agency served consumers only in urban areas, onlyin nonurban areas, or in more than one geographic area (i.e., urban,suburban/nonmetropolitan, and/or metropolitan locations).

3.2.3. Internal determinants of consumer-centricity

3.2.3.1. Strategic organizational attributes. A count variable was used toidentify the number of the following administrative infrastructuralsupports that were present in the agency: a program evaluationdepartment; a quality assurance/improvement unit or manager; and aninformation technology department or manager (Smith, 2012). Agencyaccreditationwas operationalized as a binary variable indicatingwhetherthe agency was currently accredited by the Council on Accreditation(COA), Commission on Accreditation of Rehabilitation Facilities (CARF),Joint Commission on Accreditation of Healthcare Organizations(JCAHO), and/or some other accrediting body (Lee, 2013).

3.2.3.2. Agency leadership. Two variables captured the orientation ofagency leaders to consumer-centricity: the degree of racial/ethnic di-versity among managers; and whether the agency director held an

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MSW degree. Racial/ethnic diversity among nonprofit managers hasbeen shown to impact agency responsiveness to consumer input(LeRoux, 2009a, 2009b). Given prior research reporting that 72% ofchild welfare agency managers self-identify as Caucasian (Casanueva,Horn, Smith, Dolan, & Ringeisen, 2011), the management diversityvariable was operationalized as a dichotomous variable set = 1 if 20%or more of administrators, supervisors, or other managers within theagency self-identified as persons of color. A second binary variablereflected whether the agency director reported having an MSW asthe highest degree. This measure served to capture differences inmanagement styles regarding consumer empowerment and inclusion(Hardina & Montana, 2011).

3.2.3.3. Service technology. Agency service technology was measuredusing three variables. First, the breadth of the agency service arraywas measured as the percentage of 21 possible child welfare, health,and/or social services currently provided by the agency either directlyor via subcontract with other providers. Detailed information aboutthe 21 services provided by the agencies is provided elsewhere in thissymposium (Chuang et al., 2014-in this issue). Second, a binary variablemeasured whether the agency was delivering any services throughperformance-based contracts providing additional revenue for meetingpre-specified consumer outcomes or other benchmarks. Finally, theextent to which an agency networked/contracted with other agenciesfor service delivery was operationalized as the percentage of currentlydelivered services offered via subcontract with other service providers.

3.2.3.4. Agency structure. Measures of agency age and size captureddifferences in structural characteristics potentially influencing thelikelihood of agency innovation and change. Agency age was measuredin years. Agency size was operationalized as the number of full-timeemployees (FTEs) in the agency in the last fiscal year, andwasmeasuredas a categorical variable corresponding to staffing increments rangingfrom 10 FTEs or less (=1) to greater than 1000 FTEs (=9).

3.3. Analyses

Univariate and bivariate analyses were used to describe the fullsample of nonprofit agencies. Separate multivariate regression modelswere then specified to examine associations between the identifiedindependent variables and each measure of consumer-centricity.

Insufficient observationswithin the lowest and highest categories ofeachmeasure of consumer-centricity necessitated the transformation ofdependent variables from 5-point scales to dichotomies (set = 1 ifdirectors reported an average of “A strong influence”, or “A very stronginfluence” responses on agency operations in the last fiscal year; andwith all else set= 0) and running themodels asmultivariate logistic re-gressions. The linktest was implemented to test the overall robustnessof model specification. This test computes a new regression using aspredictors the predicted values of the original model and their squares.In general, if the quadratic term is significant in this new regression,there is evidence of model misspecification (Cameron & Trivedi,2009). In the current study, this quadratic term was insignificant,suggesting no major specification errors in the logistic models.

Phi and biserial correlations between independent variables were allless than r = 0.51, with correlations between interorganizational com-petition and other independent variables less than r = 0.2. Survey itemnonresponsewas generally low anddid not exceed 7% for any given var-iable. Multiple imputations using the multivariate normal imputationmethod was implemented to reduce potential bias from missing dataand preserve the full analytic sample (Allison, 2002; Lee & Carlin,2010). A total of twenty imputations were used to reduce samplingerror. While the dependent variables were included in the imputationprocedure to maximize the information used during the imputationprocess (Von Hippel, 2007), imputed observations for the dependentvariables were not included in the final analyses. Significance tests

following imputation did not reveal statistically significant differencesbetween imputed and unimputed variables; therefore only imputeddata are reported when reporting multivariate findings. All analyseswere conducted using Stata 12.0 (StataCorp, 2011).

4. Results

4.1. Sample characteristics

Table 1 provides descriptive statistics of study measures. About halfof agency directors perceived that consumer feedback/input and thechanging needs of children and families had a “Strong” or “Very strong”influence on agency operations. With respect to potential externaldeterminants of consumer-centricity, most nonprofit agencies reportedsome level of interorganizational competition (mean = 3.51, SD =1.08), correspondingwith between “Some” and “Frequent” competitionfor funding, staff, and consumers. Just over one third of agencies (35%)reported serving consumers in more than one geographic area.

Concerning internal agency predictors of consumer-centricity, agen-cies noted having roughly two of three possible administrative supports(mean = 1.88, SD = 1.09). Over two-thirds (68%) were accredited byCOA, CARF, JCAHO, or another accrediting body. Regarding leadershipcharacteristics, about a third of agency directors had an MSW as thehighest educational degree. In addition, just over a third of the agenciesindicated that 20% ormore of supervisors and other administrators self-identified as persons of color. In terms of service technology, 23% ofagencies reported having a performance-based contract for servicesdelivered, agencies reported providing approximately half (49%) of21 possible child welfare, health, and social services, and 23% ofcurrent services were provided via subcontract. On average, agencieshad been serving families for over six decades (mean = 66.6 years,SD = 49.6 years) and reported having between 50 and 100 FTEs.

4.2. Multivariatelogistic models

In each multivariate logistic regression model, perceived interorga-nizational competition was significantly associated with the influenceof consumer-centricity on agency operations in the last fiscal year(Table 2). Holding other factors constant, interorganizational competi-tion was associated with increased odds that consumer feedback/input (OR = 1.54, p b 0.001) and changes in the needs of childrenand families (OR= 1.69, p b 0.001) would have a strong to very stronginfluence on agency operations. The magnitude of this general findingcan be expressed via predicted probabilities: all else being equal andas compared to agencies reporting “No competition”, agencies that re-ported “Constant competition” were estimated to have a 27% higherprobability of reporting a “Strong” or “Very strong” influence of con-sumer input on agency operations as well as a 25% higher probabilityof reporting a “Strong” or “Very strong” influence of changing childand family needs on agency operations.

Regarding geographic location and as compared to agencies servingmore than one geographic area, agencies serving only urban areas orserving only nonurban areas were associated with lower odds thatchanges in the needs of children and families would influence agencyoperations (OR= 0.51, p b 0.05 and OR= 0.55, p b 0.05, respectively).However, no variable pertaining to internal agency factors was signifi-cantly associated with either measure of consumer-centricity.

5. Discussion

The relationship between child welfare agencies and children andfamilies has generally been presumed to be hierarchical, where agenciesinfluence consumers. In the current paper, we consider the reverse andprovide the first examination of the extent to which consumers influ-ence child welfare agency operations. Descriptively, our results suggestthe existence of a moderate-to-high level of consumer-centricity in the

Table 1Descriptive characteristics of nonprofit child welfare agencies.

N % Mean (SD) Range

Consumer centricityInfluence of consumer feedback/input on agency operations 366 47% 0–1Influence of changes in needs of children/families on agency operations 366 50% 0–1

External factorsIntensity of interorganizational competition 370 3.51

(1.08)1–5

Agency serves only urban area 399 31% 0–1Agency serves nonurban area 399 34% 0–1Agency serves more than one geographic area (referent) 399 35% 0–1

Internal factorsStrategic organizational attributesAdministrative infrastructural supports 399 1.88

(1.09)0–3

Agency is accredited 394 68% 0–1Agency leadershipMore than 20% of agency managers are persons of color 373 34% 0–1Agency director has an MSW 398 34% 0–1

Service technologyBreadth of agency service array 399 49% 0–1Agency has performance-based service contract 399 23% 0–1Subcontracting for services 386 23% 0–1

Agency structureYears in operation 398 66.6

(49.6)2–212

Number of full-time employees (FTE) 398 4.52(1.78)

1–9

Note: Response categories for the variable pertaining to the number of full-time employees include “1”=“Fewer than 10 FTEs”, “2”=“Between 10 and 24 FTEs”, “3”=“Between 25 and49 FTEs”, “4”=“Between 50 and 99 FTEs”, “5”=“Between 100 and 249 FTEs”, “6”=“Between 250 and 499 FTEs”, “7”=“Between 500 and 749”, “8”=“Between 750 and 999 FTEs”, and“9”=“1000 or more FTEs”.

128 B. McBeath et al. / Children and Youth Services Review 38 (2014) 123–132

nonprofit child welfare sector: Roughly half of agency directors notedthat consumer feedback/input and the changing needs of childrenand families had a “strong” or “very strong” influence on starting newprograms, delivering long-standing programs, staff development, andinterorganizational alliance formation.

Interest in incorporating the preferences of consumers directly orindirectly has increased in recent years due to federal policies and per-formance incentives, and study findings confirm that attention to

Table 2The influence of external and internal factors on agency consumer-centricity: multivariate logi

Influence of consumer feedoperations

OR SE P N

External factorsIntensity of interorganizational competition 1.54 0.18 ⁎⁎⁎

Agency serves only urban area 0.81 0.22Agency serves only nonurban area 0.68 0.19

Internal factorsStrategic organizational attributesAdministrative infrastructural supports 1.17 0.14Agency is accredited 1.06 0.28

Agency leadershipMore than 20% of agency managers are persons of color 0.85 0.21Agency director has an MSW 1.01 0.24

Service technologyBreadth of agency service array 1.90 1.02Agency has performance-based service contract 1.14 0.30Subcontracting for services 1.62 0.64

Agency structureYears in operation 1.00 0.00Number of full-time employees 0.89 0.08

N = 366.a Average relative variance increase (RVI) for all models b=0.05.⁎ p b 0.05.

⁎⁎⁎ p b 0.001.

consumers is of salience to agency directors in the current fiscal/policyclimate. Whether agency directors are responding to consumers intokenistic or more meaningful ways is unclear, although the generallevel of organizational responsiveness to consumers does appearsubstantial. At a basic level, nonprofit child welfare agencies appear tobe receptive to the basic norms and values of consumer involve-ment upheld by public child welfare agencies and the overall public(Sirianni, 2009). Given the dependence of the nonprofit child welfare

stic regression results.a

back/input on agency Influence of changes in the needs of children andfamilies on agency operations

|t| 95% CI OR SE P N |t| 95% CI

1.24 1.93 1.69 0.19 ⁎⁎⁎ 1.35 2.120.47 1.38 0.51 0.14 ⁎ 0.30 0.870.39 1.18 0.55 0.15 ⁎ 0.32 0.95

0.92 1.48 0.96 0.12 0.76 1.220.63 1.78 1.28 0.34 0.76 2.17

0.52 1.39 1.16 0.28 0.72 1.880.63 1.61 0.92 0.22 0.58 1.47

0.67 5.43 1.52 0.80 0.54 4.250.68 1.90 1.30 0.34 0.78 2.120.75 3.53 1.66 0.68 0.75 3.69

0.99 1.01 1.00 0.00 0.99 1.000.76 1.05 1.00 0.09 0.85 1.19

129B. McBeath et al. / Children and Youth Services Review 38 (2014) 123–132

sector on public contracts and its historical leadership role in large childwelfare systems (McBeath et al., 2012), this general finding isunsurprising yet is reassuring from a field-based perspective.

The moderate to high level of reported consumer-centricity amongnonprofit child welfare agencies may also speak to managers' commit-ment to consumers. The managerial role is essential for organizationalinnovation and change in child welfare, as managers are responsiblefor securing resources, organizing staff, and implementing policies andcontractual requirements in alignment with agency values (Austin &Hopkins, 2004; Pecora, Cherin, Bruce, & Arguello, 2010). Managementviews on consumers should therefore inform staff behavior in theseoperational domains although frontline practices may not alwaysreflect managerial positions fully. Nevertheless, the level of managerialattention to consumers found in the current research implies thatmanagers may be incorporating consumer input in response tostakeholder demands. This augurs well for future federal and stateefforts to incorporate child and family perspectives into agencygovernance and operations.

If consumer-centricity has become “business as usual” for somenon-profit child welfare agencies, it appears to be evenmore so for agenciesin competitive interorganizational environments and those operatingin multiple locales. The overall level of interorganizational competi-tion among nonprofits, which was on average between “some” and“frequent”, was comparable to that for the overall NSPCFSA sample(McBeath et al., 2011). Current study results indicate that competitionis positively related to consumer-centricity: Within areas perceived asbeing highly competitive (possibly reflecting higher provider density),nonprofit child welfare agencies were more likely to be responsive toconsumer needs and input. In contrast, internal attributes such as ad-ministrative infrastructural supports and accreditation status, servicetechnology, agency leadership, and structural characteristics were notassociated with agency director perceptions of either the influence ofconsumer feedback or changing consumer needs on agency operations.

These results highlight the importance of the organizational envi-ronment on nonprofit child welfare agency behavior and, in particular,for nonprofit responsiveness to consumer needs and preferences. Intandem with the broad nonsignificance of internal organizational fac-tors, our resultsmay imply thatmarket conditions trumporganizationalfactors. Themore competitive the organizational market, themore like-ly it may be that agencies accommodate consumer feedback regardlessof their structural, leadership, and technological attributes. One poten-tial explanation for this finding is that consumer-centricity in competi-tive niches may be an instrumental strategy for gaining comparativeadvantage over other local providers for public and private contracts.As we were not able to ascertain the extent to which agencies wereusing child and family information in service evaluation, performancemeasurement and program reporting, and other technical methods toenhance operations and demonstrate performance to funders, furtherinvestigation is warranted into the processes that nonprofit child wel-fare agencies use to incorporate and respond to consumer perspectives.

5.1. Limitations

Although this study provides the first systematic examination ofconsumer-centricity among child welfare agencies, several methodologi-cal issues may limit the robustness of study findings. With respectto measurement, reports of consumer-centricity were obtained throughadministrator self-report. Although data were collected via anonymizedonline surveys to guard against social desirability bias, agency adminis-tratorsmayhave reportedhigher levels of consumer-centricity comparedto consumers, or if objective measures had been used. Additionally, be-cause direct measures of consumer preferences and needs were unavail-able for analysis, the studywas not able to determine the extent towhichsample agencies were responding to children and families. In addition,we did not specify a measurement model testing for potential mediationand/or moderation of external factors via internal factors given cross-

sectional data and potential insufficient sample size considerations atthe group level (Hox & Maas, 2001). For similar reasons, interactionsbetween interorganizational competition and agency service locationwere also not tested.

Other key factors that may influence consumer-centricity were notmeasured in the survey and therefore not included in analytical models,thus potentially introducing omitted variable bias. For example, nomea-sures pertaining to child and family characteristics were available todenote consumer need for services or requests for agency participationor support. There were also no direct measures of institutionalization,although we might expect the internal influence of those pressures tobe somewhat incorporated into our models throughmeasures of servicetechnology and agency demographics.

With respect to internal and external validity, the current studyemployed a cross-sectional survey design that limited the ability toidentify contemporaneous vs. past predictors of consumer-centricity.As a result, multivariate estimates reflect associational as opposed tocausal tests. Finally, sample selection may limit the generalizability ofstudy results. Because NSPCFSA respondents were recruited throughlistservs of national and state associations of private child welfare agen-cies, sample agencies may have been larger, older, and more metropol-itan than on average. Study findings may therefore be most applicableto well-established nonprofit agencies in large child welfare systems.

5.2. New directions for child welfare research on consumer-centricity

Study findings suggest new avenues for child welfare research:

▪ Description and measurement: Studies unpacking the processes andcontexts of consumer-centricity from diverse perspectives.

▪ Evaluation of impact: Research on the consequences of consumer-centricity for agency performance, service delivery, and child andfamily outcomes.

▪ Comparative effectiveness of organizational design strategies: Tests ofwhich strategies to involve consumers are most vs. least beneficialfor agencies and for children and families.

To unpack consumer-centricity, the specific organizational changeprocesses undertaken by agencies to respond to children and familiesshouldfirst be documented and the internal and contextual determinantsof these processes established. How and why do child welfare agenciescreate space for consumers, and how is this participation understood bystaff and navigated by children and families? Qualitative, case-basedstudies may provide rich information on these organizationally boundedquestions. Quantitative measurement studies may test whether internalorganizational processes promoting consumer-centricity are predictive ofthe overall construct of consumer-centricity. Consumer-centric processesmay cut across all operational domains but will likely focus on child andfamily involvement in agency governance (e.g., indirect representation ordirect involvement on agency boards), service programming (e.g., givinginput regarding how services should be provided), and actual servicedelivery (e.g., involvement in assessment and case planning). Theseorganizational efforts should differ in their use of agency resources andthe extent to which they have their basis in funding and contractualobligations; agency efforts may also depend on consumer characteristics(e.g., involuntary/court-ordered or not) and the intensity and diver-sity of consumer demands in relation to other internal and externalstakeholders. Collection of qualitative and quantitative data regard-ing consumer involvement in services planning may thus enhanceunderstanding of the diverse ways that agencies and staff respondto children and families and balance consumer requests with thosefrom other stakeholders.

Articulating a richer understanding of consumer-centricity may ad-vance subsequent research on its consequences for organizations andthe children and families they serve. Consumer-based organizationaladaptations may not always result in improved services or better childwelfare outcomes. For example, nonprofit agencies in competitive

130 B. McBeath et al. / Children and Youth Services Review 38 (2014) 123–132

markets may appeal to funders by enhancing service accessibility,effectiveness, and quality. Yet they may also prioritize service deliveryto lucrative populations over others (e.g., via cherry picking, creamskimming, rationing) or abandon traditional populations they deemtoo difficult to serve (Chetkovich & Frumkin, 2003; Hasenfeld &Garrow, 2012). Studies may examine which consumer-based agencyadaptations are associated with different agency and child and familyoutcomes for at-risk subgroups of children and families, therebyhelpingclarify the benefits and costs of consumer-centricity for child welfarepopulations and systems. Research should also examine the externalconditions under which these consumer-driven adaptations lead to im-proved outcomes. In particular, understanding the influence of specifictypes of external pressures emanating from funders and competitorsin different locales will generate insights about how agencies maymeet demands from multiple internal and external constituencies.

Finally, research might provide more fine-grained tests of therelationships between consumer-centricity and internal agency charac-teristics. Our findings suggest that nonprofit responsiveness to con-sumers appears to be uninfluenced by differences in agency servicetechnology, leadership, infrastructure, and staff demographics althoughthe reasons for these nonrelationships are unclear. Further explorationof agency-based disparities in consumer-centricity may benefit fromexamining critical subgroups of agencies (e.g., by dependence on fee-for-service revenue) and consumers (e.g., by complexity of serviceneeds) and in different institutional environments (e.g., by level ofinterorganizational competition). This line of inquirymay be broadenedto include other organizational features such as the organizational socialcontext and, in particular, the extent to which organizational cultureand climate are aligned with a perspective on organizational learningand innovation that prioritizes consumer input and responsiveness(Glisson, Green, & Williams, 2012; Schein, 1986). Given longitudinaldata documenting changes in external forces and internal organization-al adaptations, research may test path models in which internal factorsare hypothesized to mediate the relationship between external organi-zational environments (particularly interorganizational competition)and consumer-centricity (e.g., Henderson & Mitchell, 1997).

5.3. Implications for child welfare policy and practice

The relationship between competition and consumer-centricityamong nonprofit child welfare agencies has implications for policyand practice. Child welfare system leaders may promote consumer-centricity directly or indirectly through contracting or policy. Directmechanisms involve policymakers and system administrators requiringor incentivizing agencies to incorporate child and family perspectivesin agency operations and to pay close attention to levels of consumer-centricity over time. Child welfare service contracts are generally basedon service units delivered or (increasingly but still infrequently) perfor-mance. While mandating or incentivizing consumer-centricity remainsuncommon, there is growing attention to consumer involvement-based models promoting organizational excellence through integratedservice collaboratives and systems of care (Mitchell et al., 2012) as wellas to inclusive managerial approaches promoting consumer participa-tion (Feldman & Quick, 2009; Frahm & Martin, 2009; Smith, 2010).Once established through contractual requirements or incentives,commitment to consumer-centricity may be facilitated via ongoingcollection and reporting of information on how public and privateproviders are responding to the needs of children and families andwhether they are doing so in a strength-based, inclusive mannerfrom the perspective of consumers.

Indirect strategies for managing consumer-centricity focus onpromoting interorganizational competition and using other externalinstitutional pressures (e.g., courts, accrediting bodies) to supportconsumer-centricity. While systemic intervention may not be requiredin areas with a high degree of competition, administrators in areaswith a low density of providers may have to deploy strategies for

increasing competition (e.g., prohibiting servicemonopolies, expressingpreferences for culturally-specific service providers and niche agencies)(Clark, Dorwart, & Epstein, 1994; Smith, 2008). It should not be as-sumed that high levels of interorganizational competition will resultin either consumer-centricity or beneficial child welfare outcomes.That is, the process of stimulating consumer-centricity through marketdevelopment should be monitored carefully given the possibly perni-cious consequences of interorganizational competition for involuntarypopulations (Hasenfeld & Garrow, 2012).

In considering these direct and indirect approaches, systemadminis-trators and monitors may be led to reevaluate the role and value ofconsumer participation in child welfare. What are the benefits and chal-lenges associated with the direct involvement of children and families?Moreover,what drivers are seeking to expand the traditional understand-ing of children and families beyond their service recipient role, and whatare the promising approaches in doing so? If consumer-centricity is con-ceptualized through a service utilization lens, then consumer-centric pol-icy and practice innovations will likely focus solely on enhancing servicedelivery to involuntary consumer populations. However, if policymakersand administrators are informed by citizenship-infused understandingsof human services (Thomas, 2013), then there may be greater attentionto how children and families participate in decision-making andgovernance capacities in addition to their traditionally understoodroles. New roles potentially of value for consumers in child welfareagency settings include advocate, guide, translator, synthesizer,facilitator, and documenter/evaluator.

These familiar and unfamiliar roles will require dedicated organiza-tional resources to support thedevelopment of newadministrative proce-dures, staff training, and program processes. As with any organizationalinnovation and change, a combination of formal and informal organiza-tional supports is needed to develop and sustain consumer-centricity incomplex child welfare settings (Darlington et al., 2004, 2005; Jaskyte,2011; Karatekin, 2013).

5.4. Conclusion

If responsiveness to consumers is a central criterion of the quality ofchild welfare systems, then sustained attention should be paid todocumenting and understanding agency-based variation in consumer-centricity. Researchers should seek to understand the interplay of exter-nal conditions, internal agency structures and frontline processes, andchild and family needs. Policymakers should dedicate resources andprepare agency administrators to broaden the access of children andfamilies to agency decision-makers and enhance their organizationalinfluence. These new directions for research and practice are designedto infuse the interests of children and families more prominently intothe daily organizational efforts of child welfare agencies.

Acknowledgments

This research was conducted under the Quality ImprovementCenter on Privatization of Child Welfare Services funded by the U.S.Department of Health and Human Services, Administration for Youthand Families, Children's Bureau. This research was also partially sup-ported by aNational Research ServiceAward Pre-doctoral/Post-doctoralTraineeship (to Pérez Jolles) from the Agency for Health Care Researchand Quality sponsored by The Cecil G. Sheps Center for Health ServicesResearch, The University of North Carolina at Chapel Hill, Grant No.T32-HS000032. Dr. Bunger is an investigator with the ImplementationResearch Institute (IRI), at the George Warren Brown School of SocialWork, Washington University in St. Louis; through an award from theNational Institute of Mental Health (R25 MH080916-01A2) and theDepartment of Veterans Affairs, Health Services Research&DevelopmentService, Quality Enhancement Research Initiative (QUERI).

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