THE ROLE OF PARAPROFESSIONALS: An Administrative Dilemma

By Robert C. Tucker and Leota M. Tucker

Changing a paraprofessionars title will do little to improve his or her position. I f they are to compete successfully in the status and power sweepstakes, paraprofess ionals must cont inue their education. Admin i s t ra to r s shou ld make career deve lopmen t opportunities available i f the), hire paraprofessionals.

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Robert Tucker is Associate Professor in the Department of Psychiatry, Yale University Medical School and Director of the Training and Consultation Division.

Leota M. Tucker is a mental health administrator in the Department of Psychiatry, Yale University.

Since the early 1960's, there has been a dramatic increase in the number of non- credentialed workers entering the mental health services field. These new people have assumed a variety of support roles, assisting and augmenting the work of credentialed professionals. More recently, they have (iia many settings) assumed roles that were traditionally reserved for professionals, i. e., they lead therapy groups, supervise others, give lectures, and conduct workshops. Despite an escalation in responsibility, however, their status has not changed appreciably over the years.

In the early days they were called "aids", but since then have successively been referred to as

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aides, non-professionals, and paraprofession- als.* The progression of names has apparently been related to the embarrassment felt by s e n s i t i v e p r o f e s s i o n a l s w h o w e r e uncomfortable with the "servant/f lunky" connotation of each title. At the same time, paraprofessionals themselves were becoming increasingly dissatisfied with their position and began to demand change. In this milieu, conflict between the groups was inevitable.

It was the administrator who was called upon to mediate confl ic t between the aspirations of paraprofessionals and the (overt and covert) status maintenance demands of professionals. Since the administrator was a professional himself, he shared a common value system with other professionals. He was

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The administrator was called upon to mediate conflict between the aspirations of paraprofessionals and the status demands of professionals.

also aware of the fact that paraprofessionals were valuable as service deliverers and essential as front line troops. He needed both and realized that he should minister to the needs of each.

If he conceded to the paraprofessionals' demands for equal status, he would subvert extant credentialing and reward distribution systems. If he maintained existing policies limiting the roles and rewards available to paraprofessionals, he would thwart their upward mobile aspirations and incur their wrath. In this situation he needed wisdom more than courage.

F a c e d w i t h t h i s d i l e m m a , m a n y admin i s t r a to r s decis ively chose to be

*In some cases bachelor's degree holders, and even those with master's degrees, are referred to as paraprofessionals. The term paraprofessional is used here, however, to refer to all individuals working in the human services field who do not hold a bachelor 's degree. The term is utilized for convenience rather than for accuracy or appropriateness. Recently, terms such as new- professional and associate professional have gained popularity.

indecisive. They either did nothing at all or engaged in symbolic action that did little to change the status quo. Prevalent among these symbol ic gestures was name-chang ing , designed to pacify paraprofessionals and p l a c a t e n e r v o u s p r o f e s s i o n a l s . M o s t important, changing titles had a cathartic

Faced with this d i lemma, many administrators decisively chose to be indecisive.

effect in that it gave the appearance of changing the status of paraprofessionals, and made it less necessary for administrators and other professionals to feel guilty.

Reflective of the uneasiness with which certain administrators responded to sub- professional titles was Dr. Willis Bowers' assertion that he disliked "the word 'sub- p rofess iona l ' pa r t ly because it sounds demeaning, and partly because I don't quite know what it means" (Roche Report 1974). This continuing feeling of uneasiness is seldom related to how things work, but to how things look or sound. Consequently, the name game cont inues while the p r imary role of p a r a p r o f e s s i o n a l s r e m a i n s e s s e n t i a l l y unchanged.

Question of Definition

To better understand the name difficulty, it may be useful to outline and examine popular definitions for various sub-professional titles. We may then proceed to assess the s o c i a l / p o l i t i c a l i m p l i c a t i o n s of t h e s e definitions. In Webster's College Dictionary the term "aid" is defined as:

1) Help 2) . . .One who or tha t promotes or helps in something done; helper; assistant 3) Eng. Hist. An e x t r a o r d i n a r y s u b s i d y or t a x ... 4) Feudal Law. A pecun ia ry tribute paid by a vassal to his lord.

Later the "e" was added to "aid,"apparently to present an illusion of increased status, but

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the c o n n o t a t i o n of the term "aide" differed little from its predecessor. The term "non- professional" was problematic for two reasons: 1) It specif ical ly denied p rofess iona l characteristics to one who held the title (it explained what the person was no t rather than what he was), and 2) It was very clearly deprecating in the eyes of liberals and was, therefore, not acceptable. Finally, the term " p a r a p r o f e s s i o n a l " was in t roduced to demonstrate that new careerists in many ways resembled professionals -- they were a lmos t

professional. The term professional is an independent

term with its own meaning. Paraprofessional, however, implies inherent dependency. "Para" is a prefix which requires another term for its meaning. It literally cannot stand alone. We discover its meaning by defining the two parts "para"and "professional." Webster defines the prefix "para" thusly:

1) Beside, alongside of, beyond, aside from, amiss, as in parallel, paragraph, paraphrase, parody 2) a ) M e d . A faul ty or d isordered condi t ion ; abnormal; as in paranoid b) Associ- ated in a subsidiary or accessory capacity, as in parasympathetical c) Closely resembling the true form; as in paratyphoid

Built into this definition is an assumption of inferiority and subnormality. Women are often thought of as "para-men." The definition of "professional," however, is laden with positive connotations symbolic of high status and intrinsic value.

Illustrative of how professionals choose to define themselves is Morris Cogan's (1953) definition:

A profession is a vocation whose p r a c t i c e is f o u n d e d u p o n an unde r s t and ing of the theore t ica l structure of some department of learning or science, and upon the a b i l i t i e s a c c o m p a n y i n g s u c h understanding. This understanding and these abilities are applied to the vital

practical affairs of man. The practices of the profession are modified by knowledge of a generalized nature and by the accumulated wisdom and experience of mankind, which serve to correct the errors of specialism. The profession, serving the vital needs of man, considers its f irst e thical imperative to be altruistic service to the client.

A professional, therefore, would be an individual who is involved in a profession as defined above. There is probably no one definition for the term professional that all can agree with. To some, professionals include only those who practice law, medicine or theology. Others would list only those who are self-employed. Some would include only those whose practice includes an esoteric body of knowledge and specialized skills. In the health services today, however, the professional staff is usually composed of a variety of people of

The name game continues while the primary role of paraprofessionals remains essentially unchanged.

various backgrounds with the only connecting link being possession of one or more academic degrees.* The professional is expected to 1) have high-level verbal skills, 2) be capable of dealing with abstractions, 3) behave rationally, and 4) deal creatively with uncertainty and complexity.

The paraprofessional, on the other hand, is thought to be devoid of these qualities and capable of learning only simple rote tasks. In short, professionals are expected to operate on

*Generally, there are dramatic status differentials among professionals based upon discipline and number of degrees. In a mental health center, for instance, M.D.'s enjoy highest status; psychology Ph.D.'s next; sociology Ph.D.'s next; any other kind of doctorate next; social work doctorates (D.S.W. or Ed.D.) next; M.S.W. and M.P.H. next; M.A. and M.S. next; and B.A. of any kind next. Often the M.D.'s are considered the ~real" professionals while the others are viewed as supporting staff.

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the cognitive level while paraprofessionals are thought to function on the affective level:

Professional Paraprofessional skilled (specialist) unskilled (generalist) cognitive affective think feel reason intuition plan do superior inferior white Black educated uneducated management labor

This paradigm does effectively delineate the differences between two character types. The problem occurs not in the definition, but in assumptions that assign whole groups of people to one typology or the other. Further, it is inappropriate to assume as many do, that one category is inherently superior to the other at all times and in every situation.

With this caveat in mind, administrators have recently moved to do away with the term " p a r a p r o f e s s i o n a l " and are increas ingly adopting the term "non-degreed professional" to define paraprofessionals. The non-degreed professional title, however, will go the way of all the titles that preceded it, because the clear d i s t inc t ion be tween profess ionals and paraprofessionals remains.

The potent symbolism attached to titles represents an attempt to camouflage the underlying source of conflict.

The potent symbolism attached to titles represents an attempt to camouflage the underlying source of conflict. Simply stated, the reality is that professionals are unwilling to accept paraprofessionals as equals, because to do so would be to erode the professionals' position of primacy. Despite a genuine interest in improving the lot of paraprofessionals, they are not willing to do so at the risk of status loss for themselves.

The value of professional status diminishes as the ranks swell in numbers. As long as the

numbers remain small, privilege is protected; consequently, professionals devise intricate and often nonsensical ritual, language, and certification barriers that make it extremely difficult for paraprofessionals and others to enter the professions. In this process they ensure that efforts to equalize the groups will fail.

Differences Between Groups

Essentially, the major difference between professionals and paraprofessionals is formal education; and the separating line between them occurs at the bachelor's degree level. Those who hold bachelor's degrees or better are called professionals in many settings. Those who hold less than a bachelor's degree are called paraprofessionals or non-degreed profess ionals , etc. This is a powerfu l distinction in that the difference is perceived to be one of species rather than stage of development. The two groups also differ markedly in social class. Mental health professionals tend to be middle class, white, and male. Paraprofessionals tend to be work ing class, minor i ty , a n d / o r female (Tucker 1972; Navarro 1974). Consequently, professionals view themselves as socially superior to paraprofessionals ( as well as educationally superior) and strive to maintain social distance between themselves and the inferior group. Differential working hours, vacation schedules, attire, salaries, ranks, and office space are symbols that institutionalize these perceived differences. Those on either side of the line are viewed as different kinds of animals with radically different characteristics and potential - - lord vs. serf; master vs. servant; royalty vs. commoner; management vs. labor.

Individuals with bachelors' degrees a r e

considered to be somewhat inferior to those who hold doctorates, but their condition, in many cases, is thought to be a temporary one. They are of the same or a similar social class and are thought to be, at least, inherently capable of approximating the value, worth,

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skills, righteousness, etc. of the super- professional. Paraprofessionals, on the other hand, are thought to be severely limited in potential, of a lower social class, and destined to play a role inferior to that of the professional.

The responses of consumers fur ther consecrate and legitimize these assumptions. Students often feel they will learn more from a "full" professor than from an assistant professor; more from an assistant professor than from an inst ructor ; and, most importantly, more from a Ph.D. than from an M.A. instructor. The assumption is that k n o w l e d g e and t e a c h i n g a b i l i t y a re

inextricably linked to formal credentials. In clinical settings these assumptions are

even more powerful and pervasive. For instance, data collected at the Connecticut Mental Health Center (Astrachan 1974) show that patients of all races and social classes are more likely to cancel clinical appointments with low status clinicians than with higher status clinicians. Cancellations were lowest when the clinician was a psychiatrist (11%) and highest when the clinician was a psych-aide (27%). Predictably, cancellations among other clinicians also varied inversely with clinician status.

%

T A B L E I

Cancellations of Appointments by Clinician Status

30

25

20

15

10

5

11% 12%

13%

18%

27%

Discipline: Psychiatry Psychology Social Work Nursing Psych-Aide

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These data will require a great deal of study before valid interpretations may be made, but ultimate interpretation will always involve bias. Interpreted in one way they may provide jus t i f i ca t ion for ma in tenance of s tatus dif ferent ia ls , i.e., since higher s tatus individuals are bet ter " a p p r e c i a t e d " by consumers, they must be more knowledgeable and competent and should be more highly valued. A more cogent i n t e rp re t a t i on , however, might be that patients (like almost everyone else) confuse status and credentials with competence. They want the "best" clinician and assume that those who are called "Doctor" represent the best - - "Mr." or"Ms." will not do.

Feelings of superiority by professionals feed into consumers ' negat ive responses to paraprofessionals; the negative response by consumers to paraprofessionals feeds into professionals' feelings of superiority; and the negative responses of consumers and professionals cut away the confidence of paraprofessionals. These are shared feelings that all professionals are superior to all paraprofessionals.

These feelings persist despite the fact that many paraprofessionals are infinitely more competent and valuable to the work of a given o rgan iza t ion than many profess ionals .

M a n y paraprofessionals are infinitely more competent and valuable to the work of an o r g a n i z a t i o n than m a n y professionals.

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Further, it appears that the performance/com- p e t e n c e gap b e t w e e n h i g h l y s k i l l e d professionals and less skilled professionals is often greater than the gap between highly skilled profess ionals and highly skil led paraprofessionals. Credentials, therefore, do not offer a very useful c r i te r ion for differentiation.

Granting higher status and higher pay to professionals is often based upon assumptions about the different potential of the two groups,

assumptions that often have no substance in reality. At the root of these assumptions is a belief in the magic of formal education and the credentialing process which the regimen of formal education is designed to reinforce.

These assumptions are quite powerful, however, and often great ly affect the performance of individuals. C. Wright Mills' (1965) notions about "significant others" partly explain this phenomenon. If significant others (key people whose opinions are valued by the individual) assume one is competent it becomes easier for one to internalize those assumptions. The feedback of significant others reinforces feelings of self-confidence and competence . On the o ther hand , significant others may have similar impact in re inforc ing negat ive feelings, conv inc ing paraprofessionals that they are limited and "naturally" inferior.

Roots of Conflict

The result is a pattern in which professionals either consciously repress paraprofessionals because they believe them to be inferior (conservatives), or overtly press to improve the status of paraprofessionals while holding covert reservations about their potential (liberals). Neither conservatives nor liberals are genuinely convinced that paraprofessionals are their equals.

Among paraprofessionals, an associative process occurs in which a number consciously believe that they could or should never be equal to professionals (conservatives), while another group (activists) overtly express a belief in their equality. What is suggested is that some paraprofessionals, realizing that the rules of the game are not geared to their background, passively accept their lower status positions while others attempt to change the rules in a way that they may better compete. The latter effort leads to considerable conflict in which the liberal professionals and the activist paraprofessionals form a coalition against the more conservative professionals who are

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p a s s i v e l y s u p p o r t e d by c o n s e r v a t i v e paraprofessionals.

Communication is difficult in this conflict because the combatants speak different languages. The professionals respond from a "Consciousness I" political perspective - - distribution of values on the basis of loyalty and need. What results is confusion, continual conflict and little change.

This conflict suggests that the relational differentiation between the groups may be real, i.e., professionals operate on and consecrate the cognitive, while paraprofessionals operate out of and consecrate the affective sphere. Truth to professionals is discovered through rigorous empiricism and logic. Truth to the paraprofessionals is demonstrable through intuition and simple logic. Professionals generally enjoy endless bouts of theorizing, philosophizing and evaluating. Paraprofes- sionals, as a group, have little patience for "wheel spinning" and uncertainty reduction exercises. They are action oriented and are inclined to reduce dilemmas to simple, operational terms that permit quick action.

Here, perhaps, there is a legitimate base for differentiation between "most" paraprofes- sionals and "most" professionals. Certain tasks are best achieved by those who work on the basis of cognition (research, grantsmanship, etc.) and others by those who function on an affective base (counseling, interviewing, etc.). Still other tasks (teaching, administration, etc.) require both. It would be reasonable to assign people to these tasks on the basis of their inclinations, affective or cognitive. It would then follow that paraprofessionals should be most associated with tasks that involve relating to people and professionals should be associated with tasks that involve relating to things.* Those who combine both qualities should be candidates for "linking" positions as teachers and administrators.

*Also see Davis and Ballard, 1974, for a discussion on professional vs. paraprofessional response to low income and minority people.

When one compares most competent p r o f e s s i o n a l s w i th most c o m p e t e n t paraprofessionals, there are salient group differences that justify the market value gap between competent paraprofessionals and competent professionals. These differences lie in d i f ferent ia l verbal abi l i ty , long- te rm planning skills, the ability to deal with complexities, and the ability to seek resources. All other things being equal, the educated professional will be more valuable because of his greater breadth of knowledge and his ability to draw from a broad repertoire of general as well as specific skills. Individuals with these skills are at a premium and the "supply vs. demand" equation causes rather high bidding for their services.

This state of affairs is less an indictment of paraprofessionals potential and more an affirmation of the value of formal education. Romanticization of paraprofessionalism and claims that formal education is unnecessary u s u a l l y c o m e f r o m two p l ace s : 1) paraprofessionals who feel that pursuing formal education is impossible or impractical for them, or 2) quasi-radical intellectuals who choose to use paraprofessionals as spearheads in their war with the establishment (Tucker 1972).

Options for Change

Trying to remove status differences between professionals and paraprofessionals is a futile task. One's energy might be better utilized in

Trying to remove status differences between professionals and paraprofession- als is a futile task.

profess ional iz ing a n d credentializing paraprofessionals. There are those who suggest that to professionalize a paraprofessional is to destroy his most valuable asset - - his ability to relate to people. This patronizing assertion is tantamount to saying, "to educate a woman is

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to diminish her ability to relate to children," or to suggest that "to increase welfare checks is to diminish the poor's ability to appreciate hunger." It is interesting to note that these statements are seldom made by the individual who is being presented with a new opportunity but rather by others who are either competing or involved in a paternalistic relationship with him.

Navarro (1975) has identified the subtle but highly effective mechanisms developed by the corporate/professional classes to limit entry into the managerial/professional ranks. This is a c h i e v e d p a r t l y b y c o n s t r u c t i n g educational/credential barriers; setting low educational and performance expectations for working and lower class people; establishing sub-professional options; and discouraging professional aspirations among lower class people--Blacks, Hispanics, Native Americans, and women (Boyette 1974; Nash 1974). In this process, professional status is preserved for middle and upper middle class people.

The paraprofessional himself must seek to T.C.S.B. (Take Care of Serious Business) by preparing himself to survive. He is faced with two basic action alternatives: 1) he may choose to gain greater recognition and "power" for paraprofessionals, or 2) he may choose to pursue one or more academic degrees in his s p e c i a l i t y . B o t h a l t e r n a t i v e s p r e s e n t formidable problems. If he chooses to strike out at the oppressive system, he will have little energy left to improve his skills and understandings to the point where his services will be truly valuable. At best, he can look forward to slow, grudging development and acceptance of new, sub-professional job categories that will be recognized and formal ized. In the end, however , the paraprofessional will still be broadly viewed as a paraprofessional. He will earn a few dollars more a week but essentially, nothing will have changed.

On the other hand, the paraprofessional may choose the second option and invest his energy in professionalizing himself, i.e., enter college. In doing this, he should realize that much of

what he studies will have little application in his work, and that a great deal of it will have lit t le app l i ca t ion anywhere outs ide the classroom. He should also realize however, that he will pick up a great deal of useful information and will be required to look at life and events in new ways.

In this process, he will begin to see new possibilities for himself and ideally will develop a grea ter to lerance for amb igu i ty and uncertainty. At best, he will learn to view the universe in terms of probability rather than certainty and will accumulate a broad repertoire of understandings that are readily .translatable into skills. If he entered the process as a high potential person, he should emerge as a more f luent , compe ten t professional.

In deciding whether he will choose option one or option two, the paraprofessional is faced with a major quandary. If he chooses option one, all his energy will be diverted into the struggle (rather than into the development of professional skills) and the changes he stimulates will have little impact in the long run. He will, however, be "on the side of the angels" ; f igh t ing aga ins t inequ i ty and attempting to build a better system.

If he chooses option two, he will better himself at the cost of being co-opted, i.e., by design or default he will be "giving in" to the bankrupt system and will be "playing the game." In the end, he may see his self interests to be inextricably tied to that of professionals (his aspired status) and may see little need for change. This is viewed by the writer as a necessary danger. What is important is that he will then have a real choice and will not be the pawn of others who might use his plight as a base for movement toward the millennium.

It would seem that the best choice is to concentrate on option one, while devising a strategy for option two. That is to suggest that paraprofessionals who hope to raise their status should first enter college, and second, should initiate provocative action that causes managemen t to con t i nuous ly re-evaluate assumptions and reassess procedures under

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which status and responsibility are assigned within organizations.

In this process, paraprofessionals should view terminal Associate of Arts (Science) degrees as "trick-bags" designed to codify and credentialize sub-professional status. There is no evidence that attainment of an associate degree leads to higher status or increased pay.

There is no evidence that attainment o f an associate degree leads to higher status or increased pay.

An associate degree is valuable only when the individual is interested in education because of its intrinsic value, or when the associate degree is utilized as a stepping stone to a bachelor's degree - - entry level for professional status.

In this connection, it is important to note that in most cases an experienced, well trained person with an Associate degree will have more difficulty finding a job than an inexperienced bachelor's or master's degree candidate. This would be so even when the associate degree holder has undergone a rigorous, high-quality training program. The person has less than a bachelor's degree and is, therefore, still a paraprofessional.

Finally the happy day arrives, she graduates - - armed with her [A.A.] degree and her expertise in mental health, she goes forth to meet the challenge but, alas, the reality begins to come hard and fast. Jobs are few, if any at all; positions that she is qualified for and that will pay enough to support her family are not open to her. She finds that, although she is qualified, no one is willing to give her a chance to prove herself, and she sits and ponders the past two years of her life - - she wonders, why? (Stuckey, 1973).

Conclusion

Though sub-professional status is inherent in the term paraprofessional, little is achieved

by modifying or otherwise changing the title. Continually changing the name accomplishes little because the attendant negative symbolism (at least in this case) relates more to position than to title. Whether the term is "aide," "assistant," "non-professional," "non-degreed professional", or some new title, the sub- professional position remains the same. Paraprofessionals who hope to improve their status must pursue college degrees.

Most high potential paraprofessionals are capable of completing a bachelor's degree program and would do so if opportunities were available. Those who for one reason or another cannot enter a formal college program, may choose to enter a field in which college education is not so highly valued, or may choose to becomeprofessionalparaprofession- als. This last option should be made available to those who perform competently in adjunct positions and who prefer paraprofessional status. As college is not for everyone, professional status is not a desired condition for everyone.

Administrators who want to be helpful to paraprofessionals should avoid paternalistic posturing. They should devote their energies to

Administrators who want to be helpful to paraprofessionals should avoid paternalistic posturing.

crea t ing condi t ions , oppor tun i t i e s , and settings that permit paraprofessionals to receive formal college and in-service training that is readily transferable for college credits. Professionals who are currently responsible for the training of paraprofessionals should not provide "dead-end" training, but should create learn ing s i tua t ions tha t lead to the deve lopment of skills associa ted with professionalism.

Paraprofessional status should seldom be viewed as permanent, but as an apprenticeship period - - a work study arrangement under which classroom learnings and on-the-job learnings are carefully orchestrated for high-

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level skills development. Perhaps a better title would be pre-professional. It is vitally important, however, that these experiences be planned and structured in ways that permit granting of college credit and that they be acceptable as increments in a formal college program.

In this connection, Vivader's (1969) point of view may be instructive:

As a means for developing qualified manpower, the associate professional (paraprofessional) concept is predicated on two premises: 1) that associate professionals are beginning professions, inherently capable of growth to full professional competence, and 2) that qual i ty supervis ion and con t inued educational programs will be readily available during those years of personal metamorphosis.

Finally, the requirements for professional standing must be carefully re-evaluated to determine what type of training and experience is most appropriate for development of profess ional skills, unders tand ings , and practice. Whe~a this is done, it is clear that college education and supervised internship

experience will still be highly valued, but the content and form of that training will undergo radical change. Hopefully, training will include both affective and cognitive learnings, a combination of theoretical and practical knowledge, and a sensitive mix of classroom, laboratory and field experiences.

Standards based on an evaluation of performance would make quality control possible, but despite a long recognized need for means by which to audit the quality of a health worker's activities, effective systems have not been agreed upon and are not now at hand (Robbins 1972). While paraprofessionals seek "professional-

ization," professionals must work to develop a more equitable, relevant and credible training and credentialing system. The administrator's role is a central one in this process in that he can set reasonable career deve lopmen t standards, can develop appropriate training mechanisms, and can provide advancement opportunities for paraprofessionals. As a result of more rational planning for training and evaluation of all practitioners, higher quality services may be designed and delivered to the consumer.

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R E F E R E N C E S

Astrachan, Boris. "Mul t i -S ta te Informat ion System Input to Administrat ive Decision Making." Unpublished paper, January 21, 1974.

Boyette, Roberta, et aL The plight of the new careerist: A bright horizon overshadowed by a dark cloud. American Journal of Ortho- Psychiatry, 42 (4): July, 1972.

Cogan, Morris L. Toward a definition of profession. Harvard Educational Review, 23: 35- 54, Winter, 1953.

Davis, Elizabeth B. and Ballard, Bruce L. The poverty cycle and the paraprofessionals: Development and its vicissitudes in the black ghetto. Psychiatric Annals, 4 (4): April, 1974.

Gerth, Hans and Mills, C. Wright. Character and Social Structure: The Psychology of Social Institutions. New York: Harbinger, 1965.

Nash, Kermit. The group psychotherapist and the training of the new mental health workers: What else is new? International Journal of Group Psychotherapy, 24 (1): January, 1974.

Navarro, Vincente. Social policy issues: An explanation of the composition, nature and functions of the present health sector of the

United States. Unpublished paper presented at the Annual Conference of the New York Academy of Medicine, April 25-26, 1974.

Reich, Charles. The Greening of America. New York: Vintage Press, 1972.

Robbins, Anthony. Allied health m a n p o w e r - solution or problem. The New England Journal of Medicine, 918-923, April 27, 1972.

Roche Report: Frontiers of Hospital Psychiatry. Vol. 7 No. 12, World Wide Medical Press, June 15, 1970.

Stuckey, Grace. Challenges in mental health for new professionals. Amer. J. Orthopsychiat., 43 (1): January, 1973.

Tucker , Robert C. Some observat ions on neo-paternal ism in black-white managerial relations. Afro-American Studies, Spring, 1972.

Vivader, Robert M. The mental health technician: Maryland's design for a new health career. American Journal of Psychiatry, 125: 1013-1022, February 8, 1969.

Webster's New Collegiate Dictionary. Springfield, Mass: G & C Merriam Co., 1953.

ADMINISTRATION IN MENTAL HEALTH

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