Discussion 4

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Journal of Religion & Spirituality in Social Work: Social Thought

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Setting the Context Assessing the Effectiveness of Faith-Based Social Services

Ram A. Cnaan PhD & Stephanie C. Boddie PhD

To cite this article: Ram A. Cnaan PhD & Stephanie C. Boddie PhD (2006) Setting the Context, Journal of Religion & Spirituality in Social Work: Social Thought, 25:3-4, 5-18, DOI: 10.1300/ J377v25n03_02

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Chapter 1

Setting the Context: Assessing the Effectiveness

of Faith-Based Social Services

Ram A. Cnaan Stephanie C. Boddie

SUMMARY. This paper provides an overview of assessing the effec- tiveness of newly legislated social policies. In an era of growing public reliance on faith-based social services, it is imperative to be accountable and assess the efficacy and effectiveness of this set of providers. It dis- cusses the paucity of such attempts and the complications involved in measuring effectiveness of social programs, especially when religion is involved. It then reviews the contributions provided in this volume and draws conclusions for future studies. doi:10.1300/J377v25n03_02 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Web- site: <http://www.HaworthPress.com> © 2006 by The Haworth Press, Inc. All rights reserved.]

Ram A. Cnaan, PhD, is affiliated with The School of Social Policy & Practice, Uni- versity of Pennsylvania.

Stephanie C. Boddie, PhD, is affiliated with George Warren Brown School of So- cial Work, Washington University in St. Louis.

Address correspondence to: Stephanie C. Boddie, George Warren Brown School of Social Work, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130.

[Haworth co-indexing entry note]: “Setting The Context: Assessing the Effectiveness of Faith-Based So- cial Services.” Cnaan, Ram A., and Stephanie C. Boddie. Co-published simultaneously in Journal of Religion & Spirituality in Social Work (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.) Vol. 25, No. 3/4, 2006, pp. 5-18; and: Faith-Based Social Services: Measures, Assessments, and Effectiveness (ed: Stephanie C. Boddie, and Ram A. Cnaan) The Haworth Pastoral Press, an imprint of The Haworth Press, Inc., 2006, pp. 5-18. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: docdelivery@haworthpress.com].

http://jrssw.haworthpress.com © 2006 by The Haworth Press, Inc. All rights reserved.

doi:10.1300/J377v25n03_02 5

KEYWORDS. Faith-based service, program effectiveness, faith-based initiatives, evaluation, charitable choice

In the past decade, the balance between the state and faith-based so- cial providers has shifted dramatically. Prior to 1996, faith-based social services, many of which were prominent in the public social service de- livery arena, were, in fact, secular in nature. While they contained reli- gious titles such as “Catholic Charities,” “Jewish Children and Family Services” or “Episcopal Social Services,” they did not preach or dis- seminate their religious doctrines, hired professionally trained staff who were not necessarily from their own faith tradition, did not celebrate re- ligious holidays with clients, and mirrored their secular counterparts. All of this, however, began to change in 1996.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) contains a special section that has trans- formed the relationship between the public sector and faith-based social providers. This is section 104 of the Act, also commonly referred to as “Charitable Choice.” This provision significantly changes the historic relationship of the religious community and the public sector by open- ing the door for mixing religion and publicly-supported social services. Charitable Choice outlines the primary feature of this provision as follows:

The purpose of this section is to allow States to contract with reli- gious organizations, or to allow religious organizations to accept certificates, vouchers, or other forms of disbursement . . . on the same basis as any other non-governmental provider without im- pairing the religious character of such organizations, and without diminishing the religious freedom of beneficiaries of assistance funded under such program.

The objectives of Charitable Choice are to: (1) encourage states and counties to increase the participation of nonprofit organizations in the provision of federally-funded welfare programs, with specific mention of religious-based organizations; (2) establish eligibility for religious- based organizations as contractors for service on the same basis as other organizations; (3) protect the religious character and employment exemp- tion status of participating religious-based organizations; and (4) safe- guard the religious freedom of participants.

6 Faith-Based Social Services: Measures, Assessments, and Effectiveness

Since the enactment of Charitable Choice as part of welfare reform in 1996, the relationship between government and faith-based service pro- viders has undergone a revolution. Congress, the U.S. Supreme Court, and certainly the Bush administration are more receptive to the idea that government can purchase services from faith-based providers, so long as taxpayers are not paying for purely religious services such as the pur- chase of Bibles, Sunday School materials or clergy salary. This change in the balance between the state and faith-based providers was also transferred to the state level. By 2005, 27 states had enacted legislation with references to faith-based organizations, and 63 percent of states now have an individual or office to serve as a liaison.

A report by the White House Office of Faith-Based and Community Initiatives (2006) revealed that in fiscal year 2005, 10.9% of competi- tive funds distributed by the seven departments where faith-based of- fices are in place were directed to faith-based providers. This amount- ed to an annual increase of seven percent in dollar value and 22 percent increase in the number of awardees who were considered faith-based. In other words, the practice of faith-based social services provision seems to be common and is not showing any signs of phasing out. The interlinking of government and faith-based social service providers was intensified post-Hurricane Katrina. While public services from the city to federal levels failed to prevent the crisis and failed to assist the disaster victims, the only groups that came out shining and revered were the community faith-based organizations (White House, 2006). The government report on the Katrina disaster and post-Katrina re- sponse praised the faith-based community, from small churches to the larger organizations, and called upon the public authorities to better integrate them into their systems of care for future events. Again, the role of faith-based social service providers in our public social service system is still on the rise.

As new kids on the block, Charitable Choice and the faith-based ini- tiatives must legitimize the basis for their inclusion in the already-rich tapestry of public social service providers. Their origin was in the 1980s with the anti-big-government sentiment and the rise of the new-federal- ism camp. While there are many notable examples, we will highlight two that are linked to our topic of assessing efficacy. First, U.S. Senator Dan Coats (R-IN) often told the story of the Union Gospel Mission, a drug-treatment center for homeless men not far from the nation’s capi- tal. According to Coats, the mission, under the leadership of John Woods, successfully rehabilitates two thirds of its clients. Just three blocks away is a government-operated shelter with similar goals. Al-

Conceptual Analysis 7

though the government-operated shelter spends 20 times more dollars per person, it boasts only a 10 percent success rate. Senator Coats has an explanation for the disparity: “The Gospel Mission succeeds because it provides more than a meal, more than a drug treatment. It is in the busi- ness of spreading the grace of God” (Frame, 1995: 65). Careful social scientists easily refute these high rates of success, but Coats’ message is clear: faith-based social services are superior. It is more likely that the Gospel Mission picks and chooses its clients, or the clients self-select, therefore increasing the chance for success. This practice is known as “creaming.” The government shelter, on the other hand, does not have this luxury. They are mandated to admit any applicant as long as space is available and no screening is allowed. Comparing the success of a program that creams clients to one that serves any client in need, might make for good politics, but not necessarily for good social science. In addition, the study data come from different sources (as there has not been a single-study comparing both religious and public programs), therefore it is likely that the definitions of success applied are different and would thus contribute to the disparity in reported outcomes.

Second, President Ronald Reagan, who championed new federalism, was the one to plant the seed about the high expectations from faith- based social providers. Reagan reinforced the conservative viewpoint that personal character flaws and government-operated social programs were to blame for poverty:

The story of the Good Samaritan has always illustrated to me what God’s challenge really is. He crossed the road, knelt down, bound up the wounds of the beaten traveler, the pilgrim and carried him to the nearest town. He didn’t go running into town and look for a caseworker to tell him that there was a fellow out there that needed help. He took it upon himself. (Denton, 1982, Reagan Home Page, 1997)

It is important to recognize here that policies and the programs they engender reflect the values of those shaping the policy. Reagan had cre- ated a new public devil–“the government bureaucrat”–by pitting the godless, uncaring, bureaucratic caseworker against the Good Samari- tan. As part of his campaign against the power of professionals and civil servants, he relied on faith-based providers to be part of the picture by painting them as flawless angels.

The ideological campaign was fruitful. In less then two decades, Charitable Choice was enacted, the White House office of Faith-based

8 Faith-Based Social Services: Measures, Assessments, and Effectiveness

and Community Initiatives was formed, faith-based offices were estab- lished in seven key federal departments, and more and more grants have been given to faith-based providers. In many ways this is a paradigm shift and all indications are that this practice is here to stay. What we lack, however, is rigorous empirical knowledge about the efficacy of these social service providers. As McGrew and Cnaan demonstrate in the following chapter, years of academic neglect and avoidance of studying religious-related topics have left social scientists of our time lacking the know-how and the real experience in studying faith-based organizations. Many concepts are not well defined, credibility of many methods is doubtful, and years of research are sorely missing.

Furthermore, the faith-based initiative proponents have set the bar so high that no other social service agencies could possibly meet their un- realistic expectations. No social service agency that deals with unem- ployed people, substance abusers, or homeless people can claim an eighty percent rate of success and be taken seriously. It is without ques- tion that Senator Coats’ numbers are very inflated and do not represent a real and fair comparison. But our lack of knowledge is even more em- barrassing. We do not know if faith-based social services are at all ef- fective, and when compared to secular (private, public or nonprofit) social services, if they are performing equally, better or worse. In this volume, we set out focus on answering this question.

HOW DO WE KNOW?

The question of “how do we know?” has puzzled people for many generations. This epistemological search to understand and control events started at the dawn of civilization, but accelerated in the enlight- enment era. The idea of science is that internal, intuitive, a-priori know- ledge is subjective and often misleading. Such knowledge is often based on ideology or personal wish, and is akin to belief rather than true knowledge. Accordingly, only a-posteriori, external, and empirical knowledge should be considered relevant knowledge for policy mak- ing. This is knowledge that is objective and originates through system- atic empirical study.

Whenever a new mode of intervention is proposed or a new public policy is set, scholars and politicians alike argue its merits. Whether its focus is seat-belt use in cars or the long-term benefits of Head-Start pro- grams, the debate often centers on the question, “how do we know that the policy really works?” Put differently, how do we know that tax-

Conceptual Analysis 9

payer money is put to good use? In almost all public policy issues, ideol- ogy and beliefs drive a large share of the rhetoric. Without conviction and an army of believers, no policy or societal change would be legis- lated and accepted. But in areas where there has been little empirical study, the debate and legislation is founded almost entirely on a-priori convictions. Often there is insufficient time, money, and partial inter- ests to scientifically investigate the proposed changes before they are enacted, but once new policies are approved they must be followed with rigorous and impartial studies. Similarly, those supporting and those opposing a certain policy are threatened by the possible findings from an empirical investigation and prefer to stay with their own a-priori knowledge/beliefs rather than be faced with risky findings.

Real social science is predicated on the principle of “rule of evi- dence.” In the legal field, the rule of evidence is a key principle whereby any alleged matter of fact that is submitted for investigation at a judicial trial is either established or disproved. Put differently, while expert wit- nesses of opposing sides claim to the validity of opposing realities, the task of the judge is to determine whether a claim is supported or not based on the evidence presented. The same ought to apply in public pol- icy. The ideological debate and personal knowledge can only go so far. At a certain point, the rule of evidence must apply, and opponents and supporters must rely on careful studies which provide replicable results using standardized methods. This rule calls upon researchers to conduct studies as bias-free as possible, and provide valid and reliable scientific evidence that cannot be refuted.

When Charitable Choice was passed, involving religion as it did, it engendered an even higher level of ideology and a-priori conviction in the public debate than usual. While President Clinton was a strong sup- porter of faith-based social services, they are more commonly associ- ated with President George W. Bush, who established The White House Office of Faith-Based and Community Initiatives in 2001. Opponents and proponents alike use much rhetoric and can hardly substantiate their claims with solid empirical knowledge. When claims are made in politi- cal speeches that a faith-based homeless shelter or a faith-based drug and alcohol rehabilitation center is ten times more efficient than their secular counterparts, or alternatively that faith-based organizations see service provision as merely an opportunity to proselytize, those claims are typically based on pure a-priori beliefs or, at best, a few carefully chosen case studies. In this debate, the ideological fight over the role of religion in civil life conflates the discussion and makes the sides more argumentative and fearful of real empirical results.

10 Faith-Based Social Services: Measures, Assessments, and Effectiveness

It seems likely that Charitable Choice won political support at least in part due to the high level of trust Americans have in faith-based organi- zations. For example, when residents of Maryland were asked in 1999 to rate organizations according to how well they do “the job you ex- pect,” places of worship, such as churches, synagogues or mosques were ranked first with a mean of 8.0 (on a scale of ten). A replication of the same survey two years later, in 2001, showed that places of worship retained their top rank, with the rising to 8.5 (Maryland Association of Nonprofit Organizations, 2002). Similarly, the Pew Research Center for the Public & The Press (2000) reported that the majority of Ameri- cans support using public funds for social services provided through congregations and other faith-based organizations. Trust and wide- spread support are important politically and do serve as indirect evi- dence that faith-based social services are generally helpful, but this kind of evidence is no substitute for formal, rigorous studies of the efficacy and efficiency of those services. After all, public attitude may be based on political marketing and may be wrong.

As often is the case in public policy, without rigorous data and with full conviction, on January 29, 2001 President George W. Bush called for a new era of partnership between the government and religious groups. Proponents hailed the faith-based initiative. On that same day, CNN’s Tucker Carlson on The Spin Room declared that: “Study after study shows these faith-based initiatives work better, much better in most cases, than government ones.” Similarly, William Donahue, presi- dent of the Catholic League for Religious and Civil Rights, told The Washington Times, “Faith-based initiatives not only work better than their secular counterparts, they do so at a fraction of the cost” (Peres, 2001).

Proponents of the faith-based initiative claimed that faith-based ser- vices are superior to the secular services as they can use committed vol- unteers, available resources, spirit of care, have a holistic perspective, instill a spirit of hope, and are helping workers and clients to fulfill a higher goal (Carlson-Thies & Skillen, 1996; Sherman, 1999). The prom- ise was even greater for the Black community, as it suffers from greater social needs and discrimination, and as rates of religiosity and the role of the organized church are more prominent in the Black community (Alex-Assensoh, 2004; DiIulio, 1999). Surprisingly, in the political de- bate over faith-based social service provision, the opponents of this initia- tive rarely counter this unrealistic expectation of efficacy superiority. Most arguments against the faith-based initiative have centered on the separation of church and state, rights of clients, and protection of service

Conceptual Analysis 11

employees. The myth about the high efficacy of faith-based social ser- vices was not challenged and was assumed to be true. But, like in a Greek tragedy, it also trapped faith-based social service providers, as they are now expected to demonstrate a high-level of performance that is in fact barely short of impossible.

A more realistic expectation comes from the field of contract theory. Put simply, everything being equal, the greater the number of providers bidding on a contract, the higher the likelihood that the contract will be carried out to the satisfaction of the contracting agency and at a lower price. The idea is that when a group of providers bid for service, the quality of work will be more-or-less equal but the cheaper bid will save money. Thus, faith-based social providers enlarge the pool of potential bidders, lowering the cost of public social services.

Similarly, and a little less publicly, social scientists, who have a re- sponsibility to paint an objective picture, have been asking themselves “Are faith-based social service providers really that much better or even better at all? If they can in fact provide services equal to or better than secular alternatives, can they really do it more cost-effectively? How can we find out?” In 1996, and even by 2001, there was almost no solid empirical data to examine. This volume represents a slice of the first major wave of research on the effectiveness of faith-based services, but there is still far too little reliable information to properly answer those questions.

THIS VOLUME’S MISSION AND BOUNDARIES

In this volume, we set forth to tackle the essential questions of whether faith-based social services work effectively and efficiently compared to secular alternatives, but we give equal focus to method- ological concerns which must be addressed along the way to answering that question. However, before we turn our attention on this question, it is worth taking a moment to explain what is not included in this discussion.

First, we are not concerned here with specifically religious or spiri- tual interventions. There are many religious practices that are and will no doubt continue to be advocated as good social interventions. For ex- ample, there is a growing body of literature on the health or men- tal-health efficacy of meditation, intercessory prayer, and forgiveness education. Some clinical trials or controlled studies have been carried out to assess the efficacy of these modalities in health and social inter-

12 Faith-Based Social Services: Measures, Assessments, and Effectiveness

ventions (Freedman & Enright, 1996; Matthews, Marlowe, & MacNutt 2000; Targ & Levine, 2002). The difference between these studies and those we focus on in this volume is that these studies focus on the reli- gious character of interventions whereas we focus on the religious char- acter of organizations.

One example of a religious intervention that utilizes religion as part of the service provided to the client is Rational Emotive Spiritual Ther- apy (REST). The integration of a cognitive behavioral therapy approach called Rational Emotive Therapy (RET) with a spiritual or faith-based component–is cited in the literature as promising (Ellis, 2000; Hatcher & McGuire, 2001). In the REST model, the spiritual component is fully integrated into all aspects of the cognitive-behavioral intervention. The literature suggests that both the cognitive-behavioral and faith-based aspects of this intervention, which focuses on emotional healing, has the potential to reduce criminal recidivism, as well as improve problem- solving skills and psychological well-being (O’Connor, 2002).

Section 104 of PRWORA did not specify methods of intervention, but rather encouraged public funds to be used in contracting with faith-based organizations. These organizations can use religious inter- ventions (if they are not perceived as proselytizing) or secular interven- tions, but are distinct from other agencies that are also contracted by the state. The key difference is in their organizational character: they are faith-based organizations. While not all faith-based organizations are alike, differing in organizational structure and the role religion plays in them (Jeavons, 1998; Smith & Sosin, 2001; Unruh & Sider, 2001), they are the set of organizations that is the focus of the faith-based initiative. Thus, we are not focusing on religious or spiritual interventions per se, but, rather on the efficacy of one group of organizations that is reli- giously affiliated versus another group of organizations that is secular in nature.

Second, we do not focus here on whether and how the personal reli- gion of social service recipients affects the outcome of certain interven- tions. This question has also been studied, and will certainly continue to be studied (Tonigan, Miller, & Schermer, 2002). Whether, and how, re- ligious beliefs and practices of social workers and other service workers affect social service delivery are important questions, but our scope here is limited to the nature of the serving organizations. This limited scope closely matches the recent policy initiative: even under PRWORA, religious organizations are not allowed to use public funds for any overtly religious practices, nor are they allowed to impose any stan- dards of religious beliefs or practices on recipients of publicly funded

Conceptual Analysis 13

services. Yet, many of the proponents of the faith-based initiative are basing their expectations on the religiosity of the workers and their commitment to God as motivating them to be especially attuned to cli- ents’ needs.

What we are concerned with in this volume is the efficacy of certain service organizations versus other service organizations regardless of the interventions applied by specific workers, regardless of the work- ers’ own beliefs, and regardless of the manner in which these beliefs are actualized by the workers (see discussion by von Furstenberg in this volume). Put differently, although there is ample evidence to indicate that religion can have a positive impact on individuals’ wellbeing, and that workers who are motivated by religious beliefs may be more com- mitted to their clients, no such knowledge exists regarding regular so- cial services that are provided by faith-based organizations.

Efficacy studies are always very difficult to implement, but efficacy studies of faith-based social service providers encounter some unique obstacles which render them particularly troublesome. To use a meta- phor, in this volume we do not ask if “holy water” is better than “regular water” in alleviating thirst. What we do ask is if water given by holy hands is superior to water given by secular hands in alleviating thirst. If the source of the water (funding) is the same, do the holy (religious) hands somehow make a difference in the alleviation of thirst (efficacy of care) because it is better under the sacred auspices? Clearly, when so- cial and personal services are concerned, the complexity of the “water” intensifies. The process or relationships between a worker and client may have as high an impact as the prescribed intervention. So, one may ask: “If faith-based services are proven more effective–is it because they have more devoted workers or is because they are having the religious hallow around them?”

It is difficult to establish a comparison with secular service providers for several reasons. Since faith-based organizations tend to have differ- ent (and more varied) organizational structures from their secular coun- terparts, even comparable groups are tricky to identify. The fact that two organizations provide the same service does not guarantee that their budgets, personnel, policies, experiences, workers’ morale, technical know-how, and buildings are of the same nature-all of which can be in- tervening variables in assessing efficacy. The organizational literature suggests that large and experienced organizations with professional staff are, on average, better at serving poor people. However, such orga- nizations can come from either the faith-based or secular set of social service providers. In fact, some of the contributions to this volume will

14 Faith-Based Social Services: Measures, Assessments, and Effectiveness

explore the possibility that observed differences in outcomes may be the result of organizational characteristics that are not faith-related.

Even if organizational variables can be equalized, there remains a possible selection bias. Can clients be forced to go to a religious service provider? It would be clearly unethical. Charitable Choice specifically guarantees clients of a choice to bail out of a religious service provider if they wish. It is thus very difficult to resolve the question of whether a difference in outcomes is due to a difference in the quality of service, or due to a difference in the kinds of people who seek out faith-based providers.

Another major hurdle in evaluation has been the need to account for the inconsistent information flow about Charitable Choice. We are fol- lowing a new policy that has been implemented at various paces in vari- ous states and cities. Even within the same community, not all actors are informed and understand the new policy in a uniform manner. For ex- ample, Stanziola and Schmitz (2003) studied the implementation of contracting with faith-based day-care providers in Lee County, Florida. They concluded that “any devolutionary policy that aims to aggres- sively include faith-based organizations in the provision of social ser- vices will face the challenge of weak information flow mechanisms within the industry.” Not the least of these problems of implementation is the lack of knowledge and occasional opposition of the public offi- cials who are in charge of contracting or supervising the work of the faith-based social service providers. As the White House (2001) noted, “there exists a widespread bias against faith and community-based organizations in Federal social service programs” (p. 3). Charitable Choice has been almost entirely ignored by Federal administrators, who have done little to help, and have not required state and local govern- ments to comply with the new rules for involving faith-based providers.

These and other challenges have made the first wave of rigorous study both conceptually and logistically difficult. Compounded by poli- ticians’ and policy makers’ reluctance to seek answers beyond their own ideologies, our scientific knowledge as to the efficacy of faith- based social services is indeed limited.

The purpose of this volume is to collect some of the wisdom and ex- periences a group of top scholars and leaders in the field have collected so far. We approached scholars who are experts in research methods and asked them to reflect on the challenges facing empirical research- ers, and we approached scholars who have “gotten their hands dirty” and could share from their real-life experience. This volume is therefore divided into two main sections: conceptual/methodological contribu-

Conceptual Analysis 15

tions and empirical contributions. As expected, most contributions raise more questions than answers. Yet, we are convinced this volume will advance the field of assessing faith-based social services, and some ru- dimentary questions will accordingly be resolved and replaced with more sophisticated ones. Many terminological questions regarding faith- based social services are at last reaching some clarity, and the field is coming to consensus on what the important questions are. Furthermore, growing awareness of the common intervening variables will guide the work of future researchers as they design studies which account for them.

CONCLUSIONS

Any field of study that has been neglected for such a long time must be treaded in as carefully as a completely unknown field. One cannot move ahead at full speed and apply existing methods before carefully assessing their relevance. This is especially the case with assessing the effectiveness of organizations in a field as contentious as the role of reli- gion in public life. The ideological and political stakes are so high that no single study or single method can persuade believers to change their views. To achieve this, we need a large set of rigorous studies employ- ing various research designs and methods focusing on various subsets of industries (such as welfare to work, drug and alcohol rehabilitation, child day care, and adult education) in which faith-based providers play a key role.

One issue that must be acknowledged in assessing the effectiveness of faith-based social services is their potential replication. The more an intervention is religion-specific, the less likely it is that other faith tradi- tions will adopt it. Thus, evaluation of faith-based social services must precisely report the amount of religiosity in the program and its speci- ficity to one or more faith traditions.

This volume sets the foundation for such an endeavor. The first part of the volume addresses conceptual and methodological challenges in- volved in the study of faith-based social services and offers a variety of possible solutions. The latter part reports on a few select studies that have attempted to empirically answer the effectiveness question. The findings are tentative and may signify the end of the first wave of stud- ies. They suggest that faith-based social services are neither superior nor inferior to secular services, yet clients report liking them. But even this generalization needs replication from other studies before it can be

16 Faith-Based Social Services: Measures, Assessments, and Effectiveness

accepted as conclusive. Without serious commitment to evaluation re- search that will rigorously assess the effectiveness of faith-based social services, practitioners and policy-makers will continue to rely on a-pri- ori knowledge that is based on pre-conceived ideas and ideology with- out scientific evidence.

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Conceptual Analysis 17

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18 Faith-Based Social Services: Measures, Assessments, and Effectiveness