Reference no: EM133116179

Case Activity 1:

The Women''s Agency of Schaefer City offered a full range of services to women, including counseling, educational interventions, and career development programs. Services were offered by a combination of professionals, paraprofessionals, and volunteers, with self-help and peer counseling important components of most programs.

The one agency program that depended solely on professional service deliverers was the health center, located in a separate building but overseen by the same board of directors and administration. The health center dealt with a variety of women''s health needs and offered family planning and first-trimester abortions. Although medical service was provided by physicians and nurse practitioners, all counseling was provided by women with degrees in psychology, counseling, or social work.

For the abortion clinic, this approach worked very well. Each woman who came in for the abortion procedure talked first with a counselor, who took a medical history, answered any questions about the procedure, and explored the woman''s readiness for taking this step. The process of exploration often led women to reconsider their options; certainly the decision-making process was enhanced.

This program was placed in jeopardy when severe cutbacks in funding for the total agency took place. There was no consideration of eliminating the abortion clinic itself; the cutbacks, however, were to affect the counseling aspect of the program. By cutting the number of professional counselors from nine to three, enough money could be saved that the number of women served could remain constant. The agency''s administrator chose to limit the intake counseling interviews to 20 minutes each. In that time, medical information could be obtained and information about the procedure given.

The reaction to this cutback was immediate and strong. All of the professionals associated with the abortion clinic recognized that the suggested change in staffing patterns would be devastating, not just for the women losing their jobs but for the program itself.

From the patients'' viewpoint, the problem involved the fact that they would be deprived of the opportunity to consider their decisions with assistance from skilled helpers. Although they would have factual information, many of them would regret their decisions, which could have lasting effects.

The change also seemed serious in terms of the wellbeing of the professionals still offering services. No longer would they have the opportunity to provide empathy and help to people in crisis. Instead, they would be spending their time with person after person, giving and getting information in an assembly-line approach. They would not be able to stay with patients through the medical procedure or provide emotional support later. Instead, they would stay in their offices, maintain business as usual, and quickly burn out.

Given the fact that the agency had to survive with fewer resources, how could financial cutbacks have been implemented more effectively?
What leadership behaviors may be appropriate at a time like this?
What principles or tactics of organizational change could have been used to reach a better outcome in terms of results and effects on staff?

Case Activity 2:

For several decades, an important force in mental health programs has been "deinstitutionalization." Many people who were formerly patients in large state hospitals have been transferred to smaller, community-based facilities.

Window on the World (WOW) is one of the new agencies that arose in response to deinstitutionalization efforts. It was designed to act as a halfway house for people recently released from the nearby state hospital. Although the funding for WOW comes from a number of sources, the primary source involves third-party payments from the state vocational rehabilitation agency and the state and local departments of social service. Essentially, these agencies pay room, board, and fees on behalf of the clients they place in the halfway house.

The WOW facility is clean and well kept. Staff members have real concern for the clients, and efforts are made to keep the surroundings comfortable. Yet some of the staff members have begun to question the treatment plans for individual patients.

In one such recent situation, John Billings, a staff member, asked to see Harmon Fisk, the executive director, about one of the patients.

"I''d like to talk to you about Gail Drew," he began. "I''m positive she''s ready to get on her feet and start moving. If we could just cut back on her medication, I think we might really see an improvement in this case. She might even be ready to be placed in a part-time training program and come back here in the evenings. Maybe nothing really major at first, but if we could just give her a chance, just give it a try."

"Just what do you want me to do, John?"

"Well, I thought you might be able to check with Dr. Freund about whether he could change her medication. You know, the stuff she''s taking now is keeping her kind of knocked out, and...."

"Look, John. Carl Freund has been the consulting psychiatrist here since the word go. You come in here with a fresh master''s degree and want to tell him his business. Don''t you think he knows what he''s doing?"

"It''s not that, Mr. Fisk. Of course I think he knows what he''s doing. I''m just saying that I''m seeing a subtle change in this one patient, and I think she''s ready to move toward a less sheltered existence. We won''t know that unless we cut down on her medication. We can always change it back again if it doesn''t work out. What have we got to lose?"

"I''ll tell you what we''ve got to lose. We''ve got Gail Drew''s fees to lose. She''s a Social Service patient. They pay her way. But they pay her way only when she''s incapacitated. If she''s on her feet and out there being trained, the fees are cut to a quarter of what they are now, and we can''t support her on that. And if she''s out there working, her fees are cut to nothing. She can''t support herself on that. Now, what do you want me to do? Put this woman out there on her own in the cold? On your say-so?"

"Wait ... wait a minute, Mr. Fisk. We can''t just keep someone doped up because that''s the only way we can make money off her."

"No, now just you wait a minute. For one thing, you sound plenty noble, but I don''t see you turning down your paycheck on Fridays. Where do you think that money comes from?"

"I know, but...."

"I didn''t make this system. If you don''t like the way it works, talk to the government. The thing is, I don''t like seeing a patient like that lying around all day any more than you do. But believe me, we wouldn''t be doing her any favor cutting off her medication, getting her out there on the streets with her hopes up, and then having her lose the support that she''s got. Face it. These people are chronic. They''re not going anyplace. But at least here it''s clean, it''s comfortable. They''ve got a roof over their heads, and they''re not piled one on top of another in an institution like they were monkeys in a cage."

"But Mr. Fisk, Gail Drew should have a chance...."

"Have a chance for what? To starve out there on her own? Look, we need fees to run this agency. If we don''t get the fees, we don''t get to exist. Then what happens to Gail Drew and to the rest of the patients we''ve got in those beds upstairs? You think our going under is going to do them any good? Where do you think they''ll go except back to State, where they came from?"

What ethical considerations exist in this case? How would you address them?

Are there ways that differing funding patterns might be developed to make deinstitutionalization work more effectively?

If you were John Billings, what would you do now?

If you were Harmon Fisk, the director, would you be able to come up with any better answers?

Are there insurmountable differences between human service professionals and managers?

Case Activity 3:

The Community Action Coalition (C.A.C.) had occupied the same storefront setting for more than 10 years, but the times had changed. From a small group of neighbors, shop owners, and church groups that had joined to fight successfully against the potential encroachment of a superhighway through their neighborhood, the C.A.C. had grown into a major community organization. Block clubs and community interest groups still formed the backbone of the organization, but a variety of programs, services, and agencies had spun off from the original system. The C.A.C.''s attempts to enhance the lifestyle of community members had resulted in the development of programs to fight substandard housing and schools, encourage consumer awareness, provide recreational and training programs for youth, and bring thriving businesses into the area.

Throughout the years, however, the C.A.C. had maintained its little office in the heart of the neighborhood. And throughout the years, the same thing had happened again and again. When citizens of the community were faced with family problems, with concerns about their children, with crises in their own lives, the C.A.C. was the only place that attracted them. Although a community mental health center was based in a hospital in the immediate area, and although a branch of the Department of Social Services had been built just two blocks away, these institutions were underutilized as self-referral agencies. Going to the community mental health center meant that one was sick. Going to the C.A.C. meant simply that one was having a problem in everyday living.

The staff of the coalition''s storefront office welcomed the chance to try to have some effect on their neighbors'' personal lives. Sometimes troubled individuals just needed someone to listen; sometimes they needed the kind of advocacy or linkage with sources of help that the organization was best at. There were times, however, when staff members felt inadequate to deal with the problems they were facing, times when they felt that at least one professional mental health worker should be present to provide training and supervision as well as direct therapy. The need for this kind of program became so obvious that the staff members decided to apply for a grant for seed money to get their new program started. They simply needed a way to begin to implement a more organized approach to mental health, one that would involve keeping the office open through the evening hours, with volunteers providing help under the supervision of professional mental health personnel. The funds would provide for training, for a portion of the salaries of the trainer/supervisors, and for materials needed for the immediate future. Later, they felt, the organization would be able to support the new program on its own.

They did make a good case for the need and for the concept. The foundation to which they applied for funding agreed to visit the community to learn more about the proposed program and about the community itself. The organization, accustomed to this kind of site visit, geared up by preparing materials, planning a presentation, and inviting a number of community members to present their views on the day of the visit.

The day arrived and the presentation began as scheduled. The staff members who had written the grant proposal felt increasingly optimistic about their chances for funding as more and more citizens rose to express their support. Suddenly, however, a man none of them knew rose to speak.

"I''ve come to represent the community mental health center that serves this catchment area," he said. "As much as we have appreciated the fine organizing work of the C.A.C. over the years, we reluctantly have to tell you that the service they are suggesting would be inappropriate for such a nonprofessional agency. It certainly would be a duplication of the services we are presently offering with the highest level of professional staff."

"Yes," answered the foundation representative. "We did get the letter of protest from your board of directors. It does seem as though some kind of liaison needs to take place here."

After a moment of stunned silence, pandemonium broke out in the room, as the anger of community members who disapproved of the mental health center''s approach rose to the surface. Amid the shouts, one thing became clear. The Community Action Coalition would not be receiving funding to meet the mental health needs of its members.

How could this confrontation have been avoided?

What could C.A.C.''s leaders have done to prepare a better plan for mental health services?

What could staff of the community mental health center have done to represent their views on service needs in a more collaborative way?

The two agencies involved in the situation seem to have differing views concerning local needs. Does this mean that their assessments were inaccurate, or is there some other possible explanation?

If you were a member of the staff of the Community Action Coalition, what steps might you take now to salvage the planning and implementation process?

Attachment:- Case summary.rar