Reference no: EM133091066

Question: Students will provide a one-page summary of each case activity within the assigned chapter for the week''s readings in the Lewis, Packard, and Lewis (2012) text. The students will include a summary of the challenges faced by the individuals in each particular case as well as an analysis of the strengths and limitations of the approach and state whether they believe the situation was resolved effectively. In addition, students will discuss if they would have proceeded differently. Each case summary is worth 5 points. Be sure to follow APA Publication Manual (7th edition) guidelines when writing your case summary. You will need a title page and references page.

CASE ACTIVITY - THE UMBRELLA ORGANIZATION

The roots of the Atlantis Community Mental Health Center (ACMHC) were in its inpatient, outpatient, and emergency services. Although, in keeping with the federal mandate, consultation and education services had always been included, emphasis had never been placed on preventive, community-based interventions until a recent major upheaval.

In response to an evaluation report showing that many groups within its highly diverse geographic area were not being reached through traditional services, the board and administrative staff of the ACMHC decided to add several new service components. The new programs were to include an outreach program for families, a drug and alcoholism program, a crisis intervention team, and several storefront outposts that would encourage using the service by members of the minority community.

The ACMHC''s funding sources were uniformly in favor of this approach but would provide funding only if a major organizational change were made. The funding sources recognized that many of the proposed services were already being offered on a smaller scale by tiny, community-based agencies scattered throughout the area. Each of these small agencies had worked independently for years, often with unknowing duplication of the services of other organizations. This new thrust of the ACMHC was recognized as a possible vehicle for a more efficient approach to human services than had been possible before. It was suggested that the human service network of Atlantis develop more effective linkages, with each agency maintaining a degree of autonomy but with the organizations joining for the sharing of resources. The mental health center would act as the umbrella organization, offering community outreach services through existing local agencies rather than duplicating these services with the development of new programs.

Because of the obvious financial benefits to be gained through this cooperative endeavor, the mental health center and a number of community agencies made the commitment to developing a new organizational structure. A subcommittee, including a number of agency and center service deliverers, as well as funders and community members, was charged with the responsibility of drafting a suggested structure, to which the various member agencies could respond. Of course, representatives of differing organizations brought divergent viewpoints to the meeting.

Hilary Johnson, the ACMHC''s program officer, represented a major source of funding for the organization. Her primary concern was that services be effectively delivered at Atlantis without needless duplication of effort and without the usual endless competition among agencies for limited funds. She knew that all of the agencies involved provided greatly needed services, but she also knew that these services could be provided more efficiently through greater coordination. She thought it would be possible to centralize the work of these agencies to accomplish common goals and to divide resources equitably among programs.

Caroline Brown, Juan Casel, and Evelyn Mays were all staff members of small, community-based agencies. Each of them brought to the meeting a high degree of concern for maintaining the nature of his or her own agency. They knew that their agencies'' strengths lay in their responsiveness to local needs and in the fact that their programs had been developed by community members. They had always resisted pressures to expand, recognizing that the smaller agency can sometimes maintain a degree of responsiveness and flexibility that a large organization cannot duplicate. They knew that fiscal realities meant they had to become part of a larger entity, but they also realized that there would be dangers involved in losing their own identities. They could not duplicate the center''s lack of accessibility; they understood that if that happened, they would go under.

Similarly, Nick Chan and Sally Allen, representing local citizens'' groups, recognized that maintaining accessibility would be important. They knew that many of their neighbors resisted using the services of the center but felt more comfortable in their dealings with the smaller agencies in their immediate neighborhoods. They knew that the creative and open atmosphere of the small agencies needed to be maintained. Chan and Allen also realized, however, that the service consumers would be the losers if more efficient use of funds did not begin to take place.

Nelson Richards, director of the ACMHC, was most interested in the degree of centralization that could be accomplished. Although he would have preferred unilateral expansion of services on the part of the center, he recognized that some major benefits could be gained from using the center as an umbrella organization. He could see great possibilities for the sharing of resources. For instance, each agency could become part of the management information system so that the flow of clients from agency to agency would be enhanced. Common budgeting could mean a significant increase in the funding available for the center as a whole. Such activities as staff training, personnel, and purchasing could be centralized, so each agency would gain greatly in efficiency. Planning could be broadly based, and purchases could be made in money-saving quantities. Looking at it from a more humanistic standpoint, services to consumers would be improved, and no client would ever again be able to "fall between the cracks" because of lack of information or lack of comprehensiveness.

Melvin Hammond was also in favor of a high degree of centralization but for a different reason. As a human service consultant called in by the state funding agency, he knew that the best resource utilization would involve having one central agency to act as fiscal agent for funds. He recognized, however, that the direction this agency would take would depend to a great extent on the kind of organizational structure they developed. One possibility would be to departmentalize the new, enlarged organization by type of service, with all direct service providers in one department, all outreach specialists in another, and all community organizers in still another. A different alternative would be to divide the organization according to population served, with all drug abuse program personnel working in one department, all family service professionals in another, and so on. To Hammond, the important aspect of the organization was that workers should identify themselves with Atlantis rather than with their former agencies.

Each of these individuals had organizational priorities that differed. Yet the committee would need to decide on an organizational structure that would please everyone, at least to a degree, and that would work.

What are the major organizational issues involved here?

What do you see as the primary alternatives for the organizational structure? What would be the implications of varying approaches to departmentalization?

If you were asked to give input to the committee, what organizational structure would you suggest? Why?

What processes would you suggest to ensure effective coordination, decision making, and communication among the various programs?

CASE ACTIVITY - DIRECTOR OF TRAINING
When the Atlantis Community Mental Health Center became an umbrella organization, the traditional services normally offered by the center were combined, for the first time, with the more nontraditional approaches favored by the small grassroots agencies in the community. ACMHC now included both "the center" and the "neighborhood outposts" that had formerly been independent agencies.

This drastic change in the organization brought with it the need for new approaches to training. Nelson Richards, director of the center, recognized this need. His response was to hire Ellis Shore, a mental health professional with experience in university teaching, to design and implement a comprehensive training program.

Richards''s directive to his new training director was clear. The skills of the paraprofessionals in the outposts were to be upgraded. Richards felt that the service deliverers in the community-based agencies lacked the background and education that he would expect of professional helpers. These people were now working under the Atlantis name, so they would have to provide professional-level services. He would leave the methods up to Shore, but the mental health skills of the community agency workers would need to be enhanced.

Shore began this work with great enthusiasm. He created, almost single-handedly, a series of workshops designed to develop trainee competencies in individual, family, and group therapy. He also developed a complex schedule that would allow the workshops to be provided on-site at each of the neighborhood centers. Knowing that he could not provide all the training himself, he involved several mental health professionals who had been employed by the center before the creation of the umbrella organization. He asked these professionals to serve as cotrainers and made sure to include people with varying therapeutic orientations, from psychodynamic to behavioral to existential.

Shore and his co-trainers agreed that the workshops he had designed would upgrade trainees'' skills if they became actively involved in the process. Use of the outposts as training sites would mean that participation would be so convenient for agency workers that attendance could be purely voluntary.

With high expectations, the training director and his co-trainers began the first series of workshops. At the first workshop, 20 participants appeared. Although only 12 remained for the whole day, Shore was relatively pleased with the turnout. At the second workshop, only 10 paraprofessionals attended. The third drew only 6.

Shore, in frustration, confronted Isabel Phillips with this evidence of lack of motivation among agency workers. Phillips, who had administered one of the more successful of the city''s community-based agencies and who was now coordinator of the outreach program, was in touch with the paraprofessionals in the neighborhood centers. She would know how to get these service providers more actively involved.

"Isabel, I''ve been given the authority to make these workshops compulsory," Shore pointed out, "but I really don''t want to do that if I can avoid it. How can I light a fire under these people? You know them. Why aren''t they motivated?"

"As a matter of fact, you''re right," Phillips responded. "I do know these people, and what I know about them is that they''re the most motivated people you''re ever going to see in your life. Every one of them has put in more hours in a week than you can imagine for pay that hardly puts them over the poverty level. They do it because they believe in what they''re doing and because they know how much they''re needed. When you say they''re not ‘motivated,' I have a hard time picturing what you''re talking about."

"Well, what I''m talking about is the fact that they''re not showing up for these workshops, which they know are encouraged by the director, which they know they have released time for, and which they don''t even have to step outside doors of their agencies to get to. Now, if these folks are so concerned about their work, something just doesn''t fit."

"You''re right, Ellis. Something doesn''t fit, but the thing that doesn''t fit is your training program. What makes you think they need upgrading in their therapeutic skills?"

"Isabel, are you kidding? That''s what I was hired to do. When Richards gave me the job, he told me that he didn''t care what methods I used, but that the skills of the paraprofessionals in the outreach programs had to be upgraded. That was the word he used: upgraded."

"Well, let me tell you something about Richards. He''s completely out of touch with the community. He''s always been out of touch. He doesn''t know what the people need from the agencies, and he doesn''t know what kind of training the workers need. They don''t do therapy in those agencies. They don''t have the luxury of sitting in their offices dealing with one person at a time for months on end. They''re out there in the streets, getting people organized and helping them deal with real, concrete problems. In fact, has it ever occurred to you that you just might be designing all these beautiful training interventions for the wrong people? The folks in my agencies know what they''re doing. It''s the people in the center who need training. They don''t know how to do anything but therapy, and the community isn''t buying it. If you want to make a training contribution, why don''t you hire yourself some paraprofessionals as cotrainers, go up to the center, and provide some on-site training on how to close the gap between the center and its socalled consumers? From what I hear, business isn''t exactly booming in that big granite building uptown."

If you were Ellis Shore, what steps might you take to develop a more comprehensive and appropriate training program?

What special leadership issues might be involved in a decentralized agency such as the ACMHC?

CASE ACTIVITY 7.1 | THE TOKEN ECONOMY

Having worked as a therapist for a number of years, Jim Forrest had developed a high level of expertise in dealing with problems related to substance abuse. His work had included jobs in several settings, including a short-term detoxification program in a hospital, a community-based methadone treatment center, and a community mental health outpatient program.

Although his work with clients had always been satisfying, two things continued to trouble him. One major issue for Forrest was that his experience had convinced him that his clients'' milieu was more important than any other aspect of treatment. Although one-to-one counseling could be helpful, it was always less important than the reinforcement clients got for various behaviors in their immediate social environments.

The other aspect of his work that tended to trouble him was the question of management. As a professional therapist, he had grown impatient with the pressure on him to stick to specific time lines and methods regardless of his clients'' needs. In each agency, managers tended to create methods of operation based more on business principles and treatment costs than on the effects of various treatment modalities. Forrest felt that given the chance to do what he felt was best for his clients, he could work both effectively and efficiently.

Forrest finally had the chance to try out his ideas when he was invited by a former colleague to take on a job as head of a newly funded detoxification program being set up in one wing of the local community mental health center. The program had been funded to provide short-term services, and two of the therapists from the previous, smaller program were to remain on staff. With this exception, Jim would be free to develop the program in whatever way he saw fit. Funding was sufficient to provide for the hiring of a staff of four more professional therapists and eight paraprofessionals.

Forrest began interviewing potential employees, telling each of them the same thing. The program would be based on use of a token economy, meaning that clients would receive concrete and specific reinforcements for behaviors that were consistent with responsible, adult conduct. Every staff member would need to be involved in recording and reinforcing appropriate client behaviors, for only then would the clients begin to learn new ways of dealing with their environment. Beyond this "bottom line" of commitment to the token economy as a treatment modality, professionals would be free to set their own hours and work with clients according to their best interests. Newcomers would be more closely supervised at first. Later they, too, might have the kind of freedom already granted to the experienced professionals.

Most of the new workers started in at their tasks with a high degree of enthusiasm. It was like a dream come true, and after a few weeks, Forrest began to think that he was already seeing results in terms of client change. A few problems, however, were beginning to surface.

First, Hugh Schmidt, one of the two therapists who had already been employed at the center, began to complain to anyone who would listen about the idea of the token economy. Schmidt believed that long-term therapy, insight, and intrapsychic change were the only ways to deal with substance abusers. Changes in behavior could not get at the root cause of the problem, and the token economy could change only concrete behavior, not attitudes. He continued to work with clients in the same way he always had, but the token economy was constantly being sabotaged.

Another member of the professional staff was troubled not by the token economy but by the freedom Forrest allowed the employees. Carol Cooke pointed out that although the staff members had been enthusiastic at first, they would not maintain a high level of commitment unless they were aware of the rules and regulations governing their own behaviors. Forrest scoffed at these concerns until one Friday afternoon when he had to make a presentation at an out-of-town conference. When he realized he had forgotten something, he called the office. Not one of the professional staff members was there.

The problems Forrest had begun to face were minor, but they started to make him think. Could he maintain a central focus in the program if every member of the professional staff were not necessarily committed to it? Could he trust the professional staff in the way he had always wished to be trusted? The challenges began to seem a little more difficult than he had expected.

What do you think of Jim Forrest''s approach to the position of program administration? What are his strengths and weaknesses in dealing with his new leadership position?

If you were Forrest, what would you do about the problem Hugh Schmidt''s attitude poses? Is it necessary for the staff to work as a closely knit team, or is there room for a great deal of variation?

What would you do about the problem Carol Cooke poses? Do employees-even trained professionals-need clearer behavioral guidelines than Forrest provided?

Do you think Forrest has the potential to be more effective than the business-oriented professional managers he had encountered before?