Since the late 1980’s, I’ve had a strong belief in the principles and practices of Psychiatric Rehabilitation and their ability to assess an individual’s readiness to change, intervene to increase readiness if needed, and increase the skills and supports each person needs to enjoy life to its fullest. I’ve always managed under the premise that an agency is a living organism and as such can be approached in the same manner as an individual when assessing readiness to change. In 1997, I was given the opportunity to apply Psychiatric Rehabilitation tools to assess an agency’s readiness to engage in the transformation from a governmental organization to a private non-profit, and to allow for the shift towards recovery-based services.
I was hired as the first Executive Director of Putnam Family and Community Services (PFCS), a voluntary not-for-profit agency created on July 1, 1997. Just a day before, PFCS had been a collection of mental health and substance abuse programs operated by Putnam County. In the space of 24 hours, Putnam, with its population of only 100,000, became the first county in New York State to privatize its mental health services, and PFCS became a nonprofit responsible for its own services, its own finances and its own future. What makes our experience unique is that, while privatization historically has negative effects on service provision, in the last eleven years, PFCS has flourished, with increased productivity, cost-effectiveness, and most importantly, innovative new programming based on recovery concepts and outcomes. The profound organizational change created by privatization allowed for a shift from a maintenance model of service delivery to a recovery model supporting consumers to become actively involved in leading their treatment and rehabilitation and achieving what they want from life.
When I came to PFCS, I knew that we had to move to recovery-based services and I used a Psychiatric Rehabilitation Readiness Determination (PRRD) tool to assess PFCS’ readiness to change. Readiness Determination begins with assessment of the need to change and the level of dissatisfaction with the existing situation. For PFCS, dissatisfaction had been growing during the 1990’s, as the government agency had been unable to access funding and training reserved for private non-profits. In addition, behavioral healthcare was rapidly changing and Putnam County felt that a nonprofit service provider could be more responsive to changes in insurance laws, the growing role of managed care companies, state regulations and reduction in government funding.
The second dimension of readiness assessment is commitment and motivation to change, based on the belief that the change will be possible, positive and supported. Staff and consumers initially feared privatization, worrying that the agency would be forced to abandon the county run mental health service’s mission of seeing all people regardless of their ability to pay. Although there was understandable fear about the impending changes at PFCS, stakeholders did come to believe in and commit to the change. Government funders also committed to ongoing financial and professional support for the agency to assure that it would have what it needed to survive the turbulent road ahead.
On the third dimension of environmental awareness, or understanding of options that the change will afford the organization, PFCS rated fairly high. Stakeholders worked side by side to research all possibilities for change in the community and it was decided that creating an independent organization was the best way to privatize. Although small, Putnam County is fiercely independent and staff and consumers wanted to maintain their own sense of identity.
PFCS stakeholders also rated high on the dimension of self-awareness, or the amount of knowledge the organization has about why they like or dislike something they are experiencing. They developed a strong mission statement and a listing of goals and objectives for the new agency. Stakeholders were clear about the direction in which they wanted the agency to go. Staff, consumers and Board wanted their independence and they were insistent on following their own vision and mission.
Personal closeness, the last category, measures an agency’s desire and ability to trust someone enough to lead them successfully through the change process. When I became Executive Director, I knew that PFCS needed a strong leader and I made it clear that although they had previously been a disparate group of services and programs, now we were one organization with one mission and a recovery vision, and if we were to survive, we all had to work together.
The next step was to implement the activities required to develop PFCS’ readiness to change. If we view people and agencies both, from a strength-based perspective, we might see unwillingness to change, not as “non-compliance,” but as lack of preparedness. Then, agency leaders can assist those who are not ready to explore the need for change and develop readiness so that systems change can be successful in the future.
To increase commitment at PFCS, I began to open lines of communication by setting up meetings and supervisions. We began to break down the barriers between the programs, encouraging staff from different programs to work together for the benefit of the consumer. I made it clear that all of us were in this transformation together and that we could be successful if we worked together. Soon, all began to understand that change was possible, very positive for them, and it was definitely going to be supported.
The areas of environmental awareness and self-awareness were also developed with a number of activities. We began training in person-centered, recovery-oriented techniques. We invited consumer leaders into the agency to talk with our staff and consumers about recovery and the possibilities that it offered. We purchased computers and set up Internet access so that staff and clients could research job opportunities, medication education, clinical techniques and interventions and other agency websites to expand their knowledge past the boundaries of this small county.
To assure the continued success of personal closeness, I remained an extremely active and present leader, making sure that I was clear in my direction and also that I was visible. We created a shared vision and then I clearly stated the steps that we would need to take to accomplish that vision. Some staff, who did not agree or who could not change with us, left the agency. The majority of the staff, and the new staff we hired, shared our vision and began to work together to achieve it.
Managing is difficult in any environment but in our current environment of shrinking funds, increased risks of litigation and excessive government oversight, leaders can easily lose their vision and also lose their way. Those of us who have chosen to be managers have a responsibility to assure that the agencies and programs that we oversee have the resources they need to provide services that support and promote recovery. Clinicians are taught to view each person as uniquely individual and managers should do the same for our agencies, promoting their uniqueness while concentrating on the specialized things they may need to be successful. Finding innovative ways to lead our agencies through the turbulence of change can help ensure the continuance of community nonprofit agencies and also assure that the vision of recovery for all people remains foremost on the agenda of mental health care agencies now and in the future.