NextGen Healthcare

Transforming Service Delivery Systems, Organizational and Administrative Structures

In looking at organizational infrastructures and the challenges involved in bringing about antiracist change, we invited leaders of not-for profit health and human service organizations to describe their experiences, and share what they have learned about what is required for transforming organizational and administrative structures as they pursued an anti-racism agenda in their respective agencies. They speak from several different perspectives and in different voices. These differences are preserved so that each writer can reach the many audiences that make up the Mental Health News readership.

Paul Levine, LCSW, Executive Vice President and CEO, JBFCS

Where does the not-for-profit sector start in transforming organizational and administrative structures to address race and racism? My experience, as a senior administrator and executive of a large not-for-profit, is you start with the organization’s mission. This means starting as close to practice as possible.

For mental health organizations that means the therapeutic relationship, which is built on honesty, trust and mutual respect between helper and client. Of course, the relationship itself is always affected by the power equation and the feelings the patient evokes in the therapist. So it is not surprising that the feelings between the “partners” in treatment would eventually require facing race and racism. When the patient and therapist are of different races, how can they forge a successful treatment relationship if race is not on the table for discussion? If mental health organizations are to be true to their missions, race must be addressed as part of the therapeutic relationship. This is the beginning of understanding and addressing accountability.

Fundamental to accountability is developing ways of working that involve service consumers and the community in their own care, and responding to their definitions of need and relationship. Addressing racism and developing ways to be responsive and accountable to communities of color is the clinical case that must be made to staff and board members of an organization in order to gain broad support at all levels of the agency, which is the major – and exhausting—effort it takes to deal with race.

Following this, is enhancing the organization’s capacity for cultural awareness related to group identification. People want to be understood and met with empathy, especially when taking the risk to expose fears, symptoms, and personal feelings. To walk into an organization where some of the staff look like you and speak your language encourages hope and confidence that you will be understood in the treatment process. This is why staffing patterns that reflect the communities of identification of clients is so important. This is another aspect of the case that has to be made. Here, the case is not only about race. It may also be about “foreignness” in immigrant communities, about religion in orthodox or fundamentalist communities, about language, and about being sensitive to cultural differences. Staff that is representative of consumers is essential – but not sufficient. The organization must also develop feedback mechanisms for understanding community needs and service preferences that may not be obvious when viewed through a dominant culture lens. These systems of accountability will help reduce the barriers between community, consumers, helpers, and agency and encourage genuine partnerships that support culturally responsive clinical practice.

Accountability also requires an honest appraisal of systems of power within the organization: Who is making program design decisions? Who has access to decision-makers? Whose culture and race is represented within the executive management team and board of directors? How are the diverse staff members at the service delivery level of the hierarchy being prepared to move into leadership roles over time? Does the organization’s strategic plan reflect methods to ensure that the communities served will be reflected at different levels throughout the organization within a 5-10 year span?

Finally, we come to the “business case” for an organization’s transformation toward antiracist practice. Developing sensitivity and accountability regarding race and diversity promotes trust among individuals and communities that are not part of the dominant culture. In turn, increased trust among communities served will enhance an organization’s standing as a preferred provider and strengthen its competitive edge.

In sum, we must start by making the case in all three of these areas—enhanced clinical capacity, increased cultural awareness, and good business practices—if we are to successfully transform our organizations toward antiracist practice.

Phyllis Frank, Assistant Executive Director, VCS

When predominantly white organizations wish to earn the description, “anti-racist,” a commitment of time, focus and energy towards this goal must become daily fare. That is the long . . . and the short of it. It is why so few agencies, despite great intentions, ever get there. It is not easy and there is no single path to follow. Training alone, although a good start, is not adequate. To begin, whoever it is that has the real power to create everyday policy and practice, must not only want it but must insist on it. This is a step that must occur at the administrative level after learning from an analysis of structural and institutional racism in the United States.

One must question why so many of us with decades of experience and multiple degrees don’t know this already. Respect for this question – and its answer, is crucial. Understanding the depth and complexity of how racism self-perpetuates amongst white people – while producing intense denial of that very truth – is prerequisite to moving forward. Once understood, anti-racism becomes an ethical and moral mandate. Power dynamics shape racism, which is better understood when called “white supremacy.” Power dynamics must be voluntarily shifted in order to proceed. For example, no program or other initiative should be conceived without collective input from the group to be served. “Not in our name – without us!” Every policy and process must be looked at with questions. “Does this favor white people, center on norms culturally specific to European white populations; respond to the needs of funders, program managers . . . or to communities? And, of course, who gets to answer these questions?

Elwanda Young, LMSW, Chief Operating Officer, United Way of New York City

I am a woman of color who joined with colleagues – all senior executives at my organization – to participate in the Undoing Racism Workshop offered by the People’s Institute for Survival & Beyond in 2006. At the end of the workshop, staff rated our organization against the continuum of becoming an anti-racist and multi-cultural institution. We were in for a rude awakening when there was general consensus that at best we were at stage 3, or symbolic change in the range of tolerance of racial and cultural differences. We had thought of our organization as made up of well- intentioned, social minded, progressive people. After all, being of service to the community and those in need was the focus of our work. We believed ours was not an organization where racism was a serious issue.

After the initial shock and denial, the training began to sink in, we were able to expose those structural areas where racism could indeed exist and begin to constructively look for ways to move the continuum needle. We begin to examine aspects of our organization to ensure full participation and engagement of People of Color – through an anti-racist lens we looked at our vendors, our policies, Board and staff composition, our interaction and accountability to the community, our assumptions and decisions around grant making and even our role as gatekeepers. We began to develop awareness, consciousness and understanding about ways to be more effective in the work we do within our organization and the community around race.

Transforming organizations is hard work; it’s much easier to slip into the comfortable and less challenging ways of operating. When other pressing issues come to the fore, antiracist transformation can easily slip down the list of organization priorities. However real change requires a commitment on the part of the leadership to examine and expose structural and systemic racism even in organizations with the best of intentions.

Christiana Best-Cummings, PhD, Executive Deputy Director, ACS James Satterwhite Training Academy

My understanding of antiracist transformation of organizational and administrative structures begins with self-knowledge. What did I see in myself and what did I see around me as a middle manager in a public child welfare organization? In my nine years with New York City Children’s Services James Satterwhite Academy, I have experienced many moments in which some form of structural or institutional bias vividly came to my attention. One of these is what I refer to as my “elevator experiences.” At the Academy, we often share elevator rides with the people who attend varied trainings at our NYC location. When the door opens, I can always tell which class is on the elevator. If the elevator is filled with young black women, I know they are newly hired caseworkers. When largely young white women I know they are newly hired attorneys, and when middle aged white men, I know they are investigative consultants, recruited from the ranks of retired police officers.

My responsibilities at the Academy include training and curriculum development. The Undoing Racism Workshop helped me recognize my responsibility for educating others about the impact of race on child welfare policies and services, as well as on staff relationships within the agency. Self-reflection and a commitment to constantly deepening my own racial awareness is a must. This means having difficult conversations that move me and my colleagues out of our racial comfort zones. For me, this also includes helping well-intended trainers examine labeling behaviors that pathologize people of color, particularly Black people.

Armed with a better understanding of history, an analysis of power and the manifestations of structural racism as a result of my participation in the Undoing Racism Workshop, I feel I have an added responsibility to help others engage in a similar form of evolution. As one of the leaders for the Professional Development Program Department, I develop educational programs for new MSW students who are frontline staff about structural and institutional racism. This has included a series of seminars led by experts in the field of Disproportionality and Disparity. These seminars have increased staff awareness about the impact of systemic racism on how we think about the work, the clients we serve, and influences our behavior. Many forums were used to broaden the discussion beyond the Academy, which included lunchtime seminars, discussions and conferences convened by the ACS Task Force for Racial Equity, faculty of the metropolitan schools of social work, and trainings offered by People Institute for Survival and Beyond. Staff was also encouraged to participate in a racial affinity group for Men of Color and Women of Color. To promote an antiracist perspective among middle managers and supervisors, monthly meetings were facilitated to encourage open discussions about race and structural racism. These meetings use a variety of media such as articles, videos and power-point presentations.

As would be expected, there is push-back from people of different races. Some experience this as both a personal and professional loss, others are fearful about upsetting the applecart. The question I often hear is “How can we expect young, inexperienced staff to take the information they are learning about racism and apply it to practice in a way that doesn’t compromise child safety?” This is, of course, the major priority of a public child welfare organization.

In all these endeavors undertaken in the interest of promoting greater understanding about the impact of race and racism in the child welfare system, the goal is to create an atmosphere of learning and self-examination in which change could begin to occur. Education and self-awareness of the problem has to be the first step in getting buy-in. Each person is encouraged to take responsibility both internally and on an organizational level for examining polices, practice and procedures that unconsciously or consciously have a detrimental effect on the families we serve, the ability of staff to effectively carry out the work, and impact on the community at large.

Mary Pender Greene LCSW-R, Assistant Executive Director JBFCS and Lisa Blitz PhD, LCSW-R, Assistant Professor, Department of Social Work, Binghamton University

Effective implementation of multicultural antiracist practice must include active support from all levels of the organization, particularly the agency’s top executive leadership. The attitude of the chief executive officer and his or her willingness to move the initiative forward sets the tone for the rest of the organization. The role of the CEO and other top executives is to establish two fundamental aspects of multicultural antiracist practice: vision and accountability.

An antiracist vision includes:

  • The ability to imagine and communicate the essential nature of multicultural practice. It is not enough to state that diversity is beneficial or preferred; it must be valued as necessary for the agency to move forward.
  • An analysis of power, privilege, and marginalization within the organization that highlights subtle inequities that discourage employees who are not part of the dominant cultural or racial group of the organization.
  • Modeling antiracism for senior leadership, including demonstrations of the learning and professional growth process on the path toward antiracist practice.

Accountability includes:

  • The willingness to take action to oppose enactments of oppression, discrimination, or favoritism.
  • Readiness to allocate funds for professional development, specialized training, or access to needed resources to support multicultural antiracist practice.
  • Setting clear, well-articulated standards for multicultural antiracist practice that have been developed in collaboration with members of racial and cultural groups outside the dominant group of the organization.

Managers and program directors play a vital role in the realization of the antiracist vision. Mid-level managers are typically the people responsible for hiring, developing, promoting, disciplining, and firing staff. They are often more closely connected to the community or populations served by their program than upper management and have a tremendous amount of power in the program or agency culture. Managers and directors, therefore, are responsible for:

  • Defining cultural competency as including the ability to respond effectively to the dynamics of oppression and privilege and including this as criteria for hiring, promotion, and professional development.
  • Developing and maintaining a critical consciousness of all aspects of program functioning, including décor, policies and procedures, and relational practices, to ensure genuine multicultural inclusiveness.
  • Creating flexible and responsive systems of accountability to the community or population served by the agency.

Supervisors often have the most direct contact with line staff and thus have a central role in the creation of a program culture that is experienced as welcoming and responsive to the range of strengths and needs brought by the community or population served. Supervisors have the responsibility to:

  • Remain conscious of the differences and similarities between themselves and their supervisees—awareness of social distance, boundaries, and how people interpret or experience authority and relationships with people in authority.
  • Promote and teach multiculturalism, cultural competency, and responsiveness to dynamics of difference, privilege, and oppression that is incorporated into evaluations and considerations for promotion.
  • Actively recruit staff members who represent the range of clients or consumers served by the program and consistently respond to any issue within the organizational culture that inhibits the growth and development of all staff.

This is difficult work. It takes time – always more than anticipated or planned on and requires consistency and perseverance. Collective effort and commitment are essential. That said, we encourage agency leaders to engage in the antiracist transformation of their organization. Why? Because the rewards are priceless and the milestones of success – however these are described – are necessary for delivering culturally competent and effective services.

Willie Tolliver, PhD, Associate Professor, and Steve Burghardt, PhD, Professor, Hunter College School of Social Work

In 1982, a group of Hunter College School of Social Work students petitioned the faculty to have a required course for all students on “cultural diversity.” They failed. Over the years, four other student groups made the same request, with the same results. Twenty-six years later, in 2008, yet another group met with the faculty and this time succeeded. The outcome of their efforts was the School’s adoption of an anti-oppression and restorative social work lens for the year-long required foundational “Practice Lab” for all incoming students. Today, the course has moved from an exploratory pilot, to a requirement for all students. What did we learn, and what can other schools of social work take from the Hunter experience?

For us, the most important lessons fall into three areas: (1) the effectiveness of student organizing, and use of lessons from the past to strengthen tactical choices for promoting change; (2) the implications of demographic shifts in both the composition of the school’s student body and service consumers for curriculum development and renewal and; (3) the cultivation of faculty allies who have remained committed to anti-oppression work within their own classrooms and expanding the anti-racism and anti-oppression material among younger, junior faculty who are new to the School community.

First, strategic effectiveness of student activists. Most important to the change effort was students leaders within the school student governing body and others in various student alliances who began a coordinated campaign organized around the following three tactics: (1) The development of a petition campaign among all students to show the widespread support for the course and not just among community organizing students. Students consciously partnered with and gained wide support of clinical students and effective counter claims that this material would only be on interest to community organizing students; (2) Individual meetings with every faculty member to explain the course content and to ascertain their degree of support for the course. This process helped overcome untenured faculty members’ fears that such a course would be met with disapproval by their more senior colleagues and jeopardized their obtaining tenure; (3) The use of the internet to locate equivalent courses at other schools and programs to effectively argue that the course served powerful practice purposes and not simply “politically correct” positions on topics of race, sexuality, gender, and class. Such an emphasis gave their cause substantive weight related to the classroom.

Second, was the demographic shifts in student enrollment and consumers—New York City has continued to be a remarkable cultural and social amalgam of races, colors and creeds. Whites are no longer a majority in the city of 8.5 million people, and the School’s student body is increasingly reflective of the city’s diversity. The working students’ program, the One Year Residency Program, has over three-quarters students of color, many of them first generation immigrants. While the other programs are less diverse racially, significant numbers of openly LGBT students are found throughout the program, as are immigrants. Perhaps one of the most significant statistics on the conscious diversity among the students is that 57% of the entire entering class (about 450 students) is fluent in at least one other language besides English. Such remarkable diversity made the need for a required course that prepared students for effective practice with increasingly diverse consumer groups more obvious.

Third, was the cultivation and mobilization of faculty allies to institutionalize anti-racist changes. Faculty were identified who had maintained an active engagement in developing an anti-oppression framework in social work who shared past lessons and provided moral support for student efforts. From the start, students sought out faculty who were known for their anti-oppressive work in order to avoid repeating past errors of organizing or misinterpreting faculty points of view. Most of these faculty were involved in a monthly “anti-racism” faculty sub-committee attended by numerous junior faculty. Here they learned of their concerns and how to overcome them. They were also able to share that this work was not about a political stance but related to improved practice. The result was a far more collaborative and supportive environment for the work as the academic year progressed.

Thus, by the time the students attended the faculty meeting in May of 2009, there was widespread support for the anti-oppression course moving ahead first as a pilot and then, with its positive impact, into the entire School in the fall of 2010. Other factors are also important to note. During accreditation, the School administration readily embraced the inclusion of diversity content into the Practice Lab. Students further lobbied throughout the accreditation process, leading the CSWE site team leader to acknowledge their positive efforts. Now alumni, many of the leaders continue to meet with new students in a “community of practice” so that anti-oppression material is not watered down. One of the faculty involved in the earlier effort agreed to co-chair the Practice Lab and work with new faculty on how to develop this material for all students. Another continues the Anti-Racist faculty group as an arena in which new material and issues on oppression can be raised for all faculty and not just those teaching the Lab.

Strikingly, the students in last year’s pilot and new faculty to this year’s Lab have found that this material has strengthened their practice, redefined their own roles in a less hierarchical and more engaged manner, and enriched their lives as well as their work. While this content has been long in coming, anti-oppression and restorative social work practice is making a vital contribution to the Hunter College Social Work community and, hopefully, beyond.

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