Presentation Objectives

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1 The Impact of Organizational Social Context: Training Impacting Context or Context Impacting Training? 11th Annual National Services Training and Evaluation Symposium (May, 2008) Anthony Hemmelgarn, Ph.D. Children s Mental Health Services Research Center College of Social Work University of Tennessee 1 Presentation Objectives Organizational Social Context and the Socio-technical model Organizational Social Context (OSC) Measurement System CMHSRC research findings ARC organizational intervention Closing Comments 2 Quotable Quotes Have you hit him in the mouth? Here, take this paddle and whip him. If it doesn t work on his rear end, hit him in the head. That s what my daddy did with me. 3 1

2 Which of the following gets the most support in this court system? Training court officers to work with Boot Camp Instructors Training court officers to work with Multi- Systemic-Treatment Therapists A redo of the Scopes Monkey Trial 4 Quotable Quotes I see kids die every day. It s not my job to deal with parents and their mental health issues. It s my job to save lives. Mental health issues are someone else s problem. 5 Follow-up Comments I I would estimate that mental health problems are responsible for 80 to 90 percent of the injuries we see. I I don t t really see how a family centered-care care initiative would help us. 6 2

3 Empirical research is clear: Empirically-based Practices and Treatments are rarely adopted And if adopted, seldom implemented effectively or with fidelity 7 The Socio-technical Model argues The adoption of best practices, fidelity to new protocols, adherence to training, etc Are as much social as technical processes Are embedded in an organizational social context Require changes in the social context to be improved 8 Culture and Climate are the Key Constructs in Organizational Social Context These constructs are empirically associated with: service quality and outcomes morale and turnover adoption of innovations Sustainability of new programs Fidelity to practices/training 9 3

4 Culture and Climate as Distinct Constructs Culture property of the organization System norms and values The way things are done What is expected and rewarded Climate property of the individual Perceptions of work environment s s psychological impact Employees affective response to the work environment Employees sense of psychological safety 10 What Does Organizational Context Create? Rejection or adoption of new technologies - Innovative/flexible cultures try new things Positive or negative climate for associates - Defensive (active/passive) lead to poor attitudes/high turnover, and low commitment Assimilation versus accommodation of new technologies - E.g., Child welfare assessments Learning/persistence versus resistance - Associates feeling autonomy, decision control demonstrate more energy and motivation for action 11 The Impact of Organizational Culture and Climate on Training Main Effect Training Service Outcomes Culture/Climate Mediation Effect Training Culture Climate Service Outcomes Moderation Effect Training Service Outcomes Culture Climate 12 4

5 Main Effects of Culture and Climate on Service Outcomes System Norms and Values Create Individualized versus routinized care Results-oriented versus process-oriented oriented service Mission-driven versus rule-driven service Service Provider Perceptions and Attitudes Create Responsive versus nonresponsive relationships Positive versus negative affective tone Supportive versus non-supportive approach 13 Mediating Effects of Culture and Climate on Service Outcomes Intervention can affect norms for interaction (e.g., approval-seeking) Intervention can affect what type of behavior is emphasized (e.g., autonomy) Intervention can change employee perceptions of work (e.g., role ambiguity) 14 Interaction of Culture and Climate with Intervention Existing norms (e.g., conformity) can affect treatment fidelity Service provider perceptions (e.g., role conflict) can affect service that complements intervention Psychological impact of work environment (e.g., stress) can affect employees enthusiasm and commitment 15 5

6 NIMH Study of Climate - (Glisson & Hemmelgarn, 1998) Organizational Climate -.17* *.11* Service Outcomes (problem levels) -.05 County Demographics -.04 Interorganizational Services Coordination -.35* Service Quality *p<.05 χ 2 = GFI =.91 AG&I =.89 CFI =.91 w/ 370 df s 16 NIMH Study of Culture/Climate of Emergency Rooms: Emotional Support (Hemmelgarn, Glisson, & Dukes, 2001) Sources of variation SS df MS F Model (combined) ** ER experience Gender Profession Hospital ** Comparison * Comparison Comparison 1/2 3/ ** Error 2, Total 2, **p < NIMH Study of Culture/Climate of Emergency Rooms: Emotional Impact (Hemmelgarn, Glisson, & Dukes, 2001) Sources of variation SS df MS F Model (combined) * ER experience Gender Profession Hospital Comparison Comparison Comparison 1/2 3/ * Error Total 1, **p <

7 Organizational Social Context measurement system (OSC) Developed by CMHSRC Nationally Normed Provides Organizational Profile Early Warning Monitoring for Improvement 19 Organizational Social Context (OSC) Measurement System Organizational Culture 1. Proficiency expectation that service providers will be competent, have up-to-date knowledge, and place the well-being of clients first 2. Rigidity expectation that service providers will have limited discretion and flexibility, and closely follow extensive bureaucratic rules and regulations 3. Resistance expectation that service providers will show no interest in change or new ways of providing services 20 Example of Worst Culture Profile (approximately 10% of clinics) 21 7

8 22 Example of Best Culture Profile (approximately 10% of clinics)

9 New Program Sustainability as a Function of Culture Months New Program Sustained worst average best Culture Profiles Research funded by MacArthur Foundation. 25 Five Studies to date link Culture to: Individualized care by 408 service providers in 30 social service organizations (Glisson( Glisson,, 1978) Family-centered care by 131 service providers in four emergency rooms (Hemmelgarn( Hemmelgarn, Glisson & Dukes, 2001) Turnover, work attitudes, and service quality among 283 caseworkers in 33 child welfare and juvenile justice case management teams (Glisson( & James, 2002) Service quality in 15 child welfare teams serving 21 urban and rural counties (Glisson( & Green, 2006) New program sustainability in nationwide sample of 100 mental health clinics (Glisson( Glisson, Schoenwald,, Kelleher et al., 2008) 26 Organizational Social Context (OSC) Measurement System Organizational Climate 1. Engagement service provider perceptions of personal accomplishment, involvement and concern for clients 2. Functionality service provider perceptions that they receive the needed cooperation and support to do their jobs 3. Stress service provider perceptions that they are emotionally exhausted and overloaded in their work 27 9

10 Example of Worst Climate Profile (approximately 10% of clinics) Example of Best Climate Profile (approximately 10% of clinics) 30 10

11 31 Past Year Therapist Turnover Rate as a Function of Climate Past Year Therapist Turnover Rate (%) worst average best Climate Profiles Research funded by MacArthur Foundation children served by systems with worst climates (least engaged) Raw CBCL Total Score children served by systems with best climates (most engaged) Months following Initial Investigation Results of 3 level HLM 33 11

12 Organizational Culture and/or Climate Differ in organizations providing same service Predict staff job satisfaction and commitment Predict staff turnover Predict service quality Predict service outcomes Predict adoption, fidelity, and sustainability of new treatments 34 A Need for Organizational Interventions Evidence-based organization interventions are needed to improve mental health and social services Improve work environments and reduce service provider turnover Support the implementation of evidence-based training, treatments, and other best practices 35 ARC Organizational Intervention Availability Responsiveness Continuity 36 12

13 ARC Guiding Principles mission-driven vs rule driven all staff and administrative actions and decisions must contribute to children s s well-being results-oriented vs process oriented measure staff and program performance by improvements in children s s well-being improvement-directed vs status quo oriented staff and administrators continually seek to be more effective relationship-centered vs individual centered staff and administrators focus on consumer and stakeholder relationships participation-based vs authority based include line-level level staff and community stakeholders in key program decisions 37 ARC Organizational Intervention Model Uses 12 levers or intervention components Involves all organizational levels and community stakeholders Requires change agents who work directly with managers, treatment teams and community leaders 38 Twelve ARC Intervention Components Leadership development Personal relationships Network development Team building Information & training Feedback Participatory decision- making Conflict resolution Goal setting Continuous improvement Job redesign Self-regulation 39 13

14 Stages, Components and Phases of the Arc Organizational Intervention Model Stages and Components Innovation Participation Collaboration 1. Leadership development 2. Personal relationships 3. Network development 4. Team building 5. Information and training 6. Feedback 7. Participatory decision- making 8. Conflict management 9. Goal setting 10. Continuous improvement 11. Job redesign 12. Self-regulation I Problem identification Phases II Direction setting III Implement- ation IV Stabilizatio n 40 Results of ARC Intervention ARC reduced turnover (39%) vs control (69%) ARC improved climate in both urban and rural teams 41 Closing Comments True change hasn t t occurred unless an organization s s culture has changed Contexts can give life to or kill training efforts Organizational Context interventions may be required before training Training in the absence of a broader organizational plan predicts failure 42 14

15 Contact Information Children s s Mental Health Service s s Research Center. The University of Tennessee Tony Hemmelgarn ahemmelg@utk.edu 43 15