Community Mental Health Journal
Volume 3, Number 1, Spring, 1967
A CASE STUDY IN COMMUNITY AGENCY VISITATION E. R. OETTING, P~.D., CHARLES W. COLE, PH.D., AND JOHN E. HINKLE, PH.D.*
contact between two agencies, the actual effect on the people involved is almost never formally evaluated. Wherever a mental health center is considering the use of this technique as a method of involving their personnel in other community organizations, some evaluation of the effects the visi. tation had on the people involved becomes very important. Ideally, the presumed effects would be evaluated in two ways: evaluation of the effects on the organization visited and evaluation of the effects on the staff member involved in the visitation. To assess either, we need a test of knowledge and attitudes before and after the visitation. In almost all cases the practical situation prevents obtaining direct data on the attitudes within the organization. We can, however, test the staff member both before and after the visit and, to some extent, we can find out from the changes in his attitudes what his interaction with the agency and its personnel was like.
Two staff members of a mental health center were asked a series of questions about the role of a community welfare agency, its personnel, and their functions, both before and after one of them visited and worked within the agency. Changes in factor scores of a semantic differential to various staff and agency concepts were also assessed. The visitant showed considerable change, suggesting increased identification with the agency, its personnel, and its goals. The evaluation procedure itself appeared to make the visitation more effective.
The community provides many institutions that directly or indirectly affect the lives of people. Any total concern with community mental health must consider the role these institutions play in the mental health of the people with whom they become involved. Through influencing the attitudes and activities of the personnel of various organizations and health agencies, a mental health center may touch the lives of many more people than its staff could reach on a personal, one-to-one basis. However, in order to plan programs to improve the mental health aspects of an institution or agency, it is necessary to know its functions, understand its present impact on the community, create plans to support or modify that impact, and, perhaps most important, establish a relationship with the agency's personnel so that they become aware of, and interested in, the service capabilities of the mental health center. They must come to view the center as a worthwhile resource. One method of developing this kind of relationship is to have a staff member visit the agency, work with the people who work there, and observe the operation of their programs. While a visitation of this kind may be a useful method for establishing
PROCEDURE
The county welfare agency was selected for visitation. This choice grew out of conferences regarding extending services of both the mental health center and the welfare agency. It was agreed that the most effective way of exposing a staff member of the center to the welfare agency would be a "participant observer" approach. Thus, the visitant was to assume temporarily a working role in welfare operations. Prior to the actual visitation, a test battery devised to measure the amount of in. formation a staff member has about a county welfare department, its role in the community, and its personnel was administered to two members of the mental health center. One member was to go on a three-day visita-
*Dr. Oetting, a psychologist, is Associate Professor of Psychology, Colorado State University, and Evaluation Specialist, Southeast Wyoming Mental Health Center. Dr. Cole, a psychologist, is Assistant Professor ofrsyehology, Colorado State University, and Evaluation Coordinator, Southeast Wyomin$ Mental Health Center. Dr. Hinkle, a psychologist, is Executive Director, Southeast Wyoming Mental Health Center. An extended report, including the test materials, may be obtained from the Southeast Wyoming Mental Health Center, Cheyenne, Wyo. This investigation was supported in part by PHS Research Grant R 11-MH.00458 (04) from the National Institutes of Health, Public Health Service.
45
46
THE COMMUNITYMENTALHEALTHJOURNAL
tion to the agency while the other would not. The battery was administered both before and after the experience. Part of the battery also assessed the feeling of the staff members about their ability to relate to individuals in various agency positions and the staff members' estimates of their knowledge of the people involved and their functions. In addition, an 18-scale semantic differential was completed by both the visiting staff member and his control. The scales were selected to yield scores on personalitytype factors, such as tangibility, toughness, sociability, uniqueness, etc. Each mental health center staff member used these scales to rate the agency being visited, the agency director, the supervisor, caseworkers, and other agency personnel. Since one effect of giving a battery of tests of this kind would be to sensitize the person taking the tests to anything concerning the agency involved, giving the same test battery to another staff member who did not experience the visitation provided at least a partial control for changes that might occur simply from the visitant's being asked specific questions about the agency and its personnel. FINDINGS
The attitudes implicit in the statements made after the visitation also showed subtle but very important differences. Although the staffmember who had not visited the agency changed his responses somewhat, indicating that he had some contact with, or information about, the agency during this period, the contact was apparently with persons who were indirectly associated with the agency. He had picked up several rather negative and critical commentaries on agency functioning in the community. By contrast, the visiting staff member no longer mentioned the critical comments he had previously made. He now detailed the limits imposed on the agency by outside factors, such as lack of funds, lack of understanding, and insufficient personnel, along with a tremendous demand for service. This difference in tone, from blame or criticism to identifi. cation with the goals and plans of the agency and to understanding of the limitations under which it operates, was perhaps the most striking difference in the two reports. To some extent, these attitudinal changes were reflected in the data obtained by the semantic differential. The staff member who visited the agency perceived the case aides as more unique, as more distinctly individual; he perceived the agency director as more The Role of the Agency in the Community sociable. In addition, the total impact of the Before the visit, both members of the agency director, the case aides, and the mental health staff felt that they knew how agency itself increased, probably indicating the agency functioned in the community. rather directly his increased familiarity When their statements were judged for with, and appreciation of, the agency and its amount of detailed information, the member personnel. The control member who did not chosen for the visit showed a greater knowl- visit the agency also changed somewhat in edge of operational details. This might be his attitudes. The total impact of the agency expected, since the visit was in part his idea itself appeared to decrease slightly, perhaps and since he had already had contact with indicating some degree of negative evaluasome of the agency staff. tion. In terms of factor scores, clerical perAfter the visit, both showed increased de. sonnel and caseworkers were seen as more tail in specifying the agency's role in the calm, stable, and unemotional; caseworkers community. The member who did not visit were rated as more moral, dependable, and apparently had been sensitized by being sober. asked questions about the agency and had In terms of a total evaluation of the exlearned some relevant facts. However, the perience, the consistent increase in the visiting staff member showed a very great uniqueness factor for every type of agency increase in detailed knowledge, specifying person is probably of primary significance. several areas he had not previously men- The nonvisiting member showed no more tioned and amplifying and clarifying state- than random changes on this factor. It was ments he had made previously. apparent that, in general, the visitant saw
E. R. OETTINC.,C. W. COLE,ANDJ. E. HINKLE the agency and the people in it as more real and had a greater appreciation of their in- 9 dividuality. This increased differentiation is, of course, to be expected as the natural result of increased familiarity and contact.
Knowledge of Sta~ng Pattern
47
administrative staff. While the control subject rated his knowledge as insufficient, the visiting person generally felt his knowledge was highly sufficient. The visiting person also felt that he could relate to the people in the agency on all levels, and he felt even more capable of good relations after his visitation. The control, on the other hand, felt somewhat less confident of his ability to relate to the various staff persons. This might be related to the slightly negative attitude toward the agency as a whole that he developed between the two testings.
One concrete and highly specific piece of information that would show how much a person knew about an agency would be a simple listing of the agency's staffing pattern. This is the approach that was taken in this study. Here the person selected for the visit showed far greater preknowledge than the other staff member and, as would be expected, changed his statement very slightly General Observationsby the Visiting Staff after the visit. The pretesting also included Member ratings of various personnel roles in the After the visitation, the staff member preagency. In general, this section of the bat- pared a general report on the agency. This tery did show a slight improvement in un- report revealed several factors of importance derstanding as a result of the visit, but it to the evaluation of his experience. Perhaps showed more clearly the fact that the per- most importantly, the report had a positive son selected for the visit was not a stranger tone. There was clear personal identification to the agency visited and must have had with the people in the agency that was visitconsiderable contact with it at some previ- ed and considerable sympathy with their ous time. goals and their problems. He saw the agency as having positive goals and saw it as movSpecific Roles of Agency Staff ing toward the achievement of these goals. Again, the staff member selected for the This is particularly important in view of the visit showed a far more detailed knowledge slightly negative attitude developed by the of staff roles than the control subject, but control subject over the same period of the report after the visit showed an increase time. While there was no way of directly in the form of a highly detailed and very evaluating the effects of the visit on the specific description of staff roles. The con- staff of the agency, the positive attitude retrol subject changed his responses very lit- flected in the report suggests that the retle and apparently based his judgments on sultant interpersonal relationships were his general knowledge about the personnel positive on both sides. in similar positions as much as on his speThe visiting staff member questioned procific knowledge about the agency. Here it cedures and evaluated current approaches became apparent that the control subject and issues. In some cases, changes were felt that he knew the agency director or his recommended. For example, expanded use functions quite well but did not know the of case aides, subcontracting of work, and agency staff. expansion of group services were all preAlthough the visiting staff person felt his sented as possible alternative ways of meetknowledge of the staff roles was reasonably ing the increasing demand for services. good before the visit, he indicated that after Whether or not such changes would be imthe visit he was thoroughly familiar with the plemented is currently unknown, but the agency and its staffing pattern. There was a staff member had the opportunity to look at slight indication that he had spent more mental health concepts in relation to the time with the agency director than with the goals of another agency. caseworkers; perhaps he would have profAs an outside check, this final report was ited from greater interaction with the non- presented for comment to an MSW with 15
48
THE COI~fMWNITYMENTALHEALTH JOURNAL
years of field experience. He stated that the report was insightful and very positive. The visitant's statements about the limitations of the medical model that agency operations are based on were met with general agreement. He was less positive about specific recommendations. He was, for example, pessimistic about the chances for any major change in the agency over any short period of time as he felt that the perception of the agency by its clientele and by other institutions tends to prevent change. Funding is unlikely to improve and is currently so inadequate that even some improvement might do little to change the relative effectiveness of the agency. The legal-evaluative role that the agency plays is likely to remain unchanged, and the problems are complex enough that the suggestion of passing this function to a lower level of employee is unlikely to reduce the demands on senior staff significantly. On the other hand, as a resource developer, the senior staff might utilize legal consultation on complex problems while delegating routine legal-evaluative roles to junior staff. The socioeconomic level of the clientele is probably a critical factor in the planning of future programs. The agency director and the mental health center staff derive from a different population, and they are going to have to exercise extreme care in planning programs in order to communicate with and be effective with the agency's clientele. The visitor's suggestion to utilize procedures such as group meetings and group work, for example, may run into resistance because of this factor. However, groups of mothers receiving support for aid to dependent children have utilized group meetings for various purposes. Another potentially useful suggestion, one which illustrates also a role that a mental health center might play in this kind of agency consultation, was that of utilizing the center's contact with local ministers to increase their communication and involve. ment in the welfare agency's activities. The specific suggestion is not as important as the type of suggestion that was made. The idea derived from the visitant's experience with the agency and from his contact at the
mental health center with a workshop on mental health topics currently being conducted with a group of community ministers. The workshop is under the direction of another staff member, but clearly in-staff communication had occurred, and the idea emerged from two previously separated mental health center functions. As a mental health center increases its involvement with the total community, such conceptual crossfertilization should also increase. It may be, in fact, that this type of stimulation can be the major service rendered to the community by center personnel. CONCLUSIONS There is little question about the efficacy of the visit in increasing the staff member's general and detailed knowledge about the agency. In this case, the attitude of the staff member changed in a more positive direction, and it is implied that the attitudes of the staff of the visited agency may have changed in similar ways toward the mental health center. The evaluation process itself seems to have played a part in improving the effectiveness of the visit. The staff visitant was asked broad questions about agency roles, personnel, and functions and clearly paid specific attention to these variables during his visit, since he knew he would be asked again. It may be that this sort of evaluation should be considered whenever a member of a mental health center staff plans any prolonged contact with another agency; perhaps the evaluation instruments themselves could be improved with the explicit purpose of using them to sensitize the visiting staff member to specific aspects of the organization or group being visited. The final report of the staff member prorides a useful point of departure for the planning of future interactions with the agency visited. The personal relationships established by the visitant are, however, of greater importance to future planning. While there are many questions that should be answered before specific programs are planned with any agency, it is clear that continuing interaction of staff from community agencies should be encouraged.
Volume 3, Number 1, Spring, 1967
A CASE STUDY IN COMMUNITY AGENCY VISITATION E. R. OETTING, P~.D., CHARLES W. COLE, PH.D., AND JOHN E. HINKLE, PH.D.*
contact between two agencies, the actual effect on the people involved is almost never formally evaluated. Wherever a mental health center is considering the use of this technique as a method of involving their personnel in other community organizations, some evaluation of the effects the visi. tation had on the people involved becomes very important. Ideally, the presumed effects would be evaluated in two ways: evaluation of the effects on the organization visited and evaluation of the effects on the staff member involved in the visitation. To assess either, we need a test of knowledge and attitudes before and after the visitation. In almost all cases the practical situation prevents obtaining direct data on the attitudes within the organization. We can, however, test the staff member both before and after the visit and, to some extent, we can find out from the changes in his attitudes what his interaction with the agency and its personnel was like.
Two staff members of a mental health center were asked a series of questions about the role of a community welfare agency, its personnel, and their functions, both before and after one of them visited and worked within the agency. Changes in factor scores of a semantic differential to various staff and agency concepts were also assessed. The visitant showed considerable change, suggesting increased identification with the agency, its personnel, and its goals. The evaluation procedure itself appeared to make the visitation more effective.
The community provides many institutions that directly or indirectly affect the lives of people. Any total concern with community mental health must consider the role these institutions play in the mental health of the people with whom they become involved. Through influencing the attitudes and activities of the personnel of various organizations and health agencies, a mental health center may touch the lives of many more people than its staff could reach on a personal, one-to-one basis. However, in order to plan programs to improve the mental health aspects of an institution or agency, it is necessary to know its functions, understand its present impact on the community, create plans to support or modify that impact, and, perhaps most important, establish a relationship with the agency's personnel so that they become aware of, and interested in, the service capabilities of the mental health center. They must come to view the center as a worthwhile resource. One method of developing this kind of relationship is to have a staff member visit the agency, work with the people who work there, and observe the operation of their programs. While a visitation of this kind may be a useful method for establishing
PROCEDURE
The county welfare agency was selected for visitation. This choice grew out of conferences regarding extending services of both the mental health center and the welfare agency. It was agreed that the most effective way of exposing a staff member of the center to the welfare agency would be a "participant observer" approach. Thus, the visitant was to assume temporarily a working role in welfare operations. Prior to the actual visitation, a test battery devised to measure the amount of in. formation a staff member has about a county welfare department, its role in the community, and its personnel was administered to two members of the mental health center. One member was to go on a three-day visita-
*Dr. Oetting, a psychologist, is Associate Professor of Psychology, Colorado State University, and Evaluation Specialist, Southeast Wyoming Mental Health Center. Dr. Cole, a psychologist, is Assistant Professor ofrsyehology, Colorado State University, and Evaluation Coordinator, Southeast Wyomin$ Mental Health Center. Dr. Hinkle, a psychologist, is Executive Director, Southeast Wyoming Mental Health Center. An extended report, including the test materials, may be obtained from the Southeast Wyoming Mental Health Center, Cheyenne, Wyo. This investigation was supported in part by PHS Research Grant R 11-MH.00458 (04) from the National Institutes of Health, Public Health Service.
45
46
THE COMMUNITYMENTALHEALTHJOURNAL
tion to the agency while the other would not. The battery was administered both before and after the experience. Part of the battery also assessed the feeling of the staff members about their ability to relate to individuals in various agency positions and the staff members' estimates of their knowledge of the people involved and their functions. In addition, an 18-scale semantic differential was completed by both the visiting staff member and his control. The scales were selected to yield scores on personalitytype factors, such as tangibility, toughness, sociability, uniqueness, etc. Each mental health center staff member used these scales to rate the agency being visited, the agency director, the supervisor, caseworkers, and other agency personnel. Since one effect of giving a battery of tests of this kind would be to sensitize the person taking the tests to anything concerning the agency involved, giving the same test battery to another staff member who did not experience the visitation provided at least a partial control for changes that might occur simply from the visitant's being asked specific questions about the agency and its personnel. FINDINGS
The attitudes implicit in the statements made after the visitation also showed subtle but very important differences. Although the staffmember who had not visited the agency changed his responses somewhat, indicating that he had some contact with, or information about, the agency during this period, the contact was apparently with persons who were indirectly associated with the agency. He had picked up several rather negative and critical commentaries on agency functioning in the community. By contrast, the visiting staff member no longer mentioned the critical comments he had previously made. He now detailed the limits imposed on the agency by outside factors, such as lack of funds, lack of understanding, and insufficient personnel, along with a tremendous demand for service. This difference in tone, from blame or criticism to identifi. cation with the goals and plans of the agency and to understanding of the limitations under which it operates, was perhaps the most striking difference in the two reports. To some extent, these attitudinal changes were reflected in the data obtained by the semantic differential. The staff member who visited the agency perceived the case aides as more unique, as more distinctly individual; he perceived the agency director as more The Role of the Agency in the Community sociable. In addition, the total impact of the Before the visit, both members of the agency director, the case aides, and the mental health staff felt that they knew how agency itself increased, probably indicating the agency functioned in the community. rather directly his increased familiarity When their statements were judged for with, and appreciation of, the agency and its amount of detailed information, the member personnel. The control member who did not chosen for the visit showed a greater knowl- visit the agency also changed somewhat in edge of operational details. This might be his attitudes. The total impact of the agency expected, since the visit was in part his idea itself appeared to decrease slightly, perhaps and since he had already had contact with indicating some degree of negative evaluasome of the agency staff. tion. In terms of factor scores, clerical perAfter the visit, both showed increased de. sonnel and caseworkers were seen as more tail in specifying the agency's role in the calm, stable, and unemotional; caseworkers community. The member who did not visit were rated as more moral, dependable, and apparently had been sensitized by being sober. asked questions about the agency and had In terms of a total evaluation of the exlearned some relevant facts. However, the perience, the consistent increase in the visiting staff member showed a very great uniqueness factor for every type of agency increase in detailed knowledge, specifying person is probably of primary significance. several areas he had not previously men- The nonvisiting member showed no more tioned and amplifying and clarifying state- than random changes on this factor. It was ments he had made previously. apparent that, in general, the visitant saw
E. R. OETTINC.,C. W. COLE,ANDJ. E. HINKLE the agency and the people in it as more real and had a greater appreciation of their in- 9 dividuality. This increased differentiation is, of course, to be expected as the natural result of increased familiarity and contact.
Knowledge of Sta~ng Pattern
47
administrative staff. While the control subject rated his knowledge as insufficient, the visiting person generally felt his knowledge was highly sufficient. The visiting person also felt that he could relate to the people in the agency on all levels, and he felt even more capable of good relations after his visitation. The control, on the other hand, felt somewhat less confident of his ability to relate to the various staff persons. This might be related to the slightly negative attitude toward the agency as a whole that he developed between the two testings.
One concrete and highly specific piece of information that would show how much a person knew about an agency would be a simple listing of the agency's staffing pattern. This is the approach that was taken in this study. Here the person selected for the visit showed far greater preknowledge than the other staff member and, as would be expected, changed his statement very slightly General Observationsby the Visiting Staff after the visit. The pretesting also included Member ratings of various personnel roles in the After the visitation, the staff member preagency. In general, this section of the bat- pared a general report on the agency. This tery did show a slight improvement in un- report revealed several factors of importance derstanding as a result of the visit, but it to the evaluation of his experience. Perhaps showed more clearly the fact that the per- most importantly, the report had a positive son selected for the visit was not a stranger tone. There was clear personal identification to the agency visited and must have had with the people in the agency that was visitconsiderable contact with it at some previ- ed and considerable sympathy with their ous time. goals and their problems. He saw the agency as having positive goals and saw it as movSpecific Roles of Agency Staff ing toward the achievement of these goals. Again, the staff member selected for the This is particularly important in view of the visit showed a far more detailed knowledge slightly negative attitude developed by the of staff roles than the control subject, but control subject over the same period of the report after the visit showed an increase time. While there was no way of directly in the form of a highly detailed and very evaluating the effects of the visit on the specific description of staff roles. The con- staff of the agency, the positive attitude retrol subject changed his responses very lit- flected in the report suggests that the retle and apparently based his judgments on sultant interpersonal relationships were his general knowledge about the personnel positive on both sides. in similar positions as much as on his speThe visiting staff member questioned procific knowledge about the agency. Here it cedures and evaluated current approaches became apparent that the control subject and issues. In some cases, changes were felt that he knew the agency director or his recommended. For example, expanded use functions quite well but did not know the of case aides, subcontracting of work, and agency staff. expansion of group services were all preAlthough the visiting staff person felt his sented as possible alternative ways of meetknowledge of the staff roles was reasonably ing the increasing demand for services. good before the visit, he indicated that after Whether or not such changes would be imthe visit he was thoroughly familiar with the plemented is currently unknown, but the agency and its staffing pattern. There was a staff member had the opportunity to look at slight indication that he had spent more mental health concepts in relation to the time with the agency director than with the goals of another agency. caseworkers; perhaps he would have profAs an outside check, this final report was ited from greater interaction with the non- presented for comment to an MSW with 15
48
THE COI~fMWNITYMENTALHEALTH JOURNAL
years of field experience. He stated that the report was insightful and very positive. The visitant's statements about the limitations of the medical model that agency operations are based on were met with general agreement. He was less positive about specific recommendations. He was, for example, pessimistic about the chances for any major change in the agency over any short period of time as he felt that the perception of the agency by its clientele and by other institutions tends to prevent change. Funding is unlikely to improve and is currently so inadequate that even some improvement might do little to change the relative effectiveness of the agency. The legal-evaluative role that the agency plays is likely to remain unchanged, and the problems are complex enough that the suggestion of passing this function to a lower level of employee is unlikely to reduce the demands on senior staff significantly. On the other hand, as a resource developer, the senior staff might utilize legal consultation on complex problems while delegating routine legal-evaluative roles to junior staff. The socioeconomic level of the clientele is probably a critical factor in the planning of future programs. The agency director and the mental health center staff derive from a different population, and they are going to have to exercise extreme care in planning programs in order to communicate with and be effective with the agency's clientele. The visitor's suggestion to utilize procedures such as group meetings and group work, for example, may run into resistance because of this factor. However, groups of mothers receiving support for aid to dependent children have utilized group meetings for various purposes. Another potentially useful suggestion, one which illustrates also a role that a mental health center might play in this kind of agency consultation, was that of utilizing the center's contact with local ministers to increase their communication and involve. ment in the welfare agency's activities. The specific suggestion is not as important as the type of suggestion that was made. The idea derived from the visitant's experience with the agency and from his contact at the
mental health center with a workshop on mental health topics currently being conducted with a group of community ministers. The workshop is under the direction of another staff member, but clearly in-staff communication had occurred, and the idea emerged from two previously separated mental health center functions. As a mental health center increases its involvement with the total community, such conceptual crossfertilization should also increase. It may be, in fact, that this type of stimulation can be the major service rendered to the community by center personnel. CONCLUSIONS There is little question about the efficacy of the visit in increasing the staff member's general and detailed knowledge about the agency. In this case, the attitude of the staff member changed in a more positive direction, and it is implied that the attitudes of the staff of the visited agency may have changed in similar ways toward the mental health center. The evaluation process itself seems to have played a part in improving the effectiveness of the visit. The staff visitant was asked broad questions about agency roles, personnel, and functions and clearly paid specific attention to these variables during his visit, since he knew he would be asked again. It may be that this sort of evaluation should be considered whenever a member of a mental health center staff plans any prolonged contact with another agency; perhaps the evaluation instruments themselves could be improved with the explicit purpose of using them to sensitize the visiting staff member to specific aspects of the organization or group being visited. The final report of the staff member prorides a useful point of departure for the planning of future interactions with the agency visited. The personal relationships established by the visitant are, however, of greater importance to future planning. While there are many questions that should be answered before specific programs are planned with any agency, it is clear that continuing interaction of staff from community agencies should be encouraged.
