A Study of Former State Hospital Employees ata Community-Based Outpatient Clinic JOAN Senior
LERNER Research
Research
STEIN, Associate
Institutefor
Cambridge,
ED.D.
Educational
Problems
Massachusetts
LOUISE CORMAN, Research Associate Nero and Associates Arlington,
PH.D.
Virginia
The current trend toward providing community-based services for the mentally ill has had substantial impact on state hospital employees who transfer to community mental health centers. A study, through interviews and questionnaires,
of 30 Grafton
State
Hospital
employees
who transferred to a community outpatient clinic indicated initial anxiety about the hospital’s closing, the relocation process, and the lack of structure in the new community setting. Many employees stated that those initial reactions were gradually replaced by satisfaction and personal growth stemmingfrom successful adaptation to the community-based placement. UThe future of comprehensive community-based mental health care will be partially dependent on the suecessful performance of the relocated staff currently working within the state hospital network. The closing of Grafton State Hospital in 1972 presented the Massachusetts Department of Mental Health with a challenge to determine the most productive and least disruptive course to follow in the relocation of former state hospital employees. From January 1972 to September 1973 almost all 587 employees of Grafton who did not retire or resign were placed in new jobs within the department. We investigated the personal experience of the phase-out, the transition period, and the adjustment period for 30 employees of Grafton who went to work in one community setting-the Valley Adult Counseling Services (VACS) located near Grafton. VACS provides outpatient counseling and referral services to adults in
Dr.
Stein’s
Massachusetts associate
address at the 02138. Dr.
at the
institute.
institute
is 29 Ware
Corman
formerly
Street, Cambridge, was a senior research
the 15 towns that make up the Blackstone Valley mental health and retardation area. In structure and philosophy it differs radically from the traditional orientation at Grafton. The closing of Grafton had a profound effect on the development of VACS itself. Job blocks were transferred from the hospital to the community clinic, promoting rapid growth and expansion of the VACS program. Partially as a result of the Grafton closing, and the subsequent transfer of allocated positions, VACS grew from an organization with three staff members to a service with four separate centers employing more than 50 staff members and using many volunteers. While the employees who came from Grafton to VACS varied in the jobs they performed, age, length of employment at Grafton, and other characteristics, they all shared the experience of the Grafton phase-out and of having to adjust to a new, very different work setting. Our purpose was to compare the employees who went to VACS with the larger Grafton work force, and to document the process of their transition and adaptation to a community setting. The study was conducted on two levels that provided complementary data. Background information on all former Grafton employees, now at a variety of settings, was obtained. Former Grafton employees at VACS were asked to complete written questionnaires. In addition, the Grafton employees at VACS were studied in depth through tape-recorded personal interviews. All data were collected between November 1973 and April 1974.
THE
GRAFTON
EMPLOYEE
Records containing demographic information were available for 573 of the 587 employees who were on the hospital payroll immediately before the closing. From the frequency distributions of the demographic variables it is possible to draw a descriptive profile of the average Grafton employee. He was in his mid-forties, had worked at the hospital for almost ten years, had permanent civil-service status, and had a job level rating corresponding to a charge attendant nurse, assistant occupational therapist, or senior clerk. He had been born in Massachusetts and was married.
VOLUME
28
NUMBER
8 AUGUST
1977
611
Half of the employees did not graduate from high school, approximately one-third held a high school diploma, and the rest completed further schooling. Fiftythree per cent of the staff members were employed in the nursing service. Physicians, psychologists, and social workers made up only 5 per cent of the staff. Since many more women than men were on the nursing service, women were somewhat overrepresented among total hospital personnel. Approximately one-third of all employees had worked for the Commonwealth of Massachusetts before coming to Grafton, and 11 per cent lived on the hospital grounds during their employment at the hospital. Information obtained at the time of the closing indicated that about one-fourth of the employees retired or resigned when the hospital closed. Another 38 per cent were transferred to work in two state hospitals near Grafton. Of the remainder, 18 per cent were transferred to work in a state school for the mentally retarded and 5 per cent to VACS; 13 per cent either had been transferred to state hospitals outside the immediate area or had not yet left Grafton at the time the data were collected. Comparisons were made of employees who were transferred to VACS and other former Grafton employees to determine whether there were any specific background characteristics that differentiated the two groups. Statistical comparisons revealed that employees who transferred to VACS did not differ markedly from other former Grafton employees with respect to age, marital status, length of employment at Grafton, or civil-service status. However, they did differ in two important areas level of education ‘ = 22.54, df = 4, p < .001) and job category (x’ = 30.44, df 7, p < .001). While 27 per cent of the VACS employees were college graduates, only 5 per cent of the Grafton employees who transferred to state hospitals had graduated from college. Seventeen per cent of the VACS employees, in comparison with 4 per cent of other employees, had worked as physicians, psychologists, or social workers at Grafton. Only 7 per cent of the VACS employees, compared with 30 per cent of the other Grafton employees, had worked in maintenance, domestic, and similar positions at Grafton. The mean job rating of the VACS personnel corresponded to civil-service positions such as supervisor of volunteer services, x-ray technician, assistant dietitian, and senior licensed practical nurse. Personnel categories and the number of VACS employees in each category can be summarized as follows: physician, one; psychologist, two; social worker or rehabilitation counselor, two; occupational or recreational therapist, two; nursing, 17; administrative or clerical, three; and domestic or maintenance, three. Information on transfer choice, which was available for 21 of the 30 VACS employees, showed that ten of the 21 specified VACS as their first choice at the time of Grafton’s closing. Statistical comparisons of employees at VACS who chose to come to VACS with those who -
612
HOSPITAL
& COMMUNITY
PSYCHIATRY
did not indicated that those who chose VACS were more likely to be college graduates. VACS employees who did not list VACS as their first choice were more likely not to have completed high school. WRITTEN
QUESTIONNAIRES
Each of the former Grafton employees at VACS received a package of questionnaires that included three standardized instruments. They were the Baker-Schulberg Community Mental Health Ideology Scale, the J ob Description Index, and the Rotter Internal Versus External Control Scale. The instruments permit the assessment of three areas considered relevant to suecessful adaptation to work in a community setting such as VACS. The Baker-Schulberg Community Mental Health Ideology (CMHI) Scale assesses attitudes toward community mental health. Scores on the scale can range from zero to 266; a high score indicates orientation toward an ideological position favoring the community mental health movement.’ The mean CM HI score of the 27 VACS employees who took the test was 212.5; the standard deviation was 28.5. Comparison of those figures with figures obtained in prior research’ indicates that the VACS employees as a whole revealed a somewhat less positive orientation toward the community mental health ideology than professional groups known to have a strong commitment to community mental health. When scores of employees at the four VACS centers were examined separately, however, a clear difference emerged. Mean scores of employees at two of the centers (231.4±24.3 and 231.3±1.5) fell well within the range of scores of previous groups known to support community mental health, while mean scores of employees at the other two centers (196.0±18.0 and 194.0±28.6) were comparable to those of groups known to have a weaker commitment. Observation of the four centers confirmed that the two centers whose staff had high means on the CM HI were more vocal in stressing a community philosophy than the other two .centers. Significant correlation coefficients (p < .01) between CM HI scores and demographic variables revealed that employees whose score reflected a strong community mental health orientation had higher job level ratings (r = .53), more education (r = .49), had worked at VACS longer (r = .49), and received higher salaries (r .50) than employees with low scores on the CM HI. The Job Description Index (JDI) comprises five scales reflecting different areas of job satisfaction : attitudes toward work, supervision, pay, promotions, and coworkers.’ Scoring allows for separate scores in each 1
F. Baker
nity
Mental
Journal, 2
216.
H.
Health 3,
Fall
C. Schulberg,
“The
Ideology Scale,” 1967, pp. 216-225.
Development Community
of a CommuMental
Health
Ibid. C.
tion,”
Vol.
and
L. Hulin and P. C. Smith, “A Journal of Applied Psychology,
Linear Vol.
Model 49,
March
of Job Satisfac1965, pp. 209-
TABLE
1
Scores
on the Job Description
Mean score
Scale
Index Maximum possible score
SD
Work
42.75
11.24
54
Supervision
43.89
54
Pay
12.79
13.22 6.90
Promotions
11.00
6.99
27
Co-workers
46.60
10.66
54
159.46
36.50
Total
27
216
area, with a high score indicating satisfaction in that area. Table 1 presents means and standard deviations of 26 VACS employees on each scale. Differences in means of employees at the four centers were not significant. The means and standard deviations on the five scales for the VACS sample indicate greater satisfaction with work, supervision, and co-workers than with pay and promotions. Correlation coefficients revealed characteristics of employees that were related to satisfaction in each of the five areas. Significant coefficients (p < .01) indicated that employees who expressed the most satisfaction with their work tended to name VACS as their first transfer choice (rpbi .67) and to express satisfaction with supervision (r 67) and with co-workers (r .62). Employees who indicated the most satisfaction with supervision at VACS had worked at Grafton for a shorter period of time (r .65), had fewer sick days (r = .60), and more often named VACS as their first transfer choice (rpbi .66). Employees who expressed the’ most satisfaction with their co-workers tended to live closer to VACS (r .53), to live in the same residence that they lived in while at Grafton (rpbj .53), to have named VACS as their first transfer choice (rpbi .49), and to express greater satisfaction with promotions (r = .57). Those most satisfied with promotions had spent more months at VACS (r .54). With regard to job satisfaction across all five scales as reflected in total JDI scores, employees who were most satisfied were female (rpbi .50), had named VACS as their first transfer choice (rpbi .68), and lived close to VACS (r = .55). The Rotter Internal Versus External Control (I-E) Scale measures the degree to which the respondent views hi own autonomy and self-determination.4 The mean score of the 23 VACS employees who took this scale was 6.96. The standard deviation was 3.61 There were no significant differences among scores of employees at the four centers. The relatively low mean for the I-E scale reflects the high degree of internal orientation of the VACS sample as a whole. Of eight means reported by Rotter for -
-
.
4
ternal
era!
J.
B. Rotter, Control
and
Applied,
“
of
Reinforcement,”
Generalized
Expectancies for Psychological
Vol.
1, 1966,
80,
No.
pp.
1-28.
Internal
Versus
Monographs:
Ex-
widely different samples, seven showed less internal and greater external orientation than the VACS sample. Only a group of 122 male Peace Corps trainees reflected greater internal control than the VACS sample.’ Rotter suggested that the Peace Corps group’s scores may have been influenced by a social desirability response set. The possibility that this response set may have influenced scores of VACS respondents as well must be considered. Observation indicated that the leadership at VACS stressed and clearly valued an onentation toward internal control. Significant correlation coefficients (p < .05) between I-E scores and background variables indicated that highly internal employees tended to have more education (r = .40) and a higher salary while at Grafton (r = .40). PERSONAL
INTERVIEWS
Each former Grafton employee at VACS was seen for about 35 minutes for a tape-recorded interview after being at VACS approximately six months. The interview gave the employees an opportunity for a more personal recounting of the transition experience. It was structured around three areas: the initial period when the closing of Grafton was announced, the phase-out and transfer to VACS, and the early period at VACS. Employees were encouraged to talk about how their experience affected both their personal and their work lives. While there are as many stories as there are interviews, there are some common characteristics of the staff members who shared the intense experiences of upheaval and transition brought about by the closing of Grafton. The following is an impressionistic account of the process of adjustment to VACS drawn from the recollections and reflections of the employees. Reaction to the closing. Almost all respondents mitially were skeptical about the reality of the closing of Grafton. All had heard contradictory rumors concerning possible reasons for the closing. Even after the employees realized that it was necessary to close Grafton, they had feelings of sadness. As a group, however, they recognized the growing trend toward cornmunity-based care and were able to see the closing of Grafton as a progressive move. Respondents were articulate about the goals and values of community mental health and appeared to be trying to justify the closing. Many of the respondents indicated that they had felt ready for a change when the announcement of the closing was made. Some were tired of the hospital setting and didn’t want to transfer to another hospital. Some wanted to go into the community, others wanted to do a different type of work. In general, the VACS employees seemed willing to pursue new options; they expressed a sense of responsibility for their fate. Although they shared feelings of fear of the unknown and felt deep ties to the Grafton
Gen5
Ibid.
VOLUME
28
NUMBER
8 AUGUST
1977
613
community, They wanted munity.
they did not succumb to become involved
to a passive outlook. in the broader com-
Phase-out and transfer to VACS. Many respondents expressed concern about the way the patients at Grafton were treated and felt that they had suffered during the phase-out. That concern was reflected in the recollection of an atmosphere of anxiety and uncertainty that made the final months at Grafton stressful. While employees in higher positions were less likely to describe feelings of fear and doubt about what would happen to them personally, there was a general expression of worry, and the employees asked themselves many questions. Will I have to move? Will my shift be changed? Will I have to do a lot of traveling? In making the decision to come to VACS, many employees stressed the importance of family support and encouragement. Some had family difficulties. A typical pattern among women employees was having to overcome the initial skepticism of their husbands and families. Several women whose husbands had also worked at Grafton mentioned that their husbands were up tight” and appeared threatened when they did not move to another hospital with them. Most women reported, however, that family life was now better. Adjustment to VACS. Most of the respondents expressed early disappointment with VACS. All felt overwhelmed by a lack of structure. While agreeing with the philosophy of self-responsibility and group decisions, the respondents felt threatened by the sudden absence of structure and predictability. Many went through a period of self-doubt and questioning. Employees repeatedly cited examples of having to learn to speak up and to express their feelings. Respondents referred to the camaraderie and pride among the former Grafton staff members at VACS, particularly in the early days. Their need to talk about the old days” and to try to make sense out of the experience was overwhelming evidence of the profound sense of loss suffered by many. The significance of Grafton State Hospital for many of the employees, and the difficulty of the transition to another setting, is captured in this excerpt from one of the taped interviews: The largest problem for me personally was having to leave the place I had lived, was brought up, and had worked for 45 years,’ the employee said. It had been my total life. Living on the grounds, I was taught to respect the mentally ill and work for them and with them and do all I could to help them. I had never dreamed of a different life or place.” After the early anxiety wore off, however, there was an almost universal change of attitude. Many employees reported that they had experienced unexpected personal change and growth. In voices reflecting their enthusiasm, they discussed how their lives were changed by the VACS experience. They realized the benefits of struggling for an identity rather than having it prescribed for them. They reported that they had learned to express themselves and to respect feelings. They felt the time spent on internal development was “
“
“
‘
“
614
HOSPITAL
& COMMUNITY
PSYCHIATRY
worthwhile and all had grown in exciting ways. Respondents had a general feeling of satisfaction and increased self-esteem for having adjusted to change successfully. Most believed that their relationships with persons outside work had changed as a result of the new standards of honesty and openness that they developed. It is important to note that there were some exceptions to this model of self-development and change. A few employees vociferously questioned the “groupie” atmosphere at VACS; they felt that a great deal of time was wasted in endless self-analysis. Many were suspicious of the good intentions of others. Some expressed concern for the quality of care offered by VACS staff members and blamed the leaders for not providing sufficient guidance and supervision. SOME
OF
THE
TRENDS
It is both difficult and dangerous to try to characterize the typical pattern of coping with and adjusting to a community setting, yet there are trends that should be noted by planners. A dominant theme was the sense of community and family among the “Grafton people.” The rumored and then actual closing of Grafton was a major disruption in the lives of many of the staff. Employment at Grafton was a way of life as well as a job. The central position of the hospital in the daily lives of its employees must not be overlooked in assessing the impact of closing. The distortions and denials of the inevitable closing of Grafton are understandable when so much was at stake. Q uestionnaires, personal interviews, and on-thescene observations have revealed that the employees transferred from Grafton to VACS were able to alter their roles and adjust personally and professionally to the radically different atmosphere and goals of the community-care system. It may be that this group was less tradition-bound regarding treatment of the mentally ill and more able to see the potential of alternatives to the state hospital system than other hospital personnel. In the long run, VACS’s decision to emphasize internal development and organization at the expense of adherence to any externally imposed expectations may have been the best course to follow. Results of this study indicate that, at least in the short run, the ambiguity employees encountered at VACS increased their anxiety. Many felt threatened by the mandate to be open and honest with others after years of highly structured and formal on-the-job interactions. While there appeared to be a continuum of adjustment among the employees-some still felt unsure, and others felt they had found a place for themselvesalmost all identified with the feeling of being lost when they first got to VACS. Many recommended a more gradual transition. It must be emphasized that VACS is only one model for providing community-based mental health service. Consequently, statements by VACS employees may refleet their reactions to policies that might be different from those in other community settings.U
LERNER Research
Research
STEIN, Associate
Institutefor
Cambridge,
ED.D.
Educational
Problems
Massachusetts
LOUISE CORMAN, Research Associate Nero and Associates Arlington,
PH.D.
Virginia
The current trend toward providing community-based services for the mentally ill has had substantial impact on state hospital employees who transfer to community mental health centers. A study, through interviews and questionnaires,
of 30 Grafton
State
Hospital
employees
who transferred to a community outpatient clinic indicated initial anxiety about the hospital’s closing, the relocation process, and the lack of structure in the new community setting. Many employees stated that those initial reactions were gradually replaced by satisfaction and personal growth stemmingfrom successful adaptation to the community-based placement. UThe future of comprehensive community-based mental health care will be partially dependent on the suecessful performance of the relocated staff currently working within the state hospital network. The closing of Grafton State Hospital in 1972 presented the Massachusetts Department of Mental Health with a challenge to determine the most productive and least disruptive course to follow in the relocation of former state hospital employees. From January 1972 to September 1973 almost all 587 employees of Grafton who did not retire or resign were placed in new jobs within the department. We investigated the personal experience of the phase-out, the transition period, and the adjustment period for 30 employees of Grafton who went to work in one community setting-the Valley Adult Counseling Services (VACS) located near Grafton. VACS provides outpatient counseling and referral services to adults in
Dr.
Stein’s
Massachusetts associate
address at the 02138. Dr.
at the
institute.
institute
is 29 Ware
Corman
formerly
Street, Cambridge, was a senior research
the 15 towns that make up the Blackstone Valley mental health and retardation area. In structure and philosophy it differs radically from the traditional orientation at Grafton. The closing of Grafton had a profound effect on the development of VACS itself. Job blocks were transferred from the hospital to the community clinic, promoting rapid growth and expansion of the VACS program. Partially as a result of the Grafton closing, and the subsequent transfer of allocated positions, VACS grew from an organization with three staff members to a service with four separate centers employing more than 50 staff members and using many volunteers. While the employees who came from Grafton to VACS varied in the jobs they performed, age, length of employment at Grafton, and other characteristics, they all shared the experience of the Grafton phase-out and of having to adjust to a new, very different work setting. Our purpose was to compare the employees who went to VACS with the larger Grafton work force, and to document the process of their transition and adaptation to a community setting. The study was conducted on two levels that provided complementary data. Background information on all former Grafton employees, now at a variety of settings, was obtained. Former Grafton employees at VACS were asked to complete written questionnaires. In addition, the Grafton employees at VACS were studied in depth through tape-recorded personal interviews. All data were collected between November 1973 and April 1974.
THE
GRAFTON
EMPLOYEE
Records containing demographic information were available for 573 of the 587 employees who were on the hospital payroll immediately before the closing. From the frequency distributions of the demographic variables it is possible to draw a descriptive profile of the average Grafton employee. He was in his mid-forties, had worked at the hospital for almost ten years, had permanent civil-service status, and had a job level rating corresponding to a charge attendant nurse, assistant occupational therapist, or senior clerk. He had been born in Massachusetts and was married.
VOLUME
28
NUMBER
8 AUGUST
1977
611
Half of the employees did not graduate from high school, approximately one-third held a high school diploma, and the rest completed further schooling. Fiftythree per cent of the staff members were employed in the nursing service. Physicians, psychologists, and social workers made up only 5 per cent of the staff. Since many more women than men were on the nursing service, women were somewhat overrepresented among total hospital personnel. Approximately one-third of all employees had worked for the Commonwealth of Massachusetts before coming to Grafton, and 11 per cent lived on the hospital grounds during their employment at the hospital. Information obtained at the time of the closing indicated that about one-fourth of the employees retired or resigned when the hospital closed. Another 38 per cent were transferred to work in two state hospitals near Grafton. Of the remainder, 18 per cent were transferred to work in a state school for the mentally retarded and 5 per cent to VACS; 13 per cent either had been transferred to state hospitals outside the immediate area or had not yet left Grafton at the time the data were collected. Comparisons were made of employees who were transferred to VACS and other former Grafton employees to determine whether there were any specific background characteristics that differentiated the two groups. Statistical comparisons revealed that employees who transferred to VACS did not differ markedly from other former Grafton employees with respect to age, marital status, length of employment at Grafton, or civil-service status. However, they did differ in two important areas level of education ‘ = 22.54, df = 4, p < .001) and job category (x’ = 30.44, df 7, p < .001). While 27 per cent of the VACS employees were college graduates, only 5 per cent of the Grafton employees who transferred to state hospitals had graduated from college. Seventeen per cent of the VACS employees, in comparison with 4 per cent of other employees, had worked as physicians, psychologists, or social workers at Grafton. Only 7 per cent of the VACS employees, compared with 30 per cent of the other Grafton employees, had worked in maintenance, domestic, and similar positions at Grafton. The mean job rating of the VACS personnel corresponded to civil-service positions such as supervisor of volunteer services, x-ray technician, assistant dietitian, and senior licensed practical nurse. Personnel categories and the number of VACS employees in each category can be summarized as follows: physician, one; psychologist, two; social worker or rehabilitation counselor, two; occupational or recreational therapist, two; nursing, 17; administrative or clerical, three; and domestic or maintenance, three. Information on transfer choice, which was available for 21 of the 30 VACS employees, showed that ten of the 21 specified VACS as their first choice at the time of Grafton’s closing. Statistical comparisons of employees at VACS who chose to come to VACS with those who -
612
HOSPITAL
& COMMUNITY
PSYCHIATRY
did not indicated that those who chose VACS were more likely to be college graduates. VACS employees who did not list VACS as their first choice were more likely not to have completed high school. WRITTEN
QUESTIONNAIRES
Each of the former Grafton employees at VACS received a package of questionnaires that included three standardized instruments. They were the Baker-Schulberg Community Mental Health Ideology Scale, the J ob Description Index, and the Rotter Internal Versus External Control Scale. The instruments permit the assessment of three areas considered relevant to suecessful adaptation to work in a community setting such as VACS. The Baker-Schulberg Community Mental Health Ideology (CMHI) Scale assesses attitudes toward community mental health. Scores on the scale can range from zero to 266; a high score indicates orientation toward an ideological position favoring the community mental health movement.’ The mean CM HI score of the 27 VACS employees who took the test was 212.5; the standard deviation was 28.5. Comparison of those figures with figures obtained in prior research’ indicates that the VACS employees as a whole revealed a somewhat less positive orientation toward the community mental health ideology than professional groups known to have a strong commitment to community mental health. When scores of employees at the four VACS centers were examined separately, however, a clear difference emerged. Mean scores of employees at two of the centers (231.4±24.3 and 231.3±1.5) fell well within the range of scores of previous groups known to support community mental health, while mean scores of employees at the other two centers (196.0±18.0 and 194.0±28.6) were comparable to those of groups known to have a weaker commitment. Observation of the four centers confirmed that the two centers whose staff had high means on the CM HI were more vocal in stressing a community philosophy than the other two .centers. Significant correlation coefficients (p < .01) between CM HI scores and demographic variables revealed that employees whose score reflected a strong community mental health orientation had higher job level ratings (r = .53), more education (r = .49), had worked at VACS longer (r = .49), and received higher salaries (r .50) than employees with low scores on the CM HI. The Job Description Index (JDI) comprises five scales reflecting different areas of job satisfaction : attitudes toward work, supervision, pay, promotions, and coworkers.’ Scoring allows for separate scores in each 1
F. Baker
nity
Mental
Journal, 2
216.
H.
Health 3,
Fall
C. Schulberg,
“The
Ideology Scale,” 1967, pp. 216-225.
Development Community
of a CommuMental
Health
Ibid. C.
tion,”
Vol.
and
L. Hulin and P. C. Smith, “A Journal of Applied Psychology,
Linear Vol.
Model 49,
March
of Job Satisfac1965, pp. 209-
TABLE
1
Scores
on the Job Description
Mean score
Scale
Index Maximum possible score
SD
Work
42.75
11.24
54
Supervision
43.89
54
Pay
12.79
13.22 6.90
Promotions
11.00
6.99
27
Co-workers
46.60
10.66
54
159.46
36.50
Total
27
216
area, with a high score indicating satisfaction in that area. Table 1 presents means and standard deviations of 26 VACS employees on each scale. Differences in means of employees at the four centers were not significant. The means and standard deviations on the five scales for the VACS sample indicate greater satisfaction with work, supervision, and co-workers than with pay and promotions. Correlation coefficients revealed characteristics of employees that were related to satisfaction in each of the five areas. Significant coefficients (p < .01) indicated that employees who expressed the most satisfaction with their work tended to name VACS as their first transfer choice (rpbi .67) and to express satisfaction with supervision (r 67) and with co-workers (r .62). Employees who indicated the most satisfaction with supervision at VACS had worked at Grafton for a shorter period of time (r .65), had fewer sick days (r = .60), and more often named VACS as their first transfer choice (rpbi .66). Employees who expressed the’ most satisfaction with their co-workers tended to live closer to VACS (r .53), to live in the same residence that they lived in while at Grafton (rpbj .53), to have named VACS as their first transfer choice (rpbi .49), and to express greater satisfaction with promotions (r = .57). Those most satisfied with promotions had spent more months at VACS (r .54). With regard to job satisfaction across all five scales as reflected in total JDI scores, employees who were most satisfied were female (rpbi .50), had named VACS as their first transfer choice (rpbi .68), and lived close to VACS (r = .55). The Rotter Internal Versus External Control (I-E) Scale measures the degree to which the respondent views hi own autonomy and self-determination.4 The mean score of the 23 VACS employees who took this scale was 6.96. The standard deviation was 3.61 There were no significant differences among scores of employees at the four centers. The relatively low mean for the I-E scale reflects the high degree of internal orientation of the VACS sample as a whole. Of eight means reported by Rotter for -
-
.
4
ternal
era!
J.
B. Rotter, Control
and
Applied,
“
of
Reinforcement,”
Generalized
Expectancies for Psychological
Vol.
1, 1966,
80,
No.
pp.
1-28.
Internal
Versus
Monographs:
Ex-
widely different samples, seven showed less internal and greater external orientation than the VACS sample. Only a group of 122 male Peace Corps trainees reflected greater internal control than the VACS sample.’ Rotter suggested that the Peace Corps group’s scores may have been influenced by a social desirability response set. The possibility that this response set may have influenced scores of VACS respondents as well must be considered. Observation indicated that the leadership at VACS stressed and clearly valued an onentation toward internal control. Significant correlation coefficients (p < .05) between I-E scores and background variables indicated that highly internal employees tended to have more education (r = .40) and a higher salary while at Grafton (r = .40). PERSONAL
INTERVIEWS
Each former Grafton employee at VACS was seen for about 35 minutes for a tape-recorded interview after being at VACS approximately six months. The interview gave the employees an opportunity for a more personal recounting of the transition experience. It was structured around three areas: the initial period when the closing of Grafton was announced, the phase-out and transfer to VACS, and the early period at VACS. Employees were encouraged to talk about how their experience affected both their personal and their work lives. While there are as many stories as there are interviews, there are some common characteristics of the staff members who shared the intense experiences of upheaval and transition brought about by the closing of Grafton. The following is an impressionistic account of the process of adjustment to VACS drawn from the recollections and reflections of the employees. Reaction to the closing. Almost all respondents mitially were skeptical about the reality of the closing of Grafton. All had heard contradictory rumors concerning possible reasons for the closing. Even after the employees realized that it was necessary to close Grafton, they had feelings of sadness. As a group, however, they recognized the growing trend toward cornmunity-based care and were able to see the closing of Grafton as a progressive move. Respondents were articulate about the goals and values of community mental health and appeared to be trying to justify the closing. Many of the respondents indicated that they had felt ready for a change when the announcement of the closing was made. Some were tired of the hospital setting and didn’t want to transfer to another hospital. Some wanted to go into the community, others wanted to do a different type of work. In general, the VACS employees seemed willing to pursue new options; they expressed a sense of responsibility for their fate. Although they shared feelings of fear of the unknown and felt deep ties to the Grafton
Gen5
Ibid.
VOLUME
28
NUMBER
8 AUGUST
1977
613
community, They wanted munity.
they did not succumb to become involved
to a passive outlook. in the broader com-
Phase-out and transfer to VACS. Many respondents expressed concern about the way the patients at Grafton were treated and felt that they had suffered during the phase-out. That concern was reflected in the recollection of an atmosphere of anxiety and uncertainty that made the final months at Grafton stressful. While employees in higher positions were less likely to describe feelings of fear and doubt about what would happen to them personally, there was a general expression of worry, and the employees asked themselves many questions. Will I have to move? Will my shift be changed? Will I have to do a lot of traveling? In making the decision to come to VACS, many employees stressed the importance of family support and encouragement. Some had family difficulties. A typical pattern among women employees was having to overcome the initial skepticism of their husbands and families. Several women whose husbands had also worked at Grafton mentioned that their husbands were up tight” and appeared threatened when they did not move to another hospital with them. Most women reported, however, that family life was now better. Adjustment to VACS. Most of the respondents expressed early disappointment with VACS. All felt overwhelmed by a lack of structure. While agreeing with the philosophy of self-responsibility and group decisions, the respondents felt threatened by the sudden absence of structure and predictability. Many went through a period of self-doubt and questioning. Employees repeatedly cited examples of having to learn to speak up and to express their feelings. Respondents referred to the camaraderie and pride among the former Grafton staff members at VACS, particularly in the early days. Their need to talk about the old days” and to try to make sense out of the experience was overwhelming evidence of the profound sense of loss suffered by many. The significance of Grafton State Hospital for many of the employees, and the difficulty of the transition to another setting, is captured in this excerpt from one of the taped interviews: The largest problem for me personally was having to leave the place I had lived, was brought up, and had worked for 45 years,’ the employee said. It had been my total life. Living on the grounds, I was taught to respect the mentally ill and work for them and with them and do all I could to help them. I had never dreamed of a different life or place.” After the early anxiety wore off, however, there was an almost universal change of attitude. Many employees reported that they had experienced unexpected personal change and growth. In voices reflecting their enthusiasm, they discussed how their lives were changed by the VACS experience. They realized the benefits of struggling for an identity rather than having it prescribed for them. They reported that they had learned to express themselves and to respect feelings. They felt the time spent on internal development was “
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worthwhile and all had grown in exciting ways. Respondents had a general feeling of satisfaction and increased self-esteem for having adjusted to change successfully. Most believed that their relationships with persons outside work had changed as a result of the new standards of honesty and openness that they developed. It is important to note that there were some exceptions to this model of self-development and change. A few employees vociferously questioned the “groupie” atmosphere at VACS; they felt that a great deal of time was wasted in endless self-analysis. Many were suspicious of the good intentions of others. Some expressed concern for the quality of care offered by VACS staff members and blamed the leaders for not providing sufficient guidance and supervision. SOME
OF
THE
TRENDS
It is both difficult and dangerous to try to characterize the typical pattern of coping with and adjusting to a community setting, yet there are trends that should be noted by planners. A dominant theme was the sense of community and family among the “Grafton people.” The rumored and then actual closing of Grafton was a major disruption in the lives of many of the staff. Employment at Grafton was a way of life as well as a job. The central position of the hospital in the daily lives of its employees must not be overlooked in assessing the impact of closing. The distortions and denials of the inevitable closing of Grafton are understandable when so much was at stake. Q uestionnaires, personal interviews, and on-thescene observations have revealed that the employees transferred from Grafton to VACS were able to alter their roles and adjust personally and professionally to the radically different atmosphere and goals of the community-care system. It may be that this group was less tradition-bound regarding treatment of the mentally ill and more able to see the potential of alternatives to the state hospital system than other hospital personnel. In the long run, VACS’s decision to emphasize internal development and organization at the expense of adherence to any externally imposed expectations may have been the best course to follow. Results of this study indicate that, at least in the short run, the ambiguity employees encountered at VACS increased their anxiety. Many felt threatened by the mandate to be open and honest with others after years of highly structured and formal on-the-job interactions. While there appeared to be a continuum of adjustment among the employees-some still felt unsure, and others felt they had found a place for themselvesalmost all identified with the feeling of being lost when they first got to VACS. Many recommended a more gradual transition. It must be emphasized that VACS is only one model for providing community-based mental health service. Consequently, statements by VACS employees may refleet their reactions to policies that might be different from those in other community settings.U
