MENTAL HEALTH TRAINING FOR THE MIDDLE MANAGER By Raymond Bissonette and Jack Zusman Training in administration for middle managers is an important but much neglected area. While middle managers such as unit chiefs, supervisors, and team leaders have significant administrative responsibilities along with their clinical work, they are seldom trained in administration. The authors describe a program to train full and part time students for middle management positions.
This paper discusses some of the major lessons learned during our experience with an experimental program in Mental Health Service Administration Training. It addresses three major points: (1) There is a significant and increasing demand for people who will serve in middle management roles in mental health services; (2) As distinguished from the top a d m i n i s t r a t o r , the middle manager requires training differing substantially both in structure and content; and (3) Training for middle managers must combine rigorous learning standards with extensive flexibility in form. This requirement presents a number of special problems and benefits to those responsible for the training.
Raymond Bissonette is Assistant Professor, Departments of Psychiatary and Family Medicine, State University of New York at Buffalo. Jack Zusman is Medical Director, Gateways Hospital Community Mental Health Center in Los Angeles.
Background From July 1, 1971 through December 31, 1974, the Division of Community Psychiatry, Department of Psychiatry, State University of New York at Buffalo, operated an experimental program in Community Mental Health Service A d m i n i s t r a t i o n T r a i n i n g funded by the National Institute of Mental Health. The training program as it functioned during the period of Federal support consisted of five basic components: 1. Fifteen credit hours of graduate course work in l~he areas of community psychiatry, a d m i n i s t r a t i o n , and management. 2. An administrative field placement requiring the equivalent of 20 hours per week for a ten-month period to be spent as apprentice to an experienced administrator. 3. A clinical placement at a facility providing community oriented mental health services. 193
4. The completion of six to eight formal site visits to major health and mental health related facilities. 5. A paper of p u b l i c a t i o n q u a l i t y covering some subject relating to community psychiatry. The program could be completed in one year for a full-time student and in two or three years part-time. It was designed as a training vehicle for persons who would eventually assume top leadership in the mental health field. We accordingly expected to train a small number of full-time persons each year and an even smaller number of part-timers. What follows is based on our experience with the training program, our observations of developing trends in the field, and a review of the very scarce literature. Middle Management: Demand
The
Role and
the
Our original plan had been to train the "renaissance men" of mental health - - those rare and highly trained persons capable of planning and organizing large and complex m e n t a l health service systems such as community mental health centers, state hospitals and schools, or major mental health units in government. We quickly discovered, however, that the major demand for the training we offered was coming from a different population, a population we shall describe hereinafter as middle management people. In short, these are persons employed at various levels of responsibility within mental health organizations whose duties, irrespective of their official job descriptions, require
Our original plan had been to train the "renaissance" men of mental health. c o n s i d e r a b l e k n o w l e d g e and skill in administration although they are not agency administrators. The middle manager is very much as the name suggests - - o n e who stands at the 194
intersection between the front-line clinicians on the one hand and top management on the other. To operate effectively in this position, there are at least three distinguishable sets of knowledge he must command: (a) sufficient
A key task of the middle manager is coordinating resources rather than providing or allocating them. f a m i l i a r i t y with clinical p r o c e d u r e to appreciate and evaluate the activities of direct service workers; (b) sufficient knowledge of the role of top management and an appreciation of its function; and (c) solid working knowledge and skill in performing various administrative tasks. A key task of the middle manager is coordinating resources rather than providing or allocating them. The latter functions are more of a top management responsibility (Heide 1970). Although top and middle level administrators need adequate knowledge of what is happening in at least two different systems or echelons, they need not necessarily possess working expertise in all areas. Similarly, as the top manager must have the skill and knowledge to provide direction to members of the organization, the middle m a n a g e r must p r o v i d e s u p e r v i s i o n and direction to his unit or department. As Barton (1962), among others, has pointed out, failure to delegate is a sure sign of problems in any administration. The difficulty is generally e x a g g e r a t e d in m e n t a l h e a l t h service organizations due to the paucity of middle level persons trained in administration. Since it appears unlikely that sufficient resources will ever be available to develop specialized middle level administrators, we view our program as a vehicle to provide administrative training for persons within the middle ranges of the organization whose formal training has traditionally been clinical. This approach offers the economy of building on the existing manpower pool of highly motivated professionals rather than
attempting to develop yet another new s u b s p e c i a l t y . P e r s o n s s u c h as c l i n i c coordinators, unit chiefs, team leaders, et al, are doing administration anyway and will continue to whether they are trained or not.
Clinic coordinators, unit chiefs, team leaders et al, are doing administration anyway and will continue to whether they are trained or not. It must be kept in mind that we are discussing two categories of persons. On the one hand, there are those who are already in the mental health business in positions r e q u i r i n g t h e m to p e r f o r m m i d d l e management functions. Then there are others who are rather well advanced in their professional careers in fields related to but not specifically mental health. The life situations and career levels of both categories are such that they are well beyond the level of paraprofessionals and are not likely to return to school for a traditional degree program. The former group requires the training to perform their jobs more effectively. The latter require a training vehicle to help their career lines intersect with the field of mental health at a level commensurate with their general abilities and probable responsibilities. A significant number of these persons, due to lack of opportunity or personal ambition, are likely to remain at the middle management level. Fortunately for them, the community mental health movement has considerably reduced the traditional requirements of specific academic credentials for entry into and
Without formal training, they learn their administrative jobs by the sink or swim method and they often sink. advancement in the field. As a consequence, many have already entered the field at various low and middle professional levels and the
likelihood is that many more will. This is, however, a mixed blessing. Middle managers are having the same kinds of problems as top management where psychiatrists or other clinicians become administrators by fiat. Without formal training, they learn their adminstrative jobs by the sink or swim method and they often sink. When they do learn to swim, they may do so poorly. The probability that some of them will pick up the appropriate knowledge and skills on their own is especially slim in this field due to the scarcity of literature (Heide 1970). To enter the channel and negotiate it successfully requires training that is rigorous, relevant, and sufficiently flexible to preclude a major disruption of one's career and life situation. The Job Market
Based upon our experience, the demand for mid-level traineeships is real and there appears to be a market for persons completing such training. There are several indicators of an increasing potential need for mental health administrators at the mid-management level. The deemphasis of hospitalization is likely to create a demand for trained administrators at intermediate levels of responsibility. For example, the subcontract approach to service delivery and the regionalization of the New York State Department of Mental Hygiene w i l l p r o d u c e a d d i t i o n a l e c h e l o n s of a d m i n i s t r a t i v e r e s p o n s i b i l i t y w i t h i n the services network. Basically this approach provides for the restructuring of mental health/retardation, drug and alcohol services such that localities and the state would jointly plan, d e l i v e r , a n d finance them. As an immediate consequence of this unification, the Department of Mental Hygiene has been decentralized and a greater variety of programs for the m e n t a l l y ill will ensue. Both consequences will have the effect of creating new a d m i n i s t r a t i v e and p r o g r a m m i n g positions in the middle ranges. At least in New York, there will be a need for more persons 195
trained in administration, program operation, clinical services, coordination, and community mental health. This trend appears to be indicative of the future directions in which mental health services will be m o v i n g nationally. Further, there is an increasing tendency in the human services generally toward taskcentered administration and a gradual erosion of the classical distinction between program and administrative staff. This trend will mean that staff at levels will become more and more involved in the administrative process (Schatz 1966). Other observers have also predicted that the future of mental health and human services will see an increased d i s t r i b u t i o n of administrative roles and responsibilities down into the middle range of the organization (Whittington 1973; Mechanic 1973).
There is an increasing tendency in the human services t o w a r d t a s k - c e n t e r e d administration.
DESIGNING THE TRAINING Although a variety of requirements and experiences such as site visits, projects, clinical practice, etc. are appropriate to round out the training of administrators, the core of our approach is a combination of course work and intensive field experience organized around learning outcomes regarded as both necessary and achievable.
Setting Objectives In attempting to design a program of learning directly geared to job performance we looked to several sources of information: 1) the limited published literature in the area; 2) job descriptions for existing middle management positions in county and state mental health systems; 3) trainee identification of learning 196
needs; and 4) advice from field work supervisors. We then identified a number of knowledge and skill areas to serve as learning objectives against which to develop course content and field experience. The following list represents a catalog of areas in which middle managers should be competent: 1) Knowledge of acceptable standards of care in various treatment modalities. 2) Ability to translate broad policy into concrete service programs. 3) Ability to establish and monitor s t a n d a r d s of p e r f o r m a n c e and organizational objectives. 4) Knowledge of methods to recruit, train, and supervise professional and sub-professional personnel. 5) Ability to use patient care records for improved quality of care, staff training and supervision, and p r o g r a m management. 6) Knowledge of procedures for efficient distribution and control of information. 7) Ability to budget and account for operational funds. 8) Knowledge of a n c i l l a r y s u p p o r t systems within and outside of the unit or organization. 9) Ability to articulate organizational or unit programs and goals for use by higher management and/or community groups. 10) Familiarity with sources of job-related information and data, i.e., professional literature, n a t i o n a l o r g a n i z a t i o n s , local and regional planning agencies. 11) U n d e r s t a n d i n g of line and staff functions within formal organizations. 12) Sensitivity to problems and potentials of i n f o r m a l o r g a n i z a t i o n s within formal structures. 13) Knowledge of systematic techniques (e.g. PERT, MBO) for planning and implementing work. 14) Knowledge of appropriate staffing patterns and delegation of responsibility.
15) Awareness of the therapeutic and a d m i n i s t r a t i v e c o n s e q u e n c e s of various organizational models. 16) Knowledge of relevant regulatory a n d / o r statutory constraints affecting service delivery. 17) Appreciation of internal and external political realities affecting services. Course Work
The formal course offerings intended to meet these training objectives are for the most part m o d i f i c a t i o n s of the courses o r i g i n a l l y designed for top management trainees. The courses, with very brief content descriptions are listed below. The first four are required of all students with others chosen on elective basis after student/advisor consultation. Administrative Theory and Practice I n t r o d u c t i o n to the principles and techniques of management and organizational issues. This course, taught by a professional a d m i n i s t r a t o r , uses a c o m b i n a t i o n of theoretical and case materials cutting across a broad spectrum of organizational entities not limited to human services. Organization of Mental Health Services
This course analyzes a variety of major community mental health service delivery models in America and abroad. As a part of the course requirements each trainee develops a comprehensive description and analysis of an existing service program. Introduction to Community Psychiatry This s e m i n a r reviews the h i s t o r i c a l , theoretical, and operational bases for the community based approach to mental health care. Techniques of Agency Management
T a u g h t by a seasoned local agency executive, this seminar is a "how to" course in the day-to-day problems and procedures of managing a community based human service agency. With heavy emphasis on the practicum
approach, trainees learn to prepare and present budgets, write job descriptions, interview job applicants, apply systematic approaches to problem solving, etc. The Social Context of Mental Illness This seminar explores the social and cultural factors associated with the prevalence and distribution of mental illness and society's response to the problem. Evaluation of Human Service Programs
This course reviews process, structure and outcome approaches to assessing the quality, efficiency, and effectiveness of v a r i o u s therapeutic techniques and organizational models for mental health services. Trainees are expected to develop a workable design for the evaluation of an existing or hypothetical service program. Mental Health Therapy
More clinically oriented, this seminar introduces trainees to various therapeutic techniques (behavior modification, transactional analysis, network therapy, etc.) with emphasis on their relative value with respect to type of problem and available resources. The course includes a review of the literature assessing the outcomes of various treatment interventions. Politics of Mental Health Services
With an emphasis on case studies, this course covers the formal and informal political processes as they impinge on service delivery at the middle management level. Transitional Services This course reviews the design, operation, and effectiveness of a wide variety of community based transitional programs that facilitate institutionalized patients' re-entry into the community. Field Placement
For the full-time trainees, the traditional field placement model was used. The trainee 197
was placed in an agency for the equivalent of 20 hours a week for ten months under the direct supervision of the agency director. A second approach was developed to accommodate part-time trainees who were already employed full-time in a human service or mental health organization that met the program standards as a placement site. An agreement similar to a contractual relationship was reached between the director of the organization and the trainee. This e n a b l e d the latter to take on responsibilities beyond his regular duties for which he would receive field work credit. The agency director served in a dual role as the field work preceptor and the trainee's supervisor. In several situations, a trainee would be employed in an agency or setting that met the placement standards but did not have a supervisor available who qualified for the preceptor role. In these cases, a third model was developed where a senior administrator from outside the agency would work with the trainee as a preceptor. As in the second approach, arrangements were made for the trainee to assume a major administrative responsibility over and above his regular duties. The outside preceptor would meet with the trainee on a regular basis to guide him through the completion of his field project. As might be expected, the first model is the simplest to arrange, monitor, and control. The second a p p r o a c h is p r o c e d u r a l l y m o r e complex but is not significantly different in quality. Its most salient difficulty is the virtual impossibility of ensuring that the trainee actually invests the proper time and energy. While we insist that both trainee and supervisor give assurances that the field placement represents a distinct commitment, it is difficult to identify precisely where job duties end and field work responsibilities begin. In the third model, the relationship with the preceptor is entirely different. Here he acts more in the role of a consultant and the major difference has to do with the accountability of 198
the trainee to the preceptor. Our experience suggests that this arrangement must generally be limited to mature senior-level trainees who undertake a focused project, such as the development of a program plan and are capable of making maximum use of the special expertise of a non-supervising preceptor. If the goal is simplicity, the traditional field placement model is best. However, there is little evidence of serious deficiencies using the other approaches so long as great care is taken to match preceptor with trainee. It is important to obtain in precise detail the necessary clearances and understandings with all persons concerned including those in other agencies. Actually, there appears to be a distinct advantage in arranging field placements as adjuncts to regular jobs. The individual trainee is not forced to carve out a role in the agency as is necessary with the traditional type of placement. This appears to reduce significantly the startup time for getting to the real business of the placement. Conclusion Middle managers play a key role in the administration of mental health agencies, but many lack administrative training. The need for such training is great and will likely remain so in the future. Training must be made available to working professionals in mental health and those in related fields who seek to enter the system at a parallel level. To meet these needs, the training must be flexible in design and geared for both the problems and advantages of part-time students participating in the program over a protracted period of time. While part-time students are proportionately more expensive and their progress is more difficult to evaluate, their field work is often more rewarding and they help the training program develop close ties with the agencies in which they are employed. Further, their degree of commitment to training may over the long run, be greater than that of full time students.
REFERENCES
Barton, Walter. Administration in Psychiatry. Springfield, I11.: Charles C Thomas, 1962. [-Ieide, Robert. Coordination as a task of management: A review. In: Schatz, Harry A., ed. Social Work Administration: A Sourcebook. New York Council on Social Work Education, 1970. Vlechanic, David. The sociology of organizations. In: Feldman, Saul, ed. The Administration of Mental Health Services. Springfield, I11.: Charles C Thomas, 1973.
New York State Mental Hygience Law, Article 11, 1973. Schatz, Harry A. Staff involvement in agency administration. In: Trends in Social Work Practice and Knowledge: N A S W Tenth Anniversary Symposium. New York: National Association of Social Workers, 1966. Whittington, H. G. People make programs: Personnel management. In: Feldman, Saul, ed. The Administration of Mental Health Services. Springfield, II1.: Charles C Thomas, 1973.
ADMINISTRATION IN MENTAL HEALTH
199
This paper discusses some of the major lessons learned during our experience with an experimental program in Mental Health Service Administration Training. It addresses three major points: (1) There is a significant and increasing demand for people who will serve in middle management roles in mental health services; (2) As distinguished from the top a d m i n i s t r a t o r , the middle manager requires training differing substantially both in structure and content; and (3) Training for middle managers must combine rigorous learning standards with extensive flexibility in form. This requirement presents a number of special problems and benefits to those responsible for the training.
Raymond Bissonette is Assistant Professor, Departments of Psychiatary and Family Medicine, State University of New York at Buffalo. Jack Zusman is Medical Director, Gateways Hospital Community Mental Health Center in Los Angeles.
Background From July 1, 1971 through December 31, 1974, the Division of Community Psychiatry, Department of Psychiatry, State University of New York at Buffalo, operated an experimental program in Community Mental Health Service A d m i n i s t r a t i o n T r a i n i n g funded by the National Institute of Mental Health. The training program as it functioned during the period of Federal support consisted of five basic components: 1. Fifteen credit hours of graduate course work in l~he areas of community psychiatry, a d m i n i s t r a t i o n , and management. 2. An administrative field placement requiring the equivalent of 20 hours per week for a ten-month period to be spent as apprentice to an experienced administrator. 3. A clinical placement at a facility providing community oriented mental health services. 193
4. The completion of six to eight formal site visits to major health and mental health related facilities. 5. A paper of p u b l i c a t i o n q u a l i t y covering some subject relating to community psychiatry. The program could be completed in one year for a full-time student and in two or three years part-time. It was designed as a training vehicle for persons who would eventually assume top leadership in the mental health field. We accordingly expected to train a small number of full-time persons each year and an even smaller number of part-timers. What follows is based on our experience with the training program, our observations of developing trends in the field, and a review of the very scarce literature. Middle Management: Demand
The
Role and
the
Our original plan had been to train the "renaissance men" of mental health - - those rare and highly trained persons capable of planning and organizing large and complex m e n t a l health service systems such as community mental health centers, state hospitals and schools, or major mental health units in government. We quickly discovered, however, that the major demand for the training we offered was coming from a different population, a population we shall describe hereinafter as middle management people. In short, these are persons employed at various levels of responsibility within mental health organizations whose duties, irrespective of their official job descriptions, require
Our original plan had been to train the "renaissance" men of mental health. c o n s i d e r a b l e k n o w l e d g e and skill in administration although they are not agency administrators. The middle manager is very much as the name suggests - - o n e who stands at the 194
intersection between the front-line clinicians on the one hand and top management on the other. To operate effectively in this position, there are at least three distinguishable sets of knowledge he must command: (a) sufficient
A key task of the middle manager is coordinating resources rather than providing or allocating them. f a m i l i a r i t y with clinical p r o c e d u r e to appreciate and evaluate the activities of direct service workers; (b) sufficient knowledge of the role of top management and an appreciation of its function; and (c) solid working knowledge and skill in performing various administrative tasks. A key task of the middle manager is coordinating resources rather than providing or allocating them. The latter functions are more of a top management responsibility (Heide 1970). Although top and middle level administrators need adequate knowledge of what is happening in at least two different systems or echelons, they need not necessarily possess working expertise in all areas. Similarly, as the top manager must have the skill and knowledge to provide direction to members of the organization, the middle m a n a g e r must p r o v i d e s u p e r v i s i o n and direction to his unit or department. As Barton (1962), among others, has pointed out, failure to delegate is a sure sign of problems in any administration. The difficulty is generally e x a g g e r a t e d in m e n t a l h e a l t h service organizations due to the paucity of middle level persons trained in administration. Since it appears unlikely that sufficient resources will ever be available to develop specialized middle level administrators, we view our program as a vehicle to provide administrative training for persons within the middle ranges of the organization whose formal training has traditionally been clinical. This approach offers the economy of building on the existing manpower pool of highly motivated professionals rather than
attempting to develop yet another new s u b s p e c i a l t y . P e r s o n s s u c h as c l i n i c coordinators, unit chiefs, team leaders, et al, are doing administration anyway and will continue to whether they are trained or not.
Clinic coordinators, unit chiefs, team leaders et al, are doing administration anyway and will continue to whether they are trained or not. It must be kept in mind that we are discussing two categories of persons. On the one hand, there are those who are already in the mental health business in positions r e q u i r i n g t h e m to p e r f o r m m i d d l e management functions. Then there are others who are rather well advanced in their professional careers in fields related to but not specifically mental health. The life situations and career levels of both categories are such that they are well beyond the level of paraprofessionals and are not likely to return to school for a traditional degree program. The former group requires the training to perform their jobs more effectively. The latter require a training vehicle to help their career lines intersect with the field of mental health at a level commensurate with their general abilities and probable responsibilities. A significant number of these persons, due to lack of opportunity or personal ambition, are likely to remain at the middle management level. Fortunately for them, the community mental health movement has considerably reduced the traditional requirements of specific academic credentials for entry into and
Without formal training, they learn their administrative jobs by the sink or swim method and they often sink. advancement in the field. As a consequence, many have already entered the field at various low and middle professional levels and the
likelihood is that many more will. This is, however, a mixed blessing. Middle managers are having the same kinds of problems as top management where psychiatrists or other clinicians become administrators by fiat. Without formal training, they learn their adminstrative jobs by the sink or swim method and they often sink. When they do learn to swim, they may do so poorly. The probability that some of them will pick up the appropriate knowledge and skills on their own is especially slim in this field due to the scarcity of literature (Heide 1970). To enter the channel and negotiate it successfully requires training that is rigorous, relevant, and sufficiently flexible to preclude a major disruption of one's career and life situation. The Job Market
Based upon our experience, the demand for mid-level traineeships is real and there appears to be a market for persons completing such training. There are several indicators of an increasing potential need for mental health administrators at the mid-management level. The deemphasis of hospitalization is likely to create a demand for trained administrators at intermediate levels of responsibility. For example, the subcontract approach to service delivery and the regionalization of the New York State Department of Mental Hygiene w i l l p r o d u c e a d d i t i o n a l e c h e l o n s of a d m i n i s t r a t i v e r e s p o n s i b i l i t y w i t h i n the services network. Basically this approach provides for the restructuring of mental health/retardation, drug and alcohol services such that localities and the state would jointly plan, d e l i v e r , a n d finance them. As an immediate consequence of this unification, the Department of Mental Hygiene has been decentralized and a greater variety of programs for the m e n t a l l y ill will ensue. Both consequences will have the effect of creating new a d m i n i s t r a t i v e and p r o g r a m m i n g positions in the middle ranges. At least in New York, there will be a need for more persons 195
trained in administration, program operation, clinical services, coordination, and community mental health. This trend appears to be indicative of the future directions in which mental health services will be m o v i n g nationally. Further, there is an increasing tendency in the human services generally toward taskcentered administration and a gradual erosion of the classical distinction between program and administrative staff. This trend will mean that staff at levels will become more and more involved in the administrative process (Schatz 1966). Other observers have also predicted that the future of mental health and human services will see an increased d i s t r i b u t i o n of administrative roles and responsibilities down into the middle range of the organization (Whittington 1973; Mechanic 1973).
There is an increasing tendency in the human services t o w a r d t a s k - c e n t e r e d administration.
DESIGNING THE TRAINING Although a variety of requirements and experiences such as site visits, projects, clinical practice, etc. are appropriate to round out the training of administrators, the core of our approach is a combination of course work and intensive field experience organized around learning outcomes regarded as both necessary and achievable.
Setting Objectives In attempting to design a program of learning directly geared to job performance we looked to several sources of information: 1) the limited published literature in the area; 2) job descriptions for existing middle management positions in county and state mental health systems; 3) trainee identification of learning 196
needs; and 4) advice from field work supervisors. We then identified a number of knowledge and skill areas to serve as learning objectives against which to develop course content and field experience. The following list represents a catalog of areas in which middle managers should be competent: 1) Knowledge of acceptable standards of care in various treatment modalities. 2) Ability to translate broad policy into concrete service programs. 3) Ability to establish and monitor s t a n d a r d s of p e r f o r m a n c e and organizational objectives. 4) Knowledge of methods to recruit, train, and supervise professional and sub-professional personnel. 5) Ability to use patient care records for improved quality of care, staff training and supervision, and p r o g r a m management. 6) Knowledge of procedures for efficient distribution and control of information. 7) Ability to budget and account for operational funds. 8) Knowledge of a n c i l l a r y s u p p o r t systems within and outside of the unit or organization. 9) Ability to articulate organizational or unit programs and goals for use by higher management and/or community groups. 10) Familiarity with sources of job-related information and data, i.e., professional literature, n a t i o n a l o r g a n i z a t i o n s , local and regional planning agencies. 11) U n d e r s t a n d i n g of line and staff functions within formal organizations. 12) Sensitivity to problems and potentials of i n f o r m a l o r g a n i z a t i o n s within formal structures. 13) Knowledge of systematic techniques (e.g. PERT, MBO) for planning and implementing work. 14) Knowledge of appropriate staffing patterns and delegation of responsibility.
15) Awareness of the therapeutic and a d m i n i s t r a t i v e c o n s e q u e n c e s of various organizational models. 16) Knowledge of relevant regulatory a n d / o r statutory constraints affecting service delivery. 17) Appreciation of internal and external political realities affecting services. Course Work
The formal course offerings intended to meet these training objectives are for the most part m o d i f i c a t i o n s of the courses o r i g i n a l l y designed for top management trainees. The courses, with very brief content descriptions are listed below. The first four are required of all students with others chosen on elective basis after student/advisor consultation. Administrative Theory and Practice I n t r o d u c t i o n to the principles and techniques of management and organizational issues. This course, taught by a professional a d m i n i s t r a t o r , uses a c o m b i n a t i o n of theoretical and case materials cutting across a broad spectrum of organizational entities not limited to human services. Organization of Mental Health Services
This course analyzes a variety of major community mental health service delivery models in America and abroad. As a part of the course requirements each trainee develops a comprehensive description and analysis of an existing service program. Introduction to Community Psychiatry This s e m i n a r reviews the h i s t o r i c a l , theoretical, and operational bases for the community based approach to mental health care. Techniques of Agency Management
T a u g h t by a seasoned local agency executive, this seminar is a "how to" course in the day-to-day problems and procedures of managing a community based human service agency. With heavy emphasis on the practicum
approach, trainees learn to prepare and present budgets, write job descriptions, interview job applicants, apply systematic approaches to problem solving, etc. The Social Context of Mental Illness This seminar explores the social and cultural factors associated with the prevalence and distribution of mental illness and society's response to the problem. Evaluation of Human Service Programs
This course reviews process, structure and outcome approaches to assessing the quality, efficiency, and effectiveness of v a r i o u s therapeutic techniques and organizational models for mental health services. Trainees are expected to develop a workable design for the evaluation of an existing or hypothetical service program. Mental Health Therapy
More clinically oriented, this seminar introduces trainees to various therapeutic techniques (behavior modification, transactional analysis, network therapy, etc.) with emphasis on their relative value with respect to type of problem and available resources. The course includes a review of the literature assessing the outcomes of various treatment interventions. Politics of Mental Health Services
With an emphasis on case studies, this course covers the formal and informal political processes as they impinge on service delivery at the middle management level. Transitional Services This course reviews the design, operation, and effectiveness of a wide variety of community based transitional programs that facilitate institutionalized patients' re-entry into the community. Field Placement
For the full-time trainees, the traditional field placement model was used. The trainee 197
was placed in an agency for the equivalent of 20 hours a week for ten months under the direct supervision of the agency director. A second approach was developed to accommodate part-time trainees who were already employed full-time in a human service or mental health organization that met the program standards as a placement site. An agreement similar to a contractual relationship was reached between the director of the organization and the trainee. This e n a b l e d the latter to take on responsibilities beyond his regular duties for which he would receive field work credit. The agency director served in a dual role as the field work preceptor and the trainee's supervisor. In several situations, a trainee would be employed in an agency or setting that met the placement standards but did not have a supervisor available who qualified for the preceptor role. In these cases, a third model was developed where a senior administrator from outside the agency would work with the trainee as a preceptor. As in the second approach, arrangements were made for the trainee to assume a major administrative responsibility over and above his regular duties. The outside preceptor would meet with the trainee on a regular basis to guide him through the completion of his field project. As might be expected, the first model is the simplest to arrange, monitor, and control. The second a p p r o a c h is p r o c e d u r a l l y m o r e complex but is not significantly different in quality. Its most salient difficulty is the virtual impossibility of ensuring that the trainee actually invests the proper time and energy. While we insist that both trainee and supervisor give assurances that the field placement represents a distinct commitment, it is difficult to identify precisely where job duties end and field work responsibilities begin. In the third model, the relationship with the preceptor is entirely different. Here he acts more in the role of a consultant and the major difference has to do with the accountability of 198
the trainee to the preceptor. Our experience suggests that this arrangement must generally be limited to mature senior-level trainees who undertake a focused project, such as the development of a program plan and are capable of making maximum use of the special expertise of a non-supervising preceptor. If the goal is simplicity, the traditional field placement model is best. However, there is little evidence of serious deficiencies using the other approaches so long as great care is taken to match preceptor with trainee. It is important to obtain in precise detail the necessary clearances and understandings with all persons concerned including those in other agencies. Actually, there appears to be a distinct advantage in arranging field placements as adjuncts to regular jobs. The individual trainee is not forced to carve out a role in the agency as is necessary with the traditional type of placement. This appears to reduce significantly the startup time for getting to the real business of the placement. Conclusion Middle managers play a key role in the administration of mental health agencies, but many lack administrative training. The need for such training is great and will likely remain so in the future. Training must be made available to working professionals in mental health and those in related fields who seek to enter the system at a parallel level. To meet these needs, the training must be flexible in design and geared for both the problems and advantages of part-time students participating in the program over a protracted period of time. While part-time students are proportionately more expensive and their progress is more difficult to evaluate, their field work is often more rewarding and they help the training program develop close ties with the agencies in which they are employed. Further, their degree of commitment to training may over the long run, be greater than that of full time students.
REFERENCES
Barton, Walter. Administration in Psychiatry. Springfield, I11.: Charles C Thomas, 1962. [-Ieide, Robert. Coordination as a task of management: A review. In: Schatz, Harry A., ed. Social Work Administration: A Sourcebook. New York Council on Social Work Education, 1970. Vlechanic, David. The sociology of organizations. In: Feldman, Saul, ed. The Administration of Mental Health Services. Springfield, I11.: Charles C Thomas, 1973.
New York State Mental Hygience Law, Article 11, 1973. Schatz, Harry A. Staff involvement in agency administration. In: Trends in Social Work Practice and Knowledge: N A S W Tenth Anniversary Symposium. New York: National Association of Social Workers, 1966. Whittington, H. G. People make programs: Personnel management. In: Feldman, Saul, ed. The Administration of Mental Health Services. Springfield, II1.: Charles C Thomas, 1973.
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