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The
delivery of human services has for the last forty years been subject
to a command and control management which has been based upon defect
and expert models. These efforts have substantively failed. The
management style that is appropriate for cognitive behavioral services
is a total quality or continuous quality improvement management,
based on the principles of W. Edwards Deming and conceptually based
on the same learning theory as cognitive behavioral approaches.
This site will examine management of human services from the perspective
of quality or outcome management, review the seven factors which
make up a management system, and offer ethical constructs to guide
the manager and policy maker. Management of cognitive behavior and
management of service delivery are not unlike processes. In fact,
much can be learned by exploring the comparisons.
Concepts:
Schools
& Behavior Health Rehabilition Services: In Pennsylvania
the Office of Medical Assistance [Medicaid] has developed the use
of managed care organizations in an attempt to save money. This
article explores suggestions as to how to bring a very fragmented
system of child services together in creative ways to enable children
with problems in living to improve social performance. Behavioral
health is the current metaphor for 'mental illness' a metaphor for
problems in living which make the person appear to be bizarre.
Schools & Social
Competence: This article examines ways that schools can develop
services and support for students with problems in living as a means
of enhancing social competence.
Organizational Models:
Making a shift in a system of human services from a medical model
to a cognitive behavior model requires significant design changes
within all factors of the system. A paradigm shift of significant
proportions requires that the policy maker/manager understand that
most people simply "won't get it". When such changes are
attempted, managers often attempt to address only one part of the
system at a time because they are convinced that such practices
are pragmatic. However, such practices allow the old way of thinking
to continually undermine the process of change. In making the shift
from traditional models of serving people with problems in living
to a transitional model dedicated to the use of cognitive behavioral
management, one is required to look at the full range of organizational
elements which have been identified by Robert B. Waterman, Jr.,
Thomas J. Peters and Julian Phillips in a 1990 article called STRUCTURE
IS NOT ORGANIZATION.
Changing an Organizational
Culture: Managing people in an organization has certain congruence
with managing people with problems in living. In both cases, there
is a requirement to get the personal preferences of the individuals
involved compatible with a specific, defined set of assumptions
which the manager believes will be beneficial to both the individual
and the organization or society. And in both cases, the critical
assumption underlying the need for change is that the learning environment
[culture] has somehow created and maintained thoughts which are
now considered to be incompatible with the desired culture.
Performance Management:
Human service managers today are intrigued by outcomes. It is a
fad which is given a great deal of "lip service" but often
without merit. The reason for this is that we so often measure outcomes
without a standard. "I want to do what's best for kids."
What a wonderful thought. Shouldn't we all be this caring? However,
people who use this as a mantra often believe that 'what is best
for kids is' something that people who believe in social learning
theory would feel is very negative for kids. Until we decide what
is best for kids, we have no means of measuring outcome nor making
decisions about management performance.
Planning : Planning is essentially
a process of collecting information which will enable one to make
decision about some future point or goal. When one talks about planning
in the context of human services one needs to collect a great deal
of information from diverse fields; reach consensus about the relevance
of that information to groups and individuals; and make decisions
about various components of systems regarding the best possible
strategies and tactics to meet an agreed upon mission.
Philosophy: Managers often
look askance at philosophy as though it were a "frill"
and not an essential. They feel, perhaps, that results oriented
people are pragmatic, not philosophical. Unfortunately, no organization
can reach right results without a clear definition of its own summum
bonum, (life's greatest good). This process is important, not only
to the field of human services, but to the process by which people
with problems in living seek coherence.
Developing Social Policy:
We will examine coherence as it applies to the development of a
systematic connectedness based on the development and implementation
of social policy in regard to the management of the delivery of
human services. It is our hypothesis that the inability of government
to steer [set precise goals both for direction and measurement of
accomplishment]; and to learn [identify discrepancies between goals
and outcomes and design new alternatives to more optimally meet
those goals] has left our society with a human services network
which marches toward oblivion with very good intentions. We further
suggest that the conflict of explicit [that which is stated] and
implicit [that which is intended] social policy along with the fallout
lack of consistent patterns of values and incongruous sets of ideological
principles, results in real harm being done to people with problems
in living.
Values: Values are held at three
levels: as ideals which may never be reached but are what is what
we hope for; as goals which we will work towards with the expectation
that some day we will get there, and as commitments which means
that every person is working on these values NOW! Often values are
not held as commitments by staff people even though they are held
as commitments by organizations. This is sometimes due to the vague
manner in which they are articulated.
Program Management &
Staff Practice: Changing a human service system is a process
of developing clarity between beginning points and outcomes and
developing new problem solving solutions to bridge the gap between
the two. The intent here is not to develop a text in regard to all
of the specific steps of that solution process, but rather to identify
some of the salient components of a transformational system. The
most single characteristic of a human service delivery system is
the quality of its personnel.
Human Service Systems: If
the human service system is really a system, what are its goals
and outcome expectations and how are they measured? This examines
some of the pitfalls of the traditional system of providing services
to people with problems in living.
Social Context: The school can
and does influence the social sanctions which implicate our sociocultural
behavior. Therefore it behooves us to begin to dissect those aspects
of schools which enhance the ability of students not only to learn,
but to become prosocial citizens.
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