Outpatient Behavioral Treatment - Essay Example

Running Head: ORGANIZATONAL CHANGE Organizational Change Part II James Jean Barry March 27, 2008 ORGANIZATIONAL CHANGE B) My Understanding of Under-staffed Outpatient Units and The Effects on Clients. As I pointed out in section one of this paper. During school breaks, there are no interns available to provide therapy to the outpatient clients of St. Luke's. This results in one counselor seeing about 10 to 13 clients per day. Approximately 30 clients visit the section daily. Each client usually has a session lasting about an hour. (Program Description, 2008) The future is dim. As it currently stands, this means that without the help of the interns the patient coordinator will have to serve all the patients alone or seek the help of other clinicians. (Program Description, 2008) As drug abuse continues to affect individuals, families, and communities, the need for treatment will remain urgent. At the same time, current federal and state financial trends portend continued and perhaps even increasingly scarce resources. Because of the promise of interorganizational cooperation for improving access, quality, and cost-effectiveness of care (Shortell 2002), understanding what factors lead to such relationships within the drug abuse treatment sector may thus have vital implications for policy makers and managers. Getting lost in the shuffel here is that the ultimate goal of drug addiction treatment is to enable an individual to achieve lasting abstinence, but the immediate goals are to reduce drug abuse, improve the patient's ability to function, and minimize the medical and social complications of drug abuse and addiction. Like people with diabetes or heart disease, people in treatment for drug addiction will need to change behavior to adopt a more healthful lifestyle. Untreated substance abuse and addiction add significant costs to families and communities, including those related to violence and property crimes, prison expenses, court and criminal costs, emergency room visits, healthcare utilization, child abuse and neglect, lost child support, foster care and welfare costs, reduced productivity, and unemployment. (National Sruvey on Drug Use and Health (NSDUH), 2004 ). Thus, by failing to provide the proper staff for outpatient care, state funding is predicting a cycle of expense to the state without justification. More importantly, by having understaffed outpatient rehabilitation, the state is absolutely guaranteeing failure for the clients in maintaining their sobriety. C 1.) Who Might Agree With the Proposition That Understaffed Out Patient Programs Cause Harm To The Client. A 2002 estimate for the costs to society of illicit drug abuse alone is $181 billion (2002). When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity. Successful drug abuse treatment can help reduce this cost; crime; and the spread of HIV/AIDS, hepatitis, and other infectious diseases. It is estimated that for every dollar spent on addiction treatment programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some outpatient programs, total savings can exceed costs by a ratio of 12:1. (National Sruvey on Drug Use and Health (NSDUH), 2004 ) Having been in the outpatient department for a long time and with proper knowledge on the flow of the people in and out of the section, the patient coordinator understands the magnitude of the problem and I am quite sure that he will agree that it urgently needs to be addressed. Accordingly, the patient coordinator, as the one directly affected by the lack in staff would be the first person to agree with this recommendation. (Kirst-Ashman and Grafton, 2006) Scientific research since the mid-1970s shows that treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and addiction. (National Sruvey on Drug Use and Health (NSDUH), 2004). Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. Based on this research, key principles have been identified that should form the basis of any effective treatment program. Those who work with me in the outpatient department clearly understand the process of handling patients, the time each client takes and accordingly would agree with me on the recommendation. (Kirst-Ashman and Grafton, 2006) C. 2) Who Would Disagree With the Notion of Hiring More Staff For the Outpatient Program The administration may disagree with the need to hire more staff. However, the disagreement may arise more from cutting corners as opposed to an actual difference in theory. Administration is just as overloaded as those of us in outpatient but they are overloaded with requests by all of the other departments for additional staffing. Indeed the needs of the outpatient department are minimized since every new term ultimately brings in now interns, so what is the big deal if a therapist is overworked for a few days After all, after the break the student interns will be back. It is that clear my recommendation needs the support of the administration in order to achieve its goal of streamlining the services at the out patient section of the agency, however I am not likely to get it based upon the above mentioned points. (Kirst-Ashman and Grafton, 2006) Finally, it is clear that each department sees its own problems as being paramount to others. As such, it is unlikely that the outpatient department will see any aid until the outpatient clients find themselves back into the inpatient department, because outpatient was unable to assist with their crisis and the whole cycle begins again (Kirst-Ashman and Grafton, 2006) D. Data supporting description of the problem I think that there is a lot of data that supports the need to implement changes to address the problem. One of the most important data that can give accurate results that supports the need to hire more staff is the patient register data which is likely to give the number of patient attending the section and the time they take in their sessions. This will give an accurate description of the ratio of staff to patient and the time that is taken to serve each client. This ratio can be compared with that from other centers, which can clearly give the strain that those who are working in the department undergo. (Program Description, 2008) Another data that can be consulted to support the implementation of the change is that from other departments which is likely to give the ratio of staff to patients. Also data from other center's outpatient section can be used to support the need to increase more staff in the section. E. Different Solutions to the Problem Without the proper funding, there are no solutions that benefit the clients. All of the proposed solutions are bleak and stand thus: a. Reducing the number of hours that a client is served in the section from the current one hour to around 30 minutes in order to give staff time to serve more clients b. Hiring four more therapists in this section in order to increase the ratio of counselor to client, and cutting the salaries of current staff without reducing their hours. c. Implementing a grant writing team. The team can be generated by asking the interns to begin writing the grants that administration recommends. Furthermore, the interns in the outpatient would seek funding through grants for their own department thus insuring that the monies are delegated to the outpatient program exclusively. d. Shifting some counseling services to other departments in the center. e. Introducing a clinic system where patients and staff are scheduled to attend counseling service on particular days in order to regulate their attendance. Creating almost a school type environment F. The Solution That I Recommend The solution that I recommend is the hiring of four therapists for the outpatient program. Granted, funds are tight, but if the outpatient program is compromised, as it is now, the entire program will be. The key to drug rehabilitation is making sure that a client can stay sober and maintain their sobriety on their own. Indeed, the outpatient clients will become inpatient clients because the ST. Luke's system has failed them. In turn, the inpatient facility will become overwhelmed and there will be and internal and external decline in St. Luke's facility. G. Assumptions There are several assumptions that I have made while making the above recommendation. Firstly, I assume that the organization will be able to get the required staff to fill the vacancies in the department. This is a reasonable assumption because I am sure Barry University interns would consider a position at S. Luke's. Moreover, as has been previously stated, since 72% of the workers from St. Luke's are graduates from the program, certainly, there are more graduates that could be offered a job opportunity. (Program Description, 2008) By this I presume that St. Luke's will engage grant writers (such as students from Barry University) that will apply for grants specifically for the Outpatient department. (Kirst-Ashman and Grafton, 2006) The feasibility of this idea is certain because part of the internship for the Barry University students could be the grant writing, or those who are pursuing a degree in the administrative field. Although it may lead to increased expenses for the organization it will be beneficial in that the organization will be living to its mandate of alleviating human suffering. (Kirst-Ashman and Grafton, 2006) H.1) Risks To The Client Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as: Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs; Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families; motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment and finally Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs. (National Sruvey on Drug Use and Health (NSDUH), 2004). Failure to provide these treatments creates an assurance that they will find themselves back in inpatient. H. 2) Risks to Saint Luke's The risk to Saint Luke's is that it will likely fail due to its' inability to treat the outpatient clients the way they needed. Thus it may fail in any state and federal mandates required to receive funds and certification. Moreover, clients do not respond well to revolving door therapists. It takes a while to connect with a client. The relationship between a therapist and their client is entirely based upon trust. How can a client be expected to trust a turnstile agency (Kirst-Ashman and Grafton, 2006) H. 3) The Risk To Me To me there really is no risk. I may need to stay on until a suitable replacement is found. However, I have connected with my clients and do not relish the idea of leaving them. (Kirst-Ashman and Grafton, 2006) I. Potential Supporters of This Recommendation I believe that there are several supporters of my recommendation. Specifically, I feel that those who have worked with me in the department are likely to be the leading supporters of my recommendation. But also the clients are likely to be the potential supporters of my recommendation since they will acknowledge the idea of getting quality services from the section. (Kirst-Ashman and Grafton, 2006) J. Who Would Not Support My Recommendation and Why I feel that the administration is not likely to support my recommendation as much as other would support it. This is due to the financial repercussion that is likely to come with it. It may be needed to source for more funds to implement the recommendation and seeing that services are normal in the department, they may find it difficult to do so. It is the administration that overlooks the operation of all departments and although they are aware of the shortage of staff that is being experienced currently in the department, they may not be willing to hire more staff due to the financial repercussion that the agency may be likely to face. The administration may also find it difficult to hire the staff as sometime it will need to have the authority of the funding body in order to effect such a change in the functions of the department. But I hope that the administration will look closely at the data from the mentioned sources, which can convince it on the need to have more staff in the organization. (Wolfgang, 2001) For the administration, the recommendation may mean increase in the payroll but it would also means satisfaction in the services offered. To the client it would result to quick and improved services. 6.0 Summary (a) Statement of condition As it currently stands there exists a severe shortage of staff in the St. Luke's outpatient drug treatment program during school breaks. Specifically stated, there is only one therapist to handle the needs of thirty outpatient clients per diem. (b) Question for engagement What must be done in order to ensure that the outpatient program is equipped to handle clients during school breaks (b) Recommendation More staff must be hired to work during the school break in the in the outpatient program at St. Luke's in order to cover the current shortage. (d) Goal The goal of my recommendation would be to raise the funds so desperately needed to increase counselor-client ratio in order to enhance quality of services offered in the department. Treatment and prevention efforts are often overshadowed by law enforcement needs. Indeed, a recent study by the Center on Addiction and Substance Abuse ("CASA") showed that of every dollar States spent on substance abuse and addiction, only four cents went to prevention and treatment. The States and the Federal government have undeniably important legislative obligations, but we must do more to harvest their resources to help people that they are here to serve. St. Luke's can turn around the outpatient programs with funding out-patient programs that seek to reduce the harms associated with drugs, including addiction. The funding allows should focus on the capabilities, not inabilities, of our children. Most importantly we should understand that drug experimentation is different from both misuse and drug abuse, and seek ways to help those who have a problem with substance abuse. As in 12 step programs, the first step toward recovery is the recognition that we have a problem in the St. Luke's outpatient program. Organizational Change Part II James Jean Barry University March 27, 2008 Force Field Forces for change The Change Forces against I have chosen to focus on the above factors since I feel they are the ones which are likely to determine how my recommendation will be implemented. The administration will be put under pressure by the shortage of staff and the need to provide quality services in the department and at the same that if other staff throws in their support, it is likely that the recommendation will be easily implemented. (Wolfgang, 2001) The administration is a key player. In this regard it will determine how funds are sourced for the project. It will work to convince major donors to provide funds for the project since it may be facing cash constrain and addition staff may be a burden on its payroll. Without the help of the administration, it would be difficult to effect the recommendation. (Kirst-Ashman and Grafton 2006) I have focused on the shortage of staff since this is the most pressing need that this section is facing. This is the driving force which would see the project being implemented. It is the physical evidence, which can prove the need to have more staff on the department. ((Program Description, 2008) The aim of the organization is to serve the clients well by providing quality services. This can be achieved by ensuring that there is enough staff to serve the clients. Lack of proper services to the client can be another force that would be driving the organization to change and hire more staff. With the current situation, which can be experienced in this section in case there are not interns, the patients are likely to get low quality services since the patient coordinator will be striving to serve all the patients. ((Program Description, 2008) I have chosen other worker in the organization as a potential barrier to the implementation of the recommendation because they are likely to call for increment of staff in their sections as well. Many workers would like to work under less pressure, a situation which comes with more staff in a department. Hence it is possible that workers in other departments are likely to put the same kind of pressure on the administration to hire more staff for them, which would render the quest for hiring more staff in the outpatient section not taken seriously. (Kirst-Ashman and Grafton 2006) Sociogram Agency system Macro Client System This is an illustration of the sociogram of the organization and the change. (Kirst-Ashman and Grafton, 2006) Alliances and professional networks that can help to promote the change There are many alliances and professional bodies that can help me in implementing the recommendation. These include organizations that can be of help in assisting with financial aids that are likely to fund the recommendation. Also I think that professional organizations like the Agency Workers Union would be of much help in implementing the change since they would act to pressurize the organization to implement the recommendation. (Kirst-Ashman and Grafton, 2006) I also feel that health organizations that call for provision of quality services to patients would be of much help in campaigning for the organization to implement the recommendation. This is because the aim of any medical organization would be to campaign for provision of quality services to the patients and they would not hesitate to provide the needed services in effecting the change. They would help to pressurize the administration to carry out the recommendation if the center has to offer quality services to the patients. (Catholic Charities of Archdiocese of Miami, 2007) But I feel the donor organization would be best suited to help the organization since this might end up as a financial burden to the organization. In this regard I would be looking for major donors who have been working with the organization like South Florida Provider Coalition (SFPC), Fla, Department of Children and Families, United Way of Miamian - Dade, Ryan White Title- 1, and Fla. Medicaid. ((Program Description, 2008) I believe that the above donors who have been supporting the agency for a long time will find it necessary to effect my recommendation and provide the much needed funds. But the collaboration is not limited to only the above donors. I believe there are other donor bodies that would be willing to offer their help in the organization since the overall goal of the recommendation would be to enhance services to the clients. References Program Description, (2008). St. Luke's Addiction Recovery Centre: Program Description. Catholic Charities of Archdiocese of Miami, Inc. Organization description. Retrieved from, http://www.catholiccharitiesadm.org/what_we_do.htm on 9th July 2007 Kirst-Ashman, K. K. & Grafton, H. H. (2006). General Practice with Organizations and Communities. Thomson Corporation. Shortell, C. (2005). Factors Associated With Interorganizational Relationships Among Outpatient Drug Treatment Organizations 1990-2000. New York: Health Services Research. United States Department of Health (2005). 2004 National Survey on Drug Use & Health Results from the 2004 National Survey on Drug Use and Health: National Findings. Washington, Prentice Hall. Wolfgang, H. (2001). Solving Discipline and Classroom Management. New York: John Wiley and Sons. Read More