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How are human services agencies created? (Iteration One)

As a project transforms from an ad hoc initiative by a concerned group of people to a mature human services agency, there are many points at which things can and often do go astray. These range from the relatively minor and inconsequential to points where the process shifts significantly off the intended track. What the Initiators intend is only more or less realized. At times, the result has little but a vague relationship to the original intent. Let’s explore the creation process for human services agencies and see how things go right and how they go wrong.

The development phase starts when some people – the Initiators – see others who they think need help. They decide to pursue this as a personal cause or project. Typically, they then take their idea to a super-ordinate group – the Authorizers – for support and action. This could be to the Legislature, the County Commission or City Council, a philanthropic individual in the community, a foundation, or the governing group within a church or private organization. The important point is the people who actually decide if something will be done and determine what will be done are neither the group who initially want to help nor the people to be the recipients of whatever supports and services are eventually provided.

Let me pause to point out the Initiators are a group or fledgling organization that goes through stages and growing pains.  Homan (2008) suggests, “The seven common stages of organizational development and maturation are introduction; initial action; emergence of leadership and structure; let down, loss of members, and floundering; recommitment, new tasks, and new members; sustained action; and continued growth, decline, and termination.” (p. 307) Whether we use Homan’s model to understand the life cycle of the Initiators or some other conceptualization, it is important to accept the reality things likely will not always proceed smoothly or without some degree of confusion and disruption. The key is to commit to being in it for the long term and to the goal of helping people in real need. Inevitably, our eventual success is, in large measure, a product of patience and persistence.

Some human services agencies form as a result of grassroots efforts where the initiating group incorporates to provide the supports and services, using their own resources and providing the needed auspices for the effort. Clearly, this arrangement is contained much closer to those needing help and those wanting to help. A variation on this type of development also may result when one or a few major donors are (or become) the primary fund source for an agency. Those individuals then may exercise super ordinate control over the agency and effectively define themselves as the central source of authorization and auspices. However, most common are arrangements and processes separating decision making from the people to be helped, with the extent of separation increasing proportionately to the size of the authorizing entity.

Think of a triangle, with the point at the top as illustrated in Figure 1. Point “A” is at the lower left and is where the people are who need help. The decision makers and resource providers – the Authorizers – are at the top, point “B.” The people wanting to help – the Initiators – are along the left side of the triangle, going through the steps needed to make their case with the people at point “B.”

The new agency is at point “C,” at the lower right. Consider the path along the right side of this Helping Triangle from “B” to “C” as the agency emerges from the process.

Assume the Authorizers approve the formation of an agency and assure the necessary resources or at least approve the strategy planned to obtain the resources. The agency at point “C” in the triangle above now has authorization and resources potentially available. Even so, there is no agency yet. What has to happen to successfully move the process along from “B” to “C?”

The authorization provided at point “B” is never unconditional. It comes with requirements and restrictions, cautions and expectations. Depending on the size and complexity of the authorizing entity at point “B”, these conditional elements are typically extensive. What’s more, they vary from important and obviously integral to agency success on the one hand to trivial and only tangentially relevant. Nonetheless, they each represent necessary steps along the way to point “C”.

Although the specific conditional elements vary from one authorizing entity to another and vary depending on whether the entity is governmental, religious, or private, there are some elements common to all.

·       Some type of regulatory mechanism is required to transfer and account for the expenditure of financial and other resources.

·       There is a governing mechanism including either a governing Board or a Chief Executive Officer – CEO – who reports directly to the authorizing entity. – For our purposes here, I use a model including both an administrative Board frequently referred to as a Board of Directors and a CEO.

·       There is an administrative mechanism to develop and oversee local policies and implementing procedures for day-to-day operations.

·       There are qualified staff and appropriate facilities to do the work of the agency and to deliver the supports and services for which the agency exists.

·       There are mechanisms in place through which the agency reports to the authorizing entity, maintains accountability, and provides other required data and information.

·       There are related processes in place to assure the required elements are in place and working. – These latter processes may be thought of as meta-processes. This concept is discussed in more detail in Chapter Eight.

Beyond these conditional elements, there are what may seem to be endless rules, standards, and guidelines promulgated by governmental entities, whether or not the authorizing entity at point “B” in the above triangle is governmental. Additional standards and guidelines are promulgated by accrediting organizations, professional organizations, and other entities to which the agency is or will become accountable, including multiple funders. The result is the journey taken by the Implementers along the right side of the triangle from “B” to “C” is likely much more complex and potentially confusing than was that from point “A” to point “B”. Concurrently, the chances that the journey will result in a complete match between the help offered and the help needed are minimal to non-existent.

Even after the human services agency forms at point “C”, the complexity increasing from point “A” to point “B” and from “B” to “C” continues to increase. Point “C” – the new agency – must connect with point “A” – the people needing help. How does a human services agency providing supports and services connect with people needing help?

The task now is to connect points “C” and “A” to complete the Helping Triangle. The agency development process moves clockwise from “A” to “B” to “C”. The process should continue to move clockwise from “C” to connect with “A”. It should not suddenly start moving counter-clockwise from “A” to “C”. Unfortunately, the behavior of human services agencies too often suggests the expectation is people needing help will connect with the agency instead of the agency connecting with them. Suffice it to note the agency has a facility where it provides the services for which it has been authorized. It has qualified staff – the Providers – in place who can and will provide those services. The challenge now is for the agency and potential clients to connect.

Although there are numerous variations, the agency and Potential Clients connecting typically reflects a common theme. There are people who have needs, problems, or vulnerabilities with which they are struggling to cope. Perhaps they recognize the issue themselves or have it called to their attention by friends or family members. “Research indicates that most referrals are made by word of mouth. When people are in pain, they are likely to ask the advice of someone they trust.” (Mandell & Schram, 2003, p. 4) Either way, they develop a self-perceived need for help. They then seek this help within their familiar environments. This may include discussing their concerns with their neighbors, friends, ministers, doctors, or with staff members from other agencies with which they are already connected. At some point, they become aware of the agency. – Notice how the person needing help first interacts with people who know about the agency and then with the agency itself. It starts as a people helping people event. Also note the action is typically counter-clockwise with respect to the Helping Triangle, moving from “A” to “C”.

Even if the agency uses an outreach strategy attempting to emulate the people helping people model by having agency staff go to where potential clients are to initiate the contact – and human services agencies typically do not – what follows does not change much. The Potential Client goes through an induction process to determine if he (or she) is eligible to receive the services or supports. First, does the potential client actually have the need, problem, or vulnerability for which the agency is authorized to offer services? The services the client can receive are limited to those for which the agency is authorized. Next, does the potential client pass other screening criteria the agency uses to determine eligibility such as age, income, residency, or membership in a specific group or organization? If the potential client passes through the screen, it is time for services agreements.

Services agreements vary a lot in terms of content and formality, but they have common elements. Perhaps the most common element is the client’s needing to agree to the type, frequency, duration, and timing of services recommended by agency staff. The agency requires the client to agree to receive service “X” or services array “Y.” Next, the services are to be delivered on specific days at specific times. Finally, the services are expected to take a minimum amount of time from start to an end point generally not specified. The agreement clearly spells out what is expected of the client. These agreements are called service agreements, treatment plans, case plans, or have other names with a quasi-contractual quality about them. They are binding on the client to the extent services may be stopped if the client fails to comply.

These agreements are particularly one-sided. They are usually specific about what the client will or will not do but quite general with respect to what the agency or agency staff members will or will not do. The agreements may specify the agency will provide service “X” or services array “Y” but are mute on what this means, on the quality of the services, and most significantly, on whether or not the services will actually improve the client’s capacity to cope. They give no assurance the help will, in fact, help or what recourse is available to the client if receiving the services does not help. Nonetheless, if the Potential Client finds and contacts the agency, passes through the screen into services eligibility, agrees to the terms of service, and then follows through appropriately, the connection between points “A” and “C” on the Helping Triangle is established.

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