NAME=”T1″>How are human services agencies
created?



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. NAME=”ehsm_OLE_LINK235″>Homan 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.” 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 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.” 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
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.