William Gapen, B.A., B.S.W., M.S.W., Laurie Dart, M.S.W., R.S.W., Barbara Macdonald, MA (SWP), RSW.
During the past decade, much work has been done that focuses on building and maintaining responsive service systems for individuals with challenging needs or who present with complex service situations. It has been learned is that attention to specific systemic issues in the service delivery system is essential for successful outcomes for these individuals, in order that they get adequate support from a particular agency, service sector, or multiple services/sectors. Historically, services and supports for individuals with a dual diagnosis have been fragmented due to a lack of coordination and communication. One agency or service sector cannot meet all the needs of an individual with complex needs including a dual diagnosis. To be effective, service planning and delivery must be coordinated at the individual (consumer), program (specific agency services), and system (social policy and sector/community planning initiatives) levels. By creating a responsive service delivery system, service gaps can be addressed effectively, and in a timely manner. One way to support the development of a responsive service system is by building a collaborative and coordinated approach through a Community Support Network. Studies have shown that when a community based partnership approach has been utilized which reflects a more formalized network of services, better outcomes are often achieved for individuals who present even with the most challenging issues (Dart, 2002).
This article will look at key principles and strategies in building a Community Support Network. Examined will be the leadership role in developing such a Network, in particular, how a lead organization must have a clear vision that is based on a well articulated core ideology and values in order to promote organizational commitment both internally and with community partners. Finally, discussed will be the importance of creating a culture of learning to better support the lead agency and Network membership.
Setting the Context: Community Support Networks
A community network approach utilizing a systemic framework for service planning and delivery promotes an integrated service system for individuals with a dual diagnosis, and in turn, provides a range of comprehensive supports involving a number of service providers and sectors. The goal is to build a network based on a continuum of integrated services and supports. This continuum of supports represents a range of service options such as crisis, case management, day activities, treatment, respite, social/recreational and inpatient/outpatient hospital. Building this continuum through a collaborative network approach offers a wider range of support options to a consumer, with specific services being provided by agencies working in partnership within the context of a broader formalized network (Dart, 2002).
Recently evidence-based literature shows the benefits of building a comprehensive and integrated Community Support Network in partnership with others within a local community or region to support people that otherwise might have problems getting access to appropriate services and supports (Gapen, 2001). Based on several working network models developed at the Griffin Centre in Toronto, Ontario, such network approaches demonstrate that by bringing together a range of formal and informal supports and services to address specific service delivery gaps for children and adults that have complex needs a more effective and efficient response is often developed. The participation of multiple service providers, as part of a larger coordinated Community Support Network that offers a continuum of supports and services, not only often provides a more comprehensive range of care options to individuals with a dual diagnosis and their families, but also provides a more mutual-aid approach to both the individual and the service providers involved in supporting a consumers plan of care. It has been our experience that service providers might not feel that they are able to serve an individual with complex needs on their own, but are more likely to consider offering service if they are a part of a larger formal network of supports and services. Thus when individual service providers come together in a formalized partnership, as part of a larger Community Support Network, often new and innovative opportunities for service provision are created.
Of importance is the recognition that no single service or individual can achieve the goal of developing a Community Support Network alone, nor can a network be established through any single process or method. Rather, what is needed is an approach, based on a multi-level, simultaneous, inclusive framework, which ensures that coordination takes place among and between the various stakeholders. Both formal and informal supports and services need to be involved in the development of the network with formal service agreements signed by network participants outlining specific services each will provide and protocols on how to access these services. The different services provided by each network member reflect the components of the range of resources needed to develop a comprehensive continuum of supports which can offer a wide range of service options and approaches in partnership together that can address even the most complex needs. A systemic approach ensures that the essential components of the service continuum are included in the development of the support network. Formal agreements among participants also help to ensure that network members have a vested interest in the success of the network, that they are clear on their roles and responsibilities and, that they are formally recognized as a network partner with access to the range of resources provided by the networks continuum of supports and services. As well, the role of the lead agency or designated partners that assume responsibility for the overall leadership, coordination and maintenance of the Network is critical in troubleshooting and resolving problems that may arise naturally from such partnership arrangements. At this point, we will discuss some of the strategies that we have found useful in building and maintaining a Community Support Network and it various partnerships.
Strategies for Building a Community Support Network
Described below is a range of strategies that can be used when beginning to identify and develop the necessary linkages between community partners that will contribute to the Network, and that will also support the further development and maintenance of an integrated continuum of supports and services.
Reframing the Issue: Creating Shared Solutions
Frequently, caregivers and service providers involved with individuals with a dual diagnosis experience a range of concerns and feelings in trying to respond to the complexity of needs such individuals present. At an individual, program, and/or system level, stakeholders often anticipate hearing a blaming message that they are part of the problem. To get beyond these reactions, an approach must be used that promotes the ongoing participation of all the stakeholders. The initial objective is to facilitate an alliance that promotes a non-pejorative, non-judgmental approach, so that a joint process of building solutions together can be developed. Rather than focusing on the stakeholders as contributing to the problems and barriers that exist in providing services, it is important to emphasize that all perspectives are important and unique, and that opportunities exist to use the knowledge, experience and creativity of all stakeholders. Such an approach empowers stakeholders in the decision-making process, and allows them to begin seeing themselves as assets and important participants in providing the various elements needed in the service continuum. This approach is particularly important during the initial stages of building the network and working with new partners, but is also an approach which must be incorporated into all future activities of the network in order to promote a culture that allows for openness in the partnerships and strengthens the premise of a mutual-aid model of service delivery.
Supporting Partners Readiness for Change
It is important to recognize that similar to when working with individuals or families, one must be sensitive to the readiness for change at a program and systems level, and pace challenges to change accordingly. Programs and service sectors often have an investment in maintaining the status quo when exploring the possibilities about modifying their services to better accommodate the needs of individuals with a dual diagnosis. This should not necessarily be seen as overt resistance to providing service, but may be more of a reluctance arising out of ambiguity about how to provide service, and a fear that committing resources differently may result in being totally consumed by the demands of these individuals. It is important to recognize this reluctance and the reasons for it, and to be sensitive to the need to address potential partners concerns by beginning where they are in the process and building on the strengths they bring to the table.
Adopting a non-confrontational approach allows stakeholders to feel less vulnerable, thereby reducing their apparent reluctance, and making them more amenable to hearing the possibility of their participation as one component in the development of an integrated continuum of services and supports. An approach that avoids conflict and confrontation, and provides support through access to additional resources (e.g., access to education and training opportunities), encourages stakeholders, and more often leads to their initial agreement to provide service and to be a network participant.
It has been our experience that over time, this initial resistance will substantially dissipate, as network partners feel more comfortable with serving individuals with a dual-diagnosis and they gain more knowledge and skills in how to respond to the complexity of issues presented as a network partner. As well, this resistance is also further minimized as Network partners begin to realize that they are not alone in trying to provide all of the range of supports that may be required to assist an individual, but that it is a shared responsibility that is based on mutual trust and collaboration between the partnerships.
Engagement Flexibility of Network Partners: Use of Forums and Facilitation.
The principle of engagement flexibility is critical to engaging community partners in the development and ongoing maintenance of a network which reflects an integrated continuum of support and services. Similar to the strategies often used in providing community outreach to individuals with a dual diagnosis and their families, service providers may need to be engaged in a manner that recognizes and validates their apprehensions about working with these challenging consumer situations. Service providers are often more willing to commit resources, or to use them differently if their concerns have been openly addressed, and their perspectives have been validated as being important and unique. To encourage such discussions, stakeholders need to feel safe in being open about their issues, particularly if they are addressed areas which may reflect their lack of knowledge or skill level in working with the dual diagnosis population. There are two strategies that can be particularly effective in the development and ongoing maintenance of the Network, forums and network facilitation.
Various types of forums (e.g. steering or advisory committee, focus group) can be an important mechanism to allow for different partner perspectives to be heard and validated both as the network is being built and as it continues to evolve and develop. The simple process of bringing together partners to a central place or building in mechanisms to ensure each partner is heard becomes an important first step towards the development and maintenance of these formal linkages. The use of forums and the mix of participants provide a variety of information, perspectives, knowledge, and strategies, and often lead to creative opportunities to examine how existing resources might be delivered more effectively within the Network. Forums also provide an opportunity for stakeholders to work collaboratively to identify service gaps within the network, and to begin joint planning on the type of coordinated service system that they want to develop. Consequently these forums promote the clarification of language or jargon used by different service providers and sectors, resulting often in the development of a common language and vision for the network. They are also useful in establishing mutual goals and direction for the network and to troubleshoot or problem-solve issues that may be related to the partnerships or other systemic issues impacting upon the network (e.g. change in government policy, funding initiatives or service pressures). The idea of bringing network partners together creates the opportunity to plan proactively and to work collaboratively to ensure that changes to the network are either implemented or maintained over time. As well, bringing partners together in a forum to discuss and evaluate the services being delivered is one mechanism that supports quality assurance that the network is responding to the changing needs of its consumers, families and the community it serves.
Network facilitation is a key role in the development and ongoing maintenance of the partnerships within a network. The role of facilitation is to provide leadership and support between and among cross-sector activities of the network and to support all the various partners in their role as members. This may occur at an individual (person specific situation), program (agency service delivery issue to the network) and system levels (specific partnership issues arising in the overall Network). The facilitators role in relation to the network is to ensure that both the engagement and maintenance of the partnerships is carried out in an objective, flexible manner, that all perspectives are heard and to troubleshoot both potential and real problems arising from the partnerships. Also, the facilitators presence as a neutral third party can provide mediation and support to the various participants of the network. Depending on the structure and resources of a community, the functions of a facilitator may be performed by one person/agency, or shared among a number of people/agencies.
In the situation of the Griffin Centre Networks, the role of network facilitation has been ascribed to several individuals within the organization, but has been strongly supported through the policies, structures and management style of the agency. In the following section, we will discuss how the Griffin Centre as the lead agency for several networks promotes a leadership style based on its core values and ideology that parallels and supports the development of a vision that is strength-based both within the organization and as a member of its various networks.
Organizational Context: The Role of Leadership in Networks
Articulating a Vision
Whether planning intervention, treatment, or preventative measures in a collaborative way through a network approach as described above, the question of who will provide leadership and support the continuity of service development and maintenance of the network is often raised. The leadership necessary for the development and implementation of a responsive service network must embrace a vision and ideology that is committed to promoting an organizational culture of learning, supports collaboration, embraces differences among all stakeholders, and fosters good self evaluation mechanisms in terms of how its services are being offered and utilized. In the case of the Griffin Centre as the lead agency for several networks, it is paramount that this vision is not only embraced while working with external community partners to ensure the longevity of the networks, but that such an approach is inherent and reflected clearly in the day to day operations of the organization and its staff. At this point, we will discuss two primary principles that the Griffin Centre has adopted as it has moved forward with implementing a vision, or in other words how does it see its future both as an organization and as the lead in the development and maintenance of its various Community Support Networks.
Building a Core Ideology
There has been much written on the importance of an organization having a clearly articulated core ideology. Core ideology defines the enduring character of an organization - it helps to provide a consistent identity that goes well beyond the services or products it provides, management fads, and individual leaders. In fact the most significant contribution of those who build a lasting organization is one in which the core ideology endures as a source of guidance and inspiration. Any effective organizational vision must incorporate a core ideology, as this ideology helps to build the guiding principles, tenants and purpose of why an organization exists and is the fundamental building block that holds an organization together over time. (Collins & Porras, 1996)
A key component to building such an ideology is that core values for the organization must be clearly articulated and embraced not only by management but also supported by all staff within the organization. These core values must reflect a small set of timeless beliefs that have intrinsic worth and importance to those working within the organization, so that these beliefs can be used in helping to define the organization both internally and as a member of the larger community (Collins & Porras, 1996). For example, the Griffin Centre credo Everybody Counts embodies the core articulated values of accessibility; flexibility and choice; collaboration; advocacy and diversity. We operationalize these core values through a framework that is strengths-based and one that strives to build and enhance the abilities and skills of those we serve, both in terms of our consumers and our broader community Network partners. As well, such values are also reflected in the organizations management style and structure that supports our staff in doing their work both within the organization and with the various partnerships we have developed in the community. Such values define for us what we stand for, and we endeavor to hold true to them even in situations where they may put us at a disadvantage. Organizations must determine their own core values that fit with their purpose and culture. The key is not what core values an organization has developed, but that core values exist and are embraced by both management and front-line staff.
We have found that a key approach to building a core ideology has been to utilize the strengths and diversity of consumers, staff, and community partners with whom we work to help to identify a set of shared core values. The key here is to work from the individual focus up to the organization level. In other words, we build on the individual strengths and knowledge that all the above individuals bring to this process. This will promote a set of core values which are more reflective of the core ideology, and will also lead to a clearer sense of purpose for the organizations. It is important to emphasize that such a process of working from the individual to organizational level helps foster a climate of discovery of what core values and ideology an organization truly believes in and sees as authentic. This will further promote an environment of learning that will guide and inspire all staff at all levels within the organization and hopefully the broader network of community partners. An important ongoing challenge for the Centre is how do we effectively incorporate into our thinking the diversity that our consumers, staff, and partners bring to us (e.g. ethno-racial, cultural, disabilities) as we reflect upon these core values and develop services. Key questions for consideration by staff in articulating these core values and building core ideology are included in Table 1.
(Insert as table 1)
What core values as a person do we bring to work that need to be reflected in the organization?
Are the values that are being developed for the organization congruent with our own personal values?
What core values as an organization do we truly believe in and passionately hold?
Do we think these values could stand the test of time? (End Table 1)
These are just a few of the fundamental questions which may assist in moving forward the objective of developing a set of values that will lead to a core ideology and a clearer vision for the organization. Obviously there are many other questions which one would need to formulate, depending on who you are serving and what essential ideas need to be incorporated in developing the core ideology and values. For example, in the re-development of Griffins Centre core ideology and values, individual participation and involvement was seen as a key philosophical underpinning to assist the Centre in reviewing its mandate and in generating change strategies. Consequently it was necessary to establish mechanisms to obtain individual feedback and involvement through conducting ongoing focus groups; involving individuals more actively in their conferences, service planning, and in decision making.
It would be somewhat naïve to assume that all staff will buy into the core values and ideology of the organization or that all staff will be inspired or see these processes as meaningful. However by developing core values and an ideology it helps to better define the type of potential employee that may best fit into the organization. A clear, well-articulated ideology is more likely to attract individuals whose personal values are congruent with that of the organization. As well it may assist management, current, and potential staff to identify issues of incompatibility. Adopting the core ideology of the organization is not something staff can be forced to embrace if it goes against their fundamental belief system. Rather often what evolves is a clearer understanding of how to recruit and retain staff who are predisposed to share the organizations core values, ideology, and purpose. However within any organization it is necessary to nurture and validate diversity and create an organizational culture in which differences and differing viewpoints are welcomed because it reflects the community around us and who we serve and contributes to the richness of the collaboration. At Griffin Centre the commitment to a shared vision (reflected in the core values and ideology) promotes learning and a working environment that embraces the expression of differences, leads to more open and honest communication, promotes a change friendly attitude, and supports the idea of working flexibly and in collaboration both internally and with the broader network partners. As well, in the development of Griffin Centres Networks, when seeking out potential partners, reflecting back on the organizations core values and ideology is often helpful in deciding what partners might share similar values and a vision that is congruent with the organization. This has been particularly important in the early stages of the development of the Networks, when often partners may be apprehensive about becoming involved in a Network, particularly when the purpose is to serve those individuals with the most complex needs who often require significant agency resources. Consequently, the Centre has tried to articulate and promote a vision through its core ideology that is not only supported internally but also is endorsed and validated through it various network partnerships.
Promoting a Culture of Learning: The Learning Organization
We have found that by fostering a culture of learning within the context of a learning organization staff gain a better appreciation of the importance of networks and are more committed to providing services based on a model that supports mutual collaboration and shared care responsibility. The promotion of a culture that encourages and supports new ideas is essential if learning is to take place (Garvin, 1996). At Griffin Centre, some of the ways such a learning environment is promoted are described in table 2.
(Insert as Table 2)
To encourage and provide opportunities for the staff to experiment with new approaches;
To review the organization and staffs learning from their experiences and past history;
To support the learning from the experiences and best practices of others including our Network partners; and
To build in mechanisms that will assist with the transfer of this knowledge quickly and efficiently through the organization and to the broader network membership. (End Table 2)
For example, the transfer of knowledge might take place through organization or network wide discussion forums and/or other more formal staff development opportunities that are provided by the lead organization or perhaps one of its network partners. However we do concur with Goldsmith and Eggers (2004) who believe that in order to promote a Culture of Learning within the organization and ultimately the Network the following key principles must be considered: (a) the network lead organization and network facilitator must devise ways to establish communication channels, coordinate activities between network participants, share knowledge, align values and incentives, build trust, and overcome cultural differences; (b) trust is the bedrock of collaboration and learning; (c) without it, people will not collaborate or share knowledge; and (d) technology can help organizations collaborating with others to reduce transaction costs, share knowledge and build trusting relationships (Goldsmith & Eggers, 2004).
We have also learned that even within the organization, if staff work in isolation (e.g. only carry specific narrow responsibilities), silos of service approaches can develop. Consequently, creating opportunities for cross-program interaction and teamwork is highly encouraged as this provides staff with further opportunities to develop their knowledge and skills at not only a direct service delivery level, but also in learning how to work more collaboratively and flexibly with different staff, professional disciplines, and program perspectives. These cross program opportunities often provide important professional development opportunities for the organizations staff, particularly as they begin to work systemically outside the organization and more within the context of providing services to consumers in a flexible manner through specialized networks that have been developed through a range of formalized service partnerships. As well, supporting staff to work with a diverse range of individuals and programs within the organization also provides opportunities for them to develop some of their network facilitation and mediation skills, particularly as it relates to developing an approach that is adaptable and flexible in terms of not only serving individuals, but also in how to support the broader partners who may be involved with a individual referred by the Network.
Organizations that cultivate a learning environment must be committed to a process that promotes open and attentive listening, and encourages learning from others, both within the organization and from its various collaborations and partnerships. The idea of benchmarking is key here, benchmarking is an ongoing investigation and learning experience that ensure that best industry practices are uncovered, analyzed, adopted and implemented (Garvin, 1996, p. 128). The greatest benefits come from studying organizations practices, the way that work gets done, rather than just results, and may involve both the internal staff within an organization or, in the case of networks, various partners. When looking at how benchmarking can be applied to the development and maintenance of a network, it is clear that much can be learned from this approach which demands a discipline process that begins with a thorough search to identify best-practice organizations, continues with careful study of ones own practices and performance, progresses through systematic site visits and interviews, and concludes with an analysis of results, development of recommendations and implementation(Garvin, 2006). Benchmarking is one way of gaining an outside perspective on both the effectiveness and efficiency of the lead organization for a network, as well as to begin to assess the overall performance of the network itself. Currently the Griffin Centre is in the process of looking at how they can begin to use this approach to more effectively evaluate its networks.
It is also worth noting that learning and the ability to adapt as an organization will occur only in a receptive environment that is strongly supported by a management approach that supports ideas associated with learning organizations (Dumain, 147). Learning theory calls into the question the practice of developing strategic plans to chart out agency directions over a fixed time horizon (Senge, 1994). Rather, the focus is on ensuring that an agency becomes change friendly and develops a climate within the organization and broader network which supports change as well as a capacity to adapt in response to identified needs. Integration of learning organization principles into the work environment requires the staff at all levels of the organization put aside old ways of thinking; learn to be open with others; understand how the organization really works; form a plan everyone can agree on ; and then work together to achieve that vision (Senge, 1990). These principles are not only important for the designated lead agency of the network but also are important to the success in the initial development and sustainability of a Community Support Network. Consequently, the managerial approach used with staff to provide support and supervision often is a key factor in whether a culture of learning is really implemented into the daily operations of the organization and perpetuated into the network. Managers must be open to criticism or bad news and need to work hard at not becoming defensive when they are being challenged or criticized by consumers, staff, or network partners. As well, both managers and staff must critically examine both personal and professional assumptions upon which an organization or the network provides services and organizes itself to conduct business with a view to increasing leadership, enhancing skill development, and if necessary making changes within the agency and the network. This can be a difficult challenge, but it is essential for the success in promoting an environment that fosters fertile sources of ideas, creative thinking, and adaptability within staff. As well, both management and direct service staff of the network lead organization need to be open to gaining outside perspectives from the consumers they serve as well as their partners. Conversations with consumers and partners can provide up-to-date and vital information on how services are being offered, insight into preferences and changing needs regarding specific groups, and immediate feedback about services and patterns of use. All organizations need these insights at all levels from management to the direct service staff and they are a vital component to incorporate as a quality assurance mechanism for the network.
It is important to recognize that in order to promote a culture of learning it may be necessary to develop partnerships that can address a specific gap within the organization or broader network. In Griffin Centres and its Networks situation the weakness identified was staff education and training in the area of dual-diagnosis. Within our local community formal education and training opportunities to support our staff and the network partners in fundamental approaches of working with these individuals were non-existent. Both the Centres staff and our network partners identified a need for a more formalized training approach that was post-secondary accredited, in order for us as a network to better support the people we are serving. This resulted in the Centre working with one of the local colleges to develop courses that will provide an accredited certificate program in dual-diagnosis. Currently this certificate program is offered to all members of Griffin Centres Network for dual diagnosis at a minimal and subsidized cost. This certificate program has been one important mechanism to develop and support best practice approaches in the field. It has, as well promoted more of a shared value and vision among all the network partners of what constitutes good practice in this area.
Described within this article has been the rationale and experience of Griffin Centre for developing Community Support Networks to serve people with complex needs including those with a dual-diagnosis. The idea of a Community Support Network is based on a network approach that reflects a range of organizations partnering formally to offer a continuum of services in order to better address the often complex needs of consumers they service. Described is how such an approach has assisted consumers, family/caregivers, service providers and planners in overcoming long standing barriers in accessing services and filling the gaps in the continuum. Identified are a range of strategies and approaches used to create and maintain a Community Support Network.
Basic tenets associated with providing leadership to such a network are described. Particular focus is on the importance of the lead organization developing a clear vision that is based on a core ideology and set of values that are strength based and can support the principles often associated with providing effective leadership and support to a network. As well, examined is how this core ideology can provide direction and leadership to both the lead organization and all of the partners in the development and maintenance of the network.
In conclusion, discussed are the benefits of creating a learning organization as it relates to providing leadership to the network as well as in supporting the growth and development of all the partners. The authors identify how the successful adaptation of learning organization principles for the lead organization and its network partners results in superior performance, improved quality of service delivery, a focus on meeting the needs of the client, more open dialogue within the lead organization, and the network which encourages speaking out and recognizes the inter-dependence of components of the organization and network, the generation of new ideas based on learning, and the incorporation of same into the work, an energized and committed work force which acts in the interest of the whole, an ability to react more quickly to environmental changes as a result of knowing when to anticipate and ultimately, and an enhanced capacity to create the kinds of changes which are necessary (Senge, 1994).
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