Organizational Change for Community Employment.
Despite this progress, unemployment rates for people with disabilities remain unacceptably high. Improvements in employment outcomes, in many ways impressive over the last 10-15 years, have not significantly increased for the majority of citizens with serious disabilities (Louis Harris and Associates, 1998; Fesko & Temelini, 1997). Although the percentage of people with disabilities who are unemployed varies depending on the definition of disability and other variables, it is generally accepted that the rate is roughly 60% to 70% (Fesko & Temelini, 1997; Louis Harris & Assoc., 1998).
In spite of the large quantity of resources put into supported community employment over the last decade in the U.S., much remains undone (Mank, 1994; McGaughey, Kiernan, McNally, Gilmore & Keith, 1994). Many programs and models considered "exemplary" have achieved paltry results in terms of jobs, hours worked, and wages (Bond & McDonel, 1991; Mank, 1994; Vandergoot, 1987). Seventy percent of the approximately 1 million individuals served by day and employment services nationally spend their days in facility-based programs, and not in the community (Gilmore, Schalock, Kiernan, & Butterworth, 1997). Programs funded to help people with disabilities get community jobs often have low placement rates, and even individuals who obtain employment through the efforts of these service providers are often under-employed (Kiernan, Gilmore, & Butterworth, 1997; Mank, 1994). So, while progress has been made, much still remains to be done in the field of services for people with disabilities before the vast majority of individuals are working in jobs of their choosing that provide financial independence and self-fulfillment.
Employment is one of the primary mechanisms for participation in our society, and employment not only allows people with disabilities to meet their material needs, but many non-material ones, such as friendship, support, and personal growth. Also, since employment is one of the primary mechanisms for societal participation, it is only when people with disabilities are employed in significant numbers in the community that the stereotypes, ignorance, prejudices, and outright fear of people with disabilities that is often displayed by the general public, will be overcome. Therefore, studying the components of the process that leads to this significant change in people's lives, as presented in the following sections, is essential for policy makers, funding agencies, and researchers.
The organizational change model cited by Gold, Van Gelder, Schalock (in press) has three elements. These include: a commitment to change; producing change; and maintaining change. This article focuses on the first two elements, specifically examining catalysts for the change process (commitment) and processes and factors involved in organizational change (producing). While the maintenance of change is crucial in the long run, this article limits itself to issues in the initiation stages of the change process, since the concept of "conversion" to community employment still remains an elusive one for most service delivery systems.
The private, for-profit business community has also experienced dramatic changes over the last decade in its structure and management, so this article attempts to weave themes derived from the business literature in tandem with those elicited from the rehabilitation literature specific to "conversion" to community employment. The experiences of two programs converting resources to community employment are examined. The article then provides recommendations for organizational change, based on the literature review, the case studies presented, and the authors' experiences in providing consultation and technical assistance on improving employment outcomes to over 50 community rehabilitation providers.
1] A Commitment to Change:
The Importance of Mission and Values
Change appears to be driven by personal and organizational mission and values. The underlying catalyst is often an individual or group of individuals who decide that the organization is not properly meeting the needs of the individuals it serves through current services, and needs to do things differently (Goodstein & Boeker, 1991; Murphy & Rogan, 1992).
This is commonly a result of new management being brought into the organization (Goodstein & Boeker, 1991), and relates to the often-cited need for strong leadership that sets organizational values and direction, and maintains a clear focus on the goal (Butterworth, Fesko, & McGaughey, 1997), Murphy & Rogan, 1992). Though there is disagreement on whether values clarification precedes role realignment or vice-versa (Beer, Eisenstat, & Spector, 1990) there is consensus in varied literature bases that mission and values are crucial (Corrigan, 1995; Drucker, 1992; Hamel, 1996; Rogan, 1993). While those in the human services field may view those in the business world as solely motivated by financial considerations, it is interesting to note how strongly the for-profit business literature emphasizes the need for strong values. As Drucker (1992) states, "For the organization to perform to a high standard, its members must believe that what it is doing is, in the last analysis, the one contribution to community and society on which all others depend" (p. 98).
In reviewing literature focused on for-profit business, there appears to be a presumption that economic and competitive forces lead companies to undertake fundamental organizational changes. In the rehabilitation literature, economic forces are also cited as a main catalyst for organizations to change from sheltered to community employment (McCarthy, Thompson, & Olson, 1998). Such economic forces take the form of either internal agency financial instability, or public agency threats to cut funding.
Policy makers have attempted to create a variety of incentives to encourage providers to move resources from segregated environments to integrated community work places. Some examples include: higher payment rates for integrated rather than segregated services, use of the Medicaid Home and Community-Based Waiver for supported employment services, allowing higher staffing levels for community supported employment, creating an hourly rate structure for on-site support and job coaching, and implementing phase-in schedules for staff to be shifted from the workshop to the community. Despite all these attempts at reinforcement, and perhaps because of uneven application of them as instruments of policy, segregated day programs remain heavily entrenched in both the mental retardation and mental health fields (Mank, 1994; Wehman & Kregel, 1995).
Empowering and Supporting Staff
To overcome the feeling of insecurity and loss of control that are endemic to organizational change, Kanter (1989) recommends giving staff more control over their professional lives, with extra rewards based on measurable results and chances to learn new skills. Magis-Agosta (1991) notes the need for organizations to be supportive in dealing with the emotional stress of change. Butterworth, Fesko, & McGaughey (1997) emphasize how important the commitment and values of staff are to the organizational change process, and how staff and agency needs must be met simultaneously.
2] Producing Change
Change requires creating a sense of urgency and attaching a sense of inevitability to the effort
The dilemma of creating meaningful systemic change and organizational redirection has been cited again and again within both for-profit business and human services (Albin, Rhodes, & Mank, 1994; Armenakis, Harris, & Mossholder, 1993; Beer, Eisenstat, & Spector, 1990; Kotter, 1995; Majchrzak & Wang, 1996; Surles, 1987). Organizational change is a complex process that unleashes forces whose paths cannot be reliably predicted. In reorganization, the process and outcomes are unclear, and decisions cannot be held within known bounds (Hamel, 1996; (Hickson, Butler, Cray, Mallory, & Wilson, 1989) and it is impossible to completely plan or predict a change process (Hagner & Murphy, 1989; Murphy & Rogan, 1992). Some pieces of any strategic planning analysis must, of necessity, be accepted as unknown or uncontrollable.
It is fashionable within the field of human resource development to talk about working "smarter, not harder" and about the need for system redesign, not just individual change (Kotter, 1995; Wagner & Cox, 1991). However, there is less attention devoted to the fact that it is difficult, personally and organizationally, for community agencies to develop a modus operandi with staff that fully supports the goal of community employment. Change proceeds incrementally, yet is often considered to be moving at a "breakneck" pace. For real change to happen, community rehabilitation providers and rehabilitation advocates must "raise the bar" for success.
Clear quantifiable goals
Any organization or individual that seeks to create a change must define the desired outcomes of that change. The more specific the outcomes sought (e.g., all consumers working in the community within three years), the easier it is to measure progress, problems, and ultimate success. Having a mission statement that is not contradictory to the goals an organization espouses is often more crucial to the change process than an inordinate amount of time spent on fine-tuning exact wording. Thus, a community rehabilitation provider that states a mission to maximize contract sales or minimize risks to consumers would find conflict between those goals and encouraging community employment.
The base of the change efforts that this article outlines are predicated on the abilities of people with disabilities to work in the community, the necessity of environmental changes as well as changes in the person, the need for advocacy to counter employment discrimination, and the inherent worth of the goal of integrated community employment for all people. Keeping focused on the ultimate objective of finding employment for individuals can make the change process considerably smoother and shorter. Developing interim plans of action and intermediate goals often cloud, not enhance, the process of change in that they distract the efforts of the staff; they reinforce minimally acceptable, rather than excellent outcomes; and they are difficult to identify successfully (Hamel, 1996; Hickson, Butler, Cray, Mallory, & Wilson, 1989). This is not to negate the need to identify small successes along the way (e.g., community rehabilitation provider staff should rightfully celebrate the milestone of 50% of consumers working in the community as opposed to only 25% in the year prior). But, these must be kept in perspective as merely measures of progress, not achievements per se.
Extensive consumer and family involvement are crucial to meaningful change efforts in community employment.
Troubles faced by community rehabilitation programs seeking to create better employment outcomes pale in comparison to the stresses and risks that such a shift implies for people with disabilities and their families. Many current providers owe their existence to the advocacy of families who helped stimulate the creation of these alternatives to institutions. Systemic modifications must involve consumers and family members at every step of the way, from creating the vision of community employment, the development of specific action plans to bring this vision into reality, the implementation of these plans and, finally, the actual outcome of a program that focuses on successfully supporting consumers to become employed in the community (Hosack & Malkmus, 1992; Moxley, Raider, & Cohen, 1988; Spaniol, Zipple, & Lockwood, 1992). Work in organizational development suggests the possibility that any organization is served well by including a variety of customers in the planning process for organizational change (Bunker & Alban, 1992; Drucker, 1992; Wagner, Long, Reynolds, & Taylor, 1995). Family members and consumers risk much in the changeover from a facility based program to one whose primary focus is integrated community employment. These risks include: concerns over the impact of employment on disability benefits; changes from a predictable daily routine, which they may have been participating in for many years, to a daily routine which they may perceive as' less predictable and stable; concerns over the perception in some cases of the community as a dangerous and unsafe place, as compared to a sheltered facility; changes and possible loss of peer and staff relationships which may have been developed on the course of many years. Although these risks are far outweighed by both the material and non-material rewards of community employment, they need to be acknowledged and addressed directly. Therefore, organizations should be expected to provide more accommodation, support, and energy towards both including these constituents in the process and responding to their needs, fears, and concerns.
Variety of Internal/External Forces Affect the Change Process
The literature emphasizes the need for coordinated, systematic efforts in organizational change, with involvement of a variety of internal and external constituencies (Magis- Agosta, 1991; Rogan, 1993). Some note the need to nurture consensus (Becker, Torrey, Toscano, Wyzik, & Fox, 1998), while others stress that one cannot wait for all parties to be in agreement before moving ahead (Murphy & Rogan, 1992). Beer, Eisenstat, & Spector (1993) note that the change process must focus on both strategy and organization, structure and behavior, analysis and emotion, internal organizational arrangements, and the context in which the organization operates.
Any significant organizational change, according to the literature, is influenced by a plethora of factors. Common examples internal to the organization are quality of leadership (Armenakis, Harris, & Mossholder, 1993; Kotter, 1995), board involvement (Goodstein & Boeker, 1991; Hickson, Butler, Cray, Mallory, & Wilson, 1989), organizational culture (Majchrzak & Wang, 1996; Muller-Smith, 1996), level of consumer, parent, and staff involvement (Larkin & Larkin, 1996; Ray, Jeff, & Wilcox, 1994), consistent focus on vision and mission (Drucker, 1992), and realignment of roles and resources (Beer, Eisenstat, & Spector, 1990). Common examples external to the organization are political climate (Goodstein & Boeker, 1991) funding (Kotter, 1995; Surles, 1987), parental and consumer attitudes towards the change (Besancon & Zipple, 1995; Wehman & Kregel, 1995), and public attitudes (Benz, Lindstrom, & Halpern, 1995; McKnight, 1995). While there has been considerable debate in the organizational change field about the relative importance of each of these factors, there is no argument about the fact that to be successful, change must take into account multiple issues.
Therefore, the task of increasing community employment opportunities presupposes that these factors must at least be identified and strategies cultivated to address most, if not all of them. Organizations must analyze their internal and external environments so that they can develop an understanding of what areas they might influence effectively, what areas they might better ignore for the present, and what tactics might prove most beneficial in overcoming environmental obstacles.
Organizational Change Case Studies
MetroWest Human Services
MetroWest was started in the early 1950s as the Southern Middlesex Association for Retarded Citizens (SMARC), and was established by families to provide day and residential supports to children and adults with developmental disabilities. By 1985, SMARC served over 300 individuals, with 150 individuals in one facility, and a small number of individuals working in the community in individual and group placements. Starting in 1985, the Massachusetts Department of Mental Retardation (DMR), the primary funding source, encouraged the agency to expand its employment programs. Over the next seven years, several planning groups tried a variety of strategies to meet this objective, and targeted specific individuals. Starting in 1992, as part of the planning process, focus groups were held with consumers, families, staff, and funding agencies to gather information about people's interests, needs, and concerns. At this point, less than 30% of individuals worked in community employment. Pressure from funding sources for better employment outcomes was increasing.
While pressure from the funding source was a catalyst for increasing community employment, the sense of urgency was heightened by continued financial losses. The agency judged it would need to triple production and make large capital investments to become profitable. The general finances of SMARC were unstable and it was exploring a possible merger with a larger human service agency. Faced with these factors, a core planning group comprised of the executive director and several management staff made the decision to close the workshop, which was one major component of SMARC (along with housing and other day programs), in six months. At the same time, a merger was completed with the larger agency.
Once the workshop closing decision was made, meetings were held to inform people about the changes. Individuals and their families were given the choice to become involved in the new supported employment program, move to the Medicaid - funded day habilitation program, or receive assistance in finding another agency. Thirty-three individuals chose day habilitation services and 14 individuals left the agency (six to go to another workshop in the area). One hundred people were referred to the employment service. A major concern for everyone was what individuals would do during the day if they were not working. The compromise made was that anyone who wanted day support would receive it, and several satellite sites were developed in the community to serve as central meeting places for transportation and places to offer individual and group activities.
With this change, the structure of the agency consisted of five teams with each team supporting between 15-20 individuals. Over that first year, the majority of staff time was taken up with supporting people in community activities including volunteering, community awareness and exploration, and recreational activities. Employment rates increased only slightly. Staff members were frustrated with the lack of time devoted to community employment and staff turnover increased. Families and funding sources were concerned with both the unemployment rate and the type of day supports provided. State agency contracts were also due for renewal.
The organization once again restructured its services to devote more resources to developing jobs and created a program to provide day support (primarily Medicaid funded) to individuals during the time they were unemployed. The agency was awarded a one year contract through DMR which was contingent upon reaching an 80% placement rate. A site was leased, but emphasis was placed on providing services in individuals' homes or in the communities. This allowed the five teams to focus on career exploration and planning, job development, and supports.
At the same time, the parent Mental Health Center was bought by a national for-profit health care company. The executive director left and a new director who had a strong commitment to community - based services was appointed. By June of 1996, employment rates had more than doubled and nearly 80% of individuals served (out of 100) were working in community jobs. This employment rate is currently significantly higher than any other DMR-funded provider in the same service area of central Massachusetts. There remains a need to upgrade both the hours and types of employment for some of the individuals who are already employed. In addition, through the conversion process, the number of individuals served in day habilitation has almost doubled.
Mass Bay Employment Services (MBES)
The Community Adjustment Program (CAP) in the South End of Boston was a small day treatment program serving 30 adults with severe and persistent mental illness. Operated by a large nonprofit residential and day service provider, it primarily served an older population (average age was 51). The program provided an array of services, including case management and advocacy, a range of social and clinical psychotherapeutic groups, and sub-contract (sheltered workshop) work.
The funding agency, the Massachusetts Department of Mental Health (DMH), was interested in developing more community employment services. The building that housed the program was in deplorable condition. In 1995, opportunities for employment were continually prioritized highly by clients through anecdotal comments garnered from annual consumer satisfaction surveys and through systemic planning efforts. In 1995, the decision was made by the administration to close the CAP program in 12 months. Existing resources used at CAP were to be redeployed and converted into an employment program. Current clients in CAP would be transferred to a workshop, Gill Rehab, also run by the parent agency. MBES would serve consumers from the former CAP program, clients from Gill, as well as new referrals.
A new director was hired to oversee the CAP closing and the development of MBES. Staff had concerns about the closing of the program, particularly the impact the change would have on clients, some of whom had been attending the program as long as 18 years (with the average tenure approximately 8.5 years). Though staff were kept informed, they were not involved in the decision to close the program, nor was their advice solicited regarding how the change would occur. All staff were assured jobs, but there was uncertainty regarding what their new jobs would entail and where the new program would be located. By their own choice, three of the five original CAP staff didn't make the move to MBES.
After the move, the first two months were spent assisting consumers in settling into Gill and setting up the MBES services. Working conditions were less than optimal for employees. Space was allocated from current space used by the Gill program (dividers were set up to partition off part of the workshop floor). There was only one phone line, limited space to meet with job applicants and no easily accessed private space. Three staff and the director shared an office space of fewer than 120 square feet. These less than ideal working conditions did not stop the staff of MBES from making changes and improved results happen.
MBES, with a staff of four (including the director), started accepting its first referrals in June, 1996 and the first consumer found employment in late June. In the first 12 months of the program, 100 individuals were referred to the program and 50 individuals got jobs in the community (73 total job placements). Of the 30 consumers transferred from CAP to Gill, 29 made the transition. Seven of the 50 individuals who got jobs were former CAP consumers.
These organizational vignettes yield insights into concrete change efforts that have been exemplary in terms of employment results for people with severe disabilities. The success achieved in the community-employment process first must be credited to the energy, motivation, strength, and resiliency of the people with disabilities, and then secondly to the individuals who supported them in this process. As a result of these successes, there are some lessons for managers and policy makers and advocates seeking to help organizations achieve similarly impressive outcomes.
1. Leadership meets different needs at different junctures in an agency's transformation. At MetroWest, the first executive director had the skills to convince the Board and the funding agency to close the workshop. He was less concerned with reaching consensus than in making the changes to secure the fiscal situation of the overall agency. The current executive director has a strong philosophical and program orientation, and her strengths lie in developing staff and services that support continuous improvement in the lives of individuals. If the positions of the two were switched in time, neither might have been as effective.
2. It often takes some initial organizational changes to help shape a more detailed vision of the agency's structures and services. For MetroWest, it took numerous programmatic and structural changes for the agency to conceive of and implement its current situation. After the fact, several staff said they wished they had set up day-support services at the time of the workshop closing. However, the difficulties that came from supporting people without jobs forced the agency to look at other situations. It seems that the transformation process starts with internal/external pressures which help to define the mission and then lead to changes in structural processes.
1. To change attitudes and beliefs, staff need to feel respected for what they have done in the past, and participate in the process of change. At MBES, the director helped the staff set new goals while still being respectful of the old program. The new director also had to rely on the current staff to teach her about the program and consumers, and in many ways, the group jointly ran the program. The experience of MBES highlights the difficulties of change on staff, the need to acknowledge the sense of loss that occurs during organizational change, and finally, the importance of collaboration and teamwork.
2. Despite the lack of institutional supports, MBES was allowed to operate independently and individual staff had freedom and discretion in how they did their jobs. Despite the obstacles of lack of space, privacy, adequate telephones, and being housed in a psychiatric in-patient facility, the rate and number of job placements made in the initial 12 months of the program was better than many existing employment services in the area, often with considerably more resources, that serve this population. In addition to the development of a good work group, management took steps to keep MBES staff free from the day-to-day functioning of the workshop and the day program as well as agency politics. The experiences of MBES give further credence to much of the literature's emphasis on staff autonomy and empowerment as important elements of the change process (Kanter, 1989; Lowenthal, 1994).
3. Once a decision was made, the closing of the facility could have been accomplished in a much shorter time frame. Murphy & Rogan (1992) state that once a decision is made for conversion, it should not be dragged out. The experience of MBES confirms this. Much of the planning and program development that occurred in the year prior to the move could have either been done in three to four months, or done more successfully and quickly after the move. Dragging out the move only served to lengthen the period of uncertainty for staff.
The Common Experiences of Both MetroWest and MBES
Some of the themes of the two case studies transcend the individual experiences and apply equally well to both.
1. Economic pressure is a key catalyst for organizational change. In both cases, economic factors were prime catalysts, reinforcing the fact that funding systems must put their values into practice by funding alternatives they want and not funding options they deem poorer (Becker, Torrey, Toscano, Wyzik, & Fox, 1998). The pressure provided by funding agencies, the potential loss of contract dollars, and, in the case of MetroWest, general fiscal instability, were the primary catalysts in the decision to transform the organizations from facility-based to community employment. However, both cases confirm Murphy and Rogan's (1992) premise that external fiscal pressure is not by itself enough for a successful change process. Eventually, economic pressure must be combined with internal recognition of the need to change and belief in the inherent value of that change in order for organizations to get beyond merely reflexive adherence to funding options and move to a different way of thinking about the issues of community rehabilitation.
2. Leadership should include a strong philosophical base with clear values to guide actions, even in situations where the end result of putting these values into action was not clear. In the case of MetroWest, these leadership qualities didn't reside in the same person. The executive director was the one who was willing to take the risks, but two key middle managers had the vision for what the agency could become. At MBES, having a new director come in who had a strong belief in supported employment was essential, since this was not a strength of other agency staff.
3. Attitudes and beliefs are shaped by experience. Success builds confidence and support of staff, consumers and administration. Many people need to test the efficacy of old beliefs before they can adopt a new belief system. Both these cases confirm findings (Larkin & Larkin, 1996) that an effective way to communicate a value is to act in accordance with it. Specifically, as consumers became employed, more people believed in the process. At MBES, the work done prior to the move to both recruit referrals and lay groundwork helped enable the program to achieve some early successes. Equally important was keeping everything simple --no formal assessments or complicated placement criteria had to be met. At Metro West, which serves a much larger number of individuals, it was only after the agency made several attempts at trying to shape work behavior in the workshop setting that many of the staff and administration became convinced that this could not happen. Similarly, the agency had to try to make options work before they could abandon a protected work environment and focus on individual jobs in the community. It was only after the agency saw the success of supported employment with many individuals in employment services that they could find ways to develop community employment for individuals with more severe disabilities in day habilitation.
4. Staff, families, and funding agencies have a harder time adjusting to changes than individuals served. A few clients at MetroWest had difficulty with the closing of the workshop and the subsequent changes. The overwhelming majority responded positively to new experiences and expectations. There was a significant decrease of "behavioral" problems when they were out in the community. At MBES, only one consumer had major difficulties during the change. Often, staff, families, and funding agencies express concerns about consumers' capacities to adapt to situations that arise in the change process. Experiences at MetroWest and MBES point out that this fear may underestimate the coping skills of people with severe disabilities.
New values, services, and structures may require different skills and demands on personnel. Despite strong efforts to retain and retrain existing staff, both MetroWest and MBES initially experienced significant employee turnover during the change process. At MetroWest, day-to-day operations were affected negatively by the high number of job vacancies. However, because MetroWest was better able to focus on implementation of goals, it was better able to hire and keep staff who concurred with the new vision.
5. Major organizational change cannot be successful without continued internal and external marketing to develop support for the changes. Organizational change cannot wait until all parties are in agreement, or change will never occur. The experiences of these organizations reinforce the need for honest, open, and ongoing dialogue and input by those affected by the change process Armenakis, Harris, & Mossholder, 1993; Beer, Eisenstat, & Spector, 1990) and a coordinated, systematic approach, involving both internal and external stakeholders (Bunker & Alban, 1992; Murphy & Rogan, 1992). In the case of MetroWest, extensive time and effort went into informing and gathering input from consumers, families, and funding sources about the proposed changes, and adjusting the agency's plans to meet the concerns elicited. Funding agencies were a major impetus for change, yet they were some of the more vocal detractors when the initial conversion efforts were not an immediate success. The decision to close the CAP program and replace it with MBES was made without input from staff or clients. Initial staff inclusion might have decreased the animosity that staff still feel regarding the agency and how the change was handled. Seeking input and opinions before changes are made, and then addressing concerns as best as possible before, during, and after the changes are important.
Honest, open, and ongoing communication through both words and action is essential for organizational change, and requires the development of a dialogue among all staff about the change process, the barriers encountered, and possible ways to surmount them. Beer & Spector (1993) note the challenge of this: "Issues that are normally hidden because they are threatening or embarrassing must be surfaced. The low level of competence in most organizations in fashioning such an inquiring dialogue inhibits identifying root causes and developing fundamental systematic solutions." (p. 645). Majchrzak & Wang (1996) recommend wider and quicker distribution of information through networks, and the invitation to individuals from other functions to participate in program monitoring and evaluation.
6. To change the focus of an organization to community employment requires an action orientation, with substantial restructuring, and changes in procedures, staff responsibilities, reward systems, and the physical environment. Organizational change is fundamentally about changing individual behavior and group functioning. With both MBES and MetroWest, the ultimate success of the change was dependent on major shifts in the way the organizations did business, and in how they operated on a day-to-day basis. Staff training strategies were valued in both organizations, but the emphasis was on redirecting performance, not inordinately planning for change.
Relationships and teamwork are also crucial for a successful change effort (Drucker, 1992; Majchrzak & Wang, 1996). The use of teams was an important element of organizational change, and the camaraderie and support of the work group was important not only in making the change but in job retention and employee performance. At MBES, although staff had animosity toward the agency around issues regarding their role in the move, working conditions, and salaries, they felt a great sense of loyalty and belonging to MBES. The same is true of MetroWest, which implemented a team structure as part of the organizational change process. At MetroWest, those who have made it through the transition process have a strong sense of camaraderie and a belief in the values of the organization.
Reflections-Organizational Change Lessons Learned
The literature and some of the specific examples noted have implications for broader system efforts (such as those undertaken by state or county Departments of Mental Health or Mental Retardation) geared to helping people with disabilities get more opportunities for success as workers in the community. These lessons for funding systems are:
The importance of building momentum quickly
Any systemic change requires bringing considerable organizational forces and personal energy to bear on the situation as the employment service system continues to be heavily weighted toward segregated readiness and prevocational options (Bond, 1998; Wehman & Kregel, 1995). Any agent of organizational change must generate enough momentum to hurdle these obstacles. There is debate about whether the move to deinstitutionalization proceeded too quickly without adequate safeguards. However, in the authors' view, it is unlikely that these major shifts would have been possible by slowly preparing to transfer resources from institution to community, any more than other major societal shifts (e.g., civil rights for racial/ethnic minorities) could have been accomplished by ensuring that all the necessary supports and resources to accommodate these alterations were firmly ensconced in society prior to implementing these remedies.
Need to avoid using consumers and families as scapegoats.
Fears of consumers and families are continually offered as explanations of why community rehabilitation providers do not convert more quickly to community employment. While the existence of these fears is not in dispute, the most responsible way to ameliorate them often is. An organization with a goal of community employment will have staff committed to convincing clients and families that rehabilitation resources will be used to maximize benefits and reduce risks. These strategies are to listen attentively, describe positive results that might accrue from the shift, and advocate persuasively. It is part of the responsibility of staff to assist the individual and family in understanding what community employment is, and also help them understand how dismissing the concept of community employment without giving it full consideration both through thought and action, can negatively affect the individual's life.
Focusing on the positive elements of community employment is important. However, because of the fears associated with change, it is useful to demonstrate the dangers associated with the status quo as well as the risks of change. The authors are not suggesting that fears be discounted or that rehabilitation professionals adopt a "professional is always right" posture. However, it is the authors' observation that there is typically more focus by human service professionals on the risks of working compared to the far higher risks associated with not working. There needs to be emphasis on the dangers of continued long-term unemployment and societal exclusion, which far outweigh the perceived (and often mis-perceived) possible financial, psychological, and physical safety hazards associated with working in the community.
Sanctions for poor performance work better for systems than rewards for good performance
The civil rights movement in the U.S. embodies the concept of equal employment opportunity (EEO) and gives some indication of procedures that policy makers might consider, especially in advocacy to outlaw employment discrimination against racial/ ethnic minorities. Social policy in the U.S. has a broader vision: to create a society of equals where individual personal qualities are held in higher esteem than racial/ethnic identity. Governmental intervention in civil rights has been directed at what behaviors are not tolerated, rather than in creating incentives for behaviors that would serve the larger social goal of a "color blind" society.
The movement to integrated community employment for people with disabilities lacks a parallel policy emphasis on prohibited, rather than just desired, behavior and outcomes. A force for conversion to community employment is potential loss of funding and/or fiscal instability. Funding agencies have been reluctant to commit to strategies likely to move the change process expeditiously, such as de-funding segregated services, (within a phase-out period) and not allowing new entries to segregated alternatives; eliminating "credit" for segregated employment (e.g., "Status 26--Rehabilitated" closure within the public vocational rehabilitation system); and eliminating use of Medicaid Home and Community-Based Waiver for Day Habilitation and Activity services that are not integrated into the community.
Positive alternatives to segregated services should continue to be experimented with throughout the country. But without a simultaneous commitment towards robustly excluding practices that have proven deleterious in pursuit of this goal of integrated community employment, progress is likely to remain slow and only intermittently successful. Additional recommendations that funding sources could also implement to achieve better community employment outcomes are: reinforcing choice by putting money directly in the hands of consumers and families (through vouchers or cash subsidies); making contracting simpler in terms of paperwork but for shorter periods (reversing the current trend of 3-5 year contract awards for services); widely publicizing performance outcome and accreditation process reports by sending them to all consumers and their families; regularly compiling cumulative and comparative data by program, as well as aggregate data, that include measures like jobs obtained, average weekly/ monthly wages, and hours worked; and creating performance - based contracts that focus on indicators directly related to employment.
Jobs should not define the totality of the meaning of "success" for people with disabilities any more than they should be seen as definitive standards for achievement by others. Purely person-referenced outcomes like happiness, enjoyment, and contentment are things that service providers should hope to inspire within the people they serve, but nevertheless are outside the bailiwick of results for which they can logically be held accountable. Engaging in an organizational change process without using improved vocational performance goals as indicators seems spurious. Providers' contracts from funding sources should contain the outcomes desired, and subsequent fiscal allocations should be subject to modification based on program goal achievement and adherence to some recognized local, national, or international standards of good practice, such as Commission on Accreditation of Rehabilitation Facilities (CARF) or the Council on Accreditation and Quality or many individual state quality assurance systems in place.
Recommendations for Provider Agencies
For organizations that are contemplating or are in the midst of conversion from segregated day services to community employment, a number of recommendations are offered:
1. Flatten the organizational structure, thus accomplishing two things: 1) putting resources on the front-line; and 2) removing one barrier to communication.
2. Change the culture of the organization, so that open debate, discussion, and input from staff, consumers, families, and the community, are expected. This requires a management perspective that welcomes ideas from a variety of sources and an ability to listen and accept input and constructive criticism as a necessity for an innovative organization.
3. Make information (such as financial statements and status of pending service contracts, and program requirements and outcomes mandated by funding agencies) readily available to staff and consumers. Such information sharing leads to greater understanding of how the organization operates and the challenges it faces, and provides opportunities for group ownership of both problems and solutions.
4. Meaningful involvement by consumers and families goes beyond asking for opinions at a meeting or sending out a survey instrument (Hagner & Marrone, 1995). Fundamental changes should occur in the way an organization operates to include mechanisms for an ongoing role for consumers and families in determining how the agency plans and functions. Some of the obvious examples are board membership and hiring of consumers on staff, but others include mandates that consumers be included in meetings, that discussion of consumer issues and needs occur only in the presence of the consumer, and placing financial resources and discretion in the hands of consumers (such as a "draw down account" from the service contract a funder provides or greater choice in regard to staff members with whom they must interact to get services.)
5. Allow staff wide discretion in the processes of how they perform their jobs, but much less latitude in deviation from the outcomes specified, so that staff performance is measured by progress toward community employment.
6. Actively seek to make the organization more prone to change due to outside pressures. Examples might include assisting in the formulation of a local client advocacy group or voluntarily increasing contract goals for employment outcomes so that funding agencies might hold higher performance expectations.
7. Develop outcome measures that are not simply a reaction to the needs of funding agencies, but rather are used to lead and manage the organization, thus instilling accountability. Examples of such measures include: number of placements, average number of hours, average wages (hourly and weekly), average length of time on job, average length of job search before employment is secured, current unemployment and underemployment rate of individuals served, number of business contacts, etc. Such information should be compiled at least on a monthly basis, shared with all staff and consumers, and used as a measuring stick of how the organization is performing, to determine areas for action and improvement, and to set new goals. In compiling and sharing this information, care must be taken to package it in different ways in response to the needs of different audiences.
8. Create a true learning culture within the organization that goes beyond simply sending staff to training. Provide opportunities for staff to learn from one another (including use of mentors from both supervisory and experienced line personnel), to investigate issues and develop solutions, to provide intellectual stimulation through sharing of the latest information from the literature, and provide a culture in which "How can we do this better?" is continually asked.
9. Look for fundamentally different ways of doing business, which provide a break from the past, e.g., combining the residential and employment resources dedicated to an individual, so that the person can experience better quality service delivery.
10. Ensure that all activities of an organization are designed to promote the integration of individuals with disabilities into mainstream society in non-stigmatizing ways by providing support, empowering people with disabilities to do things for themselves. It also means avoiding, or using judiciously, such concepts as group placements or enclaves, work crews, and sub-minimum wage and looking to "generic" (i.e., resources used by people with and without disabilities) rather than "special" community resources. Examples of generic resources include education, training courses, transportation, and job search resources (such as the One Stop Career Centers).
11. Venture outside the disability and human services field. Stay current on the latest organizational development practices in the business world through reviews of business literature, through courses and training, and by maintaining ongoing communication with members of the business community.
12. Recognize that part of the issue of employment of people with disabilities is related to economic opportunity and career growth, and that community rehabilitation providers should be involved in addressing these issues. The current welfare-to-work and school-to-work initiatives are two areas through which mutual sharing with the rehabilitation field could provide benefits.
13. Open the organization to critical reflection and analysis through the use of consultants from both the human service and business world. Consultants from the business world may be willing to provide such services on a pro-bono basis.
Through a review of literature, case studies, and discussion, this article provided a comprehensive look at organizational change to community employment from more limiting, segregated, day-program options. The following conclusions can be drawn:
1. The main motivation to change in the for-profit business world has been financial results. In human services, with a more ambiguous bottom line, there is a need for a similar motivating catalyst. Funding agencies must expect service providers to deliver specific results with respect to community employment, with the implication that loss of funding might result if such outcomes are not forthcoming.
2. Community rehabilitation managers should hold themselves and individual staff accountable for achieving results through specific outcome measures. As with any well-managed business, these measures would be mutually agreed upon between line staff and administrators, and if they are not achieved, analysis should be undertaken to determine the best course for corrective action.
3. If a changeover to community employment is the desired result, then the organization's values must support this outcome. Everyone involved with the organization (consumers, board members, management, staff) must clearly understand and believe in the importance of employment for people with disabilities, that this is the organization's mission, and that employment is not merely a choice that people make, but it is part of a citizenship role in our society.
4. Values without action to support them are no more than empty words. Community providers demonstrate their seriousness of purpose by: establishing a mission, core values and goals; redirecting resources; and finally, substantially changing the way staff and consumers spend their time with the tangible end result of employment in the community.
5. The analysis of the literature and the case studies provide support for the three factor organizational change framework outlined by Gold, Van Gelder, Schalock (in press) involving: commitment to change, producing change, and maintaining change. Significant alterations in services result from the confluence of multi- dimensional and interactive factors. Illustrations of such factors are provided above and include: social changes, governmental policy and legislation, agency leadership, and advocacy from people with disabilities and families.
Over the past 10 to 15 years, it has been demonstrated clearly that people with significant disabilities can work in the community as little correlation has been documented between employment and disability label. Success has been achieved in obtaining employment in the community for individuals with a wide variety of significant disabilities. Stating that someone is "too disabled" to become employed is an argument without merit. Yet unemployment and underemployment of people with disabilities still causes economic and social exclusion of many people from mainstream society. Significant reductions in the unemployment rate of people with disabilities require that the public and community agencies charged with providing services for this population recast the role that community employment plays in the overall service delivery picture. It is time that employment in the community be considered not just one of several service options for people with disabilities, but as a fundamental need. Preparation for eventual employment must be seen as a primary goal of the education of young people with disabilities, as it is for all other students.
The variety of philosophies and strategies discussed are important elements in an organizational change to community employment. To truly achieve this goal, individual providers, staff, consumers, funding agencies, and all those involved in the overall field of disability services, must radically shift their own view of themselves and the services offered. It is time to consider employment of people with disabilities as a fundamental right and obligation.
The authors would like to gratefully acknowledge the extensive editorial assistance rendered in the preparation of this manuscript by Ann Balzell of Mass Bay Employment Services; Bob Schalock of Hastings College-University of Nebraska Medical Center; and, John Butterworth and Karen Zimbrich of the Institute for Community Inclusion. Also, our thanks to the staff of MetroWest Human Services, Ashland, MA for their willingness to share their experiences in the preparation of this manuscript.
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|Publication:||The Journal of Rehabilitation|
|Date:||Apr 1, 1999|
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