Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers’ cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.     

Chapter 16: Integration of Occupational Health Services in the Federal Sector

Abstract

Federal Occupational Health (FOH) is a federal sector model of the integration and collaboration of occupational health (OH) programs that includes on-site health clinics, and environmental health as well as EAP, work-life, and wellness/fitness programs. This article reviews several aspects of integration at various levels of this public health organization.

The broad objectives of occupational health programs are to promote, support, and provide a healthy and productive, highly functioning workforce to the employer. FOH staff has special expertise and knowledge related to federal procedures, regulations and agency culture, as well as the OH disciplines. With its mission to provide occupational health services to federal agencies and federal employees, FOH has the unique opportunity to provide integrated OH services, thereby providing a more comprehensive approach to the occupational health care of the individual employee, as well as a more comprehensive approach to the health and productivity efforts of the federal agencies.

Although we have made strides and engage in continuing efforts to promote integrated programs and care, a number of additional program enhancements are in discussion and/or in process. FOH is a unique entity and the largest provider of comprehensive OH services within the federal government. It has achieved some notable success with the integration of its services across various levels of the organization with different federal organizations. Efforts have been particularly successful in bringing a coordinated response to various crises and emergency situations. With increasing knowledge and data on the benefits of integration, FOH is working to reduce both internal and external organizational barriers to bring integration of services to their maximum potential.     

The Open Door Project Task Force: A Qualitative Study on LGBT Aging

This paper reports formative qualitative findings from the Open Door Project (ODP), a unique program created by the Lesbian, Gay, Bisexual and Transgender (LGBT) Aging Project. Data were collected from Open Door Task Force members (N = 34). This includes 4 focus groups that were held with a total of 22 participants; and key informant interviews that were conducted with 12 participants from 10 different agencies. Findings revealed that agencies took significant steps to make important and long-lasting structural changes, including changing their diversity and personnel policies, and intake forms to be LGBT inclusive; implementing ongoing staff training initiatives on LGBT issues; and actively involving leadership, including senior managers, executive directors, vendors, and Councils on Aging, in helping to create and sustain organizational change. The ODP is an effective model to increase cultural competence in working with aging LGBT communities.     

Diversity Within Diversity

Summary

Asian American elderly form a heterogeneous group with respect to immigration history, ethnic/cultural background, socioeconomic position, and health and mental health status. This paper provides an overview of the internal heterogeneity within the Asian American elderly population and identifies those who experience multiple stressors affecting their quality of life. Then it discusses barriers to formal service utilization as well as strengths and deficits of informal support systems. To better serve Asian American elders with their multiple needs for health, mental health, and social services, increased funding is recommended for research on this group, diversification of social service programs in coethnic communities, and increased cultural competence in non-Asian social service agencies.     

Examining the Development of Positive Space in Health and Social Service Organizations: A Canadian Exploratory Study

All health care sectors are currently examining factors that influence delivery of high-quality services for diverse groups with an understanding that minority populations experience barriers to service access that contribute to well-documented ill health and health inequities. With a goal of understanding dynamics that can improve access to care in the home care sector, this qualitative exploratory study examined processes to create inclusive, positive space for diverse lesbians, gay men, bisexuals, transgender, and queer (LGBTQ) people in community-based health and social service agencies. A purposeful sample of eight key informants from agencies in Toronto, Ontario, Canada, which offer programs and services to LGBTQ communities, completed in-depth interviews. Conventional content analysis and a critical lens were used. Themes offered insight into the histories, challenges, and turning points which shaped the development of LGBTQ-positive spaces in these organizations. Community engagement and leadership emerged as relevant, as did strategies to embed LGBTQ voices and visibility within everyday organizational functioning. Given the gap in literature addressing LGBTQ access to home care and the unique dynamics that shape care in the home, implications address the application of these study findings for creating positive space in the home care sector.     

Capacity-building needs of minority health nonprofits

This article reports on the results of a statewide assessment of the capacity-building needs of organizations that provide health services to ethnic minority groups in Ohio. The research addressed gaps in knowledge about the specific needs of these organizations for improved effectiveness and long-term sustainability. A telephone survey of 659 organizations, supplemented by focus groups with 37 participants in the state's largest cities, indicated substantial need and interest in capacity-building technical assistance in areas such as revenue-generating activities, marketing and public relations, information technology training, program evaluation, and board leadership development. The limited ability of these organizations to pay for the needed assistance creates challenges for planning approaches to meet these vital needs.     

The context of program implementation and evaluation: A pilot study of interorganizational differences to improve child welfare reform efforts

This article contributes to the growing literature on evaluation and implementation science by examining the interaction between staff perceptions of organizational strength with perceptions and indicators of program fidelity. As part of a pilot project related to the evaluation of the Family to Family initiative, a survey was distributed to employees within two urban child welfare agencies with a total of 410 respondents across both sites, for a combined response rate of 72.2%. Survey results were analyzed both in terms or respondents' perception of their agency as well as in relation to measures of program performance and workload. Multivariate models show that organizational indicators are the most significant and positive predictors of perceived program implementation. Specifically, staff who positively perceived the availability of information within their agency also believed that the programs were well implemented in their agency. These findings suggest that as the value of program changes are articulated within an organization, the implementation of the initiative is perceived to improve.     

How organizational characteristics affect the adaptive tactics used by human service nonprofit managers confronting financial uncertainty

The way that nonprofits respond to funding uncertainty is crucial to their ability to meet goals and position themselves for future success. This article investigates how structural, managerial, and financial characteristics affect the adaptive tactics used by human service nonprofits during times of financial stress. These tactics include adding new programs, reducing programs or staff, expanding or starting joint programs, pursuing earned income, and expanding advocacy involvement. Using longitudinal data on human service nonprofits collected on either side of the 2002–2003 economic downtown, we find that larger size provides organizations with a unique ability to choose among different adaptive tactics, as larger size was significantly predictive of adding new programs, reducing programs, expanding advocacy, and pursuing earned income. Strategic planning was positively associated with innovative tactics such as starting joint programs or pursuing earned income. Financial stress or declines in an organization's major funding source led to cutbacks, as expected, but managers who foresaw these challenges were able to respond proactively by adding programs or starting joint programs. However, managers with more training did not respond much differently than did other managers, and organizational age and use of performance management tools had no effect in guiding organizational responses to financial uncertainty.     

Editorial

This special issue of "Gender and Development" focuses on the challenges of implementing gender equity policies in organizations and development programs that have been influenced by hegemonic sex role concepts. Useful to this analysis is a framework developed by Schuler emphasizing the interdependence of substantive elements (laws or organizational policies), structural factors (procedures and mechanisms to enforce the substantive level), and cultural norms and attitudes. In general, adoption of a women-in-development approach has been based on efficiency rather than equality rationales, reflecting awareness of women's potential to contribute to economic growth. Other organizations have embraced gender equality as a prerequisite to poverty alleviation. Feminist organizations, in contrast, address the power inequities implicit in gender relations. Many enlightened grass-roots organizations currently face the dilemma of balancing their commitment to women's empowerment with the need to meet the funding requirements of bureaucratic donors in the context of an unequal partnership. Worrisome is an apparent shift on the part of mainstream development agencies from a women-in-development approach to a social welfare perspective. Alliances and networking between diverse stakeholders united around a common aim are essential to translate the rhetoric of gender equity into actual social transformation.     

The impact of a national strategy to increase physical activity among older adults on national organizations

This study was designed to evaluate the impact of the National Blueprint (NB) on the policies, programs, and organizational culture of selected national organizations. The theoretical model selected to assess the impact of the NB on organizational behavior was Burke's system theory of organizational change. Three organizations, AARP, the American College of Sports Medicine (ACSM), and the Administration on Aging (AoA), were selected for the study. Two individuals in each of these organizations were selected for interview. Semistructured interviews and document reviews were used in the data-collection process. Findings showed that the publication and establishment of the NB resulted in changes in the operating procedures of AARP, ACSM, and AoA. The results were broadly consistent with Burke's system theory of organizational change. The publication of the NB was shown to affect the behavior of organizational leaders, organizational culture, policies, programs, and individual and organizational performance. The new information generated has increased our understanding of the impact of health campaigns on organizational behavior.     

The importance of mentoring relationships among youth workers

Organizational leaders often work to retain their employees and teach them the knowledge needed in becoming future organizational leaders. The purpose of the study examined in this article was to determine how mentoring within Camp Adventure Child and Youth Services contributes to the development of students selected to deliver programs to children and youth worldwide. Strong evidence of mentoring and development were found in both the training and delivery of services. The results of this study are meaningful not only for the particular program studied but for all youth-serving organizations. Supervisors and administrators of youth-serving organizations should be intentional about developing and promoting healthy mentoring relationships to create positive environments for staff and the youth being served.     

The Longevity of Community Aging Initiatives: A Framework for Describing NORC Programs’ Sustainability Goals and Strategies

Naturally Occurring Retirement Community Supportive Services programs (NORC programs) aim to bring together stakeholders within a local area with a large number of older adults (e.g., a neighborhood or apartment building) to facilitate activities and services that promote aging in place. Despite enthusiasm for these programs, there is ongoing concern regarding their long-term sustainability, especially as federal funding to support NORC programs nationally has dwindled in recent years. This exploratory study aimed to develop a framework to describe NORC programs’ sustainability goals and strategies. As part of a statewide study in New Jersey, this study drew on data from semi-structured in-depth interviews with staff of 10 lead organizations that represented 15 NORC programs. Using a grounded theory analytic approach, findings revealed three types of sustainability goals: continuing the program indefinitely within the lead agency (described by eight organizations); integrating the program functions across other organizations (described by one organization); and defining the program as a finite project (described by one organization). Lead organizations implemented and developed their programs in ways that reflected their goals. This framework can be used to guide efforts to maintain, expand, and evaluate NORC programs and related community aging initiatives.     

Bridging transformational leadership,transparent communication,and employee openness to change: The mediating role of trust

Based on a random sample of employees (n = 439) in the United States, this study examined the effect of transformational leadership and transparent organizational communication on cultivating employee organizational trust during an organizational change event. We also investigated the interplay between transformational leadership, transparent communication, and organizational trust, and their impact on employee openness to change. The findings suggested that transformational leadership and transparent communication were positively associated with employee organizational trust, which in turn, positively influenced employee openness to change. Theoretical and managerial contributions of the study were discussed.     

CEO credibility,perceived organizational reputation,and employee engagement

The current study explores how corporate leadership influences the effectiveness of internal public relations by linking CEO credibility, employee evaluation of the organizational reputation, and employee engagement. An online survey of 157 employees from a Fortune 500 company shows that CEO credibility is positively associated with perceived organizational reputation and employee engagement. Perceived organizational reputation significantly and positively affects employee engagement. Employee perception of organizational reputation fully mediates CEO credibility impact on employee engagement.     

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown.Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.     

上海社会组织发展机制和体制改革研究

上海社会组织的发展不仅需要创新模式,更需要突破传统体制机制的制约。上海需探索成立市级社会组织管理服务中心,建立社会组织管理服务的第三方评价制度;出台政府购买服务的指导目录,制定政府购买服务的办法,建立政府购买服务资金的增长机制;加大社会组织人才扶持力度,出台公益人才扶持政策,打造公益人才培训基地;制订免税扩围政策,如细化免税对象、扩大免税内容、简化免税审批流程;建立扶持社会组织发展的资金体系,如建立支持草根社会组织的扶持资金、支持企业设立公益基金、设立社会组织发展的公共资金专户;开展社会组织改革创新试点,建立国际社会组织集聚园区,开展服务于外来人口的社会组织综合创新试点,建立与国际对接的志愿者服务体系。     

The Contribution of Voluntary Organizations to the Care of Children with Life-limiting Incurable Disorders and their Families

A national postal survey of voluntay organizations providing for children with life-limiting incurable disorders (n = 147) is described. The majority of organizations originated from the motivation of parents or care workers in response to deficiencies in service provision from other agencies. A wide variety of services were available from the organizations with over half providing an information service, emotional support and counselling, patient and family support and a telephone helpline. The provision of some services, for example respite care, was, hoverer, associated with the size of annual budgets. Publicity, referral and funding arrangements are also discussed. The role of voluntary organizations as partners in care with statutory agencies is discussed in the light of instability of funding arrangements and the use of health and social work staff as the main source of information about voluntary services to parents. Areas of further research in this field are suggested.     

Impacts of agency coordination on nonprofit domestic violence and sexual assault programs in communities with STOP formula grant funding

The goals of the current study are (a) to understand the community and state context in which STOP(Services* Training* Officers* Prosecutors)-funded victim service (VS) programs operate, (b) to assess the degree to which receipt of STOP funding for VS programs and the degree of state-level STOP agency support for collaboration among community agencies have led to improved program services and community interaction, and (c) to assess the degree to which improved interaction between community agencies leads to improvements for VS programs. The results show that community interaction between VS programs and other community agencies can improve VS program services as reported by service providers. In addition, the higher the pre-STOP levels of activity around violence against women issues in communities, the more agencies can enhance their service system with STOP funding. Also, STOP funding has facilitated greater levels of change for communities whose pre-STOP attention to violence against women was lower.     

Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare

Objective

High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures.

Methods

The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2346 youth aged 1.5- to 18-years-old and 1544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18-month follow-up.

Results

The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency.

Conclusions

To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.