Administrative Considerations in Developing a Volunteer Program LAUREL Clinical Survival
S. HAYLER, Director
Quincy,
Massachusetts
A.C.S.W.
provision had to be made for giving the volunteers tinuing training and supervision. Staff attitudes the volunteers also had to be considered. NEEDS
A
volunteer unctioning
program can become a solid, smoothf part of a community mental health center or other agency if it is built around the needs of both the agency and the volunteers. The author dLscusses the
need to develop realistic job descriptions, to screen the applicants carefully, and to provide continued training and supervision both individually and in groups. She emphasizes
that
staff
resistance
to a volunteer
program
can be overcome by involving staff members in the program and by making them aware of the high quality of work
the
volunteers
do.
UThe Concord (Mass.) Mental Health Center has been using volunteers in all its units for more than three years. The center is a partnership of agencies, including an inpatient ward in a general hospital, an outpatient clinic, a psychiatric day treatment center, and nursery schools for disturbed and retarded children. Volunteers perform many functions. Some are case aides who work with both adults and children. They usually make weekly home visits to the patient; they provide support, serve as role models, teach social skills, and help with problems of daily living. Other volunteers lead groups in activities such as crafts or yoga on the ward and in the day treatment center. Volunteers also work as teacher’s aides in the nursery school classes. In one year 54 volunteers contributed more than 6000 hours to the program. The volunteers, mostly women, have ranged from 14 to 64 years of age. As clinical volunteer program director at the center from 1969 to 1973, I developed the volunteer program and irterviewed all the applicants. However, before I could begin the program there were various administrative matters that needed to be addressed. The needs of both the agency and the volunteers had to be considered. Job descriptions had to be worked out and Ms. Hayler formerly was clinical volunteer program Concord (Mass.) Mental Health Center. At present director of Survival, a youth program at 725 Southern Massachusetts.
HOSPITAL
& COMMUNITY
director at the she is clinical Artery, Quincy,
AGENCY
AND
VOLUNTEERS
From the agency’s point of view the primary reasons for developing a volunteer program were the constant shortage of maqpower and the need for services in addition to those provided by professionals. Also, volunteers can meet patient needs in a special way because they have no structured professional role, Their enthusiasm, their general orientation toward health and strength, and the fact that they are not paid add to their special status. Their strong community ties can be an additional benefit for the community mental health center; they can teach the center about the community and
the community about the center. The special kind of human help that volunteers can offer is shown by one volunteer’s feelings about her work: I was apprehensive about whether or not the patients would accept me, or what I would have to offer, and I thought I would start by being a listener and an interested outsider. Patients were continually asking me questions about myself and why I was on the ward. And when they discovered I was a relatively minor threat or none at all, they were willing to talk about themselves. My neutral position helped create an openness on their part. My interest was in helping the patient do something that was constructive and fun. I was in a better position when I was dealing with strengths.” The agency staff should consider the volunteer’s needs as well as their own if they want to attract and keep quality volunteers. Kantor found that college students who worked as case aides in a state hospital gave various reasons for volunteering, such as to gain experience before entering a career in mental health, to learn more about the field, to be of service, to help meet social needs, and to learn more about themselves. Others felt the work would provide a challenge and an escape from their everyday routines.1 Our volunteers ‘
1
D. Kantor,
report,
PSYCHIATRY
OF
contoward
VOLUME
Boston
26
Student State
Volunteers Hospital,
NUMBER
in a State
October
3 MARCH
Hospital,
unpublished
1960,
1975
143
gave similar test a future tioned most DEVELOPING
reasons; the desire to help, to learn, and to career area or re-enter a field were menfrequently. VOLUNTEER
JOBS
When developing jobs for volunteers, I usually worked from staff ideas and requests; however, in one unit the patients initiated the requests for activity leaders. Requests for volunteers should be carefully screened. Sometimes an improvement in staff communication or changes in a treatment plan are more appropriate than assigning a volunteer. A program director must be sensitive to possible hidden motives in the requests, such as setting up a scapegoat or giving a staff member a political ally. Goals should be defined before volunteers are placed. Communication must be built among all involved, roles must be established, and the supervisor’s responsibility must be made clear. The patient also needs to be prepared for the volunteer. Specific goals for a volunteer case aide might be to support certain strengths or behaviors of the patient, and to help the patient with tasks he has difficulty with, such as shopping. Encouraging a patient to recognize his feelings about a situation or relationship, helping him to see alternatives, and acting as the patient’s advocate in seeking services might also be included in the job description. Underlying those specific goals are the more general ones of helping patients to be aware of their choices and encouraging them to become more independent. RECRUITMENT
AND
SCREENING
Initially volunteers were recruited with the help of the mental health association and local schools. After the program had been in operation for several months, most of the volunteers were referred by other volunteers or by staff members. Newspaper articles pointing out the need for volunteers are one way to recruit a more diverse group. Fulland part-time students who need practical experience to supplement course work are a significant potential group of volunteers. I have found that giving talks to community groups or putting up posters are much less effective ways to recruit. The volunteer screening process I used might best be described as “guided self-selection.” With very few exceptions, a volunteer who is given a careful, unhurried look at jobs with varying requirements can pick an appropriate job for herself. In the screening interview, the program director should describe in detail the requirements of the jobs. The director should know of volunteer opportunities elsewhere because of the inevitable situations where the applicant does not fit into the agency’s program. There are many ways to tell if a volunteer will be able to work well with patients. A basic indicator is that the volunteer’s affect varies appropriately as he discusses
144
HOSPITAL
& COMMUNITY
PSYCHIATRY
different subjects. Enthusiasm should be mixed with other realistic feelings, such as doubt about one’s ability to do the job or sadness upon hearing of a patient’s pain. Flexibility and ability to gain from supervision can often be judged by discussing a hypothetical case or volunteer job situation or an actual experience the applicant has had in working with people. The volunteer should be able to consider different approaches. Understanding the volunteer’s motivation is important. It is helpful to discuss other choices with anyone who is volunteering because of external pressure. The director should find out what the volunteer hopes to get out of the program and be able to point out what expectations the program probably will not meet. An open look at motivation is particularly important when the volunteer herself or a close family member has had psychiatric treatment. The program director should discuss with the applicant how that experience affects her job preference and the type of patient with whom she would like to work. Some volunteers want to work with a patient who is in a situation similar to one they have experienced. Others want to help someone with a problem that is different from their own personal experience. The volunteer may work well in either case if consideration is given to such situations in placement and supervision. Placement is made after the volunteer decides which job to accept. She meets with the supervisor and the program director to agree on the quantity of work, the initial goals, and the sources of help available to her. They decide who should be in contact with whom, who is to be clinically responsible for the patient, and who is to supervise the volunteer’s work. A written outline of those points, possibly the original request for a volunteer, is given to the volunteer, the supervisor, the clinician responsible for the patient, and the program director. TRAINING
AND
SUPERVISION
All volunteers are given a brief orientation, including a discussion of the structure of the agency, the philosophy of community mental health, and the responsibilities of volunteers. Anxiety may build up if too much training precedes placement. Role-playing is useful in early orientation and training, but it cannot match the emotional involvement of working with an actual patient. Intensive training seems to be more meaningful to volunteers when they are on the job. Group activity volunteers and nursery-school aides are assigned to individual staff members for brief supervision before or after each work session. Staff members frequently need to be reminded that volunteers require continued supervision, support, and the opportunity to discuss their ideas and problems. The program director should check regularly on the volunteer’s work progress and on the supervisory relationship. Occasional group meetings of volunteers who are doing similar work
Group
supervision
is particularly welcomed
by
the volunteers who work alone. The meetings expose them to a variety of situations and approaches. a valuable opportunity to compare experiences reactions. The case aide volunteers receive most of their supervision in groups that meet for two hours once a week; after group cohesion is established, the groups meet biweekly. Such supervision is particularly welcomed by the volunteers who work alone. The meetings expose volunteers to a variety of situations and approaches. Other volunteers often can offer support and make suggestions that are easier to accept than those made by professionals. To draw from the volunteer’s knowledge of life is usually more profitable than to teach too much psychiatric theory. For example, the supervisor might ask, In your experience how do people feel in that situation, and what things such as societal mechanisms, activities, defenses, or actions help them?” The group supervisor must make clear in advance who on the staff is clinically responsible for each case. If the supervisor is to be responsible for all of the cases, as well as for supervising the volunteer group, time should be allotted for the added responsibility. provide
and
‘
STAFF
ATTITUDES
The most difficult initial task in starting the volunteer program was to solicit staff support. Verbally everyone gave some support, but all the staff, including me, had hidden resistance to the use of volunteers. They showed their negative feelings by patronizing the volunteers, by ignoring them, and by asking them to work magic in impossible situations. Staff who had no previous positive experience with volunteers and those whose own roles were in flux seemed the most resistant to the program. My first step to educate the staff about possible jobs for volunteers was to use a small group of volunteers on my own cases and to make them highly visible. When that aroused some interest, I obtained administrative sanction for a volunteer program, and one-fourth of my time was freed for the job. Next I asked the staff for ideas about what they wanted from volunteers; that helped reduce their anxiety. I also made clear that volunteers would be placed only at the unit’s request and that lower levels of staff would be included in the negotiations. After the program was begun, I continued to involve
staff members and to keep them informed about the volunteers’ work. I set up specific times for volunteers and staff to meet and used as many staff members as possible in their training and supervision. Volunteers are included in case conferences that concern a patient they are working closely with, and they make written or telephone reports to relevant staff about their work. Regular discussions of the program at staff meetings, with the volunteers participating, lead to increased acceptance of the program by the staff. The high quality of work volunteers do can help convince staff of the value of the program. In one case a psychiatrist, a child psychiatrist, a visiting nurse, a welfare worker, a child-placement worker, and a surgeon were all able to see a volunteer’s efforts to help a family. The family came to the attention of the center staff because one of the children, a preschool girl, was referred to us during a brief postsurgical psychotic episode. The child was placed in a nursery school, and a volunteer case aide was assigned to be the primary person working with the mother, who was overwhelmed by the situation. As a child, the mother had been mistakenly placed in an institution for the retarded, and she put enormous pressure on her children educationally so they would not be “dumb” too. The volunteer helped the mother sort her children’s books and educational toys to weed out the ones that were not appropriate for their ages. She made the sorting easier by loaning the woman books her own children had outgrown and by borrowing” books that were too advanced for the woman’s young children. Using her authority as a former teacher, she helped the mother see that she gave to her children in many ways and did not need to place so much emphasis on formal instruction. To balance her role as helper the volunteer asked the woman to give her cooking lessons. Later the mother was hospitalized for a physical illness, and her children had to be placed in foster homes. The volunteer made sure that the mother got adequate information about her children and helped her deal with her depression by encouraging her to talk about her feelings of loss. The aide also set up a case conference to speed up the process of having the children returned to their mother. The professionals involved in the case were impressed by the way the volunteer worked with the woman to build her self-esteem and avoided techniques that would have made her feel she was being criticized. A final important consideration in setting up a volunteer program is to provide for feedback from all concerned about ways to revise and further improve the program. The program director may hold occasional formal and informal meetings of volunteers, supervisors, patients, and other staff aimed at developing such feedback and ideas. Of course, the meetings are most productive if they have resulted in useful changes in the past or if they lead to rapid modification of the program. #{149} “
VOLUME
26
NUMBER
3 MARCH
1975
145
S. HAYLER, Director
Quincy,
Massachusetts
A.C.S.W.
provision had to be made for giving the volunteers tinuing training and supervision. Staff attitudes the volunteers also had to be considered. NEEDS
A
volunteer unctioning
program can become a solid, smoothf part of a community mental health center or other agency if it is built around the needs of both the agency and the volunteers. The author dLscusses the
need to develop realistic job descriptions, to screen the applicants carefully, and to provide continued training and supervision both individually and in groups. She emphasizes
that
staff
resistance
to a volunteer
program
can be overcome by involving staff members in the program and by making them aware of the high quality of work
the
volunteers
do.
UThe Concord (Mass.) Mental Health Center has been using volunteers in all its units for more than three years. The center is a partnership of agencies, including an inpatient ward in a general hospital, an outpatient clinic, a psychiatric day treatment center, and nursery schools for disturbed and retarded children. Volunteers perform many functions. Some are case aides who work with both adults and children. They usually make weekly home visits to the patient; they provide support, serve as role models, teach social skills, and help with problems of daily living. Other volunteers lead groups in activities such as crafts or yoga on the ward and in the day treatment center. Volunteers also work as teacher’s aides in the nursery school classes. In one year 54 volunteers contributed more than 6000 hours to the program. The volunteers, mostly women, have ranged from 14 to 64 years of age. As clinical volunteer program director at the center from 1969 to 1973, I developed the volunteer program and irterviewed all the applicants. However, before I could begin the program there were various administrative matters that needed to be addressed. The needs of both the agency and the volunteers had to be considered. Job descriptions had to be worked out and Ms. Hayler formerly was clinical volunteer program Concord (Mass.) Mental Health Center. At present director of Survival, a youth program at 725 Southern Massachusetts.
HOSPITAL
& COMMUNITY
director at the she is clinical Artery, Quincy,
AGENCY
AND
VOLUNTEERS
From the agency’s point of view the primary reasons for developing a volunteer program were the constant shortage of maqpower and the need for services in addition to those provided by professionals. Also, volunteers can meet patient needs in a special way because they have no structured professional role, Their enthusiasm, their general orientation toward health and strength, and the fact that they are not paid add to their special status. Their strong community ties can be an additional benefit for the community mental health center; they can teach the center about the community and
the community about the center. The special kind of human help that volunteers can offer is shown by one volunteer’s feelings about her work: I was apprehensive about whether or not the patients would accept me, or what I would have to offer, and I thought I would start by being a listener and an interested outsider. Patients were continually asking me questions about myself and why I was on the ward. And when they discovered I was a relatively minor threat or none at all, they were willing to talk about themselves. My neutral position helped create an openness on their part. My interest was in helping the patient do something that was constructive and fun. I was in a better position when I was dealing with strengths.” The agency staff should consider the volunteer’s needs as well as their own if they want to attract and keep quality volunteers. Kantor found that college students who worked as case aides in a state hospital gave various reasons for volunteering, such as to gain experience before entering a career in mental health, to learn more about the field, to be of service, to help meet social needs, and to learn more about themselves. Others felt the work would provide a challenge and an escape from their everyday routines.1 Our volunteers ‘
1
D. Kantor,
report,
PSYCHIATRY
OF
contoward
VOLUME
Boston
26
Student State
Volunteers Hospital,
NUMBER
in a State
October
3 MARCH
Hospital,
unpublished
1960,
1975
143
gave similar test a future tioned most DEVELOPING
reasons; the desire to help, to learn, and to career area or re-enter a field were menfrequently. VOLUNTEER
JOBS
When developing jobs for volunteers, I usually worked from staff ideas and requests; however, in one unit the patients initiated the requests for activity leaders. Requests for volunteers should be carefully screened. Sometimes an improvement in staff communication or changes in a treatment plan are more appropriate than assigning a volunteer. A program director must be sensitive to possible hidden motives in the requests, such as setting up a scapegoat or giving a staff member a political ally. Goals should be defined before volunteers are placed. Communication must be built among all involved, roles must be established, and the supervisor’s responsibility must be made clear. The patient also needs to be prepared for the volunteer. Specific goals for a volunteer case aide might be to support certain strengths or behaviors of the patient, and to help the patient with tasks he has difficulty with, such as shopping. Encouraging a patient to recognize his feelings about a situation or relationship, helping him to see alternatives, and acting as the patient’s advocate in seeking services might also be included in the job description. Underlying those specific goals are the more general ones of helping patients to be aware of their choices and encouraging them to become more independent. RECRUITMENT
AND
SCREENING
Initially volunteers were recruited with the help of the mental health association and local schools. After the program had been in operation for several months, most of the volunteers were referred by other volunteers or by staff members. Newspaper articles pointing out the need for volunteers are one way to recruit a more diverse group. Fulland part-time students who need practical experience to supplement course work are a significant potential group of volunteers. I have found that giving talks to community groups or putting up posters are much less effective ways to recruit. The volunteer screening process I used might best be described as “guided self-selection.” With very few exceptions, a volunteer who is given a careful, unhurried look at jobs with varying requirements can pick an appropriate job for herself. In the screening interview, the program director should describe in detail the requirements of the jobs. The director should know of volunteer opportunities elsewhere because of the inevitable situations where the applicant does not fit into the agency’s program. There are many ways to tell if a volunteer will be able to work well with patients. A basic indicator is that the volunteer’s affect varies appropriately as he discusses
144
HOSPITAL
& COMMUNITY
PSYCHIATRY
different subjects. Enthusiasm should be mixed with other realistic feelings, such as doubt about one’s ability to do the job or sadness upon hearing of a patient’s pain. Flexibility and ability to gain from supervision can often be judged by discussing a hypothetical case or volunteer job situation or an actual experience the applicant has had in working with people. The volunteer should be able to consider different approaches. Understanding the volunteer’s motivation is important. It is helpful to discuss other choices with anyone who is volunteering because of external pressure. The director should find out what the volunteer hopes to get out of the program and be able to point out what expectations the program probably will not meet. An open look at motivation is particularly important when the volunteer herself or a close family member has had psychiatric treatment. The program director should discuss with the applicant how that experience affects her job preference and the type of patient with whom she would like to work. Some volunteers want to work with a patient who is in a situation similar to one they have experienced. Others want to help someone with a problem that is different from their own personal experience. The volunteer may work well in either case if consideration is given to such situations in placement and supervision. Placement is made after the volunteer decides which job to accept. She meets with the supervisor and the program director to agree on the quantity of work, the initial goals, and the sources of help available to her. They decide who should be in contact with whom, who is to be clinically responsible for the patient, and who is to supervise the volunteer’s work. A written outline of those points, possibly the original request for a volunteer, is given to the volunteer, the supervisor, the clinician responsible for the patient, and the program director. TRAINING
AND
SUPERVISION
All volunteers are given a brief orientation, including a discussion of the structure of the agency, the philosophy of community mental health, and the responsibilities of volunteers. Anxiety may build up if too much training precedes placement. Role-playing is useful in early orientation and training, but it cannot match the emotional involvement of working with an actual patient. Intensive training seems to be more meaningful to volunteers when they are on the job. Group activity volunteers and nursery-school aides are assigned to individual staff members for brief supervision before or after each work session. Staff members frequently need to be reminded that volunteers require continued supervision, support, and the opportunity to discuss their ideas and problems. The program director should check regularly on the volunteer’s work progress and on the supervisory relationship. Occasional group meetings of volunteers who are doing similar work
Group
supervision
is particularly welcomed
by
the volunteers who work alone. The meetings expose them to a variety of situations and approaches. a valuable opportunity to compare experiences reactions. The case aide volunteers receive most of their supervision in groups that meet for two hours once a week; after group cohesion is established, the groups meet biweekly. Such supervision is particularly welcomed by the volunteers who work alone. The meetings expose volunteers to a variety of situations and approaches. Other volunteers often can offer support and make suggestions that are easier to accept than those made by professionals. To draw from the volunteer’s knowledge of life is usually more profitable than to teach too much psychiatric theory. For example, the supervisor might ask, In your experience how do people feel in that situation, and what things such as societal mechanisms, activities, defenses, or actions help them?” The group supervisor must make clear in advance who on the staff is clinically responsible for each case. If the supervisor is to be responsible for all of the cases, as well as for supervising the volunteer group, time should be allotted for the added responsibility. provide
and
‘
STAFF
ATTITUDES
The most difficult initial task in starting the volunteer program was to solicit staff support. Verbally everyone gave some support, but all the staff, including me, had hidden resistance to the use of volunteers. They showed their negative feelings by patronizing the volunteers, by ignoring them, and by asking them to work magic in impossible situations. Staff who had no previous positive experience with volunteers and those whose own roles were in flux seemed the most resistant to the program. My first step to educate the staff about possible jobs for volunteers was to use a small group of volunteers on my own cases and to make them highly visible. When that aroused some interest, I obtained administrative sanction for a volunteer program, and one-fourth of my time was freed for the job. Next I asked the staff for ideas about what they wanted from volunteers; that helped reduce their anxiety. I also made clear that volunteers would be placed only at the unit’s request and that lower levels of staff would be included in the negotiations. After the program was begun, I continued to involve
staff members and to keep them informed about the volunteers’ work. I set up specific times for volunteers and staff to meet and used as many staff members as possible in their training and supervision. Volunteers are included in case conferences that concern a patient they are working closely with, and they make written or telephone reports to relevant staff about their work. Regular discussions of the program at staff meetings, with the volunteers participating, lead to increased acceptance of the program by the staff. The high quality of work volunteers do can help convince staff of the value of the program. In one case a psychiatrist, a child psychiatrist, a visiting nurse, a welfare worker, a child-placement worker, and a surgeon were all able to see a volunteer’s efforts to help a family. The family came to the attention of the center staff because one of the children, a preschool girl, was referred to us during a brief postsurgical psychotic episode. The child was placed in a nursery school, and a volunteer case aide was assigned to be the primary person working with the mother, who was overwhelmed by the situation. As a child, the mother had been mistakenly placed in an institution for the retarded, and she put enormous pressure on her children educationally so they would not be “dumb” too. The volunteer helped the mother sort her children’s books and educational toys to weed out the ones that were not appropriate for their ages. She made the sorting easier by loaning the woman books her own children had outgrown and by borrowing” books that were too advanced for the woman’s young children. Using her authority as a former teacher, she helped the mother see that she gave to her children in many ways and did not need to place so much emphasis on formal instruction. To balance her role as helper the volunteer asked the woman to give her cooking lessons. Later the mother was hospitalized for a physical illness, and her children had to be placed in foster homes. The volunteer made sure that the mother got adequate information about her children and helped her deal with her depression by encouraging her to talk about her feelings of loss. The aide also set up a case conference to speed up the process of having the children returned to their mother. The professionals involved in the case were impressed by the way the volunteer worked with the woman to build her self-esteem and avoided techniques that would have made her feel she was being criticized. A final important consideration in setting up a volunteer program is to provide for feedback from all concerned about ways to revise and further improve the program. The program director may hold occasional formal and informal meetings of volunteers, supervisors, patients, and other staff aimed at developing such feedback and ideas. Of course, the meetings are most productive if they have resulted in useful changes in the past or if they lead to rapid modification of the program. #{149} “
VOLUME
26
NUMBER
3 MARCH
1975
145
