Five of them did attend, but they sat together in a group. Later, at their Y meeting, they said that they didn't belong at the club any more—they weren't that sick. Thereafter they attempted to maintain contact only with the staff. The group members not ready to move on remained with the Tuesday Evening Club. Most of them ex perienced a crisis, which may have been partly the
result of acting out the message that they were not well enough to join the other group. During the time that the club was reduced in size, members were more agitated and anxious; the smaller group necessitated more in tense relationships, which were anxiety-provoking. Then more members were added, as planned. Even though they were severely ill, the group's anxiety level was reduced, and the club continued its program.•
Attitudesof Mental Health Center Staff Toward CommunityOrganization GERALD LANDSBERG, A.C.S.W. Director Program Analysis and Evaluation Maimonides Community Mental Health Center Brooklyn, New York ROBERT C. SAAL, M.S.W. Social Worker Child Care Service of Delaware County Upper Darby, Pennsylvania STEVEN L. TAYLOR, C.S.W. Doctoral Candidate Columbia University Graduate School of Social Work New York, New York The authors report on the differences perceptions
that
clinical
and
community
in attitudes
and
organization
staff have about the role of community organizers in a mental health center and about the center's priorities. Community organizers defined their role as one ena hung the community to act on social-welfare problems, while clinical staff defined it as a liaison role connecting community residents and clinical services. Community organizers placed less value on traditional services, and felt greater dissatisfaction with center priorities. •¿Overthe last few years, community organization has been increasingly employed in direct-service agencies. Community mental health centers, in their quest to fulfill their mandates in the areas of prevention and community consultation, have used this approach more and more. The introduction of community organiza tion, even in a limited scope, has produced some unex
230
HOSPITAL & CONINIUNITY PSYCHIATRY
pected confusion and results: uncertainty about the organizers' role and function, role diffusion, and con sequent problems in defining jobs to be done.― At the Maimonides Community Mental Health Center in Brooklyn, we have found that the subject can be ex tremely complex and problematic. Based on what we saw to be a need for further in vestigation into community organization methods, we initiated a four-month exploratory investigation in 1972 to study several questions. They included, In what ways is the role of a community organizer unclear? What is his role? What conflicts exist between community organization and direct-service staff? What, if any, organizational strains are created? Because of time restrictions, the study was focused on staff attitudes and perceptions. To that end we developed a specific hypothesis: the discipline of the worker—whether he is a community organizer or clinical worker—is directly related to the perceptions and attitudes about the role of community organization at the center, the center's priorities, and the prac titioners' satisfaction with existing priorities. A structured interview schedule was developed to test this hypothesis and to explore other areas, in cluding definition of community organization roles in mental health, communications within the center, and Mr. Landsberg's 11219. 1 C. Beallor
address is 4802 10th Avenue, et a!., “¿TheSocial
Work
Brooklyn, New York
Contribution
to the Com
munity Mental Health Center: The Development of a New Social Utility,― paper presented at the American Orthopsychiatric Associa tion meeting, New York City, April 1969. 2 A. Lurie
and G. Rosenberg,
“¿Problems in Community
tion for Mental Health,― Hospital & Community November 1972, pp. 350-353.
Organiza
Psychiatry,
Vol. 23,
intraorganizational strain. The authors conducted all interviews. The study sample consisted of 28 respondents. Because of the small number of organizers, the entire community organization staff of eight were included. The other 20 were selected at random from the center's professional staff and consisted of five social workers, five psychologists, five psychiatrists, three mental health workers, one nurse, and one educational therapist. No staff member refused to participate. The data were analyzed by several statistical tests and techniques including cross-tabulation, standard of error proportion, nonparametric means, chi square, and analysis of variance. Where sophisticated tests proved inapplicable or inappropriate, percentage comparisons were used. We found that clinical staff and community organiza tion staff see the role of the community organizer quite differently. For the most part, clinical staff regarded the community organizer's role as one of liaison, closely related to the direct services provided by the clinical staff. In their eyes it involved identification of com munity needs, detection of cases, preventive work, education of citizens about community mental health services, and public relations. Few clinicians felt the community organizer had no role in the functioning of a mental health center. Community organizers, on the other hand, defined their role as an ‘¿ ‘¿ enabling' ‘¿ one—to enable or help the community itself to act to alleviate social-welfare problems. (The differences in views of roles were not statistically significant. ) They did not perceive their goals and the goals of the center as being the same, but viewed their contribution as their efforts to shift center goals from a clinical emphasis to prevention and social action approaches. DIFFERING
PRIORITIES
Using a ten-item checklist that included the center's elements of service, we asked the 28 staff members to rate center services in terms of priorities—both the center's existing priorities and each worker's ideal listing. The results were quite revealing. •¿ Clinical staff rated clinical services, hospitalization services, and the training of professionals significantly higher (p = .05) than did the community organizers. •¿ Children's services were considered more impor tant by clinical staff than by community organization staff. The difference was noticeable but not statistically significant (p = .2). •¿ Community organizers rated outreach services (satellite centers, clinical outreach services, and con sultation and education) higher than did clinicians. Again, the difference was noticeable but not statistically significant (p = .2). •¿ Traditional clinical and inpatient services were valued significantly more positively (p = .02) by clinical staff than by community organizers. To examine differences in staff's satisfaction with ex
isting priorities, we computed a dissatisfaction score for each worker, reflecting the absolute value of the difference between their ‘¿ ‘¿ should be' ‘¿ and ‘¿ ‘¿ are― ratings. On this point differences between community organizers and clinical staff were so great as to be statistically significant at the p .01 level. Community organizers were much less satisfied with existing priorities than were clinical staff. We also included an item on communication within the center and discovered that only 20 per cent of the clinical staff were generally aware of community organization activities at the center. Seventy-nine per cent of all respondents wished they were more aware of community organization activities. As the final item in the interview, we asked staff to rate on a 5-point scale the degree of difficulty of their job and the effort expended in it, and the perceived difficulty and effort expended by others in their jobs. Differences in attitude were significant at the p .01 level. Most clinicians felt that everyone worked equally hard, but most qualified their answers by saying that the community organizers did not know how hard the clinical staff work. Community organizers, without ex ception, felt that they were the hardest working group in the center. Thus our hypothesis that a worker's discipline would affect his perception and attitudes about the role of community organization and about the center's priorities was demonstrated to be correct. The differences about the organizer's role are most likely due to the newness of community organization work in community mental health. Many of the clinical staff were ignorant of community organization techniques and purposes, and they did not regard what practices they did know about as actually being useful in prevent ing or alleviating mental health problems. The center itself had not defined the role of community organizers in its operation, and, because of communication gaps, clinicians were unaware of what organizers were doing. Given the dichotomy of attitudes and philosophies, we must ask what it means for the center. The divisions we found do create some organizational strain and cause some misunderstandings, indicating that barriers were created in the attempts to integrate the skills of the clinicians and the community organizers. As the re sult of our findings, we recommended a policy of in creased communication between the two disciplines, and of coordinated involvement of community organi zation staff in clinical service programs and clinicians in community outreach activities.U
VOLUME 26 NUMBER 4 APRIL 1975
231
result of acting out the message that they were not well enough to join the other group. During the time that the club was reduced in size, members were more agitated and anxious; the smaller group necessitated more in tense relationships, which were anxiety-provoking. Then more members were added, as planned. Even though they were severely ill, the group's anxiety level was reduced, and the club continued its program.•
Attitudesof Mental Health Center Staff Toward CommunityOrganization GERALD LANDSBERG, A.C.S.W. Director Program Analysis and Evaluation Maimonides Community Mental Health Center Brooklyn, New York ROBERT C. SAAL, M.S.W. Social Worker Child Care Service of Delaware County Upper Darby, Pennsylvania STEVEN L. TAYLOR, C.S.W. Doctoral Candidate Columbia University Graduate School of Social Work New York, New York The authors report on the differences perceptions
that
clinical
and
community
in attitudes
and
organization
staff have about the role of community organizers in a mental health center and about the center's priorities. Community organizers defined their role as one ena hung the community to act on social-welfare problems, while clinical staff defined it as a liaison role connecting community residents and clinical services. Community organizers placed less value on traditional services, and felt greater dissatisfaction with center priorities. •¿Overthe last few years, community organization has been increasingly employed in direct-service agencies. Community mental health centers, in their quest to fulfill their mandates in the areas of prevention and community consultation, have used this approach more and more. The introduction of community organiza tion, even in a limited scope, has produced some unex
230
HOSPITAL & CONINIUNITY PSYCHIATRY
pected confusion and results: uncertainty about the organizers' role and function, role diffusion, and con sequent problems in defining jobs to be done.― At the Maimonides Community Mental Health Center in Brooklyn, we have found that the subject can be ex tremely complex and problematic. Based on what we saw to be a need for further in vestigation into community organization methods, we initiated a four-month exploratory investigation in 1972 to study several questions. They included, In what ways is the role of a community organizer unclear? What is his role? What conflicts exist between community organization and direct-service staff? What, if any, organizational strains are created? Because of time restrictions, the study was focused on staff attitudes and perceptions. To that end we developed a specific hypothesis: the discipline of the worker—whether he is a community organizer or clinical worker—is directly related to the perceptions and attitudes about the role of community organization at the center, the center's priorities, and the prac titioners' satisfaction with existing priorities. A structured interview schedule was developed to test this hypothesis and to explore other areas, in cluding definition of community organization roles in mental health, communications within the center, and Mr. Landsberg's 11219. 1 C. Beallor
address is 4802 10th Avenue, et a!., “¿TheSocial
Work
Brooklyn, New York
Contribution
to the Com
munity Mental Health Center: The Development of a New Social Utility,― paper presented at the American Orthopsychiatric Associa tion meeting, New York City, April 1969. 2 A. Lurie
and G. Rosenberg,
“¿Problems in Community
tion for Mental Health,― Hospital & Community November 1972, pp. 350-353.
Organiza
Psychiatry,
Vol. 23,
intraorganizational strain. The authors conducted all interviews. The study sample consisted of 28 respondents. Because of the small number of organizers, the entire community organization staff of eight were included. The other 20 were selected at random from the center's professional staff and consisted of five social workers, five psychologists, five psychiatrists, three mental health workers, one nurse, and one educational therapist. No staff member refused to participate. The data were analyzed by several statistical tests and techniques including cross-tabulation, standard of error proportion, nonparametric means, chi square, and analysis of variance. Where sophisticated tests proved inapplicable or inappropriate, percentage comparisons were used. We found that clinical staff and community organiza tion staff see the role of the community organizer quite differently. For the most part, clinical staff regarded the community organizer's role as one of liaison, closely related to the direct services provided by the clinical staff. In their eyes it involved identification of com munity needs, detection of cases, preventive work, education of citizens about community mental health services, and public relations. Few clinicians felt the community organizer had no role in the functioning of a mental health center. Community organizers, on the other hand, defined their role as an ‘¿ ‘¿ enabling' ‘¿ one—to enable or help the community itself to act to alleviate social-welfare problems. (The differences in views of roles were not statistically significant. ) They did not perceive their goals and the goals of the center as being the same, but viewed their contribution as their efforts to shift center goals from a clinical emphasis to prevention and social action approaches. DIFFERING
PRIORITIES
Using a ten-item checklist that included the center's elements of service, we asked the 28 staff members to rate center services in terms of priorities—both the center's existing priorities and each worker's ideal listing. The results were quite revealing. •¿ Clinical staff rated clinical services, hospitalization services, and the training of professionals significantly higher (p = .05) than did the community organizers. •¿ Children's services were considered more impor tant by clinical staff than by community organization staff. The difference was noticeable but not statistically significant (p = .2). •¿ Community organizers rated outreach services (satellite centers, clinical outreach services, and con sultation and education) higher than did clinicians. Again, the difference was noticeable but not statistically significant (p = .2). •¿ Traditional clinical and inpatient services were valued significantly more positively (p = .02) by clinical staff than by community organizers. To examine differences in staff's satisfaction with ex
isting priorities, we computed a dissatisfaction score for each worker, reflecting the absolute value of the difference between their ‘¿ ‘¿ should be' ‘¿ and ‘¿ ‘¿ are― ratings. On this point differences between community organizers and clinical staff were so great as to be statistically significant at the p .01 level. Community organizers were much less satisfied with existing priorities than were clinical staff. We also included an item on communication within the center and discovered that only 20 per cent of the clinical staff were generally aware of community organization activities at the center. Seventy-nine per cent of all respondents wished they were more aware of community organization activities. As the final item in the interview, we asked staff to rate on a 5-point scale the degree of difficulty of their job and the effort expended in it, and the perceived difficulty and effort expended by others in their jobs. Differences in attitude were significant at the p .01 level. Most clinicians felt that everyone worked equally hard, but most qualified their answers by saying that the community organizers did not know how hard the clinical staff work. Community organizers, without ex ception, felt that they were the hardest working group in the center. Thus our hypothesis that a worker's discipline would affect his perception and attitudes about the role of community organization and about the center's priorities was demonstrated to be correct. The differences about the organizer's role are most likely due to the newness of community organization work in community mental health. Many of the clinical staff were ignorant of community organization techniques and purposes, and they did not regard what practices they did know about as actually being useful in prevent ing or alleviating mental health problems. The center itself had not defined the role of community organizers in its operation, and, because of communication gaps, clinicians were unaware of what organizers were doing. Given the dichotomy of attitudes and philosophies, we must ask what it means for the center. The divisions we found do create some organizational strain and cause some misunderstandings, indicating that barriers were created in the attempts to integrate the skills of the clinicians and the community organizers. As the re sult of our findings, we recommended a policy of in creased communication between the two disciplines, and of coordinated involvement of community organi zation staff in clinical service programs and clinicians in community outreach activities.U
VOLUME 26 NUMBER 4 APRIL 1975
231
