Michael Weinberg

Successful Management of EPSDT Funded Community-Based Behavioral Health Rehabilitation Services for Children (Wrap Around): What OBM Has to Offer

As part of the Behavior Analyst Todays (BAT) on going discussion of ways to improve and reform Behavioral Health Rehabilitation Programs (BHRP) for children, this paper addresses the role of behavioral management in increasing treatment integrity. With the questionability of traditional organizational development procedures (Terpstra, 1981), organizational behavior management rose in the field of management and human resources. Thus while changing corporate culture has remained an elusive task, changing corporate behaviors has prove to be quite successful and enduring (Wilhelm, 1992). ********** Critical to the long term goals of an OBM approach is increasing service quality and integrity of socially valid services, while improving specific outcomes for children within the programs. Also OBM attempts to produce more productivity and greater satisfaction in workers, thereby improving effectiveness and efficiency in organizations (Mawhinney, 1984). In addition, reducing costs is a major theme that needs to be addressed. It is hoped that this paper will spark interest from those involved in organizational behavior management to address issues of performance in social service agencies, particularly in the areas where the programs are involved directly in the field and not in the office, where practices are readily and clearly observed. An OBM approach involves (a) specification of standards for workers guided by strong behavioral objectives linked to long term agency objectives and treatment objectives tailored to the needs of the particular child in which they serve (b) measurement, particularly measures of compliance and treatment integrity (c) monitoring and feedback systems that reward appropriate behavior and offer corrective feedback and training to lessen performance discrepancies. To achieve these goals, a BHRP company needs to move past three types of common management errors: (1) inadequate structural support including supervision and representative management (2) blaming employees and (3) solely relying on grievances as a measure of treatment integrity performance. This paper will define these issues, starting with the management errors. Inadequate structural support The key player in the structuring of BHRP is the first line Supervisor (Cautilli, Rosenwasser, & Clarke, 2000). Cautilli and colleagues (2000) laid out a clear job description of the roles, responsibilities, and function of the clinical supervisor. Unfortunately, few agencies have supervisors who understand and can apply the technology of both administrative and clinical roles enhancement. Even more problematic is that most agencies have not recognized the importance of management and supervision in the overall effectiveness of BHRP. Blaming the Employee One of the strongest achievements of statistical process control and total quality management, for which behavior analysts should be deeply indebted, is the enduring lessen that these approaches have left on managers to recognize that many performance problems are indeed systemic and not the fault of a particular employee. Over the years management has developed a style in which the most natural thing for a manager to do, when a grievance or problem arises is to blame it on the particular staff member involved. For example, when faced with a grievance from the school about an employee sitting in the back of the class and not being helpful when the child is engaged in disruptive behavior, the first reaction might be to decide to remove the employee and start the process of helping this employee to find another career. This is a simplistic but counterproductive reaction. Whenever employees are punished it leads to a suppression of not just the current behavior but all behavior emitted by that employee. In addition, punishment has the distinction of bringing negative emotional side effects to the employee. Thus the employee may become less effective from the action and actually begin to blame the supervisor. …