Person-Centered Services and Organizational Context: Taking Stock of Working Conditions and Their Impact
Hulgin, K.M. (2004) Person-centered services and organizational context: Taking stock of working conditions and their impact. Mental Retardation, 42(3), 169-180.
The author compared eight agencies that had adopted person-centered services, to a greater or lesser extent, for individuals with disabilities. Her goal was to determine the types of contextual factors within an organization that would either enhance or limit the provision of person-centered services. Data was collected over a 2.5-year period and focused on the question, "What is associated with the proportion of person-centered services that an organization provides?"
The agencies were distinguished by the following factors: characteristics, images of people with disabilities, images of organizing, and approaches to policy. On a continuum that followed their allocation of resources and commitment to person-centered services, they were identified as learning organizations, a smorgasbord organization, or an innovative bureaucracy.
The six learning organizations were those most committed to person-centered service delivery. This category subdivided into ground-up and conversion organizations. The four ground-up organizations had started based on providing person-centered services and did not have a history or tradition of providing segregated, center-based services for individuals with disabilities. They also had the most control over their size, allowing a very personalized approach. The two conversion organizations had some history in providing congregate services but were still young and small enough to change to person-centered programs. Interestingly, one of the two agencies lost two-thirds of its staff and the other saw a complete turnover during the conversion process.
The smorgasbord organization was a private, parent-driven organization that had a long-standing tradition of providing services to individuals with disabilities who had been excluded from most public programs. It was innovative in getting funds but retained largely segregated programs as part of a long-standing commitment to protect those people who parents felt that the public had rejected. This did not prevent them from endorsing and utilizing some person-centered services as a formal part of their organizational programming.
The lone innovative bureaucracy was a large state agency that operated one of North America's oldest institutions. It had a long-standing history of providing segregated services for individuals with disabilities; and its limited person-centered services, although well-executed, were clearly the exception to its more traditional center-based facilities. As person-centered services are increasingly put into place, the study shows that both policymakers and organizational leaders would be wise to look at the change process in regard to organizational contexts to determine how to best move in this direction.