Clinical and Administrative Leadership in Community-Based Residential Programs

Henryk Axer

doi:10.12740/app/114167

Abstract

Oregon’s Public Mental Health System includes a continuum of small community- based residential programs offering mental health treatment and 24/7 personal care support for adults experiencing severe mental illness. A team of several mental health paraprofessionals working under the direction of the facility administrator and the Master level therapist strive to gently challenge residents to set personally meaningful goals, practice functional skills and slowly take charge of their lives in the community. The author asserts that the manner in which daily operational and behavioral challenges are resolved by the treatment team, affects residents’ lives not less than strictly therapeutic interventions. This paper has a twofold aim: 1) To characterize leadership, organization and staff communication as building blocks of the collaborative, person-centered and strength-based residential treatment; 2) To show how clinical and administrative processes must interplay to create a spirt of recovery and optimism in home-like community residential facilities.

Highlights

Management practices in small communitybased residential programs have no less impact on the therapeutic milieu than strictly clinical interventions
The administrator and the supervising therapist explain to the team how daily routines can support the overall program purpose, for example how to equalize relationships between residents and staff, and emphasize what they have in common instead of what divides them? What do staff do to facilitate practical orientation and sense of working together? How are disagreements between residents handled? Do residents and staff share meals together? Do staff make all medical appointments for residents? Can residents keep food in their rooms? Unless recovery principles are clearly translated into concrete practices, residential staff may conclude that their facility goals are either unrealistic, or residents are “too sick” and “unmotivated” to benefits from their therapeutic program [6]
Residential staff need the proper venue to talk about emotional aspects of their work away from residents [13]

Summary

INTRODUCTION

Management practices in small communitybased residential programs have no less impact on the therapeutic milieu than strictly clinical interventions. Program leaders show staff how to measure slow progress in incremental steps and how to acknowledge residents for their improvements and efforts. This is essential for building residents’ motivation to learn skills. This is necessary for sustaining a high-quality therapeutic environment over a long period and preventing the staff from feeling helpless and pessimistic. The administrator and the residential therapist spend sufficient time away from their offices to model respectful and empathetic communication with residents, without directly telling staff what to do every step of the way

ORGANIZATIONAL STRUCTURE

STAFF COMMUNICATION

CONCLUSION