In the beginning, I underrated the Montgomery Cares Behavioral Health Program (MCBHP). I was under the impression that the MCBHP program has a relatively lower capacity, serving fewer clients and with an operational structure that is not well-established. I also thought that agency might lack sufficient support for social work and social workers. I was skeptical about the agency’s capability of achieving its goal and realizing its mission.
Nevertheless, I came to realize that MCBHP plays a significant role in serving the Montgomery community providing care to a huge population. The agency has a robust and effective operational system with dedicated staff members who uphold high levels of professionalism. The agency adopts a team-based staffing model with the client being the central focus. Social workers, under the care management are fully supported and incorporated in the realization of the agency’s goals and mission.
Description of the Agency
The Physical Plant
Initially, the location and the addresses of the Holy Cross Health Center made me feel a little mixed up. The hospital’s structure is quite nice-looking and it is located within a community college, Health Sciences Center on Montgomery College’s Takoma Park/Silver Spring Campus, where I was a student. The college is on the main street Georgia Avenue and Silver Spring, (Address 7987 MD 20910) (Holy Cross Health Center, 2016).
Upon entry, double doors lead one to the waiting lounge on the right hand and on the left hand is the reception. The furniture in the waiting room is arranged in a ‘U’ shape facing the reception. High degree of cleanliness and neatness is maintained in the ever-busy waiting lounge.
The social workers’ areas are situated in the right corner at the far end near the waiting lounge where two social workers execute their responsibilities. Although the social workers’ offices are meant for one person, there is room for an extra worker.
Further, the structure seems bigger and more spacious from the inside than from what it seems from outside. The rear section of the building has several offices. Moreover, the building has many bathrooms and a comfortable room designated for lunch breaks.
Mission and Goals
Since its inception in 1993, the Primary Care Coalition, which is an organ of MCBHP, has functioned as a nonprofit independent organization. PCC’s mission is “to be the catalyst for the development and coordination of community-based health care system that strives for universal access and health equity for underserved residents” (Primary Care Coalition, 2013, p. 1).
PCC’s vision “is all the Montgomery residents will have the opportunity to live healthy lives. Montgomery County will be the healthiest community in the nation and a mode for providing access to high quality and efficient care for all” (Primary Care Coalition, 2013, p. 1). The program’s goal is “to ensure access to integrated behavioral health care to Montgomery care patients served by partner clinics by administering an evidence-based collaborative care model” (Primary Care Coalition, 2013, p. 1).
It is worth noting that a key pillar of the program’s goal is screening for psychological disorders such as depression and anxiety. When patients’ outcomes are negative or get worse, additional psychiatric tests are recommended.
Other areas of focus by the PCC’s goal include psychiatric consultations to support care provision to patients with behavioral disorders, and adopting a step-care model in patient follow-ups to facilitate appropriateness in interventions (Primary Care Coalition, 2013).
At the helm of the Primary Care Coalition is a 20-member volunteer Board of Directors. Among the Board of Directors members, are individuals who represent different stakeholders, including community/clients and healthcare providers. Experts in health policy administration represent health care providers. The key roles of the board include policy formulation, advocacy, outreach, program development, and fundraising efforts (Primary Care Coalition, 2013).
The client’s views are represented and articulated by their representatives in the board, who also play key roles in policy formulation. As such, policies are made with the consideration of community’s needs (Primary Care Coalition, 2013).
Under the Board of Directors are health workers and experts in different fields of care delivery. The key role of the health workers is implementing the policies formulated by the board, which include providing care to the Montgomery community.
The team of experts includes a care manager, team psychiatrist, the medical provider, and community resource coordinator. The team works harmoniously to provide care and support to the community.
Line workers such as social workers are under the care manager and other experts (Primary Care Coalition, 2013). For instance, I am under Sarah Frazell who is a supervisory care manager. As such, I report to the care manager.
The diagram below represents the PCC’s administrative hierarchy.
The MCBHP agency has various modes and means of communicating to the stakeholders, especially potential clients. The center has a physical address, which is accessible by potential clients who require information. In addition, potential clients can call or email pertinent staff members, managers and other relevant information sources (Primary Care Coalition, 2013).
The hospital has a website, which is easily accessed and has useful information, especially on the offered programs. Further, the website is easy to manipulate. For instance, typing the word ‘services’ in the search link leads to numerous services offered by the program and the entire hospital.
Moreover, PCC has a separate website that is specifically meant for the agency’s stakeholders. On the home page, the PCC website has three sections, including ‘For Patient’, ‘For Partners’, and ‘For Providers’ (Primary Care Coalition, 2013). Patients, therefore, can obtain the required information with ease.
The last website, which was launched in 2016, is the Montgomery Cares Website. The website is patient oriented with content in English and Spanish providing guidelines on “eligibility requirements and enrollment procedures, clinic contact information, health literacy tips, and more” (Primary Care Coalition, 2013, p. 1).
Ethics and Code of Ethics
The staff members, including all specialists and volunteers, are guided by a code of ethics. The code is communicated through various communication channels. During orientation, for instance, a new employee/volunteer is given a handbook, which contains the code of ethics that illustrate the expected ethical behaviors.
In addition, the Ethics Committee advises all volunteers and staff member on the different ethical issues. The committee has mobile and physical contacts that employees can use to reach them. The code of conduct is derived from the Holy Cross Hospital (Holy Cross Health Center, 2016).
The following is a summary of the key points of agency’s code of conduct.
- Staff members, including all volunteers, should refrain from discussing the patients. When the discussions are necessary, they should be done with utmost discretion. Members should also avoid criticizing patients, the agency, and/or their colleagues.
- Staff members should adopt meticulous adherence to all rule since every rule/regulation has justifiable and important reasons
- All staff members should show dignity and should be pleasant when dealing with their patients.
Staff members in any organization play significant roles in ensuring efficacy and effectiveness in community services delivery and the overall goal achievement. The staff members working for MCBHP endeavor to ensure that their organizational goals and objectives of serving the people of Montgomery are realized.
The MCBHP staff members include specialists and other volunteers. The specialty care is made up of the Project Access, Catholic Charities Health Care Network, Clinic-Based Specialty Services, Informal Referral Networks, and Hospital Care (Primary Care Coalition, 2013).
Project Access is made up of 120 specialists who provide care to the poor in Montgomery community. Catholic Charities Health Care Network is a team of volunteers that works with PCC on contractual terms.
In addition, services providers serve the clients depending on their areas of specializations and their given responsibilities. As such, the agency adopts a team-based staff model to provide care to the clients.
A behavioral care manager who is a qualified/accredited clinician, an accredited psychiatrist, a community resource coordinator, and a psychiatrist services coordinator work harmoniously to serve a patient (who is the center of the care). The different specialists make various departments under which social workers and volunteers execute their duties. The clarity in the division of labor and responsibilities minimizes chances of conflicts among staff members. Therefore, harmonious working conditions are achieved when every member of the agency’s staff perform their roles observing their responsibilities and the rights of their colleagues (Primary Care Coalition, 2013).
The care program is a nonprofit organization, which gets its funds from 12 Montgomery community clinics and other grants (Primary Care Coalition, 2013). The program operates with a budget of approximately $10 million. The funds are allocated to operation expenses (rent, travel, electricity, supplies, and training) (4%), psychiatry services (16%), and staff 80%. From the funds allocated to the staff, it is likely that remuneration packages are relatively competitive.
The MCBHP program serves the underserviced community in Montgomery County who suffer a wide range of ailments, including depressive and anxiety disorders, drug and substance abuse, diabetes, cancer, stroke, among other medical and psychosocial issues.
Hispanic patients make the majority with 65%. The racial composition of the racially diverse clients includes black (16%), white (20%), Asian (7%), others, including Hispanics (25%), Native Americans/ Alaskans/Hawaiians/ Pacific Islanders (2%), and unknown (29%).
Female clients make 68% of the demographics. The ages of the patients are diverse with the age bracket of 30-39 years having the majority of 27%. Other age demographics include above 65 (10%), 50-64(23%), 40-49 (22%), and 18-29 (17%).
The poor and the uninsured are the sole beneficiaries of the MCBHP program where 74% having less or equal to 100% FPL, 10% having between 101-133% FPL, and 12% reporting between 134-250% FPL.
The program offers concrete, supportive, referrals and casework services. According to Lang and Mitrowski (1981), combining services of this nature is relatively more effective in dealing with vulnerable groups. As such, the program offers counseling, provides medicine and treatment, and gives financial support, among other services. Each case is treated with the care it deserves and the patients/clients are the centers of the program. Some of the services include hospital care, informal referrals, and clinic-based specialty services.
The program adopts a collaborative care model of service delivery, which incorporates behavioral health services into primary care. Key focus points of the model include routine screening for anxiety/depression/other disorders, care management, case management, psychiatric services and consultations, and outcome monitoring. The nature of illness and treatment/care needed determine the length of service delivery and duration, with medical problems such as diabetes taking relatively longer (long-term treatment) (Primary Care Coalition, 2013).
It is of paramount importance to carry out program evaluation in community health services delivery. As such, pertinent stakeholders in MCBHP have put in place some mechanisms to evaluate the agency’s progress and achievement. The evaluation processes are aimed at testing the effectiveness and the efficacy of the program for the purposes of improving care delivery.
The organization has various approaches to evaluating its service delivery and the progress of its programs. First, the agency carries out regular clinic reviews to test the efficacy and effectiveness of administrative and clinical standards.
Second, there are regular clinical measures, including data collection, benchmarking, annual publications, and tracking performance in treating depression/chronic care/cancer screening.
Third, there are Quality Improvement Projects and Collaborative, which are involved in vigorous program testing and peer review publications on various issues.
The structure and operation of any organization have immense influences on the work practice of the employees/staff. Employees/staff execute their duties and responsibilities adhering to the provision of the organizational culture and operation. Therefore, my social work practice is highly influenced by MCBHP’s structure and operation.
The essence of the MCBHP program is providing care and empowerment to the underprivileged in the Montgomery community. As such, its structure and operation are aligned with the need to give assistance to the financially vulnerable and, therefore, shape/influence my work positively.
First, there is considerable support from all the stakeholders, including the care manager and the Board of Directors. The Board of Directors formulates policies, which I have to work under in executing my duties. The care manager acts as a link between the Board of Directors and social workers. Other staff members give the necessary support and provide a healthy working environment.
MCBHP has a code of ethics that guide the activities of social workers and, therefore, professionalism is greatly enhanced. The relationships among social workers, between social workers and their clients, and between social workers and other professional are guided by the code of ethics. Communication is sufficiently emphasized and, therefore, each social worker is aware of what is expected of them to promote professionalism.
Since the core purpose of the program is serving the less privileged, efforts are made to enhance efficacy. The agency responds promptly to the needs of the poor by providing instant care. Further, the agency sensitizes the community on the need for empowerment while communicating to the public on the available services.
Behavioral disorders are some of the major issues that affect the poor in Montgomery community. MCBHP program, therefore, offers counseling and psychiatric services in efforts to attain client psychological stability. In addition, requirements such as for food, jobs/work, emergency assistance, socialization and information on various issues are promptly provided to the clients.
Holy Cross Health Center. (2016). Holy Cross Health Center in Silver Spring. Web.
Lang, P. A., & Mitrowski, C. A. (1981). Supportive and concrete services for teenage oncology patients. Health Social Work, 6(4), 42-45. Web.
Primary Care Coalition. (2013). Primary Care Coalition. Web.