By Kirche Rogers

For the past 30 years Charles Glisson has been dedicated to creating processes to improve the lives of thousands of abused, neglected, delinquent, and emotionally troubled children. Inspired by his passion for helping at-risk children and young adults, and by his early work in mental health, Glisson founded the Children’s Mental Health Services Research Center in 1988 and continues to serve as its director. His life’s work has been well recognized by the University of Tennessee, Knoxville: he now holds both a Chancellor’s and a Distinguished University professorship. Today the center is a highly regarded and well-known research institution and is one of only seven research centers in the nation that focuses on children.

The statistics on child well-being are staggering, especially in Tennessee, which ranks 43rd out of the 50 states in child quality of life, according to a national study published in 2006.

“People don’t realize the number of kids at risk. It’s a critical problem. Each year in Tennessee alone, more than 60,000 kids are referred to juvenile courts,” says Glisson. “These kids are at risk for mental health problems that can follow them into adulthood. They face the risk of a lifetime of chronic problems that land them in the correctional system or permanently in mental health care.”

Breaking Down Barriers

Glisson’s research focuses on how to remove bureaucratic barriers to treating such children effectively. Beginning in the early 1970s, as a member of the team that worked to implement the nation’s first federal “right to treatment” guidelines in Alabama’s state mental health system, Glisson observed firsthand how service organizations created barriers to effective service.

“It was clear to me that administrative practices, bureaucracy, and red tape were debilitating to effective treatment outcomes,” he explains. “I became committed to the idea of learning how to build human service organizations that support rather than hinder the work of the staff who provide the services.”

Since receiving his Ph.D., Glisson has devoted his work to studying organizational culture and climate in relation to human services agencies and is now a leading researcher in the United States in this area of study.

Karen Sowers, dean of the College of Social Work, says, “Charles has built, and is continuing to build, an important body of research in the area of organizational culture and climate and its impact on mental health outcomes. His contribution in this area has been critical to improving services to children and families at risk.”

Mitigating the Damage

Funded by grants from the National Institutes of Health and private foundations, the center’s research focuses on local and national juvenile justice, child welfare, and mental health systems. Glisson and his colleagues at the center work with academicians and consultants from various disciplines around the nation to design strategies to improve the quality of services to families and children.

“Our main concern is that the psychosocial functioning of children improves as a result of receiving care or treatment,” explains Associate Director Denny Dukes.

Glisson adds, “The sense of urgency that’s driving us forward is the knowledge of what child abuse and neglect, poverty, and lack of mental health services do to damage the mental health of children in our society.”

The center is best known for its focus on applying organizational assessment and change models to human service systems for the purpose of improving service outcomes. Similar strategies are used in many successful organizations outside of human services, but Glisson and his colleagues have been leading researchers in the mental health field in studying how to design and implement such strategies effectively in human service institutions.

Dukes explains, “Organizations are organisms that have a very strong effect on the care that at-risk children receive. Most mental health research focuses on improving the child-therapist interaction, but we’ve found that you can’t stop there. It’s not enough to change the treatment model alone—the organization has to change to support the effective implementation and sustainability of the treatment model.”

Improving the Organization

Many social service and mental health institutions do not succeed in treating children effectively because of ineffective and inefficient organizational structures and processes.

“Many child welfare, juvenile justice, and mental health systems have what would be described as extremely debilitating work environments,” Glisson says. “There are many examples of young, motivated workers burning out quickly because of the extremely negative cultures of their organizations. They either quit their jobs or, perhaps worse, simply give up trying. Our research focuses on how we can marshal the commitment and idealism of workers and use input from them to remove barriers that prevent them from doing the job they were hired to do.”

Glisson and his colleagues approached the enormous task of determining how to help human service institutions remove those barriers by developing and testing a valid measure of “organizational social context”—an organization’s “personality profile,” which is linked to the service quality and outcomes of the organization.

The key dimensions of these personality profiles are

• culture—the system norms and values that drive work behavior and what an organization expects from its workers, and
• climate—the psychological impact of the work environment on therapists and caseworkers.

The center’s studies suggest that an organization’s culture and climate directly influence staff morale, turnover, service quality, and outcomes and can be altered with organizational change strategies. In agencies where workers are stressed and unengaged, results of the center’s work show that innovation is stifled and worker initiative is discouraged. Services to families and children are less effective and even detrimental when compared to agencies that put the well-being of their clients first, have high employee morale, and offer the help their workers need to do their jobs proficiently.

One such study, the National Survey of Child and Adolescent Well-Being, focused on improving child and adolescent well-being in 97 child-welfare systems in urban and rural counties, by following changes in the psychosocial functioning of children served by each system. The psychosocial functioning of children served by agencies with engaging and functional work environments improved significantly. Those served by agencies with the most negative work environments actually declined in functioning.

The ARC Strategy

Glisson and his colleagues are also studying the effects of an organizational and community change intervention strategy referred to as “Availability, Responsiveness, and Continuity,” or ARC. The purpose of this intervention strategy is to help human service agencies cultivate social contexts that complement and support the implementation of effective mental health services.

ARC relies heavily on the involvement of frontline staff and teaches them how to use data, work as teams, solve problems, and remove service barriers that prevent positive service outcomes.

Leaders and middle managers also play key roles in the process. ARC “change agents” employed by the center work with organizations from one to three years to implement the model. By that time, an agency’s frontline staff and leaders are fully equipped to provide high-quality services to at-risk children.

Progress, however, is often slow, as change is not easy and takes time, especially in organizations with deeply rooted bureaucratic processes, low worker morale, and poorly served clients. Some organizations can improve in one to three years, but others sometimes show little change at all.

Most agency leaders are eager to implement ARC after receiving their organization’s personality profile. According to Anthony Hemmelgarn, a research assistant professor at the center, “When leaders of the organizations we study see their culture and climate profiles, they usually become very interested in how to problem-solve and employ the ARC intervention strategy.”

In studies so far, outcomes of the ARC intervention strategy include a reduced number of children removed from their homes, less problem behavior, improved work environments for child welfare and juvenile justice casework teams, and less staff turnover.

In one recent study, Glisson and his colleagues implemented ARC in remote, rural Tennessee counties where accessibility to mental health services are very limited. Children in these counties face some of the most serious mental health risks, and juvenile courts place them in state custody at a higher rate than in urban courts. A new treatment program, which focuses on home-based, family-oriented treatment for delinquent children, was successful in improving mental health services to children and families unable to travel long distances to receive treatment. This model, coupled with ARC, produced very positive outcomes. The number of children entering state custody was reduced by more than 50 percent.

Important results of ARC include reduced turnover and increased worker morale. “We have found that ARC significantly reduces turnover, which is a major issue in human service organizations,” Dukes says. “When there’s high turnover, kids are not able to develop a stable relationship with their caseworkers. That results in poor outcomes.”

Glisson and his colleagues expect many other organizations to benefit from ARC as they continue to study its effects. No organization is immune to growing pains when new technology and change are implemented, but Glisson’s groundbreaking work is lessening the pain.

“It is not enough to merely describe problems,” Sowers concludes. “Based on our research, we must be able to say with confidence, ‘Yes, this works.’”

Thanks to the research and findings of Glisson and his colleagues, the field of children’s mental health services is able to achieve organizational changes that produce real improvements in client outcomes in Tennessee and the nation.

Visit Charles Glisson’s home page

Tags: Charles Glisson • Children • Mental Health • Social Work