Anthony Salerno, Ph.D.

McSilver Institute for Poverty Policy and Research

New York University

Paul Margolies, Ph.D.

Center for Practice Innovations

Columbia University

This article is based on a presentation made at the 2023 Alliance (formerly known as NYAPRS) Recovery and Rehabilitation Academy, held in Albany on November 8, 2023.

Overview

Although implementing innovative change within an organization can be challenging, it can be done!  Agency leaders can make an enormous difference, and so can program supervisors. But it all begins with an understanding of the impact of changes on staff members.  

The Impact of Change

Harry Woodward studied Fortune 500 companies and learned about those that thrived by adjusting to changes in their industries and those that did not do well because they didn’t make necessary adjustments.  In two books, he summarized what he learned. 

It is interesting to see how his findings are so relevant for behavioral health care agencies.  Same issues!

Three Important Things:

Woodward found that it was not unusual for employees to react strongly to recommended changes, no matter how “good” the changes appeared to be.  This was because employees were concerned about losing three important things:

• Control over their workdays, assignments, and tasks,
• Status that came to them because of their expertise, reputations, and relationships, and 
• Personal meaning in their work – what they did and why they did it

During these times, employees were hoping for information and empathy but instead all too often experienced avoidance, autocratic behavior, and cheerleading about the positives of the change without acknowledging their feelings of loss.

Organizations that handled things well were characterized by openness, support, good communication, and comfort with experimentation.  Managers who handled things well acknowledged realities, validated people’s sense of loss, involved staff in the planning and decision making, and assisted people to regain control, status and personal meaning in the new direction.

What Leaders Can Do

William Anthony and colleagues developed Psychiatric Rehabilitation, an approach that is person driven, supports people in identifying important life goals, and is based on values very much consistent with recovery and peer support.  They understood that agency leaders were essential to helping agencies adopt this important approach. 

In a book entitled Principled Leadership in Mental Health Systems and Programs, they outlined eight principles of leadership.  Each principle listed things that leaders can do to make it more likely for innovative change to happen.  

The eight principles are:

• Leaders communicate a shared vision.
• Leaders centralize by mission and decentralize by operations.
• Leaders create an organizational culture that identifies and tries to live by key values.
• Leaders create an organizational structure and culture that empowers their employees and themselves.
• Leaders ensure that staff are trained in a human technology that can translate vision into reality.
• Leaders relate constructively to employees.
• Leaders access and use information to make change a constant ingredient of their organization.
• Leaders build their organization around exemplary performers.

What Supervisors Can Do

Supervisors make an enormous difference as well.  In a 2022 conference presentation, with Natalie Lleras we discussed this at length.  We talked about the continuum of ways in which a supervisor can support the professional development of their supervisees.  Supervisors can make all the difference in the world in helping practitioners learn about and become competent with new practices.  This is where change can really happen.

Here’s the continuum:

• Level 1: Dissemination of information, tools, and resources      
• Level 2: Dissemination with follow up.
• Level 3: Individual supervision designed to offer decision support and learning of new practices. 
• Level 4: Structured peer group supervision that focuses on each participant acquiring new knowledge.
• Level 5: Facilitating group participation in educational resources as a team with follow up discussion and action steps. The emphasis is on each practitioner identifying and applying new learning as part of their work with consumers.
• Level 6: Intensive one on one detailed review and feedback of performance through detailed description associated with implementing a new practice.
• Level 7: Direct supervisory observation and provision of feedback on performance

Three Powerful Skills:

There are three powerful skills that supervisors bring to their work, all three help supervisees to make important changes in their practice.  These skills are:

• Communication/Listening      
• Intentional Reinforcement                                 
• Modeling

Take-Away Points

Practitioners and other staff members often react to change, even innovative change that will make a positive difference such as psychiatric rehabilitation.  This is to be expected.

Program/agency leaders play an essential role in implementing psychiatric rehabilitation programs and services and building strong psychiatric rehabilitation teams. 

There are concrete things that leaders can do that will set the proper expectation and tone and move the process along.

Supervisors also play an essential role in coaching and supporting staff to enhance professional development associated with best practices in the provision of evidence informed knowledge and skills. There are concrete things that supervisors can do that will make a big difference.

References

Anthony, W.A. and Huckshorn, K.A. (2008).  Principled Leadership in Mental Health Systems and Programs.  Boston, MA:  Center for Psychiatric Rehabilitation. 

Salerno, A., Margolies, P. and Lleras, N.  (2022). Psychiatric rehabilitation for supervisors. Workshop at the 13th Annual NYAPRS Rehabilitation and Recovery Academy, Albany, NY. 

Woodward, H., Buchholz, S., and Hess, K.  (1987). Aftershock:  Helping People Through Corporate Change. NY:  John Wiley and Sons.

Woodward, H., and Woodward, M.B. (1994). Navigating Through Change.  NY:  McGraw Hill.

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