Original Articles
The Effects of Organizational Climate and Interorganizational Coordination on the Quality and Outcomes of Children’s Service Systems

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Abstract

Objective: This study examines the effects of organizational characteristics, including organizational climate and interorganizational coordination, on the quality and outcomes of children’s service systems.

Method: A quasi-experimental, longitudinal design was used to assess the effects of increasing interorganizational services coordination in public children’s service agencies. The research team collected both qualitative and quantitative data over a 3-year period describing the services provided to 250 children by 32 public children’s service offices in 24 counties in Tennessee.

Results: Findings show that organizational climate (including low conflict, cooperation, role clarity, and personalization) is the primary predictor of positive service outcomes (the children’s improved psychosocial functioning) and a significant predictor of service quality. In contrast, interorganizational coordination had a negative effect on service quality and no effect on outcomes.

Conclusions: Efforts to improve public children’s service systems should focus on creating positive organizational climates rather than on increasing interorganizational services coordination. This is important because many large-scale efforts to improve children’s service systems have focused on interorganizational coordination with little success and none to date have focused on organizational climate.

Résumé

Objectif: Cette étude examine les effets du climat créé par l’organisation d’un service et par l’organisation de la coordination avec d’autres services, sur la qualité et les résultats des systèmes d’aide à l’enfance.

Méthode: Un modèle quasi-expérimental et longitudinal a été utilisé pour évaluer les effets d’une organisation accrue de la coordination entre les services dans les centres publics d’aide à l’enfance. L’équipe de recherche a collecté les données qualitatives et quantitatives au cours d’une période de 3 ans, décrivant les services offerts à 250 enfants par 32 bureaux publics d’aide à l’enfance dans 24 contés du Tennessee.

Résultats: L’étude démontre que le climat créé par l’organisation du service (peu de conflits, collaboration, satisfaction au travail et personnalisation) est le prédicteur le plus important des résultats positifs (les enfants présentaient un meilleur fonctionnement psychosocial) et un prédicteur significatif de la qualité des services offerts. Par contre l’organisation de la coordination inter-services avait un effet négatif sur la qualité des services et aucun effet sur les résultats.

Conclusions: Les efforts pour améliorer les services publics d’aide à l’enfance devraient se centrer sur l’organisation interne aux équipes et à la création d’un climat positif plutôt que sur l’organisation de la coordination entre les divers services. Ceci est important parce que l’accent des politiques à large échelle visent à améliorer la coordination inter-services et non pas l’organisation interne favorable au travail.

Resumen

Objetivo: Este estudio examina los efectos de las caracterı́sticas organizacionales, incluyendo el clima organizacional y la coordinación interorganizacional, sobre la calidad y los resultados del sistema de servicios a los niños.

Metodologı́a: Se utilizó un diseño longitudinal cuasi-experimental para evaluar los efectos de aumentar la coordinación interorganizacional de los servicios en las agencias públicas de servicio a los niños. El equipo de investigación recogió datos tanto cualitativos como cuantitativos en un perı́odo de tres años describiendo los servicios ofrecidos a 250 niños por 32 oficinas públicas de servicios a los niños en 24 condados en Tennessee.

Resultados: Los hallazgos demuestran que el clima organizacional (inclyendo bajo conflicto, cooperación, satisfacción laboral y personalización) es un predictor primario de resultados postivos en los servicios (la mejoria en el funcionamiento psicosocial) y un predictor importante de la calidad del servicio. Por el contrario, la coordinación interorganizacional tuvo un efecto negativo en la calidad del servicio y no tuvo influencia en los resultados.

Conclusiones: Los esfuerzos por mejorar la calidad de los servicios públicos a los niños debe enfocar la creación de un clima organizacional positivo en lugar de aumentar los servicios de coordinación interorganizacionales. Esto es importante porque la mayorı́a de los esfuerzos en gran escala, por mejorar los sistemas de servicios a los niños, se han centrado en la coordinación interorganizacional y ninguno, hasta la fecha, en el clima organizacional.

Introduction

Children are entering state custody in increasingly higher numbers. It is estimated that close to one million children are currently in the custody of state agencies (Barth et al 1994;Center for the Study of Social Policy 1990, Center for the Study of Social Policy 1993; National Center on Child Abuse and Neglect DHHS 1996). The majority of these children are in custody for reasons of parental abuse or neglect, and most of the other children who are in custody are there for status offenses (such as truancy or running away) or delinquent behavior. In Tennessee, over 50,000 children are referred to juvenile and family courts each year for abuse, neglect, status offenses or delinquency, and the number of children placed in state custody each year by these courts has increased by 27% in the last four years and doubled in the past decade (Tennessee Commission on Children and Youth 1997; Tennessee Council of Juvenile and Family Court Judges 1995).

As a result of the increasing numbers of children in custody, decreasing resources, and doubts about the effectiveness of systems that serve children in custody, many states have experimented with organizational strategies for improving children’s service systems (Behar 1985; Rosenblatt and Attkisson 1992). These strategies have focused on innovative changes in the organizational configurations of service systems that do not increase costs. For example, it has been argued that the multiple problems faced by children referred for custody require improvements in the interorganizational coordination of services among child welfare, juvenile justice, education and mental health systems (Burns and Friedman 1990; Dougherty et al 1987; Duchnowski and Friedman 1990). This argument is based on the belief that the relatively low cost of improving services coordination among these systems will ensure that each child receives the most appropriate services, regardless of which system has first contact with the child. It is assumed that more appropriate services will result in better outcomes for the children.

In spite of the range of efforts in many different states to improve services to children entering state custody by changing organizational configurations, there has been relatively little research to document the outcomes of those efforts. Moreover, most of the efforts to improve these service systems have not taken advantage of the information provided in the organizational effectiveness literature in either designing the changes or in assessing their effects. Of the few studies that have been conducted to document the outcomes of efforts to improve services, most have taken program evaluation approaches with no attempt to measure specific organizational characteristics or to identify each characteristic’s unique contribution to service outcomes (Hoagwood 1997). Thus, with few exceptions, the evaluations of successes and failures have been limited to conclusions about the total effect of a collection of undifferentiated program components and contribute little to understanding the specific organizational components or processes that explain those successes and failures. To date, the results of these evaluations have been disappointing, providing little or no evidence that interorganizational services coordination or other innovative organizational configurations significantly improve service outcomes for children.

This study examines an innovative pilot program in Tennessee designed to improve children’s services by reconfiguring the interorganizational mechanisms used to coordinate services. The program (labeled AIMS) created new, autonomous, case management teams to coordinate services from multiple systems to children entering state custody in 12 pilot counties in middle and eastern Tennessee. The study assesses the effects of organizational variables on service quality and outcomes in a sample of 32 public children’s services offices located in the 12 pilot counties and 12 matched control counties. The children served by these organizations had been placed in state custody by juvenile and family court judges for neglect, abuse, status offenses, or delinquent behavior. Findings from this study question the effectiveness of interorganizational services coordination and related approaches to improving services. More importantly, the study is the first to provide evidence that organizational climate is a major predictor of the quality and outcomes of children’s services.

This study also contributes to the more general human service organization literature concerned with the predictors of organizational effectiveness. Although the impact of intraorganizational and interorganizational variables on effectiveness has been the focus of much of the organizational research conducted in the last several decades, these efforts have most frequently included business and industrial organizations rather than human service organizations. Also, the efforts typically concentrate on only one of the two types of variables and rarely examine both intraorganizational and interorganizational characteristics simultaneously. As a result, there has been little effort to integrate both types of constructs within a single model of effectiveness or to compare their relative effects on outcomes. In this study, we develop and test a model of children’s service system effectiveness that includes both intraorganizational and interorganizational variables.

The study was funded as part of an effort by the National Institute of Mental Health (NIMH) to examine the effect of interorganizational services coordination on service system outcomes (National Institute of Mental Health 1991; Steinwachs et al 1992). NIMH and other funders such as the Robert Wood Johnson Foundation have supported several large projects designed to assess the extent to which interorganizational services coordination can improve the effectiveness of organizations that serve populations at risk of chronic mental health problems (Frank and Gaynor 1994; Goldman et al 1994; Morrissey et al 1994). The impetus behind these efforts has come from the belief that the individuals and families most at risk require multiple types of services (Provan and Milward 1995).

Children who are referred for state custody comprise one such group at risk. These children have been served traditionally by different primary service systems (e.g., child welfare, mental health, juvenile justice, health, education) depending on the configuration of service systems in the state and the particular problems for which the children were referred (e.g., abuse, neglect, truancy, running away, substance abuse, antisocial behavior). However, it has become increasingly evident that children referred for different reasons, as well as their families, share common problems and social histories (Glisson 1996; Klee and Halfon 1987; Melton and Flood 1994). For example, it is not uncommon for a child who has run away to also have broken the law, experienced physical abuse and been diagnosed as suffering from learning problems. This suggests that these children and their families require a variety of services regardless of the presenting problem that resulted in a referral for state custody.

While interorganizational services coordination appears to be a logical and obvious way of addressing the multiple needs of those individuals most at risk, evaluations of services coordination efforts have been unsuccessful in documenting any major benefits (Hoagwood 1997). Although the poor findings have been frustrating to those interested in developing mechanisms for improving service effectiveness, this lack of success actually supports some prior theoretical work on interorganizational relationships. While the initial theories of interorganizational relationships assumed coordination was always beneficial, especially for human services (Aiken et al 1975; Hall et al 1977), these benefits were questioned in subsequent work. Scott (1985)specifically questioned the benefits of coordination for the mental health sector. This skepticism was based on the potentially positive features associated with both loosely-coupled systems and redundancy (Bendor 1985; Landau 1969; Weick 1976). Scott (1985)suggested that an emphasis on coordination ignores the important roles played by the variety, responsiveness, and redundancy that are found in uncoordinated service systems. Bendor (1985), in particular, pointed out the benefits of having several uncoordinated but parallel systems provide services to the same population. His notion was that such parallel systems create a healthy competitiveness and provide backup systems for any systems that fail.

In spite of the conceptual critiques of services coordination and the limited empirical evidence to date supporting the value of coordination, most of the recent literature continues to argue for the benefits of interorganizational services coordination in the human service sector generally and in the mental health service sector in particular (Alter and Hage 1993; Glisson 1994; Goldman et al 1992; Provan and Milward 1995). In contrast, this study provides support for the work that questions the benefits of services coordination and suggests alternative organizational strategies for improving services to populations at risk of chronic mental health problems.

The theoretical and research literature concerning the interorganizational coordination of services generally ignores the roles of intraorganizational factors in effective service delivery. This study provides evidence that this is a critical deficit by identifying one group of intraorganizational variables, service provider attitudes, as a significant predictor of the quality and outcomes of children’s services.

The impact of employee attitudes on the performance of work organizations has been the focus of extensive research over the last half century (see early reviews in Hellriegel and Slocum 1974; James and Jones 1980; Payne and Pugh 1975; Schneider 1975). This research suggests that attitudes shared by employees about their work environment (collectively labeled organizational climate) are important determinants of the organization’s effectiveness. While most of this research has been conducted in business and industrial organizations, in recent years attention has been given to worker attitudes in other types of organizations, including government agencies and schools (Ostroff and Schmitt 1993; Soloman 1986). However, there has been almost no empirical research on the contribution of organizational climate to human service effectiveness, and none that examines the link between climate and the outcomes of human services that focus on improving individual psychosocial functioning. These human services are provided by mental health, child welfare, alcohol and drug recovery, family violence, and other organizations that focus on the psychological and social dimensions of the people they serve.

Recent studies have confirmed the importance of climate for the effectiveness and efficiency of other types of service organizations (Mayer and Schoorman 1992; Ostroff and Schmitt 1993). Although these studies have not focused on the types of human service organizations addressed here, the limited results to date indicate that climate plays as important a role in service organizations as in nonservice businesses and industrial organizations. Moreover, it is likely that climate plays a particularly important role in the performance of public children’s service organizations. This assumption is based on the nature of the work required by caseworkers who address the problems experienced by children who are served by these organizations.

The nature of this work requires that caseworkers provide services to children and families who are at risk of a variety of physical and psychosocial problems. Because the effectiveness of these services depends heavily on the relationships formed between service providers and the people who receive the services, the attitudes of the service providers play an especially important role in the outcomes of services. Successful outcomes require caseworkers to be responsive to unexpected problems and individualized needs, tenacious in navigating the complex bureaucratic maze of state and federal regulations, and able to form personal relationships that win the trust and confidence of a variety of children and families. Also, caseworkers must perform their jobs in highly stressful situations that can involve, for example, angry family members or seriously emotionally disturbed children. Therefore, the levels of conflict, role clarity, job satisfaction, cooperation, personalization, and other variables that characterize the shared attitudes and climate of their work environments should be powerful determinants of how caseworkers respond to unexpected problems, the tenacity with which difficult problems are solved, and the affective tone of their work-related interactions with children and families.

Similar to the relationships formed between teachers and their students, successful relationships enable caseworkers to identify, understand, and address each child’s individual profile of strengths and needs. Caseworkers must form these relationships in the face of very high caseloads, cope with the stressful nature of working solely with children who have been mistreated or who have behavioral problems, and manage to meet these children’s needs in spite of the barriers presented by courts, bureaucratic service systems, and extremely limited resources. A principal reason these relationships are critical to outcomes is because for their work to be successful, caseworkers must be viewed by the children and families they serve as both available and responsive (Dozier et al 1994). This requires that caseworkers react in a timely and supportive manner to what these children say and do, and that their interactions with the children and families be characterized by what Wahler (1994)has described as social continuity. That is, the interactions must be predictable, appropriate, and welcomed over an extended period of time to establish a pattern on which the children and families can depend and anticipate. For these reasons, effective casework relationships are more likely to occur in organizations where caseworkers agree on their roles, are satisfied with their jobs, cooperate with each other, and personalize their work.

Because of the importance of worker attitudes to worker-client interactions, it is important that many public human service organizations are characterized by poor worker attitudes independent of salary, type of clients, and the education and experience of individual workers (Glisson and Durick 1988). In addition, the organizations have high rates of employee turnover and low job satisfaction when compared to other types of organizations (Soloman 1986). At the same time, there is considerable variance among public human service organizations in turnover, and worker attitudes range from very negative to modestly positive. This variance provides the opportunity for assessing the relationship between organizational climate and children’s service outcomes.

The state-sponsored AIMS pilot project examined in this study was designed to improve the outcomes of children’s services through the use of interorganizational services coordination teams. The state implemented the pilot project for 3 years in two separate, six-county areas in middle and eastern Tennessee, respectively. The 12 counties included in the pilot areas ranged from the less populated (15,000) to the moderately populated (150,000). The pilot included rural counties in the poor Appalachian region of the state as well as more populated and prosperous counties, but did not include the state’s major urban areas. The pilot services coordination teams could authorize services from any state-supported child welfare, juvenile justice, education, mental health, or health service organization, regardless of the state agency that was given physical custody of the child. It was expected that the teams would increase the level of coordination among the various direct service organizations so that an appropriate array of services and residential placements could be provided to children who entered custody. In addition, a state-level council of the commissioners of the relevant service systems (child welfare, juvenile justice, mental health, education, health) was formed to facilitate the coordination of services by the pilot coordination teams.

The services coordination teams were established in the multi-county pilot areas without making any other changes in the existing direct service systems. It was intended that the teams would reduce duplication of effort, facilitate access to services, and establish mechanisms for ensuring that needed services were provided. A primary goal of the pilot project was to improve authorization, accountability and monitoring procedures. It was assumed that these improvements would enhance the quality and outcomes of services provided to the children by ensuring that the multiple needs of each child and family would be met with the most appropriate services and placements.

NIMH funded this study of the state-sponsored pilot project with the objective of assessing the impact of the services coordination effort and of examining the effects of other organizational factors on the quality and outcomes of services (Glisson and James 1992). The support from NIMH allowed the research team to follow the development and implementation of the pilot project from its beginning to its end at the state, county, and office levels. Over a 3-year period, research team members worked with state administrators, the pilot services coordination teams, the children’s services organizations, and the service system network in each of the 24 counties included in the study. Research team members made weekly visits to the pilot teams, gathered data directly from parents, teachers, caseworkers, and other service providers, and conducted organizational surveys of the caseworkers in the 32 children’s service offices.

The longitudinal nature of this study and the time spent in the field with coordination teams, parents, teachers, caseworkers, and other service providers enabled the research team to develop a thorough understanding of the service system issues and problems in each area. Not only did this allow individual children to be followed from the time they entered custody, it also ensured that the research team benefitted from anecdotal evidence and qualitative observations. This information was invaluable in developing an understanding of the roles of organizational climate, caseworker attitudes, and caseworker relationships with children that are discussed here.

An important benefit of the time spent in the field with the services coordination teams, caseworkers and other service providers was the opportunity to observe the actual day to day activities of the new pilot teams and the network of organizations that served the children. This enabled the research team to observe the extent to which each service coordination team actually did what it was designed to do. This is an important issue because it was evident from the field observations that the teams did not always achieve the intended level of responsibility and authority in the custodial and service decisions that affected the children. As a result, there was a great deal of variation across the pilot counties in the extent to which service coordination actually changed as a result of the new pilot teams.

This variation was due to a number of factors. First, referrals for state custody increased statewide after the teams were implemented and the teams were understaffed to respond to the numbers of referrals. Second, juvenile and family court judges in each county varied in the amount of discretionary power they were willing to relinquish to the teams and in some cases allowed the teams very limited power. Third, the team members received minimal training in key areas of mental health and child behavior after joining the teams. This is important because most held bachelor’s degrees as their highest degree and had very little formal education in mental health or child behavior. Fourth, the staff in some of the organizations that provided the residential placements and services believed that there was no reason to comply with the decisions of the new teams. This was due to the abundance of children entering custody, coupled with the limited residential placements and services that were available. Moreover, state contracts with private agencies for services were not affected by their degree of cooperation with the pilot teams and state facilities received more referrals than they could adequately serve.

As a result of these reasons and the varying histories of service coordination within each county that predated the pilot project, service coordination in both the pilot and control areas varied from county to county and even from child to child. The research team measured the actual amount of service coordination experienced by each child in the pilot and control areas so that treatment fidelity in each pilot county could be assessed and compared to that in the control counties (Teague et al 1995). We were thus able to document our observations that the teams increased service coordination in some counties in the pilot areas, but fell short of the original plan to increase it in all pilot counties.

The study tests a model (Fig. 1 ) that links county demographics, organizational characteristics, and the quality and outcomes of services (Glisson and James 1992). The central construct in the model is interorganizational services coordination. As explained above, this construct has been the focus of efforts in several states to improve services to children entering state custody. The pilot project was implemented in the study described here for the specific purpose of increasing services coordination. Because services coordination is the manipulated variable in the study, the model depicts services coordination as directly or indirectly affecting all other variables in the model except county demographics. It was hypothesized that increasing services coordination in each pilot county would directly affect (1) the climate of the organizations that assumed custody of the children and provided the services that were being coordinated; (2) the quality of the services provided to the children; and (3) the interorganizational relationships among the organizations in the county that assumed custody of children and provided services to them. Two of these constructs, climate and service quality, describe attitudes (climate) and behaviors (service quality) that characterize the caseworkers in the organizations who interact directly with the children. Because the attitudes and behaviors of caseworkers are assumed to be affected by services coordination and are critical elements in the services they provide, these two variables were hypothesized to link services coordination with service outcomes.

The model in Fig. 1 therefore describes changes in an organizational level variable, services coordination, as affecting service outcomes at the children’s level by affecting the attitudes and behaviors of the caseworkers who are responsible for the children. Until now, the mechanisms have not been carefully identified by which organizational level efforts to increase service coordination affect service outcomes. It is explicit in this model that the attitudes and behaviors of those who directly interact with and serve the children must be affected positively if organizational level interventions are to improve service outcomes.

Section snippets

Methodology

To assess the model shown in Fig. 1, two additional 6-county control areas (a total of 12 control counties) were selected to match the two pilot areas (a total of 12 pilot counties) county by county on total population, child poverty rates, unemployment, and education levels. Therefore, the study includes a total of 24 counties out of the state’s 95 counties. Twelve counties (six pilot counties and six matched control counties) in the sample are located in the middle of the state, and 12

Results

Linear structural equation analysis with LISREL VIII was used to examine the hypothesized model shown in Fig. 1 that describes relationships among multiple latent constructs (Joreskog and Sorbom 1993). As described above, several manifest or observed indicators are specified as measures for each latent variable. The set of equations that links these manifest indicators to the latent variables is typically referred to as the measurement model. A second set of linear equations describes the

Discussion

This study’s most important finding is that improvements in psychosocial functioning are significantly greater for children served by offices with more positive climates. The relationship found between organizational climate and the outcomes of children’s services is particularly significant because the measures of these two constructs relied on independent methods. Organizational climate was measured with self-report scales administered to caseworkers in each office, while changes in

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