Organizational Analysis of Catholic Charities Villa Maria Community Resources
Alaina Kahn, University of Maryland Baltimore
School of Social Work
History and Structure
Catholic Charities, a private, non-profit organization, is one of the nation’s most expansive providers of care. It first formed in 1792 and has continued to grow in the centuries since. In 1923, the agency grew by coordinating efforts of 12 previously separate Catholic agencies working to improve the community. While the charity’s work spreads across the globe, it is now Maryland’s largest human service organization, hosting above 80 programs at beyond 200 separate locations. With over 2,000 employees and almost 8,000 registered volunteers, the charity’s services extend through nine Maryland counties and Baltimore City. Catholic Charities holds numerous goals in its services: to overcome poverty, to provide mental and behavioral health services to low-income families and individuals, to provide educational support to children from low-income families, to provide access to affordable housing and other necessary resources for seniors, and to provide resources to individuals with developmental disabilities.
The organization follows a hierarchical decision-making and management structure. At its acme, Catholic Charities derives its inspiration from Pope Francis. On a more practical level, Bill McCarthy currently serves as the executive director. Immediately below Mr. McCarthy is a Board of Trustees composed of 38 members, including community volunteers, bishops and pastors, and representatives from major local businesses. Catholic Charities receives funding from grants, foundations, individual donors, corporations, Medicaid, and government partners. Overall, Catholic Charities provides a great number of services aiming to reduce poverty, including homeless shelters, support to those experiencing food insecurity, behavioral health treatment, adoption support services, Level II schools, access to affordable housing, and more.
Villa Maria Community Resources (VMCR) is one of many sects of Catholic Charities. VMCR focuses its efforts on children and families, specifically by providing behavioral health and psychiatric services. All families served are recipients of Medicaid. This analysis will focus primarily on the Harford County clinic location, which hosts approximately 10 therapists and 2 psychiatrists. VMCR also contracts with schools in low-income areas to provide in-school psychotherapy services to children. On its website, VMCR states its mission as follows: “We serve everyone who is eligible for our programs, regardless of race, faith, creed, or ethnicity. Our common goal is a devotion to compassionate and professional care for our clients.”
Diversity Climate
Catholic Charities and VMCR alike emphasize the importance of diversity and inclusion. Each website highlights the organization’s commitment to diversity and equity in several capacities. This devotion is reflected in the VMCR office. There are a significant number of employees of color. There are employees with disabilities. Accommodations are made seemingly effortlessly: all doors have string attached to door knobs to allow wheelchair users to close and open doors, and handicap accommodations have a permanent home in the single-stall, ungendered restroom. While there are no male employees in the office, this is relatively characteristic of the field. However, the inclusion of male social workers would add to the office culture. Staff trainings include an emphasis on diversity, including a mandatory online training for all new hires.
On intake paperwork, clients are asked to select one gender and one race. This practice inhibits expression and inclusion of diversity in the clinic, as those who are nonbinary and/or multiracial may be made to feel that their experience is being invalidated by the intake process. While this is not the value that VMCR holds, it forms a poor first impression, and would likely lead nonbinary and multiracial individuals to believe that they are not welcome seeking services in our clinic. That being noted, overall VMCR has excellent diversity practices and truly values the inclusion and experiences of all people.
Culture
Practices
In the VMCR Harford County Outpatient Clinic, the front desk staff is responsible for scheduling appointments for clinic-based therapists. This staff also compiles paperwork and intake packets, scans important documents, and send faxes on behalf of clinicians. For this system to operate smoothly, comprehensive use of the Outlook calendar is critical. Therapists share their calendars with the office and allow front desk staff ability to edit and add to their calendar. Therapists do have some flexibility to move their own clients around on their own if need be, so long as it is promptly reflecting in their Outlook calendar. Front desk administration staff, however, are the only staff members with the ability to schedule intakes and assign clients.
The therapists that primarily work in contracted space in public schools have significantly more flexibility and control over their schedule. They operate by excusing kids from class at a time of their choosing, so therapists are able to create and edit their own schedule. Intakes for school-based therapists are scheduled jointly between the clinic office and the clinician, as are monthly family appointments. These therapists also aren’t subject to cancellations, aside from a child’s absence from school, so they have an easier time avoiding last-minute changes.
The company culture in the clinic is warm and friendly. The entire staff typically eats lunch together. Clinicians engage in both work-related and casual conversation. Relatedly, there are often treats in the kitchen for staff to share. There is an unspoken policy to keep office doors open unless one is in session. This practice both notifies others when an appointment is occurring and promotes open communication throughout the clinic.
Values
One value that VMCR Community Services holds is access to treatment for all. This is a noble value and is a goal well-worth working toward. However, in efforts to achieve this value, the agency communicates that staff must push for maximum productivity. VMCR encourages its therapists to practice a process called “collaborative note-taking,” which means that at the end of each session, the therapist and client write the contact note together. This procedure helps clients have input in their documentation and improves transparency but can also focus the session on the therapists’ responsibilities. Some therapists feel that VMCR pushes this process so that therapists have to spend less time outside of session completing paperwork, and thus be able to carry higher caseload. This practice indicates values both of serving the greatest number of people in need and completing the most billable hours of work.
Full-time therapists have a minimum average number of weekly billable hours that they must complete. The average is completed at the end of each calendar year, and warnings and improvement plans are issues to those therapists that struggled to meet the minimum. Some therapists have expressed that the “numbers-based system” imposes the value quantity of service over quality of service. This system can cause staff to feel that their contributions are only valued if they are overloading themselves with clients, regardless of whether they feel that they can effectively handle such a high caseload. It also inadvertently punishes clinicians when their clients cancel appointments or simply don’t show up, which is unfortunately common. That effect can sometimes lead therapists to discharge noncompliant clients prematurely, because they are losing potential for billable hours. Further, the emphasis on maximizing billable hours pressures clinicians to complete only the minimum amount of time required with each client.
Generous bonuses are awarded to therapists that exceed the minimum number of weekly billable hours. An intern’s hours contribute to the calculation of their supervisor’s bonus. Intern’s hours, however, do not contribute to a therapist meeting their minimum number of weekly billable hours. When a clinician is not on track to meet their requirements, the therapist is de-incentivized from assigning their intern clients, as it further shrinks the therapist’s own caseload.
Another value held by VMCR is clinician competence and continuing education. VMCR provides supervision and continuing education to its therapists. Clinicians complete more than their minimum required Continuing Education Units simply by attending company-sponsored trainings and workshops. This helps VMCR employees feel appreciated and taken care of while also ensuring that the staff is highly educated on the most recent evidence-based practices.
Alignment with Social Work Values
The agency’s values of ensuring access to care for all, embracing diversity, and providing competent care perfectly align with social work values. In practice, however, VMCR exercises values of securing the most money from Medicaid by serving the most clients, regardless on its impact on quality of care. This value directly contradicts with social work values, as it could cause harm to clients encouraging clinicians to rush through appointments and paperwork. The principle of nonmaleficence states that social workers must aim to do no harm. By prioritizing billable hours above quality of care, VMCR is inadvertently leading its social workers to practice incongruently with ethical and moral values.
Environment
The proceedings at VMCR are influenced by a number of external environmental factors. The economic environment in particular affects what programing is offered. Most obviously, the organization accepts only Medicaid to cater to the large low-income population in the area. This healthcare policy, incidentally, is also a significant influence that has led VMCR to charge for services through public insurance. The high poverty rate in the area means that there are a lot of potential clients for VMCR, and there are very few local competing agencies. The VMCR Harford County Clinic has recently hired two new therapists and plans to add several additional new members to the team in response to the high need for behavioral health treatment.
The high poverty rate also affects the resources that we provide and referrals that we offer. A significant number of our clients do not have cars, and there is minimal public transportation in this area. Transportation to treatment is a notable barrier to many VMCR clients, so the agency provides pamphlets about state-sponsored non-emergency medical transportation. Similarly, VMCR contracts with local schools to provide therapy services during the school day so that parents do not have to arrange transportation. It can also be difficult for our clients to pay for childcare, particularly due to the stark number of single parents that use our services, so we offer free child-care are parent support group meetings. Further, many of our clients are food insecure, leading VMCR to develop Thanksgiving care packages.
The socio-demographic environment also plays a role in affecting VMCR policies. Many individuals in this region do not receive quality education or complete high school. In school-based treatment, the therapists operate more independently are therefore verbally review all consent forms before asking the client to sign them. In the clinic however, to saw time and maximize billable hours, clients are asked to review and sign these forms on their own in the waiting room. This policy is flawed, as clients become angry and confused when they do not have accurate expectations of the therapy process. There is also a high rate of incarceration in the population that VMCR serves. This high prominence of family separation leads to a lot of child clients working to heal from trauma. This prevalence of trauma has caused VMCR to emphasize trauma-informed care by providing trainings to their employees and informative pamphlets on trauma-informed care to all clients.
Because Catholic Charities and even VMCR are widespread organizations, there is minimal individualized program planning targeted to the specific community. Most programs and procedures are predetermined and change infrequently. This inflexibility is a downside of being part of such an expansive agency. If there were a different leadership style by the individuals closer to the top of the hierarchy, perhaps there would be more support for specialized programming on location.
Leadership
The management style at VMCR, and the greater Catholic Charities, is very linear. In the Harford County clinic, each of the two supervisors has a slightly different style in how they want things done, which at times are directly contradicting. This can lead to discrepancies in both practice and documentation throughout the clinic. Some therapists have voiced that their supervisors’ expectations regarding caseload, billable hours accumulated, attendance in training, and management of interns are not always clear. This air of confusion affects the company climate.
In terms of leadership, both supervisors in the Harford County Clinic encourage individual brainstorming and processing. Their supervisees report that generally, they are urged to develop their own solutions to problems. This leadership strategy is hands-off, but not lazy. The supervisors guide the therapists through the decision-making process and are happy to collaborate if necessary. In this way, the growing clinicians learn to make decisions independently, while still consulting with colleagues with questions of ethical practice.
Both the leadership and management styles foster independence and decision-making skills. The management style, however, has more emphasis on productivity and places less value on the individual clinician. The management style is also a more direct approach, giving directions, regardless of their clarity, and expecting therapists to follow. The leadership style has more room for individual growth and takes more of a hands-off approach. When supervisors are acting as leaders, they expect therapists to be asking for confirmation that they are doing the right thing, and not to be asking what the right thing is.
Assets and Needs
Catholic Charities and VMCR have a great number of assets. A notable asset is the organization’s access to resources. Clinicians receive new toys and games annually. There are funds for bonuses, which the billable-hours based system depends upon. Clinicians have nice office furnishings to create a safe, homey space. The staff are well-paid, which helps VMCR attract the best clinicians. The financial resources also allow for the staff to receive free training and Continuing Education Units. This emphasis on education and competency is an asset as well. When therapists are continually receiving trainings on new populations and techniques, they continue to grow and provide even better service to clients. VMCR’s contract with local public schools to provide school-based therapist is also a major asset. This provides access to a great number of clients that might genuinely otherwise not receive services. Finally, the supportive staff environment is a significant asset. While it may be easy to overlook, this environment keeps morale and motivation high, which is critical to providing the best possible care.
The organization is not without need, however. As identified, VMCR could benefit from more clarity from supervisors on performance expectations. Relatedly, the entire agency suffers due to the system that uses billable hours as the sole indicator of clinician performance. This policy takes focus away from providing quality care. As a result, clinicians feel less valued for their efforts, may be inclined to rush appointments and paperwork, and neglect to provide interns with clients. VMCR also needs further inclusion efforts by allowing multiracial and nonbinary individuals an appropriate check-box on intake forms.
The most significant barrier to change is the size of the organization. While at times, the large size of Catholic Charities acts as an asset, it also makes it difficult to implement change, because the chain of approval is so lengthy. Thus, it is difficult for clinics to have individualized policies and programs to best support their specific population.
Action Plan
To improve the current system, I recommend that VMCR eliminate the weekly minimum billable hours policy. The agency can call upon the supportive office environment and frequent staff trainings to keep clinicians motivated to perform well and serve many clients. For further motivation, the organization can maintain a system of bonuses. However, I suggest that bonuses be based on anonymous client satisfaction surveys instead of billable hours completed. This new policy will emphasis the importance of quality of care over number of clients served. Secondly, I recommend that VMCR make an adjustment to its intake forms to include options for multiracial and nonbinary individuals to be represented. To address the barriers to change that I have identified, I suggest that staff formulate a comprehensive plan and gain support from other employees. If the new policy is proposed with many of the details already arranged, it is more likely to be adopted by executives.