Program and administrative staff and client base were growing. Limited space prevented program growth, and layout was non-conducive to programmatic creativity. Administrative and program physical space was in deplorable condition; air conditioning and heating systems routinely failed. Morale of staff and clients was plummeting.

Operated in environment of severe budget constraints and unpredictable reimbursement rate cuts mandated by payor systems (county, state and federal government). Building management companies did not want to lease space to a human services agency that served the chronically mentally ill. Experience in space layout and program design was non-existent, yet organization lacked budget to hire professionals.

Successfully secured suitable property after two years. Designed layout for multiple programs that would satisfy staffing, programmatic and client needs and meet regulatory compliance. New, larger space allowed greater creativity in programming, and as a result, staff and client morale improved significantly.

Agency had reached market saturation level with current client population served. Recognized the need to diversify business/service lines. Faced with budget constraints; ROI on expansion/diversification difficult to assess when agency historically had only one business line. Additionally, no staff expertise existed in any other service areas.

Implemented strategic business plan that would lead to 90/10 diversification of business/service lines. Researched areas anticipating growth in population/demographics, as well as assisted-living programs. Purchased facility with room for expansion of ALP beds/census, plus land for adult daycare program. Developed policy and procedures manual. Brought facility into regulatory compliance, successfully completed licensure, and hired competent Program Director.

Initial market analysis indicated low market saturation; was unsure of how a primarily rural community would perceive the value of psychotherapy services. Developed direct mail campaign targeting local physicians and churches. Created the appeal of a solutions-focused practitioner working in conjunction with healthcare and spirituality, rather than in place of them. Doubled the number of clients within first few months as independent private practitioner due to success of direct mail campaign.

Recognized when hired as Regional Director that if the current pace of uncontrolled service delivery continued unabated, financial losses would become even more substantial. Management team was directionless from having been unguided for a number of months. No utilization management systems were in place, and an imbedded culture of unaccountability prevailed.

Immediately met with Program Directors to gather their perceptions and input for corrective measures. Requested action plan including any staffing changes needed for each program. Evaluated each action plan for effectiveness and efficiency, and provided Program Directors with suggestions. Utilization management system and accountability systems including concurrent utilization review were implemented across all programs. Established weekly management team meetings including round robin discussions of inter- and intra-departmental hurdles and successes.

Staff was comfortable with the status quo with regard to productivity, level of involvement in programming, level of care and quality of services provided. Management and staff were uncomfortable with quantifying human service delivery. Performance evaluations were merely a formality, and salary increases were given across the board with little to no regard for actual job performance. Faced steep learning curve to educate organization that quantifying service delivery would improve quality of care and services delivered.

Conducted assessment of staff's time allocated to performing program work, direct care, case management and paperwork. Issued directive that staff would be required to maintain a minimum 75/25 ratio of direct care to administrative duties. Program Directors would be required to provide supporting documentation for 90%+ performance evaluations and eligibility for full raises.

Once the bar was raised with existing staff, any new staff was oriented to the same high expectations of productivity. As a result, region consistently had the highest efficiency rating with bell curve performance evaluations and salary increases. Staff became aware that their prime directive was to provide care, and a 20-25% increase in delivery of direct care services was achieved.

Residential program was found to have staff on payroll that was not present during shift. Culture of secrecy and lack of accountability was pervasive and embedded. Program Director was distrustful, unreliable and evasive. Encountered appalling lack of documentation—shift coverage notes, client contact notes, service delivery and service billing was non-existent, yet payroll dollars were being disbursed. Clients needing services were not receiving care. Improvements/declines in clients' conditions/status went unreported for unknown periods. In addition, property assessments were missing and residential properties were deteriorating.

Initiated systems to maintain ongoing accountability of Program Director and staff. Implemented weekly program status meetings with Program Director. Developed system requiring end-of-shift submission of all contact notes, shift notes, and change in client status notes. Created residential property "immediate need" checklist, as well as weekly and monthly property review, assessment and follow up checklist. Each 24-hour residential property was equipped with a computer and networked to regional office.

Numerous positive changes emerged—residential program became consistently profitable, with a census rate over 90%. Program Director resigned. Staff who were on payroll but not showing up for shift resigned when unable to complete shift and client documentation; remaining staff morale improved and turnover decreased. Quality of client care, client morale, regulatory compliance, as well as inter- and intra-program communication improved tremendously, resulting in fewer client crisis interventions/ incidents. More efficient management of properties resulted in controlled and predictable costs.

Joined agency just as the program was purchased by a non-clinician. Former owner was retiring; program was poorly known due to little to no marketing effort, and minimal communication with referral sources, court system and judicial agencies, other providers, or county contracting agency. Client base was small, and fees were low. Decreased collection efforts had resulted in resistance to fee increases from existing clients.

Immediately established or re-established relationships with county contracting agency, referral sources, judicial agencies and court system, as well as other providers. Actively participated on county-wide private-provider council. Implemented structured treatment and aftercare programs. Increased fees an average of 50%, some fees upwards of 200%. Instituted policy requiring payment at time of service.

Client base increased by 50-60%, and referral sources grew by 50%. Program was run more effectively and efficiently, and measures implemented resulted in sustainable growth.

Brand new program (Correctional Options) developed by the mental health and treatment communities and the State Attorney’s office to create alternative treatment programs and sentencing options for first time offenders, as well as probationers and parolees. Challenged with extremely high hurdle to inform and educate a traditionally punitive system (court system, judges, probation officers, parole boards) to the concept of lower recidivism rates through care, treatment, life skills and job skills training. High media exposure produced pressure to create client successes.

Participated in team building meetings with Department of Parole and Probation. Developed ongoing relationships with specific probation officers and judges; furthered their education and understanding of the positive results of treatment versus punishment. Played role in development of treatment participation and performance standards. Built resource referral networks for various client needs (job skills training, housing, education, driver's license training).

Formalized a bridge for communication between the mental health/treatment community and members of the judicial system. Secured and validated program funding for present and future years. Improved treatment completion rates through earlier problem identification and resolution. Agency costs decreased as the result of lower probation/parole violation rates. Program was deemed successful in its first year upon review of short-term measurements, and was renewed and funded for additional years.

Private practice client base became heavily concentrated with couples. Drawing upon family/couples/ relationship training, developed advanced assessment and treatment skills focusing on relationship issues.

Instituted high-result therapy/treatment practices; successful outcomes provided the basis for practice specialization. Broadened personal horizons and areas of expertise.

Program recently purchased by non-clinician with no knowledge of state, county or federal regulations, and no grasp of urgency of need to bring all areas of programming into compliance. Regulatory compliance was loose; clients were unaccustomed to meeting more rigorous program requirements. Administrative staff as well as program owner needed to be educated/trained on regulations.

Spearheaded quality assurance review, as well as medical record, treatment plan and program content review to identify and resolve program deficiencies. Designed and executed more structured treatment and aftercare programs. Implemented attendance policy and random screening policy.

Brought program into full compliance with state, county and federal regulations. Licensure was renewed for maximum allowance review period (three-year licensing board approvals versus one year). Quality of care improved and was reflected in higher compliance and treatment completion rates. Retention rate improved by 50%. Clients became more actively involved in their care and treatment. Program developed a more professional reputation among referral sources and other providers, as well as licensing and monitoring agencies, resulting in increased referrals.

As a stepdown unit from inpatient, the domiciliary care unit was intended to provide short-term care with a higher level of expectation of life skills performance, greater independence, as well as more active patient participation in care and treatment. However, no outcome measurement tools were in place. Staff preferred to keep compliant patients rather than discharge them to the community and have to cycle through a new (unknown) patient.

Pioneered matrix system for meeting measurable and achievable discharge goals consistent with socialization and life skills development plan. Criteria included symptom and illness management skills, social and daily living skills achievement.

Measures produced highest discharge rate (50-100% higher than peers) in history of unit. Referral sources throughout hospital system increased. Created culture of accountability for patients, as well as between patients and staff.

Program Director position at human services agency had been vacant for several months, and program was being loosely managed by center’s owner, with little time or attention to growth. Budget was limited, and program was poorly known due to lack of marketing efforts, minimal communication with referral sources, court system and judicial agencies, other providers or county contracting agency. Little accountability was expected from existing clients.

Immediately established or re-established relationships with county contracting agency, referral sources, judicial agencies and court system, as well as other providers. Actively participated on county-wide private-provider council. Implemented structured treatment and aftercare programs. Instituted policies for random screening, attendance and payment at time of service.

Program operation became more effective and efficient, leading to improved regulatory compliance and higher treatment completion rate. Client base grew by 25%, and referral sources rose by 25-30%. Fees increased an average of 20-30%. Program developed a more professional reputation among referral sources and other providers.