Crisis intervention service model ; for mental health care delivery in a rural setting
by Wesley Rollen Davidson
A thesis submitted in partial FULFILLMENT of the requirements for the degree of MASTER OF
SCIENCE in Psychology
Montana State University
© Copyright by Wesley Rollen Davidson (1974)
Abstract:
The author has attempted here to review the historical development of a crisis intervention center. This
review is hoped to serve as a model for those who wish to establish and develop such a service for
delivery of needed mental health care services. The 24 hour crisis intervention model consists of three
main service modalities (telephone, walk-in, and outreach) and is staffed by volunteers under the
supervision of community mental health professionals. An analysis of statistical data compiled by the
center is offered as a measure of the center's success. Also offered as support for such a model is a
review of the general community reaction and support throughout the history of the center. It is
concluded that the model presented is a viable system for improving the delivery of mental health care
services through better use of available manpower (volunteers, paraprofessionals, and professionals). STATEMENT OF PERMISSION TO COPY
In presenting th is thesis in p a r tia l fu lfillm e n t o f the require­
ments fo r an advanced degree a t Montana S tate U n iv e rs ity , I agree th a t
the Library s h all make i t fr e e ly a v a ila b le fo r inspection.
I fu rth e r
agree th a t permission fo r extensive copying of th is thesis fo r schol­
a r ly purposes may be granted by my major professor, o r, in his absence,
by the D ire cto r of L ib ra rie s .
I t is understood th a t any copying or
pu blication on th is thesis fo r fin a n c ia l gain shall not be allowed w ith ­
out my w ritte n permission.
Date
r
/frY
CRISIS INTERVENTION SERVICE MODEL:
FOR MENTAL
HEALTH CARE DELIVERY IN A RURAL SETTING
by
WESLEY ROLLEN DAVIDSON
A thesis submitted in p a r tia l fu lfillm e n t
of the requirements fo r the degree
of
MASTER OF SCIENCE
in
Psychology
Approved:
Head, Major department
Graduate Wean
MONTANA STATE UNIVERSITY
Bozeman, Montana
August, 1974
iii
Acknowledgment
I would lik e to f i r s t acknowledge my w ife S h e rrie , fo r the. many
s a c rific e s she has made so w illin g ly over the years. Without her undying
f a i t h , understanding, and support, I would not have been able to have ,
continued. I would also lik e to acknowledge the many professional people
from the various e x is tin g agencies, Montana S tate U n iv e rs ity , and p riv a te
p ra c tic e who extended th e ir support to th is concept. They have provided
a much needed resource fo r the continued growth and development of the .
center and have th e re fo re contributed g re a tly to the success of the pro­
gram. To them, my most sincere;personal thank you. And w ithout whom
the program could not have functioned a t a l l , the many volunteers who
have c o n tin u a lly given of themselves in a manner which has won my fondest
admiration and respect.
Table of Contents
Chapter I .
Mental Health Care Dilemma
Chapter I I
Establishment and Development of
HELP Center
I
.
7
Chapter I I I
Evaluation o f the HELP Center
31
Chapter IV
Summary and Conclusions
49
54
Appendixes
References
•
75
L is t of Tables
Table I .
Frequency of Various Help S itu ations Responded
to During the Period from June 1.971 through
. May 1974.
Table 2.
Estimated Effectiveness o f G.C.H.D. P ro ject
Table 3 .
Observed Strengths and.Weaknesses of G.C.H^D.
P ro ject
Table 4.
H is to ric a l Review of Financial Support Received
by the HELP Center
35
43
.4 5
.
48
L is t of Figures
Figure I .
Figure 2.
Figure 3.
Y early Comparison o f Help S itu ations Responded
to in 1971, 1972, and 1973
33
Yearly Comparison o f Percentage of Cases
Referred by the HELP Center in 1971, 1972, and
1973
37
Yearly Comparison of Total Help S itu a tio n s , Cases
R eferred, and Repeat Cases fo r 1971, 1972, and
1973
39
v ii
Abstract
The author has attempted here to review the h is to ric a l dev­
elopment of a c r is is in terven tio n center. This review is hoped
to serve as a model fo r those who wish to estab lish and develop
such a service fo r d e liv e ry o f needed mental health care services.
The 24 hour c r is is in terv e n tio n model consists of three main ser­
v ic e m odalities (telephone, w a lk -in , and outreach) and is staffed
by volunteers under the supervision o f community mental health
professionals. An analysis of s t a t is t ic a l data compiled by the
center is offered as a measure o f the c e n te r's success. Also
offered as support fo r such a model is a review of the general
community reaction and support throughout the h isto ry o f the center.
I t is concluded th a t the model presented is a v ia b le system fo r
improving the d e liv e ry o f mental health care services through b e tte r
use of a v a ila b le manpower (volu nteers, paraprofessionals, and pro­
fe s s io n a ls ).
Chapter. I
. Mental Health Care D elivery Dilemma
T ra d itio n a l mental health care d e liv e ry systems are a t present
under serious question.
The systems thus f a r advanced appear to be .
f a llin g short o f th e ir goal to provide services to a l l in need.
are e s s e n tia lly two main reasons:
There
(a) a shortage of manpower and (b)
in a c c e s s a b ility due to confusion on the p art of those needing service.
Many are confused about where and how to contact the needed service,
w h ile others are unaware o f which services they re q u ire .
Both of these
facto rs can and must be overcome i f we are to develop e ffe c tiv e and
e f f ic ie n t mental health care d e liv e ry systems.
Possible Answer to Manpower Problem
The emphasis a t th is point in time is oh the development of volun­
te e r and paraprofessional workers to strengthen and support the present
system.
E lford (1970) has pointed out th a t volunteers and paraprofes­
sional s have been u t iliz e d in the past but only recen tly has serious
consideration been given to th e ir possible ro le in therapy.
Trapp &
Spanier (1973) s ta te th a t the th ird revo lutio n of mental health has been
characterized by involving volunteer and paraprofessional workers d ire c t
Iy in the treatm ent of emotional problems.
They fu rth e r in d icate th a t
th is is an extremely important trend in th a t i t begins to: (a) make
b e tte r use o f "professional ta le n t " , (b) increase mental health care
d e liv e ry capacity, and (c) reduce the cost of providing service.
Gurney
2
(1969 as c ite d by Trapp e t a l l 1973) points to the ra p id ly develop­
ing use of volunteers as telephonists in c r is is centers across the
nation as an in d ic a tio n of an intense movement in the d ire c tio n of
u t iliz a t io n o f volunteers and paraprofessionals to strengthen the
d e liv e ry systems.
Gruver (1971) has reported th a t current research data Tends
p o s itiv e support to the value o f volunteer programs in terms of (a)
personal growth of volunteers, and (b) volunteers effectiveness in
working w ith c lie n ts .
In the study conducted by Trapp e t a l . , (1973)
volunteer c r is is in terv e n tio n workers were compared to college students
Their findings compared to other such studies by Delworth, Rudow, and
Taub (1 9 72 ), Hersch, K u lick, and Schiebe (1969) in d ic a te th a t volun­
teers are g e n e ra lly more a lt r u is t ic and possess c h a ra c te ris tic s (as
outlined by C larkhuff & Berenson, 1967) s im ila r to those found to be
most d esirab le in a constructive th e ra p is t.
I t is th erefo re concluded,
th a t volunteers can serve as valuable ro le models fo r t h e ir c lie n ts .
Fu rther, Gothesfeld, Rhee, & Parker (1970) as c ite d by Poovathumkal
(1973) have reported th a t mental health care professionals have rated
the value of volunteers in mental health care d e liv e ry as essential
70%, highly desirable 22%, and unnecessary 0%.
Possible Answer to In a c c e s s a b ility Problem
The suicide prevention movement during the past decade has given
r is e to the development o f c r is is in terv e n tio n centers which are
3
croping up a l l across the United States as w ell as other countries
(Nelson 1972; Decell 1972).
These centers freq uently have th e ir
beginning in a d ir e c t response to a s p e c ific need.
However, as
Decell points ou t, the centers have g enerally moved to respond to
c a lle rs needs.
That is , they have moved from a s p e c ific ta rg e t prob­
lem approach to a broad scope approach in which they respond to any
and a l l problem areas brought to th e ir a tte n tio n .
Decell fu rth e r
states th a t the wide range of problems reported by these centers
points to a need fo r " to ta l multipurpose mental health services"
w ith in the community.
Pasewark & Albers (1972) has stated th a t " c ris is in tervention
theory can r e v it a liz e the mental health f ie ld and o ffe r hope fo r p r i­
mary prevention of mental health disorders."
He has fu rth e r noted th a t
c r is is in terv e n tio n theory i t s e l f creates much doubt as to the e ffe c t­
iveness of the tr a d itio n a l mental health care model fo r service d e liv e ry .
Pasewark e t a l . , views c r is is in terv e n tio n theory, along w ith Erikson
(1968) and Caplan (1 9 64 ), as a means through which we can increase the
effectiveness and e ffic ie n c y o f our mental health care system.
He
states: "C ris is in terv e n tio n is a theory in search o f a program."
Nelson (1972) reviewing the C ris is Call Center in N as h v ille , Tenn­
essee concluded in a three phase study th a t the center was a viable
mental health care d e liv e ry service. The center was found to be (a)
1
aware of the new developments and changing needs in the community, (b)
4
perceived as a highly a c tiv e agency compared to re la ted agencies,
(c ) perceived as an e ffe c tiv e and e f f ic ie n t re fe r r a l source, and (d)
a coordinating service which helped to in te g ra te e x is tin g community
resources fo r optimal use.
Nelson fu rth e r concluded th a t the center
played an important ro le in breaking down communication b a rrie rs in
the community.
This supports the position advanced by Decell (1972)
th a t c r is is in terv e n tio n services can bridge the gap between the
" a c tiv is t sociological emphasis in mental health care d e liv e ry and the
more tr a d itio n a l in te r n a lly oriented approach."
Pederson & Babigian
(1972) point out th a t few c r is is centers have re a liz e d th e ir po ten tial
to become an in te g ra l and central mental health resource by o ffe rin g
general mental health inform ation and coordination between agencies.
He fu rth e r states th a t c r is is centers are capable o f performing a t
le a s t four functions beyond th a t o f c r is is in te rv e n tio n .
These four
functions are seen as emphasizing prevention aspects of community
health and are as follow s:
(a) providing information to various re­
la te d agencies and professional people regarding a v a ila b ilit y o f serv­
ic e s , (b) assisting c a lle rs w ith p re -c ris is problems through counsel­
ing and r e fe r r a l to proper a v a ila b le resources, (c) d ir e c t re fe r r a l to
needed service fo r e a rly in terv e n tio n treatm ent and (d) aid in coord­
in a tio n of various mental health services provided in the community.
The current lit e r a t u r e as previously c ite d , reveals th a t mental
I
.
■
health professionals fo r the most p a rt, acknowledge and accept the .
5
ro le volunteers and paraprofessionals can play in the f ie ld o f mental
health.
This along w ith the previously indicated support fo r the
p o te n tia l o f c r is is centers as a means of employing volunteers and
paraprofessionals to e ffe c tiv e ly a lle v ia t e the curren t mental health
service d e liv e ry dilemma, brings us to the purpose o f th is th esis.
A recent survey conducted by Decell (1972) has resulted in a p re d ic t­
ion of continued growth in the area of c r is is centers and has in dica­
ted th a t there appears to be a national c r is is in terv e n tio n service
p e rs o n a lity emerging and w ith i t a need and a demand fo r national
non-compulsory g u id e lin e s .
I t has been th is author's experience
through v is it s to pther centers as w ell as national conventions and
v is it s made to our f a c i l i t y by other professionals, th a t there is
indeed a great s im ila r it y between centers.
I f one retraces th e ir
h is to ric a l development, the d iffe re n c e between centers can usually
be id e n tifie d and a ttrib u te d to differen ces in the given communities.
This of course, merely strengthens the previously noted observation
th a t said centers tend to be consumer o rie n te d , q u ite s e n s itiv e to
reading the to ta l community and f le x ib le enough to conform to those
needs as they a ris e .
Generally speaking, such centers share a basic
concept or philosophy which places a high premium on in d iv id u a l d ig n i­
ty and re s p o n s ib ility as observed by .D ecell.
This serves as a basis
fo r an approach which is b a s ic a lly non-judgemental, and person centered.
6
Statement of Purpose
With these s im ila r itie s in mind and the stated need fo r guide­
lin e s , th is author w i ll present what he considers to be an e ffe c t­
ive model o f implementation which can be employed and adapted to
f i t any s itu a tio n , by s e n s itiv e and well-meaning professionals.
The model presented does not assume th a t i t w ill answer a l l questions,
but i t w ill provide the reader w ith inform ation regarding some common
p i t f a l l s and suggestions fo r avoiding or handling such s itu a tio n s .
This presentation w ill involve, f i r s t a h is to ric a l review of the
development and implementation o f the center.
Secondly, the model
w ill be evaluated by reviewing the s t a t is t ic a l data compiled by the
center.
T h ird ly , the author w i ll present summary and conclusions
based on the model presented.
These remarks w ill have primary empha­
sis on implementation in a ru ra l s e ttin g which is described as an area
having a population of less than 50,000 as noted by Decell (1972) in
his review o f c r is is in terv e n tio n services.
The model presented here
was implemented in G a lla tin County which had a population o f 32,505.
The HELP Center was located in the county's major population center,
Bozaian, w ith a population of 18,670.
i
Chapter I I
Establishment arid Development of HELP Center
The purpose o f th is chapter is to present a h is to ric a l overview
of why and how the HELP Center was established and developed.
Purpose and Need .
The o rig in a l HELP Center grew out of the concern of a small group
of parents who had discovered th a t th e ir children had become involved
in drugs.
I t was apparent to them th a t there was a need fo r a place
where both parents and children could go or c a ll fo r help.
The parents
and children together formed a group called Parents and Children (PAC),
whose sole purpose was to t r y to fin d a way and the means to provide
help to people needing i t , s p e c ific a lly where drugs were concerned.
As
a re s u lt of the PAC meetings, a tw enty-four hour c r is is in terven tio n
center was opened.
The idea of a c r is is center was borrowed from the
concept which had been implemented in many other communities across the
nation.
The people immediately responsible fo r the center were armed .
only with a genuine concern fo r people, an idea, and a g re a t deal of
courage.
Formation of the G a lla tin Council on Health and Drugs
P rio r to the opening of the HELP Center, the PAC group had been
advised to incorporate as a n o n -p ro fit corporation.
This recommendation
f e l l on deaf ears, however, as the idea smacked of the establishment.
The in d iv id u a l responsible fo r the recommendation was extremely concerned
8
about the apparent drug problem and, being a person w ith p o litic a l and
business savy, moved to bring together a concerned group o f p o lit ic a lly
powerful and in flu e n tia l people in Bozeman and formed the G a lla tin
Council on Health and Drugs (GCHD)., a n o n -p ro fit corporation, in March
o f 1971.
The main o b je ctiv e of the group was to act as a le g itim a tiz in g
body fo r the HELP Center and to develop fin a n c ia l support.
I t was com­
prised o f a Board of D irectors (members who signed the A rtic le s of
Incorporation) and an Advisory Committee whose function i t was to advise
the HELP Center and re p o rt to the Board on the progress and problems of
the center.
Review o f the O riginal HELP Center
The o rig in a l center opened in February of 1971 in the heart of the
downtown business d i s t r i c t and provided the follow ing services and
o b je ctiv es .
Services and Objectives
The HELP Center offered 24 hour telephone, w a lk -in , and outreach
service so th a t people of a ll ages could e ith e r come in or c a ll fo r
help.
The HELP Center volunteer was to handle any c r is is which might -
a ris e and r e fe r to the professional community when necessary.
O bjective Support
Support f o r the center was evidenced through donations by p riv a te
c itiz e n s o ffe rin g tim e, money, needed goods, and space.
A lso, as previously mentioned, the GCHD was formed fo r the purpose
9
o f receiving monies to support the HELP Center and a community awareness
and education program in an e f f o r t to combat the drug problem.
P o litic a l and Communication Problems Encountered Within the Community
The HELP Center ran head-on in to a g re a t deal o f opposition from
the outset.
I t was c le a r th a t many e x is tin g agencies, p riv a te in d iv id r .
u a ls , as well as the GCHD3 had several misconceptions about the purposes
and function o f the HELP Center.
The center was located in the downtown business d i s t r ic t which
paved the way f o r a g reat deal of misunderstanding between the center
and the business community.
The w a lk -in center was viewed by many in
the community as a hang-out fo r anti-establish m ent types.
In f a c t , the
w a lk -in was used p rim a rily by young people who wore lib e r a l costumes and
long h a ir.
The business community began to fe e l the c e n te r's presence
in th e ir pocket books as business in the area, by th e ir re p o rt, began to
drop o f f .
In essence, the m a jo rity o f the people in the community saw
the center as a dividin g force and as such, a symbol of youth's d is ­
respect fo r a l l th a t the community held in esteem.
Due to the lack of meaningful communication between the represent­
ativ e s o f the center and other helping agencies, the atmosphere and
p o litic a l clim ate th a t developed w ith in the community was one of confu­
sion and m is tru s t.
P o litic a l and Communication Problems W ithin the Center
I t is im portant to note th a t confusion and m istru st was seen not
10
only as coming from outside the c e n te r, but also from volunteers working w ith in the center.
The leadership o f the center was unable to
demonstrate to the community a t la rg e , or the volunteers, how the center
would achieve it s vaguely stated goals and ob jectives.
Volunteers fo r
the most p a rt, were not screened, tra in e d , or given d ire c tio n .
In
short, there was minimal organization and a lack of meaningful leader­
ship.
A group of seven volunteers, c a llin g themselves the M agnificent
Seven and fe e lin g the need fo r constructive leadership and d ire c tio n ,
started holding p riv a te meetings in an e f f o r t to form ulate a program
which could meet the objectives and goals of the center.
I t was th e ir
in te n t to take over the center and build i t into a more constructive
and meaningful service and thus provide the service th a t was o r ig in a lly
intended.
Progress along these lin e s was in fa c t being accomplished
when the HELP Center was forced to close.
Role of the G a lla tin Council on Health and Drugs
The ro le th a t the GCHD played a t th is point in time would have to
be described as fragmented in the sense th a t only one or two of its
approximately twenty members were a c tiv e .
The GCHD, on paper, consisted
of an executive body (Board of D ire cto rs ) and an Advisory Board as prev­
iously described.
In a c tu a lity , however, the executive body had met only
fo r the purpose of inco rp oration, and did not meet again u n til a fte r the
o rig in a l center was closed.
The Advisory Board, whose main function was
U
to keep a d ire c t lin e o f communication between the center and the exec­
u tiv e body o f the Council, never held a meeting u n til approximately
two weeks p rio r to the cen ter's being closed.
In essence, both the
HELP Center and the GCHD were remarkably disorganized.
Closing of the O rig inal HELP Center
.
The end re s u lt of th is general misunderstanding, lack of pre­
planning and meaningful communication was th a t in May o f 1971 the c h ie f
of the local f i r e department closed the cen ter's w a lk -in service on the
grounds th a t i t was unsafe fo r the number of people using i t .
At th a t
tim e, there was on the average some 50 young people making use of the
w a lk -in service during any given evening with only one e x it from the
second flo o r where the HELP Center was located.
The landlord who donat­
ed the space where the center was located asked th a t the center move to. .
a new lo catio n immediately.
General Comments
I t is in te re s tin g to note th a t most centers of th is nature, espec­
i a l l y those o ffe rin g w alk-in services, usually encounter somewhat h o s tile
t.
reactions from th e ir given community when they open. Such centers pose
a th re a t to the e x is tin g community. Tiie center is in a c tu a lity a symbol
which says to the community th a t i t has problems.
In a d d itio n , i t
symbolizes re je c tio n of the community's way of l i f e .
Rejection in the
sense th a t people responding to such a center are outwardly stating
through t h e ir actions th a t they disagree w ith s o c iety's values and
12
e th ic s .
The very fa c t th a t such centers do pose a th re a t to the
community should point out the need fo r e ffe c tiv e and honest
communication between the people proposing such a center and the.
community.
Emphasis should be placed on the existin g helping
agencies and the conservative segment of the community.
The coriserv-
a tiv e segment of the community is usually in fa c t the p o lit ic a lly
powerful group and w ithout th e ir support such projects are doomed to
H
f a ilu r e .
I t is suggested th a t the o rig in a l HELP Center would have met w ith
success instead of f a ilu r e i f it s representatives had properly layed
the foundation fo r establishing such a service before a c tu a lly opening
the center.
The dynamics involved in laying such a foundation w ill be
presented in d e ta il as the approach used in re -e s ta b lis h in g the HELP
Center is reviewed.
. Development of the New HELP Center
During a period of approximately 30 days follow ing the close o f the
o rig in a l center, the follow ing steps were taken to e s tab lis h support fo r
another attempt a t developing a c r is is center.
Re-establishing Need and Support
P riv a te and public meetings were held w ith agency representatives
and in flu e n tia l people throughout Bozeman to estab lish the need fo r
action to be taken in a lle v ia tin g the drug problem.
meeting th is need was also presented.
A proposal fo r
13
Presentation o f Proposal fo r the HELP Center
During the month follow ing the close of th e .o rig in a l c en ter, th is
author presented a b r ie f proposal (See Appendix A) f o r the operation. •
of the new HELP Center as prepared by eighteen a c tiv e HELP Center
volunteers and him self.
A b r ie f comment regarding the o u tlin e format
fo r the proposal presented is of importance here.
A te n ta tiv e proposal
should take the form which w ill best accomplish it s purpose.
In th is
instance a lengthy,proposal in the tra d itio n a l w ritte n form was not
judged as necessary.
The reasons supporting the decision to merely
present an o u tlin e form proposal included:
(a) the in d ivid u als being
asked to review the proposal were extremely busy and were u n lik e ly to
take the time necessary to review a more formal proposal; (b) th is
p a rtic u la r form at le n t i t s e l f more graciously to being incorporated
in to a b r ie f personal meeting w ith the in d ivid u als reviewing i t and
acted as a c a ta ly s t f o r discussion o f points they in d iv id u a lly placed
importance on; (c) th is format also enhanced the fe e lin g s on the p art
of the people reviewing the proposal th a t they were r e a lly being in ­
volved in the decision making process and the actual development of
the cen ter.
When a fo rm ally w ritte n proposal is submitted people are
more apt to regard i t as an already developed plan of action and e ith e r
accept or r e je c t i t , thereby creating more communication and review
problems.
The o u tlin e format was adopted because i t was seen as f a c ilit a t in g
14
more open and informal discussion regarding the development o f a
g e n e ra lly acceptable stru c tu re by which the HELP Center could be
implemented successfully in the community of Bozeman.
The proposal was hand carried and presented to the local po lice
■i
.
.
•
c h ie f, school adm inistrators and counselors, representatives of
e x is tin g helping agencies, physicians and members o f the GCHD.
The
proposal was also presented to various service and church groups, as
w ell as
a t a number of public meetings.
In every instance people
were asked fo r suggestions and a lte rn a tiv e s to the proposed program,
and la s t , but not le a s t, fo r support fo r such a program.
I t is extremely important when one sets out in th is fashion th a t
he have a c le a r p ic tu re of what the needs of the community a re , and
th a t he have a w ell thought out proposal fo r meeting the needs.: He
must be ready fo r any and a ll possible questions.
This is not to say
th a t he must have a ll the answers, but he should be able to demonstrate
th a t he has given the question some thought.
The proposal being
presented must be c le a r, easy to understand, and f le x ib le in the sense
th a t it s supporters are open to suggestions offered by the various
segments of the community.
Suggestions should be welcomed and used
wherever possible, as i t gives the people making the suggestions a
fe e lin g of being involved and a p art of the program.
I t is not
recommended however, th a t suggestions be accepted which do not
strengthen the program.
15
The end re s u lt o f th is type o f communication was th a t the people
contacted, fo r the most p a rt, were w illin g to lend th e ir support and
provide an opportunity fo r the implementation o f the proposed program.
O bjective Support
Support fo r the new center was illu s tr a te d by the C irc le K Club
a t Montana S tate U n iv e rs ity , which held a "Walk fo r Mankind", and
contributed approximately $2,900.00.
A local radio s ta tio n donated three hours of radio time to hold
a radio marathon.
Approximately $1,000.00 was pledged by p rim a rily
ju n io r and senior high school students, and $849.00 was a c tu a lly
received.
As a r e s u lt of the support outlined above, the GCHD appointed a
subcommittee to secure an abandoned house owned by the county.
The
county agreed to re n t the house w ith the agreement th a t any m aterials
used to renovate the building could be applied toward the re n t.
The
Council also sent representatives to Washington D. C. to meet with
o f f ic ia ls of the O ffic e of Education to review a community awareness
proposal submitted by the GCHD.
Again, as a re s u lt o f demonstrated
support fo r the center and v is it s to Bozeman by review committee
members, the grant was awarded to the GCHD.
Review o f the New HELP Center
The new HELP Center opened in June of 1971 and was p rim a rily a
r e fe r r a l and c r is is in terv e n tio n service which provided to people in
16
need (no m atter what the problem) 24 hour telephone, w a lk -in , and
outreach services.
As pointed out by Decell (1972) the wide range
of problem areas received by c r is is centers underscores the need fo r
" to ta l multipurpose mental health" services.
In view o f the fa c t th a t
Bozeman did not have a mental health c e n te r, and recognizing the drug
problem as a symptom and not the problem i t s e l f , the HELP Center moved
immediately to provide services to a ll no m atter what the problem area.
Goals of the Center
1.
The new HELP Center was to provide helping services to those
in need.
2.
The center was to provide w e ll-tra in e d volunteers who could
respond to any c r is is or problem s itu a tio n which might present i t s e l f
and then r e fe r to the proper r e fe r r a l person or agency in the profes- '
sional community when needed.
In keeping w ith Goal One, the services offered by the center were
re s tric te d to only those in d iv id u a ls seeking help.
Help was defined
as a c r is is s itu a tio n or a c le a rly defined problem where on-going
counseling may have been of use.
This c le a rly d iffe r e n tia te d the new
center form the previous one in th a t the o rig in a l HELP Center doubled
as a c r is is center and a youth recreation center.
The o rig in a l center
offered such a c t iv it ie s as card p layin g , a d a rt board, music controlled
by the youth, and reading m aterial of the Hot Rod, F ie ld & Stream, and;
True Confessions v a rie ty .
17
These types of a c t iv it ie s were banned a t the new center in th a t
our experience from the o rig in a l center had taught us th a t such
a c t iv it ie s a c tu a lly provided escapes fo r both the people using the
center as w ell as the volunteers working a t the center.
People simply
d id n 't have to deal w ith problems when they had the a lte rn a tiv e
o f becoming
involved in the various a c t iv it ie s mentioned.
Objectives established to meet stated goals.
1.
Develop a screening process fo r the selection o f volunteers.
2.
Develop an in-depth tra in in g program fo r the volunteers.
This
o b je ctiv e c arried w ith i t a sub-objective which simply stated Was th a t:
each r e fe r r a l would be tailor-m ade to best meet the.needs o f the c lie n t
The im plications o f th is sub-objective w ill be discussed la t e r .
3.
Establish d ire c t communication between agency representatives,
professional people and the volunteers.
Selection o f Volunteers
In keeping w ith Goal Two to provide meaningful help to the people
contacting the c e n te r, a ll volunteers w ith in the program (the 18
support volunteers previously mentioned) were reviewed, and new v o l­
unteer applicants were interviewed by the d ire c to r .o f the center.
Volunteers were accepted or rejected on the basis of the subjective
evaluation of th e ir :
(a) m otivation fo r volunteering, (b) a b il it y to
keep confidences, (c) a ttitu d e toward the HELP Center and the people
they would be coming in contact w ith as volunteers, and (d) whether or
18
not they presented themselves as w ell integrated persons.
In September of 1971 a selection committee was formed and i t was
th e ir task to in terview a ll volunteer applicants.
The committee was
comprised of representatives o f the various segments of the community,
such as the schools, p o lic e , c le rg y , students, GCHD, and the HELP
Center.
In a c tu a lity , two selection committees functioned, each
interview ing h a lf of the volunteer applicants a v a ila b le a t a given
tim e.
The creation o f two screening committees accomplished two
important o b jectives:
(a) stim ulated more community involvement, (b)
lessened the time commitment necessary to serve on the committees.
The primary reason behind the formation of the selectio n committee
was to allow more people from the various segments of the community to
become involved w ith the program.
A second reason fo r the selection
committee was to create a b u ffe r zone fo r negative fe e lin g s toward
the HELP Center when c e rta in prominent c itiz e n s were rejected as
volunteers.
This proved to be an extremely important p o lit ic a l move.
I t is very important to bu ild in safeguards against negative public
re la tio n s .
The c r ite rio n fo r selection of the volunteers remained the same
as previously described.
When the d ire c to r turned the selection o f
volunteers over to the selection committees, however, he reserved the
r ig h t to r e je c t anyone they had selected.
.
19
Training of Volunteers
’
A t h ir t y hour tra in in g program was designed and implemented.
(See Appendix B)
Menbers of the professional community volunteered
time to present inform ation regarding various problem areas which
were freq u e n tly encountered by the center.
designed, performed two important functions:
The tra in in g program, as
(a) volunteers received
v a lid and u p -to -date inform ation on how to best handle various problem
areas which they might encounter, (b) i t also provided an opportunity
fo r the volunteers and representatives from the professional community
to get to know each other.
The la t t e r function is o f considerable
importance, in th a t the volunteers were more apt to r e fe r c lie n ts i f
they knew the&person to whom they were re fe rrin g .
At the same tim e,
the professional community began to look a t the center in a more p o s itiv e
li g h t , la rg e ly because they were involved and were p a rt o f the program.
A very important aspect of th is approach to tra in in g is tim ing.
I t is important to bring c e rta in tra in e rs together w ith the volunteer
s t a f f when each is ready.
The volunteers must have obtained a c e rta in
le v e l of professionalism and understanding of how professionals function
before coming in contact w ith some tra in e rs .
The professional tra in e r
is evaluating and judging the volunteers and w ill base his support or
non-support of the p ro je c t on the encounter.
At the same tim e, the
volunteers are judging and evaluating the professional tr a in e r and
20
deciding whether or not they are going to use him as a r e fe r r a l in the
fu tu re .
Due to th is mutual evaluation process, timing is extremely import­
an t.
In the beginning, less judgemental, but competent, professionals
should be used as tra in e rs .
Such professionals g enerally provide an >
acceptance o f the volunteers' ro le and are able to create a non-threat­
ening atmosphere which w ill estab lish a foundation from which the v o l­
unteers may begin to b e tte r understand the ro le of the professional.
M odification o f the volunteer tra in in g program.
The same format
fo r i n i t i a l tra in in g of volunteers was u t iliz e d throughout the remain­
der of the f i r s t year from June 1971, through May of 1972.
The only
.
change was th a t the tra in in g program was reduced to 15 hours from 30
hours.
I t was f e l t th a t one hour per problem area was s u ffic ie n t as
opposed to the two hours per area in the o rig in a l design.
A v a rie ty
of professional people from the same fie ld s were u t iliz e d where possible
to increase the exposure and ideas the volunteers would receive as well
as increase the number of q u a lifie d and competent people involved in
the HELP Center program.
.
“
New tra in in g program implemented. In June of 1972, a new i n i t i a l
tra in in g program was designed and implemented.
During.the previous
y e a r, i t had come to the d ire c to r's a tte n tio n th a t new volunteers,
although having received p e rtin e n t inform ation from the i n i t i a l tra in in g
21
were unable to communicate e ffe c tiv e ly w ith someone who was in need
of help u n til they had taken p a rt in the in -s e rv ic e tra in in g program
(to be discussed la t e r ) where they could tr y out various communication
s k ills .
In gen eral, volunteers were freq u en tly mechanical in the
manner in which they were receiving and re fe rrin g c lie n ts .
This was
unacceptable in th a t one o f the ce n te r's objectives was to tailor-m ake
r e fe r r a ls which would be most b e n e fic ia l to the c lie n t as well as the
person or agency re fe rre d to .
Some important aspects o f a t a i l o r -
made re fe r r a l which must be taken in to consideration are:
(a) s e ve rity
of problem, (b) general s t a b ili t y of the c lie n t , and (c) f l e x i b i l i t y o f
the person or agency re fe rre d to .
The three facto rs lis te d are of
v it a l importance and req u ire th a t the volunteer become involved with
the c lie n t on a humanistic person-to-person le v e l.
Volunteers operating
out of s t r i c t r e fe r r a l set w ill not become involved enough to assess
these fa c to rs .
A machine could do as w e ll.
Therefore, a 16 hour
i n i t i a l tra in in g program was designed which focused on interpersonal
communication.
The volunteers f i r s t received a tra in in g packet (see
Appendix C fo r descriptio n of contents) which contained m aterials on
the procedures of the center and the two most serious problem areas
encountered a t the center:
(a) suicide prevention, and (b) handling
of a drug c r is is .
A fte r reading through the tra in in g packet, the new volunteers
entered tra in in g .
The f i r s t four hours were, spent in o rie n ta tio n .
22
Volunteers were f i r s t introduced to the procedures and component programs
o f the center.
Volunteers were then introduced to basic communication
s k ills which would aid them in th e ir work.
Approximately six hours were
spent on interpersonal communication in facentonface contact s itu a tio n s ,
^
■
and another six hours on communication over the phone. The volunteers
.
.
ro le played the various help s itu a tio n s they might encounter in both of
these s e ttin g s .
The i n i t i a l tra in in g was now being provided by the
d ire c to r and experienced volunteers instead of members of the professignal community in an e f f o r t to b e tte r introduce new volunteers to. the
fe e lin g of the center and the work they would be doing,
Communication
between the volunteers and members of the professional community was
achieved during the in -s e rv ic e tra in in g .
In -s e rv ic e tra in in g program.
In -s e rv ic e tra in in g o f the volunteers
was introduced in September of 1971.
in small groups of f iv e .
This took the form o f ro le playing
I t proved to. be e ffe c tiv e in th a t volunteers
were able to t r y out t h e ir s k i l l s , using the inform ation made a v a ila b le
to then on the various problem areas.
This procedure.was very time
consuming, however, in th a t the volunteer s t a f f numbered 60.
Thus, i t
was replaced by a new in -s e rv ic e tra in in g program implemented in
November o f 1971.
The new program consisted of a two hour meeting every other week
in which the f i r s t h a lf hour was spent as. a business meeting.
The next
h a lf hour, to an hour, was a llo tte d f o r a formal presentation, by a
23
professional person, on a problem area where more train in g , was needed.
The volunteers were placed in six groups o f ten fo r the ro le playing
sessions.
Each group was lead by a professional person which allowed
fo r fu rth e r communication development between themselves
volunteers.
and the
Response on the p a rt of the volunteers was favorab le.
In
g e n e ra l, they f e l t th a t i t was very worthwhile and added to th e ir
experience as a volunteer.
D etailed Explanation of Services Offered by the HELP Center
The center striv ed from it s inception to o ffe r diverse m odalities >
by which i t could reach people in need o f service.
Each o f these
service m odalities are reviewed here.
Twenty-four hour telephone s e rv ic e .
This service was used
p rim a rily by the adult population (19 years and o v er).
I t served
people throughout G a lla tin County, giving in divid uals who could not
or did not want to come to the center an opportunity to reach out fo r
help.
As Berman, Davis,
& P h illip s (1973) point out, a major
a ttra c tio n o f c r is is centers is the a v a ila b ilit y of volunteers or
paraprofessionals on an anonymous and c o n fid e n tia l basis, especially
a fte r most other re la te d agencies are closed.
This might account fo r
the po pularity (based on usage) of th is p a rtic u la r m odality over other
components of the center.
Twenty-four hour w alk-in s e rv ic e .
This service was used p rim a rily
by young people (18 years and under) when the center f i r s t opened.
24
However, during the summer o f 1972 more and more adults began to use
th is service also.
The p r io r it y in the w a lk-in f a c i l i t y was to handle any c r is is or
problem s itu a tio n which might present i t s e l f . However, the w alk-in
-i'
service was expanded to include other a c t iv it ie s , such as open and
closed rap sessions, and a lte rn a tiv e programs such as a rts and c ra fts
in the f a l l of 1972.
Twenty-four hour outreach s e rv ic e .
This service was extended to
the e n tire G a lla tin County, and was aimed a t those people who could not
or did not wish to come to the center but required personal contact.
The outreach teams responded p rim a rily to cases of attempted suicide
or drug c r is is .
The service was offered v ia teams, comprised of one
male and. one female w ith the d ire c to r o f the HELP Center acting as
th e ir back-up person.
A ll volunteers serving on these teams carried
advanced f i r s t - a i d cards, and w hile on a c a ll had d ire c t lin e s of
communication w ith one o f three medical doctors.
Other programs offered w ith in the cen ter.
As stated previously,
in the beginning the w alk-in service was open only fo r c r is is in te r ­
vention.
However, in the f a l l of 1971 open, and closed rap groups, and
a lte rn a tiv e a c t iv it ie s were introduced.
. I.
The o b je ctiv e of the open raps was to allow in d iv id u a ls to
come to the center and take p a rt in discussions which might o ffe r help
in an in d ire c t manner.
They also allowed a person the opportunity to
25
come in w ithout having to s ta te his problem immediately.
I f he had
a problem he was able to pick out someone he decided he wanted to
ta lk w ith .
Although th is concept had some positve fe a tu re s , fo r the
most p a rt, i t lead to problems.
I t became easy fo r a person with
problems to hide, and i t was also an in v ita tio n fo r people to ju s t
"hang around".
As a r e s u lt, the idea of open raps a t unspecified
times was dropped in June o f 1972.
Open raps offered a f t e r June 1972
a t the center met a t specified times and lasted approximately one hour.
2.
1971.
Closed raps were introduced to the center in la te November of
The purpose and o b jective o f the closed groups was to encourage
young people, who were coming to the HELP Center on a regular basis, to
make a commitment to a discussion group where problems facing then could
be d e a lt w ith e ith e r d ir e c tly or in d ir e c tly .
A second o b je ctiv e of the
closed rap sessions was to estab lish more meaningful communications
between people from the various segments o f the community th a t were
somewhat isolated from each other.
These closed rap sessions were
discussion groups, and the p a rtic ip a n ts selected topics they wanted to
discuss.
Representatives from the professional community having
expertise in a given area of in te re s t were in v ite d to rap with them.
Topics discussed in some sessions, f o r example, were law enforcement,
sex, p a re n t-c h ild re la tio n s h ip s , e tc .
The closed groups were suspended in June of 1972 so th a t volunteers
26
in terested in becoming rap group leaders could receive group leader­
ship tra in in g during the summer months.
The tra in in g involved an
evaluation of the c e n te r's experience w ith closed groups during the
previous y e a r, as w ell as more intense tra in in g in group processes.
Again, people from the professional community w ell-versed in the
dynamics of group process were employed as tra in e rs .
Open and closed rap sessions continue to be offered a t the
HELP Center in the form of p a re n t-c h ild raps, parent raps, a d u lt raps,
■
teenage raps, e tc .
3.
The a rts and c ra fts program was seen as a preventive program
which offered a lte r n a tiv e a c t iv it ie s to a wide range of people, some of
who were
involved w ith drugs.
The program's o b je ctiv e was to o ffe r , to
those who could not otherwise a ffo rd i t , an opportunity to pursue in t e r ­
ests in any a rts and c ra fts area th a t they might wish, such a s .le a th e r,
je w e lry , p a in tin g , macrame, e tc .
The assumption here was th a t the par­
tic ip a n ts might fin d and develop an in te r e s t th a t would provide than
w ith (a) an o u tle t fo r self-expression or (b) an a c t iv it y which, they
would fin d more rewarding than becoming, or continuing to be, involved
w ith i l l i c i t drugs.
Another more important consideration was th a t th is
program might provide HELP Center s t a ff a vehicle through which they
might be able to reach and estab lish rapport with hard to reach, youth.
27
P a rtic ip a n ts were encouraged to turn in goods or money received
fo r th e ir wares, back to the program so th a t any p r o fits derived from,
the sale of such items might be used to support the program.
Cooperative Programs Offered by the HELP Center and Other Agencies
Pederson e t a l . ,
(1 9 73 ), taking the point of view th a t c r is is
centers have the p o te n tia l to apply a wide range of community mental
health p rin c ip le s , have indicated th a t few centers have re a liz e d th e ir
p o te n tia l in becoming a community mental health resource through o f f e r ­
ing general inform ation and aid in coordination between agencies.
follow ing programs demonstrate-
The
th a t cooperation and coordination between
agencies can be a r e a l it y as Pederson e t . a l . , suggest.
■
Youth employment s e rv ic e . This service was a cooperative venture
between the Montana S tate Employment O ffic e , the GCHD A lte rn a tiv e Program,
and the HELP Center.
employment.
The program was designed to help youth fin d summer
The Employment O ffic e generated the jobs and placed the
youth, w hile the HELP Center performed a follow -up program (see Appendix
D) in an e f f o r t to.measure the effectiveness o f the program.
The
questions in the follow -up data sheet were also geared to provide the
center and the GCHD A lte rn a tiv e s Program with information useful in
s e ttin g up workshops to help young people learn how to succeed on the
jo b .
The assumption was th a t i f young people could become more aware of
the dynamics o f the system from which they were a lie n a te d , th a t they would
I earn to manipulate th a t system more e f fe c tiv e ly , thereby reducing th e ir
28
a lie n a tio n .
Based on the success of the program to d a te , th is
assumption appears to be v a lid .
Volunteer drug counseling program.
This program involved the
cooperation of the 18th Ju d icia l D is t r ic t Court, 18th D is t r ic t Parole
O ffic e , County S h e r iff's O ffic e , Probation O ffic e , Bozenan C ity Police
O ffic e , and the HELP Center.
I t was directed a t convicted drug
offenders under the age of 21 who, by law, were to be given a deferred
im position of sentence.
Under th is program volunteers from the HELP
Center were allowed to enter the j a i l s to ta lk w ith the convicted drug
offender.
The D is t r ic t Court extended to the volunteer the same rig h ts
of c o n fid e n tia lity as those extended to lawyers.
The o b je ctiv e was to
estab lish a re la tio n s h ip w ith the person th a t would aid him in id e n ti­
fying w ith a new peer group, and help him obtain professional help i f
needed upon his release from in ca rc e ra tio n .
Bozeman Problem Drinking Center (BPDC).
The HELP Center estab­
lished a cooperative re la tio n s h ip w ith the BPDC upon i t s opening in
Novenber of 1972.
This re la tio n s h ip remains in ta c t a t th is w r itin g , and
consists o f telephone answering and outreach back-up services.
The 24
hour answering s e rv ic e , v ia a telephone ja c k system located a t the HELP
Center, allowed the s t a f f a t the BPDC g re a te r f l e x i b i l i t y and freedom of
I
movement. I f they had to be away from t h e ir o ffic e s , they simply would
n o tify the HELP Center and the center would receive and handle th e ir c a lls .
The outreach and back-up services offered to the BPDC served to
29
strengthen th e ir d e liv e ry of services to alcoholics when the BPDC
s t a ff was unable to respond immediately.
F u rth e r, th is arrangement
served to strengthen the services of both the BPDC and the HELP
Center by reducing unnecessary du p licatio n of services.
Dom supervisors tr a in in g .
The o ffic e of On-Campus Living a t
Montana S ta te U n iv e rs ity requested th a t the HELP Center provide the
c r is is in terv e n tio n and d rug -related tra in in g f o r th e ir resident
advisors fo r the 1972-73 and 1973-74 school years.
18th J u d ic ia l Parole O ffic e . During the. w inter o f 1974 the HELP
Center entered in to a cooperative agreement w ith the 18th Judicial
Parole O ffic e which established a r e fe r r a l network.
The parole o ffic e r
re fe rre d a ll parolees assigned to G a lla tin County to the HELP Center
fo r m o b iliza tio n o f community resources.
The HELP Center provided the
parole o f f ic e r w ith a monthly n a rra tiv e review of which resources had
been brought to bear on the in d iv id u a l parolees case.
The HELP Center
also coordinated s ta ffin g s between the parole o f f ic e r and other helping
agencies as needed.
See Appendix E fo r presentation of the formal
agreement between the Parole O ffic e and the Help Center.
O bjective Support For the New Help Center
Support f o r the HELP Center has been demonstrated in a v a rie ty of
ways such as (a ) donated m a te ria ls , time and s ervice, (b) support from
p riv a te and agency professionals, (c ) volunteer support and (d) fin a n c ia l
support.
30
Donated m a te ria ls , tim e, and service.
Necessary renovation of
the Center f a c i l i t y would not have been possible w ithout the special
buying p riv ile g e s and donations of tim e, services, and m aterials from
the labor unions, independent contractors and business community.
Support from p riv a te and agency professionals. Fu rth er, the high
q u a lity o f service could not have been achieved and maintained without
the continued support and sharing o f knowledge by p riv a te and agency
professionals such as physicians, psychologists, social workers, coun­
s e lo rs , lawyers, policemen and school o f f ic ia ls .
Volunteer support.
Another major aspect of community support
which must not be overlooked is th a t of the volunteers who u n s e lfis h ly
give of t h e ir time to jump over rigorous hurdles to p a rtic ip a te in the
program.
T h eir contribution can never be overstated fo r w ithout them
the program would cease to e x is t.
Financial support.
The HELP Center conducted it s f i r s t major fund
d riv e in the spring of 1973 and received $11,640.00 in contributions from
the residents of the c it y o f Bozeman and G a lla tin County.
This is viewed
as a major in d ic a tio n of success when compared w ith the community's
response to the o rig in a l center.
Chapter I I I
Evaluation Of The HELP Center
This chapter w ill deal s p e c ific a lly w ith the issue o f evaluation
of the HELP Center model.
In assessing the program, emphasis w ill be
placed on the goals and objectives presented in Chapter I I (pages 15
and 1 6 ).
The two main goals were: (a) to.provide help to those in d iv id ­
uals needing and wanting help and (b) to provide w e ll-tra in e d volunteers
to handle problem s itu a tio n s .
The three primary objectives were:
(a)
develop a screening process fo r the selectio n of volunteers, (b) develop
an indepth tra in in g program fo r volunteers, and (c) estab lish d ire c t
communication between agency representatives, professional people and
the volunteers.
The evaluation w ill be based on fo u r sources of data:
(a) a review
of HELP Center s ta tis tic s compiled over the past three years (June 1971May 1974), (b) p e rtin e n t findings from a program evaluation (September
1973) conducted by the General Research Corporation (GRC) fo r the United
States O ffic e of Education (USOE), (c ) re le va n t outcomes of a sociometric
study c u rre n tly (Spring and Summer 1974) being conducted by the Washing­
ton, Alaska, Montana and Idaho Medical Program (WAMI) and (d) fin a n c ia l
support from the community o f Bozeman and G a lla tin County.
For ease of reading and conceptual c la r it y , evaluation w ill be
presented as ou tlined above and re la te d to the goals and objectives as
a p p licab le.
32
HELP Center S ta tis tic s
The s t a t is t ic a l review presented here is d e s c rip tiv e ra th e r,th a n
in fe r e n tia l in nature.
The analysis o f the presented data w ill be
based p rim a rily on subjective experience and observations.
fe e ls somewhat apologetic fo r employing th is approach.
The author
HoweVer, tim e,
manpower, and a v a ila b le fin a n c ia l resources did not allow fo r a more
sophisticated approach to evaluation .
This need is recognized, however,
and i t is hoped th a t in fu tu re years more sophisticated research might
be conducted.
Frequency of help s itu a tio n s . As one reviews the monthly s t a t is t ic a l
records, i t is re a d ily apparent th a t the center has grown w ith respect
to the number of people making use o f the service.
Figure I demon­
s tra te s the s t a b ili t y o f the HELP Center's growth through a comparison
of the to ta l number o f help s itu a tio n s responded to during the same
time periods fo r 1971, 1972, and 1973.
The f i r s t year of operation illu s t r a te s the most dramatic growth *
period, w ith 40 help s itu a tio n s in June o f 1971 as compared to 206
help s itu a tio n s during the month of May 1972.
The la s t two years present
ed in d ic a te s t a b iliz a t io n , as well as, continued growth.
Comparing the
f i r s t y e a r's (1971) to ta l o f 1,593 help s itu a tio n s to the second y e a r's
(1972) to ta l o f 2,142 help s itu a tio n s , there is an observed increase of
549 help s itu a tio n s fo r the year or 45.8 more help s itu a tio n s per month
were received by the HELP Center.
Looking a t the th ird .y e a r (1973) of
HELP
SITUATIONS
33
Oj— i— *
JUNE
-—
i—
•—
NOV
*—
i—
MAY
MONTHS
to
in
Fig. I .
Y e a r l y compar i son
1 971 , 1 972 and 1 973 .
of
he l p s i t u a t i o n s
responded
34
operation, i t is observed th a t 2,225 help s itu a tio n s were responded
to as compared to the 2,142 fo r the previous year.
This re fle c ts an
increase o f 83 help s itu a tio n s fo r the year or 6.9 more help s itu a tio n s
per month.
These s t a tis t ic s demonstrate s ig n ific a n t growth during the
f i r s t two years of operation.and a s ta b liz a tio n in frequency of usage
during the th ird year.
These data are considered to represent positve
confirm ation th a t the f i r s t goal o f the HELP Center had been achieved.
Help has been provided to in d ivid u als needing, and wanting help.
These
data are offered as an acceptable measure of effectiveness on the basis
th a t increased usage o f the center indicates acceptance on the p art o f
the people using the center.
I t is assumed th a t i f the center was not
e ffe c tiv e , people would not continue to u t i l i z e i t .
The continued growth as demonstrated during the f i r s t two years and
the s ta b iliz a tio n in the th ird year is viewed as strong support fo r the
conclusion th a t the center is a needed and v ia b le service to the community.
This author believes th a t th is has resulted d ir e c tly from the fa c t th a t
the HELP Center has not specialized in any c ertain area o f need, such as
drugs or suicide prevention.
Table I illu s tr a te s the 24 d iffe r e n t prob­
lem areas u t iliz e d a t the center fo r c la s s ify in g help s itu a tio n s and
fu rth e r presents the frequency w ith which the various types o f c a lls are
received via the three main service m odalities (telephone, w a lk -in , and.
outreach).
This expanded service concept is an important point in th a t
many c r is is centers across the n atio n , which developed as a re s u lt o f the
35
TABLE I
Fr e que nc y o f V a r i o u s Hel p S i t u a t i o n s
For t h e P e r i o d o f June 1971 Through May 1974
SERVICE MODALITIES
PROBLEM AREA
TOTAL
TELEPHONE
Marital
Drugs
Alcoholism
P a r e n t - Chi I d
School
Runaways
G i r l - Boy
S u icide
Attempted
Contemplated
Depress!on
L o n e l i ness
C o n t r a c e p t i on
Veneral Disease
Pr obl em Pr egnancy
Unwed Mot he r s
Homos e xual i t y
H o u s i ng
T r a n s p o r t a t i on
Legal
Employment
Re p e a t C a l l s
Other
Ge n e r a l I n f o .
Hoax
168
271
212
257
25
62.
144
18
30
153
183
74
118
188
5
19
171
30
112
57
859
477
444
192
.
WALK IN
OUTREACH*
41
126
37
149
28
17
73
" 9
13
4
18
3
O
9
I
4
55
80
4
8
25
2
2
55
10
13
35
525
150
54
2 .
I
11 .
9
I
O
O
O
. O
2
4
O
I
41
9
O
218
410
253
424
56
79
226
21
. 35
. 219.
272
79
126
213
7
21
228
44
125
93
I ,425
, 63.6
498
192
* 0 u t r e a c h f i g u r e s are f o r the t h i r d y e a r ( 7 3 ) o f o p e r a t i o n
only.
O u t r e a c h cases wer e h o t s e p a r a t e d fr om te le p h o n e
s t a t i s t i c s d u r i n g t h e f i r s t two y e a r s o f . o p e r a t i o n .
'
,
36
drug problem, are fin d in g today they are no longer v ia b le agencies
(Drug Addiction Report, 1972).
They have become ju s t another in s t it u ­
tio n w ith respect to the people using th e ir services.
The HELP Center
on the other hand has s triv e d to meet the needs o f the people using
the center no m atter what the problem area.
For th is reason, i t has
continued to grow and to become a v ia b le and in te g ra l p a rt of the
community's to ta l helping services.
R eferral r a te . The center does n o t, in most cases, meet the long
range needs of the c lie n t d ir e c t ly .
I t serves to aid the c lie n ts in
dealing more e ffe c tiv e ly , w ith t h e ir problems through .a close cooper­
a tiv e re la tio n s h ip w ith other e x is tin g agencies and p riv a te professional
services.
Figure 2 in dicates the percentage of r e fe r r a l to other re la te d
services from the HELP Center.
Close study o f the r e fe r r a l percentages reveals th a t a r e la t iv e ly
stable r e fe r r a l ra te has been maintained.
The r e fe r r a l percentage ra te
in the f i r s t year o f operation was 56%, w h ile a r e fe r r a l ra te of 58% was
observed fo r the second year of operation as compared to a r e fe rra l ra te
of 60% during the th ird year o f operation.
R eferral work is quite
d i f f i c u l t and freq u e n tly a s ig n ific a n t amount o f ground work and.re-edu­
cating of the c lie n t must be accomplished fo r a p ro fita b le r e fe r r a l (fo r
both c lie n t and resource re fe rred to ) to be completed.
This in part
accounts fo r the monthly flu c tu a tio n s in r e fe r r a l ra te as depicted in
Figure 2.
The o v e rall s t a b ili t y of the r e fe r r a l r a te , however, is viewed
PERCENTAGE
OF
CASES
REFERRED
37
JUNE
NOV
MONTHS
F i g . 2.
Y e a r l y c ompa r i s on o f p e r c e n t a g e o f cases
r e f e r r e d by t h e HELP C e n t e r I n 1971 , 1972 and 1 9 7 3 .
38
as an in d ic a tio n o f a strong volunteer program working to bridge the
gap between e x is tin g services and people requirin g th e ir services.
This s ta b le r e fe r r a l ra te indicates the success o f the tra in in g pro­
gram which stresses re fe r r a l and improved communication w ith profes­
sional people.
This can be somewhat misleading however, so i t is
necessary to po int out th a t the r e fe r r a l ra te is affected by the
emphasis placed on r e fe r r a l by the d ire c to r of the program.
Without
his d ire c t influence in tra in in g sessions and day-to-day supervision,
r e fe r r a ls drop o f f .
Care must also be taken not to over stress r e fe r r a l
as is demonstrated by studying the re la tio n s h ip between the number o f
c a lls received (Figure I ) and the monthly re fe r r a l ra te (Figure 2) fo r
the months of January, February, and March 1973.
The re fe r r a l rates
suggest the center was more e ffe c tiv e during th is period.
However,
Figure I re fle c ts a reduction in the number o f cal l s received.
This
indicates th a t the center s t a f f became more c lin ic a l in th e ir approach
to people and the center became a less v ia b le service.
In actual pra­
c tic e a mean monthly r e fe r r a l ra te o f 60% indicates a strong viable
s ervice.
Less than 50% indicates th a t the center is. becoming in e ffe c tiv e
in it s service to the community, w hile a r e fe rra l ra te greater than
70% in dicates the center is too r ig id and c l i n i c a l .
The center then
f a ils to bridge the gap between professional services and people in need.
Yearly comparison o f help s itu a tio n s , repeat cases, and r e f e r r a ls .
Figure 3 illu s t r a te s a y e a rly comparison in the re la tio n s h ip between
■
''Y
'
, ..
'
39
2500
HELP SITUATIONS
C A S E S REFERRED
R E P E A T CASES
YEAR
2000
CASES
PER
1500
10 00
YEARS
cases
F i g . 3.
Y e a r l y c ompar i son o f t o t a l he l p s i t u a t i o n s ,
r e f e r r e d , and r e p e a t cases f o r 1 9 7 1 , 1972 and 1 9 73 .
!
40
the number of (a) help s itu a tio n s handled, (b) repeat cases, and
(c ) cases re fe rre d to other helping services.
s t a b ili t y of the HELP Center.
The data here r e fle c t the
The three year comparison shows th a t in
re la tio n to the number o f help s itu a tio n s handled during a y e ar, the
number of repeat cases does not vary more than three percent.
The
s t a b ili t y o f the center w ith regard to to ta l help s itu a tio n s as com­
pared to the number of re fe r r a ls is illu s t r a te d by a range o f 42% to 44%
over a three ye ar period.
The discrepancy in the r e fe r r a l percentage
c ite d and the previous percentage based on Figure 2 is explained as
fo llo w s.
The percentage rates were computed on the basis of the to ta l
help s itu a tio n s minus repeat cases.
The d iffe re n c e is then divided in to
the to ta l number of r e fe r r a ls made.
In Figure 3 the percentage does not
take in to account repeat cases.
The method used fo r c a lu la tin g the per­
centage ra te is ju s t if ie d because many repeat cases have been re fe rred
and our work w ith them f a l l s in to the area of support service to the
c lie n t and to the helping resource re fe rre d to .
Demographic descriptio n o f c lie n te le .
Fran the onset, the center has
s triv e d to provide service to people of a ll ages.
Due to the fa c t the
center grew out o f the drug problem, i t was generally perceived by the
m a jo rity of the people as a drug center and therefo re responsive only to
the age group and type o f people most re a d ily associated w ith the drug
c u ltu re .
While the center in it s e a rly days was p rim a rily working
w ith young people between the ages of ten to 18, i t slowly gained
41
acceptance from the a d u lt population.
On the basis of very sketchy
data, (due to the anonymity o f the work a t the center) i t can be
cautiously suggested th a t during the c e n ter's second year o f operation,
50% of the to ta l help s itu a tio n s responded to were re la te d d ir e c tly to
youth (ten to 18 years of age) w hile the other 50% o f the help s itu a tio n s
were d ir e c t ly re la te d to adults (19 to 80 years of age).
During the
th ird year of operation, however, 72% of the to ta l help s itu a tio n s
responded to involved a d u lts , w hile 28% d ir e c tly involved youth. These
observations are consistent w ith the reduction in the number o f youth
a c tiv e ly u t i liz i n g the w alk-in f a c i l i t y .
The w alk-in f a c i l i t y was
always used p rim a rily by young people and during the la s t two years
there was a steady decline in usage.
This information is presented
here as demonstrating again, the success the center has had in reaching
out to the to ta l community (across a l l age groups).
At the same tim e,
however, i t is necessary to point but th a t the center has lo s t contact
w ith youth during the th ird year.
This indicates th a t the center must
re -e v a lu a te i t s ro le w ith respect to youth in an attem pt to reach out
more e ffe c tiv e ly to th is age group.
GRC Program Evaluation Case Studies o f Selected Components (1973)
In the summer of 1973, USOE contracted with the GRC to evaluate ten
of 47 funded community and college based programs.
The evaluation was
to involve interview s w ith p ro je c t s t a f f , representatives from re la te d
agencies, p ro je c t b e n e fic ia rie s and n o n -b e n e fic ia rie s ., The la t t e r two
42
interview ing s itu a tio n s had to be cancelled due to problems with
clearance of the in terview ing instrument by the O ffic e of Manage­
ment and Budget in Washington D.C.
The remaining portions of the
evaluation attem pt were carried out however. I t must be pointed out
t
•
'
■
th a t the evaluation involved three major components o f the GCHD pro­
gram.
The HELP Center was one of the major components.
Presented
here w i ll be excerpts from the evaluation report as they r e la te
d ir e c tly to the HELP Center portion o f the GCHD program.
Before con-r
tin u in g , i t should also be noted th a t the HELP Center was the very core
o f the GCHD program, in th a t most a ll o f the programs offered through <
the GCHD had t h e ir beginning a t the center (r e fe r to Appendix F fo r
.
GCHD program overview).
.. S e lf-re p o rte d and agency appraised success.. On.the basis of s e lf reported and agency appraised success as derived from interview s held
w ith p ro je c t s t a f f and representatives from re la te d agencies, i t was
,
determined from the degree of in te rn a l and external agreement, th a t
p ro jec t s t a f f and re la te d agencies s t a f f had good communication and
th a t the p ro jec t was functioning as an in te g ra l component of the to ta l
community services a v a ila b le .
Table 2 indicates a remarkable agreement between p ro je c t s t a f f and
re la te d agency s t a f f .
The 4 .6 ra tin g r e fle c ts the mean ra tin g given by
p ro je c t s t a f f as w ell as re la te d agency s ta ffs .
This is based on a scale,
of one to six w ith one being not e ffe c tiv e a t a l l , and six being almost
43
TABLE 2
Estimated Effectiveness o f G.C.H.D. P roject^.
RESPONDENTS
P roject S ta ff
Related Agency S ta ff
MEAN ESTIMATE OF
PROJECT EFFECTIVENESS
4.6
4 .6
I.
Estimates were based on a scale o f one to s ix . One being not a t
a ll e ffe c tiv e and s ix being almost always e ffe c tiv e .
44
always e ffe c tiv e ,
j With regard to the HELP Center, th is has s p e c ific
importance as the center was rated by both p ro ject s t a f f and related
agency s t a f f as the most e ffe c tiv e program component (s p e c ific a lly in
the area of reducing drug involvement on the part of c lie n t e le ) .
i
Acceptance.
The GRC re p o rt also advanced the po sition th a t the
increased usage of p ro je c t components constituted some degree of o b je ct­
iv e measure o f p ro je c t success.
This position was based on the prev­
io usly advanced argument th a t people would not continue to u t i l i z e a
program component which was not b e n e fitin g them.
Table 3 in dicates reported weaknesses and strengths o f the p ro ject
as perceived by the GRC researcher.
The weaknesses in the area of the
GCHD projects re la tio n s h ip to the school board has to do more s p e c ific ­
a l l y w ith the GCHD School Program than w ith the HELP Center jaer se.
The
strengths presented in Table 3 , however, are seen as d ir e c tly re la te d to
the HELP Center as w ell as other components of the GCHD program.
WAMI Sociometric Study
The WAMI program, sponsored by the U n iversity o f Washington Medical
School, is an innovative approach to tra in in g medical students in the
states of Washington, Alaska, Montana, and Idaho.
Students from these
four states receive various portions of th e ir tra in in g in the p a r t ic i­
pating states by ro ta tin g p e rio d ic a lly to the d iffe r e n t f a c i l i t i e s in
these states which have been contracted to provide c e rta in aspects of
th e ir medical tra in in g .
One o f the main goals of the program is to aid
45
TABLE 3
Obser ved S t r e n g t h s
of G.C.H.D.
and Weaknesses
Project
CATEGORIES
SOURCES
WEAKNESSES
Interviews
with pro jec t
and r e l a t e d
agency s t a f f .
I.
Relationship with
!school boar d c o u l d
'be i m p r o v e d .
I
STRENGTHS
I . Much b e t t e r r e c o r d
k e e p i n g t h a n usual f o r
dr ug e d u c a t i o n p r o ­
grams .
2 . E x c e l l e n t commun­
i t y and agency a c c e p t ­
a nc e .
3. E f f e c t i v e
organization
community
work.
4 . S t a f f has i n t e ­
g r a t e d and u n i f i e d
philosophy.
.5. I n n o v a t i v e
ing.
p r o g r a m­
46
the students in developing s k ills which w i l l be useful in p r a c ti­
cing medicine in ru ra l areas.
The WAMI program is presently conducting a sociometric study
of the G a lla tin County area.
This past year has involved the gathering
o f baseline data so th a t the impact o f the WAMI program in th is area
might be measured a t a la t e r tim e.
However, some of the baseline
data collected to date are o f in te r e s t here.
.
Through personal commun­
ic a tio n w ith K. R ed fie ld , WAMI Evaluation Coordinator(1974), i t was
I earned th a t as a r e s u lt o f a sociom etric evaluation (employing card
,
sorting procedure) o f 45 selected health care personnel in the G a lla tin
County area, the GCHD had been found to be s a lie n t in th re e out of
f i v e fa c to rs .
These three facto rs were in the area o f (a ) public
health and mental h ealth , (b) program leadership, and (c ) program
maintenance.
The salience a ttrib u te d to the GCHD in these areas
indicates th a t the GCHD has achieved a high degree o f v i s i b i l i t y and
is viewed as being e ffe c tiv e in providing health care services in
G a lla tin County.
Again keeping in mind,, th a t the HELP Center was the
very core o f the GCHD program, these re s u lts are viewed as an in d ic a tio n
o f the d ire c t impact and effectiveness th a t the HELP. Center has had on
health care d e liv e ry services in G a lla tin County.
Financial Support
This section is a review o f the fin a n c ia l support the center has
received from the community of Bozeman and G a lla tin County.
In the
47
spring o f 1971, a radio marathon conducted and supported almost ex­
c lu s iv e ly by young people and a walk-for-mankind sponsored by Montana
.
;i
,
■
■
■
S tate U n iv e rs ity service group raised $3,749.80 fo r the HELP Center.
Other contributions amounted to approximately $4,000.00.
the new HELP Center to begin operations.
This enabled
In the spring of 1973, a. fund
ra is in g campaign fo r the HELP Center was conducted and a to ta l of
$11,640.00 was raised to support the HELP Center for. the 1973/74 pro­
gram y e ar.
Again in the spring o f 1974 a fund ra is in g campaign was
launched to fund the HELP Center fo r program year 1974/75;
The re s u lt
of th a t fund d riv e , a t the time of th is w ritin g , was th a t a to ta l of
$15,273.87 had been pledged toward a goal of $18,308.50.
Table 4 rep­
resents a review of the fin a n c ia l support given to the HELP Center
throughout it s h is to ry .
The fin a n c ia l support afforded the HELP Center through fund ra is in g
campaigns is taken as d ir e c t evidence o f the center's acceptance in the
community as w ell as an in d ic a tio n o f it s appraised value in the community.
General Comments
This author believes th a t the data presented in th is evaluation
points out th a t the center has g en erally met and achieved i t s stated goals
and o b je ctiv es .
While the. need fo r more sophisticated research fo r the
purpose o f evaluating the center is recognized, i t . i s f e l t th a t the data .
presented supports the conclusion th a t the c r is is in terv e n tio n model
presented is an e ffe c tiv e one.
i
"
48
TABLE 4
H i s t o r i c a l Revi ew o f
Re c e i v e d by t h e
F i n a n c i a l Support
HELP C e n t e r
YEARS
SOURCE
1971
1972
United States
O f f i c e o f Ed­
ucation
$10,128.81
$12,683.80
Communit y
Fund D r i v e
$ 7,749.80
Southwestern
Montana Drug
Program
197 3
1974
$11,640.00
$15,273.871
$ 6,000.00
$ 6,588.282
1. T h i s amount has been r a i s e d t owa r d t h e goal o f $ 1 8 ^ 3 0 8 . 5 0
2 . P r o j e c t e d amount t o be o b t a i n e d fr om a c o n t r a c t a gr e eme nt
w i t h t h e S o u t h w e s t e r n Montana Drug Pr ogr am.
Chapter IV
Summary and Conclusions
Health care d e liv e ry systems are a t present under serious question.
The systems advanced and implemented to date appear to f a l l short of
th e ir goal to e ffe c tiv e ly provide services to those in need.
The two
main reasons c ite d fo r the current mental health care d e liv e ry dilemma,
are (a) a shortage o f manpower and (b) in a c c e s s a b ility due to confusion
on the p a rt of those needing services.
These two facto rs can and must
be overcome i f we are to develop an e ffe c tiv e and e f f ic ie n t mental health
care d e liv e ry system.
.
'
A possible answer to the current shortage of manpower lie s in the
increased acceptance and usage of volunteers and paraprofessionals to
strengthen and support the present system.
This approach as appraised
by Trapp & Spanier (1973) begins to (a) make b e tte r use of "professional
ta le n t" , (b) increase mental health care d e liv e ry c a p acity, and (c)
reduce the cost of providing s ervice.
A possible answer to the problem of in a c c e s s a b ility also appears
to be w ith in reach.
Over the past decade volunteers and paraprofessionals
have been employed in the development of 24 hour c r is is in tervention
centers.
Centers of th is type c h a ra c te r is tic a lly have developed out of
a specialized need in a given problem area, however, many have moved to
become responsive to a wide-range of mental health problems and needs
(Decell 1972).
Pederson e t a l . ,
(1 972) views c r is is centers as increasing
50
the a c c e s s a b ility o f mental health care through (a) providing in fo r ­
mation to re la te d agencies and professional people regarding a v a ila ­
b i l i t y of services, (b) assisting c a lle rs w ith p r e -c ris is problems
through counseling and r e fe r r a l to proper a v a ila b le resources, (c)
d ire c t r e fe r r a l to needed service f o r e a rly in terven tio n treatment
and (d) aid in coordination of various mental health services provided
in the community.
A review of curren t lit e r a t u r e reveals th a t mental health pro­
fessionals are acknowledging and accepting the ro le of volunteers and
paraprofessionals (Poovathumkal 1973), as w ell as, the development of
c r is is centers in an e f f o r t to a lle v ia te the current mental health
service d e liv e ry
dilemma.
Decell (1972) has pointed out th a t there appears to be a national
c r is is in terv e n tio n service p e rso n ality emerging.
Along w ith t h is , a
need and a demand fo r non-compulsory guidelines is developing.
C ris is
centers tend to have basic s im ila r it ie s such as a philosphy which, places
a high premium on irld ividua! d ig n ity and re s p o n s ib ility as w ell as in
th is author's opinion, s im ila r itie s w ith regard to actual program devel­
opment.
With these s im ila r it ie s in mind and the stated need fo r guide­
lin e s , a model fo r development and implementation has been presented.
The primary service th is model performs is to o ffe r (a ) a guide to actual
development and implementation and (b) an awareness of possible p i t f a l l s
and suggestions fo r avoiding or handling such s itu a tio n s .
51
A h is to ric a l review of the development of the o rig in a l HELP
Center points, out the need f o r e ffe c tiv e and honest communication
between groups proposing such centers and the community a t la rg e.
I t is recommended th a t p a rtic u la r emphasis be placed on communication
w ith the conservative segment o f the community as i t is usually the
p o lit i c a ll y powerful group and w ithout th e ir support the program may
be doomed to f a ilu r e .
In re tra c in g the development and implementation o f the new HELP
Center, a comprehensive review of the steps taken to estab lish e ffe c tiv e
communication is presented.
Emphasis is placed on the development of
a proposal (in th is case, an o u tlin e format was employed) which w ill
aid in f a c ili t a t i n g p a rtic ip a tio n on the p a rt of those reviewing i t .
This is accomplished by stru ctu ring the proposal and communication w ith
reviewers so th a t they can o ffe r suggestions and even a lt e r the proposed
plan.
I t is important not to present a proposal which appears to be
fin a l.
This sets the stage fo r an atmosphere in which reviewers w ill
simply accept or r e je c t the proposed plan.
The model presented
here had two main goals (a ) to provide help
to those in d iv id u a ls needing and wanting help, and (b) to provide w e lltrained volunteers who could respond to any c r is is or problem s itu a tio n
which might present i t s e l f and then r e fe r to the proper professional
person or agency when needed.
Program development and implementation
is reviewed in a manner which illu s t r a te s how these goals were achieved.
52
The review takes in to account (a ) selectio n of volunteers, (b) t r a in ­
ing o f volunteers ( i n i t i a l and in -s e rv ic e tr a in in g ) , (c). a comprehen­
sive review of the service m odalities o f the center (24 hour telephone,
w a lk -in , and outreach s e rv ic e ), and (d) cooperative programs offered
by the center and other re la te d agencies.
The center is evaluated on the basis of a review o f (a ) s t a t is t ic a l
data compiled a t the center, (b) p e rtin e n t re su lts from independent
research, and (c) fin a n c ia l support from the general community.
On the basis of th is evaluation , the development and implementation
of the HELP Center is presented as a model fo r the development of other
such centers.
The model is viewed as an e ffe c tiv e method o f achieving
b e tte r mental health care d e liv e ry through the use of volunteers and
paraprofessionals in a c r is is in terv e n tio n s e ttin g , working on a cooper­
a tiv e basis w ith mental health professionals both in agency and p riv a te
p ra c tic e .
The model is fu rth e r viewed as having a s ig n ific a n t impact on
ru ra l areas where mental health care d e liv e ry is seriously lacking la rg e ­
ly due to in s u ffic ie n t numbers to warrant the fis c a l expenditures necess­
ary to estab lish the t r a d it io n a lly d e liv e ry system.
In urban areas, the
model is also seen as being b a s ic a lly applicable and desirous from the
standpoint o f increasing a c ce s s a b ility of mental health care.
However,
it s f u l l p o te n tia l may not be re a liz e d in urban areas due to the shear
numbers of people which contribute g re a tly to the in effectiveness of
53
many programs through overloading.
The HELP Center model presented
in th is paper is considered v ia b le and e ffe c tiv e , and w ith proper
implementation probably would serve to strengthen mental health care
d e liv e ry in ru ra l as w ell as urban areas.
APPENDIXES
APPENDIX A
HELP Center Proposal
Help Center
I.
Telephone and W alk-in Service
A.
B.
Telephone Service: to be located in the same building
as the w a lk -in ; however, in an is o lated area.
1.
Trained volunteers w ill man the telephone on a
24 hour basis.
2.
Records o f each c a ll of a help nature w i ll be
completed and f il e d fo r our own use.
W alk-in S ervice:
needing "help".
1.
W ill be lim ite d to those in divid u als
Help is defined as:
a.
a c r is is s itu a tio n
b.
a c le a rly defined problem where on-going
counseling may be of use.
2.
Trained volunteers w ill be used in the w a lk -in service
3.
The w a lk -in service w ill be maintained on a 24 hour
basis, however, the center w ill not be open to:
a.
general hanging around
b. . a meeting place
4*
At such time as the center fe e ls th a t i t can operate "rap
sessions in an e f f ic ie n t manner (in terms of number of
people) i t w ill begin th is type of a c tio n . When "rap"
sessions are again f u l l y in it ia t e d in to the program they
w i ll be held a t s p e c ific hours, i . e . , 5 p.m. u n til 10 p.m
Page I of 3
56
5.
The Center w ill close i t s doors a t 12 p.m. The
w a lk -in service a f t e r th is hour w ill be lim ite d
s t r i c t l y to th a t o f a c r is is nature.
2.
Records a v a ila b le to those other than volunteers d ir e c tly related
to a given case and le g a l agencies w ill be of a s t a t is t ic a l nature
only.
( i . e . , p a re n t-c h ild - I , suicide - 5, e t c . ) . Records w ill
be completed in the follow ing manner: (a) telephone service
s t a t is t ic s , (b) w a lk -in service s t a t is t ic s , and (c) overall t e le ­
phone and w a lk -in service s t a t is t ic s .
.
3.
Training of volunteers fo r telephone and w alk-in service.
4.
A.
A committee w ill be appointed to establish a tra in in g team
comprised o f professionals a v a ila b le to us.
B.
The professional tra in e rs w ill be asked to conduct tra in in g
sessions on th e ir given s p e c ia lty area.
1.
Training groups w ill range from f iv e to ten volunteers in
s iz e .
2.
The tra in e rs w ill also be asked to evaluate the volunteers
they have worked w ith .
3.
Each group of volunteers w ill ro ta te from one tra in e r to
another.
4.
At the end of the tra in in g cycle the volunteers w ill begin
working a t the center. 5
5.
The volunteer ju s t completing tra in in g w ill be observed in
a c tio n .
Screening o f volunteers:
A.
Trainers evaluations o f the volunteers
B.
Observation by experienced volunteers. In the event th a t a vplun
te e r does not appear to be working ou t, a meeting of the tra in e rs
supervisory volunteers involved, representatives from tra in in g
c o im itte e , and d irecto rs w ill be called to determine what action
should be taken.
Page 2 of 3
57
5.
1.
Retrain the volunteer in s p e c ific areas or completely
recycle.
2.
Channel the volunteer in to another area which would
not involve contact w ith in d ivid u als seeking help.
3.
Dism issal.
Relationship to G a lla tin Council on Health and Drugs (GCHD).
D e fin ite communications, should be set up between center and GCHD
Advisory Board. Al I inform ation should go d ire c tly to the D irecto r
or the secretary to avoid m isinform ation.
Page 3 of 3
APPENDIX B
HELP Center Volunteer Training Program
(I)
T h ru s., July 8
I n i t i a l Contact: Presentation of a r e fle c tiv e
approach to helping in d ivid u al using the phone
service and the w alk-in s e rv ic e . Presented by
graduate students in counseling a t MSU.
Mon., July 12
I n i t i a l Contact: Role Playing under the super­
v is io n of graduate students in counseling a t
MSU.
Tues., July 13
T h u rs., July 22
(2)
HELP Center: Presentation of the operational
procedures of the center arid a b r ie f discussion
on c o n fid e n tia lity . Presented by Wes Davidson,
. A ssistant D ire c to r, HELP Center.
Wed., July 14
Wed., July 21
Problem Pregnancy: Discussion o f counseling
a v a ila b le to the c a lle r . This presentation also
included inform ation regarding sex, venereal,
disease, and c h ild abuse. Presented by Iome
K in zie , Public Health Nurse and Ann Bolstad,
G a lla tin County W elfare.
Thurs. July 15
Tues., July 20
Groups: Discussion of groups and what consti­
tutes a group. The problem of leading a d is ­
cussion group was also explored. Presented by
John Bauer, Sociology Department, MSU.
F r i . , July 16
Mon., July 19
P aren t-C h ild , B o y frie n d -G irlfrie n d Problems:
Discussion of the problems involved in handling
these types of problems. Presented by Ann
Seibel ( P.E. D e p t., MSU) and Gail Weingart
(J r . High Counselor).
Mon., July 26
Mon., Aug. 2
Alcoholism: . Discussion of alcoholism and what
can be done to help the alco h o lic th a t c a lls .
Presented by Don K inzie.
Page I of 2
59
Tues. , July 27
Tues., Aug. 3
Drugs (M edical) Presentation o f the pharmacology o f drugs. Presented by Dr. Sippel and
Dr. Visscher. .
Wed., July 28
Wed., Aug. 4
Drugs (C r is is ): What to do in a c r is is s it u ­
a tio n . General description o f what the in d iv id ­
ual on a t r ip might be experiencing. Presented
by Jay and J u lie Brenden.
T h u rs., July 29
Thurs. , Aug. 5
Drugs (D is p la y ): Various types o f drugs which are
being abused. Presented by Doug T aylo r, Police
Dept.
F r i . , July 30
F r i . , Aug. 6
Legal: Discussion o f the legal aspects of the
HELP Center and the legal im plications of being
a volunteer a t the:HELP Center. Presented by
Gene Brown, Lawyer.
Mon., Aug. 9
Mon., Aug. 16
Runaways: Discussion of the legal aspects and
procedure fo r handling the runaway s itu a tio n .
Also a b r ie f discussion of a probation o f f ic e r 's
duties and how we can help each other. Presented
by Jim P attee, Probation O ffic e r.
Tues., Aug. 10
Tues., Aug. 17
F ir s t Aid: Presentation of a two hour seminar in
F ir s t Aid to be followed by a f i r s t aid course fo r
those volunteers who are in te re s te d . This w ill be
required fo r volunteers serving on outreach teams.
Presented by Ken Davison.
Other tra in in g sessions to be offered a t a la te r date are: Depression
(to include a discussion o f loneliness and. attempted s u ic id e ).b y Rev.
Mike M iles , and M a rita l Problems.
Page 2 of 2
APPENDIX C
HELP Center Volunteer Training Packet
Description, o f Training Packet
The tra in in g packet presented here was developed, to provide in ­
coming volunteers w ith some fa c tu a l inform ation regarding the HELP
Center, and two serious problem areas encountered by the center; those
being suicide and drug c r is is s itu a tio n s .
These two problem areas
were selected not on the basis o f frequency but as a r e s u lt of expected
impact on volunteers as these, more than any other problem areas,
would cause an inexperienced volunteer to panic.
The in te n t was not to provide in-depth inform ation of an aca­
demic nature, but only to provide e a s ily re ta in a b le inform ation in
these areas.
More in=depth inform ation was presented to the volunteers
in the in -s e rv ic e tra in in g program.
I t was f e l t th a t volunteers
needed f i r s t to be exposed to only the most essential fa c tu a l informa­
tio n in the beginning.
Of primary importance was th a t the volunteers
be exposed to some basic communication s k ills to aid them in developing,
rapport w ith c lie n ts .
As the volunteers became more involved and
progressed through the in -s e rv ic e tra in in g program they were exposed
to more in-depth inform ation on various problem areas by area
professionals.
Page I of 3
61
TRAINING PACKET CONTENTS:
I.
2.
HELP Center o rie n ta tio n
A.
Volunteer handbook (Bozeman)
B.
Guidelines fo r s t a f f and volunteers (Bozeman)
Helpful guidelines from other centers:
A.
C ris is C lin ic s (Spokane)
B.
C ris is In terven tio n (S e a ttle )
C.
Review Guidelines fo r C ris is Service
C risis in terv e n tio n tra in in g .
A.
Training o u tlin e (Bozeman)
B.
Suicide prevention
C.
1.
C ris is in terv e n tio n w ith depressive and
s u icid al c lie n ts (Bozeman)
2.
Suicide Prevention Center (San Francisco)
20 Helpful Hints fo r Telephone Workers.
3.
Suicide Prevention (Spokane)
Evaluation o f S uicidal Risk.4
6
5
4.
Excerpts from: Summary and Closing Remarks
by Mary Lohr (F o rt Logan)
5.
Youth Suicide
6.
Facts and Fables o f Suicide (Shneidman & Farberow)
Drug c r is is s itu a tio n s
1.
I f You C an't Handle I t , Don't.1 (Bozeman)
2.
The Handling of a B arbiturate Overdose (Berkley)
Page 2 of 3
62
A lte rn a tiv e s to Drug Abuse (Dr. A. Ddhner)
Page 2 of 3
/
APPENDIX D
Youth Employment Service Questionnaire
Y .E .S . Follow-up
WORKER
EMPLOYER
I.
Was appearance acceptable?
(H a ir, c le a n lin e s s, e tc .)
( I f no, please ask them to s p e c ify .)
2.
Was th e ir a ttitu d e good?
3.
Was the q u a lity of th e ir work acceptable?
then to s p e c ify .)
4.
Were they e f f ic ie n t in th e ir work?
s p e c ify .)
5.
Would you ask fo r the same kid again? ( I f no, would you use the
program again?)
6.
Ask them fo r any suggestions they might have which would improve
the program.
( I f no, please ask them to s p e c ify .)
Thank them fo r th e ir cooperation.
Page I of I
( I f no, please ask
( I f no, please ask them to
APPENDIX E
'
Cooperative Agreement
Between the 18th J u d ic ia l D is t r ic t Parole O ffice
and the G a lla tin Council on Health arid Drugs
. INTRODUCTION
The HELP Center d iv is io n o f the G a lla tin Council on Health and
Drugs and the 18th J u d icia l D is t r ic t Parole O ffic e have entered into
a cooperative agreement whereby the D is t r ic t Parole O ffic e w ill r e fe r
incoming parolees assigned to G a lla tin County to the HELP Center fo r
case review and m o b ilizatio n of community resources.
The HELP Center
acting as a clearing house f o r re fe r r a ls in G a lla tin County w ill then
review the parolees present needs and implement r e fe r r a ls to various
community resources as needed (see Attachment A fo r flow chart pre­
sentation of implementation of s e rv ic e s .)
MONTHLY REPORTS
The Associate D ire cto r fo r the HELP Center w ill provide monthly
reports to the Parole O ffic e fo r each parolee.
The monthly report
w ill consist o f n a rra tiv e review of the number of contacts the HELP
Center has had w ith the parolee and l i s t which community resources
/
have been brought to bear and the name of the agency representative
working d ir e c tly w ith the parolee.
COMMUNICATION BETWEEN AGENCIES
In an e f f o r t to m aintain sound communication between a ll agencies
Page I of 4
65
involved, the HELP Center w ill coordinate cooperative agency s t a f f ings
as needed fo r a given parolee.
CONFIDENTIALITY
Upon enrollment in the program, the parolee w ill give w ritte n
permission (Attachment B) allowing f o r a fre e exchange of information
between the various agencies which may become involved regarding his
case.
In cases where the parolee w ill not give th is permission, each
agency's contact w ith the c lie n t w ill be held in s t r i c t confidence and
permission fo r discussion and review of the case or p a rtic u la r s itu a ­
tio n w ill be d e a lt w ith as such instances may a ris e .
FINANCIAL RENUMERATION
.
.
I t is fu rth e r understood th a t th is agreement involves no monetary
reimbursement fo r services a t th is tim e.
I t is also agreed th at
representatives from the D is t r ic t Parole O ffice and G a lla tin Council
on Health and Drugs w ill meet and review the status and progress of
th is cooperative agreement from time to time in an e f f o r t to re fin e
and make changes as needed to .in s u re a strong constructive cooperative
re la tio n s h ip .
Representative, G a lla tin Council
on Health and Drugs
Page 2 of 4
Representative, 18th Judicial
D is t r ic t Parole O ffice
66
ATTACHMENT A
Service Implementation Flow Chart
18th JUDICIAL PAROLE OFFICE
( I n i t i a l in ta k e , case review, and problem assessment)
HELP Center
(Second case review , and problem assessment)
(Continued case evaluation and coordination of agencies)
(S ta ffin g s as necessary)
RELATED
DORS
(i.e .
Bozeman Problem D rinking, W elfare, Voc-Rehab., Public Health,
Employement O ffic e , Related GCHD Programs, e tc .)
Page 3 of 4
67
ATTACHMENT B
CLIENT:
While serving your Parole or Probationary period, there may e x is t
problem areas th a t, in my opinion, must be d e a lt w ith fo r completion
of a successful supervisory period. To coincide w ith t h is , other
agencies w ill in terven e, and provide the needed services th a t I am
unable to provide, due to lim ita tio n s o f tim e, and personal expertise
on my behalf.
Although there may be other agencies th a t w ill be working in your
b e h a lf, i t is essential th a t I am aware of your problems, and or
strengths, so th a t a b e tte r r e h a b ilita tiv e medium can be accomplished.
To achieve th is , there must be a fre e exchange of inform ation on a
professional le v e l, th a t w ill be to your b e n e fit. With th is in mind,
I ask th a t you read the agreement below, and sign.
I hereby authorize a fre e exchange of information re le va n t to my
case and in the in te re s ts of my personal r e h a b ilita tio n . This in ­
form ation w ill be to those who work under the auspices o f the
G a lla tin Council on Health and Drugs and i t ' s cooperating agencies.
DATE
SIGNATURE
Page 4 of 4
APPENDIX F
G.C.H.D. Program Review
GALLATIN COUNCIL ON HEALTH AND DRUGS
CORPORATE STRUCTURE
Comprised of 4 o ffic e rs :
P resident, Vice-President
S ecretary, & Treasurer who
are elected, by the Board
of D ire cto rs ,
Comprised of 30 hiembers
who are elected fo r I year
term by the general membership.
Comprised of in d ivid u als who
are in tere s ted in any program
offered by the GCHD..
^Advisory
Committees
I
HELP Center
Drug Treatment &
R e h a b ilita tio n
A lte rn a tiv e s
I
Continuation
School Program
Model P roject
^Advisory Committees are comprised o f members o f the GCHD th a t wish to
serve in an advisory capacity to a program area o f.s p e c ia l in te re s t to
them.
Page I of 7
69
G a lla tin Council on Health and Drugs
S ta ffin g :
1
3
2
I
1
2
I
I
Executive D irecto r
Associate D irectors
A ssistant D irectors
Professional Counselor
Helper
Outreach Workers
Undergraduate A ssistant
Secretary
EXECUTIVE DIRECTOR
I
HELP Center
SECRETARY
I
I----------Drug Treatment &
A lte rn a tiv es
R e h a b ilita tio n
Associate
Professional
Associate
D ire cto r
Counselor
D irecto r
Undergraduate 2 Outreach Workers
A ssistant
( I assigned to
West Yellowstone)
Coranunity Awareness
& School Program
Associate
D irecto r
I------- -------------
CONTINUATION
PROJECT
MODEL
PROJECT
A ssistant
D ire cto r
A ssistant
D ire cto r
Helper
Page 2 of 7
70
G a lla tin Council on Health and Drugs
HELP CENTER (C ris is Center)—
Target Group:
Capacity:
A ll ages - a t present range from 10-80 years
Handle approximately 180 to 200 c a lls per month
Level and In te n s ity of Services:
1.
24 Hour c r is is service
a.
b.
c.
d.
e.
Area:
Telephone
W alk-in
— Rap Sessions — open and closed
Outreach - c r is is ,
— Drug counseling in the j a i l s
Big B ro th e r/S is te r program
Telecare Program
(fo r shut-ins o f a ll ages)
2.
Comprehensive r e fe r r a l fo r a ll problem areas .
3.
One-to-one counseling when re fe r r a l unavailable or
inappropriate
G a lla tin and Meagher Counties
DRUG TREATMENT AND REHABILITATION—
Target Group:
Capacity:
A ll ages young and old — youth involved, in drugs
as w ell as adults (p re s crip tio n use)
Projected fo r th is program year 140.c lie n ts in Sustained
treatm ent.
Level and In te n s ity of Service:
I.
One to one counseling
a.
b.
c.
formal
informal (s tre e t corner)
counseling in j a i l s (w ith HELP Center)
Page 3 of 7
71
2.
Outreach
a.
b.
c.
C lie n t contact (in ta k e ).
C lie n t contact (support.to treatm ent plan)
C lie n t contact (follow -u p)
3.
Group sessions
4.
Family counseling (drug re la te d )
PROJECT REACHOUTTarget Group:
A ll ages
Capacity: Aimed a t the stable population of 700 residents in
West Yellowstone plus the tra n s ie n t population (summer)
and to u ris ts to West Yellowstone Park area.
Level and In te n s is ty of Services:
1.
C ris is in terv e n tio n (s p e c ific a lly between the hours of
3 -9 ) w in te r months - - services increased to 24 hours
during summer months.
a.
b.
c.
2.
One-to-one counseling
a.
b.
Area:
Telephone
W alk-in
— Rap sessions
— A lte rn a tiv e s
Outreach
— c r is is
— c lie n t contact
i.
intake
ii.
support to treatm ent plan
iii.
follow -up
formal
informal
G a lla tin County from Big Sky to West Yellowstone and also
Yellowstone Park a rea .
Page 4 of 7
72
ALTERNATIVES CONTINUATION PROJECT—
Target Group: Open to a ll ages, however, primary focus on.
5th grade (Tl years) through High School.
Capacity:
420 per program a year
Level and In te n s ity o f Services:
1.
Youth Employment Services
a.
b.
c.
Job generation
Job placement
Workshops based on follow -up
,
2.
Volunteer Aides
a.
b.
Youth organization
Youth Implementation
3.
Arts and C rafts
4.
Edible Wild Plants
5.
Leadership Camps — follow -up
6.
Junior High Follow-up to previous Leadership Camps
Unmet Need:
Need to be expanded to Meagher County
ALTERNATIVES MODEL PROJECT—
Target Group: A ll ages general focus on ages 13 through a d u lt­
hood w ith special emphasis on c o lle g e age youth and middle
age.
Capacity:
370 during program year
Level and In te n s ity of Services:
1.
Youth M otivation Seminar.
2.
Community Organization Camp (High School)
Page 5 o
f 7
73
Area:
3.
Fam ilies Are Responsible (Parent Education)
4.
P rescrip tion Abuse - 10 projected adults
5.
A lte rn a tiv e educational and l i f e s ty le pursuits (High
school)
6.
College Age A lte rn a tiv e s
G a lla tin County
Unmet Needs:
1.
2.
To expand to Meagher County
Development of an a lte rn a tiv e s school (High School
le v e l in the Bozeman area)
SCHOOL PROGRAM —
Target Group:
Capacity:
Teachers and Adm inistration
100 plus teachers and adm inistrators
Level and In te n s ity of Services:
1. Workshop and Seminars offered fo r college c r e d it (grad,
and undergrad)
2. In -s e rv ic e workshops in Values C la r ific a tio n
3. Follow-up to workshops
a. small groups
.
b. follow -up workshops
4. Resource — to teachers f o r presentations on drugs and
re la te d problems. Elementary, Secondary and College.
Area:
G a lla tin County
Unmet Needs:
1. Needs to be expanded to Meagher County
2. Should introduce an A lte rn a tiv e School in cooperation with
present High School in the Bozenan Area as mentioned under
Model A lte rn a tiv e Program .
COMMUNITY AWARENESS —
Target Group:
E n tire population o f G a lla tin and Meagher Counties
Page 6 of 7
74
Capacity:
Total Population
Level and In te n s ity of Services:
1.
2.
3.
4.
5.
Area:
Speakers
PSA (Radio, Tv, Papers)
Regular news a r tic le s
GCHD Newsletters
P a rtic ip a tio n in Interagency C ouncil.
G a lla tin and Meagher Counties
OFFICE —
Connected to a l l programs and provides general s e c re ta ria l
and o ffic e services to a ll programs offered by the G a lla tin
Council on Health and Drugs*
Page 7 of 7
References
Berman, P .J ., Davis, A. W., & P h illip s , L. George Washington
U n iv e rsity volunteer h o tlin e , a d e s c rip tiv e study.
Psychological Reports, 1973, 33 ( 2 ) , 364-366.
Cap!an, G. P rin c ip le s o f preventive psychiatry. New York:
Basic Books, 1964. Cited by R.A. Pasewarkj & D. A.
A lbers, C ris is in te rv e n tio n : theory in search of a
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