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Partnership Case Study: Methadone Services in Champaign
County
Bruce K. Barnard
Eastern Illinois University
Partnership Case Study: Methadone Services in Champaign
County
Description
Three organizations in Champaign County
are involved in discussions regarding the treatment of heroin addicts with
methadone. In spite of general acceptance by the medical community,
methadone replacement therapy remains controversial because the treatment
involves the administration of an addictive drug. The following case
study will evaluate the challenges and opportunities for a potential partnership
to provide methadone services. Because of my role as an administrator
with Prairie Center Health Systems Inc., I will evaluate the partnership from
the perspective of that organization.
Prairie Center Health Systems Inc.
(PCHS) is a private nonprofit organization that has been providing addiction
treatment services for over 30 years. Because of its contracts for state
and county funding, its size, and the range of services it provides, PCHS
is the dominant addictions treatment agency in Champaign County. Members
of Alcoholics Anonymous founded the organization as a halfway house for alcoholics.
While it has become a complex human service agency, the primary focus of
the agency is addictions treatment based on an abstinence model, which forbids
the use of methadone replacement therapy. Powerful constituents on
the Board of Directors and in a sister organization that holds real estate
for the agency are strong advocates for abstinence-based treatment and opposed
to methadone replacement therapy.
Harm Reduction Resource Inc. (HRR)
is a private nonprofit organization founded in 2001. The grassroots
organization has one employee who provides needle exchange services to intravenous
drug users in Champaign County. Needle exchange programs are designed
to reduce the risk of disease transmission, including HIV, by providing clean
needles to intravenous drug users. The Champaign Urbana Public Health
District (CUPH) funds the needle exchange program. HRR has been advocating
for local methadone services in HIV prevention coordination committees, public
meetings, and in the media.
CUPH is a public organization providing
and coordinating public health services in the Champaign and Urbana communities.
They are responsible for coordinating regional HIV prevention services.
Staff at CUPH have been involved in advocating for local methadone services
and have encouraged HRR to move forward with plans to open a methadone clinic.
In a public meeting regarding site approval,
serious doubts were raised that HRR has the expertise and experience to operate
a methadone clinic. In spite of public pressure to offer methadone services,
a faction of the PCHS Board of Directors has resisted developing limited
methadone services. PCHS has instead encouraged CUPH to offer methadone
services and indicated a willingness to be involved in the project.
CUPH has leased a site, part of which it intends to sublease to HRR for a
methadone clinic. As a result, discussions of the possibility of a three-way
partnership have begun.
Analysis
Partnership has been defined as “a
deliberate blending of capacities for the continuous mutual benefit of involved
parties” (Bell & Shea, 1998, p. 2). McQuaid (2000) identifies an
underlying assumption that partnerships must have “the potential for synergy
of some form, so the sum is greater than the parts” (p. 10). While PCHS
has the capacity to provide methadone services independently, it is restrained
from that level of involvement by an internal philosophical debate and concerns
about public perception. Partnership is being considered primarily
as a way to resolve the conflicting desires of two powerful constituencies,
those opposed to methadone services and those advocating for research-based
integrated treatment models.
Arsenault (1998) compares the conceptual
base of a nonprofit with the product demand life-cycle curve recognized in
the profit sector. According to this analysis, PCHS is facing the decline
of its conceptual base, traditional abstinence-based treatment. According
to Arsenault (1998), “in some cases such shifts force an organization to reinvent
itself” (p. 9). Partnerships can be effective in shifting an organization’s
conceptual base to current, or emergent concepts and improving vitality.
Bell and Shea (1998) have identified six stages in developing partnerships:
focusing, auditioning, rehearsing, dancing, hurting, and bowing out.
Focusing is developing “a clear commitment to some purpose that can best be
expressed through partnership” (p. 6). Auditioning “will delve into
an assortment of starting issues important to choosing the right partner”
(p. 7). Rehearsing involves “choreographing the relationship” (p. 7).
These steps are presented as a logical progression in the development of a
partnership. However, in this situation both internal and external pressures
have resulted in simultaneous activities associated with the steps of focusing,
auditioning, and rehearsing. PCHS continues internal discussions of
methadone and other harm-reduction services in relation to its philosophy
and existing services. Because of their respective roles and activities,
the three organizations have been forced together by circumstance and by community
advocates. Early discussions by HRR, CUPH, and PCHS regarding working
agreements, referral arrangements, and coordination of services are underway.
Bell and Shea (1998) have developed
a checklist for assessing potential partnerships by evaluating: (a) complimentary
strategies, (b) cultural congruence, (c) views of time, (d) control practices,
(e) front-line information systems, (f) shared values, (g) goals and roles,
(h) intellectual capital, (i) economic reciprocity, (j) respect for privacy,
and (k) leadership. Of these, cultural congruence and shared values
will require the most attention in this potential partnership. Trust
may be difficult to achieve given the inexperience of HRR and differing philosophies
at CUPH and PCHS.
There are significant positive aspects
to a potential partnership. While it has established contact and rapport
with the target population, HRR needs the expertise and technical assistance
of PCHS. If PCHS were to provide the service, it would need the outreach
services of HRR. The involvement of CUPH benefits all parties by defining
methadone services as a public health and HIV prevention initiative.
McQuaid (2000) points out that “bottom
up” development can succeed when “top-down” development fails to adequately
address needs. A strength of the potential partnership is that front
line workers are more concerned with community resources and pragmatic solutions
to address the needs of an individual then with issues of treatment philosophy.
In fact, pressure from those front line workers is partly responsible for
the management level discussions that have occurred.
Each of the three organizations has their own reasons for considering the
potential partnership. However, each would like to see treatment options
for intravenous heroin users that are professional, comprehensive, and integrated
with the continuum of care. It is important that any partnership
have a clearly defined vision, mission, and goal statement (Arsenault, 1998;
Bell & Shea 1998). The critical question is, “can these three organizations
negotiate such a statement that is consistent with the vision and mission
of the individual partners’ organizations”? I believe it is this process
that will determine the success or failure of the potential partnership.
Because Prairie Center’s primary motivation
in pursuing a partnership is to provide distance and protection for itself,
the partnership is likely to be very structured and have clearly defined protocols.
HRR wishes to remain a grassroots organization while Prairie Center wishes
to remain a mainstream human service agency. Bell and Shea (1998) would
describe such a potential partnership as a “square dance”. The nature
of the methadone services will require licensure, clearly defined rules,
and agreements. It follows that the partnership will also involve clearly
defined roles. Square dance partners are “careful not to alter or dilute
the company’s reputation or the distinction of its name” (Bell & Shea,
p. 19).
Strategies
PCHS should immediately institute
a strategic planning process that involves executive staff and the Board
of Directors. There are four areas that are especially relevant to
this proposed partnership: (a) significant changes in consumer demand, (b)
major shifts in funding, (c) substantial changes in knowledge base, (d) actions
of other agencies and organizations in our area (Arsenault, 1998). This
process will assist PCHS in articulating to constituents the vision and mission
of the partnership.
PCHS, CUPH, and HRR should begin a
series of frank and honest discussions of their respective visions.
These discussions should be private and the parties should agree to respect
the confidentiality of statements made in the meetings. Such candor,
free from the influences of constituents and the press, is necessary to begin
to develop trust. These meetings can form the beginning of a negotiation
process with the intent of drafting a formal agreement.
To a large extent the nature of the
partnership will be defined by the working agreements between the organizations.
These agreements should define an exit strategy that protects the interests
of all parties. Negotiation of an exit strategy will assist in defining
areas of concern for all parties and improve the sense of safety.
Clinical supervisors should encourage
communication among staff at the service provider level. Direct service
staffs are in a position to identify clear and practical strategies to meet
individual needs. The pragmatic and service oriented ideas that they
bring to the table may encourage creative solutions to problems of philosophy
and constituencies. Individual partnerships between direct service employees
will forge alliances that can strengthen the potential partnership
Summary
The development of this potential
partnership is not likely to follow the clearly defined process outlined
by Bell & Shea. The nature of the external forces has led to a
disruption in the normal process. However, it is clear that thoughtful
consideration of the requirements of each step will lead to a more satisfactory
understanding by all parties. This potential partnership has the opportunity
to provide a service to the community in a manner that is beneficial to all
parties. However, it also has the potential to destroy HRR and damage
the reputations of CUPH and PCHS. While the stakes are high for these
organizations, the stakes are infinitely higher for those struggling with
heroin addiction. It is possible for heroin addicts to live healthy,
satisfied and productive lives with appropriate treatment. It
is that vision that has the potential to form the glue for a productive partnership
between HRR, CUPH, and PCHS.
References
Arsenault, J. (1998). Forging nonprofit alliances.
San Francisco:
Jossey-Bass.
Bell, C.R., & Shea, H. (1998). Dance lessons, six
steps to great partnerships in business and life. San Francisco:
Berrett-Koehler
McQuaid, R.W. (2000). The theory of partnerships,
why have partnerships?. In Osborne, S.P. (Ed.) Public-private partnerships,
theory and practice in international perspective. (pp. 9-35). London,
New York: Routledge
copyright 2001, 2002 Bruce K. Barnard
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