HHS 497 Ashford University Human Services Discussion

Discussion 1 Prior to beginning work on this discussion forum please review the required chapters in the book Implementation of Mental Health Programs in Schools: A Change Agent’s Guide: Leadership for Implementation and Change and Selecting Interventions: Intervention Characteristics and Implementation. Please also read the article Relieving Human Suffering: Compassion in Social Policy (Links to an external site.).

Discussion 2 Prior to beginning work on this discussion forum, watch Resume Basics (Links to an external site.) and How to Write a Resume that Beats the Automated Tracking System (Links to an external site.) videos. Preparing a resume that will get you an interview requires careful analysis of a specific job description. After identifying a specific job description in the health and human services field, you will need to optimize your resume for applying to that position.

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The Journal of Sociology & Social Welfare
Volume 42
Issue 1 March
Article 6
Relieving Human Suffering: Compassion in Social Policy
Mary E. Collins
Boston University, mcollins@bu.edu
Sarah Garlington
Boston University, sgarling@bu.edu
Kate Cooney
Yale University, kate.cooney@yale.edu
Follow this and additional works at: https://scholarworks.wmich.edu/jssw
Part of the Social Work Commons
Recommended Citation
Collins, Mary E.; Garlington, Sarah; and Cooney, Kate (2015) “Relieving Human Suffering: Compassion in
Social Policy,” The Journal of Sociology & Social Welfare: Vol. 42 : Iss. 1 , Article 6.
Available at: https://scholarworks.wmich.edu/jssw/vol42/iss1/6
This Article is brought to you for free and open access by
the Social Work at ScholarWorks at WMU. For more
information, please contact maira.bundza@wmich.edu.
Relieving Human Suffering:
Compassion in Social Policy
Mary Elizabeth Collins
Sarah Garlington
Boston University
School of Social Work
Kate Cooney
Yale University
School of Management
Human suffering is always present in society. There is general
consensus that action should be taken to address suffering, but
there are differing views as to the appropriate means of doing so.
In this paper we utilize a classical understanding of the virtue of
compassion to answer the research question: How does contemporary U.S. policy address human suffering through compassionate response? To answer this question, we conduct a critical
analysis of three policy domains (hospice care, domestic violence,
and disaster relief) to determine variation in response to human
suffering. Comparisons among the domains suggest the various
ways in which compassion can be observed within formal social
policy. We discuss the implications of a compassion-focused approach to analysis of policies that address human suffering, and
more broadly, the use of a virtue-oriented perspective on policy.
Key Words: critical policy analysis, compassion, virtue ethics,
human suffering
Human suffering is always present in society. Although it
may take different forms in different historical and societal contexts, there are elements of suffering even in the most advanced
and prosperous societies. Indeed, modern prosperity, while
reducing some forms of suffering (e.g., widespread hunger)
may engender other types of suffering (e.g., alienation, social
Journal of Sociology & Social Welfare, March 2015, Volume XLII, Number 1
Journal of Sociology & Social Welfare
isolation). Furthermore, although individuals may experience
suffering, there are societal implications as well. Suffering “is
always morally regrettable” because it clearly suggests that
society is not operating at its best level (Comte-Sponville, 2001,
p. 106). To address suffering as a societal problem, the question for policy makers then centers on the appropriate policy
Although compassion is a term widely used by both professional and lay audiences, it is more narrowly defined within
moral philosophy. One contemporary philosopher (ComteSponville, 2001) explains that compassion is a form of sympathy; it is sympathy in pain or sadness—in other words,
participation in the suffering of others. Furthermore, within
some perspectives, all suffering deserves compassion; acting
compassionately does not imply that one approves of the sufferer or that the reasons for the suffering have met a standard
of deserving a compassionate response. Rather, to act compassionately “means that one refuses to regard any suffering as a
matter of indifference or any living being as a thing” (p. 106).
In this article we use compassion as the central concept of
a critical analysis of three social welfare policies that address
different forms of human suffering. To provide background we
first give a brief description of virtue ethics as applied to social
work and social policy and we introduce some recent treatments of compassion within the policy literature.
Virtue Ethics in Social Work and Social Policy
Although the study of virtue is traced to antiquity, in
modern scholarship Alistair MacIntyre (1981) is credited with
providing a contemporary approach to the study of virtue and
impacting the study of virtue across many disciplines. Thus,
in addition to coverage in modern philosophy, there is increasing study of virtue in fields related to social policy, such as
political science (Bartlett, 2002), policy analysis (Lejano, 2006;
Szostak, 2002, 2005), and organizational studies (Dutton,
Worline, Frost, & Lilius, 2006; Manz, Cameron, Manz, & Marx,
2008; Weaver, 2006). Social work scholars, also, have begun to
examine the reality and potential of virtue frameworks. Banks
and Gallagher (2009), scholars in the United Kingdom, have
Compassion in Social Policy
provided a book-length treatment of virtue ethics in social
work and health care professions. In the U.S., the attention has
been more limited but appears to be growing (Adams, 2009;
Chamiec-Case, 2013).
Adams (2009) notes that historically social work ethics has
focused on the resolution of dilemmas in practice; he then articulates the role of virtue ethics as critical to social work. As
Adams identifies, modern virtue ethics, consistent with the
older tradition of Aristotle and Aquinas,
conceive a human life as a history in which each choice
we make disposes us to make similar choices in the
future, so that ethical conduct becomes a matter of
dispositions or character—virtues and vices acquired
by practice and lost by disuse—rather than episodic,
purely rational choices. (2009, p. 85)
Virtues are stable dispositions and character traits; these
are what matter to social work—“how well we act, as a matter
of habit and will in the professional use of self, in ways required for and developed by practice within the profession of
social work” (Adams, 2009, p. 88). Chamiec-Case (2013) makes
a similar case in regard to social work education and the need
to move beyond the more observable practice behaviors to the
cultivation of virtuous character.
Discussion of “values” is more common to social work, but
values and virtues are related concepts. Chamiec-Case (2013)
helpfully distinguishes virtues from values.
Although values and virtues have some important
similarities …, values are beliefs about what is most
important to us, what we consider our priorities, and
what we believe has worth. Virtues on the other hand,
are the deeply ingrained traits or dispositions which
form our character—what fundamentally makes us
who we are and is manifested in our actions. (p. 259,
emphasis in original)
Virtues’ focus on character is also applicable at the larger
macro level. Organizational mission, for example, identifies the character of the agency that will impact the deci-
Journal of Sociology & Social Welfare
sions it makes and actions it takes. Dutton et al. (2006)
discuss this specifically in regard to the virtue of compassion at the organizational level. In the same way, policies
can be indicative of the character of a society. One example
at the municipal level is the U.S. Conference of Mayors’
recent statement adopting compassion as an effective policy
for their communities (U.S. Conference of Mayors, 2013).
Virtue of Compassion in Politics and Public Policy
Other virtues are more commonly articulated in policy
discussions; examples include justice and mercy (especially within criminal justice systems), self-sufficiency (within
welfare policy), and forgiveness (in discussions of reconciliation of national or racial/ethnic groups). Compassion does
not get as much attention in policy discourse but may have
a role in undergirding policies in more subtle ways. In his
Book of Virtues, William J. Bennett (1993), typically a conservative commentator, states a belief that the virtue of compassion may have once been undergirding America’s immigration
policy: “Lazarus’s poem [The New Colossus], like the Statue
of Liberty, came to popularize America’s mission as a refuge
for immigrants. Here is compassion as a national policy, one of
America’s great national policies” (p. 179).
In the U.S., both conservative (Olasky, 2000) and liberal
(Nussbaum, 2001) voices have articulated the potential for
compassionate responses to relieve human suffering. Olasky
sees potential for compassionate responses through community volunteers and faith-based organizations and Nussbaum
through institutional structures and educational strategies.
Through compassionate conservativism, Olasky advanced
a specific position, promoted by President George W. Bush,
on the role of government in responding to human need that
called for government action in partnership with churches,
synagogues, mosques and charities to support compassionate responses delivered by friends, families, professionals,
volunteers, or strangers (Olasky, 2000; Pilbeam, 2003). As
compassionate conservatism became defined by the 2000
presidential campaign of George W. Bush, compassion meant
“suffering with the poor and acting on the consciousness of
your suffering” with the role of government to “shift power
Compassion in Social Policy
away from the bureaucracy to the people in the compassionate
community, who actually deal with these problems” (Olasky,
2000, p. 13).
Compassionate conservatism as stated by Olasky (2000)
emphasizes a diminished role of “big government” in responding to needy Americans through programs, and prescribes
a government role that supports civil society and religious
actors to perform this front line work. Olasky also stresses the
transformational power of responding compassionately for
the giver of compassion, as well as for the recipient. As the
term compassionate conservatism suggests, the attention to
“compassion” is combined with prescriptions for behavioral
modifications in the needy or the poor (described as “challenges to change”) associated with the goals of social conservatives
and with attention to costs, effectiveness and outcomes associated with concerns of fiscal conservatives. Thus, most of the
recent attention to compassion in social policy has been situated within the discourse on compassionate conservatism as
initially articulated by Olasky and adopted by the G.W. Bush
administration. Much of the scholarly literature has examined
the resulting faith-based initiatives, their promise, politics, and
impact (e.g., Biebricher, 2011; Persons, 2011).
While compassionate conservatism has been the most
recent dominant discussion of compassion in public life, more
liberal perspectives also utilize compassion as central concept.
A liberal standpoint would suggest that, like other manifestations of social assistance, compassionate action historically occurred within the family and community. As societies become
more complex, however, government has taken on responsibilities previously held by smaller units, such as the family
and community. Social welfare policy literature, for example,
describes the way industrialization necessitated creating government structures to assist individuals as family and community structures changed (Huber & Stephens, 2001; Pampel &
Williamson, 1989; Wilensky, 1975; Wilensky & Lebeaux, 1958).
Economic and social changes wrought through the industrialization process included geographic mobility, smaller families,
dislocation from traditional communities, and new structures
of work. The increasing wealth of the state from tax revenues
provided resources with which the state could address the
needs of individuals who could no longer rely on extended
Journal of Sociology & Social Welfare
family and community networks for assistance.
Addressing compassion specifically, Nussbaum (2001), in
contrast to conservative perspectives, suggests that compassion should be approached at both the level of individual
psychology and institutional design. According to Nussbaum
(2001) prescriptions for institutional design include such things
as the basic structure of society, choice of its distributional principles, and legislation at a more concrete level (e.g., tax code,
welfare system, duties of rich nations toward poorer nations).
Institutions also teach citizens “conceptions of basic goods,
responsibility, and appropriate concern, which will inform
any compassion that they learn. Finally, institutions can either
promote or discourage, and can shape in various ways, the
emotions that impede appropriate compassion: shame, envy,
and disgust” (2001, p. 405).
Application to Policy Analysis: Values and Virtues
Public policy analysis has historically tended to focus on
narrow rather than “big” questions. It is client-oriented and
therefore the ends and goals are provided, and it has tended
to emphasize method over theory (Radin, 2000). Consequently
technical, quantitative approaches are dominant. Yet, Carrow,
Churchill, and Cordes (1998) argue that “social values” should
be at the center of both public debate and policy analysis. Social
values are one of the many factors that influence policy choices,
design, and implementation. Lipset’s (1996) major work on the
specific values that inform welfare policy, contrasting individualism in the United States to more communitarian values in
European welfare states, exemplifies the traditional way that
values-based policy analyses have been conducted.
Because virtue approaches emphasize character, behavior and action rather than mere value perspectives, they may
be better suited for analyzing policy. Situated within ethical
evaluation, virtue ethics emphasizes moral character, in contrast to ethical analysis, which focuses on either duties or rules
(deontology) or the consequences of actions (utilitarianism)
(Hursthouse, 1999). Szostak (2005) suggests that virtue-based
approaches to policy analysis represent a form of “process
ethics.” Lejano (2006) states, “Virtue is actually a strong component in policy discourse, though it may be masked as other
Compassion in Social Policy
things” (p. 141).
Elsewhere we have identified examples of the virtues of
mercy, self-sufficiency and compassion within contemporary
policy (Collins, Cooney, & Garlington, 2012). Justice is a virtue
that receives extensive attention in both academic (philosophy) and applied (legal) discourse (e.g., Rawls, 1971; Reilly,
2006). Our purpose in this paper is to present a policy analysis
with the virtue of compassion at the core. To do so, we examine
three policy domains in which suffering is likely to occur and
provide a descriptive analysis of relevant policies targeted
toward those affected. We then compare across the domains
to identify areas of variation. Although we have selected one
virtue for analysis, we recognize that compassion is not the
only relevant virtue to guide public policy. It is, however,
central to improving the human condition and is consistent
with social work’s commitment to vulnerable populations. In
our conclusion, we address how compassion might interact
with other relevant virtues.
The recognition of suffering and compassionate response
should be aimed at circumstances in which there has been a
loss of “truly basic goods” (Nussbaum, 2001, p. 374) such as
life, loved ones, freedom, nourishment, mobility, bodily integrity, citizenship, shelter. Similarly, Porter states the losses
leading to suffering must be non-trivial: “serious pain, anguish,
torture, misery, grief, distress, despair, hardship, destitution,
adversity, agony, affliction, hardship, and suffering” (2006,
p. 100). Following this scholarly guidance, we selected fairly
unambiguous instances of suffering for examination: terminal illness, violent victimization, and community disaster. We
then identified specific, relevant federal domestic policies that
address these types of suffering: the Medicare Hospice Benefit,
the Violence Against Women Act, and the Stafford Disaster
Relief and Emergency Assistance Act.
In this section we provide a description of these policies
organized according to the following criteria: (1) form of aid;
(2) eligibility criteria; (3) service delivery system; (4) role of
religion; (5) language cues in the policy regarding suffering
and compassion; and (6) implementation challenges. Table 1
identifies key elements of the policy according to the identified
VAWA (1994,
2000, 2005)
Coordination of multiple federal, state, local
systems: crisis care
for individuals (food,
shelter, counseling);
eligibility: Presidential
Palliative care to
provide comfort;
eligibility: terminally
ill, certified by doctor,
patient decision to seek
hospice care and end
treatment of disease.
Coordination of
multiple systems; crisis
care, shelter, legal
assistance, emotional
support; emphasizes
linguistic and culturally specific services.
Eligibility: determined
by individual service
providers but must
be victim, (usually
women), emphasize
based on other issues.
Form of aid/Eligibility
Table 1: Characteristics of Policies
“Victim” and
language rather
than “suffering”
and “compassion.”
“Responsive and
care for disaster
victims is FEMA’s
top priority.”
Culturally-bound perspectives on problem
can be a barrier to
service; religion as
key element of culture
could be central to
Primarily through
the role of community volunteers
who may be related
to congregations;
focus on provision of
concrete assistance
(food, shelter); some
instances of resource
Federal grants to states and
communities: formula grants
and specialized grants./
Professional (social workers,
counselors), paraprofessionals and volunteers. Advocates
committed to the cause.
FEMA coordinates with state
and local agencies. Red Cross
key component. Coordination
w/police, fire, public health,
etc., Other private professionals (doctors, nurses, social
workers) and community
Explicit goal is to
ease suffering and
reduce pain, not to
treat the disease.
Explicit language
of suffering and
Death is central
concept in religious
beliefs; dignity of
human life; pastoral
care has key role
Role of religion/religious organizations
Medicare reimbursement to
private contractors providing
hospice services/Hospice services include doctors, nurses,
social workers, pastoral staff,
and volunteers.
Service delivery system
Extensive coordination
of multiple complex
systems; by definition response occurs
on an “emergency”
basis; potential politics
in declaring federal
Services provided
in context that can
be ambivalent about
the problem; cultural
differences regarding
violence, gender, etc.;
service recipients are a
disempowered group.
Factors (societal
difficulties dealing
w/death, medical
emphasis on cure) may
prolong treatment and
delay hospice.
Journal of Sociology & Social Welfare
Compassion in Social Policy
Comparative analysis across the domains highlighted consistencies and differences in policy approaches. These observations led, in turn, to operating assumptions regarding the role
of compassion in public policy. Our discussion is based on this
comparative analysis.
Terminal Illness: Medicare Hospice Benefit
U.S. policy regarding the use of hospice care is primarily
in the form of the Medicare hospice benefit which provides
payment for care related to terminal illness. The hospice philosophy is the provision of comfort and support to terminally ill people and their families when a life-limiting illness no
longer responds to cure-oriented treatments (Myers, 2002).
This comfort includes multiple domains (physical, psychic,
social, and spiritual comfort) and aims neither to hasten nor
postpone death (Mesler & Miller, 2000). When the conditions
are met (see below), a plan of care is devised by an interdisciplinary team. The benefit covers reimbursement for the following services: skilled nursing care; medical social services;
physician services; patient counseling (dietary, spiritual,
other); short-term inpatient care; medical appliances and supplies; drugs for pain control and symptom management; home
health aide services; homemaker services; therapy (physical,
occupational, and speech); inpatient respite care (providing a
limited period of relief for informal caregivers by placing the
patient in an inpatient setting like a nursing home); family bereavement counseling; and any other item listed in a patient’s
care plan as necessary for the palliation and management of
the terminal illness (Medicare Payment Advisory Commission
[MedPAC], 2004).
The hospice benefit falls under Part A of Medicare, which
the beneficiary receives automatically with Medicare coverage. Three conditions must be met: (1) the patient’s physician and the hospice medical director certify that a patient is
terminally ill, with a life expectancy of 6 months or less; (2)
the patient chooses to receive care from hospice rather than
treatment for the terminal illness; and (3) care is provided by a
hospice program certified by Medicare. A recognized source of
Journal of Sociology & Social Welfare
ambiguity is that no common language exists for determining
if and when end-of-life care (hospice admission) is appropriate
(Brickner, Scannell, Marquet, & Ackerson, 2004).
Hospice care under Medicare became law as part of the
Tax Equity and Fiscal Responsibility Act passed in August
1982. Miller and Mike (1995) provide an historical summary
of the Medicare hospice benefit. A major impetus of the federal
legislation was the recognition that death is expensive; hospice
care could offer humanitarian help and also save Medicare
funds. Although in early years there was concern about the
low use of the benefit, in more recent years it has grown rapidly
(MedPAC, 2004).
Hospice services require coordination, but this occurs at
the individual case level in terms of a team approach to service
delivery. The policy is explicit regarding the interdisciplinary
nature of the team (registered nurse, medical social worker,
physician, and pastoral or other counselor). A hospice nurse
and doctor are on-call 24 hours a day. The use of volunteers is
also required; volunteer service must constitute five percent of
paid staff hours.
Explicit reference to easing suffering and reducing discomfort are provided in the legislation. Easing suffering is the
primary goal of the policy with attention to multiple aspects
of suffering. The legislation also recognizes the suffering of
family members with provisions for respite and for bereavement counseling after the patient’s death. In addition to language, there are visual images in policy documents that also
convey compassion. The official government booklet describing the Medicare hospice benefit has a picture of hands-holding-hands on the cover (Centers for Medicare and Medicaid
Services, n.d.). Such imagery reflects the “suffering with”
concept of compassion.
The main implementation challenges associated with
hospice care are societal and cultural factors that can make it
difficult for people to address impending death. Physicians
have expressed concerns that referral to hospice communicated “giving up” on a patient (Mesler & Miller, 2000). Some
types of death have specific associated stigmas and misunderstandings (Shega & Tozer, 2009). Minorities are less likely to
utilize hospice care, potentially due to differences in culture
related to views of death, differences in religion, and lack of
Compassion in Social Policy
access to health care and health facilities (Crawley et al., 2000)
In summary, hospice care seems to be a good fit with the
classical definition of compassionate response, “to be with in
suffering.” Moreover, issues related to death (and afterlife)
have obvious relevance to religious beliefs. The hospice team
is consistently available through the time period of care until
the time of death, including some follow-up with surviving
family members. All team members are presumably committed to the hospice philosophy. Explicit inclusion of counselingoriented staff (e.g., social workers, pastoral care) ensures attention to emotional needs in addition to technical aspects such as
pain management.
Domestic Violence: Violence Against Women Act
In the 1970s, domestic violence shifted from a private
family matter to a public social issue through the work of feminist grassroots organizations. Over the next twenty years, civil
protection orders became more available to victims of domestic violence and non-arrest policies of local police departments
began to change (Sack, 2004). The Violence Against Women
Act of 1994 (P.L. 103-322) (VAWA) was passed by Congress
and signed into law by President Clinton. It has been reauthorized by Congress in 2000 and 2005. VAWA created national
legal structures for enforcing domestic violence as a crime and
provides funds to states for services. While VAWA discusses
extensive systems-level change (e.g., arrest policy, prosecution protocol), the community programming-oriented policy
is most relevant to the discussion of compassion.
Under VAWA, the federal government provides grants to
states for the funding of community organizations (Rosewater
& Goodmark, 2007). The Office on Violence Against Women,
located within the U.S. Justice Department, administers grants
under VAWA and develops federal policy around domestic violence and related issues. Domestic violence was the primary
initial focus of VAWA; however, the focus has expanded to
other forms of violence disproportionately affecting women,
such as stalking, workplace violence, and victimization of specific groups, such as elderly or disabled individuals.
Victim services specific to domestic violence are provided
by community organizations. These services include: crisis hotlines; medical and legal advocacy; temporary housing; mental
Journal of Sociology & Social Welfare
health counseling; and coordination with other services. The
core operation of these domestic violence organizations is to
provide support, whether material or emotional, in the form
of shelters and other aid. Women disproportionately experience domestic violence (Tjaden & Thoennes, 2000), hence the
majority of programs offer services only to women. Other eligibility requirements may apply, such as income, geographic
residency, drug and alcohol history (Sack, 2004), but VAWA
emphasizes the need for assisting all victims in crisis, regardless of other characteristics.
Delivery of domestic violence victim services occurs
through a combination of government and private grants to
community organizations, as well as the coordination of community services with other service systems (police, social services, court, etc.). Providers include social workers and other
social service personnel, paraprofessionals (for example,
shelter workers), and trained volunteers. Service providers
have a range of roles, from counseling to legal and medical
advocacy to coordinating broader services (such as long term
housing, etc.).
Because of the potential for severe physical harm, domestic violence services focus initially on the safety of the victim.
As part of this, VAWA language emphasizes the suffering of
the victim and the need to address this suffering. However,
VAWA also focuses on empowering the individual beyond her
victim status. Implementation challenges range from cultural
differences in the understanding of domestic violence to drug
and alcohol use to persistent violent relationships (Burman,
Smailes, & Chantler, 2004).
Services to domestic violence victims require some coordination, but this typically occurs at the community level, as
opposed to the individual case-level, through the establishment and maintenance of coalitions. Religion is closely connected with culture, and religious leaders (e.g., ministers, etc.)
are often on the front-line in addressing problems that face
women and children. Consequently, issues related to faith can
have an important role in addressing the needs of victims,
and religious organizations, therefore, are important in coalition efforts (National Resource Center on Domestic Violence
[NRCDV], 2007a). The coalition approach has been central
to this policy domain, reflecting both an effort to coordinate
Compassion in Social Policy
services and also to be a stronger political force in the fight
for justice. Domestic violence services, particularly through
shelters, emphasize interpersonal contact between sufferer
and service providers. Within a shelter, the milieu approach
facilitates a physical nearness with the suffering and potentially can be fairly long-term. The interaction of service providers and clients, and between clients, provides the emotional
element of compassionate response.
Explicit language of suffering and compassion was not
found in the VAWA legislation. Instead, use of empowerment language was common. This is consistent with more of a
rights-based strategy of achieving justice. This legislation and
its service system have been highly intertwined with advocacy
for victims, seeking not only potentially compassionate care
but also justice in both courts and relationships.
The main implementation challenges associated with compassionate response in domestic violence are related to continued societal ambivalence regarding this type of violence as a
social problem versus a private problem. Moreover, although
in reality there is little religious justification for marital violence
(NRCDV, 2007b), an abusive mentality may aim to use religious traditions to justify abusive actions. Victims, themselves,
may struggle to regard their own circumstances as worthy of
compassionate response. Furthermore, as our analysis pointed
out, compassion does not appear to be the primary response
desired. Empowerment and consequently, justice, appear to be
the overriding considerations of intervention.
Community Disaster: Stafford Act
The key federal policy in this domain is the Robert T.
Stafford Disaster Relief and Emergency Assistance Act. (P.L.
93-288, as amended, 42 U.S.C. 5121-5207). This legislation provides statutory authority for most federal disaster response
activities, especially as they pertain to the Federal Emergency
Management Agency (FEMA). More recent legislation in response to the September 11th terrorist attacks and the aftermath
of Hurricane Katrina (i.e., Homeland Security Act and Post
Katrina Emergency Management Reform Act) also has implications for disaster management.
Journal of Sociology & Social Welfare
Title 1, Sec. 101(a) of the Stafford Act states:
Congress hereby finds and declares that—(1) because
disasters often cause loss of life, human suffering, loss
of income, and property loss and damage; and (2)
because disasters often disrupt the normal functioning
of governments and communities, and adversely affect
individuals and families with great severity; special
measures designed to assist the efforts of the affected
States in expediting the rendering of aid, assistance,
and emergency services, and the reconstruction and
rehabilitation of devastated areas, are necessary.
Both “emergency” and “major disaster” are defined in the legislation. In both cases the determination of the President is required to assess that the scale is beyond the capabilities of state
and local efforts to address alone.
FEMA works in partnership with other organizations to
form the nation’s emergency management system. Partners
include state and local emergency management agencies, 27
federal agencies and the American Red Cross. FEMA’s core
operations include: service to disaster victims; integrated preparedness; operational planning and preparedness; incident
management; disaster logistics; hazard mitigation; emergency
communications; public disaster communications, continuity
programs. As identified, services to disaster victims is listed
first and is described as follows: “Responsive and compassionate care for disaster victims is FEMA’s top priority.” The
website of the American Red Cross identifies the organization
aim of “preventing and relieving suffering.” Moreover, in addition to their role in domestic disaster relief, they offer “compassionate services” in other areas (such as educational programs that promote health and safety).
The overall service delivery system is highly complex and
involves a variety of entities and professional groups (e.g.,
civil engineers, public health, police and fire). Coordination is
an obvious central element. Moreover, each of the individual
core operations would call upon different types of skills and
expertise. The focus on services to disaster victims (as opposed
to hazard mitigation) would be the “operation” where compassion might be expected. This operation alone, however, still
Compassion in Social Policy
suggests extensive collaborative efforts would be required.
Roberts (2010) provides a discussion of the evolution of
national disaster policies and the relevant implementing organizations in the U.S. Partially in response to the uncoordinated nature of many agencies, in 1979, President Carter
established FEMA by executive order, which merged many
of the separate disaster-related responsibilities into a single
agency. More recent developments have been in response to
the terrorist attacks of 2001 and the highly public and widely
criticized failures of FEMA during and after Hurricane Katrina.
FEMA became part of the Department of Homeland Security
in 2003.
The coordination of disaster management is extensive
and involves all levels of government and the private sector.
Moreover, because disaster management must anticipate a
wide range of disasters and emergencies, planning involves a
number of units that may or may not be actually called upon
in a disaster.
Within the disaster relief domain, the nearness to the
sufferer and the potential for long term involvement would
appear more variable than in the case of hospice and domestic
violence. Partially this is due to the characteristics of emergencies—they are sudden and of varying types. Moreover, in the
immediate emergency, priority may be given to concrete assistance, particularly if danger is still imminent. Long term assistance, both concrete and emotional, would generally not be
provided, but one role of the service delivery system would be
to link persons with other potential sources of help. Research
into the activities of churches during and after the events of
Hurricane Katrina, for example, show that faith-based organizations played an equally significant role, compared to
FEMA and other secular organizations, in providing assistance to victims both in short and long term capacities (Cain &
Barthelemy, 2008; Hurst & George, 2009).
The main implementation challenges associated with compassionate response in disaster management are the extensive
coordination of multiple systems, preparation for events which
often occur suddenly, and the potential politics involved in declaring federal emergencies.
Journal of Sociology & Social Welfare
Each of these policy domains included some elements of
interpersonal connection, but utilized differing means of providing this connection. Furthermore, coordination was central
in each domain, but the mechanisms of coordination and the
relevant parties involved in coordination were sources of variation. The compassionate delivery of aid is found within each
of these three policy areas, but in each case it is a small part of
a much larger policy. This is particularly the case for hospice
(which exists in the large Medicare program) and disaster
management (in which service to victims is one of several core
operations). Other areas in which we found variation that has
relevance to providing authentic compassion include policy
origins, mechanisms of interpersonal connections, social constructions, time horizon, and the primacy of government role
in addressing suffering. These are discussed further below.
Policy Origins
Each of the three cases reflects quite different policy origins.
The hospice benefit was a development within Medicare,
a widely enrolled and supported program within the Social
Security Act. Although hospice care is well-connected to
known conceptions of compassion, interest in providing it as
a benefit through public policy was also largely related to cost
considerations. VAWA had different origins. This legislation
was the culmination of long-standing grassroots efforts to acknowledge the social problem of domestic violence, and consequently provide assistance to its victims. Stafford legislation
evolved from numerous, earlier, largely uncoordinated efforts
to prepare for and respond to both natural disasters and other
large-scale emergencies.
Each of these policy areas has continued to develop, especially VAWA and the Stafford Act. These developments have
come about in response to new knowledge development as
well as political considerations. For instance, VAWA reauthorizations have included attention to specialized groups (e.g., immigrant communities, elders), which may provide unique considerations, and Stafford reauthorizations have recognized the
changing nature of threats (e.g., terrorism), updated technologies, and post-Hurricane Katrina outrage at the ineffectiveness
Compassion in Social Policy
of FEMA. In comparison, the Medicare Hospice benefit has
remained relatively unchanged, although policy discussions
surrounding health care reform included some focus on endof-life decision-making.
Interpersonal Connection
The definitional element of compassion, “to be with in
suffering” requires nearness to the sufferer and the essential
element of human contact. This distinguishes a compassionate
response from other types of helping, such as charitable aid to
ease financial distress. Furthermore, some length of time might
also be implied. In circumstances where suffering is of a longterm nature, a caring response that is too brief may not fit with
an understanding of “being with” in suffering.
Each of the policy domains examined provides for interpersonal contact with sufferers, both through professional intervention and the use of volunteers. This is particularly important because the common use of the term “compassion”
often does not recognize the necessity of the interpersonal relationship required. In each of the three policy domains, those
on the front lines doing the bulk of the compassionate work
would need to handle the emotional demands of being with
people as they are suffering. It is not easy to sit with people
who are dying, have been battered, or are in emotional distress
because of a community emergency. A human instinct is often
to recoil from such pain. Individuals have varying capacities to
approach people in physical or emotional distress. Professional
training (social work, nursing, ministry) typically provides
targeted attention to helping individuals become emotionally
capable of handling grave distress. Moreover, professionals
generally choose the kind of work they are comfortable doing,
and thus can avoid these types of activities if they perceive
themselves unable to handle certain types of situations (e.g.,
imminent death).
Volunteers are central to service delivery (e.g., spend time
with the sufferers) in each of the domains. Religion is a central
motivation for many volunteers, and churches are often the
conduit for connecting individuals with volunteer opportunities. It is this nexus where compassion, based on religious
tradition, has the potential to be most conspicuous. But volunteers may only be capable of certain types of helping. The
Journal of Sociology & Social Welfare
type of training volunteers receive is likely to fall far short of
the emotional and technical capacities needed to assist in circumstances of real suffering. Additionally, as Evans (2011) has
noted in her discussion of the UK’s Big Society, volunteers are
not free. The infrastructure needed to recruit, train, manage,
and support volunteers can be costly.
Social Construction of Problems/Populations
Classic writing of Ryan (1976) gave prominence to the
phrase “blaming the victim” and outlined some of the psychological and social processes that result in attributing blame for
an individual’s misfortune to actions or characteristics of that
individual rather than to social conditions. Ryan emphasized
the sociological aspects of victim-blaming process, i.e., maintenance of current class structures and their inequalities as a
primary motivation for defining social problems as residing
within individuals rather than larger systems.
Even within the three relatively unambiguous cases examined—terminal illness, violent victimization, community
disaster—there can be efforts to blame the victim for his/
her misfortune and, therefore, to negatively affect the delivery of compassionate response. The aftermath of Hurricane
Katrina provides the most drastic example of this (Napier,
Mandisodza, Andersen, & Jost, 2006). In the case of domestic violence, VAWA was enacted due to long-term efforts to
change victim-blaming in domestic violence cases. Through
the advocacy work of VAWA-funded coalitions, this work
continues. The case of terminal illness is less likely to result in
victim-blaming, although there can still be psychological and
societal pressures to avoid illness and death.
Victim-blaming inclinations are entwined with beliefs
about deservedness, i.e., whether one is responsible for the
difficult circumstances they are in and, consequently, whether
they should receive assistance. Discussions of this have a long
history and cross many disciplinary and professional boundaries. Our review of the literature suggests division as to whether
deservedness is needed in order to obtain a compassionate response. Nussbaum (2001), for example, suggests the reason for
the suffering is relevant in determining whether compassion
is appropriate, whereas others (e.g., Comte-Sponville, 2001;
Whitebrook, 2002) suggest that a lack of attribution of blame is
Compassion in Social Policy
characteristic of a compassionate response and contributes to
its moral weight.
In policy discussions, “deservedness” and “power” are
key concepts to the social construction of target populations;
those considered more deserving and more powerful are likely
to get more favorable treatment in social policy (Schneider &
Ingram, 1993). Those affected by community disaster, those
who have been victims of violence, and those who are near
death are all likely candidates for a compassionate response.
Yet, the circumstances leading to this suffering may be conisderations as to whether compassion is the predominant virtue
observed and supported by the political environment.
Time Horizon
“To be with in suffering” provides no indication regarding the appropriate time period for engaging in compassionate action. Some suffering occurs over a long period of time.
The hospice care benefit is unique regarding the time horizon;
while terminal illness has qualities of both pain and fear of
death that deem it worthy of compassion, the benefit is explicitly limited to cases in which death is determined to occur
within six months. This quality imposes a short-term need for
compassionate response that likely contributes to its political
Other types of suffering may have far longer time horizons. Domestic violence victims are often engaged in abusive
relationships for extensive periods of time. Victims often make
several efforts to end abusive relationships before they are able
to fully gain their independence; some never do (Arias & Pape,
1999; Humphreys & Thiara, 2003). These realities are known to
experienced workers in the domestic violence field. Responses
to community disasters also have a complicated time horizon.
The distinction between emergency response and later efforts
at rebuilding are relevant. Scenes of devastation are generally
effective at eliciting a response that is a combination of concrete aid and emotional support. There is typically widespread
consensus of public support for intervention. But public attention, and consequent support, often wanes as the effort for rebuilding becomes more complicated.
Journal of Sociology & Social Welfare
Government Role
Some political positions espouse the need for greater emphasis on societal-level actions that take care of people and
encourage people to take care of each other. Other positions
emphasize the primacy of the individual and his/her freedom
to decide when and how to engage with others. These perspectives are common in contemporary political dialogue, but have
long-standing, even ancient, predecessors and shape policy
responses to suffering even in these three cases where some
level of compassion is undeniably appropriate.
In respect to the role of government, these three policy
examples partially bridge the liberal–conservative divide by
providing national policy structure and funding but orienting
services at the community level and facilitating community
leadership. Each of these three policy areas involves the use of
community-based agencies and volunteers in the delivery of
compassionate response.
Despite the extraordinary resources and privileges accorded to the American people, suffering abounds. Actions
to relieve suffering may take many forms. In addition to the
interpersonal connection highlighted in each of these policy
domains, concrete assistance (food, safe shelter, pain medication) is also typically needed to be effective in easing suffering.
But a requirement of compassionate response is an element of
“shared suffering.” Explicitly, compassionate response does
not allow those enduring pain and loss to deal with it alone.
Networks of family and community appropriately provide the
bulk of compassionate response. But in many instances, the
level of suffering is beyond the response capacities of these
units. Therefore, compassion appears to be a relevant virtue
for government policy.
Compassion-oriented policy requires federal and state
funding infrastructure to support community-based networks
of professionals (social workers, physicians, emergency management personnel), para-professionals (nursing assistants,
group home staff), and volunteers (advocates, mentors).
Professionals are central for several reasons. Serious suffering
Compassion in Social Policy
is often extremely difficult to be around and professional training typically (but not always) can help individuals develop the
capacity to withstand some of this very serious suffering. Also,
professionals are trained to engage with the large, complex
systems (e.g., hospitals, government bureaucracies, courts);
understanding of these systems is needed in order to effectively secure resources and conduct case and systems advocacy.
There are additional policy elements that are necessary to
achieve a sense of “shared suffering.” There needs to be formal
policy recognition that suffering does occur and that those suffering have a right to the alleviation of suffering. Moreover,
there needs to be sustained funding to allow continuity of assistance throughout the period of suffering. As noted, suffering can occur over a very long period of time.
In modern complex societies, no one virtue should undergird all of public policy. Such an approach would be simplistic.
Reconciling the variety of virtues and determining associated
policies is the role of sophisticated political leadership and an
engaged citizenry. Our analysis has focused on one virtue. We
do so for analytic purposes; we do not argue it is the only necessary virtue relevant to public policy. Many virtues are relevant
to society. Sabl (2005) has argued that some virtues are necessary for basic functioning of a liberal democracy (e.g., justice)
and that others are more specialized, needed in certain circumstances. An ongoing challenge to the role of virtue in civic life
is that virtue lists can be fluid, with the most critical virtues
being dependent on the specific social context (MacIntyre,
1981). Yet some remain fairly core to the human condition. Our
choice of compassion for analysis is due to the recognition of
suffering among vulnerable populations and our social work
commitment to these populations.
How does compassion interact with other virtues? In one of
the examples that we provided we observed an interaction of
compassion and justice in the case of domestic violence. It does
not seem necessary to choose one over the other. Compassion
might be the dominant early response in domestic violence but
may take a secondary or more episodic role as the machinery
of justice is engaged. Greater attention regarding how virtues
interact in various policy domains would be a fruitful area of
Journal of Sociology & Social Welfare
As a second example, self-sufficiency is a valid virtue,
and has been central to social welfare policy in the last two
decades. Some have asserted that it has become so dominant in
policy discourse that it is no longer even questioned (Hawkins,
2005). Elsewhere (Collins et al., 2012) we have provided some
thoughts as to how the self-sufficiency aspect of welfare policy
might be enhanced if there were more attention to compassion
in our various poverty policies. More generally, resolution of a
variety of problems might occur earlier and with a more sustained focus if compassion were delivered initially and with
more visibility. This might be the case with victims of violence,
national disaster, or the surviving loved ones of those who
have died. It might be the case with other populations—foster
children, refugees, homeless individuals—as well.
We have not argued that any of these policies are or are not
effective in their delivery of compassionate response. A virtuebased approach, however, is focused more on “being” than
“doing” and consequently more on “process” than “outcome.”
Efforts to ease suffering are considered part of a compassionate response; but even when unable to effect a change in the
conditions that cause the suffering, compassionate action is
still a worthy endeavor. Some circumstances, wounds, and
burdens may not improve (e.g., terminal illnesses, imprisonment). In these cases, the sharing of suffering is the outcome.
Sometimes the compassionate act exists largely in the ability
to be present with those suffering pain or loss. An inordinate
preoccupation with measuring objective outcomes (e.g., employment) ignores the potential benefit of intervention aimed
at the subjective reduction of suffering.
Virtue-based frameworks move to the forefront societal
questions about our ethical relationships towards others and
the building of better societies. Use of virtue-based language
forces us to confront these bigger questions motivated by
values and vision. Equally, they can force difficult decisions
about sustained character that may withstand reactive policymaking to meet an immediate need or to respond to political tension. Thus discussions of compassion within a virtueframework emphasize morality and ethics. Because of the
sense of “character” reflected in virtues, this manner of examining policy speaks more to the sustained, dispositional sense
of our nation. The more typically used policy metaphors such
Compassion in Social Policy
as “sticks and carrots,” or investment and prevention, are relegated to secondary status.
Our analysis considered cases of largely unambiguous suffering and, therefore, there is likely to be greater consensus that
action should be taken to alleviate suffering. Consideration
of additional cases would add further detail to our emerging
framework. Other relevant policy areas might include homelessness, immigration, bullying, and nursing home care. Those
who suffer in these areas might also be in need of compassionate response. Yet, issues related to social construction of
the populations, time horizon of suffering, ideologies regarding role of government, and other factors may result in a more
opaque compassionate response.
Additionally, analysis of different virtues reflected in key
policies may further clarify the utility of a virtue-based approach to policy development and analysis. We have already
noted the virtues of justice and self-sufficiency. Other notable
virtues that may lead to intriguing observations include generosity, courage, and humility, for example. We also believe our
analysis has application to the development and implementation of policies in many other countries besides the U.S. Indeed,
the focus on alleviating human suffering is likely shared across
the globe, although specific policies may differ depending on
the social, political and cultural context. Comparative analysis
across countries regarding the delivery of compassionate response may be useful to identify some of the specific cultural
elements related to the practice of compassion in the public
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Providing leadership for implementation and change in organizations
that serve the mental health needs of children and adolescents has long been
identified as an appropriate and important role for psychologists in general
and for psychologists who work in schools in particular (Magary, 1967; Sarason,
1971; Schaughency & Ervin, 2006). Contributing leadership to the effort to
develop schools as settings that nurture psychological, social, and academic
development has been suggested as a primary activity of school psychologists
in the most recent school psychology blueprint for training and practice
(Ysseldyke et al., 2008), a document initiated by the National Association of
School Psychologists, which outlines a framework for training and practice.
Implementation is a complex process that requires knowledge of and skill
in changing the behaviors of adult staff in organizations and in changing the way these organizations function. Success in both of these tasks
requires leadership skills. Leadership has been defined in many ways, but all
definitions share the view that leadership involves a process of influencing
Implementation of Mental Health Programs in Schools: A Change Agent’s Guide, by S. G. Forman
Copyright © 2015 by the American Psychological Association. All rights reserved.
others and that all leaders have one or more followers. In the context of
implementation, leadership can be seen as the process of influencing others
in organizations to use new evidence-based practices or interventions and
successfully shaping the organizational context to support the use of these
Copyright American Psychological Association. Not for further distribution.
A change agent is an individual who is actively working to bring an
innovation to use in a setting. Change agents can provide a communication
link between intervention developers and those in practice settings who can
use the intervention for the benefit of clients. They facilitate the flow of
innovative interventions from developers to implementers. Change agents
can bridge gaps in information and skill between an intervention’s developers and its potential implementers. In addition to bringing information about
an intervention from intervention developers to potential implementers and
other stakeholders, change agents can also facilitate the flow of feedback
from implementers and stakeholders back to intervention developers so that
interventions can be adapted to best meet the needs of specific client groups
and organizational contexts.
Change agents need a high degree of expertise in the innovations that
are being diffused and implemented. Thus, psychologists are in a good position to assume the role of change agent for interventions aimed at improving
child and adolescent mental health. Change agents can be either internal or
external (i.e., consultant) to the organizational setting. The school psychologist is typically the most knowledgeable member of a school or school district
staff regarding psychological and mental health issues and their effects on
learning, as well as the functioning of children and adolescents with disabilities. Thus, the school psychologist is well suited to the change agent
role with respect to interventions that have the potential to improve student
emotional, social, and behavioral development.
Rogers (2003) identified the following seven roles of change agents who
are working to introduce and implement an innovation:
1. Developing a need for change—The change agent helps organizational staff become aware of the need to do something
new by raising their awareness of problems and pointing out
alternative solutions. In this role, the change agent may be
assessing client and organizational needs and also helping to
create needs.
implementation of mental health programs
Copyright American Psychological Association. Not for further distribution.
2. Establishing an information exchange relationship—The change
agent develops rapport and credibility with stakeholders and
potential implementers. Stakeholders and potential implementers must accept the change agent as competent, trustworthy,
and caring before they will accept the new interventions that
the change agent is promoting. Rogers (2003) pointed out that
innovations are judged, in part, on the basis of how the change
agent is perceived.
3. Diagnosing problems—The change agent analyzes client and
organizational problems to determine why existing practices
and programs do not meet their needs.
4. Creating intent to change in the client—The change agent
works to motivate the interest of organizational staff in the
innovation after exploring the existing alternatives that might
meet the needs of clients and the organization.
5. Translating intent into action—The change agent works with
the social/interpersonal networks in the organizational setting
to influence the implementation process.
6. Stabilizing adoption and preventing discontinuance—The
change agent stabilizes implementation through the use of
messages to organizational staff that reinforce their use of the
7. Achieving a terminal relationship—The change agent shifts
responsibility to other organizational staff for continued implementation of the innovation and seeks to shift staff from reliance on the change agent to self-reliance in the continued
implementation of the innovation.
Exhibit 4.1 illustrates leadership roles and tasks.
Hall and Hord (2001) stated that leadership is essential to long-term
change success and emphasized that regardless of one’s formal role or position in an organization, contributions can be made in facilitating a change
process. They identified eight important functions of change facilitators:
1. developing, articulating, and communicating a shared vision of
the intended change;
2. planning and providing resources including material, supplies,
equipment, time, space, rules, guidelines, policies, staffing, and
3. providing professional learning;
4. checking on progress and assessing and monitoring implementation;
leadership for implementation and change   
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Leadership Roles and Tasks
Dr. Help was hired to serve as a psychologist for three middle schools in the Metro­
politan School District. During her first months on the job she made a point of meeting
with each principal for discussion on a regular basis, attending faculty meetings and
other school events so that she became visible to school staff, and trying to meet
most of the teachers. She also spent some time in the teachers’ lounge at the end of
each school day, where many of the teachers congregated. In dealing with students
and other issues that had been referred to her, she was careful to provide timely
feedback on her activities to the referral source. She asked the principals if she could
contribute short articles on issues related to student emotional, social, and behavioral
functioning for the school newsletters. The principals agreed to this, and she wrote
a series of short pieces on bullying prevention as there had been several incidents
in the state and national news about problems related to bullying in schools. After a
few months and some referrals of students who had been involved in bullying, she
asked the principals if she could conduct a survey of students and school staff to gain
information about whether and how great a problem bullying was in their schools. She
reviewed the survey results, which indicated that both students and staff perceived
bullying as a significant problem in their school, with the principals. She asked the
principals to set up a joint middle school task force on bullying with key faculty and
other staff members from each school as members. An assistant principal from each
school jointly chaired the task force, and Dr. Help was named a member. At the first
task force meeting, she presented the results of the survey. She also suggested that
the task force discuss whether any existing school practices or procedures seemed
to be contributing to the problem and whether any existing programs might be used
or adapted to address the problem. The task force decided that a new program was
needed to address bullying, and a subgroup began to look at the professional litera­
ture about bullying prevention/intervention programs. The task force began to agree
on a bullying prevention program to adopt. Dr. Help suggested that they talk about
how to involve key groups and additional individuals in the middle schools in the final
adoption decision to broaden support for and commitment to the program. The task
force asked Dr. Help to present the results of her survey at faculty meetings and to
conduct focus groups for school staff about the specific nature of the bullying prob­
lem in their school. The task force considered potential programs again in light of the
focus group results and made a final decision about what program to recommend.
Dr. Help was asked to participate in presentations made at faculty meetings about
the nature of the prevention program the task force felt would best meet the schools’
needs. After the final adoption decision was made, the task force met to plan the
implementation process. Dr. Help suggested that the task force consider what imple­
mentation and outcome data to collect to ascertain whether the program was working
as expected and how to provide feedback regarding that data to school staff.
5. providing continuous assistance directly related to information
gained from checking on progress through coaching, consulting, and/or follow-up;
6. creating a supportive context for change;
7. communicating externally—informing stakeholders of progress;
8. disseminating information—informing prospective adopters from
other sites.
implementation of mental health programs
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Change agents can be viewed as leaders because they are attempting to
influence others within an organization to adopt and implement evidence-based
interventions. To do this successfully, they will need to have organizational
staff members who accept and act on their suggestions and recommendations. In the language of the literature on leadership, these organizational
staff can be viewed as followers. Following is a brief historical overview of the
changing views of what leadership is and the characteristics of leaders. This
overview will provide change agents with information about the nature of
effective leadership, including effective leadership characteristics and behaviors. Change agents can use this information to examine their own leadership
qualities and to support the development of those qualities and behaviors
that will enhance their chances of success in facilitating implementation
Brief History of Leadership Research
The organizational psychology and management literatures have
addressed definitions and views of leadership for many years. Early research
on leadership conceptualized it as a general personal trait. This has been
called the heroic conception of leadership (Bolman & Deal, 1991). Current
thinking reflects the ideas that traits interact with a context and that they
are malleable and not fixed. Thus, individuals can work to develop characteristics and behaviors associated with good leaders. Several traits associated
with leadership have been identified. These include persistence, tolerance for
ambiguity, self-confidence, drive, honesty, integrity, internal locus of control, achievement motivation, and cognitive ability (Avolio, 2007). Leaders’
actions have been the focus of other approaches to the study of leadership
(Lowin & Craig, 1968). These approaches include situational theory, which
views traits and behaviors of leaders as mediating variables between structural antecedent and organizational outcomes (Perrow, 1970); contingency
theory, which focuses on the interaction of the leader and situational characteristics (Fiedler, 1967) and suggests that different styles of leadership are
needed for different situations; and normative and descriptive models, which
deal with the form and degree to which the leader involves subordinates in
decision making (Vroom & Jago, 1988).
Chin and Benne (1969) pointed out that, historically, there have been
two approaches to change: (a) the rational empirical approach, which supports the notion that a good program provided to good people will find its way
into practice; and (b) the power coercive approach, in which it is thought that
a good program delivered to good people by an authoritarian figure will result
leadership for implementation and change   
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in change in practice. Neither has been found to be effective in supporting
sustainable change; provision of information about an intervention in most
cases does not lead to implementation (Rogers, 2003), and use of power to
effect change may lead to resistance to implementation or short-term implementation rather than sustainable implementation (O’Toole, 1995). Current
approaches to leadership focus on the role of the leader change agent in understanding the organizational and systems context for change and working
collaboratively with stakeholders to accomplish it.
In general, leadership is currently viewed as being a function of the leaders, the led, and a complex context. John W. Gardner (1989), in his seminal
work On Leadership, emphasized the importance of context and the consideration of systems in conceptualizing leadership:
Leaders cannot be thought of apart from the historic context in which
they arise, the setting in which they function (e.g., elective political
office), and the system over which they preside (e.g., a particular city or
state). They are an integral part of the system, subject to the forces that
affect the system. (p. 1)
Although Gardner referenced political leaders, the systemic structure within
which every type of leader operates is important to recognize.
Some contemporary definitions view leadership as a process rather than
as a characteristic of a person. For example, Vroom and Jago (2007) defined
leadership as “a process of motivating people to work together collaboratively
to accomplish great things” (p. 18). The view of leadership advanced by this
definition emphasizes the idea that many individuals have the potential to be
leaders and that an individual can provide leadership in an organization even if
his or her formal position is not administrative or managerial with direct reporting responsibility for other staff members or budgetary control. The particular
form of influence that this definition advances is motivating; use of particular
types of incentives is not part of the definition; and the purpose of leadership is
seen as facilitating collaboration in pursuit of a common positive goal, such as
increasing use of evidence-based interventions to increase positive client outcomes. This view of leadership is particularly relevant to psychologist change
agents, as such individuals can provide leadership even if they are not in an
administrative/managerial position and lack access to financial incentives. In
addition, the emphasis on collaboration is consistent with the historically helping and collaborative nature of the role of the psychologist.
The WICS Model of Leadership
One contemporary approach views leadership as how an individual formulates, makes, and acts on decisions. Sternberg’s (2007) WICS model of
leadership has three key components: wisdom, intelligence, and creativity,
implementation of mental health programs
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synthesized. Again, in this formulation, formal position and access to formalized financial incentives are not necessary prerequisites for leadership.
In this model, creativity refers to the skills and dispositions needed for
generating ideas that are relatively novel, high in quality, and appropriate for
a given situation. Sternberg (2007) contended that creativity in leadership
includes several elements. Creative leaders engage in problem redefinition;
they do not necessarily define a problem the way everyone else does and are
willing to go against the manner in which a group is viewing a problem. They
are also skilled at problem analysis and considering whether their solution
is the best one. When they generate a solution, they realize that they will
need to put effort into selling it to others. Creative leaders recognize that
knowledge can both help and hinder creative thinking, as leaders can sometimes become rigid regarding a potential solution or course of action based
on specific information they may have and believe. Creative leaders are also
willing to take sensible risks and will work to surmount obstacles. They are
willing to tolerate ambiguity, recognizing that there may be long periods of
uncertainty. In addition, they tend to find work environments in which they
received extrinsic rewards for doing things that are intrinsically rewarding
to them, and they learn from experience, continuing to grow intellectually.
Creative leaders engage in selective encoding, through which they distinguish relevant from irrelevant information; selective comparison, through
which they relate new information to old information in novel ways; and
selective combination, through which they combine relevant information in
novel but productive ways.
In the WICS model, successful intelligence is the skills and dispositions
needed to succeed in life, given an individual’s own notion of success and his
or her sociocultural environment. Wisdom is defined as the use of successful
intelligence, creativity, and knowledge mediated by values to reach a common
good, balancing intrapersonal, interpersonal, and extrapersonal interests, over
the short and long term. Sternberg (2007) described how these components
interact and contribute to leadership:
An effective leader needs creative skills and dispositions to come up
with ideas, academic skills and dispositions to decide whether they are
good ideas, practical skills and dispositions to make the ideas work and
convince others of the value of the ideas, and wisdom-based skills and
dispositions to ensure that the ideas are in the service of the common
good rather than just the good of the leaders, or perhaps some clique of
family members or followers. (p. 40)
Wisdom, intelligence, and creativity are viewed as modifiable attributes, and
their use is seen as dependent on how situations interact with an individual’s
skills. Thus, Sternberg’s model identifies key individual attributes that can be
developed to support the effectiveness of psychologists in the role of change
leadership for implementation and change   
agent. The emphasis on working to achieve positive outcomes for others
and the common good of society, as well as the importance of enlisting the
support of others and working to overcome potential and existing barriers
in complex environments, are consistent with tasks of the change agent
working to facilitate implementation of evidence-based child and adolescent
mental health interventions.
Copyright American Psychological Association. Not for further distribution.
Change Facilitator Styles
In their research on principals as school leaders, Hall and Hord (2001)
identified three styles of change facilitators. Initiators have a strong vision
and goals for their organization and seek changes in programs and policies to
realize their vision and goals. Managers are concerned that their organization
is well organized and are supportive of change efforts initiated from above
in the organization. For example, a school principal with a manager change
facilitator style would be responsive to and effective at implementing new
programs initiated by the school district central office. Responders emphasize
their personal relationships with their staff and focus on traditional administrative tasks. They believe their role is to keep the organization running
smoothly and typically do not initiate new programs. Hall and Hord used
the “making it happen, helping it happen, letting it happen” continuum
presented in Chapter 1 to describe change facilitator styles. Initiators are
described as individuals that “make it happen,” as they have vision and
make efforts to move things in a desired direction. Managers are described
as those that “help it happen.” When implementation is an objective, they
accomplish it efficiently. Responders are described as those that “let it
happen,” as they are less active in making change and resolving problem
issues (p. 136).
Several researchers have suggested that in organizations the implementation process should be led by a team rather than by an individual (Taylor,
Nelson, & Adelman, 1999). For example, literature on implementation of
positive behavior support in schools, a program based on applied behavior
analysis procedures with the goal of decreasing school discipline problems,
has indicated that an effective leadership team is key to successful implementation (Sugai & Horner, 2006). There are several reasons for relying on
a leadership team rather than a single individual as change agent in efforts
to implement innovations in organizations. First, a leadership team can provide a range of expertise related to one or more interventions and problem
implementation of mental health programs
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areas that a single individual cannot. Second, a leadership team can provide a
broader range of knowledge about the operation of and social networks in a
complex implementing organization than could an individual. In addition,
a leadership team can shoulder the many roles and tasks of implementation
that may be difficult for one individual with other work responsibilities to
undertake. Finally, when selected to represent different stakeholder constituencies, a leadership team can help to broaden support for an implementation
Several models for and approaches to using a leadership team have
been suggested. Some of these provide information about the conditions
that should be met for leadership teams to be successful. Others outline
strategies that can be used with teams and by teams to advance the process
of implementation.
Hackman’s Theory of Effective Group Functioning
Hackman’s (2002) theory of effective group functioning is based on
research conducted by Richard Hackman and his collaborators on a variety of work teams (Hackman, 1990; Wageman, 2001; Wageman, Fisher, &
Hackman, 2009). It sets forth five conditions for team effectiveness: (a) having a real team, (b) a compelling direction, (c) an enabling team structure,
(d) a supportive organizational context, and (e) expert team coaching.
Hackman contended that these conditions can be viewed as the prerequisites
for effective team functioning and that meeting these conditions is the best
way to set up and support a group so that it has the potential to be effective.
Hackman’s (2002) first condition for team effectiveness is having a real
team. He defined a real team as one that has an appropriate team task that
requires the members to work together. A real team also has clear boundaries
so that team membership is clear and there is stability in membership. Team
members also need to have the authority to manage their work process.
The second condition, a compelling direction, involves someone in
authority setting the direction for teamwork. This should be done in a clear,
engaging, challenging, and consequential manner that engages team members’ talents. Although end states for the team should be specified, the details
of the means to those ends, in terms of specific tasks and methods, should not.
An enabling team structure establishes a basic framework for the
team’s functioning and gives the team room to mold that framework to its
circumstances. Hackman (2002) identified three key structures for effective
teamwork: (a) the design of the work the team performs, (b) core norms of
conduct that guide and constrain team behavior, and (c) the composition of
the team. Well-designed work for teams is thought to be work that is meaningful, work for which team members feel personally responsible for both
leadership for implementation and change   
Copyright American Psychological Association. Not for further distribution.
implementation and outcomes, and work in which team members receive
feedback on their efforts. These aspects of work design support motivation
in team members. Group norms are the behaviors that are acceptable and
unacceptable in the team. Hackman suggested that the most important group
behaviors are outward looking, addressing the relationship between a team
and its performance context, with team members continually scanning the
environment and adjusting performance strategies when necessary. In addition, team members should identify a small number of behaviors that are
important to regulate and that team members must always do or never do.
The composition of the team should strike a balance between those who are
similar and those who are different and should take into account the fact
that large teams may have difficulty accomplishing tasks. Hackman further
suggested that in selecting team members, the focus should be on ensuring
that members have strong task skills and at least adequate interpersonal skills.
The organizational context includes the reward system, the information system, and the educational system (training and technical assistance).
Hackman (2002) indicated that these aspects of the organization should be
supportive of the goals and tasks of the team. In addition, the availability of
material resources such as equipment, money, staff time, and physical space
are important.
Finally, Hackman (2002) indicated that the availability of expert
coaching is essential for team success. Coaching can come from any team
member, from the team leader, or from an external coach. Thus, the team
should have access to bring in expertise in areas that the team deems it needs
but does not have among its members to be successful in achieving its goals.
Such coaching can be motivational in nature, can address performance strategies, or can address knowledge and skill.
Collaborative Strategic Planning
Collaborative strategic planning (Stollar, Poth, Curtis, & Cohen, 2006)
offers another framework for effective leadership team functioning, especially
within the context of schools. It is a team-based approach that uses collaborative planning and problem solving to address student, school, and school district problems. Collaborative strategic planning teams are typically composed
of school building and district-level administrators, teachers, related service
providers, parents, community members, and other stakeholder groups. The
team facilitates the collection and use of student outcome data with the purpose of developing, implementing, and maintaining a three-tier model of
support for students. The three-tier model includes primary prevention or
universal programs for all students, secondary or targeted programs for students at risk, and tertiary or indicated programs for students with identified
implementation of mental health programs
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problems. The collaborative strategic planning process is based on a problemsolving model that consists of the following five steps:
1. Problem identification—The team explores how effective the
school is at promoting positive outcomes in its students. To
engage in this discussion, the team examines two types of information: (a) expectations for performance, such as expected student achievement levels, student graduation rates, number of
suspensions or other disciplinary incidents, or number of students referred for counseling services as a result of school-wide
suicide/depression prevention screening; and (b) actual student
performance or behavior. The purpose of examining this information is to provide data-based confirmation of discrepancies
between what is desired and what is occurring.
2. Problem analysis—The team generates questions about how and
why an identified discrepancy (problem) may exist and collects
data to answer those questions. The questions should be clearly
stated and framed in observable and measurable concepts that
lead to definitive answers, such as yes, no, or a numerical answer.
Some examples are: “How many office disciplinary incidents are
recorded per week?” or “Which school and grade level have the
most office disciplinary incidents?” or “How many incidents of
bullying have been reported by students?”
3. Goal setting—The team uses the results of problem identification and problem analysis to set a clear and public goal that will
provide an anchor for developing an action plan.
4. Plan development and implementation—The team develops
an action plan to address identified problems. Stollar et al.
(2006) suggested that closely matching each reason for a problem, found during problem analysis, with a related improvement strategy increases the potential for implementation
success. After the team selects a research-based strategy as the
basis for the action plan, the strategy should be adapted to better fit the context of the implementing school. Having teams
generate a list of possible barriers to implementation can facilitate this process because the team can then prepare to deal with
potential roadblocks to implementation success.
5. Plan evaluation—Evaluation involves both monitoring the
progress of implementation of an intervention and evaluating
student outcomes with the intention of adapting any aspects of
the intervention or implementation that need improvement
or returning to earlier stages in the planning/problem solving
leadership for implementation and change   
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The Participatory Intervention Model
The participatory intervention model (PIM; Nastasi et al., 2000) is an
additional approach that can be used to guide change leaders and leadership teams in the development of interventions that are evidence-based and
are also socially and ecologically valid. PIM is an iterative process designed
to promote ownership and empowerment among stakeholders. PIM assumes
that these stakeholders will ultimately be responsible for sustaining an intervention and that the support of a change agent will eventually diminish or
cease. In this model, social or ecological validity is conceptualized as the
culture or context specificity of interventions. The goals of PIM are to have
stakeholders come to view an intervention as their own creation and take
responsibility for and control of the intervention and the implementation
process. As a result of perceptions of ownership, it is hoped that stakeholders
will continue the intervention without support from a change agent (sustaining the intervention) and will integrate the intervention into existing
organizational practices and programs (institutionalizing the intervention).
PIM has roots in applied anthropology, specifically participatory action
research. Participatory action research is characterized by full involvement of
key stakeholders in a recursive process that links theory, research, and practice. The process begins with examination of existing research and theory
related to an identified problem to provide a basis for designing culture or
context-specific local theory. The local theory then guides development of
interventions. Evaluation of the intervention informs the modification of the
intervention and further development of culture-specific theory.
PIM involves three phases: (a) participatory generation—intervention
design, (b) natural adaptation—implementation, and (c) essential changes—
evaluation of effectiveness. Throughout these three phases, change agents in
partnership with stakeholders are continually engaging in data collection and
analysis to ensure acceptability and cultural specificity of the intervention, to
facilitate adaptation of the intervention to the demands of the context, and
to monitor change relative to intervention goals. Throughout this process
there is continual attention to issues of acceptability, integrity, and effectiveness. Using PIM, intervention implementation involves the modification or
adaptation of an evidence-based intervention to fit the needs and resources
of specific participants in a natural setting. Throughout the process of implementation, alterations are made to achieve an optimal fit of the intervention
to the context and to the local clients.
Successful local adaptation of an intervention using this model requires
continual monitoring of intervention integrity. Prior to adaptation, key or
critical elements of the intervention are identified as elements that must be
preserved. Noncritical elements are identified as those that can be varied
implementation of mental health programs
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without interfering with intervention effectiveness, and that may be important to intervention acceptability and successful implementation in the local
context. Examination of the impact of the intervention on targeted outcomes is an essential part of the PIM process. Assessment at multiple points
throughout and after the intervention is used to determine whether progress
is being made in achieving the goals of the intervention.
Through PIM, key players together design an intervention, monitor its
implementation, and evaluate its effectiveness. As stakeholders come to view
themselves as partners in this process, their sense of ownership and empowerment increases, and the acceptability of the intervention is enhanced. Using
this process, stakeholders can be assisted in developing the needed knowledge, skills, resources, confidence, and commitment for creating a context in
which the intervention will be maintained.
The change agent’s role can be viewed broadly as providing leadership for
an effort to implement an innovation such as an evidence-based inter­vention.
The literature on leadership has indicated that this role can be carried out
effectively even though the change agent may not hold a formal position of
leadership within the implementing organization or setting and may not have
direct control over the financial resources of that setting. Literature on implementation leadership also has indicated the importance of using a leadership
team to distribute leadership functions and activities, rather than concentrating leadership for implementation in one individual. Effective leadership
teams represent multiple stakeholder groups, have a clear understanding of the
goals and nature of their work, have access to needed organizational resources,
and use data-based problem solving and decision making throughout the
adoption and implementation process to yield positive implementation and
client outcomes. Both adaptive leadership, which focuses on guiding others
through change and uncertainty, and technical leadership, which focuses on
using organizational procedures to solve problems, are essential throughout
the various stages of implementation (D. L. Fixsen, Blase, Duda, Naoom, &
Van Dyke, 2010). Although in the earlier stages of implementation, there is
typically more emphasis on communicating a vision for change and inspiring
stakeholders, in the middle stages, the need to develop the organizational
supports necessary for effective implementation becomes primary. In the later
stages of implementation, both adaptive and technical leadership are important, as there is a need to maintain stakeholder motivation, as well as to adapt
and maintain organizational supports. Change agent and leadership team
functioning to support implementation is described in Exhibit 4.2.
leadership for implementation and change   
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Change Agent and Leadership Team Functioning
Dr. Hope is a staff psychologist at a nonprofit organization that has contracts with
school districts in the region to assist in dealing with various emotional and behav­
ioral problems of students. Dr. Hope provides assessment, intervention, and/or con­
sulting services to deal with these problems. The superintendent in the River School
District tells Dr. Hope that the five elementary schools in the district have high rates
of disruptive behavior among their students and don’t seem to have any consistent
or effective way of dealing with this. He would like her assistance with this issue.
Dr. Hope asks the superintendent to set up a task force with membership from the
five elementary schools, including the principal, a teacher, and a special services
provider from each school. Dr. Hope suggests that she cochair the leadership team
with the school principal who is most interested in the problem and who is also
viewed as most competent and well-liked by other administrators and staff.
The superintendent has a meeting with the five elementary school principals
to explain the purpose and general process of the task force. Dr. Hope is present
and tells the principals that she would like to meet with each of them to learn about
and discuss their current di…

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