ANALYSES OF INTERORGANIZATIONAL RELATIONSHIPS AMONG COMMUNITY MENTAL HEALTH ORGANIZATIONS IN KITIMAT AND TERRACE, BRITISH COLUMBIA (1975) by THOMAS WILLIAM COLLIER B.A., University o£ Alberta, 1971 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n THE FACULTY OF GRADUATE STUDIES (Department of Health Care and Epidemiology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1979 © Thomas William C o l l i e r , 1979 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l m a k e i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e H e a d o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t o f Health Care and... Epidemiology The U n i v e r s i t y o f B r i t i s h G o l u m b i a 2075 Wesbrook Place Vancouver, Canada V6T 1W5 D a t e October 1, 1979 6 - i i -ABSTRACT This study is, in part, a product of the efforts of the Kitimat-Stikine Regional District Health Care Research Project (1975). During the course of this project interviews with repre-sentatives of local health care organizations were held in order to inventory the kinds and numbers of health care services in the Kitimat-Stikine Regional District. In assessing the roles of health care organizations in Kitimat and Terrace, British Columbia i t became apparent that a number of community mental health organizations in these two centres were experiencing varying degrees of success and/or frustrations in attempting to meet their organizational goals. In attempting to analyse these experiences i t became evident that they were frequently described in terms of the activities and decisions of other organizations. It was also considered that individual organizations had unique characteristics of an in-ternal nature which were also seen to affect the relative success they had in meeting their goals. The question then arose as to the possibility of analysing community mental health services in Kitimat and Terrace in terms of the interrelationships of the organizations which were pro-viding these services. This was seen to be a reasonable approach to the problem of analysis i n that the s p e c i f i c intent of the re-search project from which t h i s study emanated was to provide an inventory of l o c a l health care services. In considering the methodology for the analysis of these interorganizational relationships a review of the l i t e r a t u r e showed that there had been three basic approaches to organiz-a t i o n a l research used to analyse organizational behaviour. These approaches were, i n order of t h e i r development, analysis of an organization as a single unit i n terms of i t s i n t e r n a l character-i s t i c s ; analysis of an organization i n terms of i t s relationships with other organizations and, analysis, as a unit, of a group of organizations which have recurrent interactions with one another. I t was determined that each of these forms of analysis could be u t i l i z e d i n the context of the community mental health organ-izations located i n Kitimat and Terrace. This approach has important implications from a planning point of view i n that i t affords analyses of benefit to planners and administrators of ind i v i d u a l organizations within the context of t h e i r own organization's in t e r n a l framework and within the context of the o v e r a l l a c t i v i t i e s of other organizations with which'they interact. Further more, i t provides an advantageous perspective to authorities i n central planning organizations as - iv -they attempt to coordinate activities of organizations under their jurisdiction. Five specific variables were selected to facilitate the analysis of interorganizational relationships at each of the three levels. These variables were: resources; power, organ-izational autonomy; domain consensus; and interorganizational coordination. The analyses showed that each of the three levels offer unique opportunities to view the interrelationships between and/or among organizations. It was also illustrated that the third level of analysis was an abstract concept that required further development before i t could be clearly differentiated from the other levels. The five variables selected to analyse the interrelationships at each level exhibited varying degrees of relevance to the analysis. The main observation was that, al-though there was some overlap in their application to specific issues which were discussed, the five variables were able to satisfactorily address any factors which were seen to affect interorganizational relationships at each of the three levels. Overall, the three level approach to analysis of organiza-tional exchange relationships was suggested to be an appropriate method for central planning agencies to better coordinate the activities of organizations under their jurisdiction. - V -TABLE OF CONTENTS page ABSTRACT i i TABLE OF CONTENTS v DEDICATION v i i i ACKNOWLEDGEMENTS i x CHAPTER I. INTRODUCTION . . . . . . 1 Purpose . . . 1 Background 2 Rationale 4 Methodology . . 7 Description of Systems Terminology . . . . 9 C r i t e r i a 10 Factor 11 Relationships 12 Organizations 14 Format 18 I I . HISTORICAL ANTECEDENTS TO COMMUNITY MENTAL HEALTH CARE . . 20 The Early Years to World War II 22 Treatment Revolutions 24 The Community Orientation . 26 Voluntary Groups 28 Post World War II Years 30 I I I . INTERORGANIZATIONAL RELATIONSHIPS -LEVELS AND DIMENSIONS 44 Interorganizational Relationships -Level I 45 Interorganizational Relationships -Level II 49 - v i -CHAPTER page Interorganizational Relationships -Level I I I 51 Boundary Definitions 53 Dimensions of Interorganizational Relationships 55 Resources . . . . . . 55 Power i n Interorganizational Relationships 58 Organizational Autonomy 62 Domain Consensus 67 Interorganizational Coordination 69 TV. INTERORGANIZATIONAL RELATIONSHIPS -LEVEL I 72 Skenna Mental Health Centre 73 The Three Rivers Workshop 76 The Kitimat Workshop 81 Analysis 85 Resources 85 Power . . 88 Organizational Autonomy . . . . . . . . 90 Domain Consensus 92 Interorganizational Coordination . . . . 93 V. INTERORGANIZATIONAL RELATIONSHIPS -LEVEL II 95 Osborne Guest Home . 96 Skeenaview Lodge . 100 The Terrace Association for the Mentally Retarded . . . 103 Child Development Centre -Kitimat 107 Analysis 112 Resources . . 113 Power 120 Organizational Autonomy . . . . . . . . 124 Domain Consensus 128 Interorganizational Coordination . . . . '130' - v i i -CHAPTER page VI. INTERORGANIZATIONAL RELATIONSHIPS -LEVEL I I I . . . . . . 134 Example Number One . 135 Example Number Two 138 Example Number Three . 141 Analysis 144 Resources . . . 144 Power 147 Organizational Autonomy 150 Domain Consensus 153 Interorganizational Coordination . . . 156 VII. SUMMARY AND CONCLUSIONS 159 Systems Theory Concepts as Applied to This Study 159 Three Levels of Interorganizational Relationships 160 Five Dimensions, of Analysis 162 Implications . 164 Suggested Areas for Future Research . 167 REFERENCES 168 APPENDIX I 175 APPENDIX II 177 - v i i i -DEDICATION To Margie, my wife, and friend. To Ben, my son. To Mom and Dad. - i x -ACKNOWLEDGEMENTS The completion of t h i s study i s due i n large part to the eff o r t s and i n s p i r a t i o n provided by several people. A large debt of gratitude i s owed to Dr. Anne Crichton for both her patience and urgings throughout the duration of the study. Thanks also to Dr. Larry Moore for his i n i t i a l c r i t i q u e of the nascent study and for reading the f i n a l document. Dr. Mort Warner and Dr. Pauline Morris shared the duties of t h i r d reader for the thesis and while Dr. Warner read the f i n a l document both people were of immense help i n the sorting out and organization of the various pieces of the study. Special thanks go to three of my colleagues i n the Alberta D i v i s i o n of Mental Health Services; Mr. Gordon McLeod; Mr. Robert Cameron, and Mr. John Forrester for thei r encouragement and as-sistance i n the completion of the study. I am grateful to Mr. John Pousette of the Kitimat-Stikine Regional D i s t r i c t for arranging for f i n a n c i a l assistance which contributed to the continuation of my studies. Thanks go to Mrs. Shannon Evasiuk and Miss Claudia Atkins f o r t h e i r valuable typing assistance. Lastly, the most sincere and certain thanks go to my wife, Margie, whose confidence i n me, though tested, was f i n a l l y rewarded. - 1 -CHAPTER I INTRODUCTION Purpose It is the purpose of this study to discuss and analyse factors which influence relationships between and among organiza-tions concerned with various aspects of the treatment and care of mentally i l l and disabled persons in the communities of Kitimat and Terrace, British Columbia. This discussion and analysis will be accomplished through the application of systems theory con-cepts of interorganizational relationships. A subsequent purpose is to discuss the significance of these concepts in explaining problems affecting subject organizations. Particular attention will be given to implications which could directly affect the future plans and activities of these organizations. An attempt will also be made to generalize this discussion to other related fields of social policy and planning. - 2 -Background This study i s a consequence of the writer's experience as a research assistant to the Kitimat-Stikine Regional D i s t r i c t Health Care Research Project (1975). The Kitimat-Stikine Regional D i s t r i c t i s located i n the northwest of B r i t i s h Columbia. The two major centres are Terrace, with a population of 14,500, and Kitimat, with a population of 12,500. (See Appendix I for map of the area.) During the course of t h i s employment interviews with representatives of health care and s o c i a l service organ-izations revealed that within the communities of Kitimat and Terrace there are a variety of organizations involved i n the provision of d i f f e r e n t types of community mental health care. Each of the seventeen community mental health organizations i n -corporated into the study's data base are described i n summary form i n Appendix I I . A number of agencies, associations, and individuals i n these two centres described related problems and circumstances which were seen to complicate and/or frustrate t h e i r attempts to provide care for the mentally i l l and disabled. Because the community oriented mental health care concept has only recently been operationalized i n the study area as an alternative and/or supplement to previously e x i s t i n g services, the advent of t h i s community based treatment philosophy has had an impact on the numbers and kinds of mental health services - 3 -available at the community level. For example, the Community Mental Health Centre in Terrace, under the Provincial Department of Health and Human Resources, was instrumental in the establish-ment of a short-term residential treatment facility in Terrace. This facility in turn was a catalyst in the creation of a shel-tered workshop. In the restricted geographical setting of Kitimat and Ter-race the dynamics of the evolution and operation of mental health care services becomes extremely intricate and interwoven. There are a great many factors that influence efforts to develop a coordinated and integrated community based system for provision of community mental health services. Within the study area there was an expressed concern regarding the perceived lack of support from the Provincial government to help the community organiza-tions to cope with the problems of providing services. Whilst some organizations were satisfied with the support, there were other agencies and groups which were highly critical of either the lack or kind of support they were being offered. Provision of community mental health services under the aegis of the Pro-vincial government has been somewhat fragmented. The reasons for this fragmentation stem from a number of factors such as practical problems in implementing ideal combinations of community based services on behalf of the Provincial departments of Health, Human Resources, and Education; the activity of extra-governmental - 4 -groups such as the British Columbia Association for the Mentally-Retarded; the relationships between organizations at the com-munity level; and the internal characteristics of individual organizations. While i t i s apparent that these dynamics may be widely acknowledged and understood within the study area, there s t i l l remain major obstacles to the realization of an efficient and effective system for provision of services. Acquisition and disbursement of resources, and the definition and control of organizational jurisdictions are seen to be the primary areas of concern i n this regard. Rationale Mental health services, as provided i n the Province of Brit i s h Columbia, have been described as "...the most i n e f f i c -ient, ineffective, out-dated, and discriminatory of a l l our existing social and medical programmes" and as "a maze of con-f l i c t i n g and indefinable forces" (Foulkes, 1973, p.IV-C-12-6). In light of this comment the view of mental health services as an ordered, coordinated, and integrated system does not command much cred i b i l i t y . However, this fact does not preclude the use of the term system i n a discussion of the provision of mental health care services. The assumption that the word 'system' imparts an ordered process to any activity i s not always true. A substan-- 5 -ti a l body of literature advanced under the banner of general systems theory supports the notion of a rather neutral concept of system. A system has been defined elsewhere in this research as "a set of units or elements that are actively interrelated and that operate in some sense as a bounded unit" (Baker and O'Brien, 1971, p.395). There are, as a consequence of this definition, aspects of both independence and interdependence that are germane to the system concept. The independent aspect is evidenced by the fact that each unit is distinguishable from its environment. There exists some discontinuity that affords the unit an identity of its own. A boundary exists between the unit and its environment. The interdependent aspect is evidenced in the recognition of each unit as an open-system. An open-system is viewed as open in the sense that there is an input-output exchange with other units in the environment. This exchange, of course, takes place across the boundaries that define the units. The nature of the input-output transactions between units will vary according to the permeability of these boundaries. An argument could perhaps be made for viewing the aggregate of the organizational units, or systems as a suprasystem under which a l l the activities of a l l mental health care organizations can be incorporated. However, there is an inherent danger in the assumption that there is one coherent system of mental health - 6 -care organizations whose "boundaries can be w e l l defined both conceptually and empirically" (Baker and O'Brien, p.132). A suprasystem concept assumes the p a r t i c i p a t i o n of a l l organiza-t i o n a l units as a u n i f i e d whole, while i n fact there are units which maintain greater or lesser degrees of independence. That i s , there are variations i n the permeability of the boundaries of the u nits. According to the d e f i n i t i o n above i t could be r a t i o n a l l y as-serted that a unit might take on proportions at either end of an i n f i n i t e scale. In other words, whatever point of departure i s defined as a system there are subsystems and suprasystems which are bounded and which are related i n some fashion to the o r i g i n a l system. Conceptually, at lea s t , there i s a wheel within a wheel image that can be presented from the previous description. The issue that arises as a consequence of t h i s description i s the problem i n defining at which l e v e l a system becomes c r i t i c a l for the purposes of effec t i v e analysis. For purposes of t h i s study the c r i t i c a l l e v e l (or boundary) i s to be mental health care organizations located i n the communi-t i e s of Kitimat and Terrace, B r i t i s h Columbia. This i s to be the point of departure and each organization within t h i s c l a s s i -f i c a t i o n i s to be regarded as a unit or system. The u t i l i z a t i o n of s p e c i f i c dimensions to analyse relationships between and among these organizations at three dif f e r e n t levels i s seen to be one - 7 -way of ordering existing services to the mentally i l l and d i s -abled. Such an ordering process i s necessary so as to provide a basis for l o c a l planning and change. Methodology The research method consisted of interviews during which representatives of health care organizations were in v i t e d to des-cribe and discuss the operations of t h e i r organizations. The interviews were structured i n an attempt to permit a free flowing dialogue and to minimize any feelings of anxiety concerning the purpose of the interview and/or the presence of the research team i n the Kitimat-Stikine Regional D i s t r i c t . To t h i s end the i n t e r -viewer presented himself as a member of a consultant and research team associated with the Department of Health Care and Epidem-iology at the University of B r i t i s h Columbia. The intent here was to reduce the p o s s i b i l i t y of introducing l o c a l p o l i t i c a l biases regarding the role of the Regional D i s t r i c t i n health care planning. Although no research t o o l was designed for data gathering, the interview questions were formulated according to a four t i e r view of organizational behaviour as posited by Dubin (1958, p.61). The four l e v e l s ; technical, formal, non-formal, and i n -formal, were used i n order to gain both objective and subjective - 8 -information. In each interview the questioning began by s o l i c -i t i n g technical data such as function of the organization, i t s c l i e n t e l e , catchment area, programming, and professional re-lationships. The questioning then moved to discussion of the formal structure of the organization and a description of the hierarchy, s t a f f / l i n e relationships, funding mechanisms, and the organization's personnel. The non-formal l e v e l was discussed i n terms of linkages between organizations ( l o c a l and non-local) and individuals within organizations. The intent here was to deter-mine what r e a l l y happens i n the organizations' hierarchy and what was viewed to be required i n order to get things done. Infor-mation at the informal l e v e l of the organization dealt with relationships outside the professional sphere of a c t i v i t y . Social influences and "country club" types of relationships were included here. The writer was involved i n a l l interviews regarding mental health oriented organizations. In some instances two or three members of the research team participated i n the interviews. Interview summaries were compiled by the writer from notes taken during the interview. Documents such as l e t t e r s patent, annual reports, and advertising brochures were collected as and when available and were used to supplement the interview reports. - 9 -Media coverage of the a c t i v i t i e s of organizations during the two months of study on location i n the Regional D i s t r i c t was also incorporated into the research data-base. j Description of Systems Terminology Writers and researchers involved with systems theory con-cepts have refined a number of subtle variations i n the defin-i t i o n s used i n t h e i r work. The use of jargon i s at times a bar r i e r to the understanding of basic concepts involved. In an attempt to come to terms with the systems theory argot a short narrative i s used to describe important terms that are found i n th i s study. System - i s a concept that has been applied to organ-i z a t i o n a l research i n recent years. The concept derived from work done by Bertalanffy i n the bio-l o g i c a l sciences during the 1930's. The analogy-i s drawn from the notion that l i v i n g organisms, as studied by a b i o l o g i s t , are constantly i n t e r -acting with the i r environment. In t h i s analogy organizations are accorded the status of l i v i n g organisms i n that they (the organizations) i n t e r -act with t h e i r own organizational environment. Baker (1970, p.5) uses a d e f i n i t i o n for a system that would be relevant to both the b i o l o g i s t and organizational theorist. He states that a system i s : "a set of units or elements which are act i v e l y inter-related and which oper-ate i n some sense as a bounded u n i t . " I • - 10 -Systems Theory - p e r t a i n s to the study of the con-cepts i n v o l v e d i n the i n t e r a c t i o n and i n t e r d e -pendence of the components of a system as d e f i n e d above. Open Systems - "are those through where there i s a c o n t i n u i n g f l o w o f component m a t e r i a l s from the environment, and a continuous output of products o f the system's a c t i o n back to the environment" (Baker, 1970, p.7). An o r g a n i z a t i o n viewed as an open system i m p l i e s t h a t the s u r v i v a l o f t h a t o r g a n i z a t i o n i s dependent upon the nature of the r e l a t i o n s h i p s between i t and i t s environment. I n t r a o r g a n i z a t i o n a l R e l a t i o n s h i p s - are r e l a t i o n -ships t h a t are evidenced between the u n i t s or elements t h a t are components of an o r g a n i z a t i o n . R e l a t i o n s h i p s between an a d m i n i s t r a t i v e board and an executive d i r e c t o r or between a super-v i s o r and employees are examples. I n t e r o r g a n i z a t i o n a l R e l a t i o n s h i p s - are r e l a t i o n -s h i p s t h a t are evidenced between one o r g a n i z a t i o n and another. An example of an i n t e r o r g a n i z a t i o n a l r e l a t i o n s h i p might be an agreement f o r r e f e r r a l o f c l i e n t s between two s o c i a l s e r v i c e agencies. Su p r a o r g a n i z a t i o n a l R e l a t i o n s h i p s - are evidenced between an o r g a n i z a t i o n and a higher l e v e l system w i t h i n which the lower l e v e l system f u n c t i o n s as a subsystem or component ( M i l l e r , 1965, p.218). An example here would be the r e l a t i o n s h i p between a l o c a l community o f f i c e o f a government agency and the c e n t r a l headquarters i n the p r o v i n c i a l c a p i t a l . C r i t e r i a In s t a t i n g the purpose o f t h i s study three key terms are used. S p e c i f i c a l l y , these are f a c t o r s , r e l a t i o n s h i p s , and or-g a n i z a t i o n s . While these terms may have a c e r t a i n f a m i l i a r i t y - 1 1 -they must be clearly understood in terms of their usage in this thesis. Factor A factor, as represented here, is an issue which may in-fluence the relationships between organizations. The factors that are discussed in this thesis are primarily those which were identified through the interview process by various representa-tives of community mental health care organizations in Kitimat and Terrace. Issues which were not specifically mentioned by the representative are not incorporated into the primary research data and therefore cannot be assumed by the writer to be of concern to the representatives of their organizations. Factors may also be identified through review of other research data such as newspaper articles and reports compiled by organizations in the region. In addition, there may be issues which were per-ceived by the writer to influence organizational relationships that for one reason or another may not have been identified through the interview processes. Where these types of factors are incorporated into the thesis the rationale for their in-clusion shall be developed. Discussion of factors is not limited by negative or prob-lematic criteria. That i s , factors may contribute in a negative - 12 -and/or po s i t i v e manner to organizational relationships. Clearly, discussion and analysis of both types w i l l be included i n t h i s thesis. As defined by Funk and Wagnalls New Standard Dictionary of the English Language a factor i s "one of several elements or causes that produces a r e s u l t " . In applying t h i s d e f i n i t i o n the elements or causes refer to i d e n t i f i e d issues which lead or con-trib u t e to the s p e c i f i c relationships between organizations, that i s , the r e s u l t which i s produced. Relationships While i t i s possible to preface the term relationship with various adjectives i n describing the connection between two or more things, Levine and White (1961) have developed a framework for analysing organizational relationships that i d e n t i f i e d a common, ever present c h a r a c t e r i s t i c . Their argument i s that a l l relationships among l o c a l health agencies may be conceptualized as involving exchange. Organizational exchange i s defined as "any voluntary a c t i v i t y between two organizations which has con-sequences, actual or anticipated, for the r e a l i z a t i o n of th e i r respective goals or objectives" (p.585). Organizational re-lationships are not r e s t r i c t e d to those involving mutual ex-., change. Exchange i s viewed as either u n i l a t e r a l , r e c i p r o c a l , or - 13 -j o i n t , which involves a t h i r d party r e c i p i e n t . Exchange thus conceptualized i s not limited to the transfer of material goods or immediate g r a t i f i c a t i o n . The elements actually exchanged include such things as funding, technology, c l i e n t e l e , and/or information pertaining to these elements. This broad based approach to the discussion of organiza-t i o n a l relationships has received considerable support i n organ-i z a t i o n a l research l i t e r a t u r e . Aiken and Hage (1968) state that most studies of organization interdependence e s s e n t i a l l y conceive of the organization as an enti t y that needs inputs and provides outputs, l i n k i n g together a number of organizations v i a the mech-anisms of exchanges or transactions. E l l i n g and Hallebsky (1961) use the term "support" i n making reference to the a v a i l a b i l i t y of c e r t a i n kinds of resources available to hospitals i n upstate New York. For purposes of th e i r research "support" refers to an i n s t i t u t i o n receiving from i t s environment those elements i t needs to achieve i t s goals (p.190). Organizational relationships, therefore, are seen to be based on exchange processes, as defined by Levine and White, between an organization and i t s environment which includes other organizations. Mott (1970) states that "organizations maintain themselves by entering into mutually satisfactory exchange relations with in d i v i d u a l s , groups, and organizations" (p.56). An organiza-- 14 -tion's continued existence i s argued to depend upon other organ-izations making c e r t a i n resources available. Although interorganizational relationships are often d i s -cussed i n the context of cooperation and mutual s a t i s f a c t i o n , relationships of quite the opposite nature can e x i s t . Benson (1975) says that organizations' interactions with one another "may at one extreme include extensive, reciprocal exchanges of resources or intense h o s t i l i t y and c o n f l i c t at the other" (p.230). The question arises as to whether or not i t i s appropriate to view c o n f l i c t and competition as involving exchange. The above d e f i n i t i o n of exchange by Levine and White does not seem to be compromised i n th i s regard. Support for t h i s claim i s found i n Aiken and Hage when they state that "the study of interorgan-i z a t i o n a l relationships appears to be one area which can approp-r i a t e l y incorporate the processes of both c o n f l i c t and cooper-ation" (p.913). Aiken and Hage r e l y strongly upon the concept of exchange (especially resource exchange) i n th e i r discussion of interorganizational relationships. I t should be noted that physical coercion i s not viewed as a constituent of exchange relationships (Levine and White, p. 369). Organizations The organizations surveyed and incorporated into t h i s study - 15 -are diverse i n terms of structure, composition, and orientation to the f i e l d of mental health care. In order to discuss and analyse the inter-relationships of these organizations i n a meaningful way i t i s necessary to define what i s implied when the term organization i s used. March and Simon (1958) state that " i t i s easier, and prob-ably more useful, to give examples of formal organizations than to define the term" ( p . l ) . The United States Steel Corporation, the Red Cross, the corner grocery store, and the New York State Highway Department are c i t e d as examples of organizations. March and Simon excuse t h e i r decision to forego the rigours of a d e f i n i t i o n of organizations because of a major d i f f i c u l t y they see i n c l e a r l y d i f f e r e n t i a t i n g between an "organization" and a "non-organization" ( p . l ) . E t z i o n i (1964) almost becomes an apologist for the defin-i t i o n by example approach of. March and Simon. He says that "corporations, armies, schools, hospitals, churches, and prisons" are organizations while " t r i b e s , classes, ethnic groups, friend-ship groups, and f a m i l i e s " are not (p.3). Fortunately such ambiguity i s remedied through more e x p l i c i t d e f i n i t i o n s by a number of theorists researching the organiza-t i o n a l f i e l d . Furthermore the d e f i n i t i o n s that are presented are a l l very c l o s e l y related and a common thread remains i d e n t i f i a b l e i n these d e f i n i t i o n s . - 16 -Parsons (1956) says that organizations are distinguished from other types of s o c i a l systems by one d e f i n i t i v e character-i s t i c . A l l organizations have "as a formal a n a l y t i c a l point of reference, primacy of orientation to the attainment of a s p e c i f i c goal" (p.64). Further to t h i s "an organization ... produces an i d e n t i f i a b l e something which can be u t i l i z e d i n some other way by another ... organization" (p.65). E t z i o n i (1964) interprets Parsons' d e f i n i t i o n as meaning a " s o c i a l unit devoted primarily to attainment of s p e c i f i c goals" (p.3). In a subsequent statement, E t z i o n i says that "organiza-tions are s o c i a l units (or human groupings) deliberately con-structed and reconstructed to seek s p e c i f i c goals" (p.4). Katz and Kahn (1966) describe c e r t a i n ch a r a c t e r i s t i c s of organizations i n terms of the actions of individuals composing the organization. They state that a l l organizations consist of "patterned a c t i v i t i e s of a number of i n d i v i d u a l s " and that "these patterned a c t i v i t i e s are complementary or interdependent with re-spect to some common output or outcome; they are repeated, r e l -a t i v e l y enduring, and bounded i n space and time" (p.17). These de f i n i t i o n s and descriptions of organizations are s i m i l a r enough to show that there i s some agreement as to the basic underlying characteristics germane to every organization. For purposes of t h i s thesis these cha r a c t e r i s t i c s w i l l pertain. - 17 -There must be a group of ind i v i d u a l s , working i n concert toward a common end or goal. Beyond the theoretical d e f i n i t i o n s of an organization there are other s p e c i f i c c r i t e r i a for the inclus i o n of an organization i n t h i s thesis. F i r s t l y each organization w i l l be geographically located or represented within the boundaries of the Kitimat-Stikine Regional D i s t r i c t . Local o f f i c e s of agencies which have headquarters elsewhere are thereby included i n the study. The second major c r i t e r i o n for inclusion i s not as e a s i l y defined as a geographic boundary. The d i f f i c u l t y l i e s i n the d e f i n i t i o n of a mental health care organization. From a r e a l -i s t i c point of view one cannot r e s t r i c t the discussion to organ-izations ... "l a b e l l e d mental health. The mental health of the community i s i n the hands of the schools, the churches, the s o c i a l agencies, and many other organizations" (CMHA, 1963, p.60). For purposes of t h i s thesis however, there i s no attempt to examine the welter of organizations that have various levels of involvement i n the mental health care f i e l d and to excise appropriate segments from the organization. The l o g i s t i c s of that exercise require that an arb i t r a r y d e f i n i t i o n be chosen. In order for an organization to be incorporated into t h i s thesis as a subject, the primary goal of that organization must be d i r e c t l y related to the provision of mental health services. In the case of educational, j u d i c i a l , and welfare agencies where - 18 -mental health services are considered as special supplements to the main programme of the organization only those special ser-vices will be discussed. For example, special opportunity class-rooms within the school system will be discussed whilst the school system will not, except in terms of the special programme. Finally, i t should be noted that organized consumer groups as well as direct service organizations will be considered in this study. Format This study is divided into seven chapters. Chapter I in-cludes the purpose, background, rationale, methodology, format, a discussion of terms pertinent to the thesis, and a discussion of the criteria used in defining factors, relationships, and organ-izations for purposes of this thesis. Chapter II consists of a broad historical review of the development of community mental health care movement. It is intended that this narrative will provide a longitudinal perspective from which to view the devel-opment and current status of the community mental health care services in Kitimat and Terrace. Chapter III consists of two parts. The first is a review of the literature pertaining to systems theory concepts of interorganizational relationships. In this review there will be a short discussion of each of three - 19 -levels of interorganizational analysis. These levels deal re-spectively with internal aspects of organizations which affect interorganizational relationships; relationships between organ-izations; and relationships among organizations. The second part of the chapter reviews five dimensions relevant to interorgan-izational relationships. These dimensions are resources; power; organizational autonomy; domain consensus; and interorganiza-tional coordination. Chapters IV, V, and VI will deal respec-tively with factors affecting the three levels of organization described above. Each chapter will analyse the identified factors at each level in light of the above mentioned dimensions. In Chapter VII after summarizing the major points established in the thesis and discussing the significance of interorganizational theory in explaining various circumstances affecting the subject organizations, implications for community oriented mental health care and other related fields of social policy and planning will be discussed. ; - 20 -CHAPTER II HISTORICAL ANTECEDENTS TO COMMUNITY MENTAL HEALTH CARE In this chapter a cursory history of the mental health move-ment will be presented in two sections. The first will discuss developments prior to World War II and the second will deal with the period from the end of World War II to the present. The in-tent of the chapter is not to simply chronicle events but to pro-vide examples of and insights into the processes that have led to the present organizational mosaic in the community mental health field. The community approach to provision of mental health ser-vices has been a movement which has generated, over the past quarter of a century, a large amount of attention, concern, and support but has only recently been operationalized as an alter-native to previously existing residential services. Inasmuch as these previously existing services have and likely will continue to exist, the advent of the community mental health services is more appropriately described as an addition to, rather than a substitute for, the original services. - 21 -It i s necessary to have some understanding of pre-existing services i n order to gain an appreciation for the extent and nature of the more recent changes. In addition, the development of these new and expanded services must be discussed i n order to f u l l y comprehend the issues which presently influence the a c t i v -i t i e s and interrelationships of organizations concerned with delivery of mental health services i n community settings. The h i s t o r i c milestones i n the development of the community mental health services i n B r i t i s h Columbia paralled those else-where i n North America (Foulkes, 1974, p.37). Indeed, the mental health care f i e l d , up u n t i l the end of World War I I , was rather homogeneous, i n terms of f a c i l i t y and professional development, both i n Canada and the United States. Roberts (1970) says that "The development of mental health services i n Canada has not varied appreciably i n i t s q u a l i t a t i v e aspects from the rest of North America" (p.21). A l l o d i and Kedward (1977) reinforce t h i s view by c i t i n g the d i f f i c u l t y i n describing the "evolution of Canadian psychiatry and i t s i n s t i t u t i o n s without considering at the same time a number of related events that took place i n the United States" (p.219). There are, as s h a l l be discussed l a t e r i n t h i s chapter, both s i m i l a r i t i e s and differences i n the exper-iences of both countries. The s i m i l a r i t i e s occurred p r i m a r i l y i n the years p r i o r to 1960. The early 1960's became the period of d i f f e r e n t i a t i o n , p r i m a r i l y i n the structures that were developed - 22 -i n the two countries. Because of the s i m i l a r i t i e s t h i s chapter borrows heavily from the abundance of information pertaining to the United States experience. Examples of the Canadian paral-l e l s , especially i n the early years, do not appear to be as r e a d i l y retrievable. Nonetheless, they w i l l be used where pos-s i b l e to v e r i f y that the United States information i s relevant to the Canadian experience. The Early Years To World War II H i s t o r i c a l recapitulations of the development of mental health services i n North America point out that there are ident-i f i a b l e phases defining the evolution of strategies f o r caring for the mentally i l l (Rossi, 1969: Hobbs, 1969: Brand, 1968: Foulkes, 1974). The f i r s t phase was characterized by i n d i f -ference, ignorance, and fear (Foulkes, 1974, p.12) on the part of both the c l i n i c a l authorities and the general public. The mentally i l l were usually viewed with uncertainty and mistrust and were afforded custodial care i n prisons, poor houses, a t t i c s , or l i k e accommodation. A change i n t h i s approach occurred i n the l a t e nineteenth century with the establishment of i n s t i t u t i o n a l f a c i l i t i e s dedi-cated s o l e l y to the care of the mentally i l l . In the United States the a c t i v i t y of Dorothea Dix between the years 1841 and - 23 -1887 was the p r i n c i p a l factor which influenced the various State legislatures to assume r e s p o n s i b i l i t y for more humane custody and treatment of the mentally i l l (Yolles, 1969, p.6). This process, which was replicated i n Canada (Foulkes, 1974, p.12), removed any r e s p o n s i b i l i t i e s the public may have had for the care of the mentally i l l and fostered i n society a comfortable "out of sight - o u t of mind" attitude. Although the move to i n s t i t u t i o n a l i z e d care was i n i t i a l l y based on humanitarian motives (Yolles, p.6: Hobbs, p.29: Schwartz, 1970, p.336) the hospitals of the early 1900's were soon isola t e d i n both a professional and geographical sense. The hospitals stagnated, became overcrowded, and conse-quently the humanistic motives were compromised through neglect, i s o l a t i o n , and the insular attitudes of hospital professionals which were fostered through these circumstances (Yolles, p.6). Foulkes has chronicled these developments i n the B r i t i s h Columbia experience. "A statement of p r i n c i p l e s of the "moral treat-ment" was written into the 1902 Annual Report. These were l i s t e d as e s s e n t i a l medicines; good food; reg u l a r i t y of l i v i n g habits; employment; amusement, and recreation" (p.13). Foulkes goes on to c i t e conditions of overcrowding i n B.C. i n s t i -tutions which compromised the humanistic approach nearly as soon as i t was operationalized. - 24 -"... i n spite of the transfer of 48 patients to a s a t e l l i t e unit i n Vernon i n the i n t e r -i o r of the province, surplus admissions were accommodated at the New Westminster j a i l . Some thought was given to accommodating patients i n tents during the winter as w e l l as summer when 25 paroled patients were ac-commodated i n th i s way i n 1904" (p.14). These conditions were to p r e v a i l f o r some years to come. Subse-quently the "moral" motivations become more and more obscure with the passage of time. Between 1913 and the end of the Second World War "the basic p r i n c i p l e s of indi v i d u a l i z e d treatment v i r t u a l l y disappeared" (Foulkes, 1974, p.17). Treatment Revolutions I t was during t h i s i n t e r v a l that the work of Sigmund Freud came to l i g h t and gained widespread prominance and acceptance i n explaining the causes of mental i l l n e s s . Hobbs makes reference to the paradoxical consequences Freudian psychoanalytic thinking had upon the general f i e l d of mental health and c i t e s i t as a "second revolution" having major impact upon the approach to treatment of mental disorders. While he does not s p e c i f i c a l l y discuss the relationship between t h i s second revolution and the community mental health care f i e l d , Hobbs i s c r i t i c a l of the tendency for v i r t u a l l y a l l professionals to become preoccupied with i n d i v i d u a l , one to one, treatment modalities (p.30). He - 25 -believes these approaches were counter productive i n terms of providing the most benefit for the greatest number. Psychoanalysis and more s p e c i f i c a l l y "the private practice of psychiatry or psychology ... does not provide a sound base for the development of a national mental health programme" (p.33). Hobbs' argument implies that the legacy of Freud's revolutionary approach to treatment of mental i l l n e s s may i n fact be a double edged sword, on the one,hand making advances towards explaining the nature of man's behaviour while on the other hand providing a " t o o l " far too unwieldy to e f f e c t i v e l y manipulate i n a comprehensive ap-proach to the mental health care f i e l d . This notion i s supported by Foulkes (1974) when he states that Freud's contemporary Sandor Ferenczi's "prediction that 'the insane asylum w i l l be trans-formed into a psychotherapeutic i n s t i t u t i o n i n which psycho-a n a l y t i c a l l y trained physicians w i l l occupy themselves with each case every day, and i f possible, for an hour a day', was f a r to sanguine" (p.18). The implication of Ferenczi's statement i s c l e a r l y that the psyc h i a t r i s t ' s orientation would become l o c a l -ized within the i n s t i t u t i o n thereby diminishing the role played wit h i n the community. We see, however, that i n spite of the advances i n psycho-therapy the impact of the l e g i s l a t o r s i n dealing with mental health problems was largely l i m i t e d to maintenance of the over-crowded i n s t i t u t i o n s (Yolles, p.7). Furthermore, "the attitude - 26 -toward mental i l l n e s s remained largely administrative and l e g a l , rather than medical and therapeutic" (C.H.M.A., 1963, p.3). The Community Orientation In spite of t h i s regression i n the treatment of patients i n psychiatric f a c i l i t i e s , the period between the early 1900's and the Second World War was one which was c r u c i a l to the furthering of the community mental health care system. The concept of community based psychiatric f a c i l i t i e s i s c i t e d by Rossi as dating back to the 1890's when medical men such as Frederick Pedersen and John Chapin of the United States pro-posed the creation of a "psychopathic h o s p i t a l . " This new i n -s t i t u t i o n "was to be located i n the community i t served, i n con-t r a s t to the location of asylums, and i t s primary function would be the provision of treatment rather than custodial care" (Rossi, p.11). I t was expected then that early treatment, proximity to friends and r e l a t i v e s , and the involvement of the l o c a l medical personnel would come to bear heavily on the outcome of i n s t i -t u t i o n a l care. Such hospitals, i n f a c t , were established i n the United States and, while t h e i r numbers were not large Rossi as-serts that "they were instrumental i n stimulating ... community interest i n the mentally i l l as w e l l as the interest of hospital - 27 -personnel i n communities.'' Furthermore the " i n t e r d i s c i p l i n a r y approach to the mental health problem ... was the f i r s t developed wit h i n these hospitals" (Rossi, p.11). The precursors of present day community mental health c l i n -i c s were also developed i n t h i s era. These early c l i n i c s were, i n some cases, examples of psychi a t r i c i n s t i t u t i o n s extending the bounds of t h e i r f a c i l i t i e s into the community. In other i n -stances these c l i n i c s were the products of the involvement of research, educational, philanthropic, and eventually governmental organizations i n the f i e l d of mental health. Rossi suggests that the advent of community c l i n i c s i n the United States was stimu-lated substantially i n the 1920's by three factors. These were the c h i l d welfare movement, the increased public awareness of various mental health problems brought to l i g h t by the findings of the prevalence of mental disorders i n m i l i t a r y personnel during World War I, and the increased a c t i v i t y of the National Committee for Mental Hygiene (Rossi, p.13). The c h i l d welfare movement was largely a product of "concern over juvenile delinquency" and court related punishments (Yolles, p.8). The concept, however, enlarged i t s scope to incorporate relationships with schools and s o c i a l agencies. These r e l a t i o n -ships have persevered over time to a point where the movement has developed such influence that there i s considerable evidence that through i t a comprehensive range of mental health services f o r - 28 -children can be provided (Yolles, p.9). While there appears to be no unitary body or organization that has furthered t h i s com-prehensive view i t i s apparent also that these early beginnings have yielded long l a s t i n g consequences, witness e f f o r t s of the Joint Commission on the Mental Health of Children i n the United States. The discovery of mental problems i n American r e c r u i t s during World War I prompted the development i n 1930 of a d i v i s i o n of mental hygiene i n the United States Public Health Services (Yolles, p.8). This eventuation notwithstanding i t i s apparent that i t was not u n t i l after World War II had produced grave concerns which were translated into m i l i t a r y and economic terms that "the nation's mental health was seen as d i r e c t l y influencing the functioning of the national as w e l l as l o c a l governments" (Rossi, p.25). Canada, l i k e many other nations involved i n the Second World War, saw health, generally, i n a national perspec-t i v e only after the war showed a need for rebuilding the country. Voluntary Groups The advent of c i t i z e n involvement i n mental health both i n Canada and the United States seems to be widely attributed to the e f f o r t of C l i f f o r d W. Beers i n the early 1900"s (Yolles, p.7). Beers i s credited for founding a small voluntary mental health - 29 -organization i n the State of Connecticut i n 1908. This organiza-t i o n was dedicated to the reform of the gross inadequacies e v i -denced i n the i n s t i t u t i o n a l treatment of mental i l l n e s s which Beers himself had experienced. From t h i s modest beginning Beers, only one year l a t e r and with assistance from men such as Adolf Meyer and William James, established the National Committee f o r Mental Hygiene. This or-ganization was, at f i r s t , p rimarily oriented toward research which was used to support "public education," lobbying for pas-sage of favourable l e g i s l a t i o n , and the improvement of the i n s t i t u t i o n a l f a c i l i t i e s for the care of the mentally i l l . Since that time the r o l e of the organization has broadened consider-ably. In 1950 i t became the National Association for Mental Health. There are other examples of voluntary organizations which have been imported to or created within Canadian borders. Most of these groups were philanthropic i n nature or else were based upon the concept of mutual a i d . The parent body of the C.M.H.A. i s only one of the f i r s t . The point here i s that c i t i z e n p a r t i c -i p a t i o n i n the community mental health movement was originated i n an era long past. Though the int e n s i t y of the c i t i z e n involve-ment has waxed and waned over time i t i s evident from t h i s present research that i t s current status and l e v e l of importance - 30 -i s of major relevance to organizational studies i n the community mental health f i e l d . Post World War II Years The slow change of the pattern of organization and financing of mental health services to 1950 "has culminated i n what may be a new s o c i a l concept that may we l l mark the end of the treatment, i n r e l a t i v e i s o l a t i o n , of those a f f l i c t e d with mental i l l n e s s and retardation" (Foulkes, p.27). There has been a turnabout i n the rate of change i n t h i s pattern so that today there i s a rapid acceleration of growth of community mental health concepts. A number of factors have con-tributed to t h i s phenomenon, some of which have been described i n the previous section. There are, however, two catalysts that have been primarily responsible for t h i s rapid change and which have had an impact i n both North America and Europe. The f i r s t was the advent of psychotropic drugs which demonstrated that mental i l l n e s s could be controlled, behaviour modified, and sub-sequently that early discharge from psychiatric i n s t i t u t i o n s was possible. The second factor was an administrative revolution. I t was t y p i f i e d by an increased.willingness on behalf of the psychiatric i n s t i t u t i o n s to decentralize t h e i r f a c i l i t i e s by moving from a closed system to a more open approach to treatment. - 31 -The hospital became only one of many services such as out-patient, day care, hostels, and community c l i n i c s (Foulkes, 1974, p.29: Jones, 1972, p.293). The stays i n mental hospitals were shortened and by 1960 there were even decreased i n the patient populations of these hospitals (Foulkes, 1974, p.28). I t would be misleading to suggest that these developments were e a s i l y brought about. Changes i n treatment theories and technologies have generally outpaced t h e i r implementation. The art of mental health treatment has not kept i n step with the science. As the mentally i l l were returned to the community there were many attendant problems. John and Elaine Cumming (1957) conducted studies which showed the reluctance of society to readmit the former psych i a t r i c patients to the community. Social reintegration of i n s t i t u t i o n a l i z e d patients returning to th e i r communities i s equally d i f f i c u l t for the patient who may have l o s t s o c i a l s k i l l s during a hospital stay (Goff man, 1961). It i s apparent that i n the 1950's the United States and the Canadian experiences i n the community mental health f i e l d began to diverge somewhat. The reason f o r t h i s divergence i s related to federal involvement i n funding of projects. In the United States, federal l e g i s l a t o r s introduced b i l l s that provided f i n a n c i a l backing i n support of the community men-t a l health concept (Rossi, p.10). In 1955 The Health Amendments Act provided funding to the States i n support of mental health - 32 -demonstration projects. In 1961 a nation wide project, the Joint Commission on Mental Il l n e s s and Health, submitted a report analysing the state of the mental health care f i e l d . This docu-ment c i t e d the need for change from the i n s t i t u t i o n a l approach to care and recommended the establishment of a national mental health programme u t i l i z i n g community based mental health f a c i l -i t i e s (Yolles, p.11). In 1963 The Community Mental Health Centres Act was passed which provided substantial funding for construction of community mental health centres. Although i n subsequent federal administrations the support granted through this.Act was reduced substantially (Gorman, 1976, p.123), i t i s clear that the federal involvement has had and may wel l continue to exert considerable p o s i t i v e influence on the community mental health concept i n the United States. In Canada, however, there has been a less vigorous federal involvement. Under The B r i t i s h North America Act of 1867, prov-inces were given primary r e s p o n s i b i l i t y for a l l health care mat-ters. Within that context, however, mental health, public health, and physical health services have a l l taken on dif f e r e n t structures. Mental health services have remained almost ex-c l u s i v e l y within the domain of the P r o v i n c i a l j u r i s d i c t i o n s . P r o v i n c i a l control over the other services has not been as cen-t r a l i z e d as i t has been for mental health. Public health ser-vices i n most provinces have moved, over the years since Confed-- 33 -eration, from l o c a l l y autonomous control under the j u r i s d i c t i o n of municipal governments to "the d i r e c t provision by the province of l o c a l public health services through health u n i t s , except i n the case of large c i t i e s " (Canada, 1966a, p.5). This pattern has led to a shared r e s p o n s i b i l i t y for public health services. Hastings and Mosley document that developments i n medical and hospital services have also led to a sharing of j u r i s d i c t i o n s . " U n t i l recently, a c t i v i t y by the provinces i n the d i r e c t provision of hospital service was r e s t r i c t e d to maintaining and financing care i n mental hospitals and tuberculosis sanatoria. Then during the depression of the 1930's many municipalities found them-selves unable to meet the costs of basic assistance, including h o s p i t a l i z a t i o n , f o r t h e i r indigent c i t i z e n s . P r o v i n c i a l as-sistance to general hospitals and towards plans for financing basic medical care for s p e c i f i c indigent groups began and has steadily grown. This was carried forward by the need for more extensive 1care for people with c e r t a i n types of disease, f o r example, p o l i o m y e l i t i s and cancer. Then pr o v i n c i a l hospital insurance programmes were developed after World War II i n several provinces. "Under the federal Hospital Insurance and Diagnostic Services Act of 1957 and comple-mentary l e g i s l a t i o n i n each province the operating costs of hospitals are now covered through p r o v i n c i a l l y operated plans. A good deal of supervision and advice on planning and operating hospitals are provided by the d i v i s i o n s concerned with hospitals and the hospital plans either i n p r o v i n c i a l health departments or i n separate p r o v i n c i a l hos-p i t a l commissions. As w e l l , extensive fed-- 34 -er a l and p r o v i n c i a l grants for hospital construction, extension, and renovation are now made" (Canada, 1966a, p.7). Federal involvement i n the form of the National Health Grants Program of 1948 encouraged p r o v i n c i a l health surveys which made s p e c i f i c recommendations regarding mental health services (Canada, 1966b, p.5). The recommendations produced by the prov-inces were, however, not very innovative i n that they preferred largely to deal with "expansion and extension of the existing structure and pattern of services" (Canada, 1966b, p.6). This l i m i t a t i o n , notwithstanding these surveys, d i d serve to point out the serious shortcomings of mental health services i n terms of manpower and f a c i l i t i e s . These Mental Health Grants helped to some extent to i n j e c t new v i t a l i t y into p r o v i n c i a l mental pro-grammes (C.M.H.A., p.3) but f a i l e d to provide the basis for a coordinated planning e f f o r t between the provinces and the federal government. It i s important to make a d i s t i n c t i o n between the develop-ments i n Canada and the United States after 1963. While the United States began to develop i t s Community Mental Health Centres Canadian psychiatrists through an a l l i a n c e with the Canadian Mental Health Association agitated for change using as th e i r theme the contention that 'mental i l l n e s s should be dealt with i n the same organizational, administrative, and professional - 35 -framework as physical i l l n e s s " (CM.H.A., p.38). The use of general hospital f a c i l i t i e s was advocated as a viable method of providing community mental health services. This was accepted by pr o v i n c i a l governments as a reasonable approach to providing comprehensive community mental health care programmes. Clearly the psychiatric wing of the medical profession was anxious for t h i s to happen. They did , i n making the recommendations con-tained i n More for the Mind, remain cognizant of the roles of other agencies i n the l o c a l communities. The role of the psychiatric centre however was not emphas-ized. In fa c t , i t was regarded as a poor alternative to f a c i l -i t i e s i n the general hospital. "In some circumstances i t may be desirable to base the psychiatric services for a community i n a specialized centre, but i n the interest of integration with other branches of medicine the psychiatric service i n the general hospital should become the standard pattern" (C.M.H.A., p.196). Hindsight shows that these recommendations were taken seriously by many provincial, j u r i s d i c t i o n s . Several hospitals, especially those i n the large c i t i e s have had psychiatric f a c i l -i t i e s incorporated into t h e i r operation. The creation of psy-c h i a t r i c f a c i l i t i e s i n hospitals led to a future d i v i s i o n of authority over provision of services, for i n most instances the hospital and not the province retained control over use of the f a c i l i t i e s . - 36 -Voluntary and professional organizations began to increase t h e i r a c t i v i t i e s on behalf of the mentally i l l and disabled. The Canadian Association for Retarded Children was established shortly after World War II (Canada, 1966c, p.13) and the Canadian Mental Health Association began to operate on a higher p r o f i l e on the federal and p r o v i n c i a l scenes as wel l as at the community l e v e l (C.M.H.A., p.5). In l a t e r years the Commission on Edu-cational and Learning Disorders i n Children (C.E.L.D.I.C.) pub-lished i t s report e n t i t l e d One M i l l i o n Children i n 1969. The C.E.L.D.I.C. report was the product of an amalgam of s i x Canadian voluntary organizations a l l very much concerned with s p e c i f i c areas relevant to the mental we l l being of children. The voluntary associations and government o f f i c i a l s at a l l levels worked i n concert with one another i n many respects i n -cluding research, creation of programmes, and provision of f a c i l -i t i e s (Canada, 1966c, p.13: Foulkes, 1974, p.32). While these r e f f o r t s were successful i n regard to provision of services and i n reshaping public attitudes toward mental i l l n e s s i t also had the unpropitious p r o c l i v i t y to fragment, the services. Fragmentation of services was an unavoidable r e s u l t of the m u l t i p l i c i t y of health agencies (government, voluntary, and professional) that prevailed at a l l levels of society (Goerke, 1964, p.715: C.E.L.D.I.C, Ontario Committee, 1970, p.6). - 37 -It should be noted here that there has been a recent advent of consumer oriented, mutual a i d organizations. Self help groups have been developed as alternatives to the more t r a d i t i o n a l pro-f e s s i o n a l l y staffed organizations. These organizations are not wide spread across the country but i n Vancouver, B r i t i s h Columbia an organization c a l l e d the Mental Patients Association has been i n existence for several years and has been developing a very i n -dependent r o l e i n i t s approach to mental health services. The increased a v a i l a b i l i t y of psychiatric care as provided by private physicians i n the 1950's i s another factor which con-tributes to the d i v i s i o n of u n i f i e d or coordinated mental health services. Coates (1972) has argued further that i n Canada plan-ning has been frustrated by professional dominance which i s characterized by the ps y c h i a t r i s t s desire to provide specialized services to the exclusion o£ other professionals. These profes-sionals should be able to complement any services beyond those which the p s y c h i a t r i s t i s w i l l i n g or able to provide. Coates has also been c r i t i c a l of other aspects of the plan-ning process i n provision of community mental health services. "The prime need i n mental health services i s for a reorientation of planning. Planning should s t a r t with a community, examine i t s needs and problems, i d e n t i f y the smoothly running functions and those which are con-f l i c t u a l , and only after t h i s consider the provision of services and how they best may - 38 -be organized. Such a program runs counter to a l l e x i s t i n g mental health planning i n Canada, which has begun by focusing on the most overt and pressing need, namely for psychiatric h o s p i t a l i z a t i o n , and i n succes-sive order has introduced general hospital use, prepaid psychiatric services and only now and infrequently engages with community services and community planning groups." (Coates, 1974, p . l ) . Although speaking i n a United States context the comments of Fairweather, Sanders, Tornatsky, and Harris (1974) are seemingly appropriate to Canada i n view of Coates' statements. Fairweather et a l state that, h i s t o r i c a l l y , change i n the f i e l d of mental health has never been based on validated premises. "... mental health programmes have more often than not been i n s t i t u t e d on the basis of the authority of the advocate for that programme rather than upon any careful longitudinal exploration of the outcomes ..." (p.2). B r i t i s h Columbia has not escaped the phenomenon of frag-mented services. The pattern of cooperation between governments and voluntary agencies has l e f t a legacy of special schools, classrooms, sheltered workshops, and hostels which are respon-s i b l e to various j u r i s d i c t i o n s . The government has established community mental health centres throughout the province. General hospitals have added psychi a t r i c beds to t h e i r acute care pro-grammes and the family physician has begun to widen his approach to the treatment of psychiatric disorders. The public health - 39 -un i t s , schools, and voluntary organizations have a l l become i n -volved i n the provision of direct c l i e n t services (Foulkes, 1974, p.32). In 1967 the Province of B r i t i s h Columbia acknowledged the need for increased planning, for community mental health services. Foulkes (1974) c i t e s the government's statement re f e r r i n g to the reorganization and reorientation of B.C.'s mental health services. " I t w i l l no longer be primarily 'service' oriented but w i l l assume increased respon-s i b i l i t y for the o v e r a l l aspects of mental health planning, i n order to f a c i l i t a t e the decentralization and regionalization of mental health programmes throughout the province" (p.34). This new approach seems to place increased onus upon the l o c a l communities for provision of services but at the same time i n d i -cates that the province accepts r e s p o n s i b i l i t i e s i n advancing and a s s i s t i n g i n t h i s t r a n s i t i o n to the community. The consequences of such a p o l i c y d i r e c t i o n were l i k e l y to be s i g n i f i c a n t i n determining the nature of s p e c i f i c services provided i n B r i t i s h Columbia communities. The government's desire to involve the grass roots by ex-tending to them both funding and authority may have been premature i n some instances. That i s , the delegation of respon-s i b i l i t i e s and power may have had consequences which had not - 40 -necessarily been foreseen by the governments (Crichton, 1976, p.64). Further to t h i s Crichton argues that "there has been a general absence of control over l o c a l i n i t i a t i v e s which has led to uneven development and lack of linkages between d i f f e r e n t parts of the system" (p.63). An added consideration here i s the demographic and geo-graphic d i s p a r i t i e s that e x i s t i n the Province of B r i t i s h Col-umbia. With the heavy concentration of population i n the lower mainland area there are l i k e l y to be d i s p a r i t i e s i n the rates at which the d i f f e r e n t areas of the Province are going to be able to develop. P o l i c i e s which are appropriate for areas i n the south-west of B r i t i s h Columbia w i l l not necessarily be appropriately applied to sparsely populated areas i n the north. Compounding th i s i s the d i f f i c u l t geography of the entire Province which can contribute to problems i n communication and transportation. There w i l l need to be a f l e x i b l e approach to the administra-t i o n of the p o l i c y which w i l l allow for unique community char-a c t e r i s t i c s . The implications of p o l i c y for interorganizational relations within these communities w i l l l i k e l y be as s i g n i f i c a n t as the nature of the services provided. By way of conclusion to t h i s chapter a resume of an a r t i c l e by Palmiere (1965) i s presented which, though written i n refer-ence to circumstances i n the United States, seems to appropriately apply i n summary of the present texture of the community mental - 41 -health movement in Canada as well. Palmiere cites five specific problems which affect the pro-vision of coordinated health services at the community level. The f i r s t is an inadequate knowledge of the processes and nature of mental illness. This pertains not only to profes-sionals working in the field but to other individuals who for various reasons have interests in the planning for community mental health services. Mental illness is a phenomenon which seems to invite citizen participation and about which many par-ticipants have varying levels of understanding. The second factor is the rapid change in technical,.atti-tudinal, and organizational characteristics. There are an ex-panding variety of institutions and agencies providing services within local communities. There are as a consequence, problems of competition for resources and coordination of expanded services. The third and related factor is the overlap which exists be-tween social services and medical care services. Although there are elements of each which pertain to the mental health care field, the interface between the two is subject to friction be-cause of contrasts in the organization and provision of services. The involvement of various types of governmental, voluntary, local, and non-local organizations in each area tends to accen-- 4 2 -tuate the potential for problems i n providing l o c a l community services. A fourth consideration relates to the unique characteristics of the community. Every community i s dif f e r e n t and changing as i t grows or regresses. The problems i n achieving consensus f o r programming mental health services are common to both non-local and l o c a l organizations. Programmes may have to be implemented according to unique characteristics of the community. The f i f t h problem that i s an indicator of a turbulent en-vironment relates to the planning process and the lack of a central o v e r - a l l coordinating body. Cooperation or even co-ordination become extremely complex propositions to surmount when dealing with multiple j u r i s d i c t i o n s . Planning must take into account the multidimensional relationships i n the environmental context and as a consequence i s seen to be a process requiring considerable patience and understanding on behalf of the actors i n the planning exercise. While the h i s t o r i c a l developments of the community mental health movement are only b r i e f l y summarized here the s p i r i t of the movement can be appreciated through t h i s presentation. The trend toward community mental health i s unmistakeable and i s evident throughout North America. I t has been i l l u s t r a t e d here that the trend has evolved i n two phases. P r i o r to World War II the concepts were i d e n t i f i a b l e but i t i s the era subsequent which - 4 3 -has witnessed the consolidation and ac t u a l i z a t i o n of these con-cepts i n terms of p o l i c y and service. While the actual develop-ment i s s t i l l i n i t s early stages i t i s clear that the community mental health concept has reached the end of i t s beginning and i s now being tested i n the f i e l d . - 44 -CHAPTER I I I INTERORGANIZATIONAL RELATIONSHIPS -LEVELS AND DIMENSIONS It i s the purpose of t h i s chapter to describe the three levels of interorganizational relationships that w i l l be used i n describing community mental health care services and to discuss f i v e major dimensions which w i l l be used to develop analysis of relationships at each of the three l e v e l s . The f i r s t of the three levels takes the interorganizational perspective. The in t e r n a l characteristics of an organization are related to the organization's environment. The second l e v e l con-cerns analysis of relationships between organizations that i n t e r -act with one another on a regular basis. The t h i r d and more abstract l e v e l conceives of groups of organizations acting as complete s o c i a l systems within an organizational f i e l d . The second part of t h i s chapter w i l l discuss major variables i d e n t i f i e d i n the l i t e r a t u r e as being of paramount importance to the nature of interorganizational relationships. These variables w i l l be discussed under the broad categories of resources, power, - 45 -organizational autonomy, domain consensus, and coordination of services. Interorganizational Relationships - Level I Social science research on organizations had been concerned primarily with intraorganizational phenomena such as the i n -divi d u a l within an organization, the relations among the members of a group i n an organization, informal and formal groups, and structural attributes of an organization (Evan, 1965, p.B217: E l l i n g and Halebisky, p. 188: White, 1968, p.289: Levine, White, and Paul, 1963, p.1183). It i s only recently that ind i v i d u a l organizations have been studied i n relationship to other organizations i n a t o t a l system (Negandhi, 1970, p . l ) . This new approach, notwithstanding, i t i s important not to ignore the in t e r n a l aspects of organizations when dealing with concepts of interorganizational relationships. As Zeitz (1975) argues: "Organizations are not seen as deterministic atoms operating i n a generalized f i e l d . Rather they are to a greater or lesser extent, i n -struments of s o c i a l control and s o c i a l action ... At the same time, organizations themselves are r e a l s o c i a l units with t h e i r own in t e r n a l dynamics, with power, and with survival needs which can threaten to subvert the u t i l i t y of organizational instruments f o r any ra t i o n a l s o c i a l ends" (p.45). - 46 -This study i s interested i n intraorganizational r e l a t i o n -ships p r i n c i p a l l y as they r e l a t e to an organization's r e l a t i o n -ship with i t s environment, or more s p e c i f i c a l l y , with other organizations. There i s , i n th i s t a c t i c , a subtle turnabout i n that the usual approach to discussions of i n t r a and interorgan-i z a t i o n a l relationships deals with the effect of the environment on i n t e r n a l organizational behaviour (Aiken and Hage, 1968). The more t r a d i t i o n a l approach seems to i n f e r that an organization i s a reactive e n t i t y when i n fact the relationship between an organ-i z a t i o n and i t s environment i s a double edged sword. That i s , ju s t as an organization's i n t e r n a l relationships are affected by the organization's environment so too i s that environment i n -fluenced by an organization's i n t e r n a l structure and behaviour (Levine and White, 1961, p.590). Lawrence and Lorsch (1967) have addressed the reactive or adaptive capacities of organizations. They refer to the f i t or balance that i s established between an organization's i n t e r n a l cha r a c t e r i s t i c s and the requirements of an external environment. This " f i t " i s necessary i f the organization i s to meet i t s goals e f f e c t i v e l y . The inference here i s that i f an organization does not have int e r n a l characteristics consistent with the demands of i t s environment then the effectiveness of the organization suffers. - 47 -Taking a s i m i l a r posture, Kochan (1975) has said that as organizations pursue t h e i r separate interests they must be able to adapt to constraints imposed by other organizations and to "develop an organizational structure which i s capable of coping with the others" (p.435). The reciprocal effect of an organization upon i t s environ-ment as that organization exerts i t s e l f i n order to a t t a i n i t s goals i s acknowledged by Van de Ven, Emmet, and Koenig (1975, p.20). Aiken and Hage also deal with the interaction between i n t e r -organizational relationships and i n t e r n a l organizational be-haviour and structure. They have found that an organization's in t e r n a l structure has an effect on the kinds of interorganiza-t i o n a l relationships i n which i t becomes involved. Conversely, there are examples i n t h e i r research that i l l u s t r a t e the effect or consequences that interorganizational relationships have upon intraorganizational structure and behaviour. Warren, Burgunder, Newton, and Rose (1975) have hypothesized that i n some instances there may be certain intraorganizational characteristics that w i l l have an effect on interorganizational relations (p.172). The fact that there were s t r i c t l i m i t a t i o n s placed upon the number of variables examined i n t h i s research detracts from the g e n e r a l i z a b i l i t y of the conclusions. Many factors may a f f e c t the a b i l i t y of an organization to r e a l i z e i t s - 48 -goals as i t interacts with i t s environment ( E l l i n g and Halebisky, p.187). An organization may be expected to apply whatever forces i t can muster as i t seeks to relate with i t s environment i n a manner consistent with i t s i n t e r n a l and formal goals (Kochan, p.435). In doing so i t i s expected that i n t e r n a l adaptation as w e l l as environmental adaptation may occur. The degree of impact of these changes upon either the i n t e r n a l aspects of an organ-i z a t i o n or the organization's environment w i l l vary according to the manner i n which these forces are brought to bear. As the organization s t r i v e s to reconcile i t s own goals with i t s environ-ment i t i s e n t i r e l y possible that the power of that organization may be such that i t i s able to impose i t s w i l l upon the environ-ment. If not that, at least there may be some compromise pos i t i o n to which both the organization and i t s environment w i l l move. Zeitz (1975) takes t h i s point of view. He i s c r i t i c a l of the tendency to assume that an organization i s an already con-s t i t u t e d , independently functioning u n i t . He argues that t h i s assumption i s not consistent with the view of an environment which sets constraints upon organizational autonomy (p.40). Both assumptions may apply. Indeed, as Sheldon, Baker, and McLaughlin (1970) state, f l e x i b i l i t y i s consistent with concepts of general systems theory (p.346). The open-system view of organizational input, - 49 -processes, and output, by d e f i n i t i o n , requires that a two-way re-lationship e x i s t between an organization and i t s environment. While the input from the environment w i l l influence the organ-ization's a c t i v i t i e s the output from the organization i s seen to influence the a c t i v i t i e s of i t s environment. "A system (organ-ization) must interact with and somehow adjust to i t s environ-ment" and "as l i v i n g systems adapt to t h e i r environment ... they also i n turn affect t h e i r environments and change them" (Baker, 1970, p.8). Interorganizational Relationships - Level II The second l e v e l of interorganizational analysis i s con-cerned with relationships which ex i s t between organizations. In order to d i f f e r e n t i a t e t h i s type of relationship from others described i n the organizational research l i t e r a t u r e i t i s neces-sary to keep i n mind that i t i s the organization i t s e l f , seen within a group of other organizations, which i s the basic unit of observation and analysis (Litwak and Hylton, 1962: Evan, Z e i t z ) . Evan has devised the term organization-set which he defines as the network of organizations which constitute the environment of a single organization. The environment i s viewed simply as those organizations with which a s p e c i f i c organization interacts (p. B219). He uses the organization-set to describe relations - 50 -between a focal organization and the organizational members of i t s environment. Level II analysis may also consist of analysis of relation-ships on a more limited basis, such as relations between only two organizations (Hall and Clark, 1973). Van de Ven, Emmett, and Koenig in reviewing the literature have found two approaches to Level II analysis. The f i r s t i s the comparative approach which focuses on specific organizations and, using specific dimensions, compares them according to the char-acteristics of their interactions. The second i s the relations approach which examines the linking mechanisms between organ-izations and the circumstances involved i n the types of relations that develop. Whatever perspective is taken, Level II analysis is based on the belief that a l l organizations function within "an environment of other organizations, as well as a complex of norms, values, and c o l l e c t i v i t i e s of the society at large" (Evan, p.218). This concept i s axiomatic in contemporary organizational research. The significance of the concept for studies i n interorganiza-tional relationships is great. Much of the current research deals with the organization-environment interaction (Mindlin and Aldrich, 1975, p.382). Interdependencies between an organization and i t s environment "essentially conceive of the organization as an entity that needs inputs and provides outputs, linking to-- 51 -gether a number of organizations v i a the mechanisms of exchanges or transactions" (Aiken and Hage, p.913). Interorganizational Relationships - Level I I I Organizational autonomy i s limited i n many respects by various types of s o c i a l , p o l i t i c a l , and economic pressures (Zeitz, 1967, p.40). In addition, there may be factors which are quite remote i n both a geographical and organizational sense which can influence or affect any organization's operations. Organizations at a l l l e v e l s , l o c a l , non-local, governmental, and voluntary can act together, consciously or unconsciously, i n influencing a s p e c i f i c organization's behaviour. "There does not appear to be a d i s t i n c t f i e l d of i n t e r a c t i o n at the community l e v e l which i s c l e a r l y distinguishable from the t o t a l process of m u l t i l e v e l , mixed l e v e l i n t e r a c t i o n " (Warren, 1967a, p.262). The implication i s , therefore, that while an organization may seek to control i t s own destiny, to some extent there exists an undeter-mined number of external factors that w i l l influence every organization. Warren (1967b) suggests that i t may be more f r u i t f u l to view relationships among organizational units as occuring within an interorganizational f i e l d . In developing the concept the term " f i e l d " has been borrowed from Kurt Lewin who defines i t as "a - 52 -t o t a l i t y of co-existing facts which are conceived of as mutually interdependent" (Warren, 1967a, p.397). The notion of an i n t e r -organizational f i e l d " i s based on the observation that the i n t e r -action between two organizations i s affected, i n part at l e a s t , by the nature of the organizational pattern or network within which they f i n d themselves" (Warren, 1967b, p.397). This ap-proach implies that groups of organizations could be analysed as though they were one large organization (Hall and Clark, p.45: Benson, p.230). Benson, Kunce, Thompson, and A l l e n (1973) also subscribe to the concept of the interorganizational f i e l d . They state that "when a number of organizations engage i n recurrent, extensive interactions with each other, they may be said to form a network" (p.3). This network, l i k e the interorganizational f i e l d , becomes the basic unit of analysis. I t 'has characteristics which are objects of investigation i n t h e i r own r i g h t " (Benson, p.230). The problem of d i f f e r e n t i a t i o n between Level II and Level I I I analyses i s central to the understanding of both concepts. The key point to be kept i n mind i s that while both Level II and Level I I I acknowledge the existence of networks within which organizations may function i t i s Level I I I which purports to view these networks i n a larger context. Neghandhi describes the Level I I I or interorganizational f i e l d approach by saying that relationships among different - 53 -organizations are conceived of as occuring i n the l i g h t of i n t e r -actions of a l l members of the interorganizational f i e l d (p.4). Emphasis i s upon the view of the member organizations p a r t i c i -pating i n a c o l l e c t i v e unit and there i s a subsequent s h i f t "from examining interorganizational relationships between organizations to among organizations" (p.10). Concern thus becomes centered upon "the properties of an aggregate of interacting organizations as distinguished from the properties of the i n d i v i d u a l organ-izations themselves" (Warren, et a l , p.168). Boundary Definitions I t would seem, however, that the f i e l d as described by Warren and the network described by Benson do exhibit s i m i l a r problems of boundary d e f i n i t i o n as those of analysis at Level I I . Baker and O'Brien (1971) allude to t h i s when they observe that there are obvious reasons f o r i n c l u s i o n of organizations within a s p e c i f i c f i e l d . Broadly stated, each of the member organizations may be involved i n the f i e l d d i r e c t l y or i n d i r e c t l y (p.133). The f i e l d , therefore, i s , and must be, discrete i n some fashion although the clues remain obscure as to how t h i s i s accomplished. As H a l l and Clark argue "the inclusion of s p e c i f i c organizations and each of t h e i r major contacts would r e s u l t i n ever increasing c i r c l e s of organizations which would not stop - 54 -u n t i l a l l organizations are included" (p.54). When put i n t h i s l i g h t the notion of an interorganizational f i e l d or s o c i a l system of organizations becomes blurred with the Level II approach. At Level II H a l l and Clark, as wel l as Turk (1973b) describe the d i f f i c u l t y involved i n determining the boundaries of the organization-set. In r e a l i t y there i s no one organization-set. It i s contended that for purposes of research i t necessarily becomes a selective process to determine any one "organization-set, network, or system of organizations" (Hall and Clark, p.54: Turk, 1973b, p.57). At Level I I I the same can be said. "Net-works vary i n scope and i n degree of interactions and must be a r b i t r a r i l y defined or bounded for research purposes" (Benson, et a l , p.4). The boundaries may be defined according to s p e c i f i c variables affecting relationships between two organizations at s p e c i f i c levels of int e r a c t i o n (White), among many organizations at various levels of interaction (Turk, 1973b), or among many organizations at s p e c i f i c levels of interaction (Kochan). M i l l e r (1971) confirms the researcher's prerogative of a r b i -t r a r y delimitation. He says that the system or unit of i n v e s t i -gation, once i d e n t i f i e d , w i l l , of necessity, have subsystems and suprasysterns. "Every discussion should begin with an i d e n t i f i c a -t i o n of the l e v e l of reference ... Systems at the indicated l e v e l are c a l l e d systems. Those at the l e v e l above are c a l l e d supra-systems ... Below the l e v e l of reference are subsystems ..." - 55 -(p.288). The implication is that the "level of reference" may be arbitrarily defined. The identification of subsystems and supra-systems thus become dependent upon the designated level of reference. Dimensions Of Interorganizational Relationships Interorganizational relationships at a l l three levels pre-viously outlined are subject to influence from a wide range of factors and variables. It is not intended nor even possible to deal with a l l potential factors in this study. However, i t is relevant to discuss in some depth those variables that receive greatest attention in the literature. While i t is not suggested that a l l of the specific points discussed in this section will necessarily pertain to the issues evidenced in the research data i t is intended that this review will provide a basis for an understanding of the nature of interactions that were brought to light in Kitimat and Terrace. Resources The dimension of resources is perhaps the single, most widely discussed variable affecting the field of interorgan-izational relationships and one which permeates virtually a l l its - 56 -perspectives. Resources are defined i n an economic sense as those elements which an organization requires i n order to a t t a i n i t s goals (Levine, White, and Paul, p.1185: Parsons, p.69). Yuchtman and Seashore (1967) define resources i n broader terms as the "generalized means, or f a c i l i t i e s , that are p o t e n t i a l l y controllable by s o c i a l organizations and that are p o t e n t i a l l y usable - however i n d i r e c t l y - i n relationships between the organ-i z a t i o n and i t s environment" (p.892). There are several l i s t s of resources which authors have de-vised as essential to the development and preservation of ex-change relationships between and among organizations. A l d r i c h (1975) describes four types of resources: person-nel; information; products and services; and operating funds (p.52). Levine, White, and Paul (1963) state that health organ-izations require three main resources: c l i e n t s (recipients of services); personnel; and non-human resources such as equipment, specialized knowledge, or funds (p.1185). Yuchtman and Seashore say that there are four universally required resources. They are: personnel; physical f a c i l i t i e s f o r the organization's a c t i v i t i e s ; a technology for these a c t i v i t i e s ; and some r e l a -t i v e l y l i q u i d resource, such, as money, which can be used to exchange to acquire other resources (p.895). Parsons (1956) says that a l l organizations must have land; labour; c a p i t a l , and an organization to administer these re-- 57 -sources (p.69). It would seen that Parsons and Yuchtman and Seashore are i n agreement i n t h e i r approach to essential re-sources. A l l organizations must have access to these four essential resources i f they are to r e a l i z e t h e i r organizational goals. Other non-economic resources which may be organization s p e c i f i c , that i s not required by a l l organizations, may be acquired through the manipulation of the basic resources (Levine, White, and Paul, p.1185). In addition, resources need not be viewed as tangible items as are money, personnel, and f a c i l i t i e s . Abstracted resources also e x i s t i n forms such as influence, knowledge, and authority (Benson, p.229: Goerke, p.714: Kochan, p.449: Levine and White, p.369: Baker and Schulber, 1968, p.18). These elements can be ascribed status as resources by v i r t u e of the above d e f i n i t i o n by Yachtman and Seashore. This i s j u s t i f i e d i n the sense that while these elements do not have physical or economic substance i n and of themselves t h e i r char-a c t e r i s t i c s do and must, i n a l l cases, issue from such substan-t i v e forms (Yuchtman and Seashore, p.893). In the health care f i e l d "few, i f any, agencies possess ac-cess to a l l the resources they need to enable them to a t t a i n (their) objectives f u l l y " (Levine and White, p.367). This pro-nouncement i s widely conceded. The consequences of t h i s s c a r c i t y have been interpreted i n a number of contexts pertinent to i n t e r -organizational relationships. Because of the ubiquitous nature - 58 -of the resource concepts i t i s not possible to exhaust a l l t h e i r aspects i n one section of t h i s review. I t i s necessary to deal with them i n the context of other dimensions as w e l l . The con-texts discussed i n t h i s review are power i n interorganizational relationships, organizational autonomy, domain consensus, and interorganizational coordination or services. The nature of these dimensions i s such that they are quite interrelated as w i l l be evidenced i n the following discussions. Power i n Interorganizational Relationships Social power i s defined by E l l i n g (1968) as "the a b i l i t y to influence the orientation and behaviour of others" (p.119). Sup-porting that d e f i n i t i o n i s Klein's (1965) comment that i t may also be viewed as the extent to.which one i n d i v i d u a l or group may "block or f a c i l i t a t e the g r a t i f i c a t i o n of the needs of others" (p.304). Dubin has i d e n t i f i e d three kinds of power. The f i r s t concerns technical s k i l l s , expertise, and the r e l a t i v e l e v e l of exclusive a v a i l a b i l i t y and necessity of those technical aspects (p.30). The second i s legitimated authority (p.32) and the t h i r d i s status (p.36)-. French and Raven (1960) i d e n t i f y power re-lationships which are based on the a b i l i t y of one party to reward or punish another, the legitimated prerogatives of a dominant party, referent power, and expertise (p.612). Using the broad - 59 -d e f i n i t i o n of resources which has been presented previously i t may r a t i o n a l l y be asserted that organizational power can be seen i n a resources context as proceding from control of elements organizations require to meet t h e i r goals and objectives (Klein, 1968, p.51: Cartwright and Zander, 1965, p.5). E l l i n g argues that consent of others must be given before power can be gained and that t h i s consent i s dependent upon control of sources of power or resources (p.119). K l e i n (1968) states, i n t h i s same vein, that power i s de-pendent to a degree upon the perceptions of those involved. "Power exists so long as i t i s invested i n some person, thing, or group by those who are influenced by that power" (p.52). E l l i n g and K l e i n (1968) agree with Lewis' (1970) assessment that power i s more than mere control of economic resources and o f f i c i a l authority. I t i s i n large part a function of the qu a l i t y of the boundary spanning organizational representatives. Lewis argues that power may stem as wel l from the qu a l i t y of the people representing organizations and the quantity of people thus represented. Reasoning a b i l i t y , interpretation s k i l l s , technical knowledge, personal prestige, and charisma of organ-i z a t i o n a l leaders are c i t e d as important determinants of power ( E l l i n g , p.123). A s l i g h t digression to the role of organiza-t i o n a l representatives i s i n order at th i s point. - 60 -Relationships between organizations are frequently viewed i n terms of the organizational representatives who effect and affect the relationship (Lewis, p.74). These representatives are fre-quently the media through which exchange relations are formu-lated. "Interaction is rarely the case of the total membership of one group interacting with the total membership of the other group" (Turk and Lefcowitz, p.337). At the community level this view could be extended to account for the fact that v i r t u a l l y a l l linkages between groups are accomplished by group represent-atives. Nadel (1957) argues that indeed i t is the represent-atives of organizations who "give meaning to the conception of interrelations between groups" (P.95). It is important to note, however, that there need not be one single group representative. A l l members of organizations may be viewed as representatives of their organization i n the daily routine of carrying out the interactions between themselves and non-members (Turk and Lef-cowitz, p.337). This argument notwithstanding there are specialized repre-sentatives who act on behalf of the entire organization as i f they were the personification of that organization. These repre-sentatives serve to aid i n differentiating between organizations in that they present a unitary image of their own organization and thus f a c i l i t a t e formation of stable intergroup relations without merging into a single group (Turk and Lefcowitz, p.341). - 61 -At times, however, there may appear to be a b l u r r i n g of boundaries i n that the representatives of organizations can be viewed as a group unto themselves. This may be seen to be dys-functional f o r ind i v i d u a l groups whose members perceive a mis-placed l o y a l t y i n the actions of t h e i r representatives ( M i l l e r and Rice, 1967, p.230). Nonetheless, there are situations where representatives of d i f f e r e n t organizations form groups for co-ordinative purposes. The r i s k of transferring allegiances may e x i s t but i t does not seem to preclude such coordinative under-takings. Perhaps the interpretation of misplaced l o y a l t y l i e s i n the perceptions of organizations' members as they assess t h e i r leader's a b i l i t y to assert power i n advancing the interests of his organization. The power, or lack of same, i n the i n d i v i d u a l representative's a c t i v i t i e s involving interorganizational re-lationships may be the key determinant here. At the other extreme, these representatives serving on coordinating groups may be unable to r i s e above the vested i n t e r -ests of t h e i r organizations, the consequence being the f a i l u r e of coordinated action. One f i n a l aspect of power relationships between organiza-tions that should be reinforced i s i t s ever changing nature. As discussed i n the following section resource dependence i s one factor that has consequences for organizational relationships. The health care f i e l d i s one which i s constantly changing i n - 62 -terms of technology, manpower requirements, s i z e , and composition i n terms of the organizational framework (Klein, p.51: E l l i n g , p.127). Values and attitudes are also important and changing factors which contribute to the turbulent nature of the health care f i e l d (Emery and T r i s t , 1965, p.30: Palmiere, p.568). Power i s neither l i m i t e d nor absolute because i t exists i n so many forms (Klein, p.51). Organizational Autonomy Organizational autonomy i s defined as an "organization's freedom to make r e l a t i v e l y major decisions without the consent of other organizations" (Greenley and Kirk, 1976, p.320). Organ-i z a t i o n a l autonomy i s seen as a function of the r e l a t i v e a v a i l -a b i l i t y of scarce resources. The extent to which an organization i s dependent upon another depends i n part at least upon the extent to which needed resources are controlled by that organ-i z a t i o n . The nature of interorganizational relationships i s i n large part determined by the scarcity of resources (Levine, White, and Paul, p.1185: Benson, p.229). Mindlin and A l d r i c h also state that dependence between organizations i s influenced by the degree of competition f o r and sharing of scarce resources (p.382). In other words, organization A i s dependent upon organ-i z a t i o n B to the extent that B controls resources required by A. - 63 -Further to t h i s Clark (1965) argues that l i m i t a t i o n s i n a v a i l a b i l i t y of one resource can be mitigated i f another, more available resource can be u t i l i z e d as a lever or incentive to co-operation by organizations with mutual interests and the neces-sary complementary resources (p.235). Evan concurs with these notions. He suggests that autonomy of an organization may be increased i f sources of resources are numerous and decreased i f these sources are limited (p.B223). The fact that organizational autonomy i s a function of the s c a r c i t y of resources leads d i r e c t l y to another important aspect of the resource dimension. In the framework of economics and l i m i t e d resources there exists the concept of opportunity-cost. Simply stated t h i s concept means that i n order to obtain a given product or service something must be given up or s a c r i f i c e d i n exchange. In even simpler terms i t means that i f an organization exchanges commodity A for commodity B i t gives up i t s claim on A and cannot, ever, use i t i n exchange again. The point here i s that l i m i t e d resources force choices to be made between a l t e r -natives even i f a l l alternatives available are desirable. Values are involved i n making these choices (Litwak and Hylton, p.397) and are important considerations i n interorganizational studies and s p e c i f i c a l l y for the health care f i e l d . Resources used to provide services of a certain quality i n a s p e c i f i c area may mean services of another type are not provided. In the community i t - 64 -i s attitudes which are c r i t i c a l i n determining where resources should be allocated. The universal and inescapable nature of t h i s a l l o c a t i o n problem i s summed up by Warren (1967b) when he states " a l l societies must have a s i t u a t i o n of p a r t i a l c o n f l i c t because of lim i t e d resources f o r maximizing values simultan-eously" (p.410). Further to th i s "the community interorgan-i z a t i o n a l f i e l d (is unable) to calculate r a t i o n a l l y the optimum mix from a f i e l d of competing values ..." (Warren, 1967b, p.412). Regardless of the a v a i l a b i l i t y of resources there w i l l always ex i s t value c o n f l i c t s , f o r i t i s impossible to determine the best possible mix or investment i n various values. Given li m i t e d resources and c o n f l i c t i n g values the phenomenon of s a t i s f i c i n g i s evidenced. Community resolutions and decisions regarding re-source allocations are usually made i n accordance with a con-sensus of community values (Warren, 1967b, p. 415). Complete s a t i s f a c t i o n i s never r e a l i z e d by a l l concerned as s a t i s f i c i n g denotes reaching a mutually agreed upon compromise without t o t a l l y rejecting available alternatives (Turk, 1973a, p.14). Authority i s discussed i n the interorganizational context on several levels. Benson discusses authority i n resource terms as the legitimate "right and r e s p o n s i b i l i t y to carry out programmes of a cer t a i n kind" and that "legitimated claims of th i s kind are termed domains" (p.232). This present discussion i s concerned more with pointing out that interorganizational relationships are - 65 -most frequently found to occur without any formal or h i e r a r c h i c a l structure (Turk, 1973a, p.38: Clark, p.234: Litwak and Hylton, p.398). Authority i s seen to be related to organizational auton-omy. Organizations are able to involve themselves with other organizations without necessarily compromising t h e i r autonomy because decision-making authority remains with the i n d i v i d u a l organizations. Warren (1967b) sees decision-making i n interorganizational relationships occuring within a four l e v e l continuum consisting of the federation, the c o a l i t i o n , s o c i a l choice, and unitary contexts. A federation of organizations requires some commitment on the part of organizations but authority for r a t i f i c a t i o n of decisions remains with the ind i v i d u a l organization. The c o a l i t i o n context allows that an organization w i l l have i t s own set of goals but w i l l collaborate informally and on an ad hoc basis where some of i t s goals overlap those of other organizations i n the c o a l i t i o n . The s o c i a l choice context provides that an or-ganization exercises the maximum amount of authority. Inter-organizational structures do not apply because the organization exercises t o t a l control over a l l decisions (p.p. 403-408). A fourth context for organizational decision-making that i s i d e n t i f i e d by Warren i s described as a v e r t i c a l relationship where decision-making and authority descend within a structured hierarchy. Although t h i s form i s not afforded much importance by - 66 -the authors previously c i t e d , i t i s seen by t h i s writer to be central to t h i s study. There i s , i n the l i t e r a t u r e , a tendency to ignore the circumstances of agencies of governmental authority. These agencies may be viewed as autonomous groups at the l o c a l community l e v e l where, because of t h e i r remote location from the central authority, they are able to act i n some ways as though they were independent. However, there may, i n f a c t , e x i s t a unitary perspective within which l o c a l agencies are functioning. The governmental or central authority w i l l view the organization i n t h i s context as a dependent organization s t r i v i n g to meet the goals of the central authority (Warren, 1967b, p.404). The l o c a l community agency may thereby be operating i n a s i t u a t i o n where i t i s perceived by l o c a l groups as autonomous while at the same time i t i s subject to v e r t i c a l decision-making from a central auth-o r i t y . I t i s to be expected that i n t h i s s i t u a t i o n members of l o c a l organizations may f e e l torn between l o c a l l y i d e n t i f i e d goals and the need to remain l o y a l to the central authority. As KLein (1968) states: Governmental agencies are subject to l e g a l requirements and r e s t r i c t i o n s that make i t d i f f i c u l t for them either to offer services that are adequate i n the eyes of the v o l -untary agencies or to modify programmes i n keeping with the plans of a l o c a l coordin-ating council. Among areas affected have been community health programmes, usually under government auspices and often, there-- 67 -fore, not readily integrated with the work of the voluntary family, c h i l d care, and other s o c i a l agencies. Mental health i s being sponsored and financed by government. Because of t h i s , i t , too, i s less e a s i l y i n -tegrated within t r a d i t i o n a l health and wel-fare council patterns (p.168). It i s important to note that none of the contexts of organization decision-making i d e n t i f i e d by Warren are mutually exclusive of the other as an organization may be involved i n one or a l l of these contexts at any one time. Domain Consensus Domain consensus i s defined as "agreement among participants i n organizations regarding the appropriate role and scope of an agency" (Benson, et a l , p.51). "Each organization has i t s own legitimated segment of interest: and operation ..." (Warren, 1967b, p.409). This agreement can be formally or l e g a l l y defined as i n the case of governmental agencies and i n s t i t u t i o n s with l e g i s l a t e d programmes or i n the case of contractual agreements (Clark, p.234). In other instances the agreement may be i n -formal, consisting of i m p l i c i t understandings between organ-izations as to which goals are to be pursued by which organ-izations (Levine, White, and Paul, p.1191). - 68 -Lack of c l a r i t y of the respective domain of organizations may lead to c o n f l i c t between organizations. Intrusion upon the prerogative of one organization by another, or lack of perform-ance within one's domain may re s u l t i n c o n f l i c t . That i s , j u s t as an organization may be c r i t i c i z e d f o r intruding upon, another's domain, c r i t i c i s m may also be forthcoming i f an organization i s viewed by others as not f u l f i l l i n g i t s mutually acknowledged r e s p o n s i b i l i t i e s (Levine, White, and Paul, p.1191). There also exists the p o s s i b i l i t y that lack of c l a r i t y over domain may affect relationships between more than two organiza-tions. I f two organizations are operating i n s i m i l a r areas of r e s p o n s i b i l i t y other organizations may have d i f f i c u l t y i n d i f f e r -entiating between t h e i r respective functions (Levine, White, and Paul, p.1194). In another vein Arnold and Hink, and Benson (p.238) acknow-ledge that c o n f l i c t may r e s u l t from e f f o r t s to coordinate a c t i v -i t i e s of dif f e r e n t organizations as these coordinative e f f o r t s may be seen to threaten an organization's domain. Arnold and Hink, however, also note that the opposite i s possible; cooper-ation can be the outcome (p.462). I t may be that coordinative e f f o r t s a s s i s t i n sorting out organizational domains (Benson, et a l , p.53). Benson addresses domains i n relationship to ac q u i s i t i o n of resources i n stating that "authority and money flow to an agency - 69 -on basis of i t s sphere of a c t i v i t i e s ..." (p.236) or, i n other words, on the basis of the amounts and kinds of resources that they are able to j u s t i f y (Benson, p.238). I f achieving coordin-ation among organizations requires a change i n an organization's sphere of a c t i v i t y t h i s coordination w i l l have greater l i k e l i h o o d of being actualized i f the required changes do not threaten resource a v a i l a b i l i t y (Arnold and Hink, p.462). Interorganizational Coordination Coordination of services i s frequently c i t e d as a major goal for mental health organizations but one which i s extremely d i f f i -c u l t to r e a l i z e (Klein, 1968, p.166). The reason f o r pursuing t h i s goal so ardently i s to make more e f f i c i e n t use of the l i m i t e d resources available by eliminating unnecessary d u p l i -cation and overlap of services (Warren, 1970, p.114: Coates, 1974, p.1687: Goerke, 1964, p.713). K l e i n (1968) says that coordination w i l l always remain a d i f f i c u l t achievement because i t requires a f o r f e i t u r e of organizational autonomy (p.54). This autonomy, as has been noted elsewhere i n t h i s review, may be compromised because of the r e l a t i v e i n a c c e s s i b i l i t y of resources and an organization's need to acquire same. However, coordin-ation of organizations may require that autonomy be given up for reasons that cannot be r a t i o n a l i z e d i n resource terms. In such a case a choice based on organizational and i n d i v i d u a l values i s - 70 -made which may preclude a coordinated e f f o r t on behalf of the concerned organizations (Kovar, 1970, p.145). Indeed, c o n f l i c t between organizations often arises as a c o n f l i c t over values especially i f the values i n c o n f l i c t are both desired (Litwak and Hylton, p.396). Lack of coordination does not s i g n i f y the presence of con-f l i c t i n interorganizational relationships nor i s evidence of c o n f l i c t an indicator of lack of coordination or cooperation. Interorganizational c o n f l i c t then does not necessarily lead to the breakdown of interorganizational relationships, rather i t i s a required element (Litwak and Hylton, p.415). Co n f l i c t between organizations i s , as noted above, taken as a given i n interorganizational relationships.(Turk, 1973a, p.37: Warren, 1967b, p.410: Litwak and Hylton, p.397). C o n f l i c t i s a by-product of organizational autonomy. The problem of coordin-ation between organizations i s e s s e n t i a l l y one of integrating i n t r i n s i c c o n f l i c t with the need for cooperation. Coordination between or among organizations must take into account that organizations seek to survive i n terms that they view to be most favourable to themselves (Mott, 1970, p.56). This implies that organizations which coordinate t h e i r a c t i v i t i e s may, at d i f f e r e n t times, cooperate or compete with other organ-izations depending upon t h e i r p a r t i c u l a r view of the outcome. - 71 -Certainly t h i s i s a factor i n determining i f and when cooperation w i l l occur (Thompson, 1970, p.157). Warren (1970) suggests that competition between organiza-tions may be a way of eliminating waste of resources and overlap of domains and that centralized coordination may not be the only avenue available to reach that goal. Duplication and overlap of services, he says, should not be discouraged. Rather agencies should be encouraged to close gaps i n services and thereby max-imize service to c l i e n t s (p.127). He further suggests that t h i s may be accomplished through a market-economy approach to pro-v i s i o n of services (p.123). While Warren's approach would not necessarily be t o t a l l y practicable or desirable (Kovar, p.136) the point i t helps to make i s that there i s no one to one re-lationship (inverse or otherwise) between coordination, cooper-ation, and c o n f l i c t . - 72 -CHAPTER TV INTERORGANIZATIONAL RELATIONSHIPS - LEVEL I The purpose of th i s chapter i s to discuss and analyse factors i d e n t i f i e d i n the research data as those aspects of s p e c i f i c organizations' i n t e r n a l characteristics which were seen to influence relationships with other organizations. Discussion centres on those factors which are viewed as being unique i n -ternal characteristics of in d i v i d u a l organizations. The intent here i s to discuss the various ways i n which these i n t e r n a l characteristics affect the organization's relationships with other community mental health organizations. Three organizations are selected for discussion here i n order to present the clearest examples of i d e n t i f i e d factors within the confines of the existing data base. Similar factors which are i d e n t i f i e d i n d i f f e r e n t organizations may affect the interorganizational relationships of these organizations i n dif f e r e n t ways. Where applicable, the apparent s i m i l a r i t i e s or differences i n the effects of l i k e factors upon these interre-lationships w i l l be discussed. - 73 -Skeena Mental Health Centre The Skeena Mental Health Centre, as a government agency, i s an organization which i s placed i n a p o s i t i o n requiring a c e r t a i n f i d e l i t y to both i t s c l i e n t relationships and to a central auth-o r i t y . In t h i s instance the Mental Health Centre attempts to provide a service to people wi t h i n a l o c a l catchment area while remaining under the j u r i s d i c t i o n of the more remote Provincial administration. In these circumstances much of the internal structure of the Mental Health Centre appeared to be a product of the influence of the remote o f f i c e and authority of the Provincial government, p a r t i c u l a r l y the D i v i s i o n of Community Mental Health and the C i v i l Service Commission. As a consequence of t h i s circumstance there i s an apparent l i m i t a t i o n on the extent to which the i n -ternal characteristics of the Mental Health Centre influence i t s organizational environment: that i s , the Centre's a b i l i t y to i n -fluence the central authority i s lim i t e d . For example, the personnel who s t a f f the Mental Health Centre seemed to have resigned themselves to a po s i t i o n of inef-fectiveness i n some aspects of t h e i r relations with authorities i n V i c t o r i a . Manpower and s t a f f i n g issues i n p a r t i c u l a r had been a concern i n that for a period of nearly s i x months there had been only one s t a f f member on l i n e i n the Centre. This person - 74 -was required to assume a l l administrative and service oriented r e s p o n s i b i l i t i e s u n t i l additional s t a f f could be recruited for the Centre. Obviously, without the necessary s t a f f a l l o c a t i o n there would be s i g n i f i c a n t consequences for the i n t e r n a l f a b r i c of the Mental Health Centre. In t h i s instance the agency appar-ently had no alternative but to adapt to the circumstances. Services were discontinued to a l l centres outside of Terrace pending recruitment of additional s t a f f . However, i t i s evident that i n t h i s adaptive reaction the Skeena Mental Health Centre was able to influence the organ-i z a t i o n a l environment i n the Kitimat-Stikine Regional D i s t r i c t . By exercising l o c a l authority to suspend services to areas out-side Terrace, the Centre abdicated from i t s role as a major sup-p l i e r of mental health services. The organizational domain that was ascribed to the Centre was thereby l e f t i n a vacuum of sorts. This perception was especially reinforced i n communities which had been cut o f f from the Centre's services. In Kitimat, f o r ex-ample, the Kitimat Community Services Society prepared a b r i e f to the Minister of Health which attempted to put f o r t h the s i t u a t i o n i n which Kitimat was placed as a r e s u l t of the suspension of mental health services. The b r i e f , prepared by representatives from a number of community organizations, was intended to be a comprehensive document which would not merely request reinstate-ment of services from the Terrace o f f i c e s of the Division of - 75 -Mental Health. More s p e c i f i c a l l y i t argued i n favour of extended services for the community of Kitimat over and above those i t had previously received. While i t i s true that i n t h i s b r i e f the Kitimat Community Services Society presented a wider concern than the suspension of the services of the t r a v e l l i n g c l i n i c to Kitimat i t i s apparent, from interview sources, that i t was the announcement of the suspension which precipitated the reaction of the Society. I t i s the writer's interpretation that the above example shows that an organization does not necessarily have to be dyna-mic and omnipresent i n i t s relationships with other organizations i n order to influence t h e i r behaviours. In t h i s instance a very non-aggressive r o l e evidenced by the Mental Health Centre's withdrawal of services was enough to prompt a reaction i n the organizational environment. While other agencies and organiz-ations such as Public Health, schools, and churches may have taken up the slack to some extent, i t i s clear by the reaction that the domain of the Mental Health Centre was seen to be largely i n v i o l a t e . The f a i l u r e of the Centre to f u l f i l l i t s s o c i a l contract i n t h i s regard resulted not i n other organiz-ations assuming the vacated r o l e , but i n a protest that the agency should reinstate i t s e l f i n t h i s r o l e and extend i t to provide a more comprehensive service than the one previously available. - 76 -While to a l a r g e extent the d e c i s i o n to suspend s e r v i c e s t o o u t l y i n g communities was e x t e r n a l l y imposed upon the Skeena Mental H e a l t h Centre by the. f a i l u r e of the P r o v i n c i a l government to provide adequate manpower resources, the i n t e r n a l a u t h o r i t y of the Centre was s t i l l an important f a c t o r i n the outcome. I f no announcement had been forthcoming from the Centre and s e r v i c e s had been provided t o K i t i m a t , even on the minimal l e v e l , one wonders i f the r e a c t i o n from the K i t i m a t Community Services S o c i e t y would have been so pronounced. I t i s a matter f o r con-j e c t u r e , but i t may be t h a t i t i s e a s i e r to mount a p r o t e s t a g a i n s t a t o t a l suspension o f s e r v i c e s than a g a i n s t inadequate s e r v i c e s . The i n e r t i a may be more e a s i l y overcome i n the face of a t o t a l withdrawal. The Three R i v e r s Workshop The Three R i v e r s Workshop i s an independent o r g a n i z a t i o n i n t h a t there are no formal h i e r a r c h i c a l r e l a t i o n s h i p s between i t and other o r g a n i z a t i o n a l bodies. Three R i v e r s was i n s t i t u t e d through the e f f o r t s of the Terrace A s s o c i a t i o n f o r the M e n t a l l y Retarded (T.A.M.R.) who secured i n i t i a l funding through a Federal government L o c a l I n i t i a t i v e s P r o j e c t (L.I.P.) grant. However, T.A.M.R. d i d not r e t a i n c o n t r o l of the workshop. Once estab-l i s h e d , Three R i v e r s took on an automous nature i n t h a t p l a n n i n g - 77 -of programmes and facilities were under the sole jurisdiction of the workshop director. Under the authority of the director, the workshop attempted to assume an expanded role as a training centre. Workshop policy became gradually entrenched which was intended to promote opportunities for independent living of workshop participants. A salary structure was instituted and a work experience environment was created. Financial resources from L.I.P. grants were not viewed by the workshop director as.being adequate for the needs of a train-ing centre. In order to subsidize the limited funding provided by the L.I.P. grants the Workshop secured a five thousand dollar loan for woodworking equipment and began to manufacture a line of wooden toys for sale to the local community. It was intended that the sale of these products should be used to remunerate the workshop participants and that the manufacturing process would serve as a valid training experience for future employment of the workers in local businesses. In fact, the experience of the Three Rivers Workshop was that there was an i n i t i a l compassionate response from the com-munity which provided a short-term market for the workshop pro-duct. While this community response facilitated the early re-tirement of the equipment debt, i t became apparent that there was a limit to the extent of legitimate business. The assembly line - 78 -techniques of the toy manufacturing process were not easily diversified which resulted in the accumulation of large inven-tories of unsaleable toys. With the diminution of the market for workshop products the funding for Three Rivers once again f e l l to levels which were insufficient for the operation of a training centre. In addition, L.I.P. funding was terminated. Funding from Provincial government sources was available only in amounts which were sufficient, in the Provincial view, for the ongoing maintenance of an activity centre. This was not consistent with the aspirations of the workshop manager. Attempts were made to acquire support for Three Rivers from local sources. These efforts ranged from requests for subsidized or rent-free facilities from the School Board to requests for make-work projects from local industry. It should be noted that five or six former workshop participants had apparently been able to secure employment in Terrace over the two year period during which the workshop was successfully marketing its products. In spite of this, officials of other community mental health organ-izations such as the Child Development Centre and the residential half-way house expressed concern regarding the limited programme and work-like environment of Three Rivers. In particular, the physically handicapped individuals found the environment stif-ling. There were problems in motivating people to attend the workshop on a regular basis because of the regimentation and lack - 79 -of scope in the programme. Indeed, as noted above, economic necessity precluded development of individualized or diversified activities in the workshop. The recapitulation of the Three Pavers Workshop's oper-ational history illustrates the need for establishing clear organizational goals and objectives. The facts, as represented above, serve witness as well to the importance of the leader's role in guiding an organization's destiny and its concomitant relationships with other organizations. It appears that most of Three Rivers' organizational prob-lems stem from the fact that the organization was established with a very loose framework and limited information. The man-ager, once appointed, had very l i t t l e guidance from a parent organization or board of directors and was left largely to his own devices to operate the facility. Without the benefit of either experience or outside consultation, the workshop became the creation of an individual. The community was requested to ensure the continuity of Three Rivers. While community support for the concept was quite strong, the increased involvement resulting from the support had a price. The community organizations began to evaluate the workshop role in terms of the availability of resources. If Three Rivers was to survive, its focus would have to conform to that which was defined by funding agencies. For example, the - 8 0 -local Community Resources Board indicated that i t would support the Workshop i f and when funds became available but that there would likely be a necessary limitation on the programming. (The Department of Human Resources had already stated that its funding policy would limit funds to levels which i t deemed adequate for an activity centre.) The organizational independence of Three Rivers, at least, in its local environment, had become somewhat circumscribed in that because the workshop was requested to patronize the organ-izations which controlled the resources, (or at least its man-ager) was obliged to compromise the orientation of the workshop programme. It is clear that the community was virtually blackmailed into providing support for Three Rivers. The ambitious project was established on the basis of an unstable funding source (L.I.P. grant) and unless these resources dried up, an organ-ization which had carved out. a domain for itself, was left with its empty hand extended to the community. Even though the par-ticular programme of the workshop was not widely endorsed within the community, i t was acknowledged by even its most vocal critics that the service, or something like i t , should be con-tinued. The lack of internal planning, guidance, and/or exper-ience thereby imposed a liability upon the local mental health - 81 -( and social service agencies which had come to rely upon the workshop. The Kitimat Workshop The Kitimat Workshop commenced operations with the aid of a L.I.P. grant secured by the Kitimat Association for the Mentally Retarded (K.A.M.R.). In many respects its creation replicated that of the Three Rivers Workshop in Terrace. It also incorpor-ated the notion of providing services to both physically and mentally handicapped persons. These similarities notwithstand-ing, the operations of the two facilities became diverged consid-erably with the passage of time. Much of this contrast is attributed to the internal structure and operations of the organizations. The Kitimat Workshop has, from its inception, subscribed to an activity centre model in provision of services. Even in the face of what was described, in an obvious understatement, as inadequate funding (the i n i t i a l Federal L.I.P. grant was sus-pended and the application for a Provincial government Activity Grant was later refused) there was no active consideration of attempts to become self-supporting. Generation of funds through sales of craft items had been attempted on a very limited basis, but was discontinued in view of limited community response. - 82 -The l i k e l i h o o d of a t o t a l absence of external funding d i -minished the i n i t i a t i v e s of the Kitimat Workshop personnel and that of the founding group. Staffing of the workshop and par-t i c i p a t i o n of c l i e n t s f e l l markedly over a one year period. This was due, i n part, to relocation of some persons ( s t a f f and cl i e n t s ) away from Kitimat and physical i l l n e s s of others. The committee responsible for monitoring the workshop had not com-municated plans to the workshop s t a f f f o r future operations of the workshop i n view of suspended funding. The only impetus within the group came from a parent of a mentally retarded c h i l d . (The c h i l d , at that time, was a student i n a special education classroom. Her mother was anxious that she should be attending \ the workshop i n the coming year.) The physical surroundings of the Workshop l e f t a great deal to be desired. I t was located i n the sub-basement of the Kitimat General Hospital. Access was. by use of s t a i r s . The wa l l s , f l o o r s , and c e i l i n g consisted of bare concrete. There was a low c e i l i n g and l i g h t was provided by bare incandescent bulbs. The location was d i f f i c u l t to reach for the severely phys i c a l l y disabled people who were intended to form part of the c l i e n t e l e . The consequences of the above circumstances upon interor-ganizational relationships are such that the r e l a t i v e i n a c t i v i t y of the workshop precluded extensive and meaningful in t e r a c t i o n with any external body. With funding alternatives apparently - 83 -completely exhausted, i t was doubtful that the workshop would be able to continue operations beyond the limits of its existing financial reserves. It was evident that any potential for interorganizational relationships was not being pursued. Indeed, throughout the short l i f e span of the organization there was l i t t l e evidence that the workshop had had relationships with many of the organ-izations at the local level. One of the causes or factors con-tributing to that low profile may have been the rather limited enrollment of workshop participants. The size of the organiza-tion, in terms of numbers of clientele served, may have been too limited to give the organization credibility. Certainly this was a factor in the Provincial government's decision not to fund the Workshop, there being too few clients in regular attendance to warrant Provincial support. At the local level, the credibility of the organization may have suffered as well because of the limited qualifications and programming skills of the workshop leaders. After the departure of the in i t i a l organizers to Vancouver, there was very l i t t l e expertise available. The in-terest of the workshop committee and clients began to wane. The activity of one person who, as a parent of a mentally retarded child, regarded the workshop as the only alternative for her child after leaving a special education classroom did not seem to be able to generate much concern within other community organ-- 84 -i z a t i o n s . The only discernable reaction was one of detached acknowledgement on behalf of representatives of the Kitimat Com-munity Services Society. The Kitimat Workshop was i n serious f i n a n c i a l s t r a i t s and would, i n the estimation of the people involved i n the Kitimat Community Services Society, l i k e l y be required to suspend operations. The above example of the Kitimat Workshop shows not how interorganizational relationships have been affected but rather how they have been negated because of in t e r n a l c h a r a c t e r i s t i c s . The workshop was unable to a t t r a c t and r e t a i n participants and without these the workshop suffered. Clients i n t h i s sense may be argued to resemble resources, without which there would be no organization. The leadership of the organization was i d e n t i f i a b l e . The workshop director ascribed much of the impetus of the organ-i z a t i o n to a parent who c l e a r l y had a vested interest i n the continued presence of the workshop f a c i l i t y i n the community. No matter what the incentives of the organization's leaders, there were very few options available to pursue which would ensure the future operation of the workshop. The funding of organization from Federal and P r o v i n c i a l sources had been exhausted. Neither was the support of the community seen by the workshop director or the concerned parent as a r e a l i s t i c alternative. The p r o f i l e of - 85 -the organization was too l i m i t e d and without the a b i l i t y to demonstrate need for the service, l o c a l agencies and organiza-tions simply had no reason to interact with i t . Analysis As mentioned i n the introduction to t h i s chapter, only three organizations have been chosen' for development of Level I an-a l y s i s of interorganizational relationships. The reason for t h i s i s simply that information regarding in t e r n a l c h a r a c t e r i s t i c s of other organizations was not r e a d i l y retrieved from the interviews and research data. Nonetheless, even with a small sample of organizations i t i s clear that internal characteristics can be shown to a f f e c t the nature of interorganizational relationships. A summary of the points brought out i n these examples i s presented here to i l l u s t r a t e the significance of the f i v e major variables discussed i n Chapter I I I of t h i s study. Resources Resources and t h e i r effects upon interorganizational re-lationships are p a r t i c u l a r l y germane to the discussion of i n -ternal characteristics of organizations. As described elsewhere i n t h i s study, resources can take on many diff e r e n t forms. - 8 6 -Within the organizations discussed above i t is possible to ident-ify specific resources which are associated with internal char-acteristics and which affect interorganizational relationships. Manpower, as a basic resource, is a commodity which is of critical importance for the internal workings of a l l organiz-ations. It is not manpower in and of itself that is c r i t i c a l , but rather the characteristics of that manpower. Knowledge, experience, and common sense are valued resources for an organ-ization which are present in greater or lesser amounts within an organization's manpower base. In both the Three Rivers and the Kitimat Workshops, certain of these attributes were found wanting in both the managerial and programming staff. The consequences have already been documented. In the two workshops above, examples of manpower resources pertain to qualitive characteristics. In the case of the Skeena Mental Health Centre, manpower as a resource took on a quantita-tive perspective. Because available manpower was diluted to the point where services were provided by a single person inadequate resources were available. A second quantitative context and one which has been alluded to previously is the relative availability of clients to receive services. In the Workshop environment, i t may be argued that the clients, as workers, are component parts of the organization. If this argument is accepted then i t is possible to contrast the - 87 -Three Rivers Workshop which had plentiful client resources to the Kitimat Workshop which had been virtually starved for client participation. : Other basic resources, such as funding (capital), land (physical facilities), and technology (organization) were not seen to have a strong influence at the internal level upon the nature of interorganizational relationships. However, some observations can be offered in these contexts. It appears that the relative availability of any resource could influence the structure of an organization and the ways in which i t relates to its environment. For example, Three Rivers Workshop, in response to inadequate funding, developed a mass production line of toys, the sale of which would generate income for the workshop's pro-grammes. In addition, the workshop was criticized for an ap-parent inadequacy in its programme (poor treatment technology) which deterred some people from attending on a regular basis. A drop in numbers of participating personnel could have an impact on the ability of the workshop to generate income and/or re-structure its programme. That i s , there would be a reduced productivity and a possible change in programming for economic reasons. This change might not reflect the needs of clients par-ticipating in the Workshop's programmes. Further speculation on this point is not warranted here. It shall be shown in sub-sequent sections of this discussion that resources are inex-- 88 -t r i c a b l y involved i n influencing other variables which ef f e c t interorganizational relationships. Power Power i n interorganizational relationships at the f i r s t l e v e l of analysis seemed to take at least one of the character-i s t i c forms described e a r l i e r i n th i s study. The case of the Skeena Mental Health Centre was an i l l u s t r a -t i o n of an organization exercising a legitimated authority over the extent to which i t s services were provided. The services were withdrawn from outlying areas on the prerogative of the administrative s t a f f of the Centre. This action c l e a r l y could be seen to affect the orientation and behaviour of other organ-izations located i n an area which was no longer receiving ser-vice. The only q u a l i f i c a t i o n here i s that there was no control exercised by the Mental Health Centre over the reaction of the other organizations. I t cannot be assumed that the p a r t i c u l a r reactions of organizations could have been predicted i n any fashion by the Mental Health Centre. Therefore, i t i s seen that while there was power to withdraw services, there was no power to control any reaction that might arise from that withdrawal. This example seems l i k e a simple demonstration of an organ-ization's a b i l i t y to exercise i t s administrative prerogatives. - 89 -However, this in itself is an expression of power inasmuch as the control of the Mental Health Centre's services l i e , at least to some extent, with the bounds of the local administration. Although the Centre's resources were severly limited by an ex-ternal authority, there s t i l l remained a capacity to control their distribution on a local level. A more subtle kind of power may be argued to have been evidenced in the example of Three Rivers. Here the power may be seen to l i e in a moral context in that the Workshop, having once established itself as credible and useful agency in the com-munity, was able to convince both local and governmental bodies that its continued existence was worth supporting. Certainly within the local community the economic plight of Three Rivers was sufficient to e l i c i t compassionate financial relief. This kind of power is reasoned to have evolved from internal characteristics of the organization in the sense that the manage-ment was responsible, in part, for the particular economic cir-cumstances. Over and above this, Three Rivers, by virtue of being involved in providing a direct service to the mentally handicapped, would command a charitable response from society which, in turn, might be reflected in the behaviour towards Three Rivers of other local organizations. Perhaps more importantly, Three Rivers was the only centre of its type available to the local community. Power is also - 90 -assigned to any organization which provides the only source for a particular service. The Kitimat Workshop seems to possess l i t t l e or no power which can be ascribed to its internal characteristics. There was, i t would appear, a limited need for the services of the workshop. Its services were not in high demand i f one uses the attendance rate as an indicator. The expertise within the or-ganization was limited in regard to both managerial and pro-gramming skills of the director and the managing committee. Although the Workshop might have expected some compassionate response from the community (as was received by the Three Rivers Workshop in Terrace), i t was obvious that none was forthcoming. This may have been due again to the fact that so few clients were enrolled in the workshop programme and also in part to the low profile of the workshop director and managing committee. Organizational Autonomy Organizational autonomy is an area which appears to be highly dependent upon internal characteristics of organizations and in the cases at hand is seen to be closely identifiable. With regard to the Skeena Mental Health Centre there is a dichotomy in the autonomy of that organization. On one hand the Centre controlled in a vertical relationship with a central - 91 -authority in Victoria. On the other hand, i t was able to uni-laterally and formally discontinue services to certain areas in its assigned jurisdiction. In this situation, the agency is af-forded a degree of autonomy in its relationships at the community level, but this autonomy is subject at a l l times to a central authority. The implication being that the limits to the auton-omous nature of the organization may not always be visible to other organizations at the local level. Furthermore, those limits may not be known, even to the local organizations, until they are tested by some direct action. The Three Rivers Workshop may be described as having pos-sessed different levels of autonomy at specific periods in its existence. Initially, the organization was able to exercise considerable autonomy as i t was virtually independent in terms of resource management. However, this autonomy appeared to diminish rapidly as the organization became more dependent upon other funding bodies. Autonomy was compromised in order to obtain more secure funding. Funding agencies began to indicate that funding would be available only in amounts sufficient to sustain pro-grammes they themselves defined. The Kitimat Workshop had always been autonomous although i t was evident that autonomy would have been willingly surrendered for adequate funding. In the end, there was no support for the workshop, few relationships with other organizations had been - 92 -formed, and resources were not available in any form. Autonomy was retained, but this was of no benefit to the workshop. Domain Consensus Domain consensus does not seem to be particularly germane, at least in the examples at hand, to internal features of organ-, izations. However, some limited observations are required. In the case of the Skeena Mental Health Centre, the or-ganizational domain is seen to be authorized by virtue of a legitimated authority. The terms of reference and parameters of service are the product of a Provincial government mandate issued by the Division of Community Mental Health. It is pos-sible, however, that within the unique environment of various communities that certain areas of responsibility may be negot-iated by organizational representatives. If such negotiations were to take place, i t is again possible that i t would be in-fluenced by internal traits of the negotiating organizations. In the matter of the Three Rivers Workshop, however, there is some evidence that an attempt to influence the agency's domain may be attributable to internal characteristics. As noted pre-viously, the director of Three Rivers was able to exercise con-siderable control over the emphasis of the workshop programme. It was his strong personal belief that the workshop should be a - 93 -training centre. In the absence of any conflicting opinions, the attempt was made to establish the training centre. However, when other organizations became involved with Three Rivers i t was clear that there was no consensus about the workshop role. In the final analysis, i t was never resolved what the workshop should be doing. In spite of the constraints imposed by funding agencies, the workshop director was s t i l l determined that the main emphasis should be upon training of clients. Consensus may have been achieved in the sense that funding was in fact being provided on the basis of a more limited sphere of activities. In the case of the Kitimat Workshop, the absence of funding and authority indicated that there was no domain consensus. In fact, there was no domain being recognized by funding bodies. Again, whether or not this is attributable to any internal characteristics other than limited clientele is not clear. Interorganizational Coordination Interorganizational coordination was not seen as a major factor which was influenced by interorganizational relationships at the first level of analysis. No evidence was obtained from the research data to bear.out a relationship between internal characteristics and levels of interorganizational coordination for purposes of eliminating unnecessary duplication and overlap - 9 4 -of services of d i f f e r e n t organizations. This i s not to say that no relationship e x i s t s . In the examples at hand there were no problems of coordination of services because each organization operated within a l i m i t e d sphere and was not seen to overlap services offered by any other organization. - 95 -CHAPTER V INTERORGANIZATIONAL RELATIONSHIPS - LEVEL II The purpose of this chapter is to discuss and analyse factors identified in the research data which were seen to be of primary importance in influencing relationships between organ-izations. As described in an earlier chapter, at Level II the focus is upon a single organizational entity and its relation-ships with other organizations comprising its organizational environment. In this chapter, several organizations will be reviewed in this context and relevant factors affecting the nature of their relationships with other organizations will be discussed. Because, at Level II, i t is the individual organizational unit which is the object of direct concern, each of the organiza-tions will be described and then discussed in turn under each of the five major dimensions chosen for analysing Level II inter-organizational relationships. The organizations which are dis-cussed are arbitrarily selected by the author so as to permit broad development of the available research data. - 96 -Osborne Guest Home The Osborne Guest Home was a f a i r l y new addition to the com-munity mental health organizational environment i n Terrace. At the time the data c o l l e c t i o n for t h i s study was being conducted, the guest home had been i n operation for approximately s i x months. During that period i t had successfully established i t s e l f to the extent that i t was able to provide treatment pro-grammes on an indiv i d u a l basis for a f u l l complement of r e s i -dents. Relationships with other organizations i n the community had been placed on a positive footing from the perspectives of both the administration of the Guest Home and those persons who represented other community mental health organizations i n Terrace. Furthermore, adequate and consistent funding for the home had been secured from two sources. Capital funds had been obtained from a l o c a l organization, the Skeenaview Society, and the operational budget had been secured from the B.C. Department of Human Resources. Osborne Guest Home was placed from the beginning on a very favourable operational foundation. Several factors may be seen to contribute to t h i s apparent organizational w e l l being. The h i s t o r i c a l context of the cre-ation of Osborne Guest Home provides important insights. I t had been argued for sometime by many of the l o c a l health and s o c i a l services professionals that there was a great need for a r e s i d -- 97 -e n t i a l boarding house for psychologically and physiologically impaired adults i n the Terrace region. In acting upon th i s commonly acknowledged deficiency i n health care programmes an aggressive campaign was launched by the c l i n i c a l administrator of the Skeena Mental Health Centre. This campaign had the t a c i t , i f not active, support of much of the professional manpower.in the region. Even the lay public were motivated to support the cause through t h e i r p a r t i c i p a t i o n i n the Skeenaview Society which provided the necessary c a p i t a l funding for the Home. I t i s understandable therefore, that there should be a general good w i l l surrounding the Osborne Guest Home. To a very r e a l extent i t was the product of the ef f o r t s of the l o c a l community. Another factor which would seem to lead to p o s i t i v e re-lationships between Osborne Guest Home and other organizations i n the community was evidenced i n an examination of the membership of the admitting committee. The committee was. composed of repre-sentatives from the Public Health Unit, the Skeena Mental Health Centre, the Department of Human Resources, Aid to the Handi-capped, l o c a l physicians, and the Executive Director of the Home. When one considers that r e f e r r a l s to the Home had come from Skeena Mental Health Centre, the Department of Human Resources, i n s t i t u t i o n s such as Riverview and Woodlands, as we l l as from three of the l o c a l physicians, i t i s obvious that most of the - 98 -potential sources of referrals have representation on the admit-ting committee. Such pragmatism in the committee structure should have left many of the representatives in a position to ensure that their organizational interests, at least in terms of patient or client referral, were given equal time with those of other referring agencies. Another associated result of the wide involvement of local community agencies in the operations of the Home is an enhanced understanding on behalf of the Home's administration of the oper-ations of other agencies. For example, while there was a feeling that client contact and follow-up of referrals from the local personnel of the Department of Human Resources was left wanting in terms of frequency there was some sympathy extended towards the staff of the Department. The staffing complement was too small to meet the regional demands, the Home administration thought. Because the Home provided a rather stable environment in terms of support for the clients residing there the Department was able to reduce, its level of service to those clients in order to provide needed services elsewhere. The staff at Osborne Guest Home acknowledged their own ability to compensate for the reduced contact from the Department of Human Resources and thereby gave tacit approval to the unofficial strategy of the Department. A somewhat cynical note which was never brought up is that i t may - 99 -also have been easier to compensate for the perceived under ser-v i c i n g from the s t a f f of the Pr o v i n c i a l department which provided the operational budget to the Home. An agency which did not receive the same kind of empathetic response from the Osborne Guest Home administration was the Three Pavers Workshop. The relationship between these two organiza-tions could have been more po s i t i v e than i t appeared to be. Many of the residents of Osborne Guest Home required or at least could have benefited from a sheltered workshop and/or t r a i n i n g pro-gramme such as that which Three Rivers was trying to develop. S i m i l a r i l y , i n order to remain a viable organization providing programming for mentally and physi c a l l y handicapped adults, Three Rivers required participants i n i t s programme such as those people who-resided at Osbome Guest Home. However, many of the residents at Osborne Guest Home were reluctant to go to Three Rivers Workshop because of the rout-i n i z e d nature of the programme there. I t was said to be too boring. This led to frustrations within the Osborne Guest Home. Residents of the Home chose either to remain at home or to attend on a sporadic basis. Programme eff o r t s and motivation of pa-t i e n t s were more d i f f i c u l t f o r the Home's s t a f f . Their own re-sources became taxed when outside programming, such as that at Three Rivers, proved inadequate f o r the residents. The dissat-i s f a c t i o n at the administrative l e v e l i n the Home was voiced by - 100 -the Executive Director of the Home. In spite of knowledge of the nature of inte r n a l problems at Three Rivers, there was l i t t l e tolerance for the sit u a t i o n . The Home's s t a f f r e l i e d upon the a v a i l a b i l i t y of the Three Rivers programme but found i t unac-ceptable i n i t s existing format. Thus, what could have been a strong, p o s i t i v e l y reciprocating relationship between the two organizations suffered because of the f a i l u r e of one organization to l i v e up to the expectations of another. Skeenaview Lodge The Skeenaview Lodge i s an organization which has seen many si g n i f i c a n t changes over approximately twenty-five years. I t was opened i n 1951 as a 300-bed psycho-geriatric unit and was oper-ated largely as a depository, f o r B r i t i s h Columbia's male chronic care patients. Its administrative centre was located at Valley-view and v i r t u a l l y , a l l p o l i c y decisions emanated from that i n s t i t u t i o n . As Skeenaview endured i n Terrace i t s importance to the community as an "industry" was established. In 1968 the l o c a l community successfully lobbied the P r o v i n c i a l government to abandon plans to phase out the centre. In a s t r i c t l y organizational context the most s i g n i f i c a n t change occurred i n 1972. In June of that year, i n i t i a t i v e s were - 101 -begun to turn the management of Skeenaview over to a l o c a l Board of Directors. The intention was to convert Skeenaview into a regional f a c i l i t y for both men and women. The transfer of authority took two years and on May 1, 1974, Skeenaview was turned over to the l o c a l society for a t r i a l period of one year. Since June of 1972, major changes were made i n the operation of the lodge. Staffing was increased from 74 to 137 i n 1975. A l l functions except the prin t i n g of paycheques were turned over to Skeenaview. Admissions are accepted only from the north and remotivation and r e h a b i l i t a t i o n have become the central focus of a wide variety of treatment programmes. The r e h a b i l i t a t i o n of Skeenaview as an i n s t i t u t i o n has been dramatic. An important factor i n changing i t s image was the establishing of a Board of Trustees which involves Terrace res-idents i n the management of.the Lodge. As w e l l , a young hospital administrator with great concern and i n i t i a t i v e took over the running of the organization i n 1974. Together, the Board members and the professional s t a f f , transformed the Lodge, within the l i m i t s of available resources, from a custodial care i n s t i t u t i o n to a bonafide therapeutic and r e h a b i l i t a t i o n centre for psycho-g e r i a t r i c care. v Because Skeenaview was cut o f f from the l o c a l community i n the e a r l i e r days and because the present emphasis i n mental health care was towards greater community p a r t i c i p a t i o n , very - 102 -great ef f o r t s were made to l i n k Skeenaview more closely with the rest of the community. Meetings of professionals were held i n the boardroom, v i s i t o r s encouraged, and Skeenaview provided Meals-on-Wheels and catering services for senior c i t i z e n a c t i v i t i e s . I t has already been noted i n the previous section dealing with the Osborne Guest Home that the Skeenaview Society took considerable i n i t i a t i v e i n organizing funding for the Home. This intense a c t i v i t y and energy directed towards community linkages has obviously had a great impact upon the interorganizational relationships between Skeenaview and other community mental health care organizations. The relationship between Skeenaview and the Terrace Com-munity Resources Board i s p a r t i c u l a r l y relevant to Level II inter-relationships. There are two instances which sharply i l -lustrate t h i s claim. F i r s t l y the Community Resources Board Meals-on-Wheels programme was supported s i g n i f i c a n t l y by the re-sources of Skeenaview Lodge. A l l meals sent out to the community were prepared by personnel of Skeenaview using Skeenaview's equipment and food s t u f f s . Regular production of meals by Skeenaview personnel was simply expanded to include the required number of meals for the Community Resources Board c l i e n t s . Secondly, the Chairman of Community Resources Board was the Administrator of the Skeenaview Lodge. A strong personal i n -- 103 -terest, on his behalf, i n the operations and development of the Board no doubt accounted f o r the strong support of the Meals-on-Wheels programme. It i s important to note that the Community Resources Board as an organization i s not concerned so l e l y with the f i e l d of community mental health. However, other s o c i a l services organ-izations such as the Three Rivers Workshop and the Child Develop-ment Centre were slated to receive some f i n a n c i a l support from the Board i f and when the Board was given funding authority from the P r o v i n c i a l government. In an i n d i r e c t way then, the Board served as a channel of communication through which at least the Administrator of the Skeenaview Lodge could develop relationships with other community mental health organizations. Skeenaview Lodge, at the time of the study, was an organ-i z a t i o n which seemed to be t h r i v i n g on i t s new programme inno-vations. While community relationships were only j u s t beginning to be formulated i t was evident that the administration of the Lodge was keenly interested i n establishing relationships with the l o c a l community. The Terrace Association for the Mentally Retarded The Terrace Association f o r the Mentally Retarded (T.A.M.R.), as a voluntary organization involved i n community mental health - 104 -services, offers some interesting opportunities for discussion of Level II interorganizational. relationships. A primary distinc-tion between T.A.M.R. and other organizations discussed to this point in this study is that T.A.M.R. did not provide services directly to clients. Rather i t was an organization which at-tempted to develop and support community mental health care programmes to be run by other organizations. It was reported by members of the T.A.M.R. executive that the organization had been successful in promoting the development of several community mental health programmes in Terrace. It was the T.A.M.R. initiative which secured the i n i t i a l L.I.P. funding for the Three Rivers Workshop. They also were successful in raising i n i t i a l funding for the purchase of the Alice Olsen Home facilities. Relationships with both these organizations were the principal concerns within T.A.M.R.'s organizational environment according to the executive members. Indeed, the organizational objectives of T.A.M.R. were oriented to establishing residential facilities in Terrace to house mentally handicapped children from in and around the Terrace region. Priorities were equally weighed between providing two facilities, one for young children and one for adolescents. A representative from T.A.M.R. served with individuals from Skeena Mental Health Centre,, the Public Health Unit, the Depart-ment of Human Resources, and the house parents of the Alice Olsen - 105 -Home on an admissions screening committee for the Alice Olsen Home. The T.A.M.R. representative was a local physician who con-sulted with parents regarding their decision to apply to send their children to the Home. The Terrace Association for the Mentally Retarded did not have a very large sphere of organizational activity. The most constant relationships were evidenced between i t and the Alice Olsen Home and the Three Rivers Workshop, each of which T.A.M.R. was centrally involved in establishing. Other relationships were seen to develop vicariously, through these more direct linkages. Specifically, the relationship between T.A.M.R. and the local offices of the Department of Human Resources was enhanced through the direct concern of each with the Alice Olsen Home. Both organizations made referrals to the Home and both had interests in its continuing operations. Similarly relationships between T.A.M.R. and Skeena Mental Health Centre centered around mutual areas of activity although direct formal contact between the two organizations was limited. There was an area of overlap in the counselling function. Many parents of mentally retarded children were seeking the assistance of T.A.M.R. members who were them-selves parents of mentally retarded children. It was thought that advice flowing from people who have faced similar problems often has more meaning to the uninitiated party. For this reason Skeena Mental Health would frequently suggest to parents seeking - 106 -their counsel that i t could be of additional benefit to seek out more personal advice from the lay membership of T.A.M.R. It is interesting to note in addition to the fostering of vicarious organizational relationships that there was a screening process of sorts at work. The Alice Olsen Home for instance had a strong relationship with T.A.M.R. as a founding and referring body. However, an equally strong relationship was formed between the Home and the Jack Cook School. Attendance at Jack Cook School was a compulsory condition of residence at the Home. However, this relationship notwithstanding there was never any mention by T.A.M.R. officials or the School principal of any formal ties between the two organizations. The school's admin-istration and programming were not, apparently, a concern of the T.A.M.R. membership although many of their own children were in attendance there. This observation is made only to point out the possibility that the T.A.M.R. membership may have individual priorities such as school for their children and at the same time they have have a collective priority such as boarding home faci l -ities for mentally retarded children who are not necessarily their own. It may be that the collectivity, recognizing a need for complementary facilities, focused only on the unmet need i t perceived in an attempt to build a network of facilities that would f i l l gaps in the community mental health care system. - 107 -It should be noted that T.A.M.R. has received considerable assistance and guidance in its activities from the British Colum-bia Association for the Mentally Retarded (B.C.A.M.R.). While the nature of this assistance was not made explicit i t may be that the support of that provincial organization provided T.A.M.R. with some measure of local credibility, especially in its relationships with government organizations such as the Skeena Mental Health Centre and the Department of Human Resources. Indeed the aspect of fund raising by T.A.M.R. has been closely allied to the provincial association's annual Flowers of Hope campaign. This has resulted in consistent funding over the recent years. Additional funds for specific projects have been quite readily obtained from various service clubs in the com-munity. From a financial point of view then T.A.M.R. regarded itself as solvent and even prosperous and did not need to rely on any other local organizations for its continued existance. Rather i t saw itself as a source of funding rather than as a resource user and consequently felt quite independent of other local organizations. Child Development Centre - Kitimat The Child Development Centre in Kitimat was an organization which had developed organizational relationships between itself - 108 -and various l o c a l and non-local community mental health organizations. An important non-local relationship existed between the Centre and the B r i t i s h Columbia Cerebral Palsy Association l o -cated i n Vancouver, B.C. This relationship stems back to the time of creation of the Child Development Centre when the provin-c i a l body provided assistance i n securing i n i t i a l budgeting, making grant applications, locating s t a f f , and developing a suitable organizational framework. Since then the B.C. Cerebral Palsy Association had continued to provide annual grants of money to a s s i s t i n the continued operation of the Centre. In 1975 th i s annual grant amounted to $20,000. The other services continued to be provided as w e l l . P a r t i c u l a r l y useful to the Child De-velopment Centre was the assistance i n locating manpower for professional positions within the Centre. The relationship between the Centre and the p r o v i n c i a l Cerebral Palsy Association was viewed very p o s i t i v e l y by the Centre's Board of Directors and was es s e n t i a l l y one of gratitude for the i n i t i a l assistance i n helping the Centre establish operations. Another non-local organizational relationship noted was that between the Kitimat Child Development Centre and the Terrace Child Development Centre. Although t h i s relationship was not t described i n great d e t a i l by representatives of either organ-i z a t i o n , the description that was given did establish that the - 109 -relationship was based upon a mutual sharing of staff. A highly qualified speech therapist was recruited and funded jointly by the two organizations. It was not obvious that relationships between the two organizations proceeded beyond the. shared fund-ing. No reference was made to any other organizational exchan-ges. The fact that a regional pediatrician served as medical director for both facilities was not seen by the Kitimat Board Chairman as constituting a formal organizational linkage. Any interaction between the organizations which was mediated by this physician was apparently informal and spontaneous. At the local level, interorganizational relationships be-tween the Child Development Centre and other community mental health organizations were evidenced and were identified by their representatives as being of great importance to the operation of the Centre. For example, the linkage with the Kitimat Associ-ation for the Mentally Retarded was cited by the Child Develop-ment Centre's Board Chairman as being a strong tie. The nature of this relationship was essentially a duality of membership. That is many of the people who were members of the Kitimat As-sociation for the Mentally Retarded were also involved with the Child Development Centre. While the implications of this double membership and/or representation could have been important to both organizations, i t was difficult to detect any ma j or influences that affected the - 110 -organizational character of either group. The Child Development Centre and its Board were operating a well funded, well thought out, and viable organization while the Kitimat Association for the Mentally Retarded was struggling desperately to preserve the existance of the Kitimat Workshop. However, there was some evidence of a blurring of the relative jurisdictions between the two organizations. The fact that the Child Development Centre was hopeful of offering programmes in the future to educate mentally retarded children does seem to be an indication of more than a passing interest in the welfare of the mentally retarded. In a similar view, there was mention of both organizations being hopeful of acquiring newly vacated space in a centralized building complex. The Child Development Centre did not expect to be given access to this space given the plight of other groups such as the Kitimat Workshop. There was some sympathy for the situation of the K.A.M.R. sponsored facility but there was l i t t l e opportunity to provide support for their application. In fact,. i t seemed likely to officials at the Centre that neither appli-cation would be approved. At the local level i t appeared that there were two other organizations which the Child Development Centre regarded as con-stituting a major part of their organizational environment. The fi r s t was the Public Health.Clinic. This relationship seemed to be most important to the actual operation of the Centre in that - I l l -the Public Health Nurses were seen as referral sources. It was the opinion of the Administrator of the Centre that one role of the Public Health Unit should be to go into the community and to ferret out and refer potential clients to the Centre. While this role seemed not to be fulfilled to the satisfaction of the Admin-istrator, there was evidence that information about the Centre and its programmes had been made available to the Public Health Nurses. They had made several referrals to the Centre in the past and were in frequent contact with the staff at the Centre. S t i l l i t was felt that more could be done to help the nurses to recognize the early indications of disability in children and thereby assist in more effective treatment for more children. Other than continuing the present liaison practices, there was no indication as to how the personnel at the Child Development Centre would be able to affect an increased awareness in the local nursing staff. The other organization with which the Centre had developed an important relationship was the Kitimat School District No. 80. There was an implied expectation on behalf of the Centre that children should be able to make a transition from the programming at the Centre to special classroom facilities operated by the School District. A continuum of educational programmes should be available in the local community which would or could permit children to progress from pre-school training at the Child - 112 -Development Centre right on through to participation in normal school programmes. The relationship between the Centre and the School District however, was not well defined at the time of the study. Several references were made to the potential for inte-grating the Child Development Centre programming with that of the School District but there had been no formal linkage between existing programmes run independently by these organizations. It was mentioned that a teacher for deaf children had recently been hired jointly and that this was the first time such a coordinated effort had been achieved between the two. In light of that development i t is evident that there was a recognition by both groups that there were opportunities for stronger and more formal organizational ties. Analysis The foregoing examples of specific Level II interorganiza-tional relationships provide several opportunities to analyse the ways in which resources can affect relationships between organizations. - 113 -Resources The Osborne Guest Home provided an opportunity to examine aspects of the affects of resources which were not as clearly distinguishable in the experiences of other community mental health organizations in Terrace. Most resources such as funding, physical facilities, and professional manpower were being or had been provided on a stable basis. The clientele being served were even flowing into and out of the programmes of the facility on a regular basis. This description serves to imply that the tech-nical organization of the Home was working well. In most respects the Home was interacting with members of its organiza-tional environment in a well coordinated fashion. The organizations which had collaborated in establishing or-ganizing and funding the Home were being given fair exchange for their investment in that virtually every organization which had provided assistance was now afforded the opportunity to refer clients to the Home's programme. The Osborne Guest Home became a direct resource for the activities of organizations which had facilitated its establishment. The resource providers, i t seems, had created an organization with which they intended relation-ships would be maintained to the mutual advantage of a l l con-cerned. This is evidenced in the fact that so many of the founding organizations had representatives on the Admission - 114 -Committee for the Home. Clearly the Home's primary organiza-tional relationships had not changed appreciably since its creation, especially in terms of the members of the organiza-tional environment. The resources which other community mental health organizations had invested determined to a large extent the orientation of the Home in its relationships with those i organizations, at least insofar as the admissions to the Home were concerned. Resources can also be seen as influencing the relationship between the Home and the local offices of the Department of Human Resources. As noted previously the clients who were referred to the Home were not given as intense follow-up and support by the staff at the Department because the Home was regarded as being relatively well off in terms of professional staff and programme activities. Because of the quality and quantity of resources of the Home the Department chose- to invest their own specific re-sources, such as staff time, elsewhere. This was accepted by the Staff at the Home who recognized that the relative strength of their own programming and at the same time saw that the resources of the Department were not adequate to meet the demands being placed upon them. In this instance the resources available to both organizations can be seen to influence the nature of their relationship. While this can be said of most interorganizational relationships where one organization has resources while the - 115 -other has not the distinction here is that the resources are not elements to be exchanged. The organizations can function in-dependently to a great extent and were they given more abundant resources the nature and frequency of their interchanges would likely be increased. However, under circumstances of limited resources of one organization and the relatively abundant re-sources of the other a mutually agreed upon level of exchange was established. The Skeenaview Lodge, as an established organization, had had access to sufficient resources of various kinds to maintain operations for a period of more than twenty years. In that period the resources at hand had been utilized primarily to sustain the internal functions of the Lodge as i t housed and treated the chronically mentally i l l . The basis of most of its organizational relationships was with organizations outside Terrace. Funding, staffing, patients, policy, and authority sources were a l l externally located. In spite of the geographic remoteness of the Skeenaview facility from resource centres such as the Provincial government and other psychiatric facilities in the province there remained a primary orientation of the facility to the sources controlling the resources of the Lodge. There were few, i f any, interorganizational relationships between Skeenaview and local mental health organizations. The Lodge did, however, become an "industry" in the community and as such con-- 116 -tributed to the economic fabric of Terrace. Over time, the community's economic dependence upon the Lodge became quite strong. Indeed, as noted in the above description of the Lodge, the community was successful in.its attempts to ensure that the facility was not closed down. It was not until after the Pro-vincial government transferred administrative authority to a local Board of Directors that Skeenaview Lodge began to develop relationships with other community organizations. The transfer of authority made i t possible to orient the use of certain ex-isting resources towards the local scene. The use of the Lodge's dietary facilities for the support of a Meals-on-Wheels programme is the best example from the research data of the use of re-sources (facilities and dietary department staff) for this pur-pose. Certainly the advent of this programme enhanced relation-ships between Skeenaview and the local Community Resources Board. However, the role of physical resources in enhancing the new "outward" looking orientation of the Lodge is not seen to be as important to the development of organizational relationships as is the role of human resources. The organizational mandate for Skeenaview was not to bestow funds or facilities. Rather, i t was the treatment and care of the mentally i l l . Within those terms of reference i t was the activity of the Board and administration of the Lodge which became the prime factor in developing inter-change with local organizations. The technical or administrative - 117 -organization of the Lodge was oriented towards this goal. Hence i t was the representation of people identified with the Lodge which served to develop the relationships. In this sense then the skills, knowledge, and experience of the administrative personnel combined with the technical organization of the Lodge are the resources which registered the greatest impact in de-veloping interorganizational relationships at the local level. Examples of this are the role played by the Skeenaview Board and society in assisting to establish the Osborne Guest Home. As well, the relationships between Skeenaview and the Community Resources Board was evidenced by the fact that the Chairman of the Community Resources Board was the Administrator of Skeenaview. The Terrace Association for the Mentally Retarded is an or-ganization which relied heavily upon the abilities and initiative of its own membership in establishing interorganizational re-lationships. In order to pursue its organizational objectives the Association was obliged to solicit other organizations for needed resources such as funding, organizational advice, and pro-fessional staff. The activities of the Association as described previously are analogous to that of a middle man. While in the past, the Association has not provided nor directly funded, client services, i t has identified sources of needed resources and facilitated the transfer of these resources to agencies which - 118 -do provide client services. In this role two basic types of relationships are established. The first is with organiza-tions which are resource providers. The second is with organ-izations which are designated as recipients of the solicited re-sources or on whose behalf the Association is acting. As the Association membership gained experience in their activities, the success of projects they undertook to support was greatly enhanced. Witness the plight of the Three Rivers Work-shop, which was their first.venture as compared to the more re-cent success of the Alice Olsen Home. As well as having gained experience, there was enlarged organizational environment in-volved in that more types of organizations were solicited in establishing Alice Olsen Home. The opportunity for pooling col-lective resources of several organizations was recognized in that venture. The point to be made here is that experience in and knowledge of the system of funding community mental health pro-jects became an important asset to the Association. It rarely, i f ever, controlled the disbursement of resources such as money but was able to use the resources of expertise and experience in order to achieve its goals through other organizations. The analysis of the Kitimat Child Development Centre's interorganizational relationships within a resource context again provides some unique opportunities to show the effect of re-sources upon these relationships. - 119 -The Child Development Centre relied heavily upon non-local agencies for support and assistance in both its i n i t i a l start-up period and in its subsequent operations. Funding, organizational advice, and most professional staff had a l l been provided di-rectly through the offices of the British Columbia Cerebral Palsy Association. These resources have continued to be provided in varying amounts throughout the existance of the Centre. The reliance upon the financial and organizational resources of the B.C. Cerebral Palsy Association is very high. Without this kind of support the Centre would not be able to function. In spite of this there was no mention by the Centre's rep-resentatives of any undue imposition of policy upon the Centre. The funding was provided for programming within certain para-meters but once these were met the Centre and its Board could and did exercise considerable independence in its operations. There was some pooling of resources as an attempt to stretch the programme budget of the Centre. Both the Terrace and Kitimat Child Development Centres cooperated in hiring shared profes-sional staff. However, beyond this development there were no other formal relationships between the two. It was purely an economic arrangement that was designed to enhance treatment programmes in both facilities. It is seen here that relation-ships spawned by resource related concerns are not necessarily limiting upon any organization nor do these relationships neces-- 120 -sarily proceed beyond the narrowly defined terms of resource exchange. However, these points will be brought to light in the subsequent section of the chapter dealing with organizational autonomy. Power Organizational power is an phenomenon which has several con-sequences for Level II interorganizational relationships. In consideration.of the definitions of power presented earlier in this study, the Osborne Guest Home does not appear to be a powerful organization within its organizational environment. It controlled few resources required by other organizations, had no legislative authority, and. was only just beginning to develop its credibility with other organizations. In a sense its avail-able power base had been eroded by the presence of so diverse a group on its admissions committee. With so many organizations represented on that committee the administration of the Home had l i t t l e control even over who was to be admitted as clients. The fact that the Home was a new entity in the local community mental health sphere also contributed to a relative lack of power. The Skeenaview Lodge was an organization which, in contrast to the Osborne Guest Home, was seen by the writer as an organ-ization invested with some power. While i t was not an organiza-- 121 -tion in control of economic resources to be bestowed upon other organizations i t was the human resources, discussed in the pre-vious section which were identified as the main sources of power. The first point to consider in that view, was the power over the local community which the organization probably did not acknow-ledge that i t had. In this one context the organization, as an industry, did possess economic power within the community. It is evident from the data collected on this organization that the power was only evidenced by. the community responses to the at-tempt by the Provincial government to close down the institution. In this sense, however, power does not seem to be reasonably ascribed to the Lodge. There had been no attempt on behalf of the organization to utilize its economic strength in the com-munity. However, when the administrative authority for the Lodge was placed in the hands of the local Board of Directors i t can be argued that power was then given to the organization to effect its own interorganizational relationships. Indeed, its efforts, or that of its Board, were evidenced in the creation of the Osborne Guest Home and the support given to the Meals-on-Wheels programme of the Community Resources Board. The power that was most noticeable, however, was that which was carried by the Ad-ministrator of the Lodge. This individual was a charismatic and dynamic person who served as the Board Chairman of the Community Resources Board. While the power that he had was not seen to be - 122 -u t i l i z e d i n his role as administrator of the Lodge h i s influence on the a c t i v i t i e s of the Community Resources Board served to highlight the presence of the Lodge i n the community and served to enhance the goal of the Lodge to become more prominent as a l o c a l community oriented organization. Thus, the referrent power ascribed to the leader of the organization by members of other organizations would, to some extent at l e a s t , be transposed to the Skeenaview Lodge. The power of the Terrace Association for the Mentally Re-tarded was largely a function of i t s association with other or-ganizations which controlled economic resources and/or which possessed l e g i s l a t e d authority. The Association i t s e l f con-t r o l l e d very few of these resources but did however, succeed i n obtaining resources through i t s alliances with Provincial voluntary and governmental organizations. Indeed, once the negotiations f o r support of the A l i c e Olsen Home had been com-pleted the Association was not endowed with either funding con-t r o l or administrative control over the operations of the f a c i l i t y . The Association did control access to funds, at least l o c a l l y , from sources such as the B r i t i s h Columbia Association fo r the Mentally Retarded. But even i n t h i s l i g h t , the power of the Association i t s e l f was quite li m i t e d . Any authority i t pos-sessed was vicarious i n nature and d i r e c t involvement with l o c a l organizations the Association helped to establish usually did not - 123 -result i n any long lived administrative authority being held by the Association. Further to this there did not seem to be any leadership role with the Association which would permit an in-dividual member to be identified as the representative of the Association. Hence, there was no power attributed to the Associ-ation at the local level through the strengths of i t s leadership. The interorganizational relationships of the Kitimat Child Development Centre were not seen to be affected significantly by the presence or absence of power held by that organization. In actuality the Centre controlled few economic resources except those which were for i t s own purposes. At the local level, the organizational relationships i t was engaged in were not seen to be at a l l influenced by the presence or absence of control of resources. The Centre was maintained through the financial as-sistance i t received from the British Columbia Cerebral Palsy Association. As was the case with the Terrace Association for the Mentally Retarded the relationship with the funding organ-ization was not seen to be influenced by the fact that there was heavy financial dependence. The power of the funding agency did not appear to extend to the level of influencing the programming or operational policy of the Centre. - 124 -Organizational Autonomy For each of the four organizations chosen for analysis i n th i s section of the study, organizational autonomy i s an im-portant factor. The Osborne Guest Home was an autonomous entity i n terms of administration of most of i t s day-to-day operations. None of the organizations which assisted i n establishing the Home maintained any kind of o f f i c i a l j u r i s d i c t i o n over the a c t i v i t i e s of the Home. However, there was one important factor which served to undermine the autonomy of the Home to some degree. The fact that so many organizations had representation on the admissions com-mittee of the Home has been mentioned previously as an erosion of the power of the Home. I t is. suggested as well that t h i s repre-sents a diminution of the Home's autonomy. In th i s sense, the notion of a federation of organizations as outlined by Warren (1967) would seem to apply. While the authority f o r r a t i f i c a t i o n ' of decisions regarding the admission of c l i e n t s l i e s o f f i c i a l l y with the Home, the other organizations do act together to influence the decisions that are made. In the case of the Skeenaview Lodge there was a notable h i s t o r i c a l point at which a degree of organizational autonomy was confined upon the organization by Pr o v i n c i a l authority. By es-- 125 -tablishing a local Board with administrative responsibility for the operation of the Lodge, the Provincial government may not have relinquished much of its control over the Lodge. By main-taining ultimate control over the economic resources of the Lodge the move to decentralization of authority evidenced by the creation of the Board may only have provided a degree of local autonomy for the Board. Indeed, the fact that the Board saw the enhancement of community relations as a new and important organ-izational goal may be evidence that this was the only real latitude afforded to the new Board. To oversimplify, i t may have been the only flexibility the decentralization allowed. Clearly, at the local level the Skeenaview Lodge could have remained untouched by the local organizational environment. There was no evidence that Skeenaview depended upon any of the local community mental health organizations for anything. In spite of the existance of the Board the Lodge could have remained aloof. However, the values of the local group were such that this should not be the case. The choice was made to extend the resources at the Lodge's disposal to the community. The Terrace Association for the Mentally Retarded was des-cribed earlier as being an organization with a small sphere of organizational activity. Partly as a function of this circum-stance the autonomy of the Association seems to be of only periodic significance in its organizational relationships. As a - 126 -voluntary organization which was not engaged in direct client services there were no continuous, daily operations to be per-formed. Consequently the reliance of the organization upon re-sources seemed to be project oriented. That is , i t was only when the Association identified specific projects that fund raising became important. Although there was a linkage between the Terrace organization and the British Columbia Association for the Mentally Retarded, this did not compromise the autonomy of the Terrace group. Indeed, i t appeared that T.A.M.R. was able to freely establish relationships with any organization i t chose. The alliances which developed did not, as previously noted, create any jurisdictional responsibilities. The Association was almost able to "free-lance" in its activities as i t retained l i t t l e or no administrative control over the projects i t helped to launch. The organizational autonomy of the Kitimat Child Development Centre, unlike the Terrace Association for the Mentally Retarded, was influenced to a degree by more formal and long-lived associ-ations with groups and agencies which constituted its organ-izational environment. Part of the difference is seen to be due to the fact that there were, regular organizational commitments in the provision of direct client services. In accepting these kinds of commitments and in becoming dependent upon resources of other organizations, a portion of the autonomy of the Centre was - 127 -f o r f e i t e d . The s h a r i n g of p r o f e s s i o n a l s t a f f w i t h other organ-i z a t i o n s i s not o f f e r e d here as a surrender of autonomy except t h a t i t might r e s t r i c t the scheduling of s e r v i c e s o f t h a t s t a f f member. Nor d i d the l i n k between the B r i t i s h Columbia Cerebral P a l s y A s s o c i a t i o n and the K i t i m a t Centre seem to impose r e -s t r i c t i o n s upon the programming o f the Centre. Although the B.C.CP.A. provided a l a r g e p o r t i o n o f the funding f o r the Centre, the independence of the Centre was not compromised through and l e g i s l a t e d on c o n t r a c t u a l agreements. Rather the autonomy o f the Centre operations was p o t e n t i a l l y threatened by the e x p e c t a t i o n regarding f u t u r e r e l a t i o n s h i p s w i t h other l o c a l community mental h e a l t h o r g a n i z a t i o n s . The c l u e to t h i s pos-s i b i l i t y l i e s i n the hope expressed by the a d m i n i s t r a t i o n o f the Centre t h a t a continuum of treatment programmes might be estab-l i s h e d and t h a t the programmes provided by the K i t i m a t A s s o c i -a t i o n f o r the M e n t a l l y Retarded and the K i t i m a t School D i s t r i c t No. 80 would complement each other. The e x p e c t a t i o n then, as noted p r e v i o u s l y , was t h a t a c h i l d might progress through the programmes o f f e r e d by d i f f e r e n t o r g a n i z a t i o n a l j u r i s d i c t i o n s . I t may be t h a t t h i s development would r e s u l t i n n e g o t i a t e d com-promise by a l l o r g a n i z a t i o n s concerned and t h a t the programming o f each be l i m i t e d . By engaging i n these types o f formal r e -l a t i o n s h i p s an i n d i v i d u a l o r g a n i z a t i o n ' s programming f l e x i b i l i t y c o u l d be s a c r i f i c e d . - 128 -Domain Consensus Domain consensus is a dimension which affected both the Osborne Guest Home and the Skeenaview Lodge in similar ways. Both of these organizations had clear organizational roles which were defined by contractual agreement in the case of the Osborne Guest Home (between the Home and the Department of Human Re-sources) and by legislated authority in the case of the Skeena-view Lodge. As well, neither organization was seen to overlap the jurisdictions of other organizations in the study area. These factors were likely important determinants in helping these organizations maintain positive relationships with other organ-izations. Certainly, the fact that so many organizations had input into the Osborne Guest Home should have eliminated any confusion over the role of that organization. The Skeenaview Lodge, however, because of its recently acquired autonomy and its stated goal of expanding its activities into the community could potentially intrude into established domains of other organ-izations. At the time of the study, however, there did not seem to be any evidence of this happening. Most of the efforts in the Lodge's expansion activity had been viewed by other organizations as f i l l i n g gaps in current community services. The Terrace Association for the Mentally Retarded did not seem to have clearly defined its organizational domain. It was - 129 -generally intended to advance the quality and quantity of ser-vices to the mentally retarded and to assist parents of mentally retarded children to adjust to the problems of raising those children. However, there had been an almost ad hoc approach in the kinds of projects the Association had supported. The cre-ation of the Three Rivers Workshop, the support provided to help establish the Alice Olsen Home, and the donation of a bus to a training school located in Smithers are a l l projects generally related to the provision of services to the mentally retarded. However, there were no specific agreements in existance which defined in either legal or contractual terms what the role of the Association was to be. Instead, there was an implicit kind of understanding that the Association should or could be doing the kind of things i t had been doing. The fact that funding for the Alice Olsen Home had been gathered largely through the efforts of the Association can be construed as evidence that this project was within the domain of the Association, at least in sofar as the organizations and people providing the funds were concerned. The failure of the Association to secure long-term financing for the Three Rivers Workshop may similarly be construed as evidence that that project was not seen by funding organizations as justifying ongoing support. . That being the case, the question arises as to whether that project was or should have been within the domain of the Association. No answer is offered here. The - 130 -observation is made that success and/or reasonableness of a project cannot be measured only in economic terms nor is i t an indication of an organization transgressing its organizational jurisdictions. The Kitimat Child Development Centre was another organiza-tion which lacked contractual and/or legal definition of its domain. The treatment programmes i t offered to its clients were provided according to the abilities of the professional staff. On that basis then there was an understanding about the kinds of programmes the Centre would offer. . In the absence of a like treatment organization in Kitimat there was l i t t l e chance for the programmes to be questioned by other organizations. The role of the Kitimat School District No. 80 in providing special education classes was not questioned by the officials of the Centre. Criticism was based on content of the programme not on the prerogative of the School District to provide i t . Interorganizational Coordination The f i f t h dimension to be considered in analysing Level II interorganizational relationships is that of coordination between organizations. The Osborne Guest Home served as an example of the ability of organizations to coordinate their activities to their mutual - 131 -benefit. This statement applies not only to the establishing of the Home but the way in which i t continued to operate. While the professional staff of the Home developed their own treatment styles, much of the treatment of individuals staying at the Home was based on the prior input of other mental health professionals in treating these people. That is, individual treatment pro-grammes were developed in consultation with professionals from other organizations. Another form of coordination is again evidenced by the composition of the Home's admission committee. The Home, in a very real way, became an instrument which brought together representatives of several local community mental health organizations. The form thus provided permitted a coordinated use of the facilities of Osborne Guest Home. The Skeenaview Lodge was another organization which served as a coordinating entity. Much of its treatment programmes were provided independently of the local community mental health organizations, therefore there was l i t t l e opportunity to co-ordinate their efforts at providing care. However, adminis-trative staff of the Lodge did seem to be able to offer assist-ance in local attempts to coordinate services. The support for and representation on the Community Resources Board was seen as a strong commitment to the notion of coordinated services in Terrace. Similarly, the activity of the Lodge's Board which - 132 -assisted the Osborne Guest Home in becoming established called for coordinated efforts of Skeenaview's Board and local mental health organizations. The Terrace Association for the Mentally Retarded had a pos-itive orientation to provision of coordinated mental health facilities. This was most evident in its relationship with the Alice Olsen Home. It was the coordinated activities of the Association with the Department of Human Resources which suc-ceeded in establishing the Alice Olsen Home. However, in con-trast to this coordinated effort, establishment of the Three Rivers Workshop was virtually a unilateral effort by the Associ-ation. Insufficient.attention by the Association to the long-term plans for the Workshop was due to lack of inexperience. Hindsight illustrated that this long-term planning was essential. This lesson was not lost on the Association as the success of the Alice Olsen Home shows. The administration of the Kitimat Child Development Centre had a strong orientation to the notion of coordinated services. Although there was l i t t l e evidence at the time of the study to support this claim the sharing of professional staff with the Terrace Child Development Centre was clearly an attempt to max-imize use of scarce resources. In addition, the reference to the idea of a continuing of services between different treatment agencies such as the Centre and the Kitimat School District is -' 133- -evidence of the value the administrative s t a f f of the Centre placed on the e f f i c i e n t use of resources. Speculation arises i n reference to the c r i t i c i s m of the quality of the programme cur-rently provided by the School D i s t r i c t as to the actual outcome of any attempts to coordinate services. The prospect of c o n f l i c t i n t h i s e f f o r t i s a p o s s i b i l i t y although t h i s should not necessarily mean the f a i l u r e of any coordinated e f f o r t s . - 134 -CHAPTER VI INTERORGANIZATIONAL RELATIONSHIPS - LEVEL III Conceptually, analysis of interorganizational relationships from a Level?Ill or suprasystem perspective is the greatest chal-lenge of this study. No longer is the individual organization the focus of attention. Rather, the analysis in this chapter centres upon the aggregate of community mental health organi-zations in Terrace and Kitimat viewed in the context of a single entity. This multi-organizational unit is composed of seventeen organizations which were identified as constituents of the com-munity mental health interorganizational field within the two centres. The difficulty in description and analysis of interorgan-izational relationships at this level is that the individual or-ganizations fluctuate in the degree to which they participate in the activities of the field. While the membership of the field can easily be determined, the nature of the interactions between and among the member organizations is dynamic. The structure of the field is such that there is no centralized decision-making - 135 -authority. While agreements can be negotiated by groups of organizations to proceed in specific directions there remains a considerable degree of unilateral decision-making authority within the field. A description of the structure therefore will need to be assembled through an analysis of the processes that were evidenced in the research data. These processes are the relationships between and/or among organizations which were viewed by the writer as being influenced by various factors and characteristics of the organizational environment. Example Number One The first multi-organizational relationship that is to be discussed involved an attempt to establish in Terrace an inter-organizational committee to address problems regarding children with learning difficulties. The committee was formed by the in-centives of a number of professionals from various organizations who felt that there were inadequate facilities in Terrace to pro-vide adequate treatment for emotionally disturbed children. The organizations represented on. the committee were the Skeena Mental Health Centre, the Department of Human Resources, the Local Board of Health, and School District No. 88. As well, two or three physicians were regularly in attendance at committee meetings. The composition of this committee shows that there was a consen-- 136 -sus among at least these organizations in the belief that there were gaps in services being provided to a specific clientele. It also shows that there was a willingness on behalf of the par-ticipating representatives to try to come to terms with this identified lacuna. It is apparent that the organizations had a l l been ident-ified by each other as having at least a marginal concern with the identification and treatment of emotionally disturbed child-ren. This can be assumed by virtue of their participation on the committee. It is known, as well, that the committee was intended to be a forum for communicating among the participating organizations. Until the committee was formed there had been no official and/or regular means of exchanging information regarding1 the activities of these organizations vis-a-vis the needs of emotionally dis-turbed children in the community. The' committee, therefore, was formed partly in response to that communications gap. The efforts of the committee had not borne much fruit. This may have been due in part to the short period of time which had elapsed since i t f i r s t met. The group had only been meeting for a period of six months at the time this study was done. However, i t was said by one of the participants in the group that another reason l i t t l e progress had been realized was that the level of participation by some organizations was not very intense. By - 137 -t h i s i t was meant that some representatives who attended the committee meetings contributed very l i t t l e . This may be a t t r i -butable to several factors but two important concerns become obvious. Did a l l the organizations represented actually have anything to contribute or did they participate on the committee only by v i r t u e of t h e i r a c t i v i t y i n the community mental health f i e l d ? Secondly, did the representatives to the committee lack authority and/or knowledge to make a contribution to the meetings and commitment to the other organizations? These questions can not be answered i n t h i s study. However, i n the absence of ob-j e c t i v e data, they do stimulate further questioning. Do organ-izations p a r t i c i p a t e i n such ventures because they are coerced to do so by other organizations which expect them to become involved i n that kind of a c t i v i t y ? Was there i n fact a gap i n service which required multi-organizational input for resolution? Per-haps the committee was r e a l l y trying to i d e n t i f y the true nature of inadequacies which were believed to e x i s t . I f that had been the focus of t h e i r a c t i v i t i e s then the outcome of the committee's e f f o r t may not have been viewed so p e s s i m i s t i c a l l y . Unfortun-ate l y , the committee was not subject to any interviews conducted i n the course of t h i s study and the above queries must a l l be l e f t unanswered. Nevertheless, the above example does serve to i l l u s t r a t e that there are a number of possible reasons for or-ganizations to enter into relationships with others and that the - 138' -organizational environment may serve to influence these various motivations. Example Number Two The second instance of interorganizational relationships being influenced by the interorganizational f i e l d or suprasystem of community mental health organizations i s , l i k e the previous example, related to the creation of new structures within the f i e l d . On at least three occasions l o c a l organizations took the i n i t i a t i v e i n establishing new community mental health programmes and f a c i l i t i e s . On two of these occasions a single organization, the Terrace Association for the Mentally Retarded (T.A.M.R.), was the p r i n c i -p a l actor at the l o c a l l e v e l . In i t s f i r s t venture t h i s volun-tary organization acted independently of other l o c a l agencies i n securing funding and professional advice for the establishment of the Three Rivers Workshop. T.A.M.R. members i d e n t i f i e d a l o c a l need, located funding from an external source, and established the workshop, apparently with minimal consultation with other community bodies. There was no evidence presented that other community organizations had been involved i n t h i s venture. The problems and c r i t i c i s m s which l a t e r beset the operations of the Three Rivers Workshop may have been at least p a r t i a l l y due to the - 139 r lack of any prior consultation with other local mental health organizations. However, the nature of the field was such that this kind of action could take place without extensive prior negotiations with other community organizations. Even i f other local agencies had actually been contacted in regard to the plan-ning of the workshop, i t may be assumed that l i t t l e opposition was raised. However, based on information received from T.A.M.R. officials, i t is more likely that this prior consultation did not take place. In the second T.A.M.R. sponsored project, the creation of the Alice Olsen Home, there was substantially more interorgani-zational consultation. This may have been due to the fact that T.A.M.R. had gained more experience and knowledge in the ways in which such projects should be approached. Certainly, the repre-sentatives of T.A.M.R. who spoke about this project indicated that they were far wiser as a result of their Three Rivers ex-perience. In any case, organizations such as the Department of Human Resources and the British. Columbia Association for the Mentally Retarded were highly involved in the Alice Olsen Home project. The success of such a project required the consolidated efforts of more than one organization and i t is clear that the necessary operational funding which was provided by the Department of Human Resources was a resource which T.A.M.R. now recognized as being essential for such facilities. It is interesting to - 1 4 0 ' . -note, however, that input to planning for the Alice Olsen Home from the local level, was s t i l l not very important for the plan-ning process. T.A.M.R. was able to meet its goals through the services, authority, and resources of agencies which were based at the provincial rather than the local level. The question arises as to how new services such as the Alice Olsen Home become integrated with existing services such as the Jack Cook School. It would seem, without having further information, that the facilities such as Three Rivers Workshop and the Alice Olsen Home are examples of how the local organizational environment is af-fected by plans of an ad hoc, incremental nature. This obser-vation is not made in any judgemental sense. However, the impact of the one i l l funded and i l l operated project, the Three Rivers Workshop, upon the community could stand as evidence against such a planning process. Contrasted with the success of the Alice Olsen Home, which had joint funding and support from the Depart-ment of Human Resources, one of the major actors in the local community mental health environment, i t is obvious where the ad-vantages l i e . The third facility which was established through the efforts of local organizations was the Osborne Guest Home. As was the case with the Alice Olsen Home, operational funding was secured from the Department of Human Resources. The distinction in the way the Osborne Guest Home was established lies in the magnitude - 1 4 1 -of involvement by local community mental health organizations. Stating i t very simply, more organizations identified the need for an adult residential facility and thus more organizations had input into its planning. It is clear as well that more local organizations continue to relate to the Osborne Guest Home than to the Alice Olsen Home. Although extensive reference to the Osborne Guest Home was made previously in this study in the context of Level II analysis of interorganizational relationships there are important conse-quences for analysis at the suprasystem level. The fact that local organizations had had such a unified approach in estab-lishing the Osborne Guest Home serves witness to the existance of an atmosphere conducive to coordinated efforts of community mental health organizations. It was possible for those organ-izations to act together in their own mutual interests. Example Number Three Perhaps one of the most interesting opportunities to view interorganizational relationships from the suprasystem view point is presented by a review of the Terrace and District Community Resources Board. The word 'interesting' is used because in theory the Community Resources Board was intended to be a coor-dinating body but in fact had not been able to effect very signif-- 142.; -icant responses from existing community mental health organizations. The Terrace and District Community Resources Board and others like i t throughout the province, were the product of provincial legislation which was introduced in 1974 to help communities throughout British Columbia to coordinate efforts in providing local social services. Furthermore, the legislation was an attempt by the provincial government to decentralize the provincial authority in social service areas and to place re-sponsibility for these services in the hands of local communities. While the mandate for these local boards was broadly based they were seen as organizations which could become vitally concerned with community mental health matters. In Terrace, for instance, the Community Resources Board had members on its Board of Directors from the Skeena Mental Health Centre, the Skeenaview Lodge, and two (of the local staff from the) Department of Human Resources. However, the extent to which the Board had actually dealt with specific mental health issues seemed to relate less to coordination of existing services than to provision of financial support. Three Rivers Workshop, the Child Development Centre, and the Crisis Line operated by the Board had a l l been cited as organizations which would receive financial support from the Board i f and when the authority to collect and disperse this money was given to the Board. However, - 14,3 -the intent here is not to enumerate so much what the Board had actually accomplished in its three years of existance but more to examine how its presence as a coordinating body had been received by community mental health organizations. The impact, i t ap-pears, was small. The Board had virtually no authority at the time the study was conducted and had no resources at its disposal that could have been used to direct or assist other organizations. It appeared to be a 'paper tiger' and until provincial authority was actually turned over to the Board many of the aspirations of the Board would remain unfulfilled. It may be, however, that the existance of the Board managed to afford a further opportunity for various representatives of community mental health organizations to at least meet with one another on a regular basis but the significance of that oppor-tunity can not be addressed here. It appeared to the writer that the various organizations continued to function independently of one another and that the various kinds of resource exchanges they may have had with one another was not altered or influenced by the presence of the Community Resources Board. - 144 -Analysis Resources Resources, t h e i r r e l a t i v e a c c e s s i b i l i t y , and t h e i r sources are an important concept to consider i n analysing relationships among organizations i n a specified interorganizational f i e l d . In any network of organizations resources may be expected to form a basis for exchange amongst members of the network. In the example of the organizations which formed a.committee to address problems associated with emotionally disturbed children, the re-sources involved were non-monetary. Information was the key element that was to be exchanged. This information exchange dealt with the ways i n which the organizations were dealing with s p e c i f i c c l i e n t s who were being treated by more than one organ-i z a t i o n . As w e l l , information was exchanged about c l i e n t refer-r a l s which the organizations were making to one another. A l -though these elements of exchange are i d e n t i f i a b l e as resources, the presence or absence of t h i s p a r t i c u l a r exchange may not have had important consequences for a l l participants. This i s an assumption based on the claim made by one committee member that not a l l organizations were as vigorous i n t h e i r p a r t i c i p a t i o n as could have been expected. Perhaps an overabundance of other - 145 -re f e r r a l s and c l i e n t s served to reduce the enthusiasm over pros-pects for increasing already oversubscribed case loads. In a monetary context now, the examples of how the Terrace Association f o r the Mentally Retarded acquired resources f o r cer-t a i n projects can be seen to have a relationship to the way or-ganizations interact at the l o c a l l e v e l . In both examples where T.A.M.R. sought funding, the primary sources of that funding were located outside the l o c a l organ-i z a t i o n a l environment. The reason for t h i s i s that there were l i m i t s to the amounts of money that could be secured from l o c a l sources. In T.A.M.R.'s experience most, i f not a l l , of the l o c a l l y raised financing came as charitable donations from the c i t i z e n s , service clubs, and the business community. Local community mental health organizations could not be expected to. assume the operational l i a b i l i t i e s for a new f a c i l i t y . The point to be made here i s simply that the composition of the l o c a l organizational environment did not include organizations with funding power to support other l o c a l agencies. Thus v i r t u a l l y every community mental health organization i n Terrace and i n Kitimat was dependent upon funding flowing into the region. Typ i c a l l y t h i s funding was provided by the p r o v i n c i a l government or a p r o v i n c i a l voluntary association which generated large amounts of revenue through annual charitable campaigns. - 146-In such an environment it.does not seem unusual that an or-ganization needing finances, such as T.A.M.R. did, would proceed directly to these external. funding sources without prior consul-tation with other local organizations. The model for securing funding precluded any local involvement. It was only after the external sources had been solicited and funding was denied that the members of the local organizational network were sought out to help remedy the plight of the Three Rivers Workshop. However, there does seem to be evidence of another pattern of interaction at the local level among organizations seeking funding for new facilities. This pattern is typified by local organizations banding, together to orchestrate a consolidated approach to external funding bodies. This method seems to have had more success than the unitary;approach and was used in the establishment of both the Alice Olsen Home and the Osborne Guest Home. While the external agency (the Department of Human Re-sources) was s t i l l the ultimate source of funding, local agencies were able to make and keep.limited financial commitments at the local level to obtain the i n i t i a l capital required for both these projects. Clearly, there were advantages gained by planning these kinds of ventures with other agencies and by having had prior discussion with external bodies that provide operational funding. - 147 -The notion of having a l o c a l body i n authority to coordinate these kinds of projects and to control the disbursement of f i -nancial resources at the l o c a l l e v e l was the anticipated role of the Community Resource Boards. However, with neither authority nor resources, the impact of the Boards i n Kitimat and Terrace was limi t e d . In effect the Boards were superimposed upon the s o c i a l services organizational network and gave the t a n t a l i z i n g promise of l o c a l control over resources. In Terrace the promise was s u f f i c i e n t to draw the resource hungry organizations, such as Three Rivers Workshop, into the f o l d but without actually being able to contribute spendable dollars the promise gave way to some disillusionment. The network of community mental health organ-izations was es s e n t i a l l y unaltered by the presence of the Board. Resources were s t i l l largely controlled outside the region and a l l organizations depended upon linkages outside the immediate environment f o r these resources. Power From the suprasystems l e v e l of analysis of interorganiza-t i o n a l relationships, power i s a variable which proves d i f f i c u l t to i d e n t i f y within the locale of the s p e c i f i c interorganizational f i e l d . In a resources context i t i s apparent that most of the power - 148 -that affected interorganizational relationships at the local level was in the hands of an external authority. This is par-ticularly the case in regard to financial resources. The absence of economic power at the local level may have contributed to the relative harmony or at least lack of hostility among the com-munity mental health care organizations. Each of the agencies relied independently upon external sources of funding. This consequently diminished the possibility of any local organization being in a position of dominance over another, at least from an economic point of view. The one exception in Terrace may be seen in the relationships of various organizations to the Community Resources Board. As stated previously, some organizations had gone to the Board to seek financial support i f and when i t was to be made available. Even .the.,-promise of funding was sufficient to establish a power based relationship between the Board and those dependent organizations. There may have been some evidence of certain organizations possessing referrant power at the local level. In Terrace there were three organizations which were frequently cited as being formally involved with a variety of organizations for a variety of purposes. Specifically, the Skeena Mental Health Centre had representatives involved with the Community Resources Board, the interagency committee on emotionally disturbed children, and the founding of the Osborne Guest Home.. The Department of Human Re-- 149 -sources, District #7, had been similarly involved but in addition had developed ongoing relationships with the Terrace Association for the Mentally Retarded, the School Boards in both Kitimat and Terrace, and likely several other community mental health organ-izations located outside of those two communities. The third organization which seemed to be omnipresent in community mental health activities was the Skeenaview Lodge which had participated in the creation of the Osborne Guest Home and was involved in the Community Resources Board. The extent of the interrelationships which these three organizations participated in may be evidence to support the claim that they were in positions of power in the region. While i t is difficult to assess the validity of the claim i t is interesting to note that these three organizations were operated by the provincial government. Because of the wide mandate attached to the roles of the Department of Human Re-sources district offices and the Skeena Mental Health Centre they may have assumed or been accorded a high profile in the local mental health care scene. As regards the frequency of the involvement of the Skeena-view Lodge the charismatic leadership of the administrator was likely the most important factor. - 150 -Organizational Autonomy Organizational autonomy is subject to several variables but the significance of these variables in analysing interorgan-izational relationships from a suprasystems view point seem to vary somewhat. Within the confines of the interorganizational field of Kitimat and Terrace most organizations, as has already been dis-cussed, are financially independent of one another. In this re-spect they are autonomous. Organizations are not obliged to confer with others prior to taking decisions that are related to financial matters. However, the resources that the funding se-cured such as manpower, technology, and facilities for delivering services were seen to be more frequently interrelated among or-ganizations and consequently these kinds of resources are more central to the discussion of organizational autonomy. The majority of community mental health organizations in Kitimat and Terrace were, in fact, quite active in their re-lationships with other community mental health organizations. Organizations in these interrelationships were seen to be sur-rendering various degrees of their autonomy depending upon the frequency and duration of the interrelationships, the nature of the resources being exchanged, and the long-term objectives of the exchange. - 151 -In the examples provided above none of the organizations participating in the interagency committee on problems of emo-tionally disturbed children were seen to have foresaken much of their autonomy by participating in the committee proceedings. While the committee met regularly and could possibly become a long-lived forum for the participants there was l i t t l e commitment by the organizations to exchange any resources except for infor-mation. Nor did i t seem that the committee's mandate would develop into anything more than that. The objectives of the committee were fairly general. Decisions reached about specific treatment programmes for specific clients had not been reported to have had anything but superficial impact on the ways in which the participating organizations functioned in regard to emo-tionally disturbed children. Similarly, in the case of the Osborne Guest Home where a consortium of organizations acted together to establish the Home the long-term effects of the interaction upon individual organ-izational autonomy appeared to be negligable. As discussed in a previous chapter the only organization which seemed to forfeit its autonomy was the Osborne Guest Home which, because i t was a new organization, had been established with a lesser degree of autonomy than its organizational peers. The same can be said of the Alice Olsen Home which, after its creation, was highly de-pendent upon the resources of both the Department of Human - 152 -Resources, the Jack Cook School, and the Terrace Association for the Mentally Retarded. The coalitions of organizations which helped to establish these two residential facilities were able to retract their involvement with one another and to reestablish their former levels of autonomy vis-a-vis the other community mental health organizations. . The Community Resources Boards were the closest approxi-mations of the federative approach to community mental health. Even here, however, the participating organizations were not re-quired to compromise their autonomy to any great extent. In fact the observations made during the course of this study would seem to indicate that in Terrace there were two levels of organiza-tional involvement with the Board. The first level was composed of established organizations whose representatives served in an advisory or directing role on the Board. These organizations were the autonomous groups. The second level of organizations were those which had turned to the Board for assistance. In making requests for financial aid those organizations did sur-render their autonomy because funding was to be forthcoming ac-cording to the judgement of the Board members. In this context, there was a vertical relationship established at the local level between the Board and the organizations which i t sponsored. This vertical relationship was identical to that which existed between the more affluent local organizations and their sources of -1-53 -revenue and authority. The Community Resource Board did manage (or would have, had i t had resources to disburse locally) to bring decision-making down to the local level. It seems ironic that the local decision-makers were largely those people who were employed in organizations whose funding and ultimate decision-making authority came from a remote source. Domain Consensus Within the interorganizational field set out for description and analysis in this study the concept of domain consensus is one which is particularly important to analyse. This is so because interorganizational relationships are formed on the basis of one organization's role vis-a-vis another organization's role. From a broad perspective i t was apparent that the community mental health organizations which were identified in the course of this study have a l l established their own organizational domains. These domains may.or may not be clearly and rigidly defined. In this context i t is necessary to point out that there may not be mutual agreement amongst these organizations as to the appropriateness of each others role and scope of activities. Obviously there were organizations which had unique jurisdic-tions. The Skeenaview Lodge, the Alice Olsen Home, the Osborne Guest Home, and the Child Development Centres in Kitimat and - 154" -Terrace had a l l laid claim to unique and separate mandates within the local interorganizational fields. That i s , there were no other organizations which performed similar roles. However, several organizations"were seen to have overlapping jurisdictions. The fact that an organizational domain does or does not overlap with that of another does not necessarily deter-mine the nature of interrelationships between or among the organizations. Taking again the example of the interagency com-mittee on problems of emotionally disturbed children, i t is clear that the participating organizations had either developed or were believed to have developed some expertise or involvement in the affairs of emotionally disturbed children. Participation on that committee was based on the acknowledged or accepted involvement of the organizations in that treatment area. It should be noted that there was no apparent attempt on behalf of the participating organizations to limit the activities of each other in that area. Rather coordination of efforts or at the very least exchange of information amongst the various jurisdictions was the goal. In this respect there may have been a subtle limiting effect in evidence. Coordination of activities may require that domains be readjusted to accommodate the coordinating function. No data was generated which could confirm this hypothesis. It can be assumed that the organizations did manage to agree on their respective roles or at least to accommodate each other in those roles. - 155 -One area which can not be addressed in this study but which is germane to the notion of domain consensus is the degree of difficulty other, non-participating, organizations had in dif-ferentiating between the various organizational roles. Perhaps even more importantly, could the clients and potential clients differentiate organizations clearly enough to determine with which one they were to deal? Another aspect of domain consensus which is important at the third level of analysis in this study pertains to resources. In the example of the Community Resources Boards there were several organizations in Terrace which were anxious to receive funding support from the Terrace and District Community Resources Board. Because of the representation on the Board by a number of other community mental health organizations and because of the decision-making authority of the Board in allocating resources, there was a true consensus among the members of the Board as to the appro-priateness of the domains of organizations seeking funding. In this process there was a formal discussion regarding each organ-ization's request for assistance to gain agreement as to the degree of support to be given and for which purposes the re-sources could be used. There does not seem to have been such a forum for defining the jurisdictions of other community mental health organizations. While there did not appear to be any major concerns voiced as to the appropriateness or inappropriateness of - 156--various organizational roles neither d i d i t appear that at the l o c a l l e v e l there had been any formal discussion and agreement on rol e s . The organizations seemed to be able to arrive at agree-ments regarding t h e i r domains by interpreting t h e i r l e g i s l a t e d or acknowledged mandates, i n relationship to l o c a l needs and a v a i l -able resources. In a r e s t r i c t e d geographical s e t t i n g , t h i s kind of negotiation may have been more e a s i l y accomplished than i n an urban centre with a myriad of organizations constituting an interorganizational f i e l d . Interorganizational Coordination Following from the discussion immediately preceding con-cerning domain consensus, the phenomenon of interorganizational coordination becomes p a r t i c u l a r l y relevent to analysis at the suprasystems l e v e l . The community mental health f i e l d i s an en-vironment which has been c r i t i c i z e d for i t s lack of achievement i n coordinating a c t i v i t i e s . Indeed when looking at the mosaic of community mental health organizations i n Terrace and Kitimat, there i s ample opportunity for services to become di s j o i n t e d and discontinuous: there are p r o v i n c i a l organizations operated by separate governmental departments; there are voluntary associ-ations which have s p e c i f i c f i e l d s of interest and which receive varying degrees of support from a variety of p r o v i n c i a l associ-- 157 -ations; there are regional and municipal authorities which also have jurisdictions related to community mental health; there are private physicians; there are ad hoc citizen groups which have no sponsor or legislated authority at a l l . In the weave of this organizational tapestry is the consumer, the client with some sort of psychological impairment. The rationale behind the arguments for and attempts to co-ordinate services is a strong one. Within the context of the interorganizational field of Terrace and Kitimat there was evi-dence that efforts at coordination had affected interorganiza-tional relationships on different occasions, witness the fre-quently mentioned interagency committee. However, there did not seem to be any formal process that had been established to achieve a continuity in coordinative efforts. The Community Resources Boards were the only exception. The Boards, however, had the potential to coordinate efforts of only a limited number of organizations. The composition of the board memberships may have been multi-organizational in format but there was no author-ity over any organizations except those which were designated to receive funding from the Board. Overall the impression was gained that conflict between and among organizations was minimal. This was not a measure of the level of coordination. Indeed, save for the ad hoc, project in-spired examples given above there was l i t t l e evidence of attempts 158 -at interorganizational coordination on anything but a Level II basis. There was evidence coordination between organizations was on an ongoing basis but l i t t l e to suggest substantive coordin-ative e f f o r t s among organizations. - 1 5 9 -CHAPTER VII SUMMARY AND CONCLUSIONS In stating the purpose of this study three main objectives were established. The fir s t , "to discuss and analyse factors which influence relationships between and among" community mental health care organizations in Kitimat and Terrace has been achieved in Chapters IV, V, and VI. It is the intent here to draw upon these analyses in order to address the two subsequent but more substantive purposes of the study. These are specif-ically, "to discuss the significance^ of the systems theory concepts in explaining problems affecting subject organizations" and "to generalize this discussion to other related fields of social policy and planning." Systems Theory Concepts As Applied To This Study In assessing the significance of systems theory concepts for purposes of this study the following discussion is divided into two topic areas. The first addresses the three levels used to - 160 -categorize the nature of interorganizational relationships and the second focuses on the five dimensions used to develop the analysis at those levels. Three Levels of Interorganizational Relationships The main intention of analysing interorganizational re-lationships from intra, inter, and supraorganizational perspec-tives was to determine the relative strengths and weaknesses of each of the approaches in describing the interactions of the community mental health care organizations in Kitimat and Ter-race. In this respect several observations are in order. Firstly, i t can be concluded that at each level of analysis i t was possible to analyse information regarding the ways in which individual organizations interacted with other organiza-tions. There were, however, varying degrees of success in this regard. By definition, the third level of analysis was not intended to address concerns of individual organizations. As a consequence, individual organizational interactions were seen by the writer to be most appropriately analysed from the Level I and Level II perspectives. Nevertheless, this statement should not diminish the importance of analysis at Level III even for indi-vidual organizations. The fact that a broad spectrum analysis can provide an organization with a sense of place and role within - 161 -an overall interorganizational field should be an incentive for that individual organization to document and evaluate factors which influence its position in its organizational environment. Organizational problems and/or areas of concern were clearly evidenced in this present research to stem from internal and ex-ternal sources. The external concerns were frequently of an interorganizational nature and as well were consistently viewed in the context of more than one other organization. For this reason a three level model for analysis of specific organiza-tional concerns would merit consideration. The major difficulty with this approach was in the defin-ition of the boundaries of the analysis. In regards to this study, the writer experienced two principal areas which, though resolved in theory became blurred in application of the theory to actual organizational events. Specifically, there were problems encountered in differentiating the interface of Level II and Level III and similarly in-placing a finite boundary on the organizations which were to be incorporated into the overall interorganizational field. Both Level I and Level II are clearly differentiated from one another and each can be used successfully to analyse organ-izational relationships because they deal with a single organi-zation. However, the third level of analysis is not so discreet a concept. Conceptually, analysis at the intra, inter, and - 1 6 2 -supraorganizational levels should afford a comprehensive view of any organizational concerns but there were frustrations encountered in applying the third and most abstract concept of a suprasystem of organizations to the available data base. As indicated in the earlier chapters of this study there are unfortunate character-istics of the concept which do not lend themselves to easy assim-ilation. In particular the attempt to analyse a group of in-dependent organizations as a unit was problematic as was the attempt to limit the size of the unit. These two points were seen as the most difficult obstacles to overcome. Five Dimensions of Analysis The success in the attempt to analyse interorganizational relationships at three levels of interaction on the basis of five separate dimensions requires some qualification. On the positive side i t was relatively easy to identify factors at each of the three levels of analysis which related to the selected dimensions. The only exception in this study was the dimension of interorgan-izational coordination as applied at the first level of analysis. This may simply have been a function of the subjective nature of the data base which was gathered in the research interviews. The major difficulty seen in using the five dimensions was again related to problems of boundary definition. In the an---163 -alyses presented i n th i s study i t i s evident that the dimensions are not discreet. Most notably the concept of resources was fundamentally interwoven with the concepts of power, organiza-t i o n a l autonomy, domain consensus, and to a lesser extent with interorganizational coordination. S i m i l a r l y the effects of power, organizational autonomy, and domain consensus were f r e -quently observed to be related to each other i n the analysis of interorganizational relationships at a l l three l e v e l s . However, while t h i s problem of d i f f e r e n t i a t i o n was a concern, i t was not seen to be a major obstacle to the analyses which were attempted. No observations are made here i n regard to the r e l a t i v e suc-cess of the use of these s p e c i f i c f i v e dimensions i n exhausting the analysis of interorganizational relationships. In the ab-sence of any more objective evaluation of the application of these dimensions i t i s not possible to rate th e i r r e l a t i v e im-portance, although the writer has the impression that the f i v e , as a group, were s u f f i c i e n t l y comprehensive to address most of the issues which were raised i n the research interviews. A number of other dimensions may exi s t which would have been valuable supplements to th i s type of analysis. However, i t i s the opinion of the wr i t e r , i n view of the extent to which the chosen dimensions were able to be applied to the analysis that those dimensions were among the most appropriate which might have been selected. - 164 -Implications In addressing the various factors which were revealed in the course of this study there is a logical progression of thought which seems to reflect the systems theory concept of ever-widening circles of concern. If the systems concept can be applied to the localized field of community mental health care in Kitimat and Terrace, British Columbia then what are the im-plications of extending these concepts to broader views of the community mental health care field and other related fields of social policy and planning? Conceptually, i t should be possible to identify a base system and then to subsequently identify the corresponding sub-systems and suprasystem relating to that system. As stated above, however, there are some practical considerations which must be taken into account. Boundary setting and definition of base systems have already been cited as areas which have proven to be difficult to reconcile and no further comment is offered here. The other major difficulty which has not been previously discussed in this thesis was the problem of evaluating the nature of interorganizational relationships. The literature does not fully come to grips with a l l three levels of analysis in sug-gesting criteria for measuring interorganizational relationships. The writer is of the opinion that methods for obtaining certain - 165 -quantifiable objective data may be developed through use of ap-propriate research techniques. The frequency of organizational contacts, the exchange of certain tangible resources and other such data could no doubt be collected. However, i n the presence of other non-quantifiable resources such as information, know-ledge, and experience which can affect an organization's exchange relationships may give such an inventory of exchanges very ab-stract c h a r a c t e r i s t i c s . In addition, depending on the number of systems within the suprasystem which i s being discussed, the volume of interorganizational exchanges may become extremely high. This would l i k e l y complicate further the e f f o r t s to quantify relationships. These considerations notwithstanding i t seems that advan-tages should accrue to organizations using an interorganizational approach to t h e i r planning e f f o r t s . The basic reason for making that statement i s that the approach gives organizations an oppor-tunity to view themselves not only on an in t e r n a l basis but on as broad an external basis as that organization deems necessary. In the f i e l d of community mental health where the number of j u r i s d i c t i o n s are quite numerous there should be incentives for organizations to p l o t t h e i r future endeavours with a more com-plete knowledge of the a c t i v i t i e s of other organizations with which they interact. Indeed, the exercise of i d e n t i f y i n g the structure and processes of the suprasystem within which community - i ' 6 6 ' > mental health organizations function may bring to light a variety of organizational alternatives which were never previously recognized. While the above comments apply to other fields of social policy and planning the degree of centralization within that field will likely qualify the utility of an interorganizational approach to planning, especially for the organizations of which the field is composed. Clearly, there has to be some flexibility in the operations of individual organizations before such an approach can have merit. Consequently in a more highly cen-tralized field such as education there may be fewer advantages realized by individual schools and school boards or universities and technical schools which are directly controlled by a central government agency. Nonetheless, from the point of view of a central planning or policy making agency, as opposed to the individual organization's perspective above, a l l the advantages should apply. If respon-sibility for overall operations of many organizations falls within a certain jurisdiction then that jurisdiction must have understanding of the interorganizational field for which i t is responsible. It must also remain cognizant of the individual systems and suprasystems within which each of those subordinate organizations may function. For example, any bureaucratic hierarchy may have a progressively larger domain as the bureauc-- 167 -racy proceeds downward to its lowest level. At each level, the various departments, divisions, or agencies composing the heir-archy may have interactions with other organizations outside the bureaucratic structure. If any central planning agency is to be effective in discharging its responsibilities, regardless of the degree of flexibility in the system, i t seems imperative that this central body should be able to identify interorganizational relationships which occur at these lower levels of the bureaucracy. Suggested Areas For Future Research The major limitations of this present research have been identified. The questions of boundary definitions and evaluation have been addressed elsewhere in this conclusion. A final limit-ation that must be mentioned is that the study made use of a very subjective data base. In future studies of this kind i t may be useful to attempt to develop a research tool which would be effective in gaining more objective information for analysis. Further to this an attempt should be made to develop more defini-tive dimensions for purposes of analysis or failing that, to focus on one specific dimension. The three level approach in the opinion of the writer is extremely intriguing. An attempt to more satisfactorily define and demonstrate the utility of the suprasystem approach in par-ticular is warranted. - 168 -REFERENCES Aiken, Michael and Jerald Hage. 1968 "Organizational Interdepen-dence and Intraorganizational Structure." American Sociolog-ical Review, 33:912-30 Aldrich, Howard. 1975 "An Organization - Environment Perspec-tive in Cooperation and Conflict Between Organizations in the Manpower Training System: in Anant R. Neghandi (ed.), Inter- organization Theory. Kent, Ohio: Kent University Press. Allodi, Federico and Henry B. Kedward. 1977 "The Evolution of the Mental Hospital in Canada." Canadian Journal of Public Health, 68:219-224. Arnold, Mary F. 1969 "Basic Concepts and Crucial Issues in Health Planning." American Journal of Public Health, 59:1686-1697. Baker, Frank. 1970 "General Systems Theory, Research, and Med-ical Care" in Alan Sheldon, Frank Baker, and Curtis P. McLaughlin (eds.), Systems and Medical Care. Cambridge, Mass: The M.I.T. Press. Baker, Frank and Gregory M. St. L. O'Brien. 1971 "Intersystems Relations and Coordination of Human Service Organizations." American Journal of Public Health, 61:130-137. Baker, Frank and Herbert C. Schulberg. 1968 "Community Health Caregiving Systems: Integration of Interorganizational Net-works." Presented at the Symposium, Systems and Medical Care. Cambridge, Mass. Harvard University Faculty Club. Benson, J. Kenneth. 1975 "The Interorganizational Network as a Political Economy." Administrative Science Quarterly, 29:229-249. Benson, J. Kenneth, Joseph T. Kunce, Charles A. Thompson, and David L. Allen. 1973 Coordinating Human Services, Columbia, Missouri: University of Missouri. Brand, Jeanne L. 1968 "The United States: A Historical Per-spective" in Richard H. Williams and Luzy D. Ozarin (eds.), Community Mental Health. San Francisco: Jossey-Bass Inc. Canada. 1966a Royal Commission on Health Services - Organized Community Health Services by J.E.F. Hastings and W. Mosley. Ottawa: Queen's Printer. - 169 -Canada. 1966b Royal Commission on Health Services - Trends in Psychiatric Care by D.G. McKerracher. Ottawa: Queen's Printer. Canada. 1966c Royal Commission on Health Services - Psychiatric Care in Canada: Extent and Results by Alex Richman. Ottawa: Queen's Printer. Canadian Mental Health Association, Committee on Psychiatric Services. 1963 More for the Mind. Toronto: Canadian Mental Health Association. Cartwright, D. 1965 "Influence, Leadership, arid Control" in James G. March (ed.), Handbook of Organizations. Chicago: Rand McNally and Company. Coates, Donald B. 1972 "The Role of the Psychiatrist in Primary-Health Care." Unpublished paper presented to the Community Health Centre Project. Coates, Donald B. 1975 "Mental Health Aspects of Primary Health Care: A Commissioned Paper to the Community Health Centre Project." Ottawa: Canadian Public Health Association. Commission on Emotional and Learning Disorders in Children. 1970 Report of the Ontario Committee, supplementary publication. Toronto. Crichton, A.O.J. 1976 "The Shift from Entrepreneurial to Political Power in the Canadian Health Care System." Social Science and Medicine, 10:59-66. Cumming, John and Elaine. 1957 Closed Ranks. Cambridge, Mass: Harvard University Press, Commonwealth Fund. Dubin, R. 1958 The World of Work. Prentice Hall Inc.: Engle-wood Cliffs, New Jersey. Elling, Ray H. 1968 "The Shifting Power Structures in Health" The Milbank Memorial Fund Quarterly, 46,l:Part 2:119-143. Elling, Ray H. and Sandor Halebisky. 1961 "Organizational Dif-ferentiation and Support: A Conceptual Framework." Admin- istration Science Quarterly, 6:185-209. Emery, F. and E. Trist. 1965 "The Casual Texture of Organiza-tional Environment." Human Relations, 18:21-32. - 170 Etzioni, Amatai. 1964 Modern Organizations. Englewood Cliffs, New Jersey: Prentice-Hall. Evan, William M. 1965 "Toward A Theory of Interorganizational Relations." Management Science, 11:B217-B236. Fairweather, George W., David H. Sanders, Louis G. Tornatzky, and Robert H. Harris, Jr. 1974 Creating Change in Mental Health Organizations. New York, Toronto: Pergamon Press. French, J.R.P. and B. Raven. 1960 "The Bases of Social Power" in D. Cartwright and A. Zander (eds.), Group Dynamics: Re- search and Theory. Evanston, Illinois: Row, Peterson. Funk and Wagnall. New Standard Dictionary of the English Language. Goerke, L.A. 1964 "The Relationships of Health Agencies and Planning Agencies." American Journal of Public Health, 54:713. Goffman, Erving. 1961 Asylums. Garden City, New York: Anchor Press. Gorman, Mike. 1976 "Community Absorption of the Mentally 111." Community Mental Health Journal, 12:119-127. Greenley, James R. and Stuart Clark. 1976 "Organizational In-fluence on Access to Health Care." Social Science and Med- icine, 10:317-322. Hall, Richard H. and John P. Clark. 1973 "Problems in the Study of Interorganizational Relationships." Organizations and Administrative Science, 5,1:45-60. Hobbs, Nicholas. 1969"Mental Health's Third Revolution" in Arthur J. Bindman and Allen D. Spiegal (eds.). Perspectives in Community Mental Health, Chicago: Aldine Publishing Company. Jones, Kathleen. 1972 A History of Mental Health Services, London: Routledge and Kegan Paul. Katz, D. and R.L. Kahn. 1966 The Social Psychology of Organ- izations, New York: John Wiley and Sons. Klein, Donald C. 1965 'The Community and Mental Health: An Attempt at a Conceptual Framework." Community Mental Health Journal, 1:301-308. - 171 -Klein, Donald C. 1968 Community Dynamics and Mental Health, New York: John Wiley and Sons. Kochan, Thomas A. 1975 "Determinants of the Power of Boundary Units in an Interorganizational Bargaining Relation" Admin- istrative Science Quarterly, 20:454-452. Kovar, Edward B. 1970 "Discussion of Roland L. Warren's Paper 'Alternative Strategies of Interagency Planning'": in Paul E. White and George J. Vlasak (eds.), Interorganizational Research in Health: Conference Proceedings. (National Centre for " Health Services Research and Development, D.H.E.W.) pp. 130-1. Lawrence, Paul R. and Jay W. Lorsch. 1967 "Differentiation and Integration in Complex Organizations." Administrative Science Quarterly, 12:1-47. Levine, Sol and Paul E. White. 1961 "Exchange as a Conceptual Framework for the Study of Interorganizational Relationships." Administrative Science Quarterly, 5:583-60. Levine, Sol and Paul E. White. 1963 'The Community of Health Organizations" in Freeman, Harvard E. et al (eds.), Handbook of Medical Sociology, Englewood Cliffs, N.J.: Prentice-Hall p.321-347. Levine, Sol, Paul E. White, and Benjamin D. Paul. 1963 "Com-munity Interorganizational Problems in Providing Medical Care and Social Services." American Journal of Public Health, 53:1183-1195. Lewis, Charles E. 1970 "Discussion of Basil J.F. Mott's Paper 'Coordination and Interorganizational Relations in Health'" in Paul E. White and George J. Vlasak (eds.), Interorgan- izational Research in Health: Conference Proceedings. (National Centre for Health Services Research and Development, D.H.E.W.) p.70-77. Litwak, Eugene and Lydia F. Hylton. 1962 "Interorganizational Analysis: A Hypothesis on Coordinating Agencies." Admin- istrative Science Quarterly, 6:395-420. March, James G. and Herbert A. Simon. 1958 Organizations. New York: Wiley. Miller, James G. 1971. "The Nature of Living Systems." Be- havioural Science, 16:278-301. Miller, J.G. 1965 "Living Systems: Basic Concepts." Behavioural Science. 10,3,193-237. Miller, James G. and A.K. Rice. 1967 Systems of Organizations, London: Tavistock. Mindlin, Sergio E. and Howard Aldrich. 1975 "Interorganizational Dependence: A Review of the Concept and a Reexamination of the Findings of the Aston Group." Administrative Science Quarterly, 20:382-392. Mott, Basil J.F. 1970 "Coordination and Interorganizational Relations in Health," in Paul E. White and George J. Vlasak (eds.), Interorganizational Research in Health: Conference Proceedings. (National Centre for Health Services Research and Development, D.H.E.W.) p.55-69. Nadel, Siegfried F. 1957 The Theory of Social Structure. Glencoe, Illinois: The Free Press. Neghandi, Anant R. 1975 "Interorganizational Theory: Intro-duction and Overview." in Anant R. Neghandi (ed.)., Interorgan- izational Theory. Kent, Ohio: Kent University Press. Palmiere, Darwin. 1965 "Problems in Local Community Planning of Mental Illness Facilities and Services." American Journal of Public Health, 55:561-569. Parsons, Talcott. 1956 "Suggestions for a Sociological Approach to the Theory of Organizations - I" Administrative Science Quarterly, 1:63-85. Roberts, CA. 1970 "Psychiatric and Mental Health Consultation." Canadian Journal of Public Health, 61:17-24. Rossi, Ascanio M. 1969 "Some Pre-World War II Antecedents of Community Mental Health Theory and Practice," in Arthur J. Bindman and Allen D. Spiegal (eds.), Perspectives in Community Mental Health. Chicago: Aldine Publishing Company. Schwartz, Donald M. .1970 "Community Mental Health - An.Under-view." Psychiatric Quarterly, 44:331-358. Sheldon, Alan, Frank Baker, and Curtis P. McLaughlin. 1970 "Cur-rent Issues in Systems and Medical Care": in Alan Sheldon, Frank Baker, and Curtis P. McLaughlin (eds.), Systems and Med- ical Care. Cambridge, Massachusetts: The M.'I.T. Press. - 1.73 -Terrace Report, 1974 History and Progress Report on the Terrace and District Community Resources Society. Thompson, James D. 1970 "Thoughts on Interorganizational Re-lations: A Conclusion." in Paul. E. White and George J. Vlasak (eds.), Interorganizational Research in Health: Conference Proceedings. (National Centre for Health Services Research and Development, D.H.E.W.) p.156-167. Turk, Herman. 1973a "Comparative Urban Structure from an Inter-organizational Perspective." Administrative Science Quarterly, 18:37-55. Turk, Herman. 1973b "Interorganizational Activation in Urban Communities. Washington: American Sociological Association. Turk, Herman and Myron J. Lefcowitz. 1962 "Towards a Theory of Representation Between Groups." Social Forces, 40:337-341. Van de Ven, Andrew H., Dennis C. Emmett, and Richard Koenig, Jr. 1975 "Frameworks for Interorganizational Analysis" in Anant R. Neghandi (ed.), Interorganizational Theory. Kent, Ohio: Kent University Press. Warren, Roland L. 1967a "The Interaction of Community Decision Organizations - Some Basic Concepts and Needed Research." The Social Service Review, 41:261-270. Warren, Roland L. 1970 "Alternative Strategies of Interagency Planning." in Paul E. White and George J. Vlasak (eds.), Interorganizational Research in Health: Conference Proceedings. (National Centre for Health Services Research and Development, D.H.E.W.) p.114-128. Warren, Roland L., Ann F. Burgunder, J. Wayne Newton, and Stephen M. Rose. 1975 "The Interaction of Community Decision Organ-izations: Some Conceptual Considerations and Empirical Findings" in Anant R. Neghandi (ed.), Interorgahizatiorial Theory. Kent, Ohio: Kent University Press. White, Paul E. 1968 "Myth and Reality in Interorganizational Behaviour: A Study of Competition Between Two National Vol-untary Agencies." American Journal of Public Health, 58:289-304. - 174 -Yolles, Stanley F. 1969 "Past, Present, and 1980: Trend Pro-jections" in Leopold Bellak, M.D. and Harvey H. Barton, M.D. (eds.), Progress in Community Mental Health. New York: Grune and Stratton. Yuchtman, Ephraim and Stanley E. Seashore. 1967 "A System Re-source Approach to Organizational Effectiveness." American Sociological Review, 32:891-903. Zeitz, Gerald. 1975 "Interorganizational Relationships and Social Structure: A Critique of Some Aspects of the Literature" in Anant R. Neghandi (ed.), Interorganizational Theory. Kent, Ohio: Kent University Press. - 175 -APPENDIX I - 176 -APPENDIX I Map of Kitimat-Stikine Regional District, 1973 - 177. -APPENDIX II - 178- -APPENDIX II INVENTORY OF MENTAL HEALTH ORGANIZATIONS Alice Olsen Home The purpose of the Alice Olsen Home is to provide a home living environment for retarded children brought in to Terrace from areas where there are no special education facilities avail-able. Attendance at the Jack Cook School for the Mentally Re-tarded is compulsory for the children. In addition to this more formal education provision, each child is involved in an in-home self-care social and motor de-velopment programme. There is provision for continuity in the individual programmes between the Home and the Jack Cook School. Admission to the Alice Olsen Home is subject to the approval of a committee composed of representatives from the Public Health Unit, Department of Human Resources, the Skeena Mental Health Unit, the paediatrician from Terrace, and the houseparents of the facility. 179 -Cerebral Palsy Association: Terrace Branch The purpose of this organization is to promote the estab-lishment of treatment and educational programmes for cerebral palsied and other physically handicapped educable children. To this end the Child Development Centre has been established. The Terrace Cerebral Palsy Association is one of 13 similar partially autonomous organizations in British Columbia. The par-ent body, the British Columbia Cerebral Palsy Association, f i l l s the liaison gap between its member organizations and the Provin-cial Government. The Provincial Association acts.in an advisory capacity to the local organizations and aided the Terrace Cere-bral Palsy Association in locating start-up and maintenance funding, as well as staffing and programme assistance. There is an annual meeting at which a l l the local Cerebral Palsy Associ-ations meet with the parent organization to democratically and judiciously distribute the annual government grant. The Terrace Cerebral Palsy Association exists, in effect, to sustain the Terrace Child Development Centre. It organizes local funding campaigns for on-going maintenance of the Centre and has been active in attempts to lobby for and secure both land and financing for a new Child Development Centre. - 180 -The Child Development Centre The Child Development Centre (C.D.C.) is a diagnostic, treatment, and pre-school education centre for children with various neuro-muscular dysfunctions, such as cerebral palsy, blindness, speech and hearing impairments, mental retardation, or behaviour problems. Services are offered by an interdisciplinary group of professionals: a consulting physician, a speech thera-pist, a physiotherapist, and an executive director who are salaried by the Cerebral Palsy Association of British Columbia -Terrace Branch; a pre-school teacher and a teacher's aide funded by the Department of Human Resources. The catchment area is roughly coterminous with School Dis-trict #88. A professional advisory committee to the Board is composed of representatives from public health, social work, special education, and the medical profession. Department of Human Resources - Region #7 The Department of Human Resources is a provincial government agency that administers services pertaining to legal protection of children, maintenance of children in its care, adoption, specialized child care treatment resources, social allowances, pharmacare, income assistance to the handicapped, and various - 181 -education and vocational rehabilitation services. Region #7 of the Department of Human Resources covers a vast section of northwest British Columbia from the Queen Charlotte Islands east to Burns Lake. Inter-Agency Consultation on Children with Learning Difficulties The purpose of the committee is to gain input from member agencies regarding family and social problems, of special edu-cation students outside the school context. The committee is also concerned with inadequacies i t perceives within the com-munity in terms of psychiatrically trained professionals, and residential facilities for emotionally disturbed and delinquent children. The inter-agency committee is comprised of volunteer profes-sionals from mental health services, public health, Department of Human Resources, physicians, and school teachers. The Jack Cook School The Jack Cook School is an educational facility for mentally and emotionally handicapped children under the age of 18. It is co-sponsored by the Department of Education and the Department of Human Resources. - 182 -The catchment area is coterminous with the geographic boundary of the Department of Human Resources Region #7. The Alice Olsen Home, operated by the Department of Human Resources, is a residence for students attending the school, whose homes are outside Terrace. The stated philosophy of.the School is to guarantee human dignity and prepare students to live as normal an existence as their capabilities will allow. In operationalizing this phil-osophy, there is considerable flexibility in the individual programmes for children attending the school. Osborne Guest Home The Osborne Guest Home is a boarding home primarily for mentally handicapped adults. It attempts to function as a per-sonal care facility and offers training in basic living through programmes within the residence and utilization of outside resources. Funding is provided by the Department of Human Resources at the rate of $14 per person per day, or i f funded through private resources the rate is $300 per person per month. Skeenaview Lodge The Skeenaview Lodge is a 170-bed multi-level psychiatric facility for the rehabilitation and reactivation of elderly males. Until July 1, 1974, Skeenaview Lodge was part of the Provin-cial Government's Mental Health Service and was used as an annex to the Riverview Hospital in the lower mainland. The hospital has since been taken over by the Department of Human Resources in order to take advantage of shared cost grants from Ottawa under the Canadian Assistance Plan. Its present catchment area is supposed to be the four regional districts of Kitimat-Stikine, Bulkley-Nechako, Skeena-Al, and Stikine (unincorporated), and other regions located in the northeast of British Columbia. Skeena Mental Health Centre (Mental Health District #4) The Skeena Mental Health. Centre is one of 17 (1972) provin-cially funded Community Mental Health Centres under the juris-diction of the British Columbia Department of Health, Mental Health Services. This unit is responsible for providing a broad spectrum of mental health services to individuals in a geographic area from - 184 -Kitimat in the south to the B.C.-Yukon border in the north, and from Terrace in the west to Houston, Gran Isle, and Smithers in the east. Professional staff consists of two psychiatric social workers, one psychiatric nurse. This complement is subsidized by monthly week-long visits from a psychiatrist from Mental Health Services Branch in Victoria, B.C. Terrace Association for the Mentally Retarded The purpose of the Terrace Association for the Mentally Re-tarded (T.A.M.R.) is to promote the education, development, and welfare of a l l mentally retarded, and to educate the general pub-l i c in the field of mental retardation. The membership of the Association is comprised of concerned individuals from within the community. A great deal of the activity of the Association has been directed towards eliciting community support and initiating projects in support of the men-tally retarded. The Association was instrumental in securing funds and facilities to begin both the Alice Olsen Home and the Three Rivers Workshop. - 185 -Terrace and District Community Resources Society The Terrace and District Community Resources Society was in-corporated under The Societies Act in 1973 but had existed as an agency since early 1972. The agency was comprised of people in the core service agencies who were concerned that the growing needs of the community of Terrace were being met effectively without duplication of services. To this end the agency at-tempted to determine "public awareness of existing services and their effectiveness" and to subsequently determine "public opin-ion on additional services of an immediate arid future nature" (Terrace Report, 1974, p.l). The format of the Society, since incorporation in 1973, has taken on the Community Resource Board model developed by the De-partment of Human Resources. The purpose of the Community Re-sources Board (C.R.B.) is to provide local solutions to local needs through the administration and coordination of non-statutory social services in the Terrace area. Ultimately the C.R.B. will be composed of publicly elected members under the new Resources Board Act 1973, rather than-elected members of the Society as is currently the practice. The Terrace C.R.B. has been slated as one of a number of similar - 186 -Boards throughout the province to go to public elections in the near future. A task force is to be assembled in Terrace to organize and coordinate the public election. Funding for the operation of the C.R.B. is provided by the Community Grants Division of the Department of Human Resources. These funds are to enable the C.R.B. to act as the administrative and coordinating agency for programmes i t decides to sponsor within the community. Three Rivers Workshop The Three Rivers Workshop is an activity centre attempting to serve a l l handicapped adults in the Terrace area, with work experience, reaction, and education. The workshop began its functioning through the activities of the citizens of Terrace. Initial funding through L.I.P. grants has been discontinued. The Provincial Government, through the Department of Human Resources, has provided a much smaller activity grant than is sufficient for maintaining the present level of activity in the workshop. The workshop has attempted to become self-sustaining through sale of manufactured products, such as wooden toys and planters. - 187 -Kitimat Child Development Centre This is a treatment centre for children with physical and mental handicaps. This centre is affiliated with the Cerebral Palsy Association of B.C. Funding is from two sources: 1. Provincial Department of Resources 2. Provincial Cerebral Palsy Association Staff consists of a part-time physiotherapist, part-time speech therapist, part-time teacher for deaf children, the ex-ecutive director, a pre-school teacher, and office and clerical staff. Assessment of children is made by physiotherapist, speech therapist, pre-school teacher, paediatrician, and on occasion childrens' diagnostic centre in Vancouver. Referral from a physician is required. Cormorant School The Cormorant School, an elementary school within School District #80, has been the location of a one-room facility for the operation of an education programme for the Trainable Men-tally Retarded children in Kitimat. One teacher and one child care worker provide individual programming for children who attend the class. Enrollment numbers between 8-10 students. Kitimat Association for the Mentally Retarded The function of this association is to better the lot of mentally retarded children, and to provide support and guidance to their parents. It has a 15 member directorate, 5 of whom serve on the council. Programmes supported by this association are: 1. Kitimat Workshop 2. Future development of a short stay facility so families can be given a rest from the demands of a mentally re-tarded child. The Kitimat Community Services Society The Kitimat Community Services Society was incorporated under The Societies Act in 1973. The objects of the Society are to define local needs in the area of community services and to establish priorities for meeting these needs; to ensure that agencies within the community are aware of the community prior-- 189 •-ities; to promote communication between agencies and the general public; and to dedicate whatever monies available to meeting local needs. The Society is concerned with mental health, housing, youth services, legal aid, and consumer services. Funding for the organization is provided by the Community Grants Division of the Department of Human Resources, and through local subscriptions and grants. There are no immediate plans for this society to begin functioning as a community resource board (C.R.B.) and consequently there are no plans for public elections of elected board members under the new Resources Boards Act, 1973. Kitimat Workshop This is a workshop which was intended to provide training and rehabilitation for mentally and physically handicapped children. The staff consists of one director and two mentally handi-capped assistants who have been employed to supervise and assist in the programme. Ten people attend the workshop regularly.
UBC Theses and Dissertations
Analyses of interorganizational relationships among community mental health organizations in Kitimat… Collier, Thomas William 1979
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