South Cinder Health Center (schc) started as a community mental health center in 1979 and is a refreshing example of an organization that has maintained a clear sense of its original spirit and purpose through the sometimes intense challenges of growth and development. This clarity does not happen by accident. Leadership of the agency, which the executive director says is spread throughout every level, should be commended for its attentiveness and care.
Although termed a community mental health center, schc was primarily a pass-through source of mental health dollars when it began—passing money along to other community-based organizations. Eventually, it began developing its own direct service programs and expanded quickly—without sufficient capital to support the effort. By 1984–85, schc had had two executive directors and had developed a debt of $400,000 to a local hospital. Obvious questions surfaced at that point about its ability to survive.
A third executive director helped to guide the organization through the crisis with a combination of strategies, including the closing of a major program and staff layoffs. The entire staff was engaged for two years in a common effort to “hold the line” on costs. The solidarity developed in this process extended beyond the survival of the organization to encompass the quality and meaning of the work, and the best interests of its often underserved and marginalized constituents.
Another indicator of the South Cinder’s personality was the chutzpah it displayed in standing up to the hospital to which it was in debt. One participant said, “We acted like what we were—an important institution in this community. We showed them our spine.”
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The array of programs run by schc shows them to be an important connector for those in the community with mental health–related issues and even, in some cases, for those whose life circumstances threaten their physical and mental well-being. The diversification of its services and ability to provide mobile services were both mentioned by participants as key to meeting the needs of its consumers. The 1986 adoption of the Havens, a domestic violence program as well as that of the Starlight Services, in 1997, are examples of schc’s inclusive understanding of its mission and its willingness to take some level of risk to fulfill it.
The adoptions of these two formerly freestanding organizations has reportedly greatly enhanced the quality and quantity of services. Back office services are provided by the parent organization, leaving Startlight Services and the Havens to focus on programs. The Havens specifically mentioned being able to expand and provide clinical services such as art therapy for children as a direct result of being a part of schc. These two programs, however, are also the two most financially vulnerable of all of the services provided. There appears to be a high degree of consensus throughout the organization about the critical need for the services provided by these programs, and everyone seems very attentive to their need for greater sustainability.
This attentiveness is evidenced in a number of ways. For instance, when the organization grew in complexity, the board took the initiative to reorganize the corporate structure to provide protections and a certain amount of autonomy for some activities. Participants described this as enabling the organization to approach the mission “in a more sophisticated way”—not only for the clients, but also for the staff.
There is, on the other side of this coin, a widespread organizational commitment to creative and responsive programming. Participants in this assessment described the organization as “innovative, flexible, and creative, and they freely cited examples throughout the interview of both external and internal collaboration. Internally, this has resulted in staff being unusually well informed about each other’s work. It has also led to agency-wide engagement in referral, advocacy, and fundraising activities.
The ability to be progressive and creative at all levels is aided by the agency’s belief that “work teaches the worker.” This has encouraged staff and volunteers to take responsibility for their own work, leaving the agency the opportunity for foresighted planning. Planning is continuous, but central planning is accomplished through a “strategic council” made up of program directors and other staff. A participant described schc as “always being five steps ahead.” The staff and board both reported that the organization is proactive and strategic, rather than waiting for things to happen.
They described themselves as being good team workers who are very focused on making sure that the people who contact them get the right services, whether or not they fit into one of schc’s formal programs. As one participant stated, “people understand the ‘why’ of what they do.”
Constituents are integrated into the staff and act as volunteers, running their own programs including a “warm line” (i.e., phone service designed to solve relatively minor problems or to prevent those problems from becoming serious). The community appears appreciative of all of this good energy and comes out in force (300–350 attendees) to the organization’s annual meeting.
At the time of this study, South Cinder Health Center, along with many other local service providers, had recently taken an across-the-board budget cut on state contracts. This followed cutbacks that specifically affected the domestic violence and substance abuse work, as well as 10 years of flat funding (not adjusted for inflation) for all their contracts. As one participant expressed, “funding levels are going down while demand for services is going up.” To address revenue concerns at this important level, the organization is active with the legislature—motivating staff, board members, consumers, and other volunteers, and literally sending “vanloads of people” to testify and lobby. In addition, a consumer advocacy group associated with the organization is “deeply” active among the state associations that have crafted legislative strategies. Despite this, larger economic and political forces resulted in the afore mentioned cutbacks, and schc anticipated that more would follow over the next few years.
schc is active in foundation grant seeking, but recognizes that this money must be used strategically with an eye to the fact that these investments are generally small and short term. Local foundations evidently are well disposed to the organization. Participants noted that “quality services” garnered the respect of both the funders and constituents. In addition to talking about respect for clients and constituents, staff also mentioned reporting to funders in a timely way as a very basic way of evidencing respect.
schc is also in a good position for attracting individual donors. It now runs several annual fundraising campaigns that bring in more than $100,000, and has instituted a larger donor campaign through its “leaves of hope” program, aimed at increasing the organization’s endowment. At the time of this study, staff were beginning to use a computerized donor base to track donors systematically, with the intention of upgrading them. Members of the board also actively solicit donors. There was general agreement that the individual donor work could be expanded.
The group also runs “Macie’s,” a very successful thrift store that brought in $160,000 during the year previous to this study, which went to support the under-resourced Havens program. Macie’s was expected to net $180,000 the following year, and schc was considering the development of a satellite store.
At the time of the study, there were 108 staff (including a few per diem) at South Cinder Health Center, which has all of its basics in place. Its personnel policies are continually updated and available on computer, and are also handed to people upon hiring. Supervision is done regularly—although some programs and departments are more frequent than others, all supervision is reportedly performed at least monthly. Participants noted that supervisory expectations were not documented, but were “understood.” Management evaluates staff annually and all at once for budgetary purposes. The executive director looks at all of the evaluations to inform her own understanding of the potential for growth. Staff also evaluate supervisors, with the comments being collated and given to the supervisors by the human resources department.
Benefits were reported to be excellent, with three weeks of vacation upon hire, comprehensive medical and dental coverage, tuition reimbursement, pension, and many other hallmarks of a strong benefits program. Staff expressed concern about the heavy increases in health insurance premiums, however—and their potential for eating up any possibility for salary increases.
Participants in this assessment felt the need for greater staff diversity to better reflect the demographics and meet the needs of constituents, particularly where bilingual and multilingual staff are concerned. While acknowledging the progress made to date, they agreed that there remained work to be done in this area and formed a committee to address diversity issues.
schc already makes good use of volunteers throughout the agency, but its practices are uneven. Large numbers of people are involved with this organization—a central resource for volunteer management in the agency may significantly augment both program capacity and resource generation. schc has a complex governance structure that appears to be working fairly well. At the time of the assessment, the most widespread group involved in governance was the 270 corporators. Corporators are required to come to the annual meeting. They are reviewed every year by the board of directors and constitute the pool from which the board is drawn. At the time of this study, there were 44 people involved on the four formal boards that oversaw the three interconnected subsidiary structures. The main board (South Cinder Health Center, Inc.) had 24 members and overlaps with each of the others: South Cinder Foundation, Inc., Healthwork, Inc., and South Cinder Mental Health, Inc. The overlapping, which is mandated, causes some difficulties in attendance since it makes multiple demands on the same individuals but, still, there is generally not a problem reaching a quorum.
Staff members voice a lot of respect for the board. They are grateful for the board’s attention to matters having to do with the organization’s long-term fiscal stability and laud the board both for its healthy and respectful partnership with the executive director and for its activism. In fact, the partnership extends even further—the board has a yearly retreat with the strategy council to do whole-agency planning. Other committees of the board also integrate board and staff members, as do hands-on activities including fundraising and whole-agency events like the annual meeting.
There are no consumers on the board, but there are family members of consumers. Participants expressed concern that if the board were to include consumers that careful preparation would need to be done to ensure all board members were on equal footing.
schc has its own mis director, who appears very capable and tuned in to the needs of the agency. Many of the organization’s best-laid plans in this area, however, have been waylaid by practical concerns both about hardware and software. At the time of this study, the organization needed 20 additional computers—not all staff had a computer, which made intra-organizational communication difficult. It was recognized that software to facilitate the complex infrastructure of the agency would be a big expense, but would make an enormous difference in the speed and congruity with which staff could move work along. For instance, the agency estimated that it would need $25,000 to upgrade the billing software—a priority in an organization as sophisticated as this one. schc had a budget of $6.5 million at the time of the study. Four staff members were dedicated exclusively to the accounting function of this agency—the cfo, an accounting supervisor, a bookkeeper, and an administrative assistant. The billing is separate, with an additional senior staff member and administrative assistant specifically assigned to billing (although at the time of this study much of the billing that could be done by computer was done by hand). The process of developing and managing program budgets is shared throughout the agency. Program directors are very involved in budgeting and, in turn, involve program staff. In general, participants said, program staff are “attuned to their budgets,” which makes them very aware of where funding gaps may exist. Budget cuts have heightened staff’s interest in their budgets and the budget for the whole agency. The ceo only reviews financial requests that are non-budgeted items.
Each program within schc did its own quality assurance at the time of this study (such as meeting dmh or dmr expectations or tracking outcome measurements). However, with the exception of Starlight Services, quality assurance was not tied into an overall evaluation or quality assurance for the organization as a whole, nor did it necessarily drive program development.
Participants noted that there had been dialogue about conducting satisfaction surveys across schc’s programs, as well as integrating a quality assurance system for the organization as a whole. Participants identified insufficient mis capacity as the major barrier to this endeavor.
schc is highly unusual in that it functions comprehensively as a “learning organization,” even though it does not call itself that. The organization has strong leadership with decentralized decision-making authority throughout. The staff, board, volunteers, and consumers all appear to be united and enthusiastic about their work toward a common vision.
Commentary by Margaret A. Leonard
From the purview of the best practices documented today in nonprofit literature, the South Cinder Health Center (schc) gets high marks—it is an impressive organization. The reasons are self-evident, but I will underscore a few.
First, the organization has selected enlightened leadership that can navigate seas of change and keep it on course. This is largely attributable to the fact that their mission is understood, owned, and lived at all levels of the organization, as well as being integrated into the community. There is a great consciousness of why the schc does what it does.
Another important attribute is participation, or what is defined as the “habit of working in solidarity.” Participation works as a core operating principle, impacting the quality and meaning of the organization’s work and the best interests of its often underserved and marginalized constituents. This is no small achievement. Further, the South Cinder community identifies itself not just as a service provider, but as an organizer and advocate for constituents and the community at large. This level of participation, along with continued feedback from constituents, staff, board, and community, enriches the programs, the quality of staff, and volunteer commitment and ownership. In addition, the schc is an inside-outside organization—ensuring that access to support for the most vulnerable is equally applied internally and externally. Therefore, adequate benefits, participatory evaluations, respectful treatment of staff, and creating a culture of belonging are important priorities for this nonprofit.
The schc has organizational smarts as well. It downsized when it was appropriate and knew how to consolidate its administrative functions, leading to more resources and services directed to the most vulnerable programs. It is also building the capacity of its development office and working to diversify its funding streams.
Most critical to the organization’s future is the fact that the organization constantly critiques itself. The case study alludes to the beginnings of an action plan for growth in the areas of mis systems, volunteer recruitment, financial management, major donor development, staff diversity, and much more. Maintaining this ability to look at itself critically will enable the organization to keep moving forward.
The schc has a 23-year track record and is a first-class nonprofit; it is an organization that knows itself and its purpose. The nonprofit field is currently in dialogue with a new breed of practitioners called “social entrepreneurs.” A partnership between the schc and one of these “new kids on the block” could be an important learning experience for both. As schc tackles the development of a centralized database and an mis system, it might profit from concepts like “intended impact,” “theory of change,” and “return on investment.” A mutual collaboration between these two entities—and the lessons that may be drawn from this experience—could enrich the nonprofit field as a whole.
Commentary by Paul C. Light
The South Cinder Health Center (schc) works well because it has mastered the classic problems of the enterprising nonprofit. I refer to this stage of organizational development as the “enterprising” phase, which precisely captures the aggressive pursuit of funding revealed in this case. (See Paul Light’s article, “The Spiral of Sustainable Excellence” at www.dev-npq-site.pantheonsite.io
The schc could have come down with a raging case of what I call “project-itis”—the tendency by nonprofits to make themselves extremely busy with various projects and activities without a clear sense of which of these truly advance the mission. Even though many enterprising nonprofits get lost with so much going on, the schc is holding it together with its strategic council and active board. It has a deeply committed staff, a diverse revenue stream, strong administrative systems, a willingness to take on new challenges, and plenty of guts. No wonder it stays five steps ahead.
Nevertheless, like many enterprising nonprofits, the schc is only one cut away from a trip back down the development spiral. Although it came away from its early crises with a commitment to solidarity, and has become a learning organization, it could evolve into a collection of programs with no core—mental health over here, domestic violence and substance abuse treatment over there, with a warm line and thrift store in between. Combine the breadth of the organization together with the problems competing for staff, and there could be tough times ahead.
Given its voice and reputation, I urge the schc to think about its role as an anchor for building a collective, statewide approach to the looming capacity crisis from continued budget cutbacks and labor shortages. No single nonprofit can solve these problems by itself, but a single nonprofit could provide the spark for the kind of collective action that might bring legislators and funders to the table. This could be the beginning of a more coherent approach to the funding and provision of services in the region. The sector needs its own warm line right now—could the schc provide it?