How to make an affiliate model work—A case history

Abstract

The North Shore Community Mental Health Center has an unusual mental health delivery system. “Outstationed” staff work in affiliated agencies, yet are employees of the NSCMHC. This service configuration is the result of an arduous planning process which weighed the advantages of several organizational models. On one extreme was a “Centralized” model, wherein one organization was solely responsible for delivering mental health services. On the other extreme was an “Umbrella” model, wherein the organization acted as a fiscal conduit to several service providers. Somewhere in the middle a compromise was found with a “Lead Agency” model. Here, an organization provides the administrative structure, provides some services, and subcontracts the remaining services. The North Shore Community Mental Health Center adapted this system one step further. Rather than subcontracting services, it outstationed CMHC staff to affiliate agencies.

United Cerebral Palsy Association of the North Shore is one of the CMHC's affiliates. The service need for family and play therapists resulted in two CMHC therapists being outstationed at UCP. The affiliation agreement between the two organizations specify the responsibilities and roles each have.

The hiring process between the two organizations is an example of the duality of the system. Both agencies had interviewing roles, yet the final biring decision was the affiliate's, since the employee would spend the majority of his/her time outstationed at the affiliate site.

Outstationed staff integration to the North Shore Community Mental Health Center presented problems, however. Since these were new staff hired with federal funds, and since their visibility at the Center was minimal, they had some difficulty being identified as Center staff by existing employees. A Clinical Supervisor, who had been with the agency for several years, became a key facilitator in the integration process. After two years, integration of the two staffs is still not complete, but the system has settled considerably over time.