Case Study 12: The Future of the Crossroads Center Read the case below and consider the following questions: How would you summarize the current situation at the Crossroads Center? What is the client looking to accomplish? What challenges exist for the client in accomplishing his objectives? How would you design an engagement that uses dialogic OD practices to assist this client? The Crossroads Center was founded 16 years ago as a nonprofit drug and alcohol treatment center for adults and adolescents. The center is located in a quiet, rural area about an hour from a major urban center. It consists of six separate cream-colored buildings that encircle a large park, walking paths, and a duck pond. Except for a small, almost hidden sign on the main building, most community members cannot distinguish the center from any other set of office buildings or detached apartment units located in the sleepy town. The center has two segments that operate differently depending on the patient's age. The first is an adult treatment facility, where treatment primarily consists of support provided by psychologists and licensed therapists. Adults who enroll at the center usually find out about it through their health insurance provider, which pays 100% of the center's fees for up to 30 days of inpatient treatment and 30 outpatient visits. The center's staff can support up to 120 adults at any given time. The second part of the center is an adolescent residential treatment facility, where patients live together in the facility and are supported by a network of clinical psychologists, physicians, nurses, addiction counselors, and therapists. The center also provides staff teachers who give educational assistance while the patients live at the center, which can last for up to 8 weeks depending on a patient's needs. The residential center is much more expensive to operate, given the additional staff and housing needs, so there are typically just 30 to 40 patients living at the center at any point in time. The funding sources for the adolescent treatment facility include insurance as well, but also grants and foundations as well as federal and state programs. Darrin Spoldi was appeinted director of the center almost 3 years ago. During his short tenure, the center received three new grants from national foundations and increased by one third the number of patients that the center has reached. Darrin called Lisa Rodriguez last week with an urgent request. The center was at risk due to a new law, and he needed some advice to avoid the worst-case scenario. \"I'm really glad that you're here,\" Darrin said, as he and Lisa walked along the sidewalk path outside the center. \"We're in a desperate situation, and if we don't do something soon, we may not be able to keep the center open.\" \"You sounded very concerned when we spoke last week,\" Lisa admitted. \"But | had thought when we spoke a few months ago that things were going so well.\" \"Exactly,\" Darrin said quietly, looking down at the weeds on the edge of the sidewalk. \"I had just gotten a major grant and our funding seemed more solid than at any point during my time here. Ironic, as it turns out. Things were sailing smoothly until just recently. In fact, just a few weeks ago we concluded our year-long study on adolescent recidivism since we hired the additional therapist staff.\" \"Recidivism? What's that?\" Lisa asked. \"It's our return rate. We follow up with our patients after they leave the center to see how they are doing and whether they are able to maintain the skills they learn during their time here or whether they need to return to a center for additional treatment. We found out that our patients have the lowest rates of return to drug and alcohol abuse among centers like ours in this region. In fact, the rate has improved by about 15% over a few years ago.\" \"To what do you attribute this result?\" Lisa wondered. \"There's no question. It's both our teachers and our therapists,\" Darrin said confidently. \"Patient after patient in the study we did reported that they had incredible support from the therapists, and having the teachers here on staff kept them focused on their studies, so that when they returned to school they had little difficulty assimilating. About a year and a half ago, we added three new therapists to the staff, and the change was incredible. | know how good our work is here. I've worked in treatment facilities like this throughout my career, and this is the most successful model I've seen.\" \"Tell me about what's causing your concern for the center,\" Lisa asked. \"Don't misunderstand. | might sound calm now, but | suppose I'm just numb from thinking about this. It's not just a 'concern.' This is the biggest crisis I've faced in my career,\" Darrin said. \"You might have heard about the changes that the state legislature just made to the sacial services budget for this fiscal year. Well, the budget for social services includes a set of regulations requiring that treatment facilities that receive state funding have a certain percentage of their staff hold medical degrees from an accredited medical school. | guess the regulations were intended to address the large number of facilities that are run primarily by lower-skilled technicians, with few medical professionals actually administering services. Last year's controversy regarding abuse in nursing home facilities prompted a number of community groups to call for additional regulations. The result, though, is that even facilities like ours face the same criteria. In any case, the law was just recently signed by the governor, and facilities have just 6 months to comply with the law or forfeit all state funding, retroactive to the signing date of the legislation.\" \"What does that mean for Crossroads?\" Lisa asked. \"In other words, the center will continue to receive state funding for the next 6 months, but if we cannot comply with the law in that time period, we need to return 6 months' worth of funding to the state,\" Darrin said. \"What would it take to comply?\" \"Currently, the center's staff of teachers and therapists put the staff below the required threshold to receive funding. Most of them have advanced academic degrees, but they are not medical practitioners according to the legal definition. We would have no problem if we just let our teachers and therapists go,\" Darrin said. \"But they are critical members of our staff, and as | said, our patients give them a great deal of credit for their treatment. | just don't think that is an acceptable solution. Another possibility would be to refuse the state funding, but then trying to operate with our remaining funds would be impossible. With money coming just from the federal government and from our grants, we would not only have to have a layoff of staff, we'd have to reduce the number of patients we serve by about two thirds, and we would turn away a lot of people who need our help. I've done a lot of thinking about this in the last several weeks, and | haven't been able to come up with a solution that is acceptable to anyone.\" \"Does the community understand what's happening to the center and what might happen if it closed?\" \"We have purposely maintained a low profile in the community for the last several years. Before | arrived, it's my understanding that there was a call among the county supervisors for the center to close or move, and we did not have a lot of support. | don't know what all of the issues are, but there is some animosity among the board of directors toward the county board of supervisors. Nothing came of it, obviously, and the board of directors recommended that | not spend a lot of time in the community for a while until things settled down. I'm not sure how many community leaders even know how we've contributed to the community by treating our own local adults and adolescents,\" Darrin concluded. \"What have you done so far?\" Lisa asked. \"A few weeks ago we had a small meeting of the top administrators, about eight of us. We just talked in circles, bouncing back and forth between trying to figure out how to continue to operate without state funding or trying to meet the state's requirements and maintain our current funding. We didn't come to any conclusions, but we agreed to meet again this week. | do have to say, though, that the staff has been great about this. Morale is high, and our administrators are highly involved and motivated to find a solution. I've worked with other groups that would have given up or quit, but this group is participative, engaged, and smart. They're keeping each other going,\" Darrin said. \"Let me summarize. A highly successful local center is going to close because of a state law that holds unintended consequences, and the closure will affect a large number of patients, staff, and community members. It seems to me that there are a lot of groups that have a stake in this center being successful and continuing to operate. There are the patients and staff, obviously, but also the patients' families, the grants and foundations that contribute to your success, the community, even the state legislature,\" Lisa concluded. \"You've got it,\" Darrin said quietly. Lisa continued, \"You have a lot on your shoulders here. | can see that it's affecting you a great deal personally. What do you think of bringing together a larger group to help you decide what to do? We could keep it to your staff, or we could invite members of these other groups.\" \"It sounds like a good idea,\" Darrin agreed. \"And at this point I'm at a loss about what to do next, so I'll take any suggestions. Tell me more. Who would we invite? How long would it take, and how would it be structured?\" \"Let me think more about that. | can get you a proposal quickly and we can get started as soon as possible,\" Lisa said. \"For the first time in a few weeks, I'm starting to feel hope,\" Darrin smiled. \"I'm looking forward to your proposal.\