Define and explain "Northouse" 2019- Chapter 6-7:

1. Path-Goal theory

2. Leader Member Exchange (LMX)

3. Cite applicable areas from following case study to support each theory.

Case Study:

Background on the Agency:

Phoenix Social Work Agency provides services and coordinates services for children and teens with significant behavioral health challenges that endangers themselves or others. They have therapists, psychologists, and behavior coaches as well as high needs case managers who report to team leaders through three offices that serve Maricopa County where Phoenix is located.

The services are funded through Medicaid behavioral health services--and the families either have incomes below 138 percent of the poverty line to qualify OR the children have been removed from their homes because of the endangerment present there and are under the care of the Department of Child Safety (DCS).

What High Needs Case Managers Do:

High needs case managers work with the kids who have the most at risk and extreme behaviors--they are expected to meet with the children weekly as well as work on coordinating the range of therapeutic and behavioral health services they are eligible for as well as coordinating stakeholder team meetings that occur monthly--or occasionally more often--to evaluate the needs and strategies. Parents/Grandparents/Relatives or other guardians are also involved in the therapeutic effort for both support and helping to develop more effective parenting strategies.

Background of the Children They Serve and the Services Needed:

The children have often experienced extreme trauma and/or neglect. One mother was addicted to drugs and would do sexual activity for drugs and would have her small children present when these activities were taking place. Both children were sexually molested and later engaged in sexual activity with each other.

Two other children had a mother who was constantly on drugs, and they were often left alone. Other children have been subject to physical abuse.

Some children come from homes that aren't abusive but have serious mental illness or developmental disabilities which might be combined with other behaviors like Oppositional Defiance Disorder and not exposed to these situations.

Some children are diabetic that can lead to verbal or physical aggression because the diabetes sugar levels vary despite efforts to regulate it.

One caseworker noted that in many cases she really has a "high needs" parent whose inability to make changes in howshe (usually female) approaches parenting that it either creates or exacerbates the behavior of the child (many of these parents may also be modeling what their parent(s) did).

Behaviors that manifest include depression, cutting, suicidal attempts or ideation, extreme anger that is hard to be controlled, running away, being very easily triggered into difficult behavior from actions of others at school (whatyou might find mildly irritating could send them into a frenzy).

The children receive behavior coaching to work on them trying to develop strategies to better manage situations. These coaches also need to work with caregivers (parents/guardians) to help them better manage the child's behavior--as a normal reaction is frustration and anger or responding to violence or a threat of violence with violence--all of which tend to make the situation escalate.

Crisis teams or the police are often called when crises occur.Frequently these children are also placed in short-term facilities for up to two weeks or in more extreme contexts at residential treatment facilities where they may stay for a few months.If the child exhibits the potential to sexually contact other children due his or her sexual abuse, then if she or he is in a therapeutic group home, then someone needs to constantly watch to protect those children.

The children usually also see a therapist at least weekly or some kind of therapeutic services in addition to help dealing with the deeper underlying issues and the children are usually also receiving some kind of medication.

Overall, these kids are at great risk--and this kind of intervention is important in trying to help them stabilize and adapt. In most cases these children also struggle academically. One teenager, for instance, is barely literate and is now a 6-foot-tall 14-year-old and has been in foster care for four years--since his mother continues to have significant personal challenges that she can't take care of herself, much less her children and hasn't shown progress. While he hopes for a reunion with his mother, he's currently in DCS care and very unlikely to be adopted so will likely age out of the foster care system. Meanwhile, his anger outbursts and increased noncompliance are harder and harder to deal with.

The positions, training, and working conditions:

Unfortunately, our society doesn't value the services that these children need, so those involved with these services are typically paid poorly and consequently the turnover rate is quite high as the work itself is also quite stressful and it's difficult to separate one's work from one's life--when you know how vulnerable the children you visit are.

Phoenix Social Work Agency pays a starting wage that is slightly above other agencies, $17 an hour--but still rather low for a person with a college degree. They hire high needs case workers, who are often recent college graduates, provide them with about six weeks of training, including shadowing those with more experience and near the end of the training, they begin to take on children onto their case load. Ideally, they'll also be joined by a colleague in the early stages--but due to the constant attrition that is somewhat inconsistent in practice.

A high needs case manager typically has up to 20 children to see weekly--and caseloads usually stay close to that amount. They become relatively experienced within about 6 months in terms of how to manage situations and services--though remain on a learning curve--as every day presents new challenges.

The Agency doesn't organize the children well geographically so there is lots of time in the car. In part that's because turnover in the position is quite high--so children are then transferred to remaining case workers.Finding case managers to cover kids becomes prioritized so keeping them geographically organized is more challenging.

The typical caseworker leaves after a year or year and a half.This relates to conditions at this Agency, the stress, and that once they have at least one year of experience they qualify for other jobs at other agencies that require experience to get the jobs and those jobs offer better pay and working conditions.

At Phoenix Social Work Agency, the pay you start with stays the same regardless of job performance.

The Agency refuses to pay overtime and instead insists workers take extended lunches or start late but doesn't like leaving early to make sure they don't qualify for overtime (if you are not aware overtime means their pay would be time and half or $25.50 an hour).

At the same time the agency expects 20 hours (of the 40) to be in direct contact with clients (parents and/or children) or emailing or phoningbecause that's what's billable to Medicaid (and with an email--it's only the typing part that's billable--not the prep). But they can't submit billing unless notes are done on each visit and those notes are supposed to be submitted within 24 hours of a visit (which rarely happens so case managers are frequently behind on notes--some even do notes over their lunch break even though that's a time when they are not paid). You can't bill for the time it takes to write notes unless you can manage to do some of the notes while with the client. Case managers besides drivingand needing to complete notes on their work arrange appointments so they can schedule their day, days in advance, have to arrange team meetings, deal with clients who don't show up at meetings or cancel visits that were scheduled. New case managers find it very difficult to reach 20 hours--as they become more proficient, they do better but the ability to meet it varies by person and often by issues out of their control--such as cancelled visits or simply the complex logistics of trying to schedule meetings over a wide geographic terrain around people's availability.

Funding Challenge:

Funding to support these high needs caseworkers as well as the transportation costs-which pays workers 57 cents a mile is very limited.Bill codesH2014 (Skill training and development) per 15 minutes yields $14.19 and bill codeT1016 (Case Management) per 15 minutes yields $13.69. We'll assume an average billable 15 minutes is $14 or $56 (14x4) for an hour.

This means the agency operates under real financial pressures. Twenty hours at $56 per hour billedmeans that if a high needs case manager meets productivity, the agency will receive $1,120 weekly. If that case manager is paid $17 an hour and adding in FICA (employer part of Medicare and Social Security) and other benefits like employer portion of health insurance and paid time off mean that total ERE (Employee Related Expenses)areabout1.2 times that amount. Then the employees' costs are $20.40 per hour or $816 a week. If the employee is also driving 80 miles a day at 57 cents (federal required reimbursement-but that's assumed in the rate) a mile that's $228 per week. That leaves only $76 on the positive side--and that's barely enough to cover expenses less any of the supervision or overhead of the organization (the organization does have other billing codes for other operations). But you can see that case managers who don't meet productivity place financial strains on the agency--as they cost the agency more than they bring in. Likewise, new employees while undergoing training--while not driving a lot--are also not meeting productivity so are a net short-term financial drain, and, of course, training takes from what others can be doing. That there is such a high turnover doesn't help either.

Team Leads:

Case Managers are organized into teams with about 6 to 8 case managers per team lead. Team leads provide support and supervision to case managers.

There are two supervisors at the central office.Alicia focuses especially on making sure productivity is met and the agency can receive reimbursement. She threatens sanctions if workers don't meet their 20-hour productivity--such as being written up. She checks in on how her caseworkers are doing and dictates what they should be doing anytime a case worker makes a choice that she doesn't think is the best one.Alicia checks regularly to make sure notes are in and reminds caseworkers they need to get notes in. Alicia does not allow those who she supervises to do work outside the office. They are either working by visiting homes or other sites, in their car, or working at the central office.

The other supervisor (team lead) Gwendolynprovides more autonomy and advice as requested and intervenes to take the stress off when situations emerge and a caseworker needs to be backed up due to others in a particular case whether DCS workers or parents or group home managers, appear to be creating challenges for the caseworker. She's not as concerned if circumstances in each week mean a worker doesn't meet productivity. Gwendolyn allows her employees to use their work computer at a nearby coffee shop if it makes sense as they are driving between appointments.