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I I1 ~ unwmnwmmlnmml“ luthS 3 1293 0110 LIBRARY Michigan State Univerdty This is to certify that the dissertation entitled The Effect of Telephone and Face-to-Face Advocacy Strategies in Promoting Adoption of the Community Lodge presented by Maria Isabel Fernandez Sandin has been accepted towards fulfillment of the requirements for P . . . h D degreein Psychology Major-professor 9-18-86 Date "ell-“n..- Ana... .4... I v ".1 In. 24 , ; 0‘1 1 RETURNING MATERIALS: MSU Place 1'n 51 0F drop tof remove th s chec out rom w your record. FINES will W - be charged 11" 530E is returned after the date stamped be‘low. «5-53: \ 59.3 «"‘01‘3‘3990 THE EFFECT OF TELEPHONE AND FACE-TO-FACE ADVOCACY STRATEGIES IN PROMOTING ADOPTION OF THE COMMUNITY LODGE By Maria Isabel Fernandez Sandin A DISSERTATION Submitted to Michigan State University in partial fullfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Psychology 1986 ABSTRACT The Effect of Telephone and Face-To-Face Advocacy Strategies in Promoting Adoption of the Community Lodge By Maria Isabel Fernandez Sandin This experiment was designed to examine whether telephone advocacy, a relatively inexpensive medium, could be as successful as the more costly face-to-face efforts in reducing a potential adopter’s uncertainty and promoting the adoption of the Community Lodge. It also focused on elucidating the relationship between adoption agent attributes and the process of innovation adoption. The study was cast in a two cell design. The independent variable was the type of advocacy strategy utilized, either telephone or face-to-face. The dependent variable was movement towards adoption. Twenty-nine subjects attended an introductory workshop on the Community Lodge program. Subsequently, participants were matched on their community mental health service board's management status, shared or full, and randomly assigned to the twO conditions. After 90 days, movement towards adoption of the program was measured and the experimental manipulation implemented. Fifteen subjects were visited and 14 were telephoned. The final data were collected 180 days after the workshop. The two advocacy strategies did not affect differentially movement towards adoption of the program. Both manipulations reduced uncertainty about the innovation but no significant differences between the conditions were detected. Individual's philosophical congruity with the principles of the innovation was related to adoption, while the use of cosmopolitan sources of information and communication potential were not. The change agent attributes which significantly correlate with adoption were venturesomeness, experimentativeness, perseverance and intent to work towards adoption of the program. The results of the cluster analysis revealed five oblique clusters: Adoption, Influence and Power, Personal Communication and Social Skills, Youth and Willingness to Experiment, and Role Tenure. Interestingly, all of the variables hypothesized to be related with movement towards adoption of the program were contained in the Adoption Cluster. Venturesomeness was the only personality trait included in this cluster. The implications of these findings for dissemination research are discussed. To Ramon whose love has made be bloom ii ACKNOWLEDGMENTS Dissertations are seldom individual endeavors, but depend upon the contributions of many persons. For their wholehearted efforts in designing, conducting and completing this research, I especially thank Bill Fairweather and Esther Fergus. Throughout my tenure at Michigan State, Bill Fairweather has been much more than a major professor. His wisdom, affection and advice on both academic and personal levels have been greatly appreciated. He opened his heart and his home and provided me with a "pseudo family". I appreciate his accessibility, the brilliant ideas and problem solutions, but, above all I am grateful for his loyalty. I am deeply indebted to Esther Fergus who has been both a great mentor, role-model and friend. She has had a tremendous impact on my growth and development as a psychologist, as a woman and as a personality. I want to thank her for being such a great listener, for sharing my triumphs as well as my tribulations. Her love and dedication will serve as lifelong inspirations. I am also grateful to the other members of my committee Charlie Johnson and Bill Davidson. A special note of thanks goes to Lou Tornatzky, Eco-Man, for his insightful suggestions. I am very grateful to the two most important Hungarians in my life: Jan Nagy and Steve Szilvagyi. I wish to thank Steve for so generously giving of his time, expertise and quick wit. If not for him, I would still be trying to decipher the community mental health system in Michigan. Re 111 patiently answered my questions no matter how silly and was instrumental in helping obtain funding for this project. I am indebted to Jan Nagy for being so special. Her words of wisdom helped me endure some very difficult moments. In one short year she has made an indelible mark upon my being and has challenged me seek greater levels of understanding. I shall long remember Sheldon Center and the many lunches we shared. Numerous other persons contributed significantly to the accomplishment of this task. I would like to thank Mary Scott for being resident den mother to Ecological Psychology students. A special word of thanks goes to Suzy Pavick, Marj Curtis, Roger Halley and all the other staff members. I also want to thank Brian Mavis for making me feel like if I was back at the "Fernandez Madhouse", sibling rivalries and all. Likewisn, I'm grateful to tho Miuhigan Department. .of Mental Health for funding this research and to all of the Community Mental Health Service Boards that participated in it. A special note of thanks goes to Jan Clark for helping me retrieve this section from the cruel hands of "perfect writer". To all those other persons which I have not mentioned but who have contributed to this work in one way or another, I’m grateful. There are two very special people, my mother and father, who while not directly associated with the academic portion of this work, were nonetheless vital to its fructition. I want to thank them for the wonderful gift of life, for iv having helped to make me who I am, for always being there, and for their sell'lessness and unconditional love. I appreciate my mom’s tremendous capacity to give and her direct connection to the Supreme Being. I shall long remember the antics of "Madrac, the magician"! In a very special way, I want to remember my dad. I so wish he could be physically here to share my joy. Yet, during life’s most difficult moments, I feet his presence. I know that he is "but a step away". I wish to thank Jose Corugedo for being a true friend. He always knew that I would make it and has stood by me throughout the years. A special note of thanks goes to Bob Fairweather for making me laugh and for sharing the many little things in life. I thank my Tia Lola for her regular phone calls and outlandish remarks. Many thanks go to Manny, my nephew, for his love and for bringing so much joy into my life. I also want to thank Juan and Viye Sandin for their concern and positive thoughts and for their wonderful son, my husband. Above all I wish to acknowledge my husband, Ramon, whose enthusiasm and joie de vivre are so contagious. He has been my support and inspiration and has borne the emotional brunt of this dissertation. He was always ready to do whatever... to clean, to edit, to listen, to encourage, to coax. Without his unconditional love, this past year would have been unbearable. This is truly our" Ph.D. Thank-you and I love you! TABLE OF CONTENTS LISTOF TABLES OOOOOOOIOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO. LISTOF FIGURES 0.00.00.00.00...000.00.000.00... CHAPTER I: INTRODUCTION OOOOOOOOOOOOOOOOOOOOOOO Statement of the Problem .................... Historical Perspective ...................... Classical Approach to the Study of Innovation Diffusion ................................... Problem Solver Perspective ............. Sonia] lntnrnvtinn Pnrnpnntivn ..... .......... Research, Development and Diffusion Perspective ....0.0.0.0...OOOOOOOOOOOOOOOOOO Linkage Perspective ........................ Experimental Social Innovation and Dissemination The Community Lodge: A Social Innovation .... Early Model Building Experiments ....... The Community Lodge .................... Dissemination of the Community Lodge ... Replications and Evaluations of the Community LOdge O O O I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O conClUSions O O O O I O I O O O O O O O O I O O O O O O O O O O O O I O The Role of Certainty on Innovation Adoption .. Face-to-Face Advocacy .................. Telephone Advocacy ..................... Conclusions ............................ The Role of Adoption Agent Attributes on Innovation Adoption ........................ Values, Attitudes and Beliefs .......... Cosmopolitan Information Sources ....... Communication .......................... Personality Variables .................. Social Status .......................... Formal Decision-Making Power . Summary and Conclusions ..... ..... The Present Research ............... Experimental Hypotheses ................. Outcome Hypotheses .................... Participant Characteristics Hypotheses CHAPTER II: METHOD .00....OOOOOOOOOOOOOOOOOOO... SUb‘jects OOOOOOOOOOOOOOOOOIO......OOOOOOOOOO D6811" OOOOOOOOOOOOOOOOOOOO00.000.000.000... vi Page ix xi (0H anew 10 ll 14 14 16 16 20 23 26 29 33 37 38 39 40 41 42 42 43 44 45 45 46 46 48 48 49 Materials ...................................... Procedures ............................. Subject Rm'ruitmnnt. . . ........... . . . The Workshop ....................... The Advocacy Variable .............. Instruments .................................... Individual Characteristics of Change Agents Questionnaire .............................. Workshop Questionnaire ..................... Pre-Advocacy Treatment Movement Towards Adoption Instrument ........................ Follow-up Telephone Interview and Change Scale ...................................... Reliability and Validity Issues ................ Reliability ................................ Validity ................................... CHAPTER III: RESULTS 0.0...00......OOOOOOOOOOOOOOOOO Equivalence of Treatment Groups ............... Statistical Analyses of Experimental Hypotheses Preliminary Analyses for Determining Homoge- neity of Variance and Normal Distribution . Testing of the Outcome Hypotheses ......... Behavioral Measures ....................... Correlates of Participant Characteristics Movement Towards Adoption ................. Correlates of Demographic Variables with Movement Towards Adoption ................. Cluster Analysis .............................. Adoption Cluster .......................... Influence and Power Cluster ............... Personal Communication and Social Skills Cluster ................................... Youth and Willingness to Experiment Cluster Role Tenure Cluster ....................... summary 0.0.0.0...O...0.909...0.009090000000000 CHAPTER Iv: DISCUSSION 0 O 0 O O O O I O O O O O O I O O O O I O O O O O O O O 0 Effect of the Advocacy Treatment on Movement Towards Adoption of the Community Lodge ....... Social Situational Factors ................ Time .OOOOOOOOOOOOOOOO...OOOOOOOOOOOOOOOOOO vii Page 53 54 54 58 60 60 62 63 65 67 67 71 76 76 79 79 81 93 93 96 99 100 103 105 105 108 110 112 112 112 115 Page Effect of Advocacy Treatment of Certainty ....... 117 Relationship of Participant Characteristics and Movement Towards Adoption of the Community Lodge. 120 Values, Attitudes and Beliefs ............... 121 Cosmopolitan Information Sources ............ 121 Communication ............................... 122 Social Status and Decision-Making Power ..... 123 Personality Variables ....................... 124 Threats to Internal or External Validity ........ 126 Other Limitations of the Study .................. 129 CODClUSionS ......OOOOOOOOOOOOOOOOO0.00.00.00.00. 130 REFERENCES 0.00.0000...0.0.0.0..OOOOOOOOOOOOOOCOOOO... 133 APPENDICES ......0.0000.0000....IOOOOOOOOOOOOOOOOOO... Appendix A: List of Boards in the Sample ....... 143 Appendix B: Introductory Letter ................ 144 Appendix C: Protocol for Introductory Phone Call to Agency Directors ................ 146 Appendix D: Protocol for First Contact with the Nominee O0.0.000IOOOOOOOOOCOOOOOOOOO 148 Appendix E: Confirmation Letter ................ 150 Appendix F: Workshop Schedule .................. 151 Appendix G: Intervention Protocol .............. 153 Appendix H: Intervention Handouts .............. 161 Appendix I: Background Questionnaire ........... 166 Appendix J: Individual Characteristics of Change Agents Questionnaire ............... 167 Appendix K: Workshop Questionnaire ............. 178 Appendix L: Pre-Advocacy Treatment Movement Towards Adoption Measure ........... 188 Appendix M: Follow-up Telephone Interview ...... 190 Appendix N: Change Scale ....................... 201 V111 Table 10 11 12 13 LIST OF TABLES Internal Consistency Estimates of Individual Characteristics of Change Agents Questionnaire .. Internal Consistency Estimates of Workshop Questionnaire ...OI.......OOOOOOOOOOOOOOOOOOO.... Comparison of Demographic Characteristics of Participants in the Telephone and Face-to-Face conditions. ...... OIO...00.000000000000000....... Summary of the Analyses of Variance of Pre-Test Differences Between Conditions on the Workshop Questionnaire ...O................OOOOOOOOOOOOOO. Summary of the Analyses of Variance of Pre—Test Differences Between Conditions on the Individual Characteristics of Change Agents Questionnaire .. Preliminary Tests for the Homogeneity of variances 00.0.00...COOOOOOOOOOOOOOOOOOOOOOOO0.0. Effects of Condition on Dichotomously Coded Pre- Advocacy Treatment Movement Towards Adoption score ...O.......0O0............OOOOOOOOOOOOOOOOO Comparison of Experimental Treatments on Movement Towards Adoption 00000....OOOOOOOOOOOOOOOO0...... Effects of Experimental Treatments on Overall certainty O00.0000.00.00.000000000000000000000000 Cell Means and Standard Deviations of the Certainty Scales Across Time .................... Effect of Experimental Treatment on Certainty of HOW-tO-KHOWledge 000000000oooooooooooooooooooooeo Effect of Experimental Treatment on Certainty of Feasibility QC.9009010099000.......OOOOOOOQQQOO99 Effect of Experimental Treatment on Certainty of Program Effectiveness ........................... ix Page 69 7O 77 78 80 82 84 85 86 88 89 90 91 14 15 16 17 18 19 20 21 22 Page Correlation Matrix of Certainty Scales, Intent to Work Towards Adopting Program, Perceived Readi- ness for Change and Movement Towards Adoption ... 92 Correlation Matrix of Philosophical Congruity, Power Variables and Movement Towards Adoption ... 95 Correlations of Personality Characteristics with Movement Towards Adoption ....................... 97 Correlations Between Oblique Cluster Domains and the Validities of Each Cluster Score ............ 101 Adoption Cluster ................................ 102 Influence and Power Cluster ..................... 104 Personal Communication and Social Skills Cluster 106 Youth and Willingness to Experiment Cluster ..... 107 R018 Tenure Cluster O..00.0.0.0........OOOOOOOOO. 109 Figure LIST OF FIGURES Page Michigan Department of Mental Health Service Areas in the Sample ................... 48A Experimental Design ........................... 51 Chart of Measurement Periods .................. 61 xi I NTRODUCTION CHAPTER I INTRODUCTION Statement of the Problem Social scientists have been increasingly interested in the diffusion process of technological and social innovations (Baldridge & Burnham, 1975; Fairweather, Sanders, & Tornatzky, 1974; Glaser, Abelson, & Garrison, 1983; Havelock, 1976; Rogers, 1983; Tornatzky, Fergus, Avellar, Fairweather, a Fleischer, 1980, and others). Perhaps, one reason why there is so much interest in the diffusion of innovations is because getting a new idea adopted, even when it has obvious advantages is often very difficult" (Rogers, 1983, p. 1). The diffusion literature attests- to the wide gap that exists between when an innovation is first developed and when and if it is actually adopted (Fairweather et a1., 1974; Glaser et 81., 1983; Rogers, 1983; Tornatzky et a1., 1980, and others). However, in our modern world of rapidly evolving technologies, the need for more effective ways to tackle new or continuing problems calls for the identification and rapid dissemination of the fruits of research. Ultimately, the meaningfulness of all science, natural and social, rests on the ability to maintain a responSible dialogue between science and the society that sustains it (Burns & Studer, 1975). Thus, man's survival in the modern world pivots upon his capacity to produce continuing change in his daily patterns of living. It is predicated upon his ability to transfer and utilize ever evolving funds of knowledge and to effect appropriate changes in society (Fairweather, 1972; Fairweather et a1., 1974; Glaser et a1., 1983; Glaser & Marks, 1966, and others). Yet, the available evidence indicates that man appears increasingly unable to meet this challenge, which for many is the paradox of our time (Glaser et 81., 1967; Rogers, 1983, and others). Therefore, the study of how knowledge is transferred and utilized, how change is effected and how new technological and social innovations are diffused throughout society is of paramount importance in the 1980’s. The present study attempted to elucidate some unresolved questions regarding these issues as they applied to an experimentally validated social innovation for the treatment of the chronically mentally ill, the Community Lodge (Fairweather, Sanders, Maynard, & Cressler, 1969). First, the general diffusion literature will be critiqued. This will be followed by an examination of the development and validation of the Community Lodge and a review of .previous efforts to disseminate this innovation. Last, a detailed description of the current study will be presented. Historical Perspective Rogers (1962, 1983) suggested that diffusion research began as a series of nine independent scientific enclaves, each revolving around an academic discipline. These were: anthropology, early sociology, rural sociology, education, medical sociology, communication, marketing, geography and general sociology. Each developed its own diffusion research tradition and usually concentrated on investigating the diffusion of one main type of innovation. These traditions pursued diffusion research in their own specialized way utilising the type of methodology and unit of analysis most relevant to each particular field. Initially, there was not much interchange among the different diffusion research traditions. However, in the early 1960’s the boundaries between the traditions began to break; knowledge began to be exchanged; and an intellectual integration of the field occurred. Classical Approach t the Study 21 Innovation Diffusion The classical approach to the study of innovation diffusion centers around the work of Havelock (1971) and his colleagues. These researchers synthesized the dissemination and utilization literature into three conceptual frameworks or models of social change - the Problem Solver (PBS) Perspective; the Social Interaction (S-I) Perspective; and the .Research, Development and Diffusion (R, D, l D) Perspective. Given the drawbacks of each of these perspectives, Havelock developed a fourth model called the Linkage Perspective of social change. Fairweather (1967) enhanced these perspectives by developing a fifth model, EXperimental Social Innovation and Dissemination (E.S.I.D.), which incorporated concepts from these approaches and placed them in an experimental context. These five models will be described subsequently. Problem Solver Perspective. The problem solver perspective is based upon the early work of Lewin (1951) who proposed both the existence of three major stages in the change process (unfreezing, moving and freezing) and the need to analyze the force field of the client system. Organizational change theorists (Lippitt, Watson & Westley, 1958) expanded this basic model to include several phases: 1) the development of a need for change, 2) establishing a change relationship, 3) diagnosis of client problems, 4) establishing goals of action, 5) transforming intention into actual change, 6) generalizing and stabilizing the change and 7) achieving a terminal relationship. The model views the process of change as stages of a cycle typically evolving through these six steps. If the solution doesn't satisfy the need, the process begins again and the cycle continues until the problem is adequately solved (Havelock, 1971). In this model, the role of the change agent is that of a professional helper external to the organization, whose basic function is to help the client solve a problem (Lippltt et a1., 1958). Although interpersonal and group relations may improve through the change agent’s efforts, change in structures and procedures that. would affect the organization’s function would not necessarily result. Change is not a primary task of agents. Rather, the agent's role is to provide information in order that the client may make a choice. "Thus, it appears that although the term change agent originated from the P-S perspective, in reality, the agents are not advocates for change in the form of adoption of a specific social innovation" (Fergus, 1973, pp. 3-4). The following four models, in contrast to the P-S model, define change as the adaption of an innovation that may well alter the function and structure of the client system. Social Interaction Perspective. The social interaction perspective has its roots in anthropological studies of the diffusion of cultural traits (i.e. Barnett, 1953). Although it was strongly influenced by social psychology, its tradition was shaped by the rigorous and empirically minded rural sociologists beginning with the classic study (Ryan 8 Gross, 1943) of the diffusion of hybrid corn. Even though many researchers have made important contributions to this perspective, Everette Rogers (1962, 1971, 1983) is the most well known and prolific advocate of the 8-1 tradition. The 8-1 perspective is based upon six major tenets: the importance of the social relations network; the user's position in that network; the significance of informal personal relationships and contacts; the importance of reference group identifications; the essential irrelevance of the size of the adopting unit; and the different types of influence strategies that can be applied at different stages in the adoption process. The model emphasizes the measurement of the movement of messages from person to person and focuses on the informal communication channels of the user or adopter in the context of his/her social interaction network. Society is seen as a network of roles and channels of communication with organizational, formal and informal associations forming barriers and overlapping connections (Havelock, 1971). The role of the change agent is not explicitly characterized in this perspective because emphasis is placed on the user, as opposed to the change agent per se as described in the P-S perspective. The 8-1 school possesses a phase model of the adoption process often referred to as the "AIETK" model (Havelock, 1971, p. 11-10): awareness, interest, evaluation, trial and adoption. In his 1983 edition of the Diffusion of Innovations, Rogers reconceptualized these original five stages into the following: knowledge, persuasion, decision, implementation and confirmation. Because this model was derived from cases of unplanned change whose development was characterized by the previously delineated stages, it assumes that both research and development have occurred. The major concern of change agents is the utilization of communication channels for the diffusion of innovations. As a result, the main task confronting S-I theorists is measuring the innovation’s flow through a social system over time by studying both the flow pattern and the effects of social structure, relationships and groupings on the fate of the innovation. ResearchI Development and Diffusion Perspective. The classical R, D, a D perspective can be traced back to early roots in agriculture where change often followed an orderly process from research to development to diffusion and finally to adoption. It is the most widely accepted of the perspectives and underpins our national philosophical rationale for conducting basic research. It has been used both as a research paradigm and a model for policy making (Roitman, 1984). The R, D, & D perspective supports the processes of: basic research, applied research, development and testing of prototypes, packaging and product and mass dissemination. The model posits that change proceeds through a rational sequence of activities beginning with a usable product or process demonstrated through research and development followed by packaging and dissemination. It assumes that massive planning occurs to coordinate the different activities and that there is a division of labor and a separation of roles and functions. It also assumes that there will be a more or less clearly defined target audience, a passive consumer who will accept the innovation if it is delivered through the right channel, in the right way and at the right time. Lastly, the perspective accepts that initially there will be high development costs, but foresees an even higher gain in the long run in terms of efficiency, quality and capacity to reach a mass audience (Havelock, 1971). Because the R, D, & D perspective considers a wide range of activities and roles at each stage of the change process, there is more variation among the conceptualizations proposed to represent it. There is no one particular model that is generally accepted as the prototype. (For an example of typical R, D, & D model see Guba, 1966.) Like in the 8-1 perspective, the role of the change agent is not explicitly defined. Although not stated, the person who packages and plans for dissemination may be thought of an a change agent because he/she is working towards diffusion of an innovation. Two things are true of the change agents in the R, D, a D model. First, they advocate a product or a program that is tested and second, they intend to plan for large scale diffusidn (Fergus, 1973). Recently, researchers (Berman & McLaughlin, 1978; Fullan & Pomfret, 1977; House, 1975, 1981; Roitman, 1984, and others) have questioned some of the basic tenets of the R, D, a D perspective. Fullan and Pomfret (1977) presented evidence suggesting that sites were not at all passive receivers of innovations. Others (Rogers, 1978, 1983) were amazed by the degree to which innovations were re-invented by sites to provide a sense of ownership. Still other researchers (Cyert & March, 1963; March & Simon, 1958) argued that organizational decision criteria were usually satisficing rather than maximizing, and that decision makers usually acted expeditiously rather than engaging in comprehensive searches for information and elaborate weighing of alternatives. As a result of all of this, the classical R, D, & D approach was modified. The modified R, D, l D approach encourages research and development by practitioners, utilizes active, full-time change agents to disseminate rigorously evaluated programs, and pays attention to organizational environmental dynamics shown by past researchers to be crucial for successful implementation (Blakely, Mayer, Gottschalk, Roitman, Schmitt, Davidson, & Emshoff, 1984). Unfortunately, although the modifications were grounded on empirical findings, the modified R, D, t D model has not gained the same level of acceptance as the classical approach. 10 Linkage Perspective. Although each of these three viewpoints contributes significantly to the understanding of the dissemination and knowledge utilization process, each perspective has inherent weaknesses and difficulties. Havelock (1971) created the linkage perspective in an attempt to bridge the gap between the resource system and the user system. He did this by selecting the strongest features from the three previously defined perspectives. The linkage process rests on creating interdependent and reciprocal relationships between user system and resource system. It focuses on the user as a problem solver and utilizes the problem solving cycle similar to the one used in the P-S perspective. This cycle initiates with a felt need and moves successfully to diagnosis, problem statement, search, retrieval, and application of the solution. The model stresses that the user must be meaningfully related to the outside resources and must enter into a reciprocal relationship with the resource system. In short, the resource system~ and the user system must simulate the processes occurring within each system. For instance, if the resource system can simulate the user's problem solving cycle, it would have a better understanding of the user's need; and if the user could simulate the resource system’s research and development process, it would be more receptive to adoption of the innovation (Fergus, 1973). The organization of the linkage system suggests that 11 change agents are located at the‘ interphases of the subsystems. It focuses on the practice subsystem taking on the linkage role between the resource subsystem and the user subsystem (Havelock, 1971). Lastly, linkage theorists encourage training practitioners in how to use scientific knowledge, how to adapt the findings, and how to use diagnostic tools to collect information. Experimental Social Innovption and Dissemination Despite the large body of literature on social change processes surrounding each of the four models previously defined, there is little information on the relative effectiveness of various organizational change strategies. Instead of encompassing a thorough explanation of the total process of diffusion, these models focus on some specific segment of this process. A comprehensive methodology to describe the dissemination of innovations is lacking in the strategies presented. Also, the role of the change agent in each of these perspectives is of a limited nature. He/she plays a passive role rather than being actively involved in the total diffusion effort. Furthermore, the components of these social change strategies have not been systematically evaluated, thus leaving future change efforts to rely on the subjective ”truths" of the past. In light of this, a truly comprehensive model of the 12 total diffusion process needed to be postulated. The E.S.I.D. perspective, a very rational, experimental, step—by-step approach, was developed to satisfy this need. George W. Fairweather, the major proponent and spokesperson for this perspective, delineated the model in his books: Methods for EXperimental Social Innovation (1967), EXperimental [Methods for Social Pblicy.Research (1977) and An Introduction to Community Experimentation: Theory,.Method and Practice (1986). This perspective is characterized as a "gestalt of scientific methodology blended with many philosophical and ethical considerations" (Fairweather & Tornatzky, 1977, p. 27). It traces the innovation process from initial model-building efforts focused on successive attempts at social problem solutions, to continuous evaluation of the newly developed problem solution and finally to its implementation. Experimental social innovation proceeds through four distinct phases - planning, action, evaluation and dissemination (Fairweather, 1967, p. 35). Thus, the E.S.I.D. perspective includes model-building and evaluation phases . as well as an implementation/dissemination phase consisting of approaching, persuading, activating and diffusing the model. Under the E.S.I.D. perspective, the change agent plays an important role in the implementation phase which occurs after the effectiveness of a model has been experimentally 13 demonstrated. The dominant characteristics of the E.S.I.D. change agent are as follows: is supportive of humanitarian values; is committed to solve a human problem; approaches change with a social action orientation; advocates an innovation that has been experimentally tested; and utilizes experiments with methods of change until masses adopt the innovation (Fairweather, 1967, 1972). Unlike the more passive roles given to change agents in the other perspectives, the E.S.I.D. change agent is described as one who is active and morally committed to the implementation of the particular innovation. The E.S.I.D. model is unique in that it established many of its guidelines for the role of the change agent from experimentation. The model presents a clear picture of the general role of the change agent and relies on ongoing or future experimental research to determine which roles would be most effective. Lastly, the E.S.I.D. model serves as the vehicle through which the science of knowledge utilization and dissemination can grow. It provides an experimentally sound methodology that can be employed in the evaluation process of social change strategies (Fairweather & Tornatzky, 1977). Fairweather and Tornatzky (1977) claimed that continuous experimental dissemination research is imperative because the factors affecting implementation outcomes are dependent upon the particular time frame and are subject to change 14 with changing times (Fairweather & Tornatzky, 1977). In short, the E.S.I.D. perspective is cyclical and comprehensive in scope, prescribes an active role for the change agent and utilizes experimentation at each phase of the innovation process to find the relevant determining variables. "Experimentation is thus used as a feedback mechanism to identify the key social change variables that can be used to create the desired change" (Fairweather, Sanders, & Tornatzky, 1974, p. 26). The E.S.I.D. perspective is most clearly exemplified by tracing the development of a social innovation through all of the phases of the model. What follows is a description of a prototype social innovation, the Community Lodge, as it proceeded from initial model building and evaluation experiments to its dissemination. The Community Lodge: A Social Innovation Epglzlgpgpl Building Expepiments. In 1955 Fairweather and his colleagues (Fairweather et a1., 1960; Fairweather & Simon, 1963) began a series of evaluative experiments. The first of these stemmed from a dissatisfaction with» psychotherapeutic treatment approaches and attempted to experimentally investigate the effects of this treatment modality. The results showed that patients who participated in the three most common hospital programs did no better or 15 worse in community adjustment eighteen months after release from the hospital than those patients who simply worked in the hospital setting. Armed with these findings, the researchers began a second experiment in 1958 (Fairweather, 1964) to see what kind of treatment alternative could be developed for chronically hospitalized mental patients that might have a more positive influence on their adjustment. Information obtained from readmitted patients and social psychological literature suggested that patient reference groups could perhaps be utilized to bridge the gap between hospital and community living. Thus, this second experiment was designed to evaluate whether hospitalized patients could: live in small self-governing groups, adequately solve their problems of daily living and plan for their own future. The results of this study demonstrated that this was indeed possible. However, upon discharge, the community adjustment of the small group ward patients continued to be a problem. It appeared from the results of this study that good community tenure hinged upon patients’ possessing an adequate system of social support, maintaining employment and obtaining first-class citizenship status. Thus, the next task faced by these researchers involved "the establishment of a social subsystem that is more tolerant of deviance than the community-at-large, while at the same time serving as a protective buffer between the community and the deviant 16 member” (Heller & Monahan, 1977, p. 293). The new social subsystem created by these researchers became known as the Community Lodge (Fairweather et a1., 1969). Epp,gppppnipz Lpggp. The Community Lodge has been cited among "the single most important pieces of research focused on change in the mental health system" (Rappaport, 1977,’ p. 279). The experimental test for this social model was initiated in 1963 and completed by 1969 (For a detailed description, see Fairweather et al., 1969). The results of the study showed that this community program which had been developed through continuous longitudinal research not only enhanced the ex-mental patient’s perception of himself, lengthened the time he remained in the community and increased the satisfaction of professional personnel; but it could also be carried out at one third the cost of keeping a patient in the institution. Dissemination pf_phg Community Lpggg. Bolstered by these experimental findings, the research staff approached their sponsoring hospital and made consultation visits to other mental health programs in attempts to get these organizations to adopt the Lodge. But, "except for two initial replicates...no other Lodges were adopted" (Fairweather, 1979, p. 323). It became clear that mental health organizations were not going to adopt the concept unless an active attempt at dissemination was begun. Thus, the first nationwide, longitudinal Lodge dissemination study 17 was designed (Fairweather, Sanders, & Tornatzky, 1974). This research was divided into sub-experiments each corresponding to one of the four stages of the E.S.I.D. model. In the approach phase experiment, the researchers attempted to answer the question of whom within the hospital setting should initially be approached to accept information about the Lodge. The persuasion phase tested three modes of presentation: brochure, participation in a workshop and creation of a demonstration ward. In this phase, the researchers attempted to ascertain which of these modalities was the best method of persuading the organizations to move towards adoption of the Lodge. The results showed that as far as entry was concerned, it made no difference what social position the person contacted had in the organization. In terms of the persuasion manipulation, hospitals in the demonstration ward condition were more likely to move towards adoption of the Lodge than those in the other two conditions. The purpose of the activation phase experiment was to compare the value of social change agents with the written word. Hospitals in the first condition received a written manual clearly describing each step in the movement from hospital to community setting. In the other condition, participating hospitals received periodic visits from an action consultant whose role was to help the institution move step by step towards adoption of the program. No 18 actual Lodges were established by hospitals in the written manual condition, while action consultation was found to have positive effects on adoption. In short, "action begat action" (Fairweather, 1980, p. 40). Hospitals that originally implemented demonstration wards and that were visited periodically by action consultants were the most likely to move towards adoption. The diffusion phase experiment focused on determining the degree of adoption that had occurred after all active attempts to create social change via experimental intervention and direct efforts by the change agents had terminated. It also aimed at discovering the factors involved in the diffusion process. The results showed that little diffusion occurred in hospitals that refused to participate in the other sub-experiments, with significantly greater diffusion occurring in the volunteer hospitals. These findings suggested that "diffusion must in fact be planned" (Harris, 1972, p. 67), for only those hospitals that had been actively involved with the program diffused information about it. When the first longitudinal dissemination study was terminated, only six hospitals had established 30 separate Lodges. The lack of further adoption created a dilemma for the researchers. The experiment had raised several new questions that needed answers (Fergus, 1980). As a result, another dissemination experiment was designed to explore 19 whether or not cohesive groups of adopters would themselves become the disseminators of the new mental health program (Tornatzky, Fergus, Avellar, Fairweather, & Fleischer, 1980). The approach/persuasion phase of this second nationwide dissemination study consisted of determining if structuring the workshop around group process could foster group cohesiveness and involvement. It alsoexamined the number of individuals and the level of staff (i.e. ward personnel, administrators, or a combination) that would be most conducive to adoption. The results showed that ward personnel are more likely to lead a group decision to adopt the Lodge. However, this decision did not enhance the participants’ perceptions of involvement in decision making. The group enhancement techniques and a greater number of individuals participating in the decision process lead to greater perceptions of involvement but not to a group decision to adopt the Lodge (Fergus, 1980). The activation phase consisted of combining action consultation with organizational development techniques to see if this would further the cohesiveness and goal direction essential for ultimate Lodge adoption. This was compared to a consultation only approach. The organizational development condition was found to have a significant effect over time in terms of movement towards adoption of the Lodge. 20 Two studies were conducted in the diffusion phase. The first dealt with testing the effectiveness of newsletters on the diffusion process and the other was a demonstration case study approach in which the adopters were asked to participate in planning, consulting and promoting the Lodge (Tornatzky et a1., 1980). The results of the first study indicated that the newsletter by itself had no effect on the diffusion of the Lodge. The results of the second study demonstrated that although Lodge adopters expressed an interest in disseminating the concept, first priority was given to the maintenance of their own program, starting new programs in their community and persuading local residents to support the program. National advocacy was, by default, their lowest priority (Fergus, 1980). In short, the research findings suggest that there is little peer-to-peer communication about innovations that transcend regional or organizational boundaries and that attempts to facilitate this type of communication through the printed media are not very effective. Replications ppd Evaluations pf pp; Coppppitz Lodge. Recent attempts at evaluating the effectiveness of the small group ward program (Gunter & Bedell, 1983) and the Community Lodge (Fairweather, 1980; Norwood & Mason, 1982; Shadish, 1984) indicate that Fairweather et al.’s (1969) overall findings are still relevant and applicable to the 3new chronic patient (Caton, 1981). For instance, Gunter and 21 Bedell (1983) conducted a study comparing a small group ward program with a contemporary rehabilitation therapy program using a sample composed of the typical new chronic patient. The initial sample consisted of sixty-three patients who were randomly assigned to either a small group ward or a rehabilitation therapy program. Thereafter, subjects were assigned to the two programs in matched pairs. The researchers matched on age, sex, diagnosis and prior hospitalization. Patients in the small group ward program were compared to controls on measures of self concept, perception or kind and degree of help received and recidivism rate. The results of the study indicated that small group ward patients spent significantly less time in treatment than the controls. The small group ward program was also found to be effective in reducing recidivism over an 18 month period and was less expensive than the rehabilitation therapy program. Larch (1980) provided a descriptive account detailing the fifteen year existence of the first Community Lodge replicate. As of 1980, 550 persons had moved out of the hospital into the community. Approximately 100 persons were still living in the original Community Lodge home in which they were placed. Others ”had moved to their own homes, gotten married, or were living alone. Even so, they‘ continue to act as a group" (p. 64) and no member is allowed to live off the work of other members. Larch claimed that 22 their only failures have been patients who did not participate in the small group training program. Others (Kiepke, 1980; Miller, 1980; & Mateer, 1980) have described their experiences in implementing Community Lodges from very different perspectives - as a community volunteer activity (Kiepke, 1980), as an urban council activity (Miller, 1980) and as a private nonprofit corporatiOn (Mateer, 1980). (For a detailed description see Fairweather, 1980.) Norwood and Mason (1982) conducted an evaluation of community support (CSP) programs in the State of Texas. They compared clients from Community Lodges, psychosocial rehabilitation centers and programs where the key programmatic activity was case management (i.e. day activities and supervised apartments) with clients who did not participate in any community support program. They also examined the effectiveness of each of these three progrms in terms of recidivism, cost, employment and community functioning. Although CSP clients generally did better in all of these criteria than control subjects, differences among the three community support programs were detected. For instance, Community Lodges were found to be less costly than the other two types of CSP. Also, current Community Lodge clients exhibited significantly better functioning than comparison clients on both indicators of employment status, employment rate and number of months employed during 23 a one year period. Current rehabilitation, case management clients and all former CSP clients resembled the comparison group on these two indicators (Norwood & Mason, 1982). Furthermore, lodge members were more likely to claim that CSP had been effective and perceived significantly greater program impact than other CSP participants. Although these differences were not statistically significant, current lodge clients were less likely to be hospitalized, had fewer readmissions and had spent less time in the hospital than other CSP participants. As a result of all of this, Shadish (1984, p. 726) concluded: "The Lodge reduces patients’ dependence on mental institutions and professionals, it helps patients to compete for scarce resources such as employment and it reduces society’s exposure to deviant behavior without depriving patients of access to the community - all this without exploiting mental patients.” Conclusions. Despite concentrated efforts to disseminate the Community Lodge, Fairweather and his colleagues achieved only limited success. During the course of both large scale studies, individual and organizational resistances to the dissemination efforts were encountered. Unfortunately, this finding is not at all surprising since almost all innovations, from the wheel to the computer have been feared, ridiculed and resisted (La Pierre, 1965). Shadish (1984) attributed the lack of widespread adoption of the innovation to its being inconsistent with existing 24 social structures and ideologies. For instance, the Lodge society eschews dependence on mental health professionals, but these professionals control resources that these societies need. Likewise, the philosophy of the program suggests that society causes many of the problems of mental patients, an idea which is diametrically opposed to the societal belief that individuals are responsible for their own problems. Although Lodges may) be cheaper than. hospitalization, they are not widely reimbursable or profitable under the existing mechanisms and so it is difficult to find start-up and maintenance funds for these societies (Shadish, 1984). In addition, many of the resistances to program adoption encountered stemmed directly from the mental health system itself, particularly from its organizational structure. As Pincus (1974) explained, rather than having clear incentives for efficient operation and productivity, public service bureaucracies (i.e. the mental health system) have incentives, whether of a financial or symbolic nature, that reward inefficiency or at the very least, the perpetuation of the status quo. For instance, if a rehabilitative program successfully rehabilitates all of its clients and conducts a perfect preventive program, it would ultimately go out of business. Consequently, efforts to persuade these 'agencies to adopt an innovation whose main purpose focuses on complete rehabilitation of its clients would inevitably 25 be met with great resistance. In light of this, it was not surprising that attempts to get psychiatric hospitals to adopt this community program whose goal was the deinstitutionalization of chronic clients met with little success. Also, all public service bureaucracies strive to make their task environment as predictable and devoid of irrationality as possible (Tornatzky, et a1., 1980). Thus, one of the primary functions of an organization is to reduce uncertainty about the task it is to perform (Schon, 1967; Zaltman, Duncan, & Holbek, 1973.) To accomplish this aim, many organizations develop elaborate sets of rules and ' procedures for conducting business which are difficult to circumvent. This process facilitates the day to day functioning of the organization but hinders innovation adoption since (if the innovation is of any consequence) a large number of rules and unorthodox decisions will have to be made (Fleischer, 1979). Therefore, the adoption of a social innovation is inherently an uncertainty-arousing event because it threatens the entire structure of the organization. Innovation adoption demands fluidity and flexibility of social processes to cope with this uncertainty. Unfortunately, public service bureaucracies in general, and the mental health system in particular, characteristically do not posses this fluidity and flexibility (Tornatzky et 26 a1., 1980). From an organizational perspective, the less uncertainty an innovation produces the greater its probability of being adopted. Thus, to maximize the probability of innovation adoption, uncertainty must be reduced. The Role Q£_Certainty n Innovgtion Adoption Ample research evidence exists (March & Simon, 1958; Rogers et a1. 1971; Schon, 1967, and others) to support the claim that a potential adopter’s certainty/uncertainty about an innovation is a key determinant of its subsequent adoption. The greater the certainty about an innovation, the greater the probability of its adoption. Of the five characteristics of innovations delineated by Rogers and Shoemaker (1971) four of these are directly related to uncertainty - observability, trialability, complexity and compatibility. For instance, if a potential adopter or potential adopting organization can observe the effects of an innovation, he/it will be more certain about the results. Similarly, if the innovation, or a part of it, can be tried before a complete commitment to adopt is made, the individual or organization will be less likely to fear it. Finally, if the innovation is compatible with the individual’s or the organization’s belief system, there will be greater probability of adoption. 27 Much has been written about the compatibility variable and most of this literature is based on the principle of ”homophily" (Lazarsfeld & Merton, 1964). Homophily is the degree to which pairs of individuals who interact are similar in certain attributes, i.e. beliefs, education, social status, etc. For instance, Rogers (1983) suggested that homophily (or similarity) between the change agent and the potential adopter or adopting organization enhances innovation adoption because it facilitates the transfer of ideas. Likewise, the social psychological literature indicates that similarity makes a communicator more credible. This rather consistent finding could be related to the reduction in uncertainty accompanied by what Festinger (1954) called the Social Comparison Process which indicates that people define their social realities through their interactions with others. Festinger stipulated that under conditions of anxiety people tend to evaluate themselves (and their abilities, opinions and emotions) by comparison with others. Schachter (1951) said that "on any issue for which there is no empirical referent, the reality of one’s own opinion is established by the fact that other people hold similar opinions" (p. 191). He latter qualified this statment by adding that comparison could only be effectively made if the others were similar in some relevant manner (Schachter, 1959). Consequently, in uncertainty arousing situations such as 28 the innovation adoption process, similarity between the change agent and the adopting party is of paramount importance. If the principles underlying the innovation are inconsistent with an individual’s existing belief system, the uncomfortable psychological state of cognitive dissonance may be aroused In order to reduce this dissonance, individuals will tend to chide away from the cause of this dissonance, the innovation. On the other hand, if compatibility of values occurs, this homophily will help reduce the uncertainty inherent in the innovation adoption process (Rogers, 1983). Thus, a potential adopter’s philosophical congruity with the principles of the innovation increases the probability of its adoption by reducing uncertainty about the innovation through the social comparison process (Rogers, 1983). Another way through which uncertainty about an innovation can be reduced is to provide potential adopters with more information about the innovation. Traditionally, five modalities of information diffusion have been utilized (Rogers, 1962). These are: 1) the written word; 2) face-to-face contacts and change advocacy; 3) workshops, conferences and seminars; 4) demonstrations or site visits; and 5) the mass media. Fairweather and his colleagues have utilized all but one of these approaches in their dissemination efforts of the Community Lodge. The findings of these studies indicated that the establishment of 29 demonstration wards and periodic visits from a change agent were most effective in promoting adoption. An action oriented approach coupled with face-to-face contacts were found to be of paramount importance to the dissemination of the innovation. These results are congruent with those of many studies in the area. Face-to—face Advocacy. The effectiveness of personal contact in reducing uncertainty and facilitating change has been well documented in the literature (Arensberg & Niehoff, 1964; Clark, 1962; Coleman, Katz, & Menzel, 1966; Fairweather et a1., 1974; Niehoff & Anderson, 1964; Spooner & Thrush, 1970; Tornatzky et a1., 1980, and others). In their classic study of the diffusion of hybrid corn, Ryan and Gross (1943) found that the farmer-to-farmer exchange of personal experiences with the use of the new seed seemed to lie at the heart of its diffusion. Although the typical farmer first heard about the innovation from a salesman, their neighbors were the most frequent channel leading to persuasion. When enough positive experiences were accumulated by farmers and exchanged within the community, the innovation’s rate of adoption increased tremendously. Again, Festinger’s (1954) Social Comparison Theory provides an explanation for these results. They are supported further by Schachter’s (1959) findings that the need to pursue social comparison is especially acute in stimulus situations of uncertainty and unpredictability. 30 His results suggested that in settings of information utilization, the preferred source of information seems to vary on a personal-impersonal dimension as a function of the complexity of the information. Given that the Community Lodge is a very complex innovation, it is not surprising that the more personal advocacy efforts yielded greater adoption. In their study of the diffusion of a new antibiotic, Coleman et a1. (1966) found that although over 80% of the physicians in their sample first learned about "gammanym" from the drug company, the subjective evaluations of the new drug (based on the personal experiences of a doctor’s peers) were key in promoting innovation adoption. The study established the importance of interpersonal networks as a communication channel in the innovation decision process. Coleman et al. (1966) concluded that "the extensive trials and tests by manufacturer, medical schools and teaching hospitals are not enough for the average doctor. Testing at the expert level cannot substitute for the doctor’s own testing of the new drug; but testing through the every day experiences of colleagues on the doctor’s own level can substitute, at least in part" (Coleman et a1., 1966, pp. 31-32). Berelson and Freedman (1964) utilized four different communication interventions to promote the adoption of family planning in Taiwan. These were: 1) neighborhood 31 meetings about family planning, 2) neighborhood meetings plus mailed information about family planning to likely adopters, 3) neighborhood meetings, plus a personal visit to the wife in families likely to adopt and 4) neighborhood meetings, plus personal visits to both husband and wife in families likely to adopt. They found that over 40% of the eligible audience adopted some form of family planning. The interpersonal communication manipulations had a significant impact on the adoption of contraceptives. In an interesting laboratory study in which various modes of communication were compared in a problem solving situation, face-to-face interaction was found to be essential, particularly in solving highly complexed "human relations" problems (Chapanis, 1971). In a comparison study, Chapanis (1973) found that utilization of a scientific information network was also significantly enhanced if users of the network had an opportunity to communicate directly by phone with a resource person rather than submit information requests through the mail. In another study, Stevens & Tornatzky (1980) tried to get thirty-seven drug abuse programs to adopt program evaluation, an uncertainty arousing innovation. They utilized group versus private consultations and on-site versus telephone consultations. They found that group consultations with staff produced more innovation adoption than private consultations with a program director. The 32 results yielded ambiguous support for’ the hypothesis that on-site consultations with face-to-face interactions would produce more innovation adoption than telephone consultations. Nielsen (1967) and Nielson and Crosswhite (1959) found that increased contact with farmers led to increased adoption of improved agricultural practices, which led to increased agricultural output and greater earnings. In another study, Eldersveld and Dodge (1954) found that personal visits to homes were more effective in persuading people to vote for a revision of a city charter than a mail campaign and a no treatment control group. Likewise, Spooner and Thrush (1970) reported that a personal follow-up after an interagency conference enhanced the dissemination of a mental health research finding and initiated institutional change. Although face-to-face consultation has proven to be very effective in promoting adoption, it is very costly and labor intensive, since it is usually conducted on a one-to-one basis requiring great commitments of time, human and economic resources. Given the current funding situation and the limited resources allotted to dissemination efforts of socially relevant innovations, the feasibility of always utilizing this technique is questionnable. The dilemma is apparent. On the one hand, the effectiveness of this method has been established but this typical, extensive form of 33 change advocacy may be economically prohibitive. What is needed is an advocacy strategy which is both effective and relatively inexpensive so that it can be widely utilized in promoting innovation adoption. Telephone Advocacy. One technique that could potentially be used as a relatively inexpensive advocacy medium is telephone prodding. This strategy has been used to facilitate behavior change in a wide variety of situational contexts - completion of surveys (Donald, 1960; Eckland, 1965), adoption of milieu therapy (Fergus, 1973), enhancing citizen participation (Lounsbury, 1973), reducing missed initial appointments (Hochstadt a Trybula, 1980), fulfilling blood donation commitments (Ferrari, Barone, Jason, a Rose, 1985) and others. For instance, Lounsbury (1973) conducted an experimental study designed to promote citizen environmental action. The results indicated that merely sending a person an action oriented newsletter and additionally sending the newsletter to her two adjacent neighbors were ineffective treatments for engaging middle-class citizens in environmental action. A newsletter plus a personal telephone contact by a change advocate was found to be a significantly effective method. Others (Donald, 1960; Eckland, 1965, and others) have shown that telephone prodding can be successfully used to persuade non-respondents to complete and return survey forms. In a study designed to increase blood donations, Clee and 34 Henion (1979) telephoned previous donors in a middle sized city. Each subject was read a script with one of the following requests: 1) a simple request to donate, 2) a request to donate because of a sudden need for blood, 3) a request to donate and the opportunity to join a list of permanent donors, and 4) a request to donate and a pledge that future request for donations would be postponed for some time. No significant differences among these conditions were detected. Also, the study had a rather low overall donation rate (15.4% of the donors who were contacted). Similarly, Jason, Rose, Ferrari, & Barone (1984) found that telephone calls were not effective in motivating undergraduate students to make a commitment to donate blood. In another study, Ferrari et a1. (1985) utilized telephone calls to prompt college students to fulfill their pledges to donate blood. Unlike the previous studies, the reminder call had a significant impact on actual blood donations. These researchers suggested that while telephone calls may not be very effective in motivating individuals to pledge, they served an important role in helping people keep their commitments. Chapanis & Overbeg (1971) found that utilization of a scientific information network was significantly enhanced if users of the network had an opportunity to communicate directly by phone with a "resource person” rather than 35 submitting information requests to a' tape recorder. In another study, Chapanis (1973) found that subjects solved problems much faster when they communicated in either of two oral modes, voice and natural communication, rather than in either of two hard-copy modes, typewriting or handwriting. Fergus (1973) investigated whether telephonic consultations subsequent to a five day workshop affected the degree to which adoption of a milieu therapy program took place in nursing homes and hospitals. The results indicated that telephonic consultations did not create more information dissemination or enhance utilization of particular forms of information dissemination. Hochstadt and Trybula (1980) investigated three different means of reducing missed initial appointments in a community mental health center. Eighty-eight subjects were assigned to one of four treatment conditions: 1) a letter three days prior to the initial appointment; 2) a telephone call three days prior to the initial appointment; 3) a telephone call one day prior to the initial appointment; and 4) a non-intervention control group. The results showed a significant reduction in the rate of missed initial appointments for clients telephoned one day prior to their appointments (9% nonattendance rate). Clients receiving either a letter or a telephone call three days prior to the initial appointment had a 32% nonattendance rate, while those in the control group had a 55% nonattendance rate. 36 Thus prompting, by either letter or phone call, played a salient role in reducing the nonattendance rate. However, the temporal proximity of the prompt appeared to be more important than the type of prompt itself. The authors also found that Festinger’s (1957) theory of "forced compliance" or "attitude discrepant behavior did not account for these findings (p. 264). The results of this study are at variance with those of Cauffman, Warbuton, and Schultz (1969). These researchers found that personalized prompts (home visits and phone calls) were more effective in increasing participation rates in dental and health care programs than was a less personal prompt (a letter). This finding is bolstered by many other studies (Fairweather et a1., 1974; Lounsbury, 1973, and others). In studies comparing face-to-face and telephone advocacy within the same experimental context, face-to-face efforts usually appear to be more effective. For instance, Stevens and Tornatzky (1980) found that face-to-face consultations showed a trend (p (.10) towards being more effective than telephone consultation in a two-way analysis of variance and they were significantly more effective (p (.05) in a simple analysis of variance. Likewise, Christie (1975) demonstrated that face-to-face communication was rated significantly more effective than telephone communication for complex group discussion. 37 Conrath (1975) experimentally evaluated the effectiveness of telephone versus face-to-face diagnosis of hospital patients’ medical problems. He found that in this one-way type of consultation (patients usually only providing, rather than receiving and using information) face-to-face diagnosis was more valuable in diagnosing more subtle secondary medical problems. In a field comparison of counselor communication at an outpatient counseling program, Antonioni (1973) found that face-to-face sessions yielded more positive observer ratings of counselor empathy, verbal concreteness, and client self-exploration than did counseling sessions over the phone. In an interesting fusing of laboratory and field-based research, Chapanis (1971) compared the relative utility of face-to-face interaction, telephone interaction, and written messages in communicating complex information. He found that of the three techniques studied, face-to-face interaction was essential to successful communication of the information. Conclusiong. Although "telephone advocacy has been fairly conclusively shown to facilitate behavior change in certain situations" (Lounsbury, 1973, p. 8), its role in facilitating organizational change has not been experimentally established. The bulk of the studies reviewed utilized the telephone manipulation in conjunction with another variable. For instance, telephone calls were 38 used as "prompts" rather than as advocacy strategies per se. Few studies actually compared face-to-face and telephone consultation, and in many of these, personal contact was hopelessly confounded with participation (Stevens et a1., 1980). Furthermore, while many studies demonstrated the effectiveness of an active, face-to-face approach (Fairweather et at., 1974; Tornatzky et a1., 1980), the utility of telephone versus face-to-face advocacy efforts in promoting the adoption of social innovations remains an empirical question that must be experimentally investigated. Particularly, the effectiveness of telephone advocacy in promoting adoption of the Community Lodge needs to be determined. Role pf Adoption Agent Attributes pp Innovation Adoption Aside from the type of advocacy strategy utilized to promote innovation adoption, several other variables have been found to influence an individual’s decision to engage in persuasion of others (Hill, 1982). The social psychological literature suggests that this decision is related to the net advantage to the individual, the consequences for the group, the subjective probability that the innovation will be successful and the prospect of being rewarded for fulfilling a leadership role (Cartwright & Zander, 1968; Hemphill, 1961). For instance, in a case study of innovation in a university setting Evans (1967) indicated 39 that innovation adoption was related to individual characteristics (i.e. cosmopoliteness and academic rank), perceptions of the innovation (i.e. congruence with existing practices) and contextual factors (i.e. receptivity of the social climate, of the local community and of the academic discipline). In another instance, Corwin (1972) found that innovation adoption was correlated with seven factors: quality and interdependence of boundary personnel, organizational control exercised by each organizational unit, uniqueness of outside change agents, status of staff, quality and modernization of context, competence of administration and professionalism and social liberalism of staff. He claimed that "the situation into which an innovation is introduced ... seems to be as critical as the strategy itself" (p. 452). In addition, diffusion researchers (Glaser et a1., 1983; Hill, 1982; Rogers, 1983, and others) have identified attributes that typically characterize adoption agents. These are: 1) values, attitudes and beliefs, 2) use of cosmopolitan information sources, 3) communication behaviors, 4) personality variables, 5) social status, and 6) formal decision making power. The roles that these variables play in the adoption process will be subsequently described. Values, Attitudes and Beliefs. A characteristic 40 frequently suggested to be of great importance in diffusion efforts is compatibility of the innovation with the potential adopter’s values, attitudes and beliefs. Correlational support for this proposition can be found in the diffusion literature (Becker, 1970; Fairweather et a1., 1974; Hawley, 1946; Rogers, 1962; Rogers & Shoemaker, 1971; Tornatzky & Klien, 1980). The assumption is also congruent with the concepts of selective exposure, selective perception, and selective retention. This suggests that adopters will seek information congruent with existing values; that they will tend to interpret the information according to their past experiences; and that they will remember ideas that are in accordance with their own opinions (Hawley, 1946; Rogers, 1962, 1983). Cosmopolitan Inforpption Sources. The use of cosmopolitan information sources consistently has been found to be significantly correlated with innovation adoption (Becker, 1970; Coleman et a1., 1957; Glaser et a1., 1983; Merton, 1957; Rogers, 1983; Ryan & Gross, 1949, and others). The distinction between cosmopolitans and locals was first proposed by Merton (1957) who defined cosmopolitans as those who were oriented towards the world outside their local communities and locals as those oriented towards their communities. Subsequent researchers utilized the term in relation to many other variables including the flow of communication (Katz & Lazarsfeld, 1955), evaluation of 41 research ideas and projects (Goldberg, Baker & Rubenstein, 1965), geographic mobility and dependence-identification (Abrahamson, 1965) and work goals (Ritti, 1968). However, the behavior most commonly studied and the one most relevant to innovation adoption was the use of external reference groups as sources of information (Hill, 1982). Many researchers (Becker, 1970; Coleman et a1, 1957; Rogers, 1962, 1983, and others) found a significant relationship between the use of cosmopolitan information sources and innovation adoption. Included among the cosmopolitan information sources that have been identified are: professional meetings, associations, journals, and informal relationships with other adoptors across considerable geographical distances. Communication. Another variable that has been found to affect innovation adoption is the communication potential of the change agent. Some evidence suggests that the sheer volume of communication influences the decisions of others. For instance, Reicken (1958) found that groups were more likely to accept a solution proposed by a frequent talker rather than an infrequent talker. The literature suggests that communication effectiveness may be increased if the talker and the receiver share interpersonal trust, daily contact, and frequent exchange of information (Havelock, 1969). The research indicates that an adoption agent who influences others in an organization is a skilled 42 communicator who has frequent face-to-face contact with others (Hill, 1982). Personality Variables. Although there is little empirical ‘research about the personal attributes of adopters and change agents, diffusion researchers have identified numerous personality traits and have related them to innovation adoption (Allen, 1977; Gee & (Tyler, 1976; Loy, 1969; Menzel & Katz, 1955; Rogers, 1962; Rogers & Shoemaker, 1971, and others). Personality variables were also successfully utilized to distinguish among four adopter categories (Rogers & Shoemaker, 1971). Researchers informally observed that early adoptors tended to differ from later adopters in their younger age, self-confidence, less fatalistic views, values, low security orientation, high mental ability and conceptual skill, high income, high famly aspirations, tendency to be less rigid and dogmatic, high education, high social participation, position in sociometric networks and tendency to be specialized in career (Becker, 1970; Copp, 1958; Gross, 1949; Lowry, Mayo & Hay, 1958; Menzel & Katz, 1955; Rogers, 1962; Rogers & Shoemaker, 1971, and others). Social Status. Formal and informal roles in an organization have been associated with avenues for communication and influence that may lead to innovation adoption (Hill, 1982). However, a review of the dissemination literature reveals mixed results about the 43 relation of social status to adoption. For instance, Fairweather et a1., (1974) found that the social status of the person who received information about the innovation was not related to the hospital’s adoption of the Community Lodge. However, in an academic setting where a broader range of statuses was studied, Hefferlin (1979) found that formal status was related to change. In another study (Rogers, 1958) found that "status achievement", measured by such items as rental status, education, net worth, prestige self-rating, and formal participation, was correlated with innovation adoption when five other independent variables were controlled. The controlled variables were change orientation, communication competence, cohesion with local group, family integration and cohesion with kinship group. Rogers and Shoemaker (1971) suggested that innovations may be sought most strongly by members who do not control power and decision-making. Yet, their effectiveness in promoting adoption may depend on their ability to identify the opinion leaders of the organization, to influence them and others, and to adapt the innovation to the needs of the organization (Fairweather et a1., 1974). Persons with high social status were often the first to adopt low-risk innovations, while deviant members in the organization were often the first to adopt high-risk innovations. Formal Decision-Making gpggp. Formal decision-making power has also been associated with innovation adoption 44 since persons with such power have access to the resources needed to adopt an innovation. Rogers and Shoemaker (1971) stated that adoption of an innovation seemed to be positively related to the ”degree of power concentration in a system" and to "the degree to which the social system’s leaders are involved in the decision—making process" (p.281, 284). Summary gpd Conclpgiong. Extrapolations from the numerous studies suggest that effective change agents are venturesome, persevering, imaginative, dominant, unsociable, self-sufficient, sensitive, have high social status, belong to one or more professional organization, use cosmopolitan information sources, have high communication potential and have influence and power in the organization. Although much has been written regarding the attributes of change agents and their relation to innovation adoption, most of the studies reviewed examined one or another of these characteristics. Few looked at all of these variables within one experimental context (Hill, 1982; Loy, 1969). However, dissemination researchers cannot ignore the effect that these variables can have on the adoption process. If these variables are not measured, they could potentially confound the results of experimental dissemination studies; significant differences could be attributed to the experimental manipulation, while the attributes of the change agent were actually modulating the effect of the 45 independent variable. In order to aVoid such an error, especially in studies with a limited sample size, researchers need to control for the influence of these variables. In short, dissemination researchers must heed Fairweather and Tornatzky (1977) suggestion to account for all participant and social situational variables which could potentially affect the outcome of their studies. The Pregent Research As a result of the experimental evidence reviewed, the present study was designed to accomplish these goals. First of all, it investigated whether telephone advocacy could be as effective as the more costly face-to-face efforts in promoting the adoption of the Community Lodge. Secondly, given that a potential adopter’s certainty/uncertainty about an innovation is a key determinant of its subsequent adoption, the research examined whether these two' advocacy strategies had any effect on this intervening variable. Lastly, the present study examined the relation of participant characteristics (a/k/s adoption agent attributes) to innovation adoption. Experimental Hypotheses Congruent with the theoretical rationale developed above, the following hypotheses were formulated and tested. They are divided into two main categories, those dealing with the 46 outcome variable and those dealing with participant characteristics. I. Outcome Hypotheses 1. There will be no difference in movement towards adoption of the Community Lodge between participants in the telephone and those in the face—to-face conditions. Both face-to-face and telephone advocacy will reduce uncertainty about the innovation. Certainty about the program will be positively correlated with movement towards adoption. II. Participant Characteristic; Hypptheses Individuals expressing philosophical congruity with the principles of the Community Lodge program will be more likely to move towards adoption of the program than other participants. Individuals expressing philosophical congruity with the principles of the Community Lodge program and possessing influence and status in the organization will be more likely to move towards adoption of the program than other participants. Individuals expressing philosophical congruity with 47 the principles of the Community Lodge program and possessing power in the organization will be more likely to move towards adoption of the program than other participants. Individuals who utilize cosmopolitan sources of information will be more likely to more towards adoption than other participants. Individuals possessing strong communication potential in the organization will be more likely to move towards adoption of the program than other participants. Individuals who are unsociable, dominant, imaginative, self-sufficient, venturesome, experimentative, persevering, and sensitive will be more likely to move towards adoption than those who are not. METHOD CHAPTER II METHOD Spbjects The population for this research consisted of forty—five community mental health service boards (C.M.H.S.B.) in the State of Michigan. A list of the C.M.H.S.B. in the sample can be found in Appendix A. These agencies were located in catchment areas 1, 2, 3, 8, 9 and parts of areas 4, 5, 7, and 10. (See Figure 1). Boards that had Lodge programs in the planning stages or in full operation were excluded from the study. The reasons for utilizing this subject population were as follows. Since fiscal 1985, the Michigan Department of Mental Health (D.M.H.) identified the Community Lodge as a placement alternative well suited for both long term institutionalized patients and high recidivism clients. Although three state facilities adopted the program, the Department of Mental Health wanted it to become a standard treatment option offered by all community mental health service boards in the state. Since these organizations had limited knowledge of the Community Lodge, the present study was designed to serve as the mechanism through which 48 48 A Figure 1 Michigan Department of Mental Health Service Areas in the Sample Full Management Boards Not Included in Sample Shared Management Boards 49 information on the program would be disseminated to these agencies. The executive directors of the previously delineated community mental health service boards were asked to nominate one representative from their agency to attend a workshop on this "new" community program, the Lodge. Thirty-four agreed to send someone to the workshop and the others either refused (n=9) or were unable to comply due to previous commitments (n22). Ultimately, thirty individuals attended the workshop with only 29 of these participating in the research. The sample was composed of 15 men and 14 women ranging from 29 to 57 years of age with a median age of 39. Seventy-nine percent of all participants had Master’s degrees, while 7% had earned Ph.D.s and 10% had obtained a Bachelor's degree. Only one person possessed an Associate’s Degree but was currently working on her Bachelor's Degree. All participants were employed by the community mental health system. Almost half (48.3%) of the subjects had worked in mental health for 10 or more years, while another 31% had worked in the field from seven to nine years. Likewise, 48.3% of the sample had been employed by the same agency for more than seven years with more than 34% of these having worked for the agency more than 10 years. Deana f l 38 ad anl C0] la; “an 50 The experiment is cast in a simple two cell design (See Figure 2). The independent variable was the type of advocacy strategy utilized to persuade community mental health service boards to adopt the program. The experimental treatment consisted of an introductory workshop coupled with one of two advocacy manipulations, either telephone or face-to-face. The social change outcome criterion (Fairweather & Tornatzky, 1977) was movement towards adoption of the program. It was measured at six months after the termination of the workshop and had a post only format. (For a full description of the measurement tools see the Instrument Section.) Szilvagyi (1985) suggested that any observed differences in adoption might be due the management status of the community mental health service board. To minimize the potential impact of this variable, subjects were matched on board management status, full or shared, and randomly assigned to receive either face-to-face or telephone advocacy. The sample contained representatives from 20 full and 9 shared management agencies. The telephone advocacy condition contained participants from 10 full and 4 shared management boards while the face-to-face advocacy condition was composed of representatives from 10 full and 5 shared management organizations. There were two major reasons why agencies were matched on board management status. The first of these stems from the Figure 2 Experimental Design Face-to-Face Telephone Advocacy Advocacy 52 relatively small sample size utilized in the study. Since the effectiveness of random assignment is contingent upon the "law of large numbers", its use may not produce the desired equivalence between comparison groups when only a small subject pool is available (Crano & Brewer, 1973). Thus, in order to maximize the probability that the comparison groups were equivalent in all factors except the independent variable, subjects were matched on the variable that could have the greatest impact upon the experimental manipulation (Szilvagyi, 1985). This key factor was the management status of the community mental health service boards. The second reason is based on the inherent differences in autonomy that exist between full and shared management agencies. A board’s management status determines the amount of control the agency has over its allotted funds. Full management boards possess a distinct advantage over shared management organizations. These full management agencies regulate their financial resources and can autonomously redirect monies from existing programs into new ones. 0n the other hand, to obtain funding for new programs, shared management boards must use a bid process and must submit program revision requests (P.R.R.) to the Michigan Department of Mental Health. In short, full management agencies can internally manipulate their allotted monies, while shared management agencies cannot. 53 Full management boards have an added incentive for developing Community Lodges. By adopting the program, these agencies could profit financially since they would receive all "trade-off dollars" earned from the deinstitutionalization of chronic clients. Trade-off dollars refers to the cost differential between institutionalization and community living. The per diem cost of institutionalization is about $160 per client, while the Community Lodge costs approximately $36.00. Full management boards receive this cost savings and can reallocate these monies to any program or eXpenditure they wish. The same does not hold true for shared management organizations. Materials The materials required to conduct this study were as follows. First of all, an appropriate locale in which to host the workshop was needed. Since the principle investigator is a graduate student at Michigan State University, she obtained a room at the Student Union Building for a moderate fee. Secondly, the present study required the use of a telephone with long distance access. The phone is a very important‘ instrument in this study 'because it was utilized to recruit subjects, obtain outcome data and perform part of the experimental manipulation, the 54 telephone advocacy condition. A medium of transportation, a car, utilized to conduct the face-to—face manipulation was also needed. In a few instances, motel or hotel accommodations were required. since some of the agencies in the face-to-face condition were located in the northern lower peninsula or the upper peninsula of Michigan. Last of all, the researcher needed access to a computer for data analysis and a duplicating machine for printing handouts, forms and instruments. Procedures Subject Recruitment. C. Patrick Babcock, the director of the Michigan Department of Mental Health sent introductory letters to the forty-five executive directors of the community mental health service boards previously mentioned. These letters contained a brief description of the study and its major goals and objectives. The letter also informed these directors of the researcher’s upcoming telephone call and urged them to cooperate with her by participating in the study (See Appendix B). The researcher made the initial telephone calls one week after the introductory letters were mailed. A specific protocol for these calls was designed (See Appendix C). These phone calls consisted of the following: a description and discussion of the project; an explanation of the 55 requirements for project involvement;' and obtaining the director’s decision to participate or not participate in the study. In the event that a director requested more time to decide the participation issue, a date and time (within 2 to 3 days) was arranged so his/her reply could be obtain. If the director was willing to participate, he or she was asked to nominate a representative from his/her agency to attend a one day workshop in November 1985. The directors were also asked to select a "back-up” person who would attend the workshop in the event the nominee was unable to do so. During the course of this call, the researcher assured the director that she would always be accessible and his/her inquiries or concerns would be answered promptly. Theoretically, the protocol for the second telephone call consisted of obtaining the nominees’ names, addresses, phone numbers and best time to call, as well as answering any questions. However, only one director availed of the extra time to select an agency representative. All others made their selections during the course of the first telephone call so that there was no need to utilize the second protocol. After the names were collected, the researcher telephoned each nominee. During the course of this phone call, she described the study and responded to all concerns or questions. She also explained that participation was strictly voluntary; that they could withdraw their consent 56 at any time. Nominees were assured 'of the researcher’s accessibility and of the confidentiality and anonymity of any data that would be collected. A third telephone protocol was designed for this purpose (See Appendix D). In the event that a nominee was willing to participate but was unable to attend the workshop, the "alternate" person was contacted and the previously described procedure was initiated. All volunteers were sent confirmation letters along with information on available lodging in the area and the researcher’s address and phone numbers (See Appendix E). The Workshop. The introductory workshop was held on November 21, 1985 at the Michigan State University Student Union. Prior to the formal onset of the workshop, each participant received a name tag and an information packet containing relevant literature on the Community Lodge. They also completed the Background Questionnaire. The contents of this packet were as follows: 1) What is a Lodge? (Tornatzky et a1., 1978); 2) The Strength in Us (Sanders, 1976); 3) A Profile of Lodge Program Characteristics by Region (Fergus & Mavis, 1985); 4) Chapters 4 and 17 from Cbmmunity Life for the Mentally Ill (Fairweather et 81., 1969); 5) The Task Groups: Leadership, Communication Systems, Rewards, Cohesiveness, Norms and Composition (Fairweather et a1., 1964); 6) a bibliography of relevant publications on the Community Lodge; and 7) a list of names and addresses of 57 program consultants in the state. The workshop lasted from 9:00 am to 4:30 pm. Dr. George W. Fairweather, who along with his colleagues developed the program, presided over the workshop. He gave a historical overview of the Community Lodge and explained the program’s essential components. Dr. Fairweather was also available to answer questions and allay concerns. Steve Szilvagyi, the Department of Mental Health's representative, delivered the department’s perspective and provided participants with useful tips on obtaining resources. Other individuals associated with different aspects of the program also gave relevant presentations while the researcher served as program facilitator. (For a schedule of the workshop see Appendix F.) During the course of the workshop, participants also learned that technical assistance in the form of direct consultation by program experts and additional materials would be available, at no cost, to any agency wishing to develop Community Lodges. The overall atmosphere of the workshop was informal and open. The active participation of those in attendance was encouraged throughout the day. A complimentary buffet luncheon was served and it provided an opportunity for the presenters to interact with the participants. Prior to terminating the workshop, subjects completed the Individual Characteristics of Change Agent Questionnaire and the Workshop Questionnaire (See Instrument Section). 58 Ihg_Advocacy Variable. The advocacy manipulation was implemented three months after the workshop, during the three week period spanning from February 21 to March 14, 1986. The researcher telephoned all subjects in the face-to-face condition and arranged for a mutually convenient date and time on which to visit each participant. Likewise, she telephoned all subjects in the other condition thereby implementing the second treatment. No time limit was placed on the telephone advocacy call although a limit of three hours was placed on the face-to-face condition. A careful record of the duration of each call and visit was kept. The protocols for the telephone and the face-to-face advocacy conditions were identical with the exception that one was done face-to-face and the other via the telephone. They consisted of the following: 1) introducing oneself in association with the Lodge workshop; 2) questioning what had been initiated since the workshop; 3) encouraging the dissemination of information to other staff members; 4) encouraging the creation of a group of interested staff that meets on a regular basis; 5) encouraging that specific tasks be delegated to begin movement towards innovation adoption; 6) offering to clarify points, answer questions and/or help resolve problems. (See appendix 0 for the Intervention Protocol.) Three handouts were also included as part of the 59 intervention. These can be found in "Appendix H. In the face-to—face condition the handouts were reviewed with the subject when specified by the protocol. In the telephone condition, each handout was read out loud and reviewed at its appropriate place and subsequently, mailed to the subject with an accompanying note. The final outcome data were collected in May of 1986. All participants were contacted and the Follow-Up Telephone Interview was completed. Prior to this telephone call, all participants were sent copies of the Overall Certainty and Philosophical Congruity Scales and were reminded of the researcher’s upcoming telephone call. This was done to facilitate the administration of these scales during the final data collection. During the course of this final phone call, participants were asked to refer to these "mail-out questions" as the researcher read each item. The researcher also kept a record of events that occurred during the experiment and wrote narrative accounts of all that had transpired during the intervention. Two independent raters utilized this "research journal" (Fairweather & Tornatzky, 1977) to assign a Pre-Advocacy Treatment Adoption Score to each agency in the sample. This score was used to ascertain how much change had occurred in the organization since the workshop, but prior to the advocacy manipulation (See Instrument Section). 60 Instruments Five major instruments were utilized in this study. These instruments and their measurement periods are delineated in Figure 3. The first of these, the Background Questionnaire (BQ) was used to measure participant and organizational characteristics that were of interest to the researcher. It focused on such biographical information as age, educational background, years employed in mental health etc. (See Appendix I). It also contained three items dealing with organizational characteristics: size, location and board management status. Individual Characteristic; 2: Change Agents Questionnaire. The Individual Characteristics of Change Agents Questionnaire (ICCAQ) was composed of fourteen scales. Each of these scales was designed to focus on a specific attribute of change agents found in the literature (See Appendix J). Scale scores were computed as the sum of the item responses comprising each scale. The names of these scales are as follows: Organizational Tenure, Uses of Cosmopolitan Information Sources, Communication Potential in the Organization, Social Status, Influence, Power in the Organization, Sociability, Dominance, Imaginativeness, Self—Sufficiency, Venturesomeness, Experimentativeness, Perseverance and Sensitiveness. This instrument was a modified version of Hill’s (1982) Adoption Agent 61 Figure 3 Instruments or Scales and Respective Measurement Periods INSTRUMENT/SCALE MEASUREMENT PERIOD Background Questionnaire workshop Individual Characteristics of Change Agent Instrument workshop Workshop Effectiveness Scale workshop Overall Readiness for Change Scale workshop workshop Perceived Participation Scale Overall Certainty Scale workshop & 180 days post Philosophical Congruity Scale workshop & 180 days post Pre-Advocacy Treatment Movement Towards Adoption Instrument 90 days post 180 days post Follow-up Telephone Interview Behavioral Measures day 1 through day 180 62 Questionnaire and was administered at the conclusion of the introductory workshop. The questionnaire was pretested on 19 employees of two psychiatric hospitals in the state that cperated Community Lodge training programs. Ten individuals were from one hospital and 9 were from the other. Each person who agreed to participate was given two copies of the questionnaire. They were asked to complete the first copy of the instrument, wait seven days, and then complete the second copy. All completed instruments were given to the researcher and the test—retest reliability of the scales were calculated. The test-retest reliability (Nunnally, 1979) of most Individual Characteristics of Change Agents Questionnaire scales during pilot testing was relatively high. This will be discussed further in a subsequent section. Workshop Questionnaire. The Workshop Questionnaire (WQ) was composed of eight scales (See Appendix E). Seven of these scales were developed and previously utilized by Tornatzky et a1. (1980) and Fleischer (1979). The current researcher added the perceived participation subscale and pretested it on the sample of psychiatric hospital workers used to pretest the Individual Characteristics of Change Agents Questionnaire. The same pilot testing procedures previously described were followed. The instrument was utilized to ascertain the effectiveness of the workshop and 63 the perceived participation of those in attendance. It also assessed participants’ philosophical congruity with the principles of the Lodge program, their certainty/uncertainty about the innovation and the participants’ perceptions of their respective agencies’ readiness for change. Participants completed this instrument at the conclusion of the introductory workshop along with the Individual Characteristics of Change Agents Questionnaire. Scale scores were again computed as the sum of the item responses comprising each scale. The names of the original scales and their internal consistency estimates are as follows: Overall Certainty (.82); Philosophical Congruity (.80), Workshop Effectiveness (.80), and Overall Readiness for Change (.77). The Overall Certainty Scale was composed of three subscales. These are: Certainty of How-to-Knowledge (.82), Certainty of Effectiveness (.77), and Certainty of Feasibility (.56). As previously mentioned, the present researcher added the Perceived Participation in the Workshop Scale to the instrument. In the pilot testing, tho toat-rotoat reliability of this scale was .83. Pre-Advocacz Treatment Movement Towards Adoption Instrument. The Pre-Advocacy Treatment Movement Adoption Instrument (PATMTAI) was used to determine the amount of adoptive activity that had occured in the organization since the introductory workshop but prior to the advocacy manipulation. This instrument was not included in the \ 64 initial experimental plan but was added during the course of the experiment to preserve the integrity of the advocacy manipulation. When the experiment was being designed, the research team did not foresee any social change occurring prior to the advocacy manipulation since previous dissemination research indicated that typically change does not occur in short time periods. The researchers felt that the probability of this occurring in the present study was minimized further since the time between the introductory workshop and the advocacy manipulation spanned the Thanksgiving and Christmas Holiday periods. However, while the researcher telephoned the participants to set up the experimental treatment she realized that many agencies had already engaged in adoptive activity. Thus, if no measure of movement towards adoption was obtained at this time, the results of the experiment would be hopelessly confounded. One would not be able to differentiate the effects of the workshop from those of the advocacy treatment. The research team was consulted and the Pre-Advocacy Treatment Movement Towards Adoption Instrument developed (See Appendix L). Two independent raters utilized the "research journal" (Fairweather & Tornatzky, 1977) (previously described) to determine each agency’s pre-advocacy treatment movement towards adoption score (PATMTAS). The raters received two hours of training in which they coded three sample journal 65 entries. The inter-rater reliability' for the first entry was 85%. Their responses were reviewed and each rater verbally explained their reasoning process. The inter-rater reliability for the other two sample entries were 95% and 98% respectively. Upon completion of the training session, each rater content analyzed the researcher’s journal entries for every organization in the sample and assigned one point for each action that had been completed. The sum total of these actions equaled each agency’s pre-advocacy treatment movement towards adoption score. Since the data obtained from this measurement instrument is of an ordinal nature, it was recoded to a dichotomous format. A dichotomous transformation of the data satisfies both the mathematical requirement of ordering and the requirement of equal-sized intervals because there is only one interval naturally equal to itself (Nie, Hull, Jenkins Steinbrenner & Bent, 1975). Thus, the data could be treated as if it were interval data and analysis of variance statistics could be performed on this variable. A frequency distribution of the scores yielded that half of the participants in each condition had obtained a score of three. The range of the rest of the scores was from 4 to 14. Scores then were recoded to 1 and 2 with 1 being three and 2 being greater than three. Follow-up Telephone Interview and Chapgg Sgplg. Follow-up data were collected in May 1986 from all participants in the 66 experiment. The instrument utilized to collect this information was the Follow-up Telephone Interview (FUTI) which was designed to determine what adoptive activity occurred in the organization since the experimental manipulation (See Appendix M). It was previously utilized in other dissemination efforts of the Community Lodge by Fleischer (1979) and Tornatzky et a1., (1980). This instrument is composed of both yes/no and open ended questions. It must be used in conjunction with the Change Scale developed by Tornatzky, et a1., (1980) (See Appendix N). This Change Scale was constructed to measure movement towards adoption of the program which is a highly complex task consisting of a series of measurable behavioral "steps". The information obtained from the Follow-Up Telephone Interview was utilized to 'compute each organization’s movement towards adoption score along the parameters delineated in Tornatzky et al.’s (1980) Change Scale. These two instruments were revised with the aid of Dr. Fairweather, to include steps an individual or organization must proceed through during the "persuasion phase" of the adoption process. It delineates what typically occurs in an organization prior to obtaining a decision to implement the program. These steps range from first learning about the Lodge to deciding whether or not to adopt the program. In addition to this, two behavioral items were incorporated 67 into the follow-up instrument. The first dealt with the number of contacts that participants had among themselves since the workshop related to the program. They were also asked to specify the type of contact he or she had with another participant (i.e. whether face-to-face, telephone or letter). The information obtained from the Follow-Up Telephone Interview was utilized to compute each organization’s movement towards adoption score along the parameters delineated in Tornatzky et al.’s (1980) Change Scale. Follow-up data were collected in May 1986 from all participants in the experiment, 180 days subsequent to the workshop. Three behavioral measures were also utilized. The first of these was the number of spontaneous telephone calls participants made to the researcher. Only calls requesting information were counted; calls concerning scheduling or other administrative matters were excluded. The other behavioral item was the number of spontaneous letters sent to the researcher requesting program information. The final measure was the number of contacts participants made to existing Community Lodges requesting information. Reliability and Validity Issues Reliability. Reliability refers to the consistency of scores across time. Test-retest reliability estimates were 68 calculated during the instrument development phase of the study. These estimates for the scales of the Individual Characteristics of Change Agents Questionnaire ranged from .67 (p < .01) to .97. (p < .001). Internal consistency alphas for the pilot instrument were also computed and ranged from .65 (p (.01) to .97 (p (.001). Test—retest reliability of the Perceived Participation Scale of the Workshop Questionnaire was .90 (p (.01). The rest of this instrument was not pre-tested because it had been utilized in previous dissemination studies. The Chronbach’s alphas (Cronbach, 1951) were utilized to measure the internal consistency of the data obtained in the study. Coefficient alphas were calculated for each of the scales. Alphas for the scales in the Individual Characteristics of Change Agents Questionnaire ranged form .60 to .91 and are found in Table 1. Those for the Workshop Questionnaire ranged from .35 to .85 and are listed in Table 2. Two independent raters were utilized to assess the reliability of the outcome measure. Twenty—five percent of the final telephone interviews were conducted by the two raters and these were selected randomly from the total sample using a random numbers table. The inter-rater procedures were explained to each subject prior to the onset of the interview and all of the subjects verbally consented to the presence of the two interviewers. One rater 69 Table 1 Internal Consistency Estimates of Individual Characteristics of Change Agents Questionnaire SCALE ALPHA Organizational Tenure .84 Cosmopolitan Information Sources .72 Communication Potential .76 Influence .73 Power .75 Status .83 Sociability .85 Imaginativeness .91 Dominance .72 Self-Sufficiency .60 Venturesome .83 Experimentative .79 Persevering .75 Sensitive .85 70 Table 2 Internal Consistency Estimates of Workshop Questionnaire SCALE ALPHA Workshop Effectiveness .52 Overall Certainty .83 Certainty of How to Knowledge .89 Certainty of Feasibility .35 Certainty of Effectiveness .83 Philosophical Congruity .85 Overall Readiness for Change .58 Perceived Participation .79 71 conducted the interview while the other rater listened on the telephone extension. Each rater had a copy of the instrument and filled it out as the interview progressed. At the completion of the interview each rater independently coded their responses. The agreement of the raters’ responses for each subject were utilized to compute the mean percent agreement which was 98%. Validity. Although the concept of validity historically has been given many different definitions, Fairweather and Tornatzky (1977) claimed that "the validity of an outcome measure in the field of social innovation is simply an empirical matter because it can be defined as the magnitude of its correlation with the social change outcome criterion" (p. 202). These researchers suggested that two types of validity are typically associate with social innovative experiments, outcome validity and concept validity. Outcome validity concerns the extent to which any measure correlates with the outcome that society’s agents are most interested in, while concept validity concerns the degree to which any assessment device measures what it purports to measure. While outcome validity is determined by the measure’s correlation with the social change outcome criterion, concept validity is established by conceptualizing different assessment areas that appear to measure the concept and finding their central dimension (Fairweather & Tornatsky, 1977). 72 In light of this explanation, the Workshop Questionnaire can be said to possess adequate outcome validity since most of the subscales correlated with movement towards adoption of the program (See Tables 14, 15, 16). For instance, both the certainty and the philosophical congruity scales were found to be strongly related to the outcome variable. Support for this proposition was obtained from the results of the cluster analysis which yielded an independent "Adoption Cluster". All of the variables hypothesized to be related with movement towards program adoption were included in this cluster (See Table 18). Rational support for the concept validity of the Workshop Questionnaire was derived from two sources. First, the specific items comprising the instrument were selected to sample representatively the different domains the test was designed to assess. Secondly, the instrument had been utilized previously in other dissemination studies and these results suggested that the items adequately sampled the areas being measured (Fleischer, 1979; Tornatzky, et a1., 1980). The results of the cluster analysis also provide some support for the instrument's concept validity. Most of the scales contained in this instrument were included in the Adoption Cluster. The results of this cluster suggests that there is a major dimension to which all these scales are related and that this hypothetical dimension is associated with movement towards program adoption. 73 In terms of the more "classical" estimates of validity, support exists suggesting that the Workshop Questionnaire possesses adequate content validity as evidenced from the original construction of the instrument and its use in previous dissemination studies (See Anastasi, 1976). Likewise, the instrument has face validity since the wording of the items typically described the construct they purport to measure. However, much more empirical evidence is required to measure the construct validity of the instrument. Although some evidence for the convergent validity (Campbell & Fiske, 1959) of the instrument is apparent from the correlation matrix, there is no evidence for discriminant validity. Future research should address this issue. The outcome validity of the Individual Characteristics of Change Agents Questionnaire is more difficult to assess because not all of the scales correlated with the social change outcome criterion. Some possible explanations for this lack of relationship will be discussed in a subsequent section. Most of these stem from the social situational context evident in the State of Michigan during the course of the study. However, the results of the cluster analysis provided some evidence for the concept validity of this instrument (See Tables 17 - 22). Most of the scales in the measure were contained in one of the five clusters obtained from the cluster analysis of the data. This suggested that 74 the scales comprising each cluster were somehow related to the hypothetical domain underlying the cluster. For instance, all of the items measuring influence and power, i.e. education, social status etc. were included in one cluster whose underlying domain was probably influence and power. Similar relationships emerged for the other scales. In terms of the more classical measurements of validity, the Individual Characteristics of Change Agents Questionnaire possesses adequate content validity since the specific items comprising the instrument were selected to sample representatively the different domains to be measured (Anastasi, 1976). Each of the scales of the Individual Characteristics of Change Agents Questionnaire was constructed specifically to measure one of the characteristics of change agents typically identified in the dissemination literature. Along the same line, the Individual Characteristics of Change Agents Questionnaire possesses adequate face validity. For instance, the items on the Uses of Cosmopolitan Information Sources Scale deals with such things as the number of times the person leaves the local community to gain knowledge of mental health issues each year, or the number of times the individual communicates with other professionals who do not live in his/her local community each month. Likewise, many of the items in the other scales directly refer to what the scale is measuring 75 and other ask respondents to rate themselves on certain personality variables. For instance, "I am dominant"; "I am venturesome" etc. Respondents in one of the pretest sites were asked to rate the instruments in terms of its face validity. One hundred percent of those persons questioned claimed that the measure "looked valid". Again, there is little empirical evidence to evaluate the construct validity of the instrument. Future research efforts could utilize other personality inventories to help establish the convergent and divergent validity of the measure a RESULTS CHAPTER III RESULTS Equivplence 9; Treatment Groups Prior to conducting any analysis on the outcome variables the equivalence or comparability of the experimental groups should be established. This is particularly important when an experiment contains a relatively small sample, which might abrogate the effects of random assignment. One way to test for the equivalence of the experimental conditions is to measure the relevant variables prior to the implementation of the advocacy manipulation. During the introductory workshop participants completed three instruments: the Background Questionnaire, the Workshop Questionnaire and the Individual Characteristics of Change Agents Questionnaire. The absence of differences between the two experimental conditions on these measures offers strong support for the initial equivalence of the comparison groups. Table 3 provides the Chi Square comparisons between the experimental conditions on demographic characteristics. As can be seen from the table, there are no significant differences between the conditions on any of these variables. Table 4 is a summary of the analysis of variance 76 77 Table 3 Comparison of Demographic Characteristics of Participants in the Telephone and Face-to-Face Conditions Variable X2 (df) p Sex of participants .88 1 .35 Age of participants 15.33 18 .64 Geographic location of agency 2.7 2 .25 Education level 3.6 3 .30 Size of agency 2.4 2 .25 78 Table 4 Summary of Analyses of Variance of Pre-Test Differences Between Conditions on the Workshop Questionnaire Variable F (df) p Pre knowledge about the program .19 (1,27) .67 Ever having established a new program .31 (1,27) .58 Perceptions of the Community Lodge as distinctive from other programs 1.16 (1,27) .29 Perceptions of effectiveness of the workshop .05 (1,27) .82 Perceived overall certainty about the program .13 (1,27) .72 Perceived certainty of knowledge on how to implement program .12 (1,27) .73 Perceived certainty of ' feasibility of implementing program 2.23 (1,27) .15 Perceived certainty of the effectiveness of program 1.60 (1,27) .22 Philosophical congruity with principles of program 1.07 (1,27) .31 Intent to promote adoption of the program .00 (1,27) .99 Agency’s perceived readiness to change .02 (1,27) .90 Perceived participation at the workshop .14 (1,27) .72 79 comparing the two conditions on the various scales and items on the Workshop Questionnaire. The table shows that there were no significant differences (at the .05 level) between the treatments groups on their responses to this instrument. Table 5 provides the same comparison for scales from the Individual Characteristics of Change Agents Questionnaire. As is evident in the table,_ there were no significant differences between the conditions at the .01 level. A significant difference was detected at the .04 level on the sensitive variable. However, according to the graphs developed by Sakoda, Cohen and Beall (1954) the probability of obtaining a significant statistic at the .05 level by chance alone, when calculating fourteen statistics, is 50% . Thus, the results from these preliminary analyses suggest that the treatment groups were not significantly different from each other at the onset of the study. Statistical Analyses 91 Experimental Hypotheses (In this section, the results of the statistical analyses employed to test the previously stated research hypotheses are introduced. Each hypothesis is independently addressed and all relevant data analyses are presented. Preliminary Analyses f9; Deteppining Hompgeneity p: Variance ppg, Normal Qigtribution. Preliminary tests to determine the homogeneity of variances were computed prior to running the analyses of variance. The results of these Summary of Analyses of Variance of Pre-Test 80 Table 5 Differences Between Conditions on the Individual Characteristics of Change Agents Variable F (df) p Organizational tenure .57 (1,27) .46 Cosmopolitan information sources .54 (1,27) .47 Communication potential .04 (1,27 .85 Influence in organization .47 (1,27) .50 Power in organization 2.02 (1,27) .17 Status in organization .35 (1,27) .56 Sociability .75 (1,27) .39 Imaginative .06 (1,27) .81 Dominance 1.37 (1,27) .25 Self-Sufficiency 2.52 (1,27) .12 Venturesome 1.36 (1,27) .25 Experimentative .05 (1,27) .83 Persevering .67 (1,27) .42 Sensitive 4.85 (1,27) .04 81 analyses are shown in Table 6. They suggest that the assumption of homogeneity of variances was not violated. As can be seen in Table 6, only the certainty of effectiveness scale yielded a significant F ratio. While this could be interpreted to mean that the variances are unequal, it is more likely that it represents a chance occurrence. The probability of obtaining one significant F ratio out of fourteen is 50 % according to Sakoda, Cohen and Beall (1954). Frequency distributions of participants’ scores on the different measures suggest the distributions of these scores approximate a bell shaped curve. Testing pf the Outcopg Hypotheses. The major outcome hypothesis of the study postulated that telephone advocacy would be as effective as face-to-face efforts in promoting adoption of the Community Lodge. Interestingly, all of the agencies in the sample made some movement towards adopting the program. Movement towards adoption ranged from such minimal activities as discussing the program with co-workers to actual implementation of the small group training phase. Because some movement towards adoption had occurred in some of the organizations prior to the advocacy manipulation, the relationship between the Time 1 score (preadvocacy treatment movement towards adoption) and the Time 2 score (movement towards adoption) could have affected the final outcome. To elucidate this possibility, two major 82 Table 6 Preliminary Tests for the Homogeneity of Variances Variable F Ratio (df) p Pre Advocacy Treatment Movement Towards Adoption 1.01 (13,14) .40 Movement Towards Adoption 2.04 (14,13) .20 Pre Overall Certainty 1.62 (13,14) .40 Post Overall Certainty 1.27 (14,13) .20 Pre Certainty of How to Knowledge 1.72 (13,14) .20 Post Certainty of How to Knowledge 1.15 (13,14) .40 Pre Certainty of Feasibility 2.01 (13,14) .20 Post Certainty of Feasibility 1.17 (14,13) .40 Pre Certainty of Effectiveness 3.14 (14,13) .10 Post Certainty of Effectiveness 4.16 (14,13) .02 83 tests were utilized. First, a chi square analysis was computed and reveals no significant differences between the conditions on the raw pre-advocacy manipulation movement towards adoption scores (X2: 4.51, df: 6). An analysis of variance on a dichotomously coded pre-advocacy treatment movement towards adoption scores did not yield significant treatment differences. The results of this analysis are presented in Table 7. Second, correlation coefficients between Time 1 and Time 2 outcome scores were computed. The results suggest that the pre and post measures are significantly related (r =.47, p (.04 for face-to-face; and r =.66, p (.005 for telephone. Accordingly, an analysis of covariance was done. This analysis is presented in Table 8 and suggests that the experimental manipulation did not differentially affect the two conditions. The results of this analysis support the first experimental hypothesis. The second outcome hypothesis stipulated that both experimental manipulations would increase certainty about the innovation. Table 9 summarizes the effect of the advocacy treatments on overall certainty about the program. As is evident from the table, there is a significant effect over time and it is in the hypothesized direction since an increase in certainty scores was observed over time. No significant differences were detected between the two experimental conditions suggesting that change occurred 84 Table 7 Effect of Condition on Dichotomously Coded Pre Advocacy Treatment Movement Towards Adoption Score Mean PreAdvocacy Treatment Movement Towards Adoption Score Telephone Face-to-Face 5.21 4.92 Source SS df MS F p Condition .008 1 .008 .03 .86 Error 7.23 27 .27 Total 7.24 28 .26 85 Table 8 Comparison of Experimental Treatments on Movement Towards Adoption Source SS df MS F p Condition 6.14 1 6.14 .45 .51 Regression 148.19 1 ' 148.19 10.86 .003 Error 354.90 26 13.65 Total 509.24 28 18.19 86 Table 9 Effect of Experimental Treatments on Overall Certainty Mean Pre and Post Overall Certainty Scores Telephone 49.07 54.60 Face-to-Face 47.93 55.90 Source 88 df MS F p Condition (C) 1.52 l 1.52 .02 .90 Error 2508.90 27 92.92 Time (T) 590.57 1 590.57 19.45 (.0001 T x C 9.60 1 9.60 .32 .58 Error 819.91 27 30.37 87 relatively equally for both conditions. An analysis of the condition means and standard deviations revealed that both experimental manipulations tended to increase participants’ overall certainty about the program. Table 10 presents the cell means and standard deviations for these scales. In an effort to find where the greatest change in certainty occurred, and analysis of variance on the three certainty subscales was computed. As is evident from Tables 11, 12, and 13, no significant differences were detected between the two conditions on any of the subscales. Significant time differences emerged for the certainty of how-to-knowledge and the certainty of program effectiveness subscales, but not for the certainty of feasibility subscale. This suggests that the change occurring between Time 1 and Time 2 measurement on certainty was related to cognitive knowledge about the program and its implementation but not to the feasibility of innovation accomplishment. Thus, these three analyses suggest that in the area of planning for innovation adoption, there is much more certainty in understanding the program as time passes than in the possibility of adopting it into day by day operation. The third outcome hypothesis stipulated that certainty about the innovation would be correlated significantly with movement towards adoption. As can be seen in Table 14 , the certainty variables tend correlate with movement towards Bo Table 10 Cell Means and Standard Deviations of the Certainty Scales Across Time Variable Name Phone 8 ‘ Face to Face s Pre Overall Certainty 49.07 9.38 47.93 7.38 Post Overall Certainty 54.64 6.79 55.90 7.66 Pre Certainty of How-to-Knowledge 23.50 8.36 24.47 6.37 Post Certainty of How-to-Knowledge 27.79 5.78 29.27 5.39 Pre Certainty of Feasibility 9.50 1.74 8.67 1.23 Post Certainty of Feasibility 9.79 1.97 9.40 2.13 Pre Certainty of Program’s Effectiveness 16.07 1.86 14.80 3.30 Post Certainty of Program’s Effectiveness 17.07 1.54 16.47 3.14 89 Table 11 Effect of Experimental Treatments on Certainty of How-to-Knowledge Mean Pre and Post Certainty of How-to-Knowledge Scores Telephone 23.50 27.90 Face-to-Face 24.47 29.27 Source SS df MS F p Condition (C) 21.69 1 21.69 .42 .52 Error 1408.90 27 52.18 Time (T) 298.89 1 298.89 8.89 (.006 T x C .96 1 .96 .03 .87 Error 907.63 27 33.62 91 Table 13 Effect of Experimental Treatments on Certainty of Program Effectiveness Mean Timel & Time2 Certainty of Effectiveness Scores Telephone Face-to-Face 16.07 17.07 14.80 16.47 Source SS df MS F p Condition (C) 12.74 1 12.74 1.07 .31 Error 320.32 27 11.86 Time (T) 25.75 1 25.75 15.22 (.0006 T x C 1.61 1 1.61 .95 .34 Error 45.67 27 1.69 90 Table 12 Effect of Experimental Treatment on Certainty of Feasibility Mean Pre and Post Certainty of Feasibility Scores Telephone Face—to-Face 9.50 9.79 8.67 9.40 Source SS df MS F p Condition (C) 5.38 1 5.38 1.18 .29 Error 122.90 27 4.55 Time (T) 3.76 1 3.76 1.96 .17 T x C .73 1 .73 .38 .54 Error 51.90 27 1.92 91 Table 13 Effect of Experimental Treatments on Certainty of Program Effectiveness Mean Timel & Time2 Certainty of Effectiveness Scores Telephone Face-to-Face 16.07 17.07 14.80 16.47 Source SS df MS F p Condition (C) 12.74 1 12.74 1.07 .31 Error 320.32 27 11.86 Time (T) 25.75 1 25.75 15.22 (.0006 T x C 1.61 1 1.61 .95 .34 Error 45.67 27 1.69 92 Table 14 Correlation Matrix of Certainty Scales, Intent to Work Towards Adopting Program, Perceived Readiness for Change and Movement Towards Adoption Pre-Advocacy Treatment Movement Towards Movement Towards Adoption Adoption Overall Certaintyl .11 .15 Certainty of How to Knowledge 1 -.15 -.10 Certainty of Feasibility 1 .31A .440 Certainty of Effectiveness 1 .53C .48C Intent to Work Towards Adoption .398 .42C of Program 1 Overall Certainty 2 .423 .500 Certainty of How to Knowledge 2 .18 .28 Certainty of Feasibility 2 .46C .56D Certainty of Effectiveness 2 .44C .34A Intent to Work Towards Adoption .44C .46C of Program 2 Agency’s Perceived Readiness for Change .56D .63D A B VWA OH ouo P P “II 93 adoption and pre-advocacy treatment movement towards adoption. Interestingly, the pre overall certainty score obtained from the Workshop Questionnaire was not correlated with either measure of movement towards adoption. However, the same measure obtained on the Follow-up Telephone Interview yields a strong positive correlation with the outcome variables. This suggests that increasing participants’ certainty about the innovation was somehow related to movement towards adoption. Behpvioral Measures. A frequency distribution of the three behavioral measures utilized in the study indicates that very few participants engaged in any of the three behaviors (spontaneous calls and letters to the researcher, and spontaneous calls to existing Community Lodges). In the three month period spanning the interval between the introductory workshop and the initiation of the experimental manipulation, only two participants contacted the researcher regarding programmatic issues. After the experimental manipulations were enacted, the researcher was contacted by two persons from the telephone condition and three participants from the face-to—face condition. No written requests were received from participants in either condition. Two persons from the face-to-face condition contacted existing Community Lodges, while no one from the telephone condition did so. Correlate; pf Participant Characteristics with Movement 94 Towards Adoption. The first three hypotheses about participant characteristics dealt with the relationship among participants’ philosophical congruity with the principles of the program, their influence, power and status in their respective organizations and their movement towards adoption of the program. The results of the analysis yielded a strong correlation between the outcome variables and the philosophical congruity measure obtained at the follow-up time period. These correlations, corrected for attenuation, are presented in Table 15 . This relationship was not observed with the philosophical congruity score obtained from the Workshop Questionnaire. Philosophical congruity at time two was not related to influence, status or power, while philosophical congruity at time one was strongly correlated with power. Influence, status and power were related to pre-advocacy treatment movement towards adoption score but only power was slightly correlated with movement towards adoption score. However, these variables were found to be highly intercorrelated suggesting that perhaps they were tapping the same dimension. The results of this analysis support the proposition that movement towards adoption is related to philosophical congruity. The fourth participant hypothesis stipulated that individuals who utilized cosmopolitan information sources would be more likely to move towards adoption of the program than those who did not. In the present study the 95 Table 15 Correlation Matrix of Philosophical Congruity, Power Variables and Movement Towards Adoption Pre-Advocacy Treatment Movement Towards Movement Towards Adoption Adoption Congruity of Philosophyl Congruity of Philosophy2 Influence Status Cosmopolitan Information Sources Communication Potential Power Tenure at Organization Previous Knowledge about Program Perceived Participation During Workshop .25 .403 .36B .363 .20 .19 .35A .06 .27 .22 .18 .393 .28 .29 .14 .25 .33A “.001 .29 .07 w 11" 'U'U VWA To; 016 96 hypothesized relationship between the. use of cosmopolitan sources of information and the outcome variables did not emerge. This is evident in Table 15. Likewise, communication potential in the organization was not related to movement towards adoption, which was the fifth participant hypothesis. These findings contradict most of the literature in this area. However, communication potential was strongly correlated with power, influence and status which might explain the low correlations with movement towards adoption score. The last participant hypothesis dealt with the relationship between the personality characteristics of the subjects (change agents) and movement towards adoption of the program. These results, corrected for attenuation, are presented in Table 16. Of all the personality characteristics tested, only venturesomeness, experimentativeness, and perseverance were correlated with the outcome variables. Individuals with high scores on these variables were more likely to move towards adoption of the program. Some relationships emerged between these three variables and other personality characteristics. For instance, venturesomeness was correlated with imaginativeness, dominance and experimentativeness, while perseverance was related to sociability, dominance, sensitivity and experimentativeness. Correlates pf Demographic Variables with Movement Towards 97 Table 16 Correlation of Personality and Demographic Characteristics with Movement Towards Adoption Pre-Advocacy Treatment Movement Towards Movement Towards Adoption Adoption Sociable -.09 -.06 Imaginative .12 .11 Dominant .22 .15 Self Sufficient -.24 -.27 Venturesome .480 .600 Experimentive .413 .438 Persevering .31A .12 Sensitive -.10 —.07 A‘B “013 ‘015 Sex .01 .06 Education .14 .17 Location of Agency .08 .19 Board Management Status -.04 -.31A Size of Agency .19 .23 Length of Intervention .47C .29 A = P 5.10 C = P $.01 B = P $.05 D = P p.001 98 Adoption. Table 16 also delineates the relationships among the demographic characteristics of the participants and movement towards adoption of the program. All of these relationships will be further elucidated when the results of the cluster analysis are discussed. Age was negatively correlated with certainty of effectiveness at both measurement periods and philosophical congruity with the principles of the program at Time 1. This suggests that younger participants perceived the program as more effective than older participants. They also felt that the philosophy of the program was congruent with their own principles of client treatment. Older participants perceived themselves as more self-sufficient than the younger subjects since these two variables were highly intercorrelated. Educational level was correlated with participants’ certainty of feasibility at Time 2, their influence, status, and power in the organization, and their communication potential. This variable was also negatively correlated with the sex of the participants (at pp = .08). This suggests that the males of the sample tended to be better educated than the females. Persons with the higher educational levels possessed greater influence, status and power in the agencies and were perceived as better communicators than those with less education. They also perceived the program as more feasible to implement in their organizations than did other subjects. 99 Participants’ sex was positively correlated with sociability, self-sufficiency, perseverance, sensitivity, and philosophical congruity at Time 2. It was negatively correlated with power, educational level and organizational tenure. These relationships suggest that the females of the sample perceived themselves as more sociable, self—sufficient, persevering and sensitive than the males. They also expressed more philosophical congruity with the principles of the program at the follow-up time period. However, females tended to be less educated, to possess less power and to be employed by their respective agencies less time than other participants. Cluster Analysis To enhance understanding of the data obtained in this study, a cluster analysis was computed on the two outcome measures, fourteen scale scores from the Individual Characteristics of Change Agents Questionnaire, ten scale scores from the Workshop Questionnaire, seven participant and organizational variables obtained from the Background Questionnaire, and three scale scores from the Follow-up Telephone Instrument. Because of the high intercorrelations between the certainty subscales and the overall certainty scale, only the overall certainty score was utilized in the cluster analysis. The method of cluster analysis utilized 100 was the BCTRY computer package developed by Tryon and Bailey (1970). The results from the "V" analysis, shown in Table 17, yielded five relatively interrelated oblique clusters. The items comprising each of these clusters and their cluster loadings are found in Tables 18 through 22. Each cluster is described subsequently. Adoption Cluster. This ten item cluster shows the variables most closely related to movement towards adoption of the program. As can be seen in Table 18, the defining variables in this cluster are movement towards adoption of the program, pre-advocacy movement towards adoption, participants perceptions of their organization’s readiness for change, and participants’ intent to adopt the program at Time 1. Both overall certainty measures and philosophical congruity with the principles of the program at Time 2 were loaded on this dimension. Participants’ intent to adopt the program at Time 2 and the perceived effectiveness of the introductory workshop were also included in the cluster. The only personality characteristic that entered into the cluster was venturesomeness which suggests that individuals who made more progress towards adopting the program tended to perceive themselves as more venturesome than those who did not. The internal consistency (Cronbach’s alpha) of the cluster was .89. The Adoption Cluster was most closely related to Cluster 4, Youth and Willingness to Experiment (r 101 Table 17 Correlations Between Oblique Cluster Domains and the Validities of Each Cluster Score Validities 1 2 3 4 CLUSTER 1: Adoption 4 (.94) CLUSTER 2: Influence .19 t & Power (.94) CLUSTER 3: Personal .11 -.07 3 Communication & Social Skills (.93) CLUSTER 4: Willingness to Experiment (.88) CLUSTER 5: Role -.22 .30 -.27 -.28 Tenure (.85) 102 Table 18 Adoption Cluster VARIABLE NAME CLUSTER LOADING Movement Towards Adoption * .86 Pre-Advocacy Treatment MTAS * .81 Organization’s Perceived Readiness for Change 4 .79 Overall Certainty about the Program at Time 2 .63 Participants’ Intent to Adopt the Program at Time 1 t .62 Participants’ Intent to Adopt the Program at Time 2 .55 Venturesome .54 Philosophical Congruity with the Principles of the Program at Time 2 .42 Overall Certainty about the Program at Time 1 .37 Perceived Effectiveness of the Introductory Workshop .29 CRONBACH'S ALPHA RELIABILITY OF CLUSTER = .89 103 = .33) and least related to Cluster 3, Personal Communication and Social Skills (r =.11). Influence ppd Epygp Cluster. This eight item cluster showed the relationship among the variables most indicative of influence and power. As can be seen in Table 19, the defining variables in this cluster are participants’ perceived influence and power in the organization, a high social status and a high level of education. Participants’ communication potential, prior knowledge of the program and the full management status of the community mental health service board also entered in this cluster. Imaginativeness was the only personality variable included suggesting that individuals who had the greatest influence and power in their agencies perceived themselves as more imaginative than others. These individuals tended to possess higher social status and a higher level of education. They had greater communication potential, more prior knowledge about the program and tended to be employed by full management agencies. The internal consistency (Cronbach’s alpha) of the cluster was .88. This cluster was most closely related to Cluster 4, Youth and Willingness to Experiment (r = .40) and least related with Cluster 3, Personal Communication and Social Skills (r =-.07). This cluster was also marginally related to the Adoption Cluster (r =.19). This finding correlates with previous research (Fairweather et a1., 1974) 104 Table 19 Influence and Power Cluster VARIABLE NAME CLUSTER LOADING Perceived Influence in the Organization 3 .93 Perceived Power in the Organization * .90 Perceived Communication Potential .67 Social Status I .66 Educational Level I .52 Prior Knowledge of the Program (Prior to .44 introductory workshop) Imaginative .37 Full Management Status of Community Mental Health .26 Service Board CRONBACH’S ALPHA RELIABILITY OF CLUSTER .88 105 which suggests that social status is unrelated to adoption. Personal Qpppunicgtion ppd Social Skills Cluster. This cluster was composed of seven items and was indicative of personal communication and social skills (See Table 20). The defining variables in this cluster were being female, sensitive, sociable, and persevering. Perception of the Community Lodge as more unique than other programs and the length of the advocacy manipulation also entered into the cluster. This indicates that female participants tended to perceive themselves as more sociable, more sensitive and more persevering than the males in the sample. The agencies in which these ladies worked were locate in urban areas and the length of the advocacy manipulation tended to be longer than for other participants. Also, females were inclined to perceive the Community Lodge as more distinctive than the males. The internal consistency (Cronbach’s alpha) of the cluster was .86. This cluster was most closely related to Cluster 5, Role Tenure (r = -.27) and least related to Cluster 2, Influence and Power (r =-.07). prpp gpg_ Willingness pp Experiment Cluster. This six item cluster showed the relationship between participants’ age and their willingness to experience change. The defining variable in this cluster is age. As can be seen in Table 21, younger participants expressed greater philosophical congruity with the principles of the program 106 Table 20 Personal Communication and Social Skills Cluster VARIABLE NAME CLUSTER LOADING Sensitive t .87 Sociable * .69 Sex (Females) * .65 Perseverence * .59 Located in Urban Areas .37 Time Spent in the Advocacy Phone Calls and Face-to-Face .36 Discussions Perceived Distinctiveness of the Community Lodge Program .31 CRONBACH’S ALPHA RELIABILITY OF CLUSTER = .86 107 Table 21 Youth and Willingness to Experiment Cluster VARIABLE NAME CLUSTER LOADING Philosophical Congruity with the Principles of the Program .59 at Time 1 Lack of Self-sufficiency .54 Age (Younger Participants) 4 .53 Previous Experience with Establishing a New Program .51 Experimentative .36 Participants’ Satisfaction with Their Agencies’ Current Programs for Mentally Ill Clients .29 CRONBACH’S ALPHA RELIABILITY OF CLUSTER = .77 108 at Time 1. They perceived themselves as less self-sufficient but more willing to experiment and try new things than other participants. They were more likely to have tried previously to establish a new program and to be satisfied with their agencies’ current treatment approaches for mentally ill clients. The internal consistency (Cronbach’s alpha) of the cluster was .77. This cluster was most closely related to Cluster 2, Influence and Power (r = .40) and least related to Cluster 3, Personal Communication and Social Skills (r :-.11). 391; Tenure Cluster. This cluster was composed of four variables. The defining variables in the cluster are longer organizational tenure and not utilizing cosmopolitan sources of information. As is evident in Table 22, participants with the longest organizational tenure did not utilize cosmopolitan sources of information. They tended to be employed by the larger agencies and perceived themselves as not having participated actively during the workshop. The internal consistency (Cronbach’s alpha) of the cluster was .72. This cluster was most closely related to Cluster 2, Influence and Power (r = .30) and least related to Cluster 1, Adoption (r = -.22). 109 Table 22 Role Tenure Cluster VARIABLE NAME CLUSTER LOADING Does Not Use Cosmopolitan Sources of Information 3 .75 Size of the Agency .69 Organizational Tenure t .66 Perception of Not Having Participate Actively .37 During the Workshop CRONBACH’S ALPHA RELIABILITY OF CLUSTER = .72 110 Summary The results of the present study indicate that the two advocacy strategies did not affect differentially movement towards adoption of the Community Lodge. Both of the experimental manipulations reduced uncertainty about the innovation, but no significant differences between the conditions were detected on this variable. Certainty about the innovation measured at the follow-up time period was correlated with the two outcome measures. Philosophical congruity with the principles of the program was related to organizational power and movement towards adoption but not with influence and status in the organization. Neither the use of cosmopolitan sources of information nor communication potential were related to the outcome variables, but communication potential was correlated with power, influence and status in the organization. Only venturesomeness, experimentativeness and perseverance correlated with movement towards adoption of the program. However, many of the personality characteristics were intercorrelated. The cluster analysis yielded five relatively interrelated oblique clusters: Adoption, Influence and Power, Personal Communication and Social Skills, Youth and Willingness to Experiment, and Role Tenure. The Adoption Cluster was strongly related to the Youth and Willingness to Experiment 111 Cluster and inversely related to the' Role Tenure Cluster. The Influence and Power Cluster was strongly correlated with Youth and Willingness to Experiment Cluster and least correlated with Personal Communication and Social Skills Cluster. The Personal Communication and Social Skills Cluster was inversely related with Role Tenure and least correlated with Influence and Power. The Youth and Willingness to Experiment Cluster was most strongly related to Influence and Power, and inversely correlated with the Personal Communication and Social Skills Cluster. Role Tenure was strongly correlated with Influence and Power but inversely related with the other three clusters. DISCUSSION CHAPTER IV DISCUSSION The goal of this chapter is to evaluate the major findings of the study in light of the experimental evidence. Plausible alternative explanations for the results will be discussed and the limitations of the study presented. Suggestions for future research will also be given. Effect pf the Advgpppy Treatment pp Movepent Towppdp Adoption 91 _hg Community Lpdgg The major goal of this study was to elucidate whether telephone advocacy could be as effective as face-to-face efforts in promoting adoption of the Community Lodge. The results indicate no significant differences between these two conditions, thus supporting the hypothesis. Since the results of previous efforts to disseminate the program did not compare telephone and and face-to-face advocacy, these findings are especially important. Telephone advocacy is much more economical and easier to implement than face—to-face meetings. There are numerous plausible explanations for the observed findings. The Social Sitpptionpl Factors. First and foremost among these explanations is the social climate in the Michigan Department of Mental Health during the course of the study. 112 113 Although the department had not designated additional funds for implementing the program, a section on the benefits of the Community Lodge was included in the annual budgetary guidelines. These guidelines, which were sent to all community mental health service boards in the state, are a regular part of the budgetary process and delineate departmental funding priorities for the coming fiscal year. The head of the department, C. Patrick Babcock, was clearly in favor of the program and advocated its development in both institutional and community settings. This was evident from the introductory letter sent to all community mental health service board directors, the resources allocated for the present study and the technical assistance available to agencies developing Community Lodges. Although not specifically stated, the message given was to "implement this program". Considering the many political constraints and nuances motivating bureaucratic decisions, it was not surprising that many agencies moved towards adopting the program. However, as the researcher learned during the course of the study, many agency directors resisted being implicitly or explicitly "told" what to do. In fact, as proof of their self-determinism, a few directors refused to send any one to the initial workshop! Thus, these opposing influences impinged upon the experimental context creating two very different reactions. In addition, many participants were angered by the 114 "mixed" message their agencies were' receiving from the Department of Mental Health. On the one hand, they were encouraged to implement this community program, but they were not given additional funds with which to do so. This lack of additional funding served to preserve the integrity of the experimental treatment because the effect of the independent variable was not confounded with monetary gain. Thus, movement towards adoption of this program implied a financial commitment from the adopting agency which involved either redirection of existing resources, or submission of a "PRR" (program revision request) to the Department of Mental Health. Given this, the effects of the social climate and the department’s pro-adoption bias might have been abrogated or at least minimized. Unfortunately, in other dissemination efforts of the Community Lodge, the researchers were not generally blessed with such a favorable social climate. In these cases, the more intense advocacy efforts yielded more adoptive activity. However, the implications of the present research findings should not be minimized by these previous efforts. Rather, these results support the ESID model of planning and conducting experiments (Fairweather & Tornatzky, 1977). The model stipulates that researchers must have a thorough knowledge of their problem area so they can account for the social situational variables in developing their experimental designs. Given that face-to—face advocacy, 115 although effective in reducing uncertainty and facilitating change, is very costly and labor intensive, the results of the present study suggest that it is not the only option available to dissemination researchers. Under particular social situations, telephone advocacy, which is much less costly and labor intensive, can be as effective as face-to-face efforts in promoting innovation adoption. Responsibility for selecting the appropriate advocacy strategy for their particular situation rests squarely on the social scientist. Tipg. A second factor that might account for the results of this study is the time element involved. Dissemination research is typically longitudinal in nature. The present study utilized a 180 day follow-up period which might not be a sufficient time lapse for differences between the two conditions to emerge. Perhaps telephone advocacy is as effective as face-to-face efforts to promote movement towards adoption in the short run, but its long term effects might be very different. To further elucidate the effects of time on the experimental manipulation, a one year evaluation of the experimental conditions will be conducted in November of 1986. It was interesting to note that contrary to other studies in the area, movement towards adoption of the program occurred in both experimental conditions after just three months. This was an unexpected finding and prompted the 116 development of the Pre-Advocacy Treatment Movement Towards Adoption measure. Again, the positive social climate might help to explain this rapid movement. A question that arises as a result of this change deals with the relevance of the advocacy variable. If change occurred prior to the implementation of the experimental treatment, was the manipulation necessary? Perhaps all that is required in situations with such favorable social climates is a strong initial workshop directed by appropriate person(s). The social psychological literature suggests that the originator or source of a communication is a crucial variable in determining its persuasive ability. Identification of the source provides the audience with information above and beyond the arguments or information presented in the message. The source factors most commonly studied are credibility, trustworthiness, power, and similarity with the audience (Petty & Cacioppo, 1981). Perhaps one reason why the workshop was so effective in promoting movement towards adoption stems from the source factors associated with the individuals presenting information. Dr. Fairweather, a member of the research team developing the first Community Lodge, was present. All other presenters were mental health workers who helped to implement the program. Thus, the four relevant "source" factors were satisfied and this might help to explain the apparent effectiveness of the workshop in terms of promoting 117 movement towards innovation adoption. However, although the workshop effectiveness variable formed an integral part of the adoption cluster, these scores were not significantly related to either pre-advocacy treatment movement towards adoption score or movement towards adoption score. It is conceivable that participants’ responses on this scale were tainted by the voluminous amount of information they heard during the course of the workshop and that they needed more time to process and understand its contents. Consequently, the workshop’s effectiveness could only be gauged accurately with the passage of time. Perhaps the pre-advocacy treatment movement towards adoption score is a more accurate indicator of the workshop’s effectiveness than the paper and pencil measure since the workshop’s main purpose was to promote adoption of the innovation. Effect pf Advocacy Treatment pp Certainty The second goal of this study was to elucidate whether telephone advocacy would be as effective as face-to-face efforts in reducing uncertainty about the innovation. The results of this study suggest that both experimental manipulations reduced uncertainty about the innovation. No significant differences were detected between the two conditions on this variable. As postulated, certainty was related to movement towards adaption of the program. 118 Again, these results might be tempered by the social situational factors previously discussed, but their impact would be much less pronounced than for the outcome variable. For instance, the social climate might have set the stage for individuals to learn more about the program, but greater knowledge is not necessarily related to greater certainty. Likewise, social situational factors might have predisposed some participants towards greater certainty about the innovation because people in positions of power were endorsing the program. Given this, some of the risks typically associated with innovation adoption might have been minimized and some of the uncertainty surrounding the innovation reduced. Interestingly, no change between the first and second measurement period was detected on the certainty of feasibility variable. 0n the one hand, this seems to suggest that the experimental treatment had no effect on this variable. On the other hand, it could indicate that participants, filled with the enthusiasm generated by the workshop, perceived the program as easier to implement than it actually is. For instance, participants’ initial impressions of the feasibility of finding an appropriate home for the clients in the community might have been unrealistic. Their responses on the initial measurement of this item might have been positively skewed. At the time of the follow-up measurement, participants would have 119 discovered the difficult? of the task, and their responses to this item might be more realistic, and a closer reflection of their "true scores". Although the importance of certainty about the innovation has been well documented (Fleischer, 1979; Rogers & Shoemaker, 1971;Rogers, 1983; Schon, 1967; Tornatzky et a1, 1980, and others), few experimental studies evaluated the effectiveness of telephone advocacy on reducing uncertainty. (In fact, the researcher could not find another study which compared both telephone and face-to-face advocacy on this variable.) Considering the role that certainty plays in the adoption process, the results of the present study are of some consequence for dissemination researchers. Given that telephone advocacy reduced uncertainty about the innovation, researchers can more reliably utilize this technique under the appropriate situational contexts. Of course, one cannot tell whether uncertainty reduction propelled movement towards adoption, or whether making an effort to adopt the innovation created the change in uncertainty. All that the present results indicate is that these two variables are somehow related and that a reduction in uncertainty occurred after the experimental treatments. Further support for the outcome hypotheses was obtained from the cluster analysis. Most of the variables hypothesized to be related with movement towards adoption 120 were included in the Adoption Cluster. For instance, the analysis reiterated the relationship between certainty and innovation adoption, as well as the relationship between homophily of beliefs and innovation adoption. Participants’ intent to work towards the adoption of the program was also included in the cluster. The results are indicative of the relationship postulated to exist between these variables and the hypothetical domain underlying the Adoption Cluster. Relationghip pf Participant Characterigpipg ppg Movement Towards Adoption pf ppg gppmunity Lodgg The third major objective of this study was to examine the relationship between attributes that typically characterize adoption agents and movement towards adoption. Can one enhance the probability of innovation adoption by selecting the "right" change agent? Can one select the "right" change agent on the basis of personality characteristics? Although these questions are not new to the dissemination literature, they have not as of yet been answered satisfactorily. Perhaps one of the reasons why this occurs is that a distinction between the characteristics indicating the effectiveness of the change agent and those characteristics which are the most accurate predictors of adoption has not been made. Unfortunately, the results of the present study do not advance the existing literature nor do they help elucidate the previously 121 postulated distinction. Values, Attitudes ppg Beliefs. A characteristic frequently suggested to be of great importance in diffusion efforts is compatibility of the innovation with the potential adopter’s values, attitudes and beliefs. As the experimental hypothesis postulated, philosophical congruity with the principles of the program was related to movement towards innovation adoption. Philosophical congruity was also correlated with certainty about the innovation. These results were further enhanced since both philosophical congruity and certainty about the innovation were included in the Adoption Cluster. While these observed relationships are by no means "new", the results of this study reiterate the importance of these variables in the adoption process. Dissemination researchers would be wise to evaluate and/or at least consider the potential impact these factors might have on the outcome of their efforts. Cosmopolitan Inforpption Sources. The use of cosmopolitan information sources has been found consistently to correlate with innovation adoption. Interestingly, the results of the present study do not support this proposition. Perhaps one reason this occurred was due to the characteristics of the sample utilized in the study. Over 79% of the sample was composed of master level clinical social workers engaging in the delivery of mental health services. (This suggests that 122 there was a restriction of the range of possible responses.) They were employed by relatively small (less than 60 employees) agencies located in rural areas in the State of Michigan. These agencies had rather limited resources and could not afford to send their employees to professional conferences and meetings in other states, although some were able to attend such activities in Michigan. The organizational climate did not foster or reward using cosmopolitan sources of information. Given these characteristics, it is not surprising that this variable did not attain the predicted relationship with movement towards adoption of the innovation. Qpppunicgtion. Typically, the communication potential of the change agent tends to affect innovation adoption. The results of the present study regarding this factor are of considerable interest. Although communication potential was not related to the outcome variables, it was strongly related with measures of influence and power. It also formed an integral part of the Influence and Power Cluster. These findings are congruent with much of the literature which suggests that influential individuals are often skilled communicators (Hill, 1982). If dissemination researchers could somehow identify powerful and influential individuals with strong communication potential and persuade them to work towards adoption of the innovation, persuasion of the rest of the members of the organization would be 123 greatly facilitated. However, the monumental task at hand is figuring out how to do this! Social Status ppd Decision Making 2932;. Although a change agent’s formal and informal status and power in an organization have been suggested to facilitate movement towards innovation adoption, the results of the studies reviewed were mixed. Some researchers found a strong relationship while others failed to do. so. For instance, Fairweather et a1., (1974) found that the social status of the person receiving information about the innovation was not related to the hospital’s adoption of the Community Lodge, while others (Hefferlin, 1979; Rogers, 1983) found that status was related to change. In the present study, a distinct influence and power cluster was evident, and it was not related to the adoption cluster. Interestingly, all the indicators of power and influence utilized were included in the cluster, even the full management status of the community mental health service board. Perhaps this indicates that although the power, influence and social status of the change agent might faciliate innovation adoption, they are by no means imperative to the process, since they are not always related to innovation adoption. Again, to gauge the impact of these variables one must consider the situational context. The key to elucidating this relationship might lie with the "risk" level of the 124 innovation. High status individuals are often the first to adopt low-risk innovations while the converse is true for high risk innovations. Given that the risk factor of an innovation is associated with its complexity (Rogers, 1983), it is not surprising that social status and other influence variables typically are not related to movement towards adoption of the Community Lodge, but are associated with adoption of less complex innovations. Personality Variables. Diffusion researchers have often tried to delineate the personality characteristics of the typical change agent albeit with only minimal success. The present study attempted to elucidate the relationship between the traits most frequently found in the literature and innovation adoption. The results of the study do not present a clear picture of the "typical" change agent. Although venturesomeness, experimentativeness and perseverance were strongly correlated with the outcome variables, venturesomeness was the only personality trait included in the adoption cluster. This finding is congruent with others in that venturesomeness usually appears to have the strongest relationship with innovation adoption. For instance, Loy (1969) found that venturesomeness and dominance possesed the strongest predictive ability. A similar relationship was found by Hill (1982) and others. These results tend to indicate the strength of the relationship between this characteristic and other factors 125 facilitating innovation adoption. Rather than focusing on a gamut of personality traits, perhaps dissemination researchers should focus on one or two traits in their quest to find ”good” advocates. Perhaps, venturesomeness is the crucial variable for determining effective change agents. By rating change agents on this trait, researchers might better predict movement towards adoption. The most interesting results regarding participant characteristics were derived from the cluster analysis performed on the data. Cluster 4, Youth and a Willingness to Experiment, was correlated with both the Adoption Cluster and the Influence and Power Cluster. This correlation with adoption is congruent with some of the characteristics typically found to discriminate between early and late adopters. Early adopters tend to be younger, to have a lower security orientation, to be better educated, be more willing to try new things, have different value systems, and posses greater mental ability and conceptual skills than later adopters. However, the relationship of this cluster with influence and power is somewhat harder to explain. One plausible explanation stems from the relationship between age and organizational power. Educational level, influence, social status, and power were the definers of the Influence and Power cluster. However, there was a strong negative correlation between organizational power and a participant’s 126 age which might explain the relationship between these two clusters. Threats pp Internal pp External Validity There were three major threats to the validity of the present study. The first of these dealt with the potential biases which could have resulted from the subject recruitment procedures utilized (Campbell & Stanley, 1966). In this instance, the researcher could not control subject selection because a mechanism for identifying each board’s employees did not exist. Each organization kept the only available record of its workers and as a result the researcher was forced to rely on agency directors for initial subject identification. These directors nominated a representative and the researcher invited him/her to participate in the study. Although one must consider the potential impact of selection biases as a threat to the internal validity of the present study, the apparent equivalence of the experimental conditions prior to the advocacy manipulation offered strong support for the lack of bias in subject recruitment. If an error existed in these procedures, it was equally distributed between the two conditions and did not affect the comparability of the treatment groups. In addition to the experimental evidence, the descriptive information obtained also supports this proposition. A frequency 127 distribution of the official position of each participant yielded a wide variety of roles and no differences were detected between the two conditions. (In all but one instance, the agency director selected their nominee during the course of initial telephone call which indicated that the procedure utilized to identify subjects was similar for the majority of the organizations. The second major threat to the validity of the present experiment dealt with ”experimenter effects”. Rosenthal (1966) and his associates have demonstrated that the expectations of an experimenter seemingly can be transmitted to experimental subjects, be they elementary school children, college sophomores, or Sprague-Dawley albino rats. These experimenter effects may bias a research study when the experimenter is not "blind" to the treatment conditions and has the opportunity to affect the subjects’ outcomes. "All too often, the mere presence of the experimenter in the research setting results in a very subtle but nevertheless potentially powerful ’treatment’, differentially affecting subjects’ responses as a function of the experimenter’s theoretical expectations, thus promoting responses not related in any way to the independent variable manipulation" (Crano and Brewer (1973, p. 67). Experimenter effects could be a problem in the present study since there was only one researcher (namely the author) and she was aware of which agencies were in each 128 condition. The strongest argument against the threat posed by this variable stems from the complexity of the innovation being disseminated. Although the personality of the experimenter is an important variable to facilitate initial entry into an organization, it takes much more than a pleasant personality to motivate individuals to conduct all of the activities necessary to adopt the Community Lodge. A participant may have liked the experimenter very much, but the amount of work and the risks involved in trying to get the program adopted, far out weigh the impact that this variable could have had upon the final outcome. Support for this explanation can be found in previous dissemination research (Fairweather et a1., 1974; Tornatzky et a1., 1980) in which no significant differences were detected among the different consultants used to disseminate the Community Lodge despite their different personalities. The third major threat to the validity of this study stems from the relatively small sample size and the number of variables that were utilized. These factors could have affected the outcome in three ways. First of all, as previously stated, random assignment is contingent on the "law of large numbers". Thus, the sample size could have biased the random assignment procedures. However, in order to minimize the effect of this variable, participants were matched on the management status of the community mental 129 health service board. The initial' equivalence of the treatment groups provides support for effectiveness of the random assignment protocol utilized. Secondly, a small sample size makes it more difficult to detect differences between the experimental treatments since the effect of the manipulation would have to be relatively strong in order to achieve ‘statistical significance. The only way to counteract this would have been to increase the size of the sample. However, the only way to have accomplished this end was by increasing the number of participants from each agency since all of the community mental health service boards in the state were contacted. Unfortunately, this would have altered significantly the experimental design by introducing a new variable. Thirdly, given the relatively small sample size and the number of variables that were utilized, the results of this study must be interpreted with caution. Qppgp Limitations p§_ppp Sppdy Besides those already mentioned, interpretations of this study are limited in several ways. First, the participant’s understanding of the innovation was not assessed. There was no conclusive evidence which suggested that these individuals fully comprehended this complex innovation. Misperceptions could have affected participants’ initial enthusiasm or their ability to make an accurate and 130 appealing presentation of the program in their respective agencies. Second, this research was also limited by its examination of the first 180 days subsequent to the introductory workshop. This implies that the results of the present research may change over longer periods of time. Longitudinal research by Fairweather (1974) indicated that the factor loadings of variables may become stronger over time. Greater variance in the outcome variables may reveal additional relationships between movement towards adoption and participant characteristics. Third, the results of this study must be interpreted with caution because of the low alpha coefficients of some of the scales utilized. The generalizability of the results is also limited because nonprobability sampling was utilized. Conclusions The major findings of the present study, while only preliminary in scope, may have implications for the field of dissemination. If the lack of significant differences between the two experimental manipulations continues across time, other researchers might consider utilizing telephone advocacy as a relatively low cost, but effective strategy. However, the present experiment should be replicated before the effectiveness of this technique can be assessed adequately. There is a clear need for more longitudinal 131 studies in which telephone and face-to-face advocacy are compared within the same experimental context. One of the more interesting questions that arose from the present study dealt with the relevance of the advocacy variable per se. Given the social situational context, was the manipulation necessary? Perhaps under these circumstances, researchers should focus on strengthening the initial workshop and supplementing its impact via telephone consultations. Again, this question can only be answered through experimentation. This study, like many others, has revealed the complexity and inconclusiveness of research efforts designed to elucidate the characteristics of effective change agents. Interestingly, many of the hypothesized relationships did not emerge. However, future research efforts should evaluate the role that venturesomeness plays in facilitating innovation adoption. Clarification must be made between which characteristics indicate the effectiveness of the change agent and which are the most accurate predictors of adoption. Research efforts should also attempt to elucidate the interaction between the disseminators and potential adopters. Which aspects of adoption are influenced by characteristics of the adopters and which are influenced by those of the disseminator? 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APPENDICES APPENDIX A List of Boards in the Sample ...; OCDmQODUI-wat—b 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 143 List of Boards in the Sample Alger/Marquette Alpena Au Sable Valley Barry Bay/Arenac Branch Berrien Calhoun Central Michigan Delta Dickinson/Iron Eaton/Ingham/Clinton Grand Traverse/Leelanau Ionia Kalamazoo Kent Mason Midland/Gladwin Montcalm Muskegon Newago Ottowa Saint Clair Saint Joseph Sanilac Schoolcraft Shiawassee Tuscola Van Buren APPENDIX B Copy of Introductory Letter 144 MICHIGAN DEPARTMENT OF MENTAL HEALTH Lewis Cass Building Lansing, MI 48909 September 20, 1985 NAME title board address city, state zip Dear , In last year’s DMH facility budget instructions, we identified the Fairweather Lodge as a placement program well suited to a number of long term inpatients and high recidivism clients. The program is a variation of the community residential supported independent level of care for the mentally ill adult. Since the lodge has become an effective placement for long term inpatient clients and because its daily cost is much less than other placement alternatives; DMH has encouraged the development of lodge proposals for mentally ill adult facility utilization reduction. During the past two years, numerous state facilities have initiated attempts at establishing lodges as placement alter- natives. Among these are Ypsilanti Regional, Northville, and Clinton Valley Center. However, the lodge program is not only suited for use with institutionalized MI patients. Its concept can be adapted for use in day treatment centers and it has been demonstrated to increase the community tenure of clients participating in the program. DMH would like to see the Fairweather Lodge program become a standard treatment option offered under residential services for inpatient and outpatient clients. However, we understand that your knowledge of the program may be somewhat limited. As a way to increase awareness and understanding of the Fairweather Lodge program, Isa Fernandez, a doctoral student of Dr. Fairweather, will be conducting a study aimed at disseminating information on the lodge program to community mental health service boards in Michigan. Ms. Fernandez will sponsor a workshop on the campus of Michigan State University, November 21, 1985. The workshop will provide both theoretical and practical information on the lodge program and it will be conducted by Dr. Fairweather and others directly associated with the program and its implementation. 145 As directors of the CMHSBs you will be asked to nominate some- one to attend the workshop (i.e. someone responsible for residential services development). Ms. Fernandez will be contacting you within the next few days to confirm your willingness to participate in this study. I urge you to cooperate with her and to participate in the program. It will be a worthwhile endeavor. Sincerely, C. Patrick Babcock APPENDIX C Protocol for Introductory Phone Call to Agency Directors 146 Name: Date: Hello , my name is Isa Fernandez, and I’m a doctoral student in psychology at Michigan State Unversity. I believe you have received a letter from Mr. Babcock regarding a study I am conducting. (Pause and wait for response. If they say they’ve received the letter, go to next line. If they’ve not received the letter explain the content of the letter and promise to send a copy.) Do you have any questions regrading this letter? (Pause and wait for a response. If no go to next line) As was mentioned in the letter, the department of mental health wishes to disseminate information regarding the Fairweather Lodge program as a variation to the community residential semi-independent level of care for the mentally ill adult. To facilitate this end, I will be conducting a workshop on the Fairweather Lodge program at Michigan State University in November. The purpose of the workshop is to explain the program and to aid your organization in developing your own Lodges, if you are so inclined. (Pause and wait for a comment. If comment go to next line) Do you have any questions? (If yes, answer their questions. If no go to next line.) The workshop will last for one day and are free of charge. We will provide lunch for all participants. However, I cannot incur the travel costs for anyone attending the workshop. Each agency will have to bear these costs. If you do decide to participate in the study, I will send a price list of hotels and motels in the area. Do you understand all of this? (Pause and wait for a comment. If no comment go to next line) If you decide to participate, I will ask you to nominate one person from your agency that will be willing and able to attend this workshop I previously mentioned. This person will also be asked to complete three paper and pencil instrument that deal with their perceptions of the workshop and other relevant factors. I will also ask that you nominate a back-up person who will be willing to attend the workshop in the event that the original person cannot. Do you have any questions or comments? (Pause and wait for a comment. If no comment go to next line) 147 Well, given all that we’ve discussed, will you be willing to participate in the study? (Pause and wait for a comment. If no response go to next line) If yes, ask for the name of the alternate and nominee. If no ask what prompted this decision. Thank them for their time and tell them that if they change their minds they can reach me at (517) 355-0166 If they are unsure of their responses, tell them that you will call them back. Ask them to please think about it. APPENDIX D Protocol for First Contact with Nominee 148 Name: Date: Hello , my name is Isa Fernandez, and I’m a doctoral student in psychology at Michigan State Unversity. Your director has nominated you to attend a workshop in November 21, 1985 at Michigan State University. conducting. (Pause and wait for response. If they say they’ve received the letter, go to next line.) The workshop is on the Fairweather Lodge program. Have you heard of this program. (Pause and wait for a response. Answer appropriately.) The program has been identified by DMH as a placement program well suited to a number of long term inpatients and high recidivism clients. It is a variation of the community residential semi-independent level of care for the MI adult. The program has been utilized in many places around the country and has been repeatedly found to be an effective placement alternative for these clients. Its daily cost is much less than that for other treatment alternatives. As a result DMH is encouraging the inclusion of the lodge program among the residential alternatives regularly available to appropriate clients. The workshop is part of a study aimed at disseminating information about the program to community mental health service boards in the state. It is part of my doctoral dissertation. The study involves attending this workshop which will be held on November 21, 1985. You will be asked to complete 3 paper and pencil measures and I will either telephone or visit you three months after the termination of the workshop. One hundred and eighty days latter, I will telephone you again to ask a few questions regarding your agency’s progress or lack there of to work towards adopting the program. Participation in the study is strictly voluntary. Any information that you provide will be kept strictly confidential. If you so desire, you may attend the workshop and chose not to participate in the study. If at any time you wish to withdraw your participation, you are also free to do so. (Pause and wait for a response. Answer any questions.) Now given all that we’ve discussed, do you think you would like to participate in this study? (Pause and wait for a response. Answer appropriately.) Great! I will be sending you in the very near future, a 149 confirmation letter which will include an information packet and my telephone and address. Do you have any questions? (Pause and answer appropriately) I also want you to know that if you have any questions or concerns please don’t hesitate to call. My number is ----- . If for any reason you will be unable to attend the workshop, please let me know as soon as possible so that I can make other arrangements. ' I look forward to seeing you at the workshop. Remember look for my packet in the mail. You correct mailing address is: (write address) Good-bye. APPENDIX E Copy of Confirmation Letter 150 MICHIGAN STATE UNIVERSITY Psychology Department Psychology Research East Lansing, MI 48824-1117 NAME title board address city, state zip Dear , I’m writing to confirm your attendance at the Fairweather Lodge workshop that is going to be held in the Minnesota Room at the Michigan State University Student Union on November 21, 1985. The workshop will begin at 9:00 and will terminate at about 4:00 p.m. Coffee, tea and cookies will be available from 8:30 to 9:00 am. I am enclosing a campus map listing the site of the workshop and best place to part in the area. I suggest the parking ramp in East Lansing which is about a five minute walk away from the M.S.U. Union. I am also including a list of hotels and motels that are closest to the university. The price per room are current since they were obtained this week. I also wish to thank-you for agreeing to participate in my study. If you’ve got any questions, please don’t hesitate to call. My number is (517) 355-0166. I look forward to meeting you at the workshop. Until then, I remain, Cordially yours, Isa Fernandez, M.A. Fairweather Project APPENDIX F Workshop Schedule 8::30 9:1)0 10:15 10:30 11:00 11:30 12:00 9:00 :05 :45 10:15 10:30 11:00 11:30 12:00 1 :00 151 FAIRWEATHER WORKSHOP SCHEDULE MORNING SESSION COFFEE AND COOKIES WELCOME Introductions. Provide list of activities and topics for the workshop. (Isa Fernandez) OVERVIEW OF THE COMMUNITY LODGE Definition and components of the program. Historical perspective including the early mode building experiments; the creation of the Community Lodge; the national diffusion studies (Bill Fairweather) QUESTIONS, ANSWERS AND DISCUSSION (Bill Fairweather) BREAK OVERVIEW: THE STATE’S PERSPECTIVE Brief introduction and overview of the state’s efforts at disseminating the Fairweather Lodge program. A small statement of why we’re here. (Steve Szilvagyi) THE LODGE, COMMUNITY MENTAL HEALTH AND THE LODGE COORDINATOR Panel discussion of the interface among these three topics. (Linda Powell, Judy Zarend, Dorothy Baugh) QUESTIONS, ANSWERS AND DISCUSSION LUNCH Captain’s Room '1:30 1:45 2:00 2:15 2:30 2:45 3:30 4:00 :30 :45 :00 :15 :30 :45 :00 :30 :00 :30 152 ESSENTIAL COMPONENTS OF THE PROGRAM AFTERNOON SESSION GETTING RESOURCES How to obtain funding; How to find consultants How to locate resources in the community. (Steve Szilvagyi) QUESTIONS, ANSWERS AND DISCUSSION HOME IDENTIFICATION Identifying sites; securing a residence; dealing with community (Esther Ullman) QUESTIONS, ANSWERS AND DISCUSSION BREAK RUNNING A BUSINESS AND ORGANIZING WORK Establishing a legal entity; training for work; selecting a business; role of Lodge coordinator (Linda Powell and Judi Zarend) QUESTIONS, ANSWERS AND DISCUSSION TRAINING AND SELECTING CLIENTS Overview of how to select clients; how to prepare the groups; how to foster cohesiveness and participation among the group members. (Bill Fairweather) QUESTIONS, ANSWERS AND DISCUSSION CONCLUDING REMARKS AND COMPLETION OF INSTRUMENT (Isa Fernandez and Steve Szilvagyi) APPENDIX G Intervention Protocol 153 Date: Organization: Name: Time interview started: Time ended: Good morning/afternoon ! I’m so very glad to see you again. Your directions and map were flawless. I got here without any problem. wait for a response and answer appropriately. You may already know the purpose of my visit today. We are going to discuss the Fairweather program via a via your agency. wait for a response and answer appropriately. WHAT ACTIONS, IF ANY, HAVE YOU TAKEN SINCE THE WORKSHOP TO HELP GET THE FAIRWEATHER PROGRAM ADOPTED IN YOU AGENCY? write down any response given You know, one of the very first issues that a person in your position faces when trying to get a new program adopted deals with informing other persons in the agency about the program. 1.HAVE YOU DONE ANY INFORMATION SHARING ABOUT THE FAIRWEATHER PROGRAM WITH OTHERS IN YOUR AGENCY? IF YES With whom have you shared this information? (try and determine 154 the role of these persons in the agency. (i.e. administrator) IF SHARED WITH ONLY ONE OR TWO PEOPLE Sometimes it is helpful to share this type of information with many people. We have found, in our past dissemination work, that we may need to talk to 10, 20 or even 30 people before we find an advocate or someone who is inspired by the principles of the Lodge Society. Pause and wait for response Can you think of names of people whom you might approach with this information? IF YES: Who are they and what positions do they hold? IF NO Our past research has shown the importance of sharing informa- tion about the program with others in the agency. There are numerous ways in which you can do this. Wait for a response. If no response, continue... ~.—-—--. —- -..-.--- -... .... ...-.--r.‘.- . ..4 ‘,.~- -7 ..l I a .-o--_.. For instance, you can do it on a very informal level during lunch or during a break. You can write a short synopsis of the program in the agency newsletter if it has one. Another technique that you can use is holding a meeting of interested persons. In this meeting you should describe the Fairweather program, discuss the beneficial impact that it has on clients, and the benefits that the program can have on the agency. You should also photocopy some of the handouts you received at the workshop and distribute them during the meeting. I can send you more manuals or additional material if you need them. Wait for a response. 155 Can you think of names of people whom you might approach with this information? IF YES Write names down: IF NO (Go to # 2, if no) 2. AS YOU MAY KNOW, IMPLEMENTATION OF THIS TYPE OF PROGRAM REQUIRES ADVOCACY OF SOME PEOPLE WHO HAVE INFLUENCE AND ACCESS TO THE NECESSARY RESOURCES FOR PROGRAM DEVELOPMENT. LET’S LOOK AT THIS LIST AND SEE WHETHER WE HAVE PEOPLE WITH SUCH ATTRIBUTES. IF NO In your agency is there anyone who works with the chronic population? If yes, ask for a name Is there anyone developing community placements for the chronic population? If yes, ask for a name Do you have a day treatment program? If yes, who heads it? Is there a work program for the chronic population? If yes, who heads it? These are some of the staff positions that one might logically approach with this program. If possible, call a meeting in which you invite these individuals to discuss the program. 3.1DENTIFYING A COMMITTEE From this meeting and your discussions with coworkers, identify a group of interested persons who are willing to promote the adoption of the program. If this group is too large, form a committee that is willing to meet on a regular bases to prepare information and develop a strategy to gain approval of the program. If possible, committee members should represent different professional groupings i.e. social work, 156 psychologists, administrators etc. wait for a response; answer any questions. (One of the initial tasks that this committee will face is preparing a presentation on the program for administrators and other decision makers in the agency. If the committee feels that this is the most viable option to follow, plan the meeting well. Request that as many administrators as possible attend the meeting and that all decision makers that would be involved be present. The person in the agency that is most familiar with the program should chair the meeting. If you need help in planning this meeting, please call me. I’ve brought an outline of the major points you need to cover in this meeting. Give person a copy of the outline. Let person look it over and answer any questions. As you can see from the outline, this meeting is very similar to the initial meeting you held with persons interested in the Lodge. (IF person has not held a meeting say: is very similar to the workshop you attended). You will describe the program, discuss its effectiveness, its benefits etc. Can you think of any other topics that would be helpful to cover for your agency? Wait fer a response 4.FUNDINO ISSUES One of the important questions you will probably face is that of obtaining funding. I hope that summary and protocol that I’ve provided is helpful in describing the steps you need to take. If you need more information regarding budget matters contact Steve Szilvagyi at D.M.H. His address and phone number are written on the summary sheet. wait for a response. Give handout 157 Another thing you should discuss is the current status of the Fairweather program in the state. I've brought you a copy of the state directory in case you might want the names and addresses of persons involved with the program. wait for a response. Give out handout IF THERE IS OVERWHELMING SUPPORT FOR THE PROGRAM AT THIS MEETING YOU ARE BLESSED. GO TO 6 5.IF YOU HAVE ONLY A FEW PEOPLE IN SUPPORT OF THIS PROGRAM, CONVENE A MEETING WITH THESE INTERESTED PEOPLE. At this meeting develop a plan of action about what in your judgement can be done to develop the Fairweather program. Can this group go on with implementation plans for program development? Do you have the resources and approval to pursue development? IF YES, Can you describe the strategy you will pursue? IF NO, Can other staff with resources and access to the patient population be identified? If need he go back to #2 and remind person of the different persons within the agency that could be involved with the program. IF YES ' How receptive do you think these people might be to this program? You should convene another meeting of the few interested 158 persons and ask them to attend a planning session to go over the lodge principles and their application to develop a program in your community. You should design this meeting along similar parameters than the previous one. IF NO Think about others who did not come to this initial meeting that might be interested in this idea. Ask persons to provide names IF YES, Meet with these individuals IF YOU FIND LITTLE SUPPORT, DO NOT DISPAIR. Sometimes situations in agencies change. With these changes, we have found that persons who at one time expressed little interest in the notion, suddenly become interested and support program development. Perhaps priorities in your agency may change and lend themselves to a more favorable attitude change for developing the program in the future. wait for a response. 6. WHEN YOU GET A COMMITTEE ESTABLISHED..... The committee’s next task is program development. Many decisions have to be made. First of all, you need to decide what type of client training program will be utilized either community or hospital based. Delegate to committee members specific tasks that must be accomplished in adopting the program. I’ve got these specific tasks listed in this protocol that I am going to leave with you. Give person a copy of the protocol. Let’s go over the protocol and answer any question you might have. Go over the protocol. 7. LET US PUT A TIME TABLE FOR SOME OF THESE TASKS. IF YES, Write down time and tasks to be accomplished. 159 Are there other issues and tasks pertinent to your agency that we have overlooked? IF NO, Please feel free to call me if you have any questions regarding these tasks as you begin to implement them. 8.IF THERE IS INTEREST, I CAN ARRANGE FOR DR. FAIRWEATHER TO VISIT YOU SOMETIME IN MAY 0R JUNE. Think about it and let me know, you’ve got my number. Wait for a response. 9.SUMMARY AND CONCLUSIONS We have talked about a number of things specific to your agency. I’d like to summarize what we have discussed and review the possible areas that you thought you might be able to explore in the pursuit of planning to develop/ or planning to share further information about the Fairweather program. LIST ACTIONS TO BE TAKEN BY CONTACT 160 LIST WHAT PROMISES YOU MADE --.—-.-—.».._-..-..—-.----. . ”...."— ,,_‘ . .. .-.- -_ ---_ -..._.. -m. Remember, if there is anything you need, please call. You’ve got my phone number and address. Thank-you so very much for your time. If I don’t hear from you sooner, I will contact you in May to see how it is all going. Good-bye! APPENDIX H Intervention Handouts 161 OBSTACLES AND PROBLEMS HINDERING PROGRAM DEVELOPMENT HOUSING We have historically found communities in our area banning development of this type of residential programs. As you recall the Fairweather program is not a licensed facility and is not a group home. As such we do not need to have approval from the community to develop such a residence. A Fairweather program can be established in any area except those zoned as R 1. Unlike ex-patients who live in group homes, Fairweather residents do not have staff living with them, although they do have a coordinator on call. They have some degree of gainful employment so they are productive citizens in the community; they may also own the business and they have been trained to problem solve complex issues that face them in the community and are responsible for each other. We have a lawyer who has worked with DMH on development of Fairweather program homes in Michigan. He advises that we do use the term Fairweather program because the term ”lodge" connotes a fraternal order in a legal sense. He also advises that we look at the zoning ordinances within the community so that we do not violate the current zoning. He suggests finding a residence in an area of town zone for multiple family dwellings or better still one in which is multiple zoned i.e. one where there are business intermingled with family dwellings (an area zoned commercial/multiple family dwelling). He suggests that the home be situated in a corner (less neighbors to deal with). When you do have a home identified Garrett said to take a picture of the home in relations to the other homes on the block, obtain the zoning map and then to mail these things to him at: JOHN GARRETT 1050 Buhl Blvd. Detroit, MI 48226 Other things Garrett suggested were: 1. If at all possible don’t let city official into the home. The less information (i.e. ammunition you can provide) the better. 2. Provide a business address other than that of the home. (i.e. P. O. Box number etc.) 3. Make sure provider doesn’t list the Fairweather home as his/her business address. 4. Do not refer to these as LODGES. NOT ENOUGH OF A PATIENT POPULATION 162 There are many chronic mentally ill ex-patients in our society who can still profit from the Fairweather program. Many of these ex-patients are not gainfully employed. Perhaps employment is the most significant attribute of the lodge. You may find these types of ex-patients in you day treatment programs. They may be living in adult foster care homes, in group homes, or in individual apartment or with families. Since the size of the lodge varies, it seems that you might be able to identify at least 6 or 7 of these individuals for the initial program. Of course these individuals need to exhibit variation in social activity levels. What hospital is your agency connected with? Perhaps some of the patients leaving the hospital could be identified for this program. In addition you may find referrals from families and private physicians who work with the chronic population. (neighboring county collaboration) EMPLOYMENT WE HAVE THE HIGHEST RATE OF UNEMPLOYMENT HERE IN THIS COUNTY. Historically, the chronic mentally ill population has experienced great difficulty in securing any type of employment. As you know the Fairweather program is based on the notion of group employment. Many of our groups have secured employment in the service industry - mainly in the janitorial area. Of course we have had other types of employment including farming, furniture refinishing, shoe repair, printing, and other such service occupations. From our past experience, we discovered that while the health of the local economy was somewhat important, with good market study and persistent search for contracts through friends and helpful others, Fairweather program businesses have been developed even in an area of high unemployment. Assess your local area by talking to various citizens, business operators, accountants, etc. to glean ideas about businesses that have low overhead and start-op costs. The idea is that development of this type of program will engender numerous obstacles, but our job is to continuously problem solve. You may want to assess the client population identified for the lodge and see what skills and resources they have. They may have ideas for possible businesses also. 163 FUNDING CONCERNS FOR FAIRWEATHER PROGRAM To request funding for a Fairweather program go through the PRR’s (Program Revision Requests). The amount of money to ask for is found in the rate chart. a.) Shared management boards: follow regular program directions and regular PRR’s use bid process b.) Full management boards: redirection of money is available The new PPG (Guidelines) will come out sometime late April or May. In next year’s budget request you could put through a PRR for revising or expanding a residential program. The department will provide technical support and consultative help in getting the program started. If you feel you need additional funding, you may request additional funding from the department. The department will also provide the standard start-up funds for each home that opens. (As of this writing, the start-up funds total $20,000.) Direct all funding questions to: STEVE SZILVAGYI Bureau of Comm. Residential Services, Programs, Policy and Standards Department of Mental Health Lewis Cass Building Lansing, MI 48926 (517) 373-2741 Per diem cost of a Fairweather home is $34.39 before reimbursements. After SSI reimbursements it totals $18.00. (See FY’86 Residential Home Cost Guidelines.) Fairweather programs can be helpful in reducing the utilization of facilities and by so doing will make CMHB eligible for trade off dollars. Fairweather programs can also be helpful in reducing the number of days the "revolving" door client spends in facilities and increasing his/her community tenure. (Remember that even a small amount of utilization reduction can translate into a $$$ savings.) 164 PRINCIPLES OF THE FAIRWEATHER PROGRAM! MEMBERS MUST HAVE A "STAKE" IN THE SYSTEM. THEY MUST VIEW THE TASKS AND ROLES THEY PERFORM AS MEANINGFUL AND MUST HAVE AN INVESTMENT IN THE GROUP. This "stake" or investment in the group can be obtained through a myriad of ways. For instance, it could be may be having a voice in governance, having significant group employment, having significant social and financial roles in the system etc. THE PROGRAM MUST PROVIDE MEMBERS AS MUCH AUTONOMY AS POSSIBLE. (This should be consistent with their behavioral performance.) OPTIONS FOR PROMOTION AND RISING TO HIGHER STATUS MUST BE PROVIDED. This entails having a "vertical organization" were a division of labor is possible and a meaningful role can be found for all members. VALUES OF THE LARGER SOCIETY SHOULD BE REFLECTED IN THE PROGRAM. The program must be compatible with the environment in which it is implanted. For instance, most people in our society possess a strong work ethic. Since developing gainful employment for the residents is an integral part of the Fairweather program, this value is compatible with those of the society at large. THE PROGRAM’S ATTRIBUTES MUST BE COMPATIBLE WITH THE ENVIRONMENT IN WHICH IT EXISTS. The quality of the program must reflect the characteristics of the society in which it is implanted. For instance, if the program is to be implanted in a large urban setting it must reflect the characteristics of this setting i.e. highly populatmi with jobless, poor and minority members. INTERNAL NORMS FOR THE PROGRAM NEED TO SUPPORT TOLERANCE OF DEVIANT BEHAVIOR THAT IS NORMATIVE FOR THAT PARTICULAR POPULATION. Tolerance of idiosyncrasies among the group that are not harmful to them selves or others must be established. A SPECIFIC COMMUNICATION SYSTEM NEEDS TO BE DEVISED. CONTINUOUS INFORMATION FEEDBACK TO MEMBERS ABOUT THEIR PERFORMANCE IS CRITICAL. Staff must have the flexibility and wisdom to provide structure when needed and withdraw supervision when the group functions adequately. Members must be encouraged to provide feedback to each other. 165 8. THE PROGRAM SHOULD PROVIDE OPEN ENTRY AND EXIT FOR MEMBERS WITHOUT PENALTY TO THE INDIVIDUAL. Procedures for accepting new members and handling exists must be established. 9. MEMBERS SHOULD PERFORM AS GROUPS WHEREVER POSSIBLE. Group decision-making and mutual work leads to shared pride in the organization.. This structure helps to emphasize the worth of every individual and thus results in high group morale. Support from group members continues to be crucial for the survival and success of the members for handling everyday problems. 10. ONLY A LIMITED NUMBER OF PEOPLE SHOULD PARTICIPATE IN THE PROGRAM AT ONE TIME. Close interpersonal contact should be established for the members because it promotes identification with the group and its goals. 11. THE SOCIAL ORGANIZATION OF THE PROGRAM SHOULD BE ARRANGED SO THAT INDIVIDUALS MAY SUBSTITUTE FOR OTHER INDIVIDUALS WHEN REQUIRED. For instance, in work arrangements, crews can provide for substitutes to complete work when needed. 12. THE PROGRAM SHOULD NOT BE DEPENDENT UPON THE GOOD WILL OF THE SURROUNDING COMMUNITY FOR THEIR BXISTENCB. A8 muvh nu punnibln, tho program ahould 1m wolf sustaining and not be subject to the whims of the neighborhood. 13. BOTH REHABILITATIVE AND WORK NORMS SHOULD BE EQUALLY SUPPORTED. Care should be taken to avoid overly zealous work norms that are counter-productive to the rehabilitative aspect of the program. 14. AN ONGOING MECHANISM TO HANDLE DAILY LIVING PROBLEMS NEEDS TO BE IMPLANTED. For instance, an appropriate system for handling medications must be established. *These principles are taken from Fairweather, G. W., Sanders, D. H., Cressler, P. D., Maynard, H. Community Life for the Mentally Ill, Aldine Publishing Company, 1969. APPENDIX I Background Questionnaire 166 BACKGROUND INFORMATION Name: Sex: Age: Address: Phone: Place of Employment: Position/Title: Address: Phone: County: Educational Background: 1. The organization I work for is affiliated with Community Mental Health Services. 2.The organization I work for is situated in a: rural area mixed urban area 3. My Community Mental Health Service Board is a: full management board shared management board 4. The size of the organization I work for is small (less than 30 employees) medium (31 to 60 employees) large (more than 61 employees) APPENDIX J Individual Characteristics of Change Agent Questionnaire 167 QUESTIONNAIRE Name: County: PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK BESIDES THE ANSWER THAT MOST CLOSELY REFLECTS YOUR INDIVIDUAL SITUATION. 1.1 have worked in my current place of employment for less than one year 1 - 3 years 4 - 6 years 7 - 9 years 10 or more years 2.1 have worked in the field of mental health for less than one year ‘ 1 - 3 years 4 - 6 years 7 - 9 years 10 or more years 3.1 have worked in area of community residential services for less than one year i 1 - 3 years 4 - 6 years 7 - 9 years 10 or more years 4.1 have worked for organizations in the past 5 years. one two three four to five six or more Ill PLEASE ANSWER THE FOLLOWING QUESTIONS BY WRITING THE APPROPRIATE RESPONSE IN THE SPACE PROVIDED. 5.1 subscribe to professional journals a month. 6.1 belong to professional societies. 7.1 read professional journals almost every month. 168 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PUTTING A CHECK MARK BESIDES ALL THE RESPONSES THAT APPLY TO YOU. 8.Almost every month, I read from the following sources of information in my area of specialization. journals books unpublished reports professional magazines and newspapers newsletters none of the above other; please specify 9.Almost every month, 1 read from the following sources of information outside my area of specialization. Journals books unpublished reports professional magazines and newspapers newsletters none of the above other; please specify 10.During the year, I travel to gain information about resi- dential services for M. 1. clients in the following ways. consulting with colleagues consulting with representatives of regional or national organizations. attending state or regional association meetings none of the above other; please specify PLEASE ANSWER THE FOLLOWING QUESTIONS BY PUTTING A CHECK BY THE RESPONSE THAT MOST CLOSELY REFLECTS YOUR SITUATION. 11.During the year, 1 usually leave my local community times to gain knowledge about mental health issues. 7 or more 5 or 6 3 or 4 1 or 2 none 169 12.During the year, I discuss issues in mental health by either telephone or letter with approximately colleagues a month who live in Michigan cities other than my own. 7 or more 5 or 6 3 or 4 1 or 2 none 13.During the year, I discuss issues in mental health by either telephone or letter with approximately ___ colleagues a month who live in states other than my own. 7 or more 5 or 6 3 or 4 1 or 2 none PLEASE ANSWER THE FOLLOWING QUESTIONS BY CHECKING THE RESPONSE THAT BEST DESCRIBES YOUR ACTIVITIES AND BEHAVIORS WHILE AT WORK. 14.When a co-worker wants to meet with me, he/she can usually do so within a few hours. sometime that same day. within a few days. within a week. after a week or so. 15.1n most committee meetings, I express my opinions to the group. very often fairly often occasionally once in a while very seldom 16.1 would say that approximately % of my co-workers consider me a skilled speaker. 81 - 100% 61 - 80% 41 - 60% 21 - 40% 0 - 20% 170 17.1 would say that approximately me a skilled writer. 81 - 100% 61 - 80% 41 - 60% 21 - 40% O - 20% % of my co-workers consider 18.1 ’m involved in tasks requiring persuasion of coworkers almost every day every few days every week every few weeks once a month or less PLEASE ANSWER THE FOLLOWING QUESTIONS BY CHECKING THE RESPONSE WHICH BEST DESCRIBES YOUR ESTIMATE OR GUESS OF YOUR INFLUENCE IN YOUR C.M.H.S. OR YOUR PLACE OF WORK. 19.1 have considerable amount of informal influence in my agency. very often fairly often occasionally once in a while very seldom 20.1 have considerable amount of informal influence in my C.M.H.S. very often fairly often occasionally once in a while very seldom 21.1 have a considerable amount of informal power in my agency. very often fairly often occasionally once in a while very seldom 22.1 have a considerable amount of informal power in my C.M.H.S. very often fairly often occasionally once in a while very seldom 171 23.1 have considerable amount of social status in my agency. very often fairly often occasionally once in a while very seldom 24.1 have a considerable amount of social status in my C.M.H.S. very often fairly often occasionally once in a while very seldom 25.1 am among the first to adopt new ideas which are later accepted in my place of work. very often fairly often occasionally once in a while very seldom 26.1 enjoy talking to people. very often fairly often occasionally once in a while very seldom 27.1 am creative. very often fairly often occasionally once in a while very seldom 28.1 am in control of situations. very often fairly often occasionally once in a while very seldom 29.1 30.1 31.1 32.1 33.I 34.1 172 depend on others. very often fairly often occasionally once in a while very seldom take chances. very often fairly often occasionally once in a while very seldom lead in group discussions. very often fairly often occasionally once in a while very seldom command others. very often fairly often occasionally once in a while very seldom do things for myself. very often fairly often occasionally once in a while very seldom am daring. very often fairly often occasionally once in a while very seldom 173 35.1 try new ways of doing things. very often fairly often occasionally once in a while very seldom 36.1 give orders. very often fairly often occasionally once in a while very seldom 37.1 tend persist at any task to which I’m committed. very often fairly often occasionally once in a while very seldom 38.1 am sensitive to others’ attitudes and feelings. very often fairly often occasionally once in a while very seldom 39.Approximately x of my co-workers have contacted me in the last year to obtain advice or information about programs in the area of community residential services for M.I. clients. 81 - 100% 61 - 80% 41 - 60% 21 - 40% 0 - 20% 40.1 would say approximately % of my co-workers have contacted me in the last year to discuss general mental health issues. 81 - 100% 61 - 80% 41 - 60% 21 - 40% 0 - 20% 174 41.My co-workers would say that I am resourceful. very often fairly often occasionally once in a while very seldom 42.My co-workers would say that I am controlling. very often fairly often occasionally once in a while very seldom 43.My co-workers would say that I have high professional prestige in our place of work. very often fairly often occasionally once in a while very seldom 44.My co-workers would say that I am friendly. very often fairly often occasionally once in a while very seldom 45.My co-workers would say that I am sensitive. very often fairly often occasionally once in a while very seldom 46.My co-workers would say that I depend on others. very often fairly often occasionally once in a while very seldom 47.My 48.My 49.My 50.My 175 co-workers would say that I take risks. very often fairly often occasionally once in a while very seldom co-workers would say that I like to experiment. very often fairly often occasionally once in a while very seldom co-workers would say that I am persevering. very often fairly often occasionally once in a while very seldom coworkers would say I am receptive to the feelings of others. very often fairly often occasionally once in a while very seldom 51.1 hold or have held an administrative position in my C.M.H.S. very often fairly often occasionally once in a while very seldom 52.1 am or have been a member of some of my Community Mental Health Services Board’s most influential committees. very often fairly often occasionally once in a while very seldom 176 THE FOLLOWING ITEMS DEAL WITH HOW YOU PERCEIVE YOURSELF TO BE. IF YOU HAVE NO OBJECTION, PLEASE RATE YOURSELF ON THE FREQUENCY OF OCCURRENCE OF THE FOLLOWING CHARACTERISTICS BY PLACING A CHECK IN THE BLANK THAT BEST DESCRIBES YOU. 53.1 am sociable. very often fairly often occasionally once in a while very seldom 54.1 am imaginative. very often fairly often occasionally once in a while very seldom 55.1 am dominant. very often fairly often occasionally once in a while very seldom 56.1 am self-sufficient. very often fairly often occasionally once in a while very seldom 57.1 am venturesome. very often fairly often occasionally once in a while very seldom 177 58. I am experimentive. very often fairly often occasionally once in a while very seldom 59.1 am persevering. very often fairly often occasionally once in a while very seldom 60.1 am sensitive. very often fairly often occasionally once in a while very seldom APPENDIX K Workshop Questionnaire Name: 178 QUESTIONNAIRE "..-—...... --..._._.-._.-__..--*_.-a‘—. A BELOW ARE SOME QUESTIONS ABOUT THE WORKSHOP AND YOUR AGENCY. PHJEASE COMPLETE THE QUESTION BY PLACING A CHECK BEFORE THE ANSWER OR BY WRITING THE RESPONSE IN THE SPACE PROVIDED. THIS JJWFORMATION WILL BE KEPT IN THE STRICTEST CONFIDENCE. 11.The following include different ways you may have heard about the program. Check all the ways you've heard about the program. lllllll never heard about the program before this study heard about it from a fellow mental health worker read an article about it listened to a talk about it attended a workshop on it read Community Life for the Mentally Ill read Social Psychology in Treating Mental Illness read The Fairweather Lodge: A 25 Year Retrospective other, please specify 2.How satisfied are you with your organization’s present programs to help clients remain in the community successfully? very satisfied satisfied somewhat satisfied dissatisfied very dissatisfied 3.Have you ever tried to set up a new program? 4.If yes 5.18 the yes no to number 3, How successful were your attempts? very successful somewhat successful neither successful nor unsuccessful somewhat unsuccessful very unsuccessful Fairweather program different from other programs that you have known such as halfway houses etc? extremely different very different somewhat different very little difference no difference 179 €5.How effective was the workshop in providing information about the Fairweather program? very effective moderately effective neither effective nor ineffective ineffective very ineffective 7.How effective was the workshop in providing information about the small group training component of the program? very effective moderately effective neither effective nor ineffective ineffective very ineffective 8.How effective was the workshop in providing information about the community living component of the Fairweather program? very effective moderately effective neither effective nor ineffective ineffective very ineffective 9.Do you feel you know enough about how to set up a Fairweather program to be able to do it at your place of work? definitely enough almost enough not sure probably not enough definitely not enough 10.How much more do you feel you need to know about the follow- ing aspects of the Fairweather program in order to set one up? Aspect much more some more little more no more a) step level system b) note system 0) client selection d) developing group cohesion e) developing work assignment 180 11.. How much more do you feel you need to know about the follow- ing aspects of the Fairweather program in order to set one up? .o-n-ooowHy-u-o—o—a-n --——-‘-vo——w-w- ~-w.—w--~--o~--—-—v-'nw-n—-~.------u._w starting the business training clients to work obtaining funding obtaining housing lack of live in staff 12. How difficult do you think it would be to obtain funding to set up a Fairweather program at your workplace? very easy somewhat-easy somewhat difficult very difficult impossible 13.How difficult do you think it would be to obtain housing in the local community for a lodge? very easy somewhat easy somewhat difficult very difficult impossible 14.How difficult do you think it would be for lodge members to establish their own business in the community? very easy somewhat easy somewhat difficult very difficult impossible 15.How certain are you that the Fairweather program could in- O ’1 (D N m (D the time chronic M.I.clients spend in the community? extremely certain very certain somewhat certain slightly certain doubtful 181 16.How certain are you that the Fairweather program could increase employment for chronic M.I. clients? extremely certain very certain somewhat certain slightly certain doubtful 17.How certain are you that chronic M.I. clients can learn to resolve their own problems in the community? extremely certain very certain somewhat certain slightly certain doubtful 18.How certain are you that chronic M.I. clients can live in a Fairweather lodge without live-in staff? extremely certain very certain somewhat certain slightly certain doubtful 19.My C.M.H.S. Board should adopt the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 20.Chronic MI clients can live useful lives in the community. strongly agree agree neither agree nor disagree disagree strongly disagree 21.My own philosophy of client treatment is similar to the philosophy underlying the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 182 132.Chronic M.I. clients would not need to totally give up their delusions and hallucinations to live in the community. 230COMOH. how to Ill 24 COMO”. member 250COMOH. strongly agree agree neither agree nor disagree disagree strongly disagree workers should allow clients to make decisions about handle daily problems. strongly agree agree neither agree nor disagree disagree strongly disagree workers should be willing to expose Fairweather lodge to real life situations where they might fail. strongly agree agree neither agree nor disagree disagree strongly disagree workers should be willing to have Fairweather Lodge members control their own living situation. 26 OCOMOH' strongly agree agree neither agree nor disagree disagree strongly disagree workers should be willing to have Fairweather Lodge members take responsibility for their own medications. strongly agree agree neither agree nor disagree disagree strongly disagree 183 27.C.M.H. workers should be willing to help Fairweather Lodge members develop their own business. strongly agree agree neither agree nor disagree disagree strongly disagree 28.C.M.H. workers should be willing to allow clients to make decisions about how to handle their daily problems. strongly agree agree neither agree nor disagree disagree strongly disagree 29.C.M.H. workers should be willing to evaluate the decisions of clients rather than making the decisions for them. strongly agree agree neither agree nor disagree disagree strongly disagree 30.C.M.H. workers should be willing to perform tasks not demanded of them in setting up the Lodge (drive residents to work, paint) strongly agree agree neither agree nor disagree disagree strongly disagree Ill 31.My C.M.H.S. Board would offer little resistance to the adoption of the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 32.8tarting this program in my agency will be a complex undertaking. strongly agree agree neither agree nor disagree disagree strongly disagree 184 33.My C.M.H.S. Board COULD make available the necessary funds and facilities for setting up a Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 34.The people I work with would feel highly motivated to implement programs like the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree Ill 35.My C.M.H.S. Board would feel obligated to develop programs like the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 36.1t is easy to understand & communicate the ideas of the program. strongly agree agree neither agree nor disagree disagree strongly disagree 37.The people I work with could be given time to work setting up a Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree 38.The people I work with would want to set up this program. strongly agree agree neither agree nor disagree _disagroc strongly disagree i l l l 185 39.Now would be a good time for my C.M.H.S. Board to consider adopting the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree Ill 40.My C.M.H.S.Board's philosophy of client treatment is similar to the philosophy underlying the Fairweather program. strongly agree agree neither agree nor disagree disagree strongly disagree Ill 41.Developing programs to maintain M.I. clients in the com- munity is now a high priority activity of my C.M.H.S. Board. strongly agree agree neither agree nor disagree disagree strongly disagree Ill 42.1t is clear what steps my C.M.H.S. Board should take to adopt the Fairweather program. strongly agree Burnt: neither agree nor disagree disagree strongly disagree Ill 43.1 intend to actively support the adoption of this program. strongly agree agree neither agree nor disagree disagree strongly disagree 44.What specific action, if any, do you intend to take concern- ing your agency’s adoption of the Fairweather program? 186 45.1 would like the following: lllll || llll more material on training clients more material on setting up the program more material on the business component list of Lodge programs in the state list of names and addresses of hospitals in the state that currently have Fairweather training programs list of names & addresses of Michigan Lodge directors a copy of the directory of Lodge programs in existence throughout the nation access to M.S.U. Fairweather Lodge consultants visit an established Lodge home a workshop in my place of work help in setting up a Lodge program in my agency other (please specify) THE NEXT FEW QUESTIONS ARE DESIGNED TO OBTAIN YOUR REACTIONS TO THTS WORKSHOP. PLEASE PUT A CHECK BESIDES THE ANSWER THAT MOST CLOSELY REFLECTS YOUR FEELINGS. 46.1 actively took part in the sessions of the workshop. Ill always very often often not very often never 47.The moderators of the workshop were very successful in getting me to present my opinions to the group. always very often often not very often never 48.During the workshop, I felt bored and uninterested in the topics being presented. always very often often not very often never 49.During 187 the workshop, I got the chance to hear how other participants felt about certain issues. 50.During always very often often not very often never the workshop, all participants got the chance to express their Opinions and feelings. 0'! H H '1 CD (D H always very often often not very often never that percent of the people at the workshop actively participated in the sessions. 81 — 100% 61 - 80% 41 - 60% 21 — 40% 0 — 20% 52.1 actively participated in the sessions of the workshop percent of the time. 81 - 100% {Ill 61 - 80% 41 - 60% 21 - 40% 0 - 20% APPENDIX L Pre-Advocacy Treatment Movement Towards Adoption Measure 188 Knowledge 1 : Never heard of the lodge, even though they may have heard of Fairweather’s name. Can describe nothing about the lodge. 2 = Heard of the lodge and can describe it, even superficially; no subsequent discussion. Persuasion 3 = Knows of minimal discussion about the lodge since the workshop at MSU. Evidence that less than five persons have discussed the lodge. talked to peers talked to director talked to supervisor individual vs group presentation degree of plans made ex. proposal to board re: efficacy of the program 4 = Great deal of discussion among staff in the center staff but no identified task group to work on plans for the development of the program. 5 = Task group, committee or individual identified to work towards program development; no commitment made to adopt the program. 6 = Task group, committee or person identified; they meet regularly. INVITE TO MSU FOR CONSULTATION IF SITE HAS A SCORE OF 7 OR ABOVE. 7 2 Task group or committee has decided to adopt program. Has board approved? yes no Implementation 8 - 15 = Task group has taken action on (Sum over all actions taken) securing resources for program development (Ex. submitted a PRR) identifying: a house 189 a business a group of ex-patients a lodge coordinator a provider a training site useful consultants (accountant, lawyer) 16 - 20 Implemented any of the following tasks: began training patients in problem solving secured a house trained for the business secured insurance and bonding hired a coordinator set up a legal entity APPENDIX M Follow-Up Telephone Interview 190 Name: Date: Organization: Hello . This is Isa Fernandez from Michigan State University. We meet in November at the Fairweather Lodge conference. (Pause and wait for reply/acknowledgement etc.. and answer appropriately.) As you might recall, during the conference I mentioned that I would be calling you to ask a few questions regarding your experiences at your agency. Do you have a few minutes? (Pause and wait for a response. If person has no time, arrange for a time and date to call back within the next few hours or days. If alright, go to next question.) 1.Since the workshop, have you discussed the Lodge program with any of your co-workers? yes no If yes, with how many co-workers? 2.Since the workshop, have you discussed the Lodge program with the director of residential services? yes no If yes, how many times? 3.Since the workshop, have you discussed the Lodge program with the director of your Community Mental Health Service Board? yes no If yes, how many times? 191 4.Have you read Cbmmunity Life for the.Mentally Ill? yes no 5.Do you have a group that meets regularly to discuss plans for implementing the program? yes no If yes, how many times have they meet? 6.Have you gotten your supervisor’s Ok to draft a proposal for implementing the Fairweather Lodge program in your workplace? yes no (Go to next item) If yes, have you drafted a proposal? yes no If yes, when was it drafted?~mt,u_hufimu_“_M”*m_n_m4”Mm If yes, has it been approved? 7.Have you got the necessary funding for implementing the program? yes no 8.Have you got an implementation and program development committee organized? yes no If yes, how often does it meet? 9.Have you gotten committee members to read Community Life for the Mentally? yes no 192 10.Has the committee gone over the Lodge training manual? yes no 11.Have you or any one in your group sought advice or help in implementing the program from an individual or group that is an expert in the area? yes no If yes, who did you or anyone in your group speak with? How many times have you or any one in your group spoken to this individual? 12.Have you decided on a start up date for your Lodge program? yes no If yes, when 13.13 the small group training phase now in operation? yes no If yes, when did it start? If no, go to # 3O SMALL GROUP TRAINING PHASE ITEMS: 14.Have you selected an appropriate place to conduct the small group training? yes no If yes, where 15.Have you selected the staff who will be monitoring the training? yes no 193 16.Has a step-level reward system been established? yes no If yes go to #17; if no go to # 19. l7.Are staff satisfied with how the step-level reward system is working? yes no Why or why not? 18.18 the step-level reward system used to shape client’s group behavior? yes no 19.Has the note system been established? yes no 20.Have the clients been selected? yes no 21.Have the clients been assigned to small groups based on social activity score? yes no 22.Have client groups organized themselves will enough to handle the problems presented to them? yes no 23.1n the daily group meetings, do the client groups meet without staff present? yes no 194 24.Have the group work assignments been arranged? yes no 25.Are the clients working together as groups in their work assignments? yes no 26.Are the groups being allowed to function autonomously in the work assignments? yes no 27.Has a daily schedule been developed? yes no 28.Has the self-medication program been developed? yes no 29.Have the necessary forms for the program been completed? yes no 30.Has the Community Mental Health Service Board hindered the development of the program? yes no If yes, explain 195 31.Has the director of residential services hindered the development of the program? yes no If yes, explain 32.13 there any future plan for the development of a small group training component? yes no If yes, how soon do you think this will happen? within a month 2 - 3 months 4 - 5 months 5 - 6 months more than six months If no, go to # 33, 34, & 71 and then end the interview. If yes skip # 34. 33.Why is there a delay? 34.Why did your organization decide not to adopt the Fairweather Lodge program? 196 COMMUNITY LODGE ITEMS 35.Has anything been done by the clients to prepare themselves for the move to the lodge residence? If, yes name them. 36.Have the residents meet to discuss plans for the lodge? yes 7 no 37.Have they made any decisions about their living arrangements in the lodge? yes no 38.Have decisions been made about assigning roles to lodge members such as cook, crew chief, etc? yes no 39.Has anything been done about staff coverage in the lodge? 40.Has the lodge coordinator been assigned? yes no If yes, what is his/her name? 197 41.Has a system ben established for the coordinator to communicate with C.M.H.? yes no 42.11as anything been done towards establishing housing for the residents? 43.Has a building for the lodge been found in the community? yes no 44.Has the financing for the house been resolved? yes no 45.Have the furnishings been obtained? yes no 46.What type of residence is it? 47.What is the socio-economic status of the community where the lodge will be located? 48.Has anything been done of living arrangements in the community for the lodge residents? 198 49.Have arrangements been made for residents to receive their medications? yes no 50.Has a system been formulated for how food will be purchased and prepared? yes no 51.Has a system been formulated for how laundry will be done? yes no 52.Has a system for staff coverage been developed for lodge residents during hours that the coordinator is off duty? yes no 53.Have arrangements been made for transportation? yes no 54.How much has been accomplished in the way of securing and running a business? 55.Has a business been selected? yes no 56.What kind of work will they do? 57.Has the lodge coordinator been trained in that particular business? yes no 199 58.Have the clients been trained in the necessary skills for the business? yes no 59.Has any plan been made about how quality of work will be monitored? yes no 60.Has necessary equipment been obtained for their work? yes no 61.Has insurance been secured? yes no 62.nnve bonding arrangements been made for the residents? yes no 63.Has a decision been made about how the income from their work will be divided? yes no 64.Will the residents work in crews? yes no 65.Have residents gone out on any actual jobs? yes no 66.Has a non-profit corporation or other legal entity been established? yes no If yes, could you describe the type of legal entity? 200 67.Do you have a Board? yes no 68.Whfi sits on the Board? 69.What type of expertise do they have? 70.Has a decision been reached about the legal status of the residents in the lodge? yes no If yes, what is it? 71.18 there anything else you want to add or comment you want to make? 72.Since the workshop, have you spoken to any other person who attended the workshop? yes no If yes, with how many people? How many times? Thank-you very much for your time. APPENDIX N Change Scale 201 PRE-PROGRAM DEVELOPMENT ITEMS: Discuss Lodge program with co-workers Discuss Lodge program with director of residential services Discuss Lodge program with director of C.M.H.S.B. Read Community Life for the Mentally Ill Establish a group that meets regularly to discuss plans for establishing the program Get supervisor’s 0K to draft a proposal for implementing the program Get the proposal approved Get necessary funding Get an implementation and program development committee organized Get committee members to read Community Life for the Mentally Ill Get the committee to hold weekly meetings Go over Lodge training manual Get questions answered/concerns cleared with program expert (i.e. associates of Lodge dissemination study) Decide on start up date for the program SMALL GROUP TRAINING ITEMS: Select an appropriate place to conduct training Assign staff to monitor the training Establish step-level reward system Establish note system Select clients Assign clients to groups based on social activity SCOPE Arrange group work assignments Develop daily schedule Develop self—medication program Complete forms necessary for program 202 COMMUNITY LODGE ITEMS: Residents meet to discuss plans Residents make decisions about living arrangements Assign roles to members Assign Lodge coordinator Establish communication system between Lodge and C.M.H.C. Find housing Find financing for housing Obtain furniture Arrange for medications System for food purchase and preparation System for laundry System for staff coverage Arrangement for transportation Select a business Train Lodge coordinator in business Train residents Develop plan for monitoring work Obtain equipment Secure equipment Arrange for bonding Decide how income will be divided Decide whether work will be done in crews Go out on a real Job Establish a legal entity Decide on legal status of residents Choose a Board of Directors HIC RRIES ll mmmm