HD460 Unit 6 Seminar Reflection on Staff Turnover Example

Just Give Them to the Other Counselor: A Unit 6 Seminar Reflection on a Mid-Program Resignation

[Student Name]

Purdue University Global

HD460: Health Education Program Implementation and Evaluation

Unit 6 Seminar Reflection

[Instructor Name]

[Date]

The program, the counselors and the seminar are composite; the implementation review, the home-based trial and the reflective model cited are real.

The Situation

The instructor described the composite case. Counselor B gave two weeks' notice for family reasons. Her sixteen active participants had completed between two and five of their eight visits. Counselor A already carried eighteen and had a waiting list. The agency could not hire a replacement for at least six weeks.

My First Answer

I answered first and quickly: transfer all sixteen to Counselor A, add phone visits to make room, and hire as soon as possible. It seemed efficient. Nobody would be dropped, and the program's numbers would hold. I had already pictured the next process report showing no lost participants, and I was a little proud of how quickly I had solved it. In hindsight, that speed was the problem: I answered before I had asked a single question about the sixteen people involved.

The Question That Undid It

A classmate who works as a hospice social worker asked what the participants had been telling Counselor B. Many of them, she said, would have talked about grief, loneliness or conflicts with their children, things they had told no one else. A new counselor arriving with no warning, by phone, to a caseload she could barely manage, would not be the same program. Some participants would simply stop answering. She described a woman in her own caseload who had told her about a son she had not spoken to in ten years, and who had refused to see anyone else when that social worker went on leave. The relationship, she said, was not a side effect of the program; for many participants it was the reason the program worked.

Another classmate, who manages a home care agency, added that Counselor A's caseload would rise to thirty-four, nearly double the planned eighteen, and that the program's own fidelity plan would show her visits slipping within weeks.

My answer protected the program's numbers, but it treated a relationship built over several home visits as if it were a file that could be handed to someone else.

What the Group Proposed Instead

The group worked out a different plan. Counselor B would use her last two weeks for a closing visit with each participant, introducing Counselor A by a joint phone call where possible. Participants with five or more visits completed and improved scores would finish with two monthly check-in calls rather than full visits. Those with fewer visits or higher scores would transfer to Counselor A in order of need. The psychiatric consultant would review all sixteen cases in a single extra session. And the agency would ask the mental health center whether one of its clinicians could take four cases temporarily.

What Changed for Me

I had been thinking about continuity in terms of whether people kept receiving sessions. The seminar taught me that continuity in this kind of program means continuity of a relationship, and that a transfer needs to be planned with the participant, not done to them. The model the program follows depends on trust built over repeated home visits (Ciechanowski et al., 2004), and implementation research notes that staff turnover is one of the most common threats to delivering a program as designed (Durlak & DuPre, 2008).

Gibbs's reflective cycle asks what else I could have done. I could have asked about the participants before proposing a solution, which is what the hospice worker did (Gibbs, 1988). The analysis stage also made me see that my answer was shaped by the course's emphasis on fidelity and dose, which are easy to count, rather than by what participants experience, which is harder to measure but just as real.

What I Will Do Differently

When a program faces a staffing problem, I will ask first what the people receiving it will experience, and second what the numbers will show. I will also suggest that implementation plans include a transition plan for staff departures before one happens, with closing visits and a ranking of cases by need. I would also ask counselors to keep short handover notes as they go, written with the participant's permission, so that a successor knows what matters to each person without having to start from the beginning.

An Unanswered Question

How could a program judge whether a transfer worked? Attendance after the transfer is one measure, but it would not show whether participants felt as able to talk to the new counselor as to the old one.

References

Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., Kulzer, J., Gray, S., Collier, C., & LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA, 291(13), 1569-1577. https://doi.org/10.1001/jama.291.13.1569

Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3-4), 327-350. https://doi.org/10.1007/s10464-008-9165-0

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.