Here are the readings that need to be incorporated in the assignment.

�e Journal of Sociology & Social Welfare Volume 25 Issue 4 December

Article 5

June 2015

Termination: Extending the Concept For Macro Social Work Practice Marcia P. Harrigan Virginia Commonwealth University

David P. Fauri Virginia Commonwealth University

F. Ellen Ne!ing Virginia Commonwealth University

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Recommended Citation Harrigan, Marcia P.; Fauri, David P.; and Ne;ing, F. Ellen (2015) "Termination: Extending the Concept For Macro Social Work Practice," �e Journal of Sociology & Social Welfare: Vol. 25: Iss. 4, Article 5. Available at: h;p://scholarworks.wmich.edu/jssw/vol25/iss4/5

Termination: Extending the Concept For Macro Social Work Practice

MARCIA P. HARRIGAN DAVID P. FAURI

F. ELLEN NETTING Virginia Commonwealth University

School of Social Work

This article identifies the ways in which macro practitioners manage and respond to termination issues in organization and community arenas. To conceptualize and partialize problems related to termination, the authors developed a typology in which the purposes, roles, and tasks related to macro termination situations are identified and grouped by three levels of practice: The Technical; The Managerial; and The Institutional. Within each part of the typology the needs are articulated, objectives of the macro practitioner identified, and the role of the practitioner explicated. Several exemplars and an integrating vignette illustrate termination concerns, dilemmas, and the complexity of macro practice with the intent of recogniz- ing the opportunities and constraints presented by issues of termination within macro practice.

Introduction Macro practitioners face multiple termination issues with

groups, organizations and communities. Planned change requires careful attention to termination so that change is "institution- alized" or "stabilized". Little attention is paid in the literature, however, to the role of the macro practitioner in overseeing the micro practice use of termination. Finally, there are serious voids in the literature about the application of knowledge and skills of termination to professional staff dynamics and the empowerment of groups and communities. The primary purpose of this article is to identify the many ways in which macro practitioners are responsible for responding to termination issues in organization and community arenas. We contend that the macro practitioner

62 Journal of Sociology & Social Welfare must take a proactive stance to address termination issues at multiple levels within an organization.

Background The concept of termination is well developed in micro social

work practice as a term either to understand human behavior or to use as a phase of the intervention process. In human behavior ter- mination relates to attachment and separation, and/or grief and loss, constructs essential to client assessment and intervention (Woods & Hollis, 1990). As a phase of intervention, termination is a concluding step between client and worker. It includes specific objectives and tasks for both social worker and client(s) and is typically planned for during the initial phase of intervention as essential to the working contract (Hepworth, Rooney & Larsen, 1997). Recently the micro practice and generalist practice litera- ture has presented termination as needing differential application to reflect variations in interventive problems/goals, modality, and length of intervention (Compton & Galaway, 1989).

Yet, in comparison to the micro practice literature, in macro practice termination as an interventive phase has been over- looked or merely underdeveloped. For example, the most recent Encyclopedia of Social Work (NASW, 1995) and the immediately pre- ceding edition (1987) contain articles on "Termination In Direct Practice" but do not mention it in either macro or generalist prac- tice. While Tolson, Reid and Garvin (1994) discuss termination for generalist task centered practice across a range of client system sizes, their cursory discussion for communities and organizations (in contrast to individuals, families and groups) is striking. In the group practice literature Toseland and Rivas (1995) indicate that endings vary depending on whether the group's purpose is treat- ment or task. Task groups involve feelings at a lower level of inten- sity, and task group literature focuses on ending specific meetings rather than ending the group experience. Only one recent author was found who discusses termination at every level of generalist practice, using a problem solving framework (McMahon, 1994). While McMahon's discussion of termination as an interventive phase is applied to individuals, families, groups, communities, and organizations, the vast majority of examples focus on work with individuals, families, and groups. Consequently, a differ- ential emphasis prevails, perhaps leaving the reader to imagine

Termination in Macro Practice 63 more comprehensive applications in macro practice or to believe that this phase is less applicable when compared to micro practice.

Termination: A Macro Typology In order to conceptualize the complexity of termination in

macro practice, we have developed a typology based on James Thompson's (1967) concept of organizational levels. The pur- poses, roles, and tasks related to macro termination situations are identified and grouped by the level of practice at which macro practice occurs: The Technical Level; The Managerial Level; and The Institutional Level (see Table 1). In each level the focus varies: for the technical level it is to ensure that agency workers are able to fully address termination issues with their clients; for the managerial level the focus is the organization employee; and for the institutional level the focus is ensuring lasting change within the community and/or organization. In the following discussion, each section of this typology is introduced by a review of selected micro and/or macro literature followed by the identification of related objectives of the macro practitioner and the explication of the role of the practitioner. Exemplars illustrate termination concerns and dilemmas, with the intent of recognizing opportu- nities and balancing constraints presented by termination aspects of macro practice. A final vignette that integrates each part of the typology concludes our discussion.

The Technical Level The first category of the typology focuses on the facilitation

and oversight of employees in a social service organization's tech- nical core use of termination, assurance of resources, protection of the client in the face of unexpected project/service reduction or close down, and quality assurance. Facilitation of the technical core level requires the macro practitioner to understand the micro practice knowledge base and skills that relate to termination in the helping process. Examples of the macro role are used to illustrate this.

Facilitation and oversight of technical core use of termination. Net- ting, Kettner and McMurtry define macro practice as "profes- sionally directed intervention designed to bring about planned change in organizations and communities... [which includes]...

64 Journal of Sociology & Social Welfare

Table 1

Typology for Termination in Macro Social Work Practice

Practice Example Level Purpose Setting Focus

Technical Facilitation & oversight of technical core use of termination

Ensuring resources for appropriate services

Protecting client in face of unexpected project/service close down

Quality Assurance; MIS; caseload monitoring

Managerial Ensuring orderly & humane employee transitions

Managing task groups; teams

Agency; organization unit

Agency; organization unit

Agency: community

Agency; organization unit

Agency; human resource system

Agency; the loosely coupled organization

Contracting with clients

Program planning for length of intervention

Planned referrals; case reassessment; time share loss

Case status/ statistical reporting; utilization review; accreditation/ certification

Resignations; staff/program reductions; retirement/ promotion; gain/loss

Creating, rewarding & ending task groups or teams

continued

Termination in Macro Practice 65

Table 1

Continued

Practice Example Level Purpoose Setting Focus

Supervising diverse employees

Attending to employee motivation & morale maintenance

Change stabilization; refreezing change situation; transfer power and authority; ensuring continuity. Empowering clients: Preparing for transitions & self-governance; promoting growth and development

Agency; the loosely coupled organization

Agency; the loosely coupled organization

Community; organization; group

Recognizing and valuing diversity

Group decision making; beginnings & endings; replacement of leaders and key people

Ritual/ ceremony; formal minutes and reports; informal rituals; replace personnel; embracing a vision statement, charters, by- laws; securing on-going funding

activities [that] go beyond individual and group interventions but are often based on needs, problems, issues, and concerns identified in micro activities." (1993, p. 3). Macro practitioners are not often directly involved in termination with clients, but they must possess a basic understanding of termination as both

Institutional

66 Journal of Sociology & Social Welfare social work product and process and ensure professional practice that reflects this knowledge.

Hess and Hess (1989) refer to organizational influences on termination by stating:

... termination ... is shaped by the organization context within which social work intervention occurs. The organizational mission delineates boundaries both for the nature of the client problems addressed and the typical or preferred treatment modalities utilized. Intra-organizational and inter-organizational factors may also affect the timing and process of termination (pp. 653-54).

These organizational factors must be identified and influenced by the macro practitioner. Attention to the use of contracting with clients is one example.

Contracting typically addresses termination for the first time when the expected length of service is established between social worker and client (Hepworth, Rooney & Larsen, 1997; Northen, 1994; Toseland and Rivas, 1995; Woods & Hollis, 1990). Organiza- tional recognition, promotion, and support of contracting as both process and product is necessary. As process, establishment and oversight of practice standards ensures that termination occurs within a specified time frame. As product, the development and use of forms (contractual agreement form) and other record keep- ing items (checklists; closing summary outline) facilitate effective micro practice. Ensuring Resources. Termination necessitates the use of agency resources. Perhaps the most obvious resource is the micro prac- titioner's time to provide service to a manageable size caseload, which ultimately translates into costs per unit of service. If agency services become more limited due to cutbacks or downsizing, at- tention to termination rituals and tasks may need to be rethought as workers consider the limited service hours available for each client. When third party reimbursement for service is exhausted, social workers may not have time to recognize termination pro- cesses and may feel pressured more by administrative and economic imperatives than by practice wisdom or empirical evi- dence. An example may elucidate this.

A micro practice social worker in a community mental health agency suddenly terminated employment. Concerned that

Termination in Macro Practice 67 agency revenues were less than forecasted, the agency adminis- trator directed the receptionist to tell the former worker's clients that a new worker would contact them within a few weeks, so as to allow planning time and not disrupt other services. This response failed to consider the immediate impact of a worker's sudden and unexplained departure on clients. When this directive was over- heard by a micro social worker, it was challenged as unsound clin- ical practice related to termination (Hepworth, Rooney & Larsen, 1997). An alternative was implemented that resulted in incoming calls from these clients being dispersed among the clinical staff in order to assess each client's response to the sudden departure of the social worker and then to develop individualized plans. However, this approach altered caseload reassignment policies and necessitated worker time that was not always reimbursable. When the macro practitioner later reviewed revenue short-falls with the Board of Director's Finance Committee, the underlying negative circumstances were turned into a positive justification to increase funding from outside sources in order to protect clients from being harmed by such staffing crises. Finally, the macro practitioner provided leadership to develop new agency policy in the face of any future situations involving the sudden departure of a social worker that may lead to an unsound and unethical practice response.

Unexpected project/service close down. With the increasing unpre- dictability in funding, macro practitioners must respond to the sudden loss of micro practice positions or even entire service programs. Regardless of the level of practice, the values and ethics represented in the NASW Code of Ethics (1996) place client interests as primary. Abruptly withdrawing services violates this basic principle, leaving the macro practitioner with an onerous task. Strong advocacy for client needs, perhaps even couched in terms of legal rights, may be used to influence a funding source to delay withdrawal of funds in order to ensure completion of termination tasks. Contingency planning for abrupt termination also is essential. For example, maintenance of an up-to-date com- munity resource file of related services facilitates enactment of an emergency plan for case referral or transfer in the face of a service shut-down or worker termination. Referral and transfer in lieu of

68 Journal of Sociology & Social Welfare termination of services helps to address the crises and helpless- ness felt by workers and clients in the face of the unexpected (Hepworth, Rooney & Larsen, 1997).

Quality assurance; MIS; caseload monitoring. Another responsibil- ity of the macro practitioner is the collection, analysis and use of client data for fiscal accountability, for ensuring quality services, and for administrative and program planning (Netting, Kettner & McMurtry, 1998). With pressures for greater accountability there is increased attention to the evaluation of client outcomes and the need for empirically based practice (Bloom & Fisher, 1995). Macro practitioners must link this push for accountability with the needs and goals of the micro practice social worker who may feel increasingly burdened to produce more (seeing more clients with more complex problems while documenting greater client outcomes) with less (decreased number of reimbursable client contacts and fewer available hours due to larger caseloads). In order to meet these needs, the right questions must be asked to collect data efficiently. This requires that the macro practitioner express needs, expectations, and demands "of one system in the terms and concepts of another system" to make what Havassy describes as a "cross-system translation" (1990).

Evaluation of outcome is particularly important at the ter- mination phase. In fact, outcome data may signal the need to commence the termination process either due to lack of progress or due to the attainment of client goals (Bloom & Fisher, 1995; Hep- worth, Rooney & Larsen, 1997; Jordan & Franklin, 1995; Nurius & Hudson, 1993). The following example illustrates the use of client outcome data related to termination as well as the use of a MIS for monitoring to improve direct practice services.

In a public family services agency a quality service standard required that no more than a two week waiting period occur be- tween an initial client contact and the intake appointment. As re- ferrals increased and resources did not, caseload size for all micro practitioners increased. Unable to manage an increased number of clients, one social worker failed to close cases to which no services were being delivered or for which no progress was noted. While the intentions of the worker were good, i.e. to deliver quality service, underdeveloped skills in assessment of client outcome

Termination in Macro Practice 69 and poor caseload monitoring created workload inequity and ul- timately discontent among professional staff. More importantly, alternatives existed to assist the social worker in managing a larger caseload. Due to a management information system which yielded data to compare caseload size and activities among work- ers and units, this problem was identified during administrative review and addressed. In response, the social worker was pro- vided with case management training which included the use of tools to assess client outcomes and track client progress efficiently and ultimately to terminate appropriately. In turn, other workers participated in similar training leading to better client outcome as- sessment, better termination planning and implementation, and greater worker satisfaction.

The Managerial Level The second category of the typology focuses on the man-

agerial level. Macro practitioners are charged with conducting orderly and humane employee transitions; managing task groups and teams; supervising diverse employees; and helping employee with motivation and the maintenance of morale. All require at- tention to termination issues. We will address each of these areas, again using exemplars to illustrate major points. Ensuring Orderly/Humane Transitions. In today's world of rapid organizational change, individual longevity in organizations seems fleeting as workers assume new positions, move to new locations, witness downsizing, and brace themselves for unprece- dented change. Past expectations about tenure in one job or with the same human service organization are dashed as political cli- mates dictate rapid-fire work force reductions and organizational restructuring. While there have always been transitions as people enter and leave specific jobs, it is unlikely that there has ever been a more volatile time when occupants of jobs in all sectors of the economy have experienced such a rapid and untimely potential for job displacement. Smallen (1995) addresses this concern: "Job displacement, which resulted in the unemployment of 4.3 million people from 1985 through 1989 has a particularly devastating effect on the disenfranchised populations typically served by social work" (p. 533). She indicates that social work interven- tion has been tied to plant closings and unemployment, and

70 Journal of Sociology & Social Welfare identifies ways in which social workers can assist those persons laid off, terminated or coerced into termination. With increasing displacement comes conflicts in the perception of social timing, particularly among cohorts of older workers who have made as- sumptions about projected career paths. "Today's older workers may have their self doubts about their once comfortable work- role identifications" (p. 535) and one's sense of life coherence and continuity in terms of both work and self identity may be sorely disrupted.

Within this increasingly complex environment there is rarely time to grieve what was or to even acknowledge the loss of that group, organization or community from which one has termi- nated. Social workers, perhaps in contrast to other disciplines, are positioned by their knowledge and skills in termination to maximize positive transitions.

Social workers themselves are subject to rapid and sweeping cutbacks and change and can face many of the same issues iden- tified by Smallen. A growing literature on privatization and the divesting of government commitments points out the "accompa- nying trend [in] the reduction of professional social work services in favor of managed care provisions ... creating an environment in which social workers have reported a higher level of burnout and lowered morale in general" (Motenko et al, 1995, p. 457). Social workers are being asked to document more, generate more fees, are losing peer relationships so important for consultation, and are being assigned unrealistically high caseloads. The macro social worker can not loose sight of what constitutes a humane response. Any action taken must reflect values of worth, dignity, and the primacy of the client and not merely respond to short- sighted external pressures.

In host settings where there are multiple professionals in- teracting, fears of termination can become all-consuming. For example, hospital social work departments are being disbanded in order to place individual practitioners with cost centers such as pediatrics and oncology. In turn, social workers are grieving over the loss of departmental identities and former managers of those departments (also social workers) are faced with uncertainty over what their roles will be. Over the course of a year, one such man- ager unexpectedly went from being the Director of Social Services

Termination in Macro Practice 71 to being in three different lower level positions as the hospital structure was repeatedly reorganized. This treatment, resulted in lower morale which negatively impacted work productivity. A simple but more humane alternative may have been to include the department head in decision making as new organizational imperatives arose.

Within this milieu, a major challenge for the macro practi- tioner is to try to establish a climate in which orderly and humane employee transitions can occur even though these changes may be precipitated by factors beyond both the employee's and the supervisor's control. For changes such as routine resignations, retirements and promotions there are typically established rituals involving gifts and farewell events. Organizations have norms and appropriate ceremonies for these partings. However, in the event of staff and program reductions, there are not always norms, precedents, and established rituals so that developing creative alternatives becomes imperative.

Not all termination situations are the result of employees tossed in a sea of political turbulence. There are situations in which employees can not, or do not, perform their jobs in an acceptable manner, and it is up to the supervisor to carefully assess what is happening. "When workers fall short of perfor- mance goals, an all-too-frequent response of some supervisors is to assume the worst about the intentions, motivation, and character of the 'offender'" (Lee & Cayer, 1994, p. 221). There are established procedures for dealing with persons who do not meet minimum performance standards. Typical steps include: informal talking or counseling, oral warning, written reprimand, suspension, demotion and reduction in salary, and termination (Lee & Cayer, 1994, p. 230). Macro practitioners must deal with employee disciplinary action and possible termination and assure that employees have access to these policies.

Managing Task Groups/Teams. The macro practitioner is often responsible for the creation, oversight, and participation of var- ious task groups and teams. Fatout and Rose (1995) identify various types of task groups including focus groups, adminis- trative groups, committees, delegate councils, teams, treatment conferences, and social action groups. Task groups and teams may

72 Journal of Sociology & Social Welfare be interdisciplinary and project-based, changing as the needs of clients and the agency change.

Sensitivity to group needs requires the macro practitioner to anticipate termination issues concerning group purpose and time commitment. For example, in an ad hoc team members expect to complete their tasks and then terminate. On the other hand, a team formed to oversee a long-term project will develop its own group identity and subculture, requiring a termination phase when the project is complete. It is important for the manager or supervisor to recognize when a group is having a difficult time with termination. In a changing work environment employees may indeed want to hold onto group experiences that have been positive and supportive. Fatout and Rose (1995) indicate that the ending of team meetings can be a positive experience in that a task has been accomplished, a report or series of reports have been issued and disseminated, and that there is a normal feeling of closure on a project. They also say that "team members should be informed about the decision to terminate or end and be involved in termination decisions related to both substantive and symbolic issues" (p. 60) all of which needs to be ensured by the macro practitioner.

Supervising Diverse Employees. In today's work force, it is critical to recognize the increasing diversity among employees including race, ethnicity, gender, sexual orientation, disability, age, religion, and profession (Cox, 1994). The meaning of work, work longevity, and work place identity have cultural determinants to be con- sidered when the macro practitioner identifies and responds to employees facing termination. It takes skill and insight on the part of the macro practitioner when facing both tough termination issues and unique individual and cultural differences.

Thomas (1991) has written about race and gender diversity in the work place. For example, a female employee may per- ceive termination handled by a male supervisor as inappropriate if he does not communicate in a gender sensitive manner. By attempting to be highly "professional" and "to the point", he may explain that she has been laid off without entertaining her need to verbally process how this feels. The different lenses each person brings to the situation can lead to mis-communication in

Termination in Macro Practice 73 the face of an already difficult situation. He may assume that she would be embarrassed to state her feelings and thus provides an opportunity for her to leave quickly. She may see him as unfeeling and devaluing of women. As work place diversity continues to increase, it is imperative that the macro practitioner continually expand a culturally specific knowledge base in order to respond to termination issues with cultural competence.

Attending to Employee Motivation & Morale. Attending to em- ployee motivation and morale is an ongoing process for the macro practitioner. As employees increasingly encounter organizational downsizing and out placement, they are subjected to loss at sev- eral levels. For example, team spirit and work place friendships are lost when employees are terminated, and for those who re- main, a sense of job insecurity may arise. The macro practitioner recognizes and responds to these losses not only because it is the humane thing to do but also because, if left unattended, they can lead to decreased productivity and effectiveness. In addition, macro social workers must recognize and deal with their own feelings about changes in their work settings.

An example of a large public welfare agency, which experi- enced rapid change when a new governor assumed office, points out management level termination issues. The social work man- ager heading a social services unit was aware that many of the persons in leadership positions had been appointed by a previous administration and would be subject to dismissal as the new governor placed his appointees in strategic positions. There were widespread comments that "things would change" and rumors were circulating in the hallways. The culture of the organization was changing in that employees who had previously worked with their doors open, were closing them, and conversations among staff were whispered and seemed strained. The social work man- ager proactively used every opportunity to inform staff about what was going on in the agency. Even when decisions had not been made, information was presented in staff meetings so that staff would know why they had not heard of anticipated results of decisions. The manager also worked with the human resources and employee assistance unit to see what options employees would have in the event of rapid downsizing, a topic widely

74 Journal of Sociology & Social Welfare discussed in the media as part of the governor's approach to re- ducing the state budget. At the request of the social work manager, a support group of key staff was developed so that several units within the agency could benefit from the cooperation of various managers in the event of unexpected changes. The major thrust was to recognize how disconcerting it is when employees work in a climate in which they do not feel secure or valued as well as advocate for employee's rights.

The Institutional Level The macro change process has roots in the 1950s work of

Lippitt, Watson and Westley (1958) who used a systems approach to focus on the dynamics of planned change. It is noteworthy that their phases of planned change included two final ones: change being generalized and stabilized; and the helping relationship being ended or redefined (p. 123).

Major application of change process and social systems knowledge was made by Warren (1963) in work on community change. He adapted the social systems approach, applying it to community analysis, recognizing the subsystem categorization of a client system and a change agent system. While not neces- sarily intended solely for social work practice, this approach was tremendously important to the developing social work method of community organization and has continued to be reflected in macro practice.

Pincus and Minahan (1973) furthered the social work use of the change process from a social systems perspective in their text on generalist practice. In the 1980s the systems approach to change was further developed as the basis for the popular planned change text by Kettner, Daley and Nichols (1985) who in the final chapter specifically addressed the stabilization of change. More recently, a systems approach to change is reflected in the 1998 text by Netting, Kettner and McMurtry, but since this work was not intended to address the change process beyond the problem analysis and strategy selection stages, it does not address termination or change stabilization. Change Stabilization. The concept of "change stabilization" found in macro practice literature is associated with "the termina- tion process," being the phase of the change process in which the

Termination in Macro Practice

macro practitioner ends the change effort. This is not commonly referred to as termination, but it involves ending the helping relationship while preserving the gains which were made. It is also referred to as "institutionalizing" the change.

The change stabilization process allows for closure of the change effort while the change agent or worker "terminates" from the change process, leaving the targeted organization or commu- nity in an improved condition. Associated with this purpose is the need for the practitioner to step out of the change setting so that the organization or community may fully own and integrate the change. Alternatively, a decision may be reached not to continue the change process because costs and benefits are out of balance or there are insufficient resources for continuation.

Ending the change effort involves tasks that ensure that the change is stable, accepted and institutionalized. The practitioner examines means of giving up the change agent role and com- pletely separating from the change setting. Alternatively, if the practitioner is an on-going member of the organization or com- munity in which the change took place, future activity must be restricted to an on-going, established role and responsibility to ensure that change is fixed with some other individual, position, group, or unit. This is a major factor in change theory-part of the "refreezing" (Lewin, 1951) of the system in the new state as the change continues without the change agent's presence.

In completing termination the practitioner reassesses the changes that have taken place to determine: (1) if the changes are those planned for; (2) if there are any unintended changes or consequences of the change effort that should be dealt with before the practitioner steps out; and (3) if the change is permanent by evaluating the level of acceptance of the changes to see if further work is needed. The ultimate question is: Should and can the change be permanent-that is, do benefits outweigh costs and are sufficient resources present to maintain the change? The possibility of non-continuance of the change is recognized as one alternative, and a decision not to continue, when it is the best course of action, is not necessarily seen as negative.

Empowering groups and communities. Empowerment is a tradi- tional goal or component of macro practice, particularly in

76 Journal of Sociology & Social Welfare community organization. In recent years empowering clients has gained new attention as a major theme for social work, although as Simon (1994) points out, it dates in social work to the Pro- gressive Era. Lee's (1994) recent work, for example, incorporates and identifies in a single model an "empowerment approach" for meeting oppression which includes work with individuals, families, specific populations, and groups as well as political and community practice.

Institutional level practice may include developing organiza- tion or community ability to make decisions based on a repre- sentational system, gaining and maintaining political power, and ensuring the decisions are implemented for the benefit of the orga- nization or community. The very process of decision making and implementation leads to further increases in competency, self- direction, and representational influence in community political processes.

The macro practitioner recognizes both instrumental and af- fective elements in termination, especially when it comes to em- powerment. Members of communities and organizations want to gain and use power to bring about a better life for themselves, and they also want to acquire and hold feelings of empowerment- to be part of the community and society, to be heard, and to have ability to influence public processes (Mondtos & Wilson, 1994). Termination provides the opportunity to review completed work, its stabilization and reinforcement of empowerment, and its institutionalization in organizations and community bodies.

Conclusion: Termination on All Fronts In conclusion, we offer the following vignette and then sum-

marize the levels in the typology we have presented as they appear in the vignette.

An innovative project is funded by a foundation grant to target frail elderly who live alone. It integrates case managers with primary care physician community-based practices. The project physicians, originally solo and small group practitioners, have just been hired by a large health care system. The project manager, a social worker, is aware that the grant is for a three year period and that the program becoming economically self-sufficient is a requirement of the grant.

Termination in Macro Practice

Careful plans are made to assure that case managers alert clients to the fact that this is a time-limited grant and that there is the possibility that service may not continue after three years unless other resources are located.

As the grant nears the end of the second year, the health care organization in which the project is housed undergoes tremendous change and 100 employees are laid off. Administrators change and the commitment to continue the project is lost. The project manager knows that the physicians have become very pleased with the work of the case managers and that clients express great satisfaction, but the new administrator says that "keeping people happy is nice, but I see no evidence that this intervention has decreased hospital utilization." The case managers begin job hunting, stating that "the handwriting is on the wall." Clients are expressing concern over rumors that the program will not continue, and finally the health care system administrator decides to return the third year of fund- ing because the project does not fit with re-engineered goals. The macro practitioner has to face issues related to personal job loss; premature termination with a funding source; termination of case managers; and ensure proper client termination from case managers and physicians.

Applying our typology of termination for macro practice pro- vides a way to conceptualize and partialize the problems in order to formulate plans for intervention, illustrating the importance of the termination concept in macro practice. At the technical level, micro practice termination issues are known to the macro practitioner when this case scenario begins. This is a three year grant, and there is always the possibility that at grant's end the project will not be self-sufficient or that what was learned during the grant period will change the intervention. Therefore, the practitioner ensures through agency policy that staff possess the knowledge and skills to inform clients that the contract is short-term and that their relationship may not continue after three years. Further, as time progresses and as new clients are enrolled in the project, decisions must be made in terms of when to cease enrollment. Aggregate client data for cases in which there was optimal outcome could be used to identify enrollment time parameters. These decisions require that the manager be as sensitive as the micro practitioners to client contracting and termination issues.

78 Journal of Sociology & Social Welfare At the managerial level of the typology, the macro practitioner

is enmeshed in multiple termination issues as the grant nears the end of its second year. Physicians have been pleased with case management services but evidence of decreased utilization is undocumented. How does the practitioner communicate with physicians so that they are aware of the problems inherent in continuing the program without damaging established relation- ships? How does the practitioner deal with staff who are feeling insecure in their jobs? Opening communication channels and fo- cusing issues so physicians and case managers each can commu- nicate their concerns with project administrators are management level strategies for helping people confront issues and remain committed. Another strategy involves working with the case management team to determine how to make changes in project monitoring so that outcomes acceptable to key decision-makers are highlighted. It is the responsibility of the macro social worker to provide the leadership and structure for this to occur as well as model the requisite communication skills.

Last, institutional level change is the very essence of this case example. The hope is that enough adjustments can be made so that case management will become part of this health care system's culture. The macro practitioner must apprise health care administrators about both the subtle, quality of life changes in individual client's lives and the potential benefits to the larger health care system. Preventing termination of the project may literally be dependent upon the practitioner's ability to advocate and negotiate with persons from other disciplines and reframe institutional level approaches to the change process.

Recognizing that termination is as much a part of macro prac- tice as it is of micro practice provides a rich opportunity to draw on and extend what social workers already know about termination. Skill in addressing the socio-emotional realities faced by workers in the midst of these issues is essential to contemporary practice.

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