Metropolitan Health and Human Services

Case Study

Metropolitan Health and Human Services


Metropolitan Health and Human Services (MHHS) is a mid-sized community-based health and human services organization operating in two suburbs of a large city. MHHS has been in business as at non-profit 501 (C) 3 for the past 25 years. The organization was founded by a group of three retired physicians who wanted to address some of the issues in their community. In the early years of the organization they focused on providing financial assistance to clients unable to pay for medical bills. At that time, the organization was managed and staffed by the three retired physicians who quickly realized that they were unable to fulfill their dreams for the organization without help. Within five years of its inception, the organization was incorporated with its own board of Directors and the first CEO was hired. This CEO ran the organization for the next 10 years, and grew the organization from one program to a multi-service organization.

The Mission of MHHS is provide services needed to strengthen families and communities.

The vision is to known as a major catalyst and resource for promoting family and community strengths.

Current Programs of MHHS include:

Financial Assistance: Provides financial assistance to individuals and families that have suffered a financial crisis and need assistance with paying bills. This program employs one director and one case manager and represents 5% of the budget expenses. The program is funded through federal and state grants. The program has been operating at a loss for the past five years.

Medical/Dental Clinic: Provides free preventative medical/dental services to individuals and families that are either at poverty level or experiencing a financial crisis. The clinic is staffed by volunteer physicians and dentists. This program employs one director and one case manager and represents 10% of the budget expenses. There are six active volunteers. The program is funded largely through grants and community support. The program has been breaking even for the past five years.

Transitional Housing: Provides transitional housing to formerly homeless individuals and families in community-based apartments and homes. This program employs one director and five case managers, and represents 10% of the budget expenses. The program is funded largely through federal grants. The program has been operating at a loss for the past five years.

Counseling: Provides counseling services to any individual or family needing assistance. This program employs one director and five counselors, and represents 5% of the budget expenses. The program is funded through client and insurance payments as well as payments from other programs within the organization. The program provides services to all the programs within the organization and has been operating at surplus for the past five years.

Educational Services: Provides an alternative education to adolescents unable to attend their own school due to behavioral or emotional issues. This program employs one principal, two teachers and two teacher aides and represents 5% of the budget expenses. The program is funded by tuition payments. The program was previously operating with a surplus but in the last five years it has declined and is operating at a significant loss.

Foster Care: Contracts with the State to license and provide foster care services to wards of the State. This program employs one director, 10 supervisors, 80 case managers, and 10 case aides, and represents 55% of the budget expenses. The program is funded by the State. The program is considered the “cash cow” of the organization and is operating at a surplus.

Violence Prevention Programs: The programs provided prevention education services that target the prevention of child abuse, domestic violence and sexual assault. The program employs one director and three prevention educators. They also use volunteers and interns. The program represents 10% of the budget expenses. The program is funded through State and Federal grants and some community-based fundraising. The program is operating at a surplus.

Administrative Expenses are 10% of the organizations budget expenses.

About the community:

MHHS operates in two communities and has offices in both locations. Their main headquarters is in a large middle to upper middle-class suburban community about 30 miles from the large City.


· White – 76%

· Asian – 15%

· Hispanic or Latino – 4%

· Black -5%

· Median Age: 35

· Median Family Income: $127,000

· Median Household Income: $109,000

· Housing Value: $378,000

· Average Contract Rent: $1,300

· Persons in Poverty: 4%

The second location for MHHS is in a neighboring, lower middle-class community about 40 miles from the City.


· White – 27%

· Asian – 3%

· Hispanic or Latino -40%

· Black -20%

· Median Age: 33

· Median Family Income: $50,000

· Median Household Income: $42,000

· Housing Value: $150,000

· Average Contract Rent: $900.00

· Persons in Poverty: 22%

Demographics of Clients Served:

· 30% White

· 40% Hispanic of Latino

· 28% Black

· 2% Asian

The current organizational chart for MHHS is attached.

Current Size of Organization

The organization has an operating budget of eight million dollars. The main office is located in the upper to middle-class community and houses all of the administrative staff. Some of the services provided out of this office include financial assistance and counseling.

The remaining services are provided out of the office in the second location.

A new CEO has been recently hired and has identified some of the major issues the organization is facing.

Current Issues

1. In the past 10-years the organization has changed leadership 4 times. Only one CEO has stayed longer than three years. The other three have left within one year of hire. The new CEO is the first female the organization has ever had in a leadership role.

2. The board of directors is unclear of what their role is and often gets involved in day to day issues within the organization

3. There has been a decline in funding for financial assistance the organization.

4. The Medical/Dental clinic director has difficulty getting volunteers for the program and is unable to meet the needs of the clients being referred to the program. He has stated he just does not know how to recruit physicians and dentists to work in the program.

5. A client in the transitional housing program burglarized several apartments in his building and this has created a crisis for the CEO who must now respond to the community.

6. The Educational Services Director has just been informed that the schools referring to his program will not be using their program next year as they plan to offer these services within their setting. They have asked the organization leadership to assist them in getting started.

7. The State leadership has told MHHS leadership that they can no longer use foster care surpluses to fund other programs within the organization.

8. Case load sizes for foster care workers exceed 25 clients and case workers are starting to complain that it is impossible to do an effective job even with the assistance of the case aides.

9. The Director of the Violence Prevention Programs has been very successful at raising funds for her programs due to coordinating two major special events a year. She is frustrated that the surplus money she raises is being used elsewhere in the organization.

10. The CEO believes the organization should be restructured allowing for fewer direct reports to her.

11. The organization operates in Silos with very little interaction between programs (other than the counseling program)

12. The organization relies heavily on government funding.

13. The organization is facing a budget shortfall for the second year in a row.

14. There is no training program in the organization and as a result staff in programs all do things their way rather than in a consistent manner.

15. Record keeping of client services within programs is inconsistent. There are no policies and procedures on how records should be kept nor are there forms available to staff to use when providing services to their clients.

16. The staff lacks diversity with 90% of the staff being white, 5% African American and 5% Hispanic. 75% of the staff are females yet 90% of the directors (other than the CEO) are males. There is no training on cultural diversity.

17. About 10% of the clients serve speak only Spanish and the organization does not have any Spanish speaking staff. They rely on the client’s children or other relatives to translate for them.

18. A parent of a child being served In the educational program has complained to the Principal that her child is being bullied because he is gay. The school staff are dismissing the complaint stating the child is just overly sensitive.

The organization has been provided an anonymous gift of 300,000 to address the challenges they face.

You will be selecting a project to do during the duration of this class. You can propose your own project or use one of the suggested ideas below.

Possible Project ideas:

· Reorganize/restructure the organization with a clear designation of roles and responsibilities from the top down. Include an organizational chart using a program like Pingboard. Suggest what programs might be eliminated and/or merged. Re-create vision and mission statements and suggest and justify training for each role within the organization.

· Develop a comprehensive fund development plan/program. Include how this program will be managed and led

· Develop of comprehensive training program including orientation to the organization and program specific training.

· Choose a program and develop a program specific record keeping plan with forms and explanations of how to use the forms.

· From a human services provider perspective analyze the challenges you would face in working in one of the programs in this organization. Include the program you would work in and the challenge you would face at all levels on both a professional and personal level. Develop a plan to address these challenges.

· Develop a comprehensive plan to implement culturally sensitive practices within the organization. Include in the plan a recruitment and retention strategy for a more diverse workforce.

· Suggest a project of your own based on the case study.

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