California State University, Sacramento SW 140C: Social Work Practice SPRING 2010

Bart Phelps MSW, LCSW Office: 5045 Mariposa Hall Phone: (916) 764-1442 Class: Section 02, TR 9:00-10:15 a.m. MRP 1014 E-Mail: [email protected] Office Hours: M 5:30-6:30, Tuesday & Thursday 8:00-10:00 a.m. And by appointment.

Course Description This course focuses on the social work practice process and the building of generalist practice skills. Generalist practice skills are the core of social work practice at all levels (individuals, families, groups, organizations, communities, and society-politics). The social work process will be keenly examined and social work practice skills honed. Social work practice--relationship building, assessment, intervention, and termination skills--will be the primary focus of both SWRK 140B and SWRK 140C. SWRK 140B focuses on social work practice with individuals and families. SWRK 140C focuses on social work practice with families, groups, communities and organizations.

Both SWRK 140B and SWRK 140C emphasize practice within a diverse (age, gender, ethnicity, mental and physical ability, sexual orientation, religion/spirituality) society. This emphasis is supported by the NASW Code of Ethics which states that “Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, and mental or physical disability” (NASW Code of Ethics, 1.05c).

Required Texts

1.Kirst-Ashman Understanding Generalist Practice 2. Corey Groups: Process and Practice Use an older edition if available.

COURSE OBJECTIVES The course provides learning opportunities for students to develop or achieve the following course objectives: 1) Articulate and apply the generalist social work practice process and operating principles to practice with and on behalf of families across the lifespan, groups and communities. 2) Develop a critical perspective of the frameworks and theories utilized in multi-level social work practice with vulnerable populations for application in case management. 3) Apply the strengths, empowerment, and ecological frameworks when working with families, groups,organizations, and communities multi-level generalist practice. 4) Understand social work practice models and theories and apply these in classroom discussion and field settings with families (across the lifespan), groups, communities, organizations and large systems. 5) Further develop your personal and professional capacities and the ability to manage personal and professional boundaries (this includes demonstration of the ability to apply the values and ethics of social work as articulated in the NASW Code of Ethics) in your work with clients, groups, communities, organizations, large systems, and colleagues. 6) Develop and demonstrate the ability to engage with culturally competent practice skills in all phases (engagement, assessment, planning, intervention, ending, and evaluation skills) of the social work practice process with diverse client systems (for example; LGBT, immigrants, older adults, etc. 7) Increase relationship building capacities and further develop culturally competent communication skills in working with client systems. 8) Further develop understanding of the forms of oppression and social injustice in the lives of clients systems. 9) Understand issues of micro, meso and macro assessment and intervention. 10) Understand and develop skills for program development, assessment and evaluation. 11). Further develop understanding of organizations within an ecological perspective including the process of identifying existing and needed resources in response to emergent and unmet client needs. 12. Further develop and demonstrate the capacity to use supervision and consultation for advancing self awareness, application of social work knowledge, values and skills in working with diverse client systems.

Course Format This course is a learning-doing class in which a variety of teaching and learning methods are used. These include lecture, discussion, experiential exercises, group work, video and audio material, and case studies. The instructor implements cooperative and collaborative learning processes as the primary engines for learning. It is important to realize that this is not a lecture, note taking, and multiple choice type of course. This is a social work practice course and demands your active engagement and participation for successful completion.

Cooperative and collaborative learning are dependent upon student preparation and active participation. There will be a significant amount of reading and critical thinking involved in this course. Students are expected to have read all readings and complete all assignments before the class session for which they are assigned. It is critical that each student be active in cooperative and collaborative learning exercises and class discussion. Each student member of this course carries an especially important responsibility for being prepared and for participation given that we meet only five times throughout the semester.

As a guideline for organizing your workload, note that it is standard educational expectation that students spend 2-3 hours outside of class time “studying” for every hour spent in class. It is expected that student class members spend 6-9 hours a week working with the material in preparation for our class meetings.

As a member of the classroom community, all students will lead and participate in group discussions, class exercises, and experiential exercises. This requires that all students attend every class from the beginning to end of each class session. Students grades will be lowered 10 points per missed session after 2 classes.

Given the integrative nature of our Division’s practice course with field experience, it is important that students bring to class experiences from their field practicum and other human services experiences. Following social work ethics and values, it is important to note that all in- class practice examples and case presentations are bound by the rules of confidentiality.

Assignments

GENOGRAM/FAMILY JOURNAL (20% of grade) DUE DATE: Thursday 2/25/10 Students are expected to compose a genogram of their family representing at least three generations. This assignment is intended to be both instructional and enlightening, which is the reason I am asking you to use your own family. If completing this assignment using your family is not possible, you may choose to interview someone and gather information regarding three generations of their family. The basic format of a genogram is to draw a family tree, females are represented by circles, males by squares, and triangles represent an unknown gender. See Chapter of your text. Marriage is indicated by a solid horizontal line connecting 2 individuals, a solid horizontal line with 2 hash marks indicates divorce. Children are indicated by lines coming from underneath the line between the parents. Death is indicated by an "X" through the individual’s name. Most genograms indicate the dates of birth, death, marriage, and divorce, however, there is no standard format for indicating whether a date means birth or death or divorce. This will be left to you. It will also be left to you to come up with symbols or abbreviations which indicate ethnicity (if different from the rest of the family), sexual orientation (gay), mental illness (indicate diagnosis if possible), substance abuse (name substance if possible), spirituality/ religion (specify if possible, this may include conversions over a lifetime), physical/medical problems, and education level. This is a very detailed genogram--and it is not expected that you will have reason to include ALL these categories when you are practicing, or that you will be able to include ALL this information on the genogram itself, however, this exercise is intended to make you aware of the many different aspects of an individual's life which could be represented on a genogram. This exercise will also acquaint you with different symbols that come to YOUR mind to indicate different aspects of an individual’s life. For example, pink and black triangles are well known symbols for gay men and women, you might want to choose a small triangle to indicate a gay identity. A red cross could indicate chronic illness. These decisions are yours, however, you will also need to include a legend indicating what all the symbols and abbreviations mean. Please attach a short (very short) narrative that includes all the information that you could not include in the genogram itself, i.e. if you were not able to fit education level and physical/medical problems in the genogram, attach a very brief narrative that includes this information about all the family members. Genograms are assessments in visual format—keep them as visually easy to look at as possible—no long narratives—do not worry about complete sentences here. In addition to the genogram, you will need to thoughtfully complete the Family Journal (page 105 in Family text). Not unlike the 1st assignment last semester, these are personal questions, I am requesting you give them each a lot of thought and answers should reflect insight about yourself and your family. GROUP MEETING (20% of grade) DUE DATE: Tuesday 3/23 Presentation/Paper. Students will attend a group meeting, i.e. alcoholics anonymous, Al-Anon, Al-Ateen, narcotics anonymous, a codependency group... Students will need to identify a particular kind of group (or talk with the instructor) to allow for diversity in presentations. The paper should be approximately 5-7 pages long, describing your reflections of the meeting i.e. leadership style, how would it feel to be a group participant, cohesion in the group… In addition the paper should examine some “practical considerations” Corey & Corey discuss in Ch 4: homogeneity, duration of the group, location, size… The presentations will be informal and will be included in the integrated seminar section of the class (spread throughout the semester). AGENCY ASSESSMENT (25% of grade) (April 17th) Students will write a 7-10 page paper (not including a cover page and reference page) assessing their field placement agency. The framework utilized to assess families, a small system, can be used effectively to assess agencies and organizations. In particular, students are asked to use the Hepworth, Rooney, Rooney, Strom-Gottfried, and Larsen’s (2005) Family Assessment framework (Chapter 10) gather data on their field placement agency. For example, agencies with ineffective communication patterns are as dysfunctional as family’s that have poor communication patterns. Once you understand the basic principles involved in family assessment—you understand the basic principles involved in agency assessment. This assignment is intended to help you assess not only your current placement—but will hopefully help you assess your future employment opportunities. We have few choices regarding our families of origin—we can, however, choose where we work. It is my hope that this assignment will help you choose wisely. The paper is to be typed, double spaced, and written using APA format. At least five references from course readings should be included in your paper.

Final Project—due the last 3 class sessions GROUP ORGANIZATION PROJECT (25% of grade) Students will divide into groups of four for the final presentation. Groups will be expected to make a presentation on a organization. Organizations will include: Ben & Jerry’s, Glide Methodist Church, Southern Poverty Law Center, and Graystone Bakery. (2 Groups will present on an organization, 1 group will present on an international organization)

The presentation should include: A history of the organization: describe the beginnings of the organization, events which served as turning points in the organizations and possible geographic influences (i.e. coastal or mountain city).

Identify the factors which solidify as well as fragment the organization.

Examine the power structure within the organization, discuss any power struggles both past and present.

Describe how this organization “resides” within the community (geographic, social service, corporate, cultural…)

The presentations will take place on the last two class sessions; presentations should last approximately 75 minutes. Groups are encouraged to use a variety of mediums to present the community to the class (i.e. video, oral presentation, role play or reenactment of a community ritual). This assignment is a presentation with a copy of the outline given to the professor. There is NO written paper

GROUP COMMUNITIES PROJECT (25% of grade) Students will divide into groups of four for the final presentation. Groups will be expected to make a presentation on a "community." Communities could include: The Castro, Haight Ashbury, or Hunter's Point. Communities are not always geographic in nature, i.e. the deaf community or the sex trades community, could also be examined. (2 groups will present on a community) The presentation should include: A history of the community: describe the beginnings of the community, events which served as turning points in the community (i.e. World War II or a natural disaster such as a flood or earthquake), and possible geographic influences (i.e. coastal or mountain city).

Describe the day to day life within the community today.

Identify the factors which solidify as well as fragment the community.

Examine the power structure within the community, discuss any power struggles both past and present. Describe the procedure a member of the community would follow if they had a problem.

Include an examination of social services which exist within the community. Look at how social services came into existence (i.e. from the federal or state government-- outside the community or were services created at a grassroots level). In speaking with key informants, discuss the effectiveness of the current services and what could be done to improve services in the future. Look for possible obstacles both inside and outside of the community to improved services. Identify the service which could most benefit the community, which is currently unavailable; discuss why it is unavailable and what needs to be done to implement the service.

The presentations will take place on the last two class sessions; presentations should last approximately 75 minutes. Groups are encouraged to use a variety of mediums to present the community to the class (i.e. video, oral presentation, role play or reenactment of a community ritual).

Grading of the presentation will be based on 3 criteria: 1) creativity and originality- 25 points, 2) organization and preparedness-25 points, 3) content-50 points

Although it is expected that some information can be found on the internet—it is expected that most of the material presented would come from other sources—books, interviews, personal impressions…. Also—it is a requirement that all group members visit the community.

Papers Except for the genogram and family journal, all papers are expected to be in APA format. This means citations are expected, even from brochures, personnel policies and personal communications (interviews). My definition of plagiarism is using someone else's thoughts or ideas without citing the source. Any more than 3 exact words in a row that are taken from a work, need to be put in quotation marks and cited. Any paper that is plagiarized will result in failure of the class and possible dismissal from the university. Papers are expected on their due dates, late papers will be penalized 5 points per day. PLEASE ALWAYS keep a copy of any assignment you turn in.

CLASS AGENDA

Week 1 1/25 Syllabus review Families-Assessment Kirst-Ashman Chapter 9

Week 2 2/01 Families-Assessment Family Interventions Kirst-Ashman Chapter 9 Thomlison Chapter 4* Week 3 2/08 Families—Interventions Kirst-Ashman Chapter 10

Week 4 2/15 Families--Interventions

Week 5 2/22 Families--Interventions *Family Assessment (genogram/journal) Due 2/25

Week 6 3/01 Groups: Introduction, Ethical and Legal, Forming a Group Corey/Corey Chapters 1, 3, & 4 Class Exercise

Week 7 3/08 Groups: Beginning, Middle and Ending Phases of a Group Corey/Corey Chapters 5, 7 & 8

Week 8 3/15 Groups: Children, Adolescents Corey/Corey Chapters 9 & 1

Week 9 3/22 Groups: Adults and Elderly Populations Corey/Corey Chapters 11 & 12 Group Meeting Assignment Due (twelve-step, support group…) 3/23

Week 10 3/29 Spring Break

Week 11 4/05 Organizations Brueggemann Chapters 9 &10 Class Exercise

Week 12 4/12 Communities Brueggemann Chapters 5 & 6

Week 13 4/19 Communities Brueggemann Chapters 7 & 8 Agency Analysis Due 4/20

Week 14 4/26 INTERNATIONAL ORGANIZATION PRESENTATION Global Social Work Brueggemann Chapters 15

Week 15 5/03 ORGANIZATION PRESENTATIONS

May 16 5/10 COMMUNITY PRESENTATIONS ORGANIZATIONAL BIOPSYCHOSOCIAL Students will write a 7-10 page paper assessing their placement agency in much the same way we assess families. Utilizing Hepworth, Rooney and Larsen’s Family Assessment (Chapter 10) gather data on your placement agency. A handout on family assessment detailing family roles, rules, boundaries, communication patterns…should be utilized to determine the roles, rules boundaries…which exists within your placement agency. Agencies with ineffective communication patterns are as dysfunctional as family’s that have poor communication patterns. Once you understand the basic principles involved in family assessment— you understand the basic principles involved in agency assessment. This assignment is intended to help you assess not only your current placement—but will hopefully help you assess your future employment opportunities. We have few choices regarding our families of origin—we can,however,choose where we work. It is my hope that this assignment will help you choose wisely. Hepworth, Rooney & Larsen Chapter 10 Assessing Family Functioning OVERRIDING CONCEPTS WHICH GUIDE ANALYSIS OF FAMILIES AND ORGANIZATIONS Homeostasis A unit’s attempts to maintain and preserve balance. Families and organizations develop similar mechanisms to maintain balance. Behavior is restricted when balance is threatened (not unlike a thermostat that governs the temperature of a room.) Homeostasis can be threatened by the normal course of events. Within a family: children mature and old rules are no longer appropriate. Within an organization: new funding regulations mandate a revision of services. Homeostasis can also be threatened by unusual events. Within a family: death or divorce can shift emotional and economic stability. Within an organization: budget cuts can force employee lay-offs. Families as well as organizations will rely on established patterns to return to homeostasis when balance is threatened. In both cases, these patterns can be functional and dysfunctional. It is vital that social workers identify the variables involved in both healthy and unhealthy responses to threats to balance within families and organizations.

Rules Rules govern the actions, rights and duties of family members and personnel. Rules dictate appropriate behavior and can be implicit (unwritten or unspoken) or explicit (written or spoken). Social workers are most often interested in implicit rules, these are the rules that cause the most emotional damage and limit the ability to accommodate change. Because implicit rules are not stated or written their enforcement, often goes unrecognized and the proceeding damage often goes unstated. Families and personnel seem to propelled by unseen forces, adhering to rules they are not aware of, hence perpetuating the problem—which they will often complain about. Rules are crucial to the operation of a successful family and organization. Rules can be based on culture, religion, laws, policies, tradition, or efficiency. Rule Violations When rules have been broken, the system tries to bring the system back into balance by reinforcing the rules. This usually includes words like: “should,” “ought” and “don’t.” The emotional aftermath of rule violations can include: anger, depression and withdrawal. It is important to note how rule violations are handled in families and organizations. Rule Flexibility Optimally families and organizations are flexible enough to accommodate changes within their systems. This can be observed in looking at how a family or an organization adjusts to changes. Successful responding to a changing world requires changing of the rules. Families and organizations that find themselves in conflict and can be characterized by low morale, have encountered an accumulation of events which have strained the systems coping mechanisms. ORGANIZING THE DATA YOU COLLECT IN A FAMILY/ORGANIZATIONAL ASSESSMENT 1) Family Context Looking at the family unit within the context of a larger system, includes race, ethnicity, sexual orientation---oppression, discrimination, and resources. How is family defined? What are family traditions? Are traditions shared by others within the community share? (Kwanza, Christmas, Solstice, Pride, Yom Kippur, New Year…) How is family defined? Do behaviors fall within cultural norms? Example: Children growing up with lesbian parents will have a different experience if they grow up in Berkeley, CA or Dallas, TX or Ardmore, OK.

1) Organizational Context Looking at the organization within the context of the larger system (non-profit, for-profit, public/private). The racial- ethnic, gender, sexual orientation…make-up of the staff, clients, management, and boards. A non-profit agency that is funded by United Way is contextually different from a public county agency, which is contextually different from a corporate for-profit organization. How is the organization defined (usually found in mission or vision statements). Do the people employed at this organization reflect the clientele (ethnic, gender, sexual orientation...) Cultural norms of the organization (religiously based, issue based, politically based…) Example: Catholic based organizations have a different culture than a public organization.

2) Family Strengths Discovery could be a difficult task--most families dwell on the problems in search of a "cure." Families strengths and resources can include: family history, traditions, their hopes and dreams, even their help-seeking behavior. Example: Mother and/or father have a trade/profession or children are in good health.

2) Organizational Strengths Looking at the strengths the organization brings to the community. History and tradition of service and contributions to the community. This can include: fiscal stability, being viewed as “the expert” in the community, or a central location. Example: A national organization such as the Salvation Army has different strengths than a local county-owned shelter.

3) Family Boundaries and Boundary Maintenance These are abstract dividers between family members and between family members and the environment. Boundaries should change over time as children grow and family evolves. Are boundaries in flux? Example: Children over six years old can take part in family therapy; children under four usually do not participate in family therapy. External Boundaries--Open systems allow the outside world into the family; closed systems strictly regulates outside elements from entering family system. Example: A family may have an open system with some closed system elements such as restrictions on computer internet and cable television. Internal Boundaries--husband/wife, child/adult, sister/brother---these subsystems are vital to the health and well-being of the family. Example: In a family where a parent has substance abuse issues, children can often have adult roles and responsibilities. 3) Organizational Boundaries and Boundary Maintenance How does the organization share information, within the organization and outside the organization. What is the degree of interface between departments? How is information transmitted to other organizations and to the community? Are there inter- agency agreements? Does the funding source require collaboration? How have boundaries changed with the use of technology within the agency? External Boundaries—Open organizations allow a free flow of information both in and out of the agency. Information regarding clients is almost always restricted (closed) however, dissemination of information regarding agency rules, policies and standards can be indicative of an open organization. Example: Is the organization part of a coalition? Does this organization have any inter-agency agreements? Internal Boundaries—Professional/non-professional, salaried/waged, supervisor/employee… while some boundaries are blurred at times, boundaries between personnel based on wages and job responsibilities are necessary for the structure of the organization and individual expectations. Example: If an executive director occasionally empties the trash, it can indicate humility and teamwork to colleagues, if a salaried employee is expected to work overtime with no compensation, it can be oppressive and exploitive.

4) Family Power Structure The construct of power is shaped by culture and neighborhood. External forces (oppression, culture, religion) helps define internal power structure. Roles and rules are how families maintain behaviors within acceptable limits. Shifts in the balance and distribution of power, brings people into contact with social workers: death, stepfamilies, divorce, unemployment... Example: What happens when a family member breaks the rules and behavior exceeds acceptable norms?

4) Organizational Power Structure Agency policies and standards are how organizations maintain behaviors within acceptable limits. The organizational structure, governing body (board of directors, advisory committee…) funding mandates and personnel policies, all contribute to an organizational power structure. The construct of power within the organization is defined by the management style and philosophy of the agency. The distribution and balance of power can be overt or covert. Performance measures can be driven by external and/or internal organizational forces. Example: Does the agency have an executive director? How is the executive director hired/fired? Does the executive director sit on the board of directors? Is he/she a voting member of the board of directors?

5) Family Decision-Making Process Families range in extreme from leaderless decision making, to democratic decision making, to absolute power in decision making. Decision-making approaches usually change over the life of the family. Example: Who makes decisions regarding social events? Bedtimes? Allocation of money? 5) Organizational Decision-Making Process Organizational leadership styles vary widely, even within the same organization. Some supervisors are more autocratic than others, while some are more participatory, while others are more lasses faire. Some agencies have begun to include client participation in decision-making. As an organization grows and ages, decision-making styles usually evolve and change; older agencies have a tendency to become entrenched in old decision-making models unless innovation is coerced by a compelling influence. Example: Does the agency have regular scheduled case staffings where case workers can bring difficult cases? Are clients or family members represented in these staffings?

6) Family Goals Goals of families can be culturally or societally proscribed as well as individually driven. Goals may be openly stated or covert: "We want to maintain the old customs" or "We want to be at the top of the social ladder." Family goals may conflict within the family or between the family and the environment. Example: A common conflict of family and career goals takes place when a parent who has a demanding job also wants a high level of family interaction.

6) Organization Goals Goals of the organization can be culturally or societally proscribed, as well as individually driven by a power broker within the organization. Organizational goals can be overt as well as covert. Organizations goals are often combinations of societal expectations, program mandates, target population needs, and environment and funding logistics. Example: Many organizations addressing substance abuse, hold abstinence as the only successful outcome, while others subscribe to a harm-reduction model, where individual progress in reducing self or other/societal harm is the goal.

7) Family Myths and Cognitive Patterns Shared perceptions within a family maybe shared by neutral outside observers or maybe distortions of reality. Internalized prejudice may also be a part of a family's distortion of reality. A family often defines itself based upon lineage, gender, sexual orientation, culture…this picture is often compared to the larger society. Example: The Randolphs have always been poor, but they have always maintained a good reputation by their honesty and hard work.

7) Organizational Myths and Cognitive Patterns Many organizations have an epic, myth or story of the organization’s development. Some organizations publicize the story of the organization’s roots in the agency brochure or a plaque on the wall. Other organizations pass their history down in the

form of oral narrative to the personnel. The publicized organizational history has a tendency to be biased in the direction of a positive organizational image. Example: The founder of the Salvation Army, William Booth, had a vision from God for the creation of “an army of God.”

8) Family Roles Roles within the family are assigned in a number of ways: chronological status, gender, legal status, societal or cultural status. Each family member has a number of roles both inside and outside of the family. Roles and role expectations are influenced by family and societal socialization. Example: A working wife and mother has a number of roles to fulfill at work, home, school, socially…all of these demands can conflict and at times feel overwhelming, as well as contribute to sense of belonging and well-being.

8) Organizational Roles Roles play out in a number of ways within organizations. Personnel roles are often defined in the program or job description. Titles and job responsibilities are the most obvious realm of roles within an organization, however, personal and social roles also play a part in organizations. Organizational roles will often acknowledge and accommodate an individual’s social or familiar roles (flexible schedule to accommodate a sick child or little league practice). It is also common for employees to act out their family roles within the workplace (an oldest child has more authoritative personality characteristics than youngest children). Example: Organizations can be very “traditional” in the roles of employees: female administrative assistants, male supervisors, immigrant custodial staff, while other organizations have a mix of genders and ethnicities in all roles.

9) Communication Styles and Family Members Cultural norms often dictate the level of open honest communication allowed within a family. Social work as a profession, however, values open expressions of feelings. It is vital to recognize that not all individuals hold honest self-expression in such high regard. Family members convey messages both verbally and nonverbally, it is essential that all forms of communication are identified. Example: When interviewing a family, note which family member speaks first, who “defines” the problem, the seating arrangement, who cries, who makes jokes…

9) Organizational Communication Styles Organizational culture as well as agency policies dictate how information is passed within the organization. Information transmittal is both formal and informal (inter-office memo and the water cooler). Organizational meetings may or may not have minutes, if minutes are taken they may or may not be “approved” and distributed to the staff. Some organization’s communication styles have a tendency to be more informal, even folksy, while other organizations endeavor to have a written record of all communications. Currently most organizations do not have a “policy” surrounding email communications, this form of communication fluctuates between formal and informal in most organizations.

Organizational communication styles extend to communications with the public as well. Organizations can communicate with the public via press releases, public meetings, brochures or educational material. Example: Communications styles within an organization are never more vital than in termination of personnel. How are individuals fired? Is there a mandatory employee review at designated intervals? Is there an appeal process? 10) Family Life Cycle Carter and McGoldrick (1988) identified six stages of family development: 1) unattached young adult, 2) new couple, 3) family with young children, 4) family with adolescents, 5) family launching children, and 6) family in later life. Each of these stages offers special challenges which individuals and families must navigate. There are variations in family life cycles depending on culture and family composition. Example: Culture as well as cost of living will often define when an adult child leaves the family home to establish their independent household.

10) Organizational Life Cycle Using a variation on the stages of family development, organizational development can be framed as 1) pilot or demonstration project, 2) new organization, 3) niche within the community, 4) an established reputation, 5) entrenched within the community, 6) reestablishment of organization within changing community or dissolution of organization. Example: Hospices in the United States were privately funded until 1985 when Medicare began to reimbursement for services. Many hospice organizations failed during this time period due to a failure in reliable funding. Currently palliative agencies are facing the same dilemma, their continued existence demands a stable dependable funding source.