March 15, 2004
Bigger. Better?
By Jess Kilby
Practically every Maine resident has heard of Sweetser. The sprawling social services organization encompasses more than 50 locations around the state, employs 1,200 people and serves 16,000 clients a year, from children with autism or learning disorders to adults coping with mental illness. It's Maine's largest mental health provider and the fifteenth largest employer in the state, with an annual operating budget of $56 million. The agency just completed a yearlong celebration of its 175th anniversary, an event that was feted with ongoing coverage by media across Maine.
But it wasn't always this way. Just a few years ago, the organization ˆ which can trace its lineage back to the Female Orphan Asylum of Portland, founded April 1, 1828 ˆ bore a much closer resemblance, at least in size and geographic reach, to the organization of its founding; until 2000, it was still known as Sweetser Children's Services. In 1999, however, Sweetser formalized the first of two major expansions (one an acquisition, the other a merger) that added more services for adults, as well as for children, and that have shaped the agency into a social services powerhouse.
The man behind Sweetser's growth, CEO Carl Pendleton, last year celebrated his 25th anniversary with the organization. Pendleton, 56, a Saco native, began his career at Sweetser as a teacher. He quickly rose through the ranks to become principal of The School at Sweetser, then director of educational services and, in 1991, its CEO. Mainebiz spoke with Pendleton recently about his career, the organization's growth, how Sweetser is perceived in Maine social service circles and other issues.
Why did you go into social work?
I guess I was greatly influenced by my mother and father, who always exhibited a kind of caring-for-their-fellow-man mentality. My father was a police officer, and wound up a pharmacist's aide, and finished his career actually doing some work at Sweetser. My mother happened to be an orphan, who at 65 years old discovered her birth mother. But both of them, their entire adult lives, demonstrated to my brother and sister and I the value in giving rather than receiving. I decided that I really kind of enjoyed working with children, and people, and chose education. So I started my career at Center Drive Junior High School in Orrington as a teacher and principal.
From there you went to Sweetser, in 1978. What was that transition like?
When I went to Sweetser, I actually started as a teacher again, which was great; it was the breath of fresh air I needed. Unfortunately, there weren't a whole lot of male role models in the field, and I spent a large part of my time dealing with kids who were severely acting out in the school. Just because, back in those days, those kinds of interventions often required a male to do the work, as opposed to the women teachers. That's really changed over the past 20 years. So I rapidly left the classroom and became the principal of The School at Sweetser.
You went from principal to director of educational services, then became CEO of Sweetser in 1991. What opportunity did you see in expanding the organization from small and local to nearly statewide?
It kind of mirrored my professional career, where if you apply the best practices and skills of your craft to a larger and larger audience, the more positive [the] influence. If you think you're right, and the people who get your services think you're right, the greater impact you can have on the quality of life in Maine, whether it's schoolchildren, families experiencing distress or an adult with prolonged mental illness.
I also felt, as the leader of an organization that is 175 years old, which has been supported by Maine citizens for all those years, that we have this responsibility to make sure we maximize our capabilities to help those Mainers with needs. And so we have grown planfully ˆ we think skillfully and responsibly ˆ so that we have gone from being, when I took over, an organization that dealt with about 200 kids annually to impacting 16,000 lives on an annual basis, statewide.
In 1999, Sweetser acquired the Family Institute of Maine, and in 2000 it acquired Shoreline Community Mental Health. How did they come about, and why?
Opportunity presented itself at the perfect time. The Family Institute of Maine was an extremely well-run professional counseling organization here in Portland, privately owned. But the future of delivery of health care services was challenging the organization. So Cynthia Osborne, head of the Family Institute, knew that the way for them to survive was to partner with someone. According to her, she did her homework, and kind of liked what Carl Pendleton and Sweetser were doing. And she proposed marriage. This marriage ended up being an acquisition. And so we bought the Family Institute on April 1, 1999.
At that time Sweetser probably had a staff of 600 or 700, with lots of training requirements. Acquiring the Family Institute allowed us to bring in all of our training capabilities internally, which saved us some money. It allowed us to continue contracts with the university system and other providers to provide clinical training. And it helped our clinicians better understand serving people whose primary way of paying for these services was through insurance companies, which was a new experience for us. So it expanded our horizons.
How did most of your clients pay before this?
We were primarily a government-funded agency. Government and private fundraising.
You mentioned the Family Institute was being challenged by the future of health care delivery. What were those challenges?
Commercial insurance companies have whittled down their rates of reimbursement, just like you've experienced in your own medical plan. They were not getting enough in rates of reimbursement to sustain themselves over the long run.
What prompted your merger with Shoreline Community Mental Health?
As we'd grown as a children's provider, our strategic plan was to go where the people were. If you looked at a map of Maine, you would see that we saturated the coast of Maine from the Bucksport-Belfast area down to the York-Kittery area. But an area of the state with a healthy population base but not a whole lot of service delivery from Sweetser was the Bath-Brunswick mental health area, where Shoreline was.
In this particular case, again, I was invited to a wedding by a wonderful young lady, Grete Chandler, who continues to work for me, who was the executive director at Shoreline. And like the previous acquisition, the challenges of the future for a community-based mental health center with limited funds were very challenging.
We had mutual respect for one another, we had similar missions, and in September 1999 she asked if I'd consider merging. I went to my board, and on January 1, 2000, we merged with Shoreline to become Sweetser. Prior to that time my organization had been known as Sweetser Children's Services.
So this expanded your adult services?
This expanded my adult services so that we became really a full service agency. Today we deal with infants to adults in the twilight of their lives. We still clearly have stronger concentrations of those populations in different parts of the state, but what we've chosen to do is not duplicate or replicate existing providers of service. So if somebody's doing a good job of providing adult services in Saco, we're not replicating that. Whereas in Brunswick we were primarily the main show for mental health for adults ˆ we have lots of services there.
And now you're in more than 50 locations around the state. Is there a downside to being so large?
Oh, sure. I don't get to know all my employees in a warm fuzzy way. I'm a people person, so I miss the personal contact, and the knowledge of every single person who's employed by Sweetser. It doesn't mean I care any less, but it does feel different.
From a professional point of view, I think that being as large as we are makes people suspect of us. We're the proverbial elephant in the china shop, or the bully on the street. And to be honest with you, it's too bad that size comes with that reputation, because we've grown twice, and in both cases we were invited ˆ we didn't seek it out. So we haven't acquired or merged with anybody who didn't come to us first and ask.
The bully image you mention relates to my next question. People in the social services community seem to have a general perception of Sweetser as the "corporate" nonprofit in the state. How does that match with Sweetser's perception of itself? Is being corporate bad?
Well, it's like anything else. If you look at an organization just predicated on statistics, I don't know many statistics that feel warm and fuzzy. When people look at an organization that has an annual budget of $56 million, employs 1,200 people, impacts 16,000 lives, and has more than 50 facilities statewide, they see "big corporation in Maine." The reality is, we're about people, not the business of peopleˆ And I think our size has enabled us to help more people get what they need, not just what's available. We've helped people get access to services that used to be filled with waiting lists. We are very focused on keeping families intact, and serving people in their home communities. When you extract somebody from their community and treat them in a hospital, or treat them in a residential treatment center, you're really doing a disservice to them.
So we're big because we need to be big to do what we want to do. We think we get great results. Our customer satisfaction surveys are usually 94%-95% satisfaction by our entire population. It's a piece of data that we're extremely pleased with. And you couldn't be as big as we are if people didn't turn to you, right?
Sweetser's clinicians and therapists are measured and to some extent compensated based on how many clients they see each week. How strong is the drive for productivity in social services?
Certainly the managing of care in our funding world is driving the whole issue of productivity. It isn't exclusive to Sweetser. It's happening in hospitals, it's happening in other social service agencies. And it's not foreign to business in general. What basically happens is, you are receiving rates of reimbursement that are less favorable than ever before, and in order to make ends meet, people have to do more in their allotted work week. What that means for people, unfortunately, is that the cup of coffee first thing in the morning is shortened. It means that we're more concerned about those people who don't show up for appointments. It means we want to make sure that people want to come to see us. It means that we have to be available at different venues. It means that more services are being offered. The challenges you have include maintaining your quality of care and retaining your staff, because [the work] can burn them out fast. Also, how do you reward, in a fair way, that hard work and extra effort?
How has Sweetser met those challenges?
We try to make sure our clinicians have great work space. We are constantly tinkering with our systems that support them to make sure they're efficient, and assist them in their productivity targets. We try to make their training available at times when it's most conducive to them, and not in the way of them seeing their clients. We try to make sure we market ourselves and draw clientele to our organization. We adhere to national accreditation standards ˆ we've been an accredited organization for almost 30 years.
Are clinicians who don't meet their targets punished in some way, like having their vacation time cut?
If you aren't hitting your productivity targets and can't achieve the income level that you'd hoped you were going to, that's your choice, not my choice ˆ I've given you all the tools to get it. If you feel like you've fallen behind for some reason and don't want to take a particular period of time for a vacation and want to work it, that's your choice, not mineˆ I think people who don't like the concept of working in a productivity-measured environment move on. They either adapt and embrace this as a way that they can make more money and do more good for mankind, or they decide that maybe this isn't for them and they do their own practice, if they're licensed at a high enough level, or they go to a smaller agency where maybe it doesn't seem as pressure-packed as Sweetser might feel. So it's really a partnership between the organization and its employeesˆ
I'm not saying everybody is always happy. We have stressful work. We have [clients] who are in denial. We have people who can get very violent. We have people who are very traumatized. It can be tough work.
What's your turnover rate like?
Below the national average in almost all areas. The national turnover rate in the area of youth and family workers, for example, is about 37%-44%. At Sweetser we run about 20%-23%
How does Sweetser measure its financial performance?
We aspire to a balanced budget, and if ever possible, a half a percent margin is kind of an unspoken goal. We measure [performance] in terms of making sure our processes are cost-effective and we don't have waste in management. We try to keep our management costs at or under 18% of budget, because what's really important is direct service, not management. We have a wonderful development department that raises private funds, and we try to get the most we can for the people we serve.
What's the competitive environment like in social services right now in Maine?
It's not as competitive as it is in the rest of the country, actually. Maine is notoriously a great state for providing quality education and social services for 1.2 million people. That said, we continue to have a need to better manage our system of care. I hope instead of our organization growing, Sweetser and other organizations can talk and collaborate, to see if there are any other ways to enhance either party's capabilities. It's been my experience that partnerships and collaborations do a better job at providing services.
But it wasn't always this way. Just a few years ago, the organization ˆ which can trace its lineage back to the Female Orphan Asylum of Portland, founded April 1, 1828 ˆ bore a much closer resemblance, at least in size and geographic reach, to the organization of its founding; until 2000, it was still known as Sweetser Children's Services. In 1999, however, Sweetser formalized the first of two major expansions (one an acquisition, the other a merger) that added more services for adults, as well as for children, and that have shaped the agency into a social services powerhouse.
The man behind Sweetser's growth, CEO Carl Pendleton, last year celebrated his 25th anniversary with the organization. Pendleton, 56, a Saco native, began his career at Sweetser as a teacher. He quickly rose through the ranks to become principal of The School at Sweetser, then director of educational services and, in 1991, its CEO. Mainebiz spoke with Pendleton recently about his career, the organization's growth, how Sweetser is perceived in Maine social service circles and other issues.
Why did you go into social work?
I guess I was greatly influenced by my mother and father, who always exhibited a kind of caring-for-their-fellow-man mentality. My father was a police officer, and wound up a pharmacist's aide, and finished his career actually doing some work at Sweetser. My mother happened to be an orphan, who at 65 years old discovered her birth mother. But both of them, their entire adult lives, demonstrated to my brother and sister and I the value in giving rather than receiving. I decided that I really kind of enjoyed working with children, and people, and chose education. So I started my career at Center Drive Junior High School in Orrington as a teacher and principal.
From there you went to Sweetser, in 1978. What was that transition like?
When I went to Sweetser, I actually started as a teacher again, which was great; it was the breath of fresh air I needed. Unfortunately, there weren't a whole lot of male role models in the field, and I spent a large part of my time dealing with kids who were severely acting out in the school. Just because, back in those days, those kinds of interventions often required a male to do the work, as opposed to the women teachers. That's really changed over the past 20 years. So I rapidly left the classroom and became the principal of The School at Sweetser.
You went from principal to director of educational services, then became CEO of Sweetser in 1991. What opportunity did you see in expanding the organization from small and local to nearly statewide?
It kind of mirrored my professional career, where if you apply the best practices and skills of your craft to a larger and larger audience, the more positive [the] influence. If you think you're right, and the people who get your services think you're right, the greater impact you can have on the quality of life in Maine, whether it's schoolchildren, families experiencing distress or an adult with prolonged mental illness.
I also felt, as the leader of an organization that is 175 years old, which has been supported by Maine citizens for all those years, that we have this responsibility to make sure we maximize our capabilities to help those Mainers with needs. And so we have grown planfully ˆ we think skillfully and responsibly ˆ so that we have gone from being, when I took over, an organization that dealt with about 200 kids annually to impacting 16,000 lives on an annual basis, statewide.
In 1999, Sweetser acquired the Family Institute of Maine, and in 2000 it acquired Shoreline Community Mental Health. How did they come about, and why?
Opportunity presented itself at the perfect time. The Family Institute of Maine was an extremely well-run professional counseling organization here in Portland, privately owned. But the future of delivery of health care services was challenging the organization. So Cynthia Osborne, head of the Family Institute, knew that the way for them to survive was to partner with someone. According to her, she did her homework, and kind of liked what Carl Pendleton and Sweetser were doing. And she proposed marriage. This marriage ended up being an acquisition. And so we bought the Family Institute on April 1, 1999.
At that time Sweetser probably had a staff of 600 or 700, with lots of training requirements. Acquiring the Family Institute allowed us to bring in all of our training capabilities internally, which saved us some money. It allowed us to continue contracts with the university system and other providers to provide clinical training. And it helped our clinicians better understand serving people whose primary way of paying for these services was through insurance companies, which was a new experience for us. So it expanded our horizons.
How did most of your clients pay before this?
We were primarily a government-funded agency. Government and private fundraising.
You mentioned the Family Institute was being challenged by the future of health care delivery. What were those challenges?
Commercial insurance companies have whittled down their rates of reimbursement, just like you've experienced in your own medical plan. They were not getting enough in rates of reimbursement to sustain themselves over the long run.
What prompted your merger with Shoreline Community Mental Health?
As we'd grown as a children's provider, our strategic plan was to go where the people were. If you looked at a map of Maine, you would see that we saturated the coast of Maine from the Bucksport-Belfast area down to the York-Kittery area. But an area of the state with a healthy population base but not a whole lot of service delivery from Sweetser was the Bath-Brunswick mental health area, where Shoreline was.
In this particular case, again, I was invited to a wedding by a wonderful young lady, Grete Chandler, who continues to work for me, who was the executive director at Shoreline. And like the previous acquisition, the challenges of the future for a community-based mental health center with limited funds were very challenging.
We had mutual respect for one another, we had similar missions, and in September 1999 she asked if I'd consider merging. I went to my board, and on January 1, 2000, we merged with Shoreline to become Sweetser. Prior to that time my organization had been known as Sweetser Children's Services.
So this expanded your adult services?
This expanded my adult services so that we became really a full service agency. Today we deal with infants to adults in the twilight of their lives. We still clearly have stronger concentrations of those populations in different parts of the state, but what we've chosen to do is not duplicate or replicate existing providers of service. So if somebody's doing a good job of providing adult services in Saco, we're not replicating that. Whereas in Brunswick we were primarily the main show for mental health for adults ˆ we have lots of services there.
And now you're in more than 50 locations around the state. Is there a downside to being so large?
Oh, sure. I don't get to know all my employees in a warm fuzzy way. I'm a people person, so I miss the personal contact, and the knowledge of every single person who's employed by Sweetser. It doesn't mean I care any less, but it does feel different.
From a professional point of view, I think that being as large as we are makes people suspect of us. We're the proverbial elephant in the china shop, or the bully on the street. And to be honest with you, it's too bad that size comes with that reputation, because we've grown twice, and in both cases we were invited ˆ we didn't seek it out. So we haven't acquired or merged with anybody who didn't come to us first and ask.
The bully image you mention relates to my next question. People in the social services community seem to have a general perception of Sweetser as the "corporate" nonprofit in the state. How does that match with Sweetser's perception of itself? Is being corporate bad?
Well, it's like anything else. If you look at an organization just predicated on statistics, I don't know many statistics that feel warm and fuzzy. When people look at an organization that has an annual budget of $56 million, employs 1,200 people, impacts 16,000 lives, and has more than 50 facilities statewide, they see "big corporation in Maine." The reality is, we're about people, not the business of peopleˆ And I think our size has enabled us to help more people get what they need, not just what's available. We've helped people get access to services that used to be filled with waiting lists. We are very focused on keeping families intact, and serving people in their home communities. When you extract somebody from their community and treat them in a hospital, or treat them in a residential treatment center, you're really doing a disservice to them.
So we're big because we need to be big to do what we want to do. We think we get great results. Our customer satisfaction surveys are usually 94%-95% satisfaction by our entire population. It's a piece of data that we're extremely pleased with. And you couldn't be as big as we are if people didn't turn to you, right?
Sweetser's clinicians and therapists are measured and to some extent compensated based on how many clients they see each week. How strong is the drive for productivity in social services?
Certainly the managing of care in our funding world is driving the whole issue of productivity. It isn't exclusive to Sweetser. It's happening in hospitals, it's happening in other social service agencies. And it's not foreign to business in general. What basically happens is, you are receiving rates of reimbursement that are less favorable than ever before, and in order to make ends meet, people have to do more in their allotted work week. What that means for people, unfortunately, is that the cup of coffee first thing in the morning is shortened. It means that we're more concerned about those people who don't show up for appointments. It means we want to make sure that people want to come to see us. It means that we have to be available at different venues. It means that more services are being offered. The challenges you have include maintaining your quality of care and retaining your staff, because [the work] can burn them out fast. Also, how do you reward, in a fair way, that hard work and extra effort?
How has Sweetser met those challenges?
We try to make sure our clinicians have great work space. We are constantly tinkering with our systems that support them to make sure they're efficient, and assist them in their productivity targets. We try to make their training available at times when it's most conducive to them, and not in the way of them seeing their clients. We try to make sure we market ourselves and draw clientele to our organization. We adhere to national accreditation standards ˆ we've been an accredited organization for almost 30 years.
Are clinicians who don't meet their targets punished in some way, like having their vacation time cut?
If you aren't hitting your productivity targets and can't achieve the income level that you'd hoped you were going to, that's your choice, not my choice ˆ I've given you all the tools to get it. If you feel like you've fallen behind for some reason and don't want to take a particular period of time for a vacation and want to work it, that's your choice, not mineˆ I think people who don't like the concept of working in a productivity-measured environment move on. They either adapt and embrace this as a way that they can make more money and do more good for mankind, or they decide that maybe this isn't for them and they do their own practice, if they're licensed at a high enough level, or they go to a smaller agency where maybe it doesn't seem as pressure-packed as Sweetser might feel. So it's really a partnership between the organization and its employeesˆ
I'm not saying everybody is always happy. We have stressful work. We have [clients] who are in denial. We have people who can get very violent. We have people who are very traumatized. It can be tough work.
What's your turnover rate like?
Below the national average in almost all areas. The national turnover rate in the area of youth and family workers, for example, is about 37%-44%. At Sweetser we run about 20%-23%
How does Sweetser measure its financial performance?
We aspire to a balanced budget, and if ever possible, a half a percent margin is kind of an unspoken goal. We measure [performance] in terms of making sure our processes are cost-effective and we don't have waste in management. We try to keep our management costs at or under 18% of budget, because what's really important is direct service, not management. We have a wonderful development department that raises private funds, and we try to get the most we can for the people we serve.
What's the competitive environment like in social services right now in Maine?
It's not as competitive as it is in the rest of the country, actually. Maine is notoriously a great state for providing quality education and social services for 1.2 million people. That said, we continue to have a need to better manage our system of care. I hope instead of our organization growing, Sweetser and other organizations can talk and collaborate, to see if there are any other ways to enhance either party's capabilities. It's been my experience that partnerships and collaborations do a better job at providing services.
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