It’s not all growth all the time. The natural world experiences disruptions. A forest fire or hurricane moves through an ecosystem and creates a huge change in the natural order of things. A drought may wipe out a farmer’s crop. A virus may eliminate a whole species of trees, i.e., the American Chestnut. Existing structures are broken down and any saved resources in the system are much smaller. However, the cycle doesn’t stop. Instead of growing, the ecosystem begins to adapt.
So in the last blog we focused on the “front loop,” the Growth Phase of the adaptive cycle. In this blog we will discuss the “back loop” or Adaptive Phase. The “back loop” moves in the opposite direction of the S-curve of growth and creates a lemniscate. Just like the Growth Phase, the Adaptive Phase has two phases embedded within it. They are Release and Reorganization. Release is characterized by a disruption that forces an ecosystem or organization to let go of existing structures, ways of thinking, and saved resources.
Oftentimes Release looks like an organization that might unexpectedly experience a reduction in funding. There may be an executive leadership change. A natural disaster may move through a community requiring emergency responses. These disruptions are often painful and disorienting, especially if employers have to downsize programs and organizations.
Other times, the disruption may be the result of something positive. As we continue to follow AIDS Services Organizations (ASOs) through the Adaptive Cycle, they began to experience a different type of disruption. They were disrupted when antiretrovirals started showing promise in the suppression of the human immunodeficiency virus. ASOs had spent the late 1980s and early 1990s building their infrastructure and funding in order to meet the growing need of individuals who were dying of AIDS. Volunteers were mobilized to support those who were ill. However, antiretrovirals shifted things. Within five years, between 1995-2000, AIDS became a chronic illness and not a “death sentence.” ASOs had to respond. It was now a matter of accessing these life-saving treatments. Case managers and health care providers focused on how to enroll patients in programs that would help them get the drugs they needed to suppress HIV, Antiretroviral Therapy (ART).
As treatment options grew the final phase of the Adaptive Phase or Reorganization occurred. The science helped us understand that early detection coupled with treatment compliance (taking your medications every day) was crucial to suppressing the virus so that resistance was not created. Providers saw first hand that accessing the medication began to be an issue of health equity. Those who had resources (health insurance of some sort) were able to get the medicines, those without may not be able to get the medicines for long enough. Partnering with other organizations that advocated to increase access to Medicaid and health insurance became a new strategy for ASOs. They adapted and reorganized their efforts.
Then along came PrEP (pre-exposure prophylaxis). Again, the advances in treatment allowed people who were not infected with HIV to take preventative treatments that can stop them from being infected. Reaching out to those who were at risk of infection became a new strategy to prevent the spread of the virus across diverse communities. Outreach and prevention efforts focused on education about the new medications. Programs were reorganized.
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None of these changes occurred overnight, and individuals had to begin to understand the options that they had with regard to their sexual health. However, ASOs continued to innovate, change and adapt as the treatment options and resources changed over time.
These first four blog posts have introduced you to the Adaptive Cycle and how it might be applied to human service organizations. It provided an example of how AIDS Services Organizations (ASOs) navigated the changing landscape of HIV infection from the mid 1980s to the 2010s. As we continue this blog series, we will begin to explore additional topics related to the Adaptive Cycle, including traps that can hinder the momentum along the cycle.