A very heated dialogue began at this point. The advocacy coordinator explained that her program was most in line with the overall mission of National, that the intent of local chapters was to advocate for research so that pain could eventually be eliminated. She added, somewhat as an afterthought, ‘‘Direct service is fine, but it really is only a Band-Aid to meet immediate need. What we need to do is find alternative approaches to drug dependency.’’ This had turned the direct service coordinator’s head, but he had held his tongue. The education coordinator was quick to respond that without education of physicians, nurses, social workers, and a host of allied health professionals there was little need to target the general public. ‘‘Unless you get health professionals to acknowledge that chronic pain is a problem for their patients, and that drug companies have to be kept in line, it doesn’t matter what anyone else thinks or does. They have to be willing to recognize that patients are not just hypochondriacs who are difficult to treat. [The patients] live in hell most of the time and it affects everything they do!’’ The direct service coordinator, seeing a window of opportunity, quickly added, ‘‘My point exactly! If we don’t intervene with the people who need us most, how will they ever advocate for themselves within insensitive systems of care?’’ He sat back, certain that he had countered the previous point about ‘‘Band-Aids.’’ As the dialogue continued, it became obvious that the three programs within this small organization were in competition with one another, rather than connected in a joint collaboration. In addition, each coordinator was a champion for his or her program, but the staff as a whole didn’t know what all the programs were doing nor how they worked together. And when concerns about volunteers came up, it was clear that they were competing for the same volunteers. In some cases, and almost by default, volunteers were the only links between programs, such as four retired social workers who were all engaged in doing advocacy, education, and direct service functions. Ironically, these volunteers seemed to see the linkages between the programs better than did the coordinators of the programs. The volunteers had actually taken the initiative and developed a pilot project with local hospice and palliative care units to share information on pain management. As the retreat continued, a number of questions were raised: Should we restructure the programs so that they don’t have their own identities, and make them into one large program with different component parts? Should we combine the advocacy and education programs into one unit, since there is so much overlap? Should we hire a volunteer coordinator for all volunteers so that assignments can be monitored and overseen, and so that the program coordinators do not compete for volunteers? Should we go back to the drawing board and think through what it is we want to be, and then consider if reorganization of program units and services are in order? As these questions were raised, the direct service coordinator became increasingly concerned. With a furrowed brow, he said, ‘‘This raises the whole question of identity and vision. We are a chapter among many, and we can’t be the first chapter that has struggled with these issues. What are other chapters doing? And, more importantly, what guidance can National provide for us? They must have some idea about what they want to see happen.’’ As the meeting ended, there appeared to be more questions raised than directions set. In the weeks that followed, the CEO met with other chapter directors in the region, hoping to locate an ideal programmatic structure. In fact, more questions came to mind as he talked with others. He made a list: What is our relationship to National? If we are branded as a chapter of NACPC, how far can we go in what we do and still maintain our relationship?