Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
Marjorie
Dunaway, Community Member
Robyn Henry, Facilitator, Mental Health
A review of the Mental Health (MH) and Early
Intervention/Infant Learning Program (EI/ILP) provided by Bristol Bay Area
Health Corporation (BBAHC) was conducted from January 16th to 18th,
2001 using the Integrated Quality Assurance Review process.
This report is the summation of the impressions of a community team after interviewing consumers, staff members, community members and staff of other agencies. It also includes a limited administrative review. It does not represent or reflect a comprehensive review of this agency. The community team has collaborated on this report and the findings represent their consensus.
Description of
Services
BBAHC is an Alaska Native Health Corporation that provides health services to children and adults who live in the Bristol Bay Region. Located in southwest Alaska, the Bristol Bay region includes 34 villages and covers over 40,000 square miles with a population of approximately 7,500 people, 75% of which are Alaska Natives.
A thirty-five-person board of directors governs the corporation, which includes representation from each of the villages in the region. The corporation employs approximately 300 people and is the primary heath care provider for the region.
The BBAHC MH program currently has an open caseload of approximately 200 clients. The program employs nineteen staff in Dillingham and seven village-based staff. Services provided by the program include outpatient individual, family and group therapy, emergency services, psychiatric services, crisis respite, residential services, education/prevention services and village-based services.
Through the agency’s Community Support Program the agency provides outreach, case management, employment/education and recreation services to adults diagnosed with a major mental illness and severe emotional disturbances. The program operates under a 2.1 million dollar budget, over half of which comes from the corporation. The program staff works in cooperation with a ten member advisory board that meets quarterly.
The corporation’s EI/ILP services provide care to children and their families in the Bristol Bay region plus the community of Port Alsworth. The program’s current caseload includes nine villages plus Dillingham. Twenty-nine children are currently being served in this home-based program with an additional nine children on a waiting list. The program employs two people on a budget of $186,000 a year, all of which are state funds. The program works in cooperation with a newly formed four-member parent advisory board.
Description
of Process
To conduct this review, an interview team
consisting of two facilitators, two community members, a peer reviewer and a
state ILP technical assistant conducted 46
interviews over a three-day visit in Dillingham, Alaska. An EI/ILP peer
reviewer who had been scheduled to participate on the team had to cancel due to
weather.
Ten interviews were with adults who receive MH
services. Two interviews were with parents of children who receive MH services
and 9 interviews were with parents of children who receive ILP services.
Twelve interviews were conducted with related
service professionals and 9 interviews were with program staff. Four people who
serve on the BBAHC board of directors or on the program advisory boards were
also interviewed. Interviews lasted from 15 minutes to an hour and were held in
person, at BBAHC offices, and by telephone.
The interview team members also reviewed seven
personnel files, the agency employee handbook, program policies and procedures
and other administrative documents. After gathering the information, all the
team members met to review the data and draft the report, which was presented
to the administrative staff on the final day of the visit.
Open
Forum
A public forum was held in Dillingham at the
Dillingham City Council Chambers at 7:00 P.M. on January 16th. BBAHC advertised
the event by radio and newspaper. There was no attendance at this meeting.
Progress
Since Last Review
This is the first review of BBAHC MH program using these new program standards, therefore there is no previous action plan using the Integrated Quality Assurance Standards for the MH program.
The previous review of the EI/ILP, using the previous ILP standards, recommended “future goals” for program enhancement and improvements. The following lists the goals and the remediation taken by the program. The items in bold have not been met and will be carried over as items to be addressed in this review:
1.
Disseminate awareness materials to all communities
in the service region. Action Taken: Packets have been created and disseminated
in the service region. Area Met (1.1.1).
2.
Use T.V./radio advertising about ILP. Action Taken:
Radio ads/info. are being used; monies are not available for T.V. ads. Area Met
(1.1.2).
3.
Complete a multi-disciplinary evaluation within the
45-day timeline. Action Taken: Now using health aide or other related medical
persons’ reports/evaluations as second discipline. Area Met (2.1.5).
4.
Involvement of the second discipline does not meet
the 45-day timeline due to limited resources. Action Taken: Health aides and
other medical reports are being used. Area Met (3.1.1).
5.
Continue to incorporate RETT input into the IFSP
goals and have them sign the IFSP as a team member. Action Taken: This is being
incorporated and is on-going. Area Met (3.1.2).
6.
No IFSP’s reviewed included updated status of IFSP
goals. Action Taken: All comply. Area Met (3.1.4).
7.
Families
want more visits. Action Taken: Additional funding has been requested but is
not available at this time. Area not met (3.1.5). More staff is needed to meet
needs but funding does not exist for more staff.
8.
A goal of the program is to improve transition to
school districts by continually educating parents as to their rights and
encouraging school districts to meet their obligations. Action Taken: Have been
very successful with transition to school districts now and had transition
training through the State Transition Team in 1999. Area Met (5.2.4)
9. Monies received by the agency are allocated
appropriately but are insufficient to meet the needs in this area. Action
Taken: Funding still being requested but still under funded. Area not met
(7.3.3).
10. Explore ways to elicit feedback from surveys
given to families to assist with planning and
improving services .
Action Taken: Created a new survey and started a parent advisory group.
Area Met (7.6.1).
11.
Continue and expand work with other agencies. Action Taken: Meetings
with interagency
groups occur on a regular basis, as well as regular contact with at
least 12 related agencies.
Area
Met (7.8.1)
12. There are underserved and unserved children in the region due to
lack of resources. Area not met; still under funded. (8.4.1)
The team identified the following strengths under
Choice and Self Determination for those receiving MH services:
+
Most of the clients indicate that they feel they
have a lot of choices regarding the services they receive especially when it
comes to making choices about the medication they take.
+
Most people indicated that they are involved in the
development of their service plans and that the plans reflect their own goals.
The team identified the following weaknesses under
Choice and Self-Determination for those receiving MH services:
-
One person said they feel that staff are involved
in too many meetings and not enough in actual services.
-
Two persons reported that they are unhappy that
they do not have choices about psychiatric services including frequency of
visits, choice of appointment time and choice of place.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ All people interviewed said they feel that their confidentiality is well protected by program staff.
+
All people interviewed said that they feel they are
respected by staff and treated with dignity. Comments about staff included “He’s
a good listener.” and “People are comfortable and friendly.”
The team identified the following weakness under Dignity, Respect and Rights for those receiving MH services:
-
Quite a few people interviewed said they do not
know their rights as clients and are not aware of the client grievance process.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ Several people stated that staff is good at addressing their health concerns and connecting them with available services when needed.
+ A couple of people reported that staff helped them get medical services through mini-grants.
+
One person reported that “Staff helped me feel safe
when the voices were really bad”.
+ Several people expressed their appreciation for the “Our House” respite program and the availability of staff when they are feeling bad or need a break.
+ Some of the team members are impressed with the lengths to which the staff will go to support a person in crisis, including the use of the local hospital beds to insure a safe haven and so avoid the use of out of town inpatient care.
The team identified the following weakness under
Health, Safety and Security for those receiving MH services:
-
Several people indicate the need for dental care.
The team identified the following strengths under Relationships for those receiving MH services:
+ Most people reported that they are satisfied with their current support system.
+ A parent reported that staff are very good about supporting the whole family when they are providing services to their child.
+ One person indicated that their counselor expresses a great deal of empathy then they are dealing with relationships and issues around loneliness.
+ Another person said they feel very comfortable going to their case manager about relationship issues.
The team did not identify any weaknesses in the area of Relationships for those using MH services.
The team identified the following strengths under Community Participation for those receiving MH services:
+
Most people interviewed indicated that they are
satisfied with their level of participation in their community.
+
Several people indicated that they are involved in
various vocational activities including going to school, volunteering in the
community and working.
The team did not identify any weaknesses in the
area of Community Participation for those using MH services.
The team identified the following strengths under
Choice and Self-Determination for those receiving EI/ILP services:
+
All people interviewed indicate that they feel that
they are given choice regarding services. One person stated “ We are
completely satisfied; we were given our preferences. Linda is very flexible to
our needs.”
+
Everyone felt that they are given choices with a
thorough explanation of the process in a way that is easily understood. One
person explained “At first I was intimidated because I didn’t understand
about the program. Now I look forward
to Sarah’s visits. She really understands my child.”
+
“Mostly I tell (staff) what I want. I want
help in communicating with my child and they did a really good job in helping.”
+ One parent reported that ILP staff sometimes sends them a written report of the home visit and that is very helpful. They would like them to send a written report all the time.
The team did not identify any weaknesses in the
area of Choice and Self-Determination for those receiving EI/ILP services.
The team identified the following strengths under Dignity, Respect and Rights for those receiving EI/ILP services:
+ Most people reported that the ILP staff are very approachable and accommodating.
+
People overwhelmingly felt that they are treated with
dignity and respect. Many times their
response to this area was “absolutely”.
+ Overall, people reported that they feel comfortable asking ILP staff for help. One person explained, “They make me feel special as a foster parent for doing what I’m doing.”
+
One person reported “We really couldn’t imagine what
it would have been like without ILP. (It is a) very high caliber of
services”. Another reported “ They helped me understand that my
child is normal”.
+ Parents indicated that they feel very comfortable about their rights and how they are explained to them.
The team did not identify any weaknesses in the area of Dignity, Respect and Rights for those using EI/ILP services.
The team identified the following strengths under Health, Safety and Security for those receiving EI/ILP services:
+
One person reported “Linda always washes her hands
before working with my child and always cancels appointments if she is not
feeling well so not to expose our family to illness.”
+
“Definitely without question (staff) cares genuinely
for my child”
The team identified the following weaknesses under Health, Safety and Security for those receiving EI/ILP services:
- One person reported ILP staff has trained their family in sign language but they would like a manual to help out more.
- Two parents commented on a need for speech therapist services in town and in the schools.
The team identified the following strengths under Relationships for those receiving EI/ILP services:
+
All people interviewed said that ILP supports and
involves the family in services. Comments included: “We are thriving as a
family because of ILP services.” “Being able to access ILP services
has taken a lot of frustration out of our lives.” “(The staff) always came to
our house and involved siblings in everything and always works around our
schedule.” and “Linda provides parenting advice and is
encouraging in helping us relate to our child.”
+
One person explains how services helped the home
situation: “We were really having a hard time before Sarah started working
with us. We were frustrated. Within a
month of Sarah’s help, it got better.”
The team did not identify any weaknesses in the area of Relationships for those using EI/ILP services.
The team identified the following strengths under Community Participation for those receiving EI/ILP services:
+
Several people reported that the transition from ILP
services to school and preschool was excellent. One person explained “The
extra work Linda put into making my child’s transition into pre-school was
great, way over and above the call of duty.”
+ One person indicated that staff help parents connect with other parents, especially through playgroup.
The team did not identify any weaknesses in the area of Community Participation for those receiving EI/ILP services.
Staff
Interviews
Nine staff from both the EI/ILP and MH programs were interviewed. All the staff interviewed expressed a consumer-centered approach to their work with clients. Each person expressed a commitment to the organization’s mission of providing the best possible services to their clients with an emphasis on culturally oriented services.
Overall, staff speak highly about their work and are generally very satisfied with the organization. Strengths of the work environment include a strong feeling of teamwork and mutual support among staff, ongoing training opportunities (MH) and the weekly clinical support meetings (MH). Areas of need identified by staff include limitations caused by the geography, the need for additional resources, the need for a more extensive orientation process and the need for the development of a local NAMI chapter for consumers and their families.
EI/ILP staff identified the need for additional staff for the program (to help cut down on the enormous amount of uncompensated overtime and to provide services to families on the waiting list), the need for clerical support and the need for a larger workspace.
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 43 items, 38 of
which are completely met by BBAHC. Those standards not fully met are:
1.
Standard #11
The mental health office building and the ILP offices are not handicap
accessible.
2.
Standard #12
The ILP program administers an annual survey to get feedback about
services. The MH program has no formal way to solicit consumer input.
3.
Standard #13
The ILP program administers an annual survey to get feedback about
services. The MH program does not
currently directly involve consumers in the agency planning and evaluation of
services.
4.
Standard #22
While clients usually have the opportunity to give input to the
selection of foster and respite care providers, there is currently no process
for incorporating consumer feedback in the hiring and evaluation of other
direct care service staff.
5.
Standard #30
There is limited training for ILP staff because of lack of funding.
6.
Standard #39
EI/ILP staffing ratios are inadequate.
7.
Standard #41 EI/ILP staffing
does not provide adequate specialized personnel.
These areas refer
to both programs unless indicated by bold print as belonging to either MH or
ILP.
Other
Recommendations
The team wishes to thank the staff of BBAHC for
their cooperation and assistance in the completion of this review. A process
such as this can be very disruptive to the office environment and your
hospitality was much appreciated by all of the team members.
The final draft of this report will be sent to
Northern Community Resources for final review. You will receive the final
report within approximately thirty days, including a Plan of Action form,
listing the Areas Requiring Response. You will then have an additional thirty
days to complete the Plan of Action. The directions on how to proceed from
there will be included in a cover letter you will receive with the final report
and Plan of Action form.
Once NCR has reviewed the completed Plan of Action,
it will be sent to the DMHDD Quality Assurance Section. The QA Section will then contact you to
develop collaboratively a plan for change.
Attachments: Administrative and Personnel
Checklist, Interview Form for Staff of Related Agencies (tallied), Score sheet