Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
PILOT PROJECT
Chris
See, Self Advocate, Community Member
Marge
Hays, Community Member
A review of the developmental disability (DD)
services provided by Frontier Community Services was conducted from February 23
to 25, 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.
Frontier Community Services (FCS) offers DD
services in the Central Kenai Peninsula, primarily the communities of Kenai,
Soldotna and Anchor Point, and has recently begun providing services in Valdez.
DD services include vocational and living supports, care coordination, family
support, foster care, respite, and core services.
FCS also provides services for early intervention,
adults with physical disabilities and older Alaskans, and provides diagnostic
services for people with alcohol-related disorders but those services are not
part of this review.
Description
of Process
At the direction of the Quality Assurance
Committee, this site review pilots a slightly different review structure.
Following the selection of individuals receiving services who would be
interviewed, FCS and the facilitator developed interviews based on the circles
of people involved in each consumer's life. The team worked to develop a
rounded familiarity with each person receiving services that was selected for
interviews and with the people involved in his or her life.
The team interviewed 9 individuals who receive
services at Frontier, 11 support staff who are directly involved in the lives
of one or more of these individuals, 4 people who are natural supports in these
consumers’ lives, one employer and 13 related agencies. The team also
interviewed three management staff, two board members and 9 people who attended
the open forum.
Open
Forum
FCS arranged an open forum and advertised it with a
mailing to all consumers and with newspaper notices. Eight people attended and
one was interviewed by telephone. The applicable comments of those people have
been included in appropriate sections of the report.
Progress
Since Last Review
1. Most Individual Service Plans (ISP’s) don’t contain measurable goals and objectives.
The agency has been addressing this; of the nine consumers reviewed,
the team was not able to locate ISPs or goals in some of the files. Standard
not met.
2.
One of the ISP’s reviewed was two years old.
ISP’s were up to date, but two files did not have ISP’s. Standard
not met.
3.
Include specific goals and procedures when people
desire changes in an individual’s challenging behavior.
FCS has addressed this with behavior plans, and should continue
to formalize positive behavioral supports and develop staff training
programs. Standard met.
4.
Respite provision should have a feedback system
that is common across the agency, that verifies respite provision and that
assures that respite is provided in the manner that the family desires. See
Administrative & Personnel section.
All consumers (or their families) receive a consumer
satisfaction survey annually. Standard
partially met.
5.
Assure that a staff development plan, including
goals and objectives, is included in each employee’s annual evaluation
(Administration & Personnel Standards #29 & 32).
Continued attention needed in the area of training and staff
development. Standard not met.
The dedicated staff at FCS are passionate
about their work.
Frontier Community Services has excellent
interaction with other agencies. The staff use a collaborative approach to
building support for people across the many organizations in the area.
FCS has been willing to take on new unmet needs
in the region. This has brought growth-related stresses to the agency. The
staff is actively working to establish systems and infrastructure that will
provide for smoother operations, improvements in personnel management and
efficient paperwork.
The team identified the following strengths under
Choice and Self Determination for those receiving DD services:
+ Nearly everyone talked about how happy they were
that FCS is available.
+ There is a strong family presence and choices are
respected by FCS
+ People that a consumer did not want to work with
anymore have been reassigned upon the consumer's request.
The team identified the following weaknesses under
Choice and Self Determination for those receiving DD services:
- Some people are concerned that individuals don't
get to choose when and where to use their spending money; documentation does
not always indicate a behavioral plan related to using money as a re-enforcer.
- Individuals in shared living situations do not
always have choice of roommates, although their guardians do.
- Support staff are sometimes assigned to work with
an individual without the consumer/guardian having a choice.
The team identified the following strengths under
Dignity, Respect and Rights for those receiving DD services:
+ Support staff and vocational staff appear to
develop positive, caring relationships with the people they support.
"If I wanted to do something that FCS didn't
agree with, they would respect that," a consumer said.
+ Families feel their rights are respected and
valued in the development of ISP's.
+ FCS has improved in informing consumers about
their rights, in the view of a family member.
+ Calls are returned in a timely manner.
The team identified the following weaknesses under
Dignity, Respect and Rights for those receiving DD services:
- Several families spoke about late renewals,
delays in writing plans and a sense of being rushed to make decisions once the
staff is ready to act on the paperwork.
- A staff member made a related comment, saying: "Follow-through
needs to improve."
- Some families expressed lack of knowledge about FCS
activities and would like a consistent newsletter.
The team identified the following strengths under
Health, Safety and Security for those receiving DD services:
+ The supports offered by FCS help families and
individuals to feel safe in their homes.
+ The protocol for emergencies is well established
and seems responsive.
The team identified the following weakness under
Health, Safety and Security for those receiving DD services:
- A wide variety of people noted inadequate
training, especially in supporting people with histories of challenging
behavior and physical management of individuals in wheelchairs (lifting).
The team identified the following strengths under
Relationships for those receiving DD services:
+ Members of the FCS staff encourage individuals'
contact with natural supports and families.
+ People have rich, varied relationships with a mix
of paid and unpaid people.
+ Consumers develop positive, trusting
relationships with staff. "She knows that what I'm telling her is
in her best interest," a staff member said about a consumer.
+ Families expressed praise for support staff. "
I don't know what I would do without the support staff. She's one of the
family."
The team did not identify any weaknesses in the area of Relationships for those receiving DD services.
The team identified the following strengths under
Community Participation for those receiving DD services:
+ Many individuals participate in Special Olympics.
+ People have a good time at the Activity Place. It
provides opportunities for interaction among peers, skill building and fun.
+ FCS offers many outings, including trips to Homer
and Anchorage.
+ Consumers enjoy shopping and other excursions.
+ Many people view FCS as providing a positive
contribution in the Kenai/Soldotna community.
+ Consumers are employed in local businesses.
The team did not identify any weaknesses in the
area of Community Participation for those receiving DD services.
Staff
Interviews
+ Several staff members talked about developing
high levels of trust with consumers and have built strong relationships. A
number of direct service staff said they enjoy their jobs, and specifically
working with consumers. "This is the best job I've ever had."
- FCS works with some very complex individuals. To
increase success, both more general training and more comprehensive training in
behavioral supports and developmental disabilities should become a structured
and ongoing element. Staff from all parts of the agency indicated needs for
training.
- A recurring theme was that direct service staff
do not feel valued or appreciated and don't feel they can comfortably provide
critical feedback to management.
- Several staff said community living situations are understaffed and under trained, which places consumers and staff at risk. Management and staff should develop a system for agreeing upon and clearly communicating consumer staff ratios in a variety of circumstances.
+ Staff communicate consumers’ needs well.
+ FCS staff and consumers are well received in the
community.
+ Positive relationships exist between FCS and such
agencies as Food Bank, DFYS, CPCS.
+ FCS staff always have best intentions with
consumers.
+ FCS is very supportive of and good in working
with consumers and families preparing to transition between school and adult
life, especially the use of transition packets.
- FCS staff need more training in behavior
management and general training in working with people with disabilities. One
agency suggested FCS could consider bringing a behavioral specialist on staff.
Standard # 9. There is no formal evaluation of the
agency director, although the board president maintains a close working
relationship that includes informal evaluation.
Standard # 12, 13, 14. Other than the annual
consumer satisfaction survey, which staff reported has very low response,
consumer input is provided informally and does not appear to be actively
solicited. FCS does not have a systematic annual process of involving
consumers, staff and community in agency planning. Although reportedly this is
informally accomplished, concerns voiced by staff and consumers/families
indicate needs for concentrating on effective methods of feedback that feel
comfortable and impact agency planning and program evaluation.
Standard # 19. Lack of adequate training for
support staff was a recurrent theme of the review.
Standard # 22. FCS has procedures for hiring and
evaluation of staff with consumer choice, but they appear to be implemented
inconsistently.
Standard # 24. The agency meets this standard. The
team recommends that FCS implement FBI background checks for all employees.
Standard # 28, 31, 32. Performance appraisals are
not applied consistently to all employees and feedback and recognition seem
lacking for some employees.
Standard # 29, 30. FCS should develop written
professional development plans and agency wide training plans. Training occurs,
both formally and informally; the agency should implement a system for
assessing, providing and tracking the training.
Program
Management
This agency is actively
working to catch up with the growth and changes of recent years. People are
presently being interviewed for a new management level human resources
position. The team sees this as a very positive step that should allow
objective treatment of issues between management and staff, as well as
assisting the agency to provide better communication, conflict resolution, and
employee relations.
Among the critical issues
that need to be addressed are developing and monitoring regular written
evaluations and staff development plans. Employees need to know what is
expected of them and would like to receive credit when appropriate as well as
knowing that disciplinary procedures will be uniformly applied.
FCS has grown rapidly but some systems still rely
on procedures that worked well when everyone knew all the employees and
consumers. In a larger agency, those informal processes can lead to
inconsistency and discord. Several consumers and staff talked about not knowing
how to get resolution of concerns without fear of retribution. "Don't
rock the boat," was the operating principle expressed by more than one
person.
ISP’s do not consistently provide measurable goals,
and in some cases there are no written goals.
Nobody can be held accountable for either the
consumers' or the agency's progress if it isn't documented.
FCS has restructured to become more responsive to
writing plans and renewals. Staff are addressing a backlog of overdue ISPs.
Some families said when renewals are due, staff wait too long and create a
situation that doesn't give families adequate notice to prepare for a meeting.
Medicaid waivers are part of a very complicated and
confusing system. The State of Alaska can help by providing clear information
about services to consumers and guidelines to agencies. FCS can help by
encouraging clear communication between care coordinators and
consumers/families about options and updates.
The frequency with which training emerged as a
concern indicates the agency should place concerted efforts on strengthening
the training provided to staff. FCS notes that it is difficult to locate
appropriate training in developmental disabilities services. The team suggests
the agency could take advantage of a variety of training opportunities through
University Affiliated Programs, accredited or informal online courses,
Community Schools, Stone Soup and many other possibilities.
Areas
Requiring Response
1. All consumer files should contain Individual Service Plans. (Prior review)
2. All Individual Service plans should contain measurable goals and objectives. (Prior review)
3. Respite provision should have a feedback system that is common across the agency, verifies respite provision and assures that respite is provided in the manner that the family desires. (Prior review)
4. There is no formal evaluation of the agency director, although the board president maintains a close working relationship that includes informal evaluation. The Board is to formally evaluate the agency director (Standard # 9).
5. Utilize the consumer and family input gathered in the consumer satisfaction survey and by other means to determine policy and program delivery. (Standard #12)
6. Systematically involve consumers, staff and community in annual agency planning and evaluation of programs, including feedback from the consumer satisfaction survey. (Standard #13)
7. Formalize a process by which to develop annual goals and objectives in response to consumer, community and self-evaluation activities. (Standard #14)
8. To comply with Standards 12, 13, and 14, facilitate the reception of critical feedback to management from consumers and staff.
9. FCS staff need more general training and more comprehensive training in positive behavioral supports, developmental disabilities, body mechanics, such as for individuals in wheelchairs, structured and ongoing training programs (Standard # 19).
10. Consistently utilize agency procedures for hiring and evaluation of support staff (Standard # 22).
11. Assure that performance appraisals are applied consistently to all employees and that they include feedback and recognition. (Standard #28)
12. Write a staff development plan annually for each professional and paraprofessional staff person. (Standard #29 and prior review)
13. Develop agency-wide training plans and implement a system for assessing, providing and tracking the training of staff. (Standard #30)
14. Assure that the performance appraisal system adheres to reasonably established timelines. (Standard #31)
15. Establish goals and objectives for the period of employee appraisal. (Standard #32 and prior review)
16. Assure that consumers/guardians can exercise choice in the assignment of support staff and that consumers as well as guardians have a choice of roommate.
17. Seek to improve employee morale. Employees need to know what is expected of them and should receive credit when appropriate as well as knowing that disciplinary procedures will be uniformly applied. A recurring theme was that direct service staff do not feel valued or appreciated
18. The organization should clarify with all staff the expectations for relationships between staff members and consumers.
19. Management and staff should develop a system for agreeing upon and clearly communicating consumer staff ratios in a variety of circumstances.
20. FCS needs to continue developing the systems and infrastructure that will accommodate its recent growth.
21. Seek to familiarize families with FCS activities.
22. When individuals don't get to choose when and where to use their spending money, documentation should indicate the reasoning or conditions associated with such limits.
23. Continue efforts to improve timeliness and provide adequate notice of meetings.
Other
Recommendations
1. Several consumers' families expressed great
confusion and frustration about the DD service system. They find it difficult
to know where to look for information and are overwhelmed by jargon, especially
regarding Medicaid. The State of Alaska should publish clarifying information,
both paper- and Web-based.
2. Some people requested more information and
support with guardianship issues; this is an area in which the State could
assist agencies and individuals.
3. The team recommends that FCS implement FBI
background checks for all employees.
4. Not all board members have clear understanding
about the role of the board, the amount of oversight they provide or their
responsibilities as individual members of the board of directors. The site
review team commends the agency for the board training planned in the spring,
and recommends that it include training about roles and responsibilities.
The site review team appreciated the participation
of everyone involved in the site review, and the hospitality and helpfulness of
FCS staff.
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
(averaged)