Northern
Community Resources
(907) 225-6355 FAX 225-6354
Rex Blazer, Community Member
Jeanette Miller, Community Member
Peggy O’Neal, Peer Reviewer
Sherry Modrow, Facilitator
A review of the Developmental Disabilities (DD) services
provided by Hope Community Resources in
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.
Hope Community Resources serves
A team of provider organizations collaborate on planning and delivering recreational activities, primarily in summertime. Recent fundraising spearheaded by a Hope employee resulted in a public ceremony that took place during the site review to deliver a lift-equipped van to a family whose child receives services through Hope.
Description of
Process
To conduct this review, an interview team consisting of two
community members, a peer reviewer and a facilitator met in
Five interviews were conducted with related service professionals, although the Hoonah Indian Association representative could not be reached for that scheduled appointment. Eleven interviews were with Hope Community Resources staff. Interviews lasted from 15 minutes to an hour and were held in person, in the community and by telephone.
The interview team members also reviewed personnel files, the agency employee handbook, the program’s Policy and Procedure Manual and other administrative documents. After gathering the information, 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
Hope Community Resources held an Open Forum in the Mendenhall Library the first evening of the review. Advertising was placed in the newspaper and on the local cable scanner. Eight people spoke at the forum, and their comments have been incorporated into this report.
Progress Since Last
Review
1. “Strengthen your documentation and billing process with related agencies to keep services consistent for clients and families.” (Standard #17).
Progress: Files indicate positive change in this regard. Standard met.
2. “Develop and implement an organizational structure that will delineate staff duties and provide it to the public and consumers.” (Standard #21).
Progress: There is confusion about certain roles and lines of communication voiced by staff members and by consumers. Standard partially met.
3. “Move your FAX machine to a side office to protect confidentiality of information.”
Progress: The fax machine is secure. Standard met.
4. “Keep discussion of clients to private offices.”
Progress: This has been accomplished. Standard met.
5. “Don’t
use cordless phones for business calls.”
Progress: This policy is in place. Standard met.
The team identified the following strengths under Choice and Self Determination for those receiving DD services:
+ Hope staff respond to concerns. One person says, "The
director is accessible. Whether or not
he is glad to see me, the door is open." A parent reports:
"Hope really tried to make up for past problems, and because of that
effort, those problems have been overcome."
+ Hope's respite features flexibility. People can plan respite to meet their needs.
+ A family who changed care coordinators said the
improvement had been "like night and day."
+ People have choices.
As one person comments, "We had lots of say; it's a great
team."
+ Many people indicate they like the variety of choices
offered by having both Hope and REACH available. One person states: "Hope
works exceptionally well with REACH."
+ An individual speaks of having the supports she needs to do what she wants, which includes attending college classes.
The team identified no weaknesses in the area of Choice and Self Determination.
The team identified the following strengths under Dignity, Respect and Rights for those receiving DD services:
+ People say they are listened to. One young adult says, "We
meet and talk about my needs."
+ Many people say Hope staff respond immediately when they are unhappy. "They
are very respectful in responding."
+ "I'm in charge at home," one individual states.
+ Hope goes to extra lengths to provide services or equipment, in some cases before funding mechanisms are finalized. "Without Hope sticking their neck out, we wouldn't be where we are now. They have really helped with modifications and equipment," is what one parent says.
The team identified the following weakness under Dignity, Respect and Rights
for those receiving DD services:
- Two people say they have had a struggle getting the services they want from Hope.
The team identified the following strengths under Health, Safety and Security for those receiving DD services:
+ The agency takes prompt action to remove providers who use
poor judgement or who behave inappropriately.
+ The screening process for applicants for staff positions protects consumers.
One consumer says, "I take it in stride. It's not easy to find replacement staff, but
they do it."
+ A parent speaks highly of staff efforts to help an individual stop smoking.
+ Hope staff arrange for medical appointments that suit the scheduling preferences of the individual.
+ One parent reports "The case manager calls
regularly to see how the person is doing."
The team identified the following weaknesses under Health, Safety and Security
for those receiving DD services:
- Some families say that required equipment has taken over a
year to get through the various approval processes and actually arrive.
Although they don't know exactly "where the glitch is in the system,
the amount of delay is unacceptable."
- Several families report inadequate in-home support coverage, especially regarding summer coverage. One says "I have a child with nowhere to go."
- At least two families address concerns about unacceptable delay in getting plan of care renewals processed, believing the delay is at least in part Hope's responsibility.
The team identified the following strengths under Relationships for those receiving DD services:
+ A consumer says staff facilitate dates with her and her
boyfriend.
+ Hope staff help with communication between individuals who receive services
and their families. One states, "They help me work out my
problems."
+ Supports provided by Hope facilitate individuals' involvement in a variety of family activities, trips and recreation.
+ Respite gives families a break and allows family members to concentrate on other family needs and relationships beyond the intense needs of the consumer.
The team identified no 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:
+ Most people say they have the supports they want for
participating in activities of their choice.
+ Hope works well with ORCA to increase recreational opportunities in Juneau.
The partnership and collaboration between ORCA and Hope are mentioned by many
people as being of particular benefit to people with disabilities.
+ Several people note that having day habilitation helps children have
involvement in such activities as swimming, craft activities and various kinds
of summer programs. An individual
comments, "Hope helped me adapt myself to the community."
+ The team notes that Juneau's generally inclusive nature complements Hope's efforts in community participation.
The team identified no weaknesses in the area of Community Participation for those receiving DD services.
+ An informal network of direct care staff appears to function well to support each other, anticipate scheduling needs and meet families' needs (although it does not include all direct care staff).
"I
get along fine with everybody here."
"I
really like working here."
+ The Juneau-based management team has an esprit de corps and a sense of collective purpose, with good working relationships that allow Hope to effectively address problems.
+ Evaluations have improved significantly since Tom came on board.
+ One employee says, "I feel that Hope really
listens to us, and I feel comfortable expressing concerns." Another
states, "I can talk to my supervisor…though I'm not always sure who
that is supposed to be."
- Most staff members indicate needs for more training. Several people say better opportunities for training, including assistance with time or funds for higher education, would enhance retention.
- A more formalized support system for staff is suggested by
some staff as a needed improvement. "We work in isolation; we need
opportunities to get together."
- Several staffers express general uncertainty about avenues of communication and authority and whether or not information ultimately gets accurately handled.
- Several employees say there has been a "scramble" for coverage of consumers as school lets out for the summer vacation, and some indicate there was a lack of adequate planning for this event.
- Staff say they would like more positive reinforcement from management.
- Communication within Hope can be problematic between managers and direct providers. Some staff report they avoid coming to the office except when required.
- One says, "I want to see Internet rather than paper to enhance requests and simplify communication."
- An employee speaks about abrupt reassignment, without adequate preparation or training, to begin providing services for another consumer.
- Some staff indicate that more diverse and in-depth training is necessary for staff and for Hope’s care coordinators in order to work effectively with families.
+ Every agency commends Hope's cooperative working relationships to support consumers.
"Collaboration has improved dramatically," said one person.
Another stated "We're part
of a team."
+ "Hope's work with other service providers has produced some really exciting opportunities for families."
+ "Hope tries to empower families and help them support their child with appropriate supports."
+ "John invited REACH and ORCA to work with the
community recreation grant that previously only supported Hope consumers."
+ Collaboration has enhanced team meetings for person-centered planning.
+ "I'm hearing an increase in satisfaction from Hope's consumers," a related agency staff person says.
+ There is a good effort for collaborative meetings that include all the players: families, Hope staff, staff of coordinating agencies and the independent care coordinator, for cooperative planning, developing job supports, assisting with benefits and the like.
+ "Hope does an incredibly good job under incredibly
difficult circumstances." Another says, "My hat is off to
Hope."
+ "There is good assistance with transitioning from school to the rest of their life: shared meetings, shared resources. Hope will do whatever they can to facilitate a child's plan.”
+ "If somebody isn’t happy, Hope staff take the time to figure it out. They work very hard to fix problems."
- Several agencies say that friction between the parent network and the independent care coordinator on one hand, and Hope on the other hand, complicates the delivery of services. "Fires are created where fires aren't," says one.
The following standards have not been met:
#6: "The agency's governing body includes significant membership by consumers and embraces their meaningful participation." The local advisory board is not active at present. The governing board of Hope Community Resources Inc. has secondary, but not direct consumers.
#19: "Staff who are employed by, contract with, or volunteer for the provider agency have appropriate training (credentials where required), experience, and supervision to perform their job functions and meet all necessary legal, ethical, and regulatory requirements." The team heard concerns that some direct care providers do not have adequate basic skills to work with people who experience disabilities at the time they are hired.
#30: " The agency identifies available resources to meet the assessed training needs of staff." Needs for training were a recurrent theme during the site review.
5. Hope has made great efforts to deliver services in the timeframe promised rather than waiting for
authorization. This creates a higher level of expectation than the agency can presently, reliably
deliver.
6. Hope must address significant concerns regarding training of direct care staff, specifically for care
of medically complex children, and basic expectations of employees in the field. Training gives
employees opportunities to bond, share ideas, develop a sense of Hope's mission and to feel a
part of a team. Cross-training of existing employees to build additional, specialized skills for working
with people who have complex conditions or challenging behaviors would increase Hope's ability to
meet families' needs and would improve retention of employees. Hope might want to consider
implementing a system of pay that recognizes the additional training and skills.
1. From the previous review: "Develop and implement an organizational structure that will delineate staff duties and provide it to the public and consumers." At present, there is confusion about certain roles and lines of communication, as expressed by staff members and consumers. The structure appears to be in place, but consistent effort is needed in implementation and follow-through. There is widespread uncertainty about how information gets processed internally. Hope Juneau needs to develop and follow clear procedures for supervision. The agency should have a single point of contact for scheduling families and direct care providers.
2. The time between requesting and receiving equipment can be very long. Even if the cause is outside Hope's control, can staff provide assistance to families by way of tracking and advocating?
3. At least two families addressed concerns about unacceptable delay in getting plan of care renewals processed, believing the delay was at least in part Hope's responsibility.
4. Many people describe a positive environment for service delivery, and real attention to providing appropriate supports for individuals. Two people say they have had a struggle getting the services they want from Hope. The agency should continue to strengthen efforts to assure high quality in all services.
5. The Juneau team appears to be building depth and capacity in staff. However, the site review team heard repeated concerns about inadequate staffing, particularly for preparation in scheduling and coverage of consumers (e.g. as school lets out for the summer) and related questions about the adequacy of agency planning in advance.
6. Standard #6: "The agency's governing body includes significant membership by consumers and embraces their meaningful participation." The local advisory board is not active at present. The governing board of Hope Community Resources Inc. has secondary but not direct consumers.
7. Standard #19: "Staff who are employed by, contract with, or volunteer for the provider agency have appropriate training (credentials where required), experience, and supervision to perform their job functions and meet all necessary legal, ethical, and regulatory requirements." The team heard concerns that some direct care providers do not have adequate basic skills to work with people who experience disabilities at the time they are hired.
8. Standard #30: " The agency identifies available resources to meet the assessed training needs of staff." Requests for more formalized supports for training and attention to incentives for retention of direct care staff were recurrent themes in the site review.
Other Recommendations
1. The addition of the community staff supervisor position has been very positive, but it appears to be too big a job for one person. As staff continues to grow and Medicaid waivers increase, the pressure on this crucial position will increase.
2. Hope should develop policies and procedures for communicating with all entities involved in planning (schools, independent care coordinators and other agencies). In addition, Hope should look to the statewide provider organization and perhaps to DMHDD to develop a statewide approach to collaboration.
3. Some families expressed grave concern about Medicaid billings for care coordination that may have been recoded during processing. These bills then have been sent to consumers' private insurance as PT/OT services. Families feel that Hope is funded to help them find out how this is happening. The team finds that this may be an issue beyond Hope’s control.
4. In a community where independent care coordinators provide services for consumers of the agency being reviewed, they should be included as part of the required interviews of related service providers. (This is not the responsibility of this agency.)
5. The State of Alaska and the Quality Assurance Sub-Committee should require quality assurance reviews of independent care coordinators who provide services for individuals with developmental disabilities.
Closing Note
The team thanks Hope's Juneau staff for warmly welcoming and accommodating the site review team and related activities.
The final draft of this report will be sent to Northern Community Resources for 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 for 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 Sheets (averaged)