Northern
Community Resources
(907) 225-6355 FAX
225-6354
Linda Erickson, Community Member
Ray Collins, Peer Reviewer
Sherry Modrow, Facilitator
A review of the Developmental Disabilities (DD) services
provided by Hope Community Resources in Dillingham was conducted from April 17
to
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 Dillingham and 32 villages
throughout the
Hope Community Resources provides a range of supports to 34 individuals and their families. Three individuals live with full-time staff in the assisted living residence in Dillingham and two individuals live in their own apartments. The respite program has 22 people enrolled.
Types of supports include case management, direct care, transportation, assistive technology, home modification, outreach and advocacy.
Description of
Process
To conduct this review, an interview team consisting of one community member, a peer reviewer and a facilitator met in Dillingham for three days. The team interviewed 20 people, including 8 adults who receive DD services and 2 interviews with parents of children who receive DD services. One person attended the Open Forum. Five interviews were conducted with related service professionals and four 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 Dillingham City Schools building the first evening of the review. Advertising was placed in the Bristol Bay Times, on radio, and on the cable scanner.
One person attended, and the comments received at the Open Forum have been incorporated into the report.
Progress Since Last
Review
The team identified the following strengths under Choice and Self Determination for those receiving DD services:
+ Individuals who participate in subsistence activities have
regular opportunities to experience the traditional ways of living that many of
them were brought up with.
+ Subsistence activities are well-equipped and the equipment appears to be
well-maintained.
+ Hope encourages culturally appropriate subsistence activities with the supports people need to participate in hunting, fishing, snow machining, boat trips and the like.
+ Hope's voucher system allows people a broad range of choices for employing friends, relatives and community members to provide respite.
+ Individuals appear to find their own place within the
community, with peers at the
+ Several consumers have non-paid occupational experiences, and one speaks of having a job with regular wages.
The team identified the following weaknesses under Choice and
Self-Determination for those receiving DD services:
- Several individuals and families report they need support (particularly respite caregivers) but are unable to find those supports in their natural settings, where resources are lacking.
- Opportunities for paid vocational experiences are limited; several people have non-paid jobs that lack consistent schedules or financial compensation.
The team identified the following strengths under Dignity, Respect and Rights for those receiving DD services:
+ Consumers have support for participating in culturally
relevant lifestyles.
+ People living in Hope's assisted living residence have their own rooms and
are able to enjoy their space in ways that are relevant to each of them.
+ Hope staff present supports according to the wishes and needs of people who
live in
+ The recorded telephone message at Hope Community Resources Office begins with a greeting in the Native language.
The team identified the following weaknesses under Dignity, Respect and Rights
for those receiving DD services:
- A deaf individual appears to have inadequate supports in communicating with others via sign language.
- There does not appear to be a social circle for people who have disabilities in Dillingham.
- A consumer stated, "There are too many white
people here."
The team identified the following strengths under Health, Safety and Security for those receiving DD services:
+ Hope's staff nurse visits Dillingham to review medication
records and to assure that residents in assisted living obtain physicals and
dental care.
+ The care coordinator provides two visits per month with individuals on
waivers.
+ Hope staff make arrangements for and accompany an
individual who has to travel to
+ When an individual required a greater level of support than was available in Dillingham, staff addressed the issue and located adequate supports outside the community.
The team identified the following weakness under Health, Safety and Security
for those receiving DD services:
- In the assisted living home, some mattresses appear to be overly worn. Staff report that they were new as of June 2000.
The team identified the following strengths under Relationships for those receiving DD services:
+ Individuals at the assisted living residence are afforded opportunities to participate in daily household responsibilities.
+ Staff are aware of and support positive interaction
between consumers and others in the community.
+ There appear to be very positive relationships between Hope staff and employers
who foster positive vocational supports.
+ Hope's consumers have very positive relationships with staff and patrons at the Senior Center.
+ Several people mention positive relationships between consumers and Native elders.
+ One of the strengths for DD consumers in small towns is the wealth of naturally occurring supports and friendships.
The team identified the following weakness under Relationships for those
receiving DD services:
- A deaf individual appears to have inadequate support for communication in the community residence. He expresses joy at being able to actively sign with a visitor to the residence.
The team identified the following strengths under Community Participation for those receiving DD services:
+ Residents and staff of the assisted living home attend a
variety of athletic and community events.
+ Consumers in Dillingham have a wide range of personally chosen activities,
such as visiting friends, attending church, having lunch at the Senior Center.
+ Individuals travel to their home communities to visit families and friends.
The team identified the following weaknesses under Community Participation for
those receiving DD services:
- Children with DD need organized after-school activities that provide a positive environment for recreation and socialization.
- A parent speaks of limited public tolerance for children with disabilities in Dillingham, and few community efforts to increase awareness.
Staff Interviews
An increased caseload requires increased staff to provide services and to avoid staff burnout.
Staff report that it can be difficult to obtain funds or approval to replace furnishings, appliances and large household items.
+ Other agencies speak about positive relationships with the
coordinator in Dillingham, reporting a level of accessibility and collaboration
that stands out. "They run a good program."
+ Several people report that Hope's staff have relationships with consumers that enhance other agencies' ability to provide services.
+"Hope staff are flexible and willing to go the
extra mile; it's not just a job but a passion."
+Many agencies say strong interagency collaboration and commitment by Hope staff make positive changes in the lives of consumers.
+Vocational supports and collaborative efforts may provide consumers with employment or business opportunities in tourism in King Salmon, Dillingham, Togiak and New Stuyahok.
-Several people indicate the community needs a long-term
residential facility for children and teens with developmental disabilities, as
well as a shared residence of supported living or group home for young adult
women. One person said, regarding children, "Group homes work; foster
homes do not."
-Sexuality in the lives of maturing teens and young adults needs to be addressed.
-Several agency staff indicate that futures planning for youth with developmental disabilities would be beneficial for addressing what lies ahead for them when they are done with school.
-In a small community, people accept that there are finite resources and limited opportunities for children and young adults with developmental disabilities, but better supports could provide them with the ability to develop to their greatest potential.
-One agency says Hope seems to have less presence in the community, and less staff in the office, than previously. With just one person, the office is closed when the coordinator travels.The coordinator has less and less time to build the program and is instead putting out one fire after another.
Of the thirty-four Administrative and Personnel Standards that agencies providing DD services must meet, Hope Dillingham meets thirty-three of them. The one standard that is only partially met is Standard 6. This standard requires that the agency’s governing body includes significant membership by consumers (DD, MH) or consumer family members (ILP), and embraces their meaningful participation. While parents of consumers are on the board, no direct consumers are board members.
Program Management
+The coordinator has significant ties to the community and the region.
+The service area is very large, and the agency attempts to provide reasonable contact with the villages. There are consumers in at least 16 communities in the Bristol Bay region, and the coordinator visits each community at least twice a year. Individuals have quarterly telephone contact with Hope staff in Dillingham, unless they request more frequent contact, and they visit with the coordinator when they go to Dillingham for other purposes.
-Accurate information needs to be readily available to the community about services, funding and the waitlist process to avoid miscommunication or misinformation regarding DMHDD waivers, waitlists, CORE services, referrals and sources of funding from other service providers.
-Many people express concern about the current turnover of the coordinator position in Dillingham, along with anxiety that the position is difficult to fill.
1. The agency’s governing body includes significant membership by parents of consumers, but does not include direct consumers on the board. (Standard #6)
2. The agency is understaffed. Hope should evaluate not only the increasing caseload, travel requirements, and routine aspects of the work, but also the intensity of consumers' needs and community needs when considering the size of the staff.
3. The agency could invest in a more formalized effort to meet needs of individuals who experience developmental disabilities while also addressing community-wide concerns related to futures planning and employment opportunities. (Prior and current review finding)
4. The team heard confusion about how to access services and how to plan for future needs. Educate the community regarding how to access services and how to plan for future needs. (Prior and current reviews)
5. People also spoke to the team about needs for greater community awareness and acceptance of people with disabilities. Hope Community Resources could join with other agencies at events such as the health fair or job fairs to present information about services and to help to educate the community about those who experience developmental disabilities.
6. Children with developmental disabilities have been able to participate in some after school activities in Dillingham, such as Boys' and Girls' Club. Hope staff must continue to seek options for after-school programs for children who experience developmental disabilities. (Prior and current reviews)
7. More planning could improve opportunities for deaf consumers to develop communication and social skills, including interaction with other hearing impaired individuals.
8. Hope should investigate the potential for residential options for female individuals.
Other Recommendations
1. Hope staff could consider taking a role in any community efforts that seek to break the cycle of alcohol dependence and resulting disabilities.
2. Multiple service providers and parents in the community note that placement options for children with developmental disabilities warrant immediate attention and exploration, given the current lack of natural supports and foster care environments in the Bristol Bay Region.
3. One member of the site review team notes the apparent residue of cigarette smoke inside the assisted living home. Staff state that no one smokes inside the residence, but Hope should ensure compliance with a no-smoking policy in the assisted living home.
Closing Note
The site review team appreciates the hospitality extended to us by Hope Community Resources in Dillingham.
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 30 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)