Northern Community Resources
(907) 225-6355 FAX 225-6354
Carole Starace, Community Member
Robert Brown, Community Member
Pat Gakin, Community Member
Robyn Henry, Facilitator
A review of the mental health (MH) services provided by Life
Quest was conducted from
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
Life Quest provides MH services to children and adults who live in the Mat-Su Borough. Life Quest offers clinical, emergency, rehabilitation, medical, residential and prevention/early intervention/community education services. Rehabilitation services are provided to youth with severe emotional disabilities and adults with serious mental illnesses. The age groups served include young children (beginning at age three), adolescents, adults and seniors.
The settings for these services are schools, a clubhouse, two six-unit transitional housing units, six single family homes, two four-plexes and one six-plex as well as Life Quest's central offices.
Life Quest's service area is the Mat-Su Borough, which encompasses some 24,000 square miles including Wasilla, Palmer and nine small communities in a largely rural section of the state. The population of the area has been increasing and is approximately 60,000 at present.
Most of the services are provided in the Wasilla area. In conjunction with the Sunshine Clinic (a primary care clinic), services are being provided in Talkeetna, where a clinician is available four days per week and an Advanced Nurse Practitioner, two days each month. Itinerant case management is provided in the seven remaining communities.
A nine-member board of directors governs the agency. Life Quest employs approximately 120 staff.
Description of
Process
To conduct this
review, an interview team consisting of a facilitator, three community members,
and a peer reviewer conducted forty-one interviews over a four-day visit in
It should be
noted that the agency scheduled a total of thirty consumer interviews from the
randomly selected case numbers (twenty-one with adults and nine with parents of
children receiving services). Ten scheduled
interviews were “no shows”. Interviews
lasted from 15 minutes to an hour and were held in person at Life Quest’s
offices and by telephone.
The interview
team members also reviewed nine personnel files, the agency’s employee
handbook, the Policy and Procedure Manual 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 at the
There were three people in attendance at this meeting. In addition one person provided feedback to the team by phone. The feedback received during the public forum and the phone interview is incorporated into the findings in this report.
Progress Since Last
Review
The following recommendations were identified during the May 1999 site review as areas that need attention from the organization. Progress in these areas is noted:
Progress: The agency, in cooperation with hospital and other community agencies has increased its outreach efforts to community members in crisis. One service provider noted “Crisis Respite is absolutely wonderful… when I need someone in crisis respite I just have to make a phone call, real seamless now (including for non-clients).” The executive director indicated that he is hopeful that current discussions with the hospital will lead to possible future DET beds. Standard met.
Progress: Over the last two years the agency has made various concerted efforts to increase staff support and morale including an overall re-evaluation of staff benefits and pay which resulted in pay increases and the addition of a staff retirement package. During our interviews a couple of staff commented on low staff morale and several consumers interviewed commented on high staff turnover. One consumer indicated that they didn’t know from one appointment to the next who they would see working at the agency. While it is understood that staff retention and morale is an ongoing issue for most large agencies, it is none the less an area that needs ongoing attention. Standard partially met.
Progress: The board meetings are now published in the local paper. Standard met.
Progress: Within the last two years Life Quest has developed and/or updated their clinical policy and procedure manuals for each of the programs in the agency. The executive director reported that he has focused much of his attention to the stabilizing the infrastructure of the organization with the goal of managing planned growth that is sustainable, thus preventing the “roller coaster” expansions and contractions of the past. Standard met.
Progress: The agency has revised and/or rewritten all of the policy and procedure manuals. They now reflect the agency’s core values and mission. Standard met.
Progress: Several consumers noted that they felt they did not get enough education and support regarding medication and treatment. They described a process of brief sessions with the doctor for medication check and no other support. Area needs continued attention. Standard not met.
Progress: Several consumers again noted a lack of individual or family counseling. The state QA staff, in completing their chart audit, noted a lack of clinical services including individual and family counseling. The team noted and consumers commented that there was a lack of a primary consumer contact person that helped people get linked to services beyond medical staff. Area needs continued attention. Standard not met.
Progress: Most consumers interviewed reported that they did not know the agencies client grievance process. Area needs continued attention. Standard partially met.
Progress: Of the nine members on the board, three are family members of people who have received services. One direct consumer board seat was recently vacated and is open at this time. Standard partially met.
Progress: Corrective action was taken on the recommendations outlined in the management letter of the FY98 financial audit. A draft of the FY00 audit was reviewed. Standard met.
Progress: Of the nine staff files reviewed that included six people who had been with the agency over one year, all files included current evaluations. Standard met.
Progress: The agency currently has a process for documenting employee orientation and reference checks. Standard met.
Progress: The current agency evaluation form includes space for staff feedback. Standard met.
15. Provide goals, objectives and time lines in each annual employee evaluation.
(Administrative Standard #31, 32)
Progress: The current agency evaluation form includes annual employee goals and objectives. Standard met.
16. Continue revision of guidelines and job descriptions for each position. (Administrative
Standard #20, 21)
Progress: The agency currently revises job descriptions on an ongoing basis as needed and does a comprehensive review of all job descriptions annually. Standard met.
17. Continue efforts to meet ADA standards in all facilities. (Administrative Standard #11)
Progress: The agency has made steps to improve accessibility of their offices including adding rises to the doorways and replacing difficult door hinges. There remain barriers inside the building including narrow halls and doorways leading into offices and bathrooms. Area needs continued attention. Standard partially met.
18. Seek training and/or technical assistance on treatment planning.
Progress: The DMHDD QA staff reports that they have provided 2-3 trainings on planning to staff over the last two years. Standard met.
19. Develop a policy on conflict of interest as it affects the Board. (Administrative Standard
#10)
Progress: The agency currently has a policy regarding conflict of interest as it applies to board members. Standard met.
20. Analyze data from client evaluations of services and utilize it in the program evaluation and planning processes. (Administrative Standards #12,13,14).
Progress: While the agency continues to collect feedback from consumers regarding services they do not formally use that feedback in the planning process. Area needs continued attention. Standard not met.
21. Revise agency publications to reflect consumer centered service values. (Administrative
Standard #16)
Progress: The agency has recently published a brochure that reflects consumer-centered values. Standard met.
The team identified the following strengths under Choice and self-determination for those receiving MH services:
+ Several people report that they are involved in the development of their plans and that the plans reflect their goals and desires.
+
Several people report that they are satisfied
with services and the choices they have. One client reports “I make my own choices and the agency is
responsive to my requests.” Another says, “Although they have offered me more services, I’m happy with what I’m
getting.”
The team identified the following weaknesses under Choice and Self-Determination for those receiving MH services:
- Several people report that they are not a part of their treatment planning process. One person says they don’t know why they are getting services.
- Several people report that they do not feel they have enough choices about what services they receive. One person reports “No one talks to me about the choices I can make. Groups were suggested but then nothing materialized.”
- Several people report that treatment is limited to just medication prescribing with no other supports.
- Several people identify the need for more individual, family and group counseling services.
- One parent reports that while they are allowed to be in their child’s treatment planning session, no one listens to their concerns and wishes.
- Another parent indicates that after their small child had a couple of visits to the counselor, the counselor escorted the child to the parent in the waiting room and announced that no other sessions were needed. This decision was made without the parent’s involvement.
- One parent reports that they quit having their child go to Life Quest because they were not getting the services they need: no case manager or care coordinator was assigned and no individual counseling services were provided.
- One family member expresses great concern regarding the discontinuation of AYI services.
- Several people identify the need for dual diagnosis services.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Most people report that they feel they are treated with dignity and respect. One person reports “Dignity and respect showed immensely.”
+ Several people report that the services they receive in a time of crisis are very helpful to them.
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving MH services:
- A couple of people report that they feel they are not listened to.
- Most people report that they do not know about the client grievance procedure.
- Several people report that they do not know about their rights.
- A couple of people comment on the dismal atmosphere in the waiting room. One person reports that they came in to the agency in a crisis and that all that the front desk staff cared about was that they call their insurance company and make sure that the services are covered. A couple team members also noted that the person behind the desk was unfriendly and unhelpful when they first came to the agency to do the review.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ One person reports that Life Quest was very helpful to them after the Big Lake fire. They report “I don’t know what I would have done without Life Quest…They worked overtime for me.” They report that staff supported them for a long time after the fire.
+ Many people report that they feel the agency does a good job supporting them by getting help with physical health issues.
The team identified the following weaknesses under Health, Safety and Security for those receiving MH services:
- Many people report that they need dental services. (system issue)
- Some people report that they need vision services. (system issue)
- One person reports that they do not receive support in getting their health care services.
- Several people report that they are not getting any information about their illness or about the medications they are taking.
- One person identifies the need for a Social Security office in the Valley (community issue)
The team identified the following strengths under Relationships for those receiving MH services:
+ A foster parent reports that they are very pleased with the support they are getting from Life Quest.
+ Several people report that they feel good about the support they are getting from Life Quest regarding relationships.
The team identified the following weakness under Relationships for those receiving MH services:
- Several people report that they would like to have more support in relationships and in getting to groups that could help them in this area.
The team identified the following strengths under Community Participation for those receiving MH services:
+ Overall, people report that Life Quest does a good job at encouraging community participation.
+ Several people report that they appreciate community services to children.
The team identified the following weaknesses under Community Participation for those receiving MH services:
- Many people cited lack of transportation to both community and Life Quest services as an issue. (community issue)
- Several people indicate that they are very disappointed that the clubhouse activities were discontinued.
Staff Interviews
Five members of the agency staff were interviewed. All the staff interviewed expressed a consumer-centered approach to their work with clients. Staff identified two assets of the agency.
+ Staff expressed positive feedback regarding the new staff evaluation system.
+ Staff expressed positive feelings about the executive director and the changes that are occurring in the agency.
Staff expressed several concerns.
- There is a need for more training.
- There is pressure to produce billable hours.
- There is a need for a new building and new office equipment (computers and copy machines).
- There is a lack of communication among staff.
- There is difficulty dealing with middle management.
- There is the feeling that staff are not treated fairly (pay does not reflect skill level and education).
- There is the need for better case management services for adults.
- There is the need for more therapists and a child psychiatrist.
Note: The agency provided the team with a copy of a recent comprehensive staff survey and analysis that encompasses a much more in-depth report on staff satisfaction and issues.
Several agency strengths are noted.
+ There is responsiveness when police ask for assistance.
+ There is collaboration and work with the multidisciplinary team.
+ There is responsiveness to community requests for services.
+ One agency reported that Life Quest was good at dealing with confidentiality and still giving good information.
+ Crisis Respite services are responsive and helpful.
+ Overall, there was the opinion that Life
Quest does a good job with services “On a
scale from 1-10, I would give them a 9.”
Related agency staff had a long list of concerns.
- There is need for inpatient beds in the community as opposed to having to take people to Anchorage. Once in Anchorage, people are some times turned away at the door. (community issue)
- There is need for more training for line staff and better supervision.
- There is lack of follow-through and responsiveness regarding agreed upon services.
- There is a refusal to share needed information regarding clients.
- There is a long wait for services which sometimes results in people giving up. This was cited repeatedly.
- There is a lack of community awareness regarding the crisis hot line.
- There is a need for more vocational services and concern about the non-interest in becoming a VR vender.
- Intake services take too much time.
-
Good services are “personnel dependent. The program is only as good as the person in the
job.”
- There is a need for services for children 3 years old and under. (community Issue)
Program Management
The most consistent feedback given by consumers, staff and related agencies was the feeling that the executive director is doing a good job and that he is well liked. It was obvious to the team and to many of those interviewed that the director has worked hard in the last two years to institute changes in the agency in order to improve services. Many changes are still underway and others are on the horizon. Several people indicated that, based on the changes in the last two years, they have a lot of hope for the future of the organization.
Another common theme reported by consumers, staff and
related agencies was that mid-management in the agency could be a factor that
slows down agency progress. As one related agency puts it “Dysfunctional members of mid-management are thwarting the progress of
the agency.”
It was reported that the organization is very close to beginning the project of building the new building that has been in the planning stages for many years. This would be a welcome addition to the already enhanced services.
The Administrative and Personnel Checklist is included at the end of this report. It includes 43 items, 37 of which are completely met by Life Quest. Those standards not fully met include:
1. The governing board is to have significant consumer membership. (Standard #6)
2. All facilities and programs operated by the agency provide equal access to all individuals. (Standard #11) The agency has made steps to improve accessibility to their offices and to other agency buildings including having a full ADA accessibility assessment completed. They are currently working on a plan of correction to bring all buildings up to ADA standards. There remain barriers inside various buildings including narrow halls and doorways leading into offices and bathrooms.
3. The agency actively solicits and carefully utilizes consumer and family input in agency policy
setting and program delivery. (Standard #12) There is currently no systematic mechanism to
include consumer and family feedback in agency policy setting and program delivery.
4. The agency systematically involves consumers, staff and community in annual agency planning and evaluation of programs, including feedback from its current and past users about their satisfaction with the planning and delivery of services. (Standard #13) While the agency solicits consumer and family feedback regarding service delivery, there is no mechanism for considering that feedback in the planning and delivery of services.
5. The agency develops annual goals and objectives in response to consumer, community and self-evaluation activities. (Standard #14) Consumer, community and self-evaluation activities are not a part of the annual agency goal setting process.
6. The organization has and utilizes a procedure to incorporate consumer choice into the hiring and evaluation of direct service providers, and to ensure that special individualized services (e.g. foster care, shared care, respite care providers) have been approved by the family or consumer. (Standard #22) The agency currently has no procedure of incorporating consumer choice in the hiring and evaluation of staff.
7. The agency provides new staff with a timely orientation/training according to a written plan, that includes, as a minimum, agency policies and procedures, program philosophy, confidentiality, reporting requirements (abuse, neglect, mistreatment laws), cultural diversity issues, and potential work related hazards associated with serving individuals with severe disabilities. (Standard #25) The agency has a well defined and structured orientation process, which includes all of the topics listed with the exception of addressing cultural issues.
Areas Requiring Response
1. Continue
to address issues of staff morale and staff retention. It is suggested that you
specifically look at issues such as staff stress management, supervision and
support to staff and staff compensation.
(Prior and current reviews)
2. Increase your efforts to support and educate people who are getting medication services only. (Prior and current reviews)
3. Consumers and the QA records review noted a lack of individual and family therapy. Include these treatment modalities in the agency planning process. (Prior and current reviews)
4. Utilize and educate clients about effective client grievance procedures and incorporate findings into staff training plans and agency planning. (Prior and current reviews)
5. Seek to increase consumer participation on the governing board. (Standard #6) (Prior and
current reviews.
6. Continue efforts to meet ADA standards in all facilities. (Standard #11) (Prior and current reviews)
7. Develop a process to formally solicit consumer and family input in setting policy and program delivery. (Standard #12) (Prior and current reviews)
8. Develop a process for formally involving consumers in program planning and evaluation. (Standard #13) (Prior and current reviews)
9. Develop a process for setting annual goals and objectives based on consumer, community and self-evaluation activities. (Standard #14) (Prior and current reviews)
10. Develop and utilize a procedure to incorporate consumer choice into the evaluation of direct service providers. (Standard #22)
11. Incorporate education regarding cultural issues in your staff orientation process and part of the agency’s ongoing training to staff. (Standard #25)
Other Recommendations
1. Develop a process and plan for increasing client awareness of their rights and the agency grievance process.
2. Increase your focus on the quality and context of services provided to adults with serious and persistent mental illnesses including identifying core competencies of staff.
3. Identify a clearly defined primary staff person for people who initially receive services from the agency and ensure continual services monitoring to ensure that clients do not fall through the cracks.
4. Develop training and clearly defined protocols regarding confidentiality and the release of client information and address these protocols with related agencies.
5. Executive management should assess the effectiveness of mid-management positions and explore the internal and external perceptions of the effectiveness of these positions in meeting the agency ‘s goals and community needs.
Closing
The team wishes to thank the staff of Life Quest for their cooperation and assistance in the completion of this review. We know 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 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 sheets (averaged)
NCR 8/00