Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355 FAX 225-6354
Glenda Lord, Community Member
Robyn Henry, Facilitator
A review of the mental health (MH), developmental disabilities (DD), and early intervention/infant learning (EI/ILP) services provided by North Slope Borough Health Department (NSBHD) was conducted from March 26-29, 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
NSBHD provides health services to children and adults who live in the North Slope Region. Located in the northernmost part of Alaska, the North Slope region includes seven villages and Barrow. The North Slope Borough covers over 89,000 square miles and has a population of approximately 8,000 people, half of whom live in Barrow.
The governing body is the elected North Slope Borough Assembly. There is a health board appointed by the assembly as well as a disability advisory task force that makes recommendations to the health board.
The health department employs approximately 300 people and is the primary heath care provider for the region. The NSBHD MH program provides services to approximately 1,500 people.
Mental health services provided by the program include outpatient individual, family and group therapy, emergency services, psychiatric services, psychosocial rehabilitation and case management services. Services to children and youth include family support and counseling.
Through the 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 agency provides services to 38 individuals who experience developmental disabilities. Services provided under the DD program includes case management, respite care, and in-home support service.
The agency provides services to 117 families through the EI/ILP. Services provided include ChildFind evaluations, family service coordination, individual family service planning, early intervention services in the home or natural environments, and transition.
Description of
Process
To conduct this
review, an interview team consisting of two facilitators, one community member,
(a second scheduled community member did not participate), two peer reviewers
and an EI/ILP technical assistant conducted sixty-eight interviews during a four-day visit in Barrow,
Alaska. The process included telephone
interviews with people in village locations.
The team
interviewed eighteen adults who receive MH services and five parents of
children who receive MH services. Five interviews were with parents of children
who receive DD services and three with adults who receive DD services. Five
interviews were with families who receive EI/ILP services.
Nineteen
interviews were conducted with related service professionals and nine
interviews were with program staff.
NSBHD’s governing board was in budget hearings during the site visit.
Therefore, the review team was not able to interview a board member.
Interviews
lasted from 15 minutes to an hour and were held in person, at NSBHD offices, in
the community and by telephone.
The interview
team members also reviewed seven personnel files, the agency employee handbook,
the program Policies and Procedures 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 Barrow's Tuzzy Consortium Public Library at noon on March twenty-seventh. NSBHD advertised the event by announcing it on the radio and posting flyers around town. There were four community people in attendance at this meeting. The feedback received during the public forum is incorporated into the findings in this report.
Progress Since Last
Review
The following recommendations were identified during the January 1999 site review of the MH and DD programs as areas that need attention from the organization. Progress in these areas is noted.
1. The agency should develop a clinical practice policy based on the five (5) Quality of Life Values (Choice and Self-Determination; Dignity, Respect and Consumer Rights; Health, Safety and Security; Relationships; Community Participation).
Progress: The agency has developed a set of new clinical policies and procedures including policies that incorporate the 5 quality of life areas. Standard met.
2. Train all staff on the five (5) Quality of Life Values as a foundation of service delivery (as
defined in the Integrated Standards adopted by the State of Alaska, October 15, 1998).
Progress: The agency has incorporated the five quality of life values as part of the ongoing training of staff. Standard met.
3. Provide community education about the five (5) Quality of Life Values that govern service delivery.
Progress: The agency increased their efforts to educate the community about the quality of life values. Standard met.
4. Implement service delivery in compliance with the five (5) Quality of Life Values.
Progress: The agency is
making an ongoing effort to increase the quality of services in a manner
consistent with the quality of life values outlined in the QA standards. Standard partially met.
5. Review hiring practices in order to expeditiously fill vacant positions.
Progress: Vacant positions are filled. Standard met.
6. Hire a full time DD Specialist position.
Progress: The DD specialist position is filled. Standard met.
7. Develop and implement individualized employment/subsistence goals of consumers.
Progress: Within the last two years the Borough hired a full-time disability employment specialist and during that time, in collaboration with the local tribal organization, submitted and was awarded a substantial tribal VR grant. Standard met.
8. Create a documentation process that will substantiate and support budget controls, conduct staff training on the process developed so that good clinical practices are used and conform to State of Alaska DMHDD requirements. (Standard #4)
Progress: The agency has developed a documentation and staff training process that addresses these issues. Standard met.
9. Continue to find ways to include family members of DD and Mental Health Consumers on the Board of Directors. (Standard #6)
Progress: The Borough health board, in addition to having consumers included in its membership, has created a disabilities task force, of which the majority are people who experience mental health, developmental disabilities and/or substance abuse disorders. Standard met.
10. Include consumers’ and family members’ input in the reorganization plan and future policy
setting. (Standards #12 & #13)
Progress: The agency has policies and procedures for accomplishing this. They are continuing to work on this. Standard met.
11. Agency needs to develop annual goals and objectives in response to consumer feedback. (Standard #14).
Progress: The program has developed a process for developing goals
and objectives. Standard met.
12. The agency needs to collect required DD data and submit it to the appropriate state agency. (Standard #18)
Progress: The agency is working with the state to collect required data. Standard partially met.
13. DD staff need to have technical training with regard to grant and waiver management. (Standard #22)
Progress: Staff received Care Coordinator training in January 2001. The need for training will continue as the agency begins to bill for Medicaid services. Standard met.
14. The agency needs to assure that criminal background checks are completed on prospective employees and place documentation in employee files. (Standard #24)
Progress: Standard met.
15. The agency has not yet fulfilled an annual written staff development plan for each staff member. (Standard #29)
Progress: The agency currently has staff development plans in place. Standard met.
16. Develop a training plan for the Care Coordinator and the new DD specialist that is specific to the development and maintenance of DD services.
Progress: There is no training plan for the DD
specialist. Standard partially met.
Note: The issues reported in this section are based on the file review standards in use at the time of the previous review. File reviews are currently being done during a separate review process. Any follow-up to these standards will be included in the 2001 file review.
1. Document that the program follows up with referral sources.
Progress: The program
currently has a documented referral & follow up process in place. Standard met.
2. Policy needs to state that evaluations must include a minimum of two disciplines and must occur within 45 days from referral or why it can’t be done.
Progress: Not documented;
program has developed the form and is currently incorporating it into file
system. Standard partially met.
3. Document that two different disciplines are involved in the evaluation.
Progress: Program now
documents that there are two disciplines; however when the evaluation is done
on separate days, documentation should mention in both the first report and the
second report that they were done on separate days. Standard partially met.
4. All IFSPs should include the name or signature of the second discipline involved in the multidisciplinary evaluation and recommendations from all participants as selected by the family.
Progress: Some of the
files have this; continue to develop this consistently. Standard partially met.
5. Assure that all assessments are performed annually.
Progress: Program is
working toward this, but still needs to document the reason when it is not
performed. Standard partially met.
6. Need to clearly identify natural supports.
Standard met.
7. Provide written notification to parents and all team members of the IFSP meeting.
Progress: No written notification was found; this needs to be done. Standard not met.
8. Assure that the IFSP documents transitioning planning consistently.
Progress: Transition is
being documented through the IFSP; it is not yet consistent. Standard partially met.
9. Add to the parent rights policy timely access to records; assure the right of parents to request correction or deletion of records.
Standard met.
10. Develop a process for involvement of families in the hiring of new staff.
Progress: Process has
been developed. Standard met.
11. Expand the utilization of paraprofessional services to families to better meet needs identified on the IFSP.
Progress: Program is
working to develop this on an ongoing basis.
Continue emphasis. Standard
partially met.
Mental Health Counseling. Many consumers indicate that they are very satisfied with the out-patient counseling services provided by the mental health program. Others, including related community agencies, express appreciation for the agency’s crisis response system. People repeatedly cited examples of counselors going out of their way to support them. One client said, “They always talk to me when I need help (and they) always follow up. If I don't call them, they call me and ask me how I'm doing.” Several commented on the flexibility of support, indicating saying that the “door is always open”. The team noted that the counseling staff are very skilled and caring people who are good at their jobs.
Administrative & Personnel Standards Tool The agency has developed a comprehensive notebook that outlines the process by which the agency’s policies and procedures meet the DMHDD and EI/EI/ILP Administrative and Personnel Standards. The team was impressed with the amount of work the agency put into developing this tool. As the agency continues to embark on its program development efforts, it is clear this tool can be used as a guide to help the program focus on consumer-centered services within the guidelines of the QA process.
The approach taken by the current EI/ILP Specialist gives particular attention to visiting and ensuring village services. The EI/ILP Specialist goes to extra lengths to be involved in the activities of each village. There appears to be an exceptionally high trust level between community members and the ILP specialist. With more resources and staff under the direction of this specialist, these services can be enhanced and expanded. Examples of enhanced practices include the creation of a partnership with the EI/ILP program and the local day care program, instituting enhanced duties for the village counselors to include EI/ILP services and hiring two village-based teacher consultants to provide EI/ILP services in the school.
The team identified the following strengths under Choice and Self-Determination for those receiving MH services:
+ Several people are aware of what a treatment plan is and that they participate in developing it and feel the goals reflect what they want and need.
+ Most people say they feel they have choices about what they do daily and in the services they receive.
The team identified the following weaknesses under Choice and Self-Determination for those receiving MH services:
- Most people are not aware of a written treatment plan.
- The agency’s frequent reorganizing or restructuring limits access to and availability of services.
- Several people say the program has limited resources to serve people with very high mental health support or residential needs.
- Several people indicate that high staff turnover and the transferring of positions is disruptive to services. One person says: “The department keeps firing good people who are trying to do good work.” Another person comments: “The Department needs consistency.”
- Several people say they wish there were more parent support groups available such as a teen AA group, MH support or Al-Anon.
- Many people mourn the loss of the public health nurse who provided services to people with
special needs, and they feel they no longer have adequate support within the MH program for
case management, advocacy, medication monitoring, juggling and tracking appointments,
and assistance with school IEP’s.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Most people report that they are respected and are treated with dignity.
+ Many people report that they feel good about their clinician and feel that they can trust the clinical staff.
+
Most people say they understand the concept of
confidentiality and feel their confidentiality is protected. A consumer states, “When I moved here, I
worried about small town talk, but I learned that my confidentiality was
protected.”
+ “The Borough was always there to help with these referrals. Without them, (this consumer) would be spending his time in jail.”
+ “Staff have been caring and consistent; clinicians know and have a tie to the consumer, the family, Native Village of Barrow, Inupiat Community of the Arctic Slope, and the general community.”
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving MH services:
- Many people say they do not know about their rights as a consumer.
- Several people comment that referring to people as “CMI’s” is disrespectful.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ Several people report their clinician takes a whole-person approach to providing services.
+
One parent
states “The program was instrumental in immediately getting my child to
a safe place” when the child was in crisis.
+
One parent
reports the program was really helpful in getting the medication needed to
reduce her child’s psychiatric symptoms: “I’m so glad to have my child
back”.
+
Several people
say they appreciate the day program as a safe place to go where they can
shower, get a meal, relax, wash clothes, and be out of the weather. One said: “Katilvik
is awesome!”
The team identified the following weaknesses under Health, Safety and Security for those receiving MH services:
- Several people report a lack of crisis respite or crisis residential services for individuals, both locally and for village residents.
- Several people, including staff and clients, report that MH clients have been victimized in the Transitional House.
- One parent reports great concern for their adult child’s physical health, including weight loss and malnutrition, while they are in the agency’s residential program care.
- Several consumers and staff members feel the transitional home is not an appropriate placement for people with severe mental illness, citing among other things the safety of vulnerable clients as a concern.
The team identified the following strengths under Relationships for those receiving MH services:
+ Several people report that more than one family member receives individual counseling and this is helpful in the family getting along better.
+ Several people say the counseling they have received has helped build and maintain family relationships.
+ Some people say the Wednesday group at the Day Program has been helpful in building relationships.
The team did not identify any weaknesses in the area of Relationships for those receiving MH services.
The team identified the following strengths under Community Participation for those receiving MH services:
+ Several people talk about enjoying school or work activities.
+ Several people feel the Day Program helps them get out into the community.
The team identified the following weaknesses under Community Participation for those receiving MH services:
- Some people report that there is limited community activity for them to get involved in.
- Many people say the programs should provide greater community awareness about services.
- A family member and a couple of staff report their concern for consumers who isolate themselves in the transitional home. It is suspected that this isolation is due in part to lack of staff support.
The team identified the following strengths under Choice and Self-Determination for those receiving DD services:
+ Several people indicate they are able to make choices, although choices are limited by lack of services and lack of staff or staff turnover.
+ Families of consumers report that they have choices about where they live and the activities they choose with their child on a daily basis.
The team identified the following weaknesses under Choice and Self-Determination for those receiving DD services:
- Several people indicate that high staff turnover and transferring of positions is disruptive to services.
- Frequent reorganizing or restructuring limits access to and availability of services.
- “The department keeps firing good people who are trying to do good work”.
- “The Department needs consistency”.
- “Every time they reorganize, we have to start from scratch”. Consumer
- “So many people [visiting Barrow] have told me I should have access to more services”. DD Consumer
- Two families say they want a group for parent support and for FAS/FAE children.
- Several families understand it is their responsibility to contact staff if they want services, but based on the program’s track record, families remain skeptical of service availability.
- Several families in the North Slope who have been drawn for waiver services are not
receiving services. One Plan of Care is being updated and at least three other waivers need
to be developed and approved.
- Many people mourn the loss of the public health nurse who provided support to people with
special needs, and they feel they no longer have adequate support within the DD program for
case management, advocacy, medication monitoring, juggling and tracking of appointments
and assistance with school IEP’s. This has left many families feeling lost in the system.
The team identified the following strengths under Dignity, Respect and Rights for those receiving DD services:
+ Several people indicate that they feel current staff give them appropriate respect.
+ Most people report that they are respected and are treated with dignity.
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving DD services:
- Several people indicate that they don’t know if they are on the waitlist for DMHDD, but they have filled out the paperwork several times.
- Several people report that they feel false hopes have been raised by staff who make promises for support (respite, SSI, assistive equipment, home modifications) and then do not follow through, often because of work overload or staff turnover.
- Many families express frustration that the health department wants providers to be responsive to the Borough’s interests above the clients’ needs.
The team identified the following strength under Health, Safety and Security for those receiving DD services:
+ Several people report their clinicians take a whole-person approach to providing services.
The team identified the following weakness under Health, Safety and Security for those receiving DD services:
- Families express a need for additional services to address health and safety issues related to lack of staff or staff turnover.
The team identified the following strength under Relationships for those receiving DD services:
+ Several people say the counseling they have received has helped build and maintain family relationships.
The team identified the following weakness under Relationships for those receiving DD services:
- Several families report that due to the lack of available services, family members, including siblings, become burdened with excessive care.
The team identified the following strength under Community Participation for those receiving DD services:
+ Several people talk about enjoying school or work activities.
The team identified the following weaknesses under Community Participation for those receiving DD services:
- Many people say the programs should provide greater community awareness about services.
- Some families report difficulty getting out into the community due to medical complexity or limited wheelchair access.
The team identified the following strengths under Choice and Self Determination for those receiving EI/ILP services:
+
“The new Coordinator helps: pretty
wonderful!”
+ Most families say they have choices and participation in planning services.
+ All families interviewed say that there is a plan in place and, for the most part, goals reflect what they want and need.
The team identified the following weaknesses under Choice and Self-Determination for those receiving EI/ILP services:
- There was a lapse in services from the previous to the current ILP Coordinator.
- Frequent reorganizing or restructuring limits access to and availability of services.
- Some families do not have enough choices in services and experience delays in getting services
- Two families say they want a group for parent support for children with disabilities, and for FAS/FAE children.
- Several people indicate that high staff turnover and transferring of positions is disruptive to services.
The team identified the following strengths under Dignity, Respect and Rights for those receiving EI/ILP services:
+ Most people report that they are respected and are treated with dignity.
+ “(The current ILP coordinator) understands the people and the people/family in turn trust and value her.”
The team identified the following weakness under Dignity, Rights, and Respect for those receiving EI/ILP services:
- One family reports that it takes a long time to get records.
The team identified the following strengths under Health, Safety and Security for those receiving EI/ILP services:
+ Several families comment that the program brings a team of doctors and specialists to
Barrow and into some of the villages to perform evaluations.
+ “EI/ILP is a strong advocate
for finding resources for health, safety and security”.
+ A family says “The program is a great tool for parents
out there, and it taught us how to work
with our child”.
The team did not identify weaknesses in the area of Health, Safety and Security for those receiving EI/ILP services.
The team identified the following strengths under Relationships for those receiving EI/ILP services:
+ Families are involved with day care and playgroups in partnership with EI/ILP in the villages.
+ People see the current ILP coordinator as a strong advocate for families.
The team did not identify any weaknesses in the area of Relationships for those receiving EI/ILP services.
The team identified the following strengths under Community Participation for those receiving EI/ILP services:
+ EI/ILP participates in Health Fairs and other community activities in Barrow and in villages.
+ The ILP coordinator makes extra efforts to do outreach in village communities.
The team did not identify any weaknesses in the area of Relationships for those receiving EI/ILP services.
Staff Interviews
Nine members of the agency staff were interviewed. All the staff interviewed expressed a consumer-centered approach to their work with clients. Each person expressed a commitment to providing the best possible services to their clients. A staff person reported that the administration understood the importance of their program and valued it. Another staff reported that relationships between peer employees are good.
Concerns expressed by staff included a lack of orientation to agency services, a lack of regular performance evaluation, a concern with poor staff morale, grave concerns about the stability of the system, grave concerns about work location changes (four moves in one year), the need for more training of line staff and a lack of vision and leadership from top management. Several staff and consumers indicate that they do not feel staff are appreciated by the Borough.
The agency strengths identified include
- Lots of collaboration; key players at IEP meeting (MH)
- Services have improved since the last reorganization was completed. (all programs)
- Katilvik day program provides ongoing support and a place in the community for people. One related service person said: “When I ask people what they want, they say they want continued contact and involvement with Katilvik. It’s really a neat environment”.
- The new ILP coordinator is getting things going; developing new relationships; things are getting better.
- Related agency personnel are pleased with the support, supplies, training, and evaluation teams at one village location. (EI/ILP)
-
Related agency personnel are very happy with
collaborative relationships. One person
reported, “Without them I would not be
able to get the services to the people. I’m struck with how well staff work
together both within and across departments”. (all programs)
- The staff presence at court hearings supports consumers.
-
The MH/DD
programs act as a bridge between agencies for consumers.
-
Mental health
does a good job at responding to community crises.
Concerns identified included:
- There is no one picking up the EI/ILP portion of the transition team. (EI/ILP)
- Transition process needs to be revived. (EI/ILP)
- Concern about lack of a ChildFind system. (EI/ILP)
- The need for training/orientation describing DD services to other service providers. (DD)
- A lack of wrap-around services and counseling for children or families with mental health needs. (MH)
- There is too much turnover with staff. (all programs)
- Several people noted a lack of interagency communication.
- There is limited communication with Adult Public Assistance, which may limit access to financial resources for people with disabilities.
- DD services in the villages are non-existent.
- There wasn’t anybody providing ILP services, or it seemed that way. Some villages reported that they have not had visits in up to two years. (EI/ILP)
- Health Department staff are active in working on FAS/FAE issues. If the EI/ILP specialist is not yet involved in the community task force on FAS/FAE, that should be happening.
- There is a need for long-term housing for people with chronic mental illness.
- “It would be good to know what the program options are, where they are located, and who is working in which jobs.”
-
Concern that too
often there is no advocate for parents for school IEP meetings for children
with MH or DD.
Program Management
Many people in the community including consumers say that staff get moved around or reassigned to different jobs without regard to talent or preferences. The agency has developed many plans for stabilizing and improving services. In the past, relocation of program offices, staff churn and top-down instability have inhibited these efforts.
It is the team's hope that future stability will enhance the program improvements that staff are trying to implement. The team noted an absence of comments in interviews about the existence or quality of DD services. The team thinks this is due to insufficient services being available and a general lack of awareness in the communities that DD services should be available.
The Administrative and Personnel Checklist is included at the end of this report. It includes 43 items, 38 of which are completely met by NSBHD. Those standards not fully met are:
1. The agency collects required data and submits it to the appropriate state agency. (Standard #18) DD and management staff are currently working closely with the state DD regional specialist to come into compliance with this standard.
2. 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) While the agency has developed a process for including consumers in the hiring of staff, there is currently no procedure for incorporating consumer feedback in the evaluation of staff.
3. The agency evaluation system provides performance appraisal and feedback to the employee and an opportunity for employee feedback to the agency. (Standard #28) Of the seven personnel files reviewed, two files did not include any evaluations and one person’s evaluation was overdue.
4. The performance appraisal system adheres to reasonably established timelines (Standard #31) Of the seven personnel files reviewed, two files did not include any evaluations and one person’s evaluation was overdue.
5. Staffing patterns include adequate specialized personnel to provide the services agreed to in the IFSP. (Standard # 41) At this time the agency has only one person designated to work in the EI/ILP program and while she does an excellent job, there are not enough staff resources to meet the service needs.
1. The DD staff need ongoing and consistent support from the NSB to develop dependable services for people experiencing developmental disabilities and their families. (DD)
2. The DD staff needs to update core service plans for individuals eligible for core service funding and develop plans of care for families eligible for waiver services. (DD)
3. At this time only two consumers in the system are receiving respite care. DD staff need to recruit and make available respite care services for those who need such services. (DD)
4. The agency needs to develop an adequate crisis respite for people with mental illness. (MH)
5. The agency needs to replace the current residential services provided to adults with serious mental illness under the “transitional program”. The agency needs to separate these high need, vulnerable clients from the chemical dependency and crisis respite clients and provide services that go beyond “warehousing” and focus more on rehabilitation. (MH)
6. The agency needs to collect required DD data and submit it to the appropriate state agency. (Standard #18 and prior review) (DD)
7. The organization needs to develop and utilize a procedure to incorporate consumer feedback into the evaluation of direct service providers. (Standard #22)
8. The agency evaluation system needs to provide performance appraisal and feedback to all employees and an opportunity for employee feedback to the agency. (Standard #28)
9. The performance appraisal system needs to adhere to reasonably established timelines for all staff. (Standard #31)
10. Staffing patterns in EI/ILP need to include adequate specialized personnel to provide the services agreed to in the IFSP. (Standard #41) (EI/ILP)
11. The agency needs to develop and provide DD services and provide them consistent with service principles. (Prior and current reviews) (DD)
12. In the DD program, Medicaid billing will allow families to receive services appropriate for their needs, and will allow the agency to expand services for other families. The team finds urgent need for the NSBHD to institute a coordinated system of service provision paired with billing under Home and Community Based Waivers. (DD)
13. Develop a training plan for the DD specialist. (Prior and current reviews) (DD)
Note that the follow up from the prior EI/ILP review will be included in the EI/ILP file review portion of the review.
Recommendations
1. The NSBHD should provide stability and ongoing support to allow MH, DD & EI/ILP services to recover from previous reorganizations and turmoil.
2. The DD Coordinator should receive training, ideally on-site, by an experienced care coordinator on the development of waivers.
3. Staff and community members need programs to stay in a consistent physical location to offer continuity and dependable services to clients.
Closing
The team wishes to thank the staff of NSBHD for their cooperation and assistance in the completion of this review. The team noted the long hours, the holiday abandoned, excellent support for the review, and the large number of interviews as evidence of how seriously the staff took this process. 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 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 and the Early Intervention Technical Assistant. The QA Section and Early Intervention Technical Assistant 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)