Northern Community Resources
(907) 225-6355
FAX 225-6354
Linda
Jackson, Community Member
Robyn
Henry, Facilitator
A review of the mental health (MH) services
provided by Providence Kodiak Island Mental Health Center (PKIMHC) was
conducted from May twenty first 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.
Description of
Services
PKIMHC is a program of Providence Health System in
The agency’s service area includes 15,000 residents who live in the Kodiak Island region including the city of Kodiak and the seven other villages on and around the island. The program is governed and administered by Providence Health System and takes advisement from a nine-member local advisory board.
The agency employs 20 full and part-time people. The PKIMHC MH program carries an active caseload of approximately 375 people including 30-35 people served in the Community Support Program.
Mental health services provided by the program for adults include outpatient individual, family and group therapy; emergency service; psychiatric services; psychosocial rehabilitation and case management services. Through the agency’s 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.
Services to children and youth include family support, counseling, and direct support to children in the schools. SED youth and their families receive family skill development, home-based therapy and skill development. The agency also provides services in the schools throughout the island.
Emergency services are provided on a 24-hour/7 day a week basis through a rotating on-call system. The local hospital can accommodate Title 47 clients, providing 24-hour evaluation and 72-hour hold.
While residential services are not provided, the Borough owns housing in the same complex that houses PKIMHC. This housing is available to CSP clients. Services are available in the apartments during normal business hours. Currently four people are receiving housing at this location.
Description
of Process
To conduct this review, an interview team
consisting of a facilitator, two community members, and a peer reviewer
conducted 34 interviews over a
three-day visit in Kodiak, Alaska. Seven interviews were with adults who
receive MH services. Three interviews
were with parents of/or children who receive mental health services. Fifteen
interviews were conducted with related service professionals and six interviews
were with program staff. One of the interviews was with a person who serves on
the PKIMHC advisory board.
Interviews lasted from 15 minutes to an hour and
were held in person, at PKIMHC offices, by telephone and in the community.
The interview team members also reviewed personnel
documents, the agency employee handbook, the program 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 in Kodiak at the Bayside Fire Department Training Room at 7:00
P.M. on May 21st. PKIMHC advertised the event by announcing it on the radio,
posting flyers around town and publishing an announcement in the newspaper.
There were fifteen people in attendance at this
meeting. In addition, three people requested and received individual meetings
with team members. The feedback received during these meetings is summarized in
the body of 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:
1. “The
mission statement and program philosophy do not reflect the ways in which
consumers and their families are empowered.
Revise mission statement and program philosophy to be particular to and
appropriate for a publicly funded community mental health center. (Administrative Standard #1)”
Progress:
The program has revised its mission statement and program philosophy/values
statement to reflect a more consumer- and outcome-oriented approach to
services. Standard met.
2. “Staff
education and orientation do not reflect or do not make explicit a focus on
consumer centered services. Revise staff
materials to include both the language and intent of consumer centered
services. (Administrative Standard #2)”
Progress:
The program has developed a staff orientation and training process that
reflects a more consumer-centered approach to working with clients including a
new mission and values statements and the institution of more regular training
to staff. Standard met.
3. “No
copy of the audit or of the management letter was provided. Establish a means by which to provide the
annual audit and its results.
(Administrative Standard #3)”
Progress:
A copy of a summary of the 1999 financial audit for Providence Alaska Service
Area was presented. The 2000 audit was not available at this time. Standard met.
4. “The
local mental health board does not participate sufficiently in the review of
policies and their effect on local mental health consumers. Include the local mental health board in
policy discussions, allowing them to mold those policies to meet local needs,
values and concerns. (Administrative
Standard #5)”
Progress:
It is current practice that all new policies are reviewed and approved by the
program advisory board. Standard met.
5. “The
local mental health board does not participate in a review of the annual budget
nor does it have a role in program evaluation.
Inform the local mental health board of the annual budget and the value
system it represents; include the local mental health board in meaningful
program evaluation. (Administrative
Standard #7)”
Progress:
The advisory board and program management recently established a policy that
outlines the means by which the board will evaluate program effectiveness
through consumer surveys. The advisory board was not presented with this year’s
budget prior to submission. Standard
partially met.
6. “The
local mental health board does not participate in the selection of the agency's
director. Define the role of the mental
health board in this decision making process.
(Administrative Standard #9)”
Progress:
While the advisory board does not have the ultimate decision-making authority
of hiring the agency director, it currently does have the ability to give
formal input in this decision as well as give input into the formulation and
revision of the director job description. Standard met.
7. “Currently
there is not equal access to services for all people. Formalize arrangements for translators;
provide signage in multiple languages including Braille as possible; provide a
TTY system as possible; seek direction in these efforts from local consumers,
related agencies and advocates.
(Administrative Standard # 11)”
Progress:
The program currently has access to the above stated services through the
umbrella services of Providence. Standard
met.
8. “There
exist insufficient means by which the agency solicits and utilizes consumer and
family input in policy setting and program development. Create a means by which to receive continuously
consumer and family input through surveys, interviews and the like; develop and
document the means by which this information is reflected in policy and in
programming. (Administrative Standard
#12)”
Progress:
As stated above, the advisory board has developed a new policy which outlines a
formal process to survey consumers every two years and to then systematically
use the results of the survey in policy making and program decisions. The
program should follow though with this new policy. Standard met.
9. “There
is not currently a process allowing for annual program evaluation, which
includes staff, community and consumers together. Together with the local mental health board
develop a process for an annual program evaluation in which staff, community
including other service providers and consumers and their families actively
participate. (Administrative Standard
#13)”
Progress:
Program management currently works with the advisory board annually to develop
program planning. Efforts continue to be made to increase involvement of
consumers, staff and community members in this process. Standard partially met.
10. “There
is no documentation of program planning based on the results of an annual
evaluation performed by staff, community and consumers. Develop a means by which the results of the
evaluation referred to in item 9 above lead to program planning. (Administrative Standard #14)”
Progress:
Once the planned survey process is complete this standard can be addressed. Standard not met.
11. “Agency
publications do not uniformly reflect a consumer-centered focus. Begin to revise or create new publications,
which reflect consumer-centered services.
(Administrative Standard #16)”
Progress:
The agency has created a brochure for each program within the mental health
center. These publications reflect a focus on consumer-centered services. Standard met.
12. “The
agency does not have a procedure to incorporate consumer opinion into the
hiring and evaluation of providers.
Develop an employee evaluation system that can include consumer
opinion. (Administrative Standard #22)”
Progress:
Ideas for meeting this standard are currently being considered. Ideas were
discussed with the site team facilitator. Standard not met.
13. “Staff
development plans included in each employee evaluation are perfunctory. Include a staff development plan for each
employee at the time of the annual evaluation and provide timelines for
completion of each goal. (Administrative
Standards # 29, #31 and # 32)”
Progress: The agency has revised
its staff evaluation system to include staff development plans that include
goals and objectives and timelines. Standard
met.
14. “There
is a concern on the behalf of a related service agency that Alaska Native
people are hesitant to use PKIMHC's services as they are unaccustomed to paying
for health services and may shy away from sites of conflict (a reference to the
agency's past). Continue efforts to
provide culturally sensitive services to Alaska Natives.”
Progress:
The program director discussed with the local Native provider ways to increase
the ease of access and comfort for Native people seeking services. As a result
of that discussion the agency sent referral packet information to the Native
agency and explained the referral process. This issue did not arise during this
site visit. Standard met.
15. “There
is a perceived disruption in the continuity of care for the transitioning from
API to Kodiak; transitional housing does not meet all of these needs. Explore the means of providing smoother
transitions for consumers as they move from different levels of care.”
Progress:
Issues regarding transitions continue.
Standard not met.
The team identified the following strengths under Choice and Self-Determination for those receiving MH services:
+ Many people indicate that they are satisfied with their role and level of involvement in the development of their service plan and that the goals in the plan reflect their hopes and desires.
+ Many people say that they feel that the staff psychiatrist is very good at offering choices and including them in decisions regarding medications and treatment.
+ One person expresses gratitude and pride in the fact that they manage their own finances and control their own affairs.
The team identified the following weaknesses under
Choice and Self-Determination for those receiving MH services:
-
Several people indicate the need for more
housing options and the need for more ongoing support to consumers in the
community.
-
Several people indicate that the plan that
was developed for them is not reflective of their goal and desires.
-
One person says that they were not made
aware of the availability of CSP services for the first two years of getting
psychiatric services from the specialty clinic.
-
Many people, including consumers, related
agencies and staff express great frustration at the fact that the agency
psychiatrist refuses to work with clients who are also receiving services from
one of the psychologists in town.
-
A number of people indicate that there are
not enough choices for recreational and skill building activities for CSP
clients and that CSP support is limited to business hours.
-
Several people report that there are limited
services available during the day to people in crisis. Many people identify the
need for walk-in psychiatric services for those in “pre-crisis.”
- Several people including consumers and related agencies identify the need for mental health
and substance abuse services for both adolescence and adults.
- Several people identify the need for more staff training, especially in specialized skill areas
such as working with young children, working with children with ADHD, crisis prevention,
anger management, and sex offender treatment.
- Many people identify billing and insurance coverage as being a big problem, even to the point
that these problems get in the way of accessing services. Several people indicate repeated
mistakes in billing, non-coverage of services, and not being able to access services on a
sliding fee scale because of being court ordered. These issues are barriers to getting needed
treatment.
- Many people comment on the fact that there is often a long wait to get an appointment with the psychiatrist. A number of people note the need for “walk-in” psychiatric support.
- Several people identify the need for having a psychologist on staff.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Most people say they are treated with respect and dignity by staff and that they appreciate staff efforts.
+
Most people say they are very satisfied with
their services and the way they are treated by staff. “(Staff) are always
agreeable to listening.”
+ “(Staff) are quick to respond to crisis.”
+
“(The psychiatrist) is patient and is good
about fine-tuning my meds.” and “(The psychiatrist) listens to input on
medications and makes changes”.
+ Most people indicate that they know about their rights regarding confidentiality and that those rights are protected.
The team identified the following weaknesses under
Dignity, Respect and Rights for those receiving MH services:
-
A few people say that they do not know about
their rights and most people say they are not aware of a consumer grievance
process.
-
Several people comment that the front desk
staff are sometimes rude to them; that they usually ask them who they are and
what they want; they repeat this information in front of others.
-
Several people identify one long-time staff
person as being disrespectful to clients and at times talking about clients
while in common areas of the agency and in front of other staff and other
clients.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ Most people indicate that they feel safe and secure in their living environments.
+
Most people say that they feel supported by
staff in getting their health needs met. One person explains that the staff
psychiatrist was instrumental in diagnosing a medical problem others had said
was “all in (my) head”.
+ Many people express appreciation for the expertise of the staff psychiatrist in prescribing and managing their medication.
+ Several people say they feel the agency is a “warm and comfortable place to be”.
+ One person explains that “(The staff) saved my life”.
The team identified the following weaknesses under
Health, Safety and Security for those receiving MH services:
-
One resident in the housing program says
that they have no idea what to do if there is an emergency.
-
Several consumers mentioned a fire that had
occurred in residential housing several years ago, indicating that they feel
that no safety precautions have been instituted to protect clients.
-
One parent says that their child could not
get enough support in Kodiak so they had to send their child out of town.
-
One parent says that their child had to get
into trouble to get any help.
-
Several people note the lack of supports
provided to people in the agency housing program and the difficulties they have
in getting support “after hours” even though there is a live-in staff member on
the premises.
-
A couple of people indicate that there is a
lack of support for ongoing health needs in the home.
-
One person reports living in their car and
that they are frustrated by the fact that they can’t get housing.
- Many people across all interviews cite high staff turnover as a major problem for the agency.
Such turnover has a very detrimental effect on clients’ sense of security and on services. One
related provider said “I don’t ever know who works here.”
The team identified the following strengths under Relationships for those receiving MH services:
+ Most people say that staff support them in building and maintaining relationships.
+ Several family members report that the agency’s management is responsive to issues regarding services to their loved ones.
+ One person reports that the staff psychiatrist encourages them to set goals of building family relationships.
The team identified the following weaknesses under
Relationships for those receiving MH services:
-
One person indicates that they get very
lonely during the day and on weekends and that they want more support for
building relationships.
-
One person reports that, although they are
living with their child and the child is an integral part of their life, there
is no inclusion of the child or of their relationship to the parent in the
service plan.
-
A couple of people identify the need for
parenting classes.
The team identified the following strengths under Community Participation for those receiving MH services:
+ A couple of people commend the support they receive from the staff psychiatrist regarding work. One person says “Dr. Jensen has helped me in my work atmosphere.”
+ Another consumer indicates receiving help with work problems.
The team identified the following weaknesses under
Community Participation for those receiving MH services:
-
Several people report that they are not
supported in accessing community activities and services. When requesting
assistance with transportation they are told “We are not a taxi service.”
and told to take the bus. One person reports that when they decided to try and
take the bus they were given no support in learning how to use the bus for the
first time.
-
Several people identify a lack of vocational
services and support to CSP clients. Even a goal of volunteering in the
community is not supported.
-
Several people identify places to go and
activities they want to participate in the community, but said they do not get
support.
Six staff members were interviewed. The strengths of the agency identified by staff are positive relationships and support from their peers and from administrative staff.
Areas of need identified are the need for more clinical support and more clinical staff; the need for more moral support to staff; the lack of leadership from management (despite the fact that they are nice people); the heavy workload with no relief in sight and a sense of separation between clerical staff and clinical staff, one group not knowing what is happening with the other.
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 28 of
which are completely met by PKIMHC. Those standards not fully met include:
1. The
governing body oversees the agency budget and ensures program quality.
(Standard #7)
2. The
agency actively solicits and carefully utilizes consumer and family input in
agency policy setting and program delivery. (Standard #12)
3. 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)
4. The
agency develops annual goals and objectives in response to consumer, community
and self-evaluation activities. (Standard #14)
5. The
agency actively participates with other agencies in its community to maximize
resource availability and service delivery. (Standard #17)
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)
It has been three years MH services were transferred from the borough to Providence Health Care System. The agency has made many positive changes in that time but continues to be in a state of flux. The program is a picture of contrasts. It does some things well, such as crisis intervention, yet falls short of providing comprehensive services to people in the community. It is perceived by some to be a lifesaver and to others as non-responsive to their needs.
The program psychiatrist is seen as more accessible
to some clients than to others in the community. For example, a client accessing services
though the specialized clinic (where the clinical director has a separate
contract) reportedly gets appointments sooner then those seeking services
through the mental health center. The psychiatrist appears to be hard working
and responsive to clients and yet is perceived as less accessible to staff and
community agencies.
The school program seems to be mostly successful,
yet it falls short of meeting the needs of young children and seriously
problematic youth.
While there seems to be an abundance of low cost
housing as well as vacant agency-controlled housing, many residential and
home-based service needs go unmet.
There is an across-the-board dissatisfaction with
staff turnover and staff vacancies. There appears to be an abundance of
clerical staff, yet there are many complaints about billing errors and about
being turned over to a collection agency without warning.
Other
Recommendations
The team wishes to thank the staff of PKIMHC for
their cooperation and assistance in the completion of this review. A process
such as 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