Northern Community Resources
(907) 225-6355
FAX 225-6354
Site
Review Team
Mike
Curran, Community Member
Robyn Henry, Facilitator
A review of the mental health (MH) and
developmental disabilities (DD) services provided by Wrangell Community
Services (WCS) 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
Wrangell Community Services is a non-profit, community-based program incorporated in 1989. The agency provides MH and DD services to children, their families and adults who live in Wrangell and in some of the surrounding areas. The current population of Wrangell is between 1,900 and 2,000. A six-member board of directors governs WCS. The agency employs 5 full-time and 27 part-time people.
The WCS MH program provides services to approximately 30 people including outpatient individual, family and group therapy, emergency services, psychiatric services, psychosocial rehabilitation and case management services. Services to children and youth include family support, counseling, peer helpers in the schools and wrap-around 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.
The agency provides services to eleven individuals who experience developmental disabilities. Services provided under the DD program include: case management, respite care, shared care and in-home support service.
Description
of Process
An interview team consisting of two facilitators,
three community members and two peer reviewers conducted this review and
completed 45 interviews over a
three-day visit in Wrangell, Alaska.
Nine interviews were with adults who receive mental
health services. Three interviews were with parents of children who receive
mental health services. Three interviews were with parents of children who
receive DD services and five interviews were with adults who receive DD
services. Ten interviews were conducted with related service professionals and
14 interviews were with program staff. One of the interviews was with a person
who serves on the WCS governing board. The interviews lasted between 15 minutes
and an hour and were held in person at WCS offices or by telephone.
The interview team members also reviewed five
personnel files, the agency employee handbook, the program’s 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 Wrangell Middle
School at 7:00 P.M. on March 19th. WCS advertised the event by announcing it on
the radio and posting flyers around town. There were four people in attendance
at this meeting. In addition eight people requested and received individual
meetings with team members. The opinions voiced during these contacts are
included in the narrative.
Progress
Since Last Review
The following recommendations were identified
during the January 1999 site review as areas that needed attention from the
organization. Progress in these areas is noted:
1. Board
meetings need to be accessible to the community and should be advertised at
least
one week
in advance.
Progress: The agency now advertises the board meeting on the radio one
week prior to the
meeting. Standard met.
2.
Consistently include service providers in the individual’s/family’s goal
planning process and
document
the inclusion of all team members present, including signatures.
Progress: As a practice the agency now includes related service
providers in the service
planning
process, as appropriate, including representatives from DFYS, the school
district and
the
addictions program. Standard met.
3. Include
staff and community members in the development of an agency mission or value
statement. (Standard #1)
Progress: The agency has recently revised its mission statement and
included staff and
community members in the revision process. Standard met.
4. Involve
staff in developing a system to revise job descriptions as new programs are
developed and implemented. (Standard #20)
Progress: The agency is currently in a process of revising all personnel
job descriptions and
has
included staff member feedback in this process.
Standard met.
5. Develop a
uniform policy regarding information sharing between WCS and the hospital
medical
staff following crisis assessment.
Progress: The agency currently has a MOA with the hospital and provides
assessment and
planning
services when requested. Standard met.
6.
Individualize training for paraprofessionals before placing to work with
MH /DD
consumers.
Progress: Many staff reported that they felt that they had adequate
training but others reported
that
they felt they would benefit from further training including in areas such as
CPR, safety, and
blood
borne pathogens. Standard partially met.
The team identified the following strengths under Choice and Self Determination for those receiving MH services:
+
Overall, people are very positive about the
agency regarding the choices they have and state that the agency accommodates
them in choosing providers and scheduling appointments. Several people noted
the agency’s flexibility in providing services.
+
Most people report that they are included in
the service planning process and that the goals on their plan reflect their
needs and preferences. One person reports that “agency staff makes
suggestions and I’m happy with that.”
The team identified the following weaknesses under
Choice and Self-Determination for those receiving MH services:
-
Several people report that there is not
enough planning for services and that plans sometimes fall apart or there is no
follow through.
-
Many people express frustration with the
psychiatrist’s schedule, indicating that he is not here enough and that
appointments are not long enough.
-
Several people feel that the agency is
accommodating, but services are often fragmented.
-
One person feels they don’t have enough
information to make choices and is confused about how to make choices.
-
Several people said they feel that consumers
are not getting enough vocational support and
that programs focus just on maintenance
rather than rehabilitation.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Many people report that they feel their rights are respected and that their confidentiality is kept.
+
Many people really appreciate the work done by
staff. One said, “Alice does a great job, responds quickly and always
treats me with dignity. I like Alice.” Another said, “Sondra is careful
with my feelings.” A third exclaimed “Very much so about all the
statements about dignity, rights and respect. I’ve been here for years and I’ve
always been treated with respect.”
+ One person expresses appreciation for the fact that billing is lenient.
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving MH services:
- Several people say they don’t trust or want WCS services because they feel that certain staff
members breach confidentiality. One person reports strong suspicion of a staff member
following an alleged breach of confidentiality when information from WCS was passed
around town.
- One person reports that they “felt victimized” by the agency because their spouse’s therapy
took precedence over their own and it took many months for them to receive services.
- One person reports that a related service provider came to their door to provide services as a
result of a WCS referral. This arrangement was made without their consent or prior
knowledge.
- Several
people feel “looked down on” and “talked down to” by WCS staff.
- Several
people feel WCS puts dollars before services.
- There
is concern that a lack of information and education are provided regarding peoples’
rights.
- Several
people expressed a concern that the agency does not provide full disclosure of
either
program information or funds allocation.
- One person suggests the need for window coverings in the waiting room to protect client
confidentiality.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ Most people report that overall they feel safe and that their health needs are being adequately met.
+
One person reports “I’ve been given lots of
help with SSI paperwork; it made me feel very secure.”
The team identified the following weaknesses under
Health, Safety and Security for those receiving MH services:
-
One person reports that there is “too
much shuffling across agencies. I don’t feel protected.”
-
One person indicates the need for a shelter
for victims of domestic violence here in Wrangell. (community need)
-
One person reports “I’ve tried to get
services and didn’t get them. Someone has dropped the ball at WCS.”
-
One person expresses concern for the safety
of young children in school and indicates that there is a need for counselors
in the elementary and middle school. They add “The principals and
teachers can’t do it all.” (community need)
The team identified the following strengths under Relationships for those receiving MH services:
+
One person reports that therapy has been
very helpful to them in understanding their relationship with their spouse.
The team identified the following weakness under
Relationships for those receiving MH services:
-
Several family members report that their children
need socialization skills training and don’t know why it isn’t provided.
The team identified the following strengths under Community Participation for those receiving MH services:
+ Several people report that they are satisfied with this area of their life and that they do not want these issues addressed.
+ One person says they are encouraged by a staff member to get together with another person and they go out and do things together.
+ One person reports that they like to go to craft bazaars and school functions.
The team identified the following weaknesses under
Community Participation for those receiving MH services:
-
Several people express a concern for the
lack of employment services and meaningful activities for people.
-
One person would like help with casual group
relationships and socialization.
-
Team members notice a lack of WCS brochures
and agency visibility in the community.
The team identified the following strength under
Choice and Self-Determination for those receiving DD services:
+
WCS appears to involve consumers in choosing
their own service providers and participating in the plan development. One
person reports “Alice does her best to give us the services we want”.
Another said, “The agency sends a provider based on what I need.”
The team identified the following weaknesses under Choice and Self-Determination for those receiving DD services:
-
One person reports a situation where they
were told they would be receiving some equipment and it never happened,
explaining, "sometimes the staff drops the ball.”
-
One parent reports that they are not able to
get answers from staff to questions regarding Medicaid insurance.
-
Several people feel that consumers are not
getting enough vocational support and that programs focus just on maintenance
rather than rehabilitation.
The team identified the following strengths under Dignity, Respect and Rights for those receiving DD services:
+
Overall, people feel they are supported and
treated with respect. One person explained, “I feel very comfortable
with my care coordinator.” Another said, “I feel if I ever have a
problem I can go to my care coordinator and we work it out”
+
Several people express appreciation for
staff support: “Alice makes every effort to help out and she is always on
top of things”. “I feel I could use
their services anytime I need it” and “Marci helps out in every
way”
+
Most people report that they are aware of
their rights.
The team identified the following weaknesses in the
area of Dignity, Respect and Rights for those receiving DD services.
- Several people say they don’t trust or
want WCS services because they feel that certain staff
members breach confidentiality.
- Several people feel “looked down on”
and “talked down to” by WCS staff.
- Several people feel WCS puts dollars
before services.
- Several people express a concern that the
agency does not provide full disclosure of either
program information or of funding
allocation.
- A concern is expressed that a lack of
information and education is provided regarding
peoples’ rights.
- One person notes that there is no accessible parking for people with mobility problems
because staff takes all the close parking spaces.
The team identified the following strengths under Health, Safety and Security for those receiving DD services:
+ Several people express their confidence in the agency. One parent says the providers are well trained. Another says, “They are very careful of my child’s care and are very responsible”. A third exclaimed, “I will never move because of the great services I receive.”
+ One person expresses appreciation for support in meeting their basic needs. “WCS is helping me get my (vehicle) fixed so I can get around and they help me get food stamps.”
The team identified the following weaknesses under Health, Safety and Security for those receiving DD services:
- One family member expresses concern for the overall physical health and daily care of their loved one in the group home and that they have trouble accessing medical information about the client.
- Team members notice that the group home appears to be overcrowded. (community need)
-
One person says it is difficult to get
qualified staff to work with clients with complex medical needs.
The team identified the following strengths under Relationships for those receiving DD services:
+
Most people report that WCS is very helpful
in the area of building relationships.
+
A parent is very thankful for WCS’ arranging
sign language classes to help them communicate with their child.
+
Several people report that they receive
support on family relationships. One person reports that staff “helps me
keep close to my family.” Another indicates that the agency helps the
family use a sibling for respite services.
The team did not identify any weaknesses under
Relationships for those receiving DD services.
The team identified the following strength under Community Participation for those receiving DD services:
+ Many people report that WCS staff is very supportive in getting consumers out in the community. One person explained “My respite provider goes out with me to eat a couple of times a week.”
+ Providers take consumers swimming, to ball games, open gym and the teen center.
The team identified the following weakness under Community Participation for those receiving DD services:
- The team notices, and others comment on, the need for vocational skill building and placement activities for clients.
Staff
Interviews
Fourteen staff were interviewed. All of the staff interviewed expressed a consumer-centered approach to their work with clients. Each person expressed a commitment to the organization and to providing the best possible services to their clients. Overall, the staff spoke highly about their work and were generally very satisfied with the organization.
Staff identified strengths of the work environment including open and supportive communication among staff, support with getting training and a positive evaluation process. Areas of need identified by staff include the need for training in family support, basic safety, CPR and blood-borne pathogens and the agency mission, the need for health insurance and retirement benefits and a chance to meet all other staff members.
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 27 of
which are completely met by WCS. Those standards not fully met are:
1. The
agency actively solicits and carefully utilizes consumer and family input in
agency policy setting and program delivery. (Standard #12) The agency has a DD
advisory board. In the past the agency has used a survey to get MH & DD
consumer and family input, but is not currently doing this on a regular basis.
2. The
agency systematically involves consumers, staff and the community in annual
agency planning and evaluation of programs, including feedback from its current
and past users, and about their satisfaction with the planning and delivery of
services. (Standard #13) Aside from past
surveys and the DD advisory board, there is currently no systematic means for
involvement in annual planning and evaluation.
3. The
agency develops annual goals and objectives in response to consumer, community
and self-evaluation activities. (Standard #14) Aside from past surveys and the
DD advisory board, there is currently no systematic means for involvement in
developing agency goals and objectives.
4. The
agency evaluation system provides performance appraisal and feedback to the
employee and an opportunity for employee feedback to the agency. (Standard #28)
The current evaluation format does not provide for employee written feedback to
the agency.
5. A
staff development plan is written annually for each professional and
paraprofessional staff person. (Standard #29) The current staff evaluation
system does not include annual staff development plans.
6. The
performance appraisal system adheres to reasonably established timelines (Standard #31). Of the five
employee files reviewed, three had current evaluations on file.
7.
The performance appraisal system establishes
goals and objectives for the period of appraisal. (Standard #32). The current
evaluation system does not include a process for establishing goals and
objectives.
Judging from the number of people who either attended the public forum or requested private interviews, the review team feels there are a number of community members who currently feel disenfranchised from WCS. Several people feel that management staff are unapproachable and either stay behind closed doors or value degrees and licenses over the provision of good services.
It was further noted that, in talking with many of these people, they could very likely benefit from services and yet are not currently comfortable with the agency.
It appears to the team that WCS has limited staff to meet the obligations of the multiple services offered. WCS has been very innovative, but the agency may not currently be able to sustain the broad array of services it has so dedicatedly created. A return to basics and to those services WCS does well seems appropriate at this time.
Areas
Requiring Response
The team wishes to thank the staff of WCS 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 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 sheets
(averaged)