September
21 – September 23, 1999
Fairbanks,
Alaska
SITE
REVIEW TEAM:
Betty
Taaffe, Community Member
Vickie
Horodyski, Community Member
Dennis
Manson, Peer Reviewer
Sherry
Modrow, Facilitator
The Site Review Team reviewed DMHDD funded
Developmental Disabilities Supported Services provided by Adult Learning
Programs of Alaska (ALPA) from September 21 to September 23, 1999, 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. DMHDD Quality
Assurance staff provided an informal review of consumer files during the site
review.
ALPA is a nonprofit organization providing support
for 45 adults who experience developmental disabilities, in addition to
providing comprehensive educational development for adults, out-of-school youth
and Head Start-eligible children. ALPA’s nine member board of community
volunteers sets policy and supervises the executive director. The organization
employs about 72 full- and part-time staff members, including seven full-time
Supported Services employees and 19 part-time Supported Living/Educational
Respite Providers.
ALPA’s Supported Services currently receive
approximately $325,130 in funding from DMHDD, $161,947 as Medicaid waivers and
a small amount of long-term follow-up funds from the Division of Vocational
Rehabilitation. Services include
Supported Employment, Supported Living, Case Management or Care Coordination,
and Educational Respite. The Fairbanks
North Star Borough forms the service area.
ALPA has responded to requests to provide supports for more consumers,
and the program has experienced growth over the past two years, primarily in
the supported living area.
The site review team met for three days at ALPA’s
office in Fairbanks. The team consisted
of two community members, a peer reviewer, a member of the DMHDD Quality
Assurance staff, and a facilitator. Team members conducted interviews with 11
consumers and four family members, one board member, and six ALPA employees:
four direct service providers, the program manager who also provides direct
service, and the agency’s executive director.
The team also interviewed three individuals who work at related
agencies: Alaska Division of Vocational Rehabilitation, Crossroads and ACCESS
Alaska. Interviews lasted between 20
minutes and one hour and were conducted by telephone or in person at people’s
homes or at ALPA.
ALPA planned and advertised an Open Forum on
September 21 at the Noel Wien Library. A notice ran in the local events section
of the newspaper. Postcards were mailed to the agency’s consumers, and 45
businesses and related service agencies received faxed fliers describing the
event. One person attended, and
comments made at the Open Forum have been incorporated into the body of this
report. The primary issue discussed
during the forum was the difficulties faced by consumers or family members who
are new to the DMHDD system and who have complicated cases involving a variety
of service agencies, and how instrumental ALPA has been in helping families
negotiate the maze of service coordination.
Progress
Since Previous Review:
1.
Previous Recommendation: The Board should explore
ways to include consumer representation.
Action
Taken: The Board promotes consumer representation agency-wide and when recruiting for Board members
actively seeks representation of people with disabilities. Although there was a Head Start
parent of a child with multiple special needs on the Board in FY99, there is currently no
consumer representation on the Board.
This continues to need
action.
2.
Previous Recommendation: Assure the written appeals
process revision is completed.
Action
Taken: This has been completed.
3.
Previous Recommendation: The facility does not
provide equal access to all individuals.
Action
Taken: ALPA’s offices and classrooms moved into the Tanana Chiefs Conference building in 1998. The building meets all standards for
accessibility.
4.
Previous Recommendation: Assure that all employees
undergo timely background checks.
Action
Taken: This has been implemented.
5.
Previous Recommendation: Explore ways to increase
consumers’ involvement in hiring and evaluating staff.
Action
Taken: This recommendation has been met.
A consumer sits on the interview panel
for new full-time hires in the Supported Services program.
6.
Previous Recommendation: Create an evaluation
system that assesses the employee performance and provides staff regular
feedback.
Action
Taken: In place since June 1998: All staff evaluations are completed at least annually.
7.
Previous Recommendation: Find ways to connect
people with non-paid community members.
Action
Taken: The agency includes training on encouraging and facilitating the development of
natural supports in its staff development.
Transportation continues to be a serious
barrier for consumers to attend as many activities as they would like, and a community task force has
met to address transportation issues and needs. While the agency
has implemented the recommendation, staff find the limits of funding for transporting people to be a continuing concern
beyond their control.
8.
Previous Recommendation: Increase efforts to expose
people to a wide variety of typical community activities.
Action
Taken: The agency has made significant efforts in this area. A calendar of events is provided for consumers, who are encouraged to take
advantage of the wealth of opportunities
provided by other programs within ALPA.
Staff coordinate special events on a
regular basis.
9.
Previous Recommendation: Assure that consumers
participate in the planning process.
Action
Taken: Recommendation implemented.
Staff survey consumers and their families on an annual basis, and the information is incorporated
into ALPA’s program goals.
10. Previous
Recommendation: Staff should gather the appropriate information from all key
parties prior to creating or revising the planning document.
Action
Taken: Recommendation implemented. An
assessment process assists staff to determine
the appropriate parties to be involved in service planning for consumers.
11. Previous
Recommendation: Assure that plans contain clear, measurable goals and
strategies.
Action
Taken: Recommendation implemented.
12. Previous
Recommendation: Work with employers to assure they become the primary problem
solver.
Action
Taken: The recommendation has been met.
Staff work in consultant roles rather than
serving as the primary problem solver for workplace situations.
ALPA staff worked for an extended period of time to
help a consumer realize the long-standing dreams of owning a home and having a
pet. The staff arranged the necessary
supports, legal, financial and logistical, to bring about this remarkable
accomplishment. In the process, the
staff reported that this consumer became
the first person in the state to successfully access the Alaska Housing Finance
Corporation’s HOPS program, which establishes gap financing for people with
disabilities. ALPA staff coordinated or
helped arrange for the additional involvement of individuals and agencies in
the community to help the consumer move into, maintain and improve the
home. This individual has realized a
sense of accomplishment and well-being through this process, and now has the
companionship of a pet as well:
“They
want to help people to make their life better.”
Consumer
Individual home ownership is not practical or necessary for everyone. However, the team felt the willingness of ALPA staff to believe in people’s dreams and access the resources and supports necessary to help bring dreams to reality demonstrates a model of support that should be widely emulated.
·
ALPA staff work hard to provide the services people
need when they need them.
·
The consumer is the center of an organization with
great attention to detail, in which employees feel empowered to problem-solve
by using creative, innovative methods.
·
ALPA works “outside the box” to provide supports
individuals desire.
·
ALPA has responded to consumer requests for
services both by growing and by providing innovative services.
The team identified the following strengths under
Choice and Self-Determination for people receiving DD services from ALPA:
+ Staff help consumers establish independence and
exercise choices.
“He wants to be on his own.” Staff member
“ALPA has always been consumer
driven.” Family member
“______ ran her own planning meeting, with
10 people there. Our whole point is
helping people explore what they want to do and then finding ways to make that
happen.” Staff member
+ ALPA puts combinations of services together to enhance the independence of individuals.
“This is every parent’s dream to have
services in place like this; you raise your child to become independent.” Family
member
A
family chose a shared care arrangement that they reported as being very
beneficial.
+ Consumers indicate that staff are very responsive to their desires and choices; services focus on the desires of individuals.
+ Staff work to establish good relationships with
consumers and family members, while not getting enmeshed in interpersonal or
family issues.
“Val is great.” Consumer
+ People have jobs where they feel they contribute and have meaningful relationships.
The site review results did not indicate material
weaknesses in the area of Choice and Self- Determination.
The team identified the following strengths under
Dignity, Respect and Rights for people receiving DD services from ALPA:
+ Program staff model a strengths-based approach to
interacting with individuals, with a focus on the positive.
+ Consumers report they feel that staff act more
like friends than paid providers.
“They treat you good.” Consumer
+ Family members reported letting go of worries and
responsibilities because of the agency’s supports.
“It has normalized life for me.” Parent
+ Consumers feel they have options without being
pushed to accept particular ones.
+ Staff consider consumers’ dreams to be realized
possibilities.
The site review results did not indicate material
weaknesses in the area of Dignity, Respect and Rights.
The team identified the following strengths under
Health, Safety and Security for people receiving DD services from ALPA:
+ People have choices of providers and feel comfortable having them in their homes.
“Capable and trustworthy staff.”
Consumer
+ Very high trust levels exist between consumers
and providers.
“I have never been dissatisfied with any
worker.” Family member
+ Staff help people make health appointments and help them get there.
+ The agency encourage staff to use flexibility in
meeting the needs of individuals; they take on activities that go beyond
typical definitions.
The site review results did not indicate material
weaknesses in the area of Health, Safety and Security.
The team identified the following strengths under
Relationships for people receiving DD services from ALPA:
+ Staff model how to develop good relationships
with people by establishing strong relationships with individuals they serve
and with providers of related services.
“It took a lot of work and planning to make
this happen; five people now cover most of my parental activities.” Parent
“Excellent relationship and getting better
as we all learn and grow.” Related
service provider
A
consumer reported wanting to stay in touch with his provider because “it’s not just a job to them,”
even though the individual needs little day-to-day assistance.
+ Staff are very loyal to consumers in helping them to research positive outcomes, sometimes continuing to stay in touch after people move on from ALPA.
+ Consumers have opportunities to develop
relationships with people in a wide variety of locations and activities.
“It really helped when my provider got me
involved in Special Olympics, ice skating and bowling.” Consumer
+ There is a good balance between providing services
and giving consumers space to grow.
“I can choose a friend or relative or
whoever I want for respite.” Consumer
The site review results did not indicate material
weaknesses in the area of Relationships.
The team identified the following strengths under
Community Participation for people receiving DD services from ALPA:
+ ALPA assists people with taking part in
activities outside their homes, and there is a wide variety of participation
supported by the agency.
Providers
have recently provided supports to help people vote, learn to swim, go to line
dancing classes, volunteer at Head Start, work out at a gym, attend free movie
night at UAF, participate in Special Olympics and related dances, and “hang
out” at Denny’s and other social scenes.
The site review results did not indicate material
weaknesses in services provided by ALPA in the area of Community Participation.
Note: This chart applies only to consumer satisfaction with quality of life and supports that ALPA services can impact. Funding issues impact conditions that affect some responses.
DD
|
Choice
N=15
|
Dig&Res. N=15
|
Hth,Saf,Sec N=15
|
Relatns. N=15
|
Com.Par. N=15
|
||||||||||
Outcome
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
Partial |
|
Person/Parent/ guardian |
15 |
0 |
|
15 |
0 |
|
15 |
0 |
|
15 |
0 |
|
11 |
0 |
4 |
Staff
Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person/Parent/guardian |
15 |
0 |
|
15 |
0 |
|
15 |
0 |
|
15 |
0 |
|
14 |
1 |
|
Growth and change in the program have meant an
intense time for the staff; they feel the addition of new positions is already
having an impact on lowering caseloads and, in one employee’s words, “making it
better.” Because of their attention to
detail and high priority on meeting the needs of individuals, staff members
feel they are still somewhat understaffed.
Paperwork, files and training manuals contain
excellent detail and are maintained in an organized manner.
Staff have positive attitudes towards the agency,
their jobs and the people they serve.
They report excellent relationships among members of the Supported
Services team, and appear to have uniformly high opinions of the program
manager, an opinion expressed by many consumers as well. Staff have opportunities for professional
and personal development and participate in varied educational pursuits. Cross-training will add depth to both
administrative and direct service capacities, and this effort is currently
underway. This will provide a means of preventing problems when particular
employees are unavailable for issues related to a particular consumer’s needs,
as well as providing program staff with a global understanding of services to
consumers. Members of
ALPA’s staff feel the organization trusts them to
make good decisions and empowers them to be creative in working with consumers.
Several people mentioned the potential for
increasing space needs if the program continues to grow.
The three related service agency staff interviews
characterized ALPA services as being flexible, innovative and focused on positive
outcomes for consumers. ALPA staff are
willing to work with individuals who are hard to serve or who have complicated
histories. The communication and
supervision required between agencies under these circumstances highlight the
willingness of ALPA staff to go the extra distance to provide individuals with
choices.
ALPA is well-run and fully meets nearly all of the
DMHDD administrative and personnel standards.
Administrative procedures seem to be well integrated into the everyday
activities of the staff. The training
manual used to orient new members of the Supported Services staff is an
outstanding tool.
The ALPA Board does not include representation or
membership of people who experience developmental disabilities. The agency is recruiting for two board seats
and hopes to have a consumer or family member on the Board this year.
ALPA’s personnel policies do not specifically speak
to conflicts of interest, but several key features are addressed under such
headings as political activity and nepotism.
ALPA’s space provides barrier-free access in a
building that houses several other human services agencies. Staff report increased cooperation with
those organizations. Supported Services
had several changes in program management, but has a strong, highly regarded
manager now.
ALPA staff report positive relations with the DMHDD
regional program specialist, with high levels of support for consumers.
Waivers add flexibility in some areas but remove it
in others. Particularly as regards care
coordination, ALPA has no way to receive compensation for the many hours the
staff put into some of the extremely complex cases with which they work. The State needs to address this issue to
prevent agencies from having to limit their efforts on behalf of consumers.
Files were arranged in an organized manner and
contained relevant information. All
files reviewed contained the required documentation. All staff members, consumers and guardians participating in the
development of the plan should sign the plan, documenting their
participation. Some case notes were
brief and could have been more developed.
Overall, the files were very well documented and well organized.
Areas
Requiring Response
1.
The ALPA Board does not include representation or
membership of people who experience developmental disabilities. The agency is recruiting for two board seats
and hopes to have a consumer or family member on the Board this year (Admin. Standard
6). Restructuring of the governing
board to allow for consumer and family member participation and sustained
effort in recruitment could offer solutions.
2.
ALPA’s personnel policies do not specifically speak
to conflicts of interest, but several key features are addressed under such
headings as political activity and nepotism (Admin. Standard 10). Minor revision to the policies to address
conflicts of interest would satisfy the standard.
Other
Recommendations
1.
Some people would like to have more options for
their leisure time. Lack of
transportation
options in the Fairbanks area severely limit access to community
participation, and ALPA
continues to support the efforts of the community task force as it seeks
solutions to the lack of
transportation. ALPA staff
provides people with many opportunities and should continue to
explore ways to help people access groups such as service organizations,
churches and clubs
where
they can expand their networks independently.
2.
While staff provides excellent opportunities for
individuals to develop relationships with people from all backgrounds, some
consumers express a desire to spend time with people who experience
developmental disabilities. Staff may
consider supporting the development of linkages between consumers with similar
interests and talents.
3. The
agency’s offering of cross training is an excellent opportunity for staff and
will no doubt
result
in even better services. This effort
should be encouraged and supported.
4.
Collaborate with the Regional Program Specialist regarding compensation
for care coordination.
The site review team would like to thank the staff,
board and consumers who aided in the review.
It is a pleasure and an honor to participate in reviewing an agency
where standards of service are excellent.
The commitment of staff to carrying out the wishes of people who use
ALPA’s services was a central theme during interviews.
The final draft of this report will be prepared
within 30 days and sent to DMHDD. ALPA
and DMHDD will collaborate on a plan to make needed changes.