INTEGRATED QUALITY ASSURANCE REVIEW
May
15-17, 2000
SITE REVIEW TEAM
Kelly
Behen, Representative, Alaska Mental Health Board
Gail
Slentz, Community Member
Patti
Hauser, Peer Reviewer
Anne
Henry, DMHDD Special Projects Staff
Robyn
Henry, Facilitator
A review of Mental Health services provided by
Communities Organized for Health Options (C.O.H.O.) was conducted from May 15th
through May 17th, 2000, using the Integrated Quality Assurance Review
process.
The content of
this report is the summation of the impressions of the 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 Program services
C.O.H.O. is a
non-profit community mental health (MH) and substance abuse counseling center
serving adults, adolescents and children who live on Prince of Wales Island.
The island includes remote areas that have up to a 4-hour gravel road drive or
are accessible only by boat or float plane.
C.O.H.O. provides outpatient services including
individual, family and group therapy, psychiatric evaluations and
consultations, medication management, crisis intervention, case management and
outreach services. Through their Family Services program C.O.H.O. also provides
services to DFYS-referred clients who have lost or are at risk of losing their
children to State custody. Staff reported that they serve a small number of
people who have serious and persistent mental illness (CMI). The team did not
interview any these clients.
A nine-member Board of
Directors, who meets quarterly, governs the agency. The agency, including both
MH and substance abuse programs, employs nine full and part time people. The
agency’s Executive Director oversees the programs, working two days a week.
Description
of the process
To conduct this review, an interview team
consisting of a facilitator, a community member, a peer reviewer, a
representative of the Alaska Mental Health Board and a State representative
conducted 19 interviews over three days in Craig, Alaska. Consumer interviews,
which included adult consumers and the parents of child consumers, were taken
from a list of 30 randomly selected cases. Of those people successfully
contacted from the list, six were interviewed. Seven interviews with a total of
10 people were conducted with related service professionals, one interview was
with a Board member, and five were with C.O.H.O. staff. Interviews lasted from
15 minutes to an hour and were conducted by telephone or in person either at
the C.O.H.O. offices or in the community.
The team members also reviewed four personnel
files, the agency 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 agency staff on the
final day of the visit.
During this same period of time, one member of the
DMHDD Quality Assurance Unit did a review of randomly selected client records.
The report of those review findings was presented under separate cover.
Open Forum
An open forum was held in Craig at the Presbyterian
Church at 7:00 P.M. on May sixteenth. C.O.H.O. advertised the event by posting
flyers throughout town. There was no community attendance at the forum.
Progress
Since Previous Review
As this is the first review of C.O.H.O. using the
new program standards, there is no previous action plan on which to report.
Choice/Self-determination
The team
identified the following strengths under Choice and Self-determination for
those receiving services at C.O.H.O.:
+ Most people reported that they were a part
of the development of their service plan and that the plan reflects their
desired goals.
+ Several people expressed praise for the
staff they have worked with.
“I
really like Doug, he’s good to talk
to.”
“Susan saved my life”.
The team identified the following weaknesses under
Choice and Self-determination for those receiving services from C.O.H.O.:
-
Several people interviewed identified the need for a female therapist
and a need for more than two therapists.
- One
person reported the need for more specialized expertise in therapists,
providing, for example, child or marital counseling.
- One
person indicated that they would like to see more public relations activities
and advertising about C.O.H.O. services so that people in need could get
general mental health services.
Dignity,
Respect and Rights
The team
identified the following strengths under Dignity, Respect and Rights for those
receiving services from C.O.H.O.:
+
Consistently, people reported feeling respected and valued by C.O.H.O.
staff.
+ People
reported that they felt that their confidentiality was protected and that
keeping information confidential was an agency priority.
+
Everyone interviewed said they had been informed about their rights.
+ Overall
appreciation for Doug’s personal efforts were reported.
+ People interviewed reported a sense of
support from the center to those that they serve. One person expressed their
praise for the agency when they said:
“People
think C.O.H.O. is a place
you go when you get into trouble, when you get a DWI… people like myself, who
are just productive and can be more,
it can help too. I would like the word out.” Another reported “Everyone is really nice there.” Still
another said, “It comes across that they
really care, not because they are
doing a job, but because they want to”.
The team did not identify under weaknesses under
Dignity, Respect and Rights.
Health, Safety, Security
The team
identified the following strengths under Health, Safety and Security for those
receiving services from C.O.H.O.:
+ Overall, people reported that they feel
safe in their home and in the community and that their basic needs are being
met.
The team identified the following weaknesses under
Health, Safety and Security for those receiving services from C.O.H.O.:
- Two
people reported on the need for a local pharmacy or better access to pharmacy
services and that there is often at least a three day wait for prescription to
be filled in Ketchikan. (community need and not the responsibility of this
agency)
- One
person reported that they were in need of physical therapy services but
couldn’t get services because of the cost. (community need and not the
responsibility of this agency)
- One
person reported that staff turnover at C.O.H.O. causes stress.
- Several
people expressed concern that staff burnout could create problems of access to
services.
- Several
people reported the need for more services in outlying communities.
- Several
people reported the need for more services in relation to domestic violence.
Relationships
The team
identified the following strengths under Relationships for those receiving
services from C.O.H.O.:
+ Overall, people reported being satisfied
with their relationships.
+ Most people reported that they felt
supported and encouraged in the use of their natural support system.
The team identified the following weakness under
Relationships for those receiving services from C.O.H.O.:
- One
person reported the need for programs in the community to support single
parents.
The team
identified the following strengths under Community Participation for those
receiving services from C.O.H.O.:
+
Overall, people reported being well integrated into the community.
+ Several
people reported that they enjoyed local outdoor activities.
+ One
parent reported that they feel very supported by the community and that people
are very friendly with their child when they are in public; there was no
feeling of being stigmatized for using mental health services.
The team identified the following weakness under
Community Participation for those receiving services from C.O.H.O.:
- One
person reported that the geographical distances and the lack of public
transportation creates a problem for accessing services and a feeling of
isolation.
Staff
Interviews
The team interviewed five of the C.O.H.O. staff.
Most staff reported that they really enjoyed working for the agency. Several people commented on the strong
collaboration among staff and that they appreciated the open communication
among people. Most people reported they have adequate training for their job
and that they feel very supported in getting additional training as needed. The
ability to use flex time and the support in getting time off was also cited as
a plus. Several people commented positively about the integrated mental health
and substance abuse setting indicating that they felt this had a positive
effect of services.
Areas of concerns cited by staff included the need
for more physical space in the office, the need for additional MH clinicians,
and all staff noted that there was no regulated system for determining pay
raises. A concern was raised about the level of administrative support and
understanding regarding MH services. One person also expressed a strong desire
for follow through with the new substance abuse treatment facility, citing the
need for these additional services.
The team sensed in talking to the staff that they
are very involved in the community and that they have a strong sense of ethical
boundaries and respect for the people with whom they work.
Collateral
Agency Interviews
Ten people from seven collateral agencies were
interviewed including representatives from the Craig High School, Klawock
School, Craig Police Department, DFYS, Community Connections, Head Start and
the Seaview Clinic. Most of the feedback about the program was very positive.
There were reports of good collaboration and communication. One person
identified C.O.H.O. as a “key piece of the health of the community”;
another person echoed similar comments when they said, “C.O.H.O. has come through every time we’ve needed them”. Another
agency person commented that they “feel
believed in by the clinicians and agency…very complimented and validated’.
Regarding C.O.H.O. staff one person commented “there seems more of a team then there ever
has been”. A couple of people
commented on the value of the Family Services project and several people
praised the Peer Helpers project commenting that, although it is primarily a
substance abuse project, it has a positive effect on the mental health of the
community.
Areas of need identified by collateral agencies
include the strong need for a female clinician; at least three additional
clinicians, one specializing in children’s issues; the need for FAS/FAE
services; parenting classes; a batterers/domestic violence program; more
violence prevention services for both youth and adults.
A couple of people also reported that the
month-long absence of a C.O.H.O. clinician created some interruptions and
delays in services and also highlighted the continual need for the services
that C.O.H.O. provides. The need for more services in outlying areas was also
cited.
Administrative/Personnel
Narrative
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 27 of
which are completely met by C.O.H.O. Those standards not fully met include:
1.
The agency actively solicits and carefully utilizes
consumer and family input in agency policy setting and program delivery.
(Standard #12). Although the
organization incorporates consumer/family input into policy making though the
input of the five consumer/family member board members, there is no formal
means for getting input from all service users.
2.
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) The agency reports that it
has done informal, key-informant interviews with agencies and other community
members and uses the feedback in agency planning, but this has not been done on
a formal basis.
3.
The agency develops annual goals and objectives in
response to consumer, community and self-evaluation activities. (Standard
#14) As above, the agency reports that
this has been done informally, but this has not been done on a formal
basis.
4.
The organization has and utilizes a procedure to
incorporate consumer choice into the hiring and evaluation of direct service
providers, and to ensure that special individualized services (e.g. foster
care, shared care, respite care providers) have been approved by the family or
consumer. (Standard #22) The
organization does not formally incorporate consumer choice in the hiring and
evaluation of staff.
5. A
staff development plan is written annually for each professional and
paraprofessional staff person. (Standard #29)
The current evaluation system does not include a written staff
development plan.
6.
The performance appraisal system adheres to
reasonably established timelines. (Standard #31). Of the four personnel files
reviewed, two did not have current annual evaluations.
7. The
performance appraisal system establishes goals and objectives for the period of
appraisal. (Standard #32) The current
evaluation system does not identify staff goals and objectives.
Areas
Requiring Response
1.
Develop a process for soliciting and utilizing
consumer input into policy setting and program delivery. (Standard #12)
2.
Develop a system to formally and systematically
involve consumers, staff and agencies in annual planning and evaluation of
programs including feedback from current and past users of services. (Standard #13)
3.
Develop a system to develop annual goals and
objectives in response to consumer, community and self-evaluation
activities. (Standard #14)
4.
Develop a process to incorporate consumer choice in
the hiring and evaluation of direct service staff. (Standard #22)
5.
Write a staff development plan annually for each
professional and paraprofessional staff person. (Standard #29)
6.
Adhere to reasonably established timelines in the
staff evaluation process. (Standard
#31)
7.
Incorporate into the staff evaluation process a
staff development plan that includes staff goals and objectives. (Standard #32)
Other
Recommendations
1.
Consider hiring a third clinician to help fill the
gap for needed mental health services.
2.
Consider hiring a female clinician.
3.
Consider having at least one clinician with
specialized skills in working with children.
4.
Continue to explore ways to enhance emergency
services.
5.
Consider expanding services in outlying areas and
other communities on the island.
6.
Increase services to include more focus on violence
prevention and intervention.
7.
Collaborate with other agencies to expand needed
services in such areas as domestic violence, FAS/SAE, and youth issues.
Closing
The team wishes to thank the staff of C.O.H.O. 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. Kudos go particularly to
Robyn, the office assistant, and Doug for their extra support to the team.
The final draft
of this report will be prepared within 30 days and sent to the agency along with
a Plan of Action form. The agency will
then have 30 days in which to complete the Plan of Action and return it to
NCR. NCR will forward the completed
Plan of Action to DMHDD, who will then contact the agency about instituting the
changes.
Attach: Administrative and Personnel Checklist;
Questions for Related Agencies (tallied), Report Card (tallied)