INTEGRATED QUALITY ASSURANCE REVIEW

Communities Organized for Health Options

May 15-17, 2000

Craig, Alaska

 

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

 

 

INTRODUCTION

 

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.

 

FINDINGS

 

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.

 

The Five Life Domains

 

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.

 

Community Participation

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)