Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
Terry
Boroughs, Community Member
Robyn Henry, Facilitator
A review of the mental health (MH) services
provided by Central Peninsula Counseling Services (CPCS) was conducted from
September 26 to September 29, 2000 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.
Description of
Services
CPCS is a non-profit community mental health center that provides services to children and adults who live in the central Kenai Peninsula Borough. The agency service area population is 30,000 people and covers an area that spans from Cooper’s Landing to Ninilchik, Alaska. In FY99, CPCS served between 1400 and 1500 people and currently has open charts for between 600 and 700 clients.
Adult services provided by the agency include outpatient therapy, emergency services and payee services. Through the agency’s Community Outreach Program (COP) the agency provides outreach, case management, housing, employment and recreation services to adults diagnosed with a major mental illness. Case management services are available for adults diagnosed with a severe emotional disturbance through the agency’s Transitions Program.
Children’s services provided by the agency include outpatient individual, group, family and activity therapy. Wrap-around services are offered to children with severe emotional disturbances through the Alaska Youth Initiative (AYI) program. In collaboration with the Kenai Peninsula Borough School District, the agency also offers a comprehensive school-based program providing crisis intervention, psychological and psychiatric services, prevention services, summer therapeutic programs and family support services to children and their families. The program offers these in-school services to fifteen schools in the borough.
Senior Services are offered by the agency through the Forget-Me-Not Center. In this center the agency offers a day program of social activities for seniors who need daytime supervision due to physical or emotional challenges. The center also offers support to caregivers including on-site care and respite services.
A seven-member board of directors, who meets monthly, governs the organization. The agency employs approximately ninety-five full and part time people.
Description
of Process
To conduct this review, an interview team
consisting of a facilitator, three community members, and a peer reviewer
conducted forty-six interviews
over four days in Kenai, Alaska. Eighteen interviews were with both adults and
parents of children who receive services. Eleven interviews were conducted with
related service professionals and fourteen interviews were with program staff.
An additional three interviews were with agency board members. Interviews
lasted from 15 minutes to an hour and were held in person, at CPCS offices, in
the community or by telephone.
The interview team members also reviewed eight
personnel files, the agency staff orientation and training plan, program
policies and procedures manuals 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 Kenai at the Merit Inn
at 7:00 P.M. on September twenty-sixth. CPCS advertised the event by posting
and mailing flyers throughout the community, announcing it on the local radio
station and advertising it in the local newspaper. Six people attended this
event. The feedback provided by attendees of this event is incorporated in the
findings of this report.
Progress
Since Last Review
This is the first review of CPCS using the Integrated
Quality Assurance Review program standards; therefore, there is no previous
action plan for the mental health program.
School-Based Services Program – Many of the people we interviewed identified the school-based children’s services as being invaluable to the community. Both parents and school district staff expressed their sincere appreciation for the support they receive from school-based counselors. The services clearly help to keep children in school who would otherwise not be able to maintain in the school setting. One school district principal commented “I can’t imagine how we could operate without the services” and a parent commented that “the school-based system is working” and that the services along with the home-based services have helped her family a great deal.
The Housing Program – The agency has an extensive housing program that offers a range of housing options including support with home ownership. It was reported that in the last year the agency has been instrumental in supporting four people in building or buying their own home.
The team identified the following strengths under
Choice and Self Determination for those receiving MH services:
+
Most people reported that they have choices about
the services they receive.
+
Most people reported that they have choices about
their lifestyles including where they live and what they do.
+
Most people said they feel like they have choices
regarding their medications including the choice not to take medications. They
also indicated that they have a good understanding of their medications as a
result of education from staff members.
+
Several people reported that case managers take a
strong “hands on” approach to working with clients that focuses on independence
and self-determination.
+
Most people indicated that they have a high degree
of involvement in their service planning process and that the goals on their
plan reflected their own goals and desires.
+
The high level of flexible client support in the
COP program appears to be a key factor in keeping some clients in the community
rather then forcing them to seek that level of support in a more urban setting.
+
One person reported that staff were very good about
explaining their treatment to them.
The team identified the following weaknesses under
Choice and Self-Determination for those receiving MH services:
-
Several people said that they felt they had no
choice about their treatment or their medications.
-
A couple of people were not aware of their goals or
treatment plan.
-
One person reported that when they wanted to move
out of the area, they were talked out of it rather then being supported in
making that choice.
-
Several people reported that, while they may
theoretically have choices, they feel they would not be supported in making
choices outside of what is predetermined as “right choices”.
-
One person indicated that staff support to get out
more often felt more like pressure.
-
In both client reports and client records there
appeared to be some discrepancy between what the client needs and wants and
what is in the client service plans. Assessed needs were not on plans. Many
plan goals were automatically carried over for long periods of time and
clients’ own personal goals were not on necessarily in the plans.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+
Almost all people interviewed said they felt respected
and valued by staff. One person reported that staff “teach me how to feel
good;”” another said, “The friendliness is overwhelming…they do
understand me.”
+ Many people reported that they felt that staff are very collaborative and responsive to their needs.
+
One parent expressed their appreciation for the
services offered to children by saying “the counselors keep the kids
on the up and up.”
+ Many
people said that the direct service staff were very caring and that staff took
a genuine
personal interest in their welfare.
+ One
person said that they appreciated the fact that the reception staff were so
friendly.
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving MH services:
-
One person said that they “feel like a puppet”,
that they were not aware of their client rights and that their providers
present “roadblocks” to their appointments because the doctor is
difficult to reach and there is a waiting list.
-
One person said they rarely see their provider and
that they are just called to sign papers.
-
A couple of people said that they thought that the
upper administrative staff were unfriendly
and don’t appear to care about clients.
One person cited the “firing of four clients” as
something that was unfair.
-
Many people said that they thought the COP building
was uninviting, not accessible and not
comfortable.
-
Several people questioned the mixed client roles
citing as unfair that some clients get paid for
their work while others do not. One
person reported that another client was hired to do work
for them and that they wanted to fire
them because of a shortage of money but that they didn’t
know how to get out of the situation.
-
At least two people reported negative actions by
staff in the COP program including
bickering between staff members in front
of clients and “public embarrassment” of consumers
by staff.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+
All people reported that they feel safe and secure
in their current living environment.
+
Many people reported that their health needs are
being met.
+
One person reported that they have received dental
care through a grant and another said that they are up for a dental grant soon.
+
One person appreciated the fact that staff
supported them with their medications and that staff were always there to give
out the medications.
+ Several
people reported that there appears to be very few homeless people in the
community
and if
there are people who are homeless, the COP takes care of them. Another client
said that
if it
wasn’t for COP they “would be in bad shape”.
The team identified the following weaknesses under
Health, Safety and Security for those receiving MH services:
-
One person indicated that they did not feel safe at
the COP around the other clients.
-
Many people indicated that they needed dental care.
A couple of people said that gaps in health care services were “beyond the
control of the agency”. (system issue)
-
One person said they wanted more support with their
medically prescribed diet.
-
Many people reported having complicated health
needs and that their case manager was not always able to help them.
-
One parent reported that their foster child was
sometimes threatening at home but that the child had not acted on the threats
yet.
-
One person reported the need for dual diagnosis (MH/substance
abuse) services.
-
One person expressed the desire for regular
individual therapy. This need was
indicated in the assessment and in the plan in their chart but was not carried
out.
-
One person reported that they felt that staff were
overworked and not modeling “good mental
health self-care tactics”.
The team identified the following strengths under Relationships for those receiving MH services:
+
Most people
reported being satisfied with their relationships and the agency’s support in
this area.
+
Several parents reported that they felt that staff
supported their whole family.
The team identified the following weaknesses under
Relationships for those receiving MH services:
-
One person said that as a spouse of an adult
receiving services, they were neither encouraged nor welcomed into being a part
of their loved one’s care.
-
One person said that, while staff have asked about
their family support system, they do not include their family members in their
treatment.
-
Two people reported that their children are not
welcome at COP and that this unfriendliness towards families prevents then from
attending program activities.
-
One person said that they had difficulty making
friends and that they were not encouraged to make friends.
-
A couple of parents indicated that their child had
difficulty making friends because of their disability.
-
One person reported that they stay at home because
of health problems and that they “have no friends and do not want
friends”.
The team identified the following strengths under Community Participation for those receiving MH services:
+
One person expressed appreciation for the fact that
the agency supported her in attending out of town NAMI meetings.
+
About half of the people interviewed reported that
they worked or participated in other meaningful community activities.
+
Most people said they were encouraged to get out
into the community.
+
Several parents said they felt positive about the
school program and that the services helped their child stay in school.
+
Several people commented on the support they get
for transportation from the COP staff. Staff go beyond just taking people to
activities. They help people get to
appointments, community events and access natural supports such as friends and
family.
The team identified the following weaknesses under
Community Participation for those receiving MH services:
-
One person reported having difficulty in and not
getting support for reconnecting with her church.
-
One person reported a lack of transportation
services in the rural areas as the reason for not getting out into the
community.
-
Many people reported that many of the community
activities do not meet the individualized needs and interests of the clients.
-
Many clients reported that they would like more
activities in the COP program. Some indicated that they would like activities
that were more meaningful and were geared more to learning and growing.
Fourteen staff were interviewed during the site
review. Nine interviews were with staff selected and scheduled by the agency.
The remaining interviews were either initiated by staff while the team was
onsite or were impressions gathered during conversations with team members and
staff during the review. Overall, the staff interviewed seemed to have a
genuine caring and respect for the clients with whom they work.
While the overall staff feedback about the agency
was mixed, many people interviewed expressed various levels of concern and fear
about their current working environment. Several people indicated that they
were hesitant to speak about issues candidly to the interviewer for fear of
retaliation from agency management.
Concerns expressed by staff included high staff
turn over; sudden program changes; lack of communication and collaboration
regarding changes and proposed changes affecting staff compensation such as
rate of pay and loss of benefits. A couple of people said that, while
previously there had been an “open door” policy with the agency
administration, there is now a “closed door”.
Many people summarized these changes as the agency
becoming more business-oriented, some feeling that this was at the expense of
client care. Several people said that if their concerns are not addressed, they
were not sure they could stay with the agency and thought that others would
also leave.
Needs expressed by staff included the need for
increased staff orientation and ongoing training, the need for more structured
meetings and the need for more open communication and collaboration.
Agency strengths cited by staff are the high level
of clinical supervision and the employee evaluation system.
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 26 of
which are completely met by CPCS. Those standards not fully met include:
1.
The agency’s governing body includes significant
membership by consumers (DD, MH) or consumer family members (ILP), and embraces
their meaningful participation.
(Standard #6) The agency currently
has no consumers on its governing board, although it says it currently is in
the process of recruiting a consumer member.
2.
All facilities and programs operated by the agency
provide equal access to all individuals. (Standard #11) The Community Outreach Program building is currently not handicapped
accessible. The agency has indicated that they have grant funding to put an
elevator in the building.
3.
The agency actively solicits and carefully utilizes
consumer and family input in agency policy setting and program delivery. (Standard
#12) Although the agency attempts to get
some consumer input through the various programs, there is no overall agency
method for getting consumer input for policy setting and service delivery
decisions.
4. 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 currently does
not have a method for including consumers in their annual planning and
evaluation process.
5.
The agency develops annual goals and objectives in
response to consumer, community and self-evaluation activities. (Standard #14) The agency currently does not have a method
for including consumers’ feedback in its agency goal setting process.
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) The COP program currently has a process for
including clients in the hiring and evaluation of staff; at this time the other
programs do not have such a process although this is under consideration.
7.
The performance appraisal system adheres to
reasonably established timelines
(Standard #31) Of the eight
personnel files reviewed, four had not had an evaluation since 6/99. In
addition, one staff member interviewed indicated not being evaluated in 15
months.
8. The
performance appraisal system establishes goals and objectives for the period of
appraisal. (Standard #32) The current
employee evaluation system does not establish employee goals and objectives.
The agency clearly has been in a great deal of transition for the last two years since the departure of the last executive director. The current executive director was hired four months ago; prior to that, the agency had two interim directors. The agency has a new financial director who filled a year-long vacancy. The newly hired clinical director will be starting full-time within the next month.
1. The
agency needs to add consumer members to its governing board. (Standard #6)
2. The
agency needs to make the COP building handicap accessible. (Standard #11)
3. The
agency needs to develop a process to actively solicit and carefully utilize
consumer and family input into agency policy setting and program delivery.
(Standard #12)
4. The
agency needs to systematically involve consumers, staff and the 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)
5. The program needs a process to develop annual
goals and objectives in response to consumer, community and self-evaluation
activities. (Standard #14)
6. The
agency needs to develop and utilize 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)
7. The agency needs to evaluate all staff
performance on an annual basis.
(Standard #31)
8. The agency needs to include a system for
establishing employee goals and objectives in the staff evaluation system. (Standard #32)
9.
The agency needs to educate clients continually
about the agency grievance procedure and should re-evaluate the current
grievance system to make it more user friendly (e.g. not require that the
client have to go to the person involved first).
The agency administration may want to focus on the
issues that are affecting staff morale. Identified staff issues include staff
feeling unappreciated; sudden changes in policies and procedures; a lack of job
security and satisfaction due to loss of benefits; changes in rates of pay and
job funding uncertainty. Also identified was a lack of communication and
collaboration between staff and management.
Closing
The team wishes to thank the staff of CPCS 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. 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 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), Report Card
(tallied)