Mental
Health Site Review
Copper
River Mental Health Center
June
2-4, 1999
Copper
Center, Alaska
Site Review Team:
Wick
Wright, Community Member
Margaret
Hagar, Community Member
Barbara
Price, Facilitator
Dan
Weigman, DMHDD QA Staff
A review of the mental health (MH) services
provided by Copper River Mental Health Center in Copper Center, Alaska was
conducted from June 2-4, 1999.
Community mental health services are provided through Copper River Native
Association. This Association was founded
in 1964 and formally incorporated as a nonprofit organization eight years
later. The mental health center has
been located within CRNA since July of 1981, the first year that state mental
health funding was received in the region.
CRNA serves the Ahtna Region, roughly the size of
Ohio, and covering some 23,000 square miles.
The mental health service area, with somewhat different limits, serves a
14,000 square mile area. The
communities within this region are Chistochina, Chitina, Copper Center, Gakona,
Gulkana, Tazlina, Glennallen, Kenny Lake, Slana, Mentasta and Cantwell. Mental health services in this latter
community are shared with Railbelt Mental Health and Addictions, based in
Nenana; services in Mentasta are shared with Tok Area Mental Health Center,
based in Tok.
The year round population of this service area is
approximately 5,000 with a seasonal increase (May - September) of between
45,000 and 65,000 people including transients, tourists and seasonal
workers. A marked increase in tourist
traffic is anticipated with the completion of a new National Park Information
Center complex.
Approximately 40% of the population of the area are
Native, based on CRNA census figures.
CRMHC holds a community mental health center grant
from the State of Alaska which funds 2.4 FTE's: one full time Master's level
clinician, the Director (0.9 FTE) and a 0.5 FTE Program Administrator. All of these positions are full time and
funded through additional federal or state grants.
The Director describes CRMHC services as out
patient MH services, community support program (CSP) for chronically mentally
ill adults; support to the school and to Head Start including individual and
group sessions; consultation and training; emergency services. Individual
mini-grants have been obtained from the State for specialized services to
individual consumers.
CRNA has
augmented these services by funding monthly group trips to Anchorage (CSP),
serving as payee for CSP clients and providing transportation of consumers to
the center for psychiatric and other clinical services. MH staff assist with educational programming
at CRNA, including anger management, parenting and relapse prevention.
CRNA provides several complementary services which
can be utilized by some consumers.
These include Family Support and Family Preservation, Alcohol and Drug
Education provided through five community counselors, Nutrition and Transport
services (an elders program), an ICWA worker, an Activities Coordinator and
Rural Human Services training for community counselors, all of whom hold state
certification as well.
Substance abuse services are provided to the five
compacting tribes only as there is no state substance abuse (DADA) grant. MH staff does provide assessment and
evaluation for substance abuse clients, however.
As the Director of Mental Health services is also
CRNA's Director of Human Services, there is considerable integration of MH
services into the larger CRNA system.
Two physicians provide psychiatric services: Dr.
Battaglia, the state-contracted psychiatrist, offers services through a pilot
program using video contact. The
majority of psychiatric consumers are seen by Dr. Pollock who travels to the
area approximately every 6 weeks, remaining for two days each time. Both psychiatrists are available for phone
consultation with clinical staff as needed and Dr. Pollock consults with a
local physician on medication and diagnostic matters and with a local
pharmacist on medication.
The State MH grant includes $35,000/yr for psychiatric
services and $170,000 for other MH services.
The program's Medicaid income has been as high as $12,000/yr in an area where there are few
eligible cases and even fewer enrollees.
A more typical year would show $3,000 to $4,000 from Medicaid. CRMHC has attempted to educate the
communities regarding the availability of Medicaid funding but has found a
generalized suspicion of "government programs."
The indirect cost, the amount passed on to CRNA, is
currently 36.4% and provides for accounting services, facilities and
supplies. The fringe benefit cost
(which includes health coverage including dental and a 401K pension plan to
which CRNA contributes 8% once certain criteria have been met) is 33%
currently.
The Director states that CRNA's contribution to the
program far outweighs the indirect cost, amounting to some $400,000/yr or two
thirds of the cost of the program. He
believes that without CRNA's generosity, MH services could not be provided
adequately. Despite funding
difficulties, he announces "We're running one heck of a community mental
health center here."
This opinion would seem to be borne out by the
figures provided on psychiatric hospitalizations: 119 hospitalizations
averaging 2.5 days each in 1992; 1 hospitalization for 3 days in 1998. The Director states that the open caseload in
any given month is 120 cases with 18% to 22% of these cases being CMI
adults. There is no waiting list. The Director currently provides emergency
services. Staff make every effort to
respond to clients' emergency needs whether local or in one of the villages.
Regular services to the outlying villages are no
longer provided due to funding constraints.
Direct services are provided in the villages when the need is
urgent. Otherwise, transportation is
provided by CRNA to the offices in Copper Center.
In cooperation with the Family Support and Family
Preservation Project (a separately funded program working with DFYS, village
council and tribal council referrals), weekly services have been offered in
Chitina by the MH clinician. This
service was highly valued and highly praised by that village as
"excellent" and "effective". Rob's work there was singled out for praise both by the village
and by the CRNA staff person in charge of the project.
This is the first review conducted of CRMHC using
the Integrated Standards and Quality of Life Indicators.
To conduct this review, a team consisting of a
facilitator, two community representatives and a member of the DMHDD Quality
Assurance Unit, met for three days in Copper Center. The team conducted 17 interviews, of which 6 were individuals who
receive services from CRMHC, 3 of the latter taken from DMHDD's random
selection of cases. Five interviewees
were related service professionals, one was a board member and 5 were CRMHC
staff or very closely related CRNA service providers.
Interviews were held in person at CRMHC's offices
or by telephone. The interviews lasted
from 15 to 60 minutes. After gathering
the information, the team members met to draft this report, which was presented
to the staff on the final day of the visit.
Monitoring and reporting the quality of life and
the quality of services for individuals and families makes an important
contribution to the State of Alaska's understanding of the effectiveness of
program services and supports.
The review team's findings are reported below. The report includes a review of the previous
findings, a list of areas of excellence, an administrative review, areas of
programmatic strength, specific services or procedures that are recommended for
improvement and tables of consumer satisfaction with quality of life and
services.
As this is the first review of CRMHC using the new
program standards, there is no previous action plan for these integrated
standards. A plan for improvement for
required chart reviews will be addressed separately in the DMHDD QA report.
1.
The level and efficacy of psychiatric services
provided by CRMHC is a model for all State MH programs, rural and urban
alike. The innovative use of video
conferencing as a pilot project is a clear example of creative thinking to
maximize the effectiveness of limited funds.
The frequent visits of a second contract psychiatrist is nearly
unprecedented in rural Alaskan programs.
The integration of psychiatric services into CRMHC combined with their
collaborative efforts result in improved services for all consumers, patients
of other medical providers as well as for CRMHC clients. The obvious comfort of both psychiatrists
with rural settings and rural services eases this integration, collaboration
and the acceptance of services by consumers and their families. The dramatic decrease in hospitalizations of
this region's residents is a great gift to consumers, their families, the
communities, regional law enforcement and, we must note, saves DMHDD a
considerable sum of money, far exceeding the cost of these services. CRMHC is deserving of the highest praise for
the level and quality of psychiatric services.
It is the sincere hope of this team that the funding that allows for
these services will be maintained if not increased.
2.
The team notes the superb quality of CRMHC's
approach to client services and the holistic nature of these services. CRMHC seeks to provide services to all, to
offer multiple services, to effectively utilize regional and state resources in
support of consumers, to advocate vigorously and to make clear, in these and in
other ways, that the consumers are valued, cared about and more than worthy of
these efforts. The provision of
educational resources in the form of referrals, workshops, reading material and
the like are particularly extensive and effective. Consumers are well educated about their diagnosis and its
implications as well as about their medications.
3.
The team feels that one employee is deserving of
special recognition. Crystal, Program
Administrator, is described by one and all as "unselfish, giving of
herself", reliable, always "maintaining an excellent attitude",
dedicated, willing to do all and more to serve consumers. Her longevity with the agency adds to her
effectiveness as "historian", as a source of perspective for planning
and evaluation, the one "with all the connections." Crystal has, over the years, served MH as
receptionist, secretary, prevention technician, case manager and administrative
assistant as well as in her current role.
Given the concerns voiced regarding turn over, Crystal, with ten years'
experience, offers stability and a comfortable familiarity for consumers and
other providers and a welcome change to the typical rural MH pattern of one to
two years of service by a human service worker in any one location. The team profited from her ability to find
any fact or figure from any year, plucking from her extensive files just the
right piece of paper within minutes.
Governance
A twelve-member board including a President, Vice
President, Secretary/Treasurer, representatives from each of the eight local
Native Village Councils and an Elder board member governs CRNA. In addition there is the honorary position
of Youth Director. This board meets
monthly and privately. An annual
meeting is open to CRNA members.
An advisory board has existed at CRMHC in the
past. Membership has been five to
six. A current member describes the
advisory board's functioning as "very sporadic." In fact, during her two to three year term
there have been few effective meetings.
This is the case despite active efforts to recruit members including the
allure of a lovely luncheon.
Board members have, in the past, been involved in
outreach, explaining services to the community and encouraging involvement in
these services. At this time the grantor's
requirement of quarterly meetings of a board that represents the socio-economic
and ethnic composition of the area is not met despite the program's sincere
efforts. There is consumer
representation on the advisory board.
Neither the governing board nor the advisory board
entirely meet the standards for governance.
This is addressed in the Areas Requiring Response.
Audit and Financial Issues
The annual audit for the federal fiscal year ending
9/30/98 was provided. There were no areas of non-compliance and no material
weaknesses noted. A minor finding was
the need for CRNA to document its inkind contributions and matching funds. There was no doubt that the match was being
met. The Director of Human Services
estimates that CRNA's contributions are equal to two thirds of the program
cost.
Additional income to the program is limited to some
$6,000 to $12,000 per year from Medicaid, other third party payers and direct
payments by consumers. This limited
income from billing is caused in part by changes in the position of billing
clerk and by the complexity of Medicaid billing. The Director of Human Services
estimates that the cost of the staff time for documentation of and billing for
Medicaid services is approximately equal to the amount received from Medicaid.
CRMHC does maintain a sliding fee scale, using
family size and income as indicators of need.
The sliding fee amount varies from a low of 10% to a high of 100%. The full fees range from $50 for group
treatment, $60 for family support and case management, $120 for individual
therapy to $150 for psychiatric services.
Personnel Policies
Of the three personnel files pertaining to mental
health, two were provided for review.
The files included an extensive orientation process, background checks and
reference checks. Drug free workplace
information and acknowledgement were included.
Both files contained recent annual evaluations, which included employee
signature, date and place to indicate agreement or disagreement. Information was included on the grievance
process. Job descriptions were included
in the files.
Separate training files were provided for these
same two employees. These included detailed employee training plans with
specific guidelines. Documentation of
training was included as well.
The employee handbook for all CRNA employees was
complete and informative.
Staff
The mental health Director, 90% of whose position
is paid through the MH grant, provides clinical supervision and sees 10% to 20%
of the clients. The Director also provides
all MH management services and, as Director of Human Services, reports directly
to the CEO of CRNA as one of the four department heads within the larger
agency. Weekly Directors' meetings aid
in the coordination of services. And,
with five years in this position, the Director provides a sense of stability
for the community and for CRNA alike.
He is described by a CRNA staff member as "a good presence."
The clinician, who is paid entirely from the MH
grant, sees most of the clients and coordinates CSP services. Seeing most people individually, he also
provides services to couples and groups and travels to villages when the need
is urgent. He provides consultation services
and coordinates psychiatric care with the two contract psychiatrists and the
local physician. Rob is described by a
co-worker as having "excellent rapport with clients" and as
"invaluable" to CRNA services.
Related service providers outside of CRNA also praise Rob as "good
to work with."
MH has employed the Program Administrator for ten
years, one of only three long time employees of CRNA. During the last decade
she has held several positions including prevention technician, receptionist,
secretary, case manager and administrative assistant. Her current position seems to include all of these
functions. She is known and trusted by
consumers, some times assisting with case management in the absence of other
staff. She is knowledgeable in regard
to MIS, consumer file systems, related programs and agencies and is the
historian for the program. She created
the schedule for the site review and kept it running smoothly for which she
deserves a special star!
The staff is viewed positively by the
community. Compliments included a
description of staff as "very open, very friendly", collaborative and
"a great team."
The relationship of CRMHC with other CRNA staff was
characterized as "teamwork."
CRNA is described as a fine employer, offering the best fringe benefit
package of any employer in the region.
When asked about working for CRNA, a staff member who frequently bridges
with MH staff said, "It's an honor."
Recently, monthly staff meetings have resumed. These meetings include the community
counselors (working under an Indian Health Services grant and trained through a
Rural Human Services grant) and representatives of the Family Support and
Family Preservation program, the alcohol prevention/education program and the
elders program along with mental health.
An increase in intra-agency communication has resulted.
Three themes emerged from this team's interviews:
1) frequent turn over of staff has hurt the program and sometimes disrupted
direct services. 2) That the current staff is pushed "to the limits"
with one clinician essentially providing almost all clinical services. This clinical position is about to become
vacant again and the loss of Rob is a true loss. 3) That "they could use more help" in the words of the
contract psychiatrist, especially in the area of youth services. The need for services for children and teens
was heard repeatedly, with an educated estimate by the FSFP staff member that
at least one full time clinical position dedicated to this population is a
realistic expectation based on potential case load.
It should be reiterated that despite the obstacles,
the program is described by the consulting psychiatrist as doing "an
incredible job with the resources they have."
Service Coordination
There is especially effective coordination between
MH and other CRNA services. The
availability of additional services at the same site is of great benefit to
qualified consumers.
Coordination with the school district ceased about
five years ago and has not effectively resumed. The school district does have a counselor providing guidance and
counseling for all school children with an emphasis on junior high and high
school. He is described as "doing
an incredible job."**
CRMHC's ability to collaborate with Crossroads
Medical is a rather recent event and one heralded by many community members,
staff and the contract psychiatrist as aiding in the provision of effective
services. For consumers choosing to
receive services through Crossroads, the consulting psychiatrist and the
clinician consult with the medical center in order to coordinate care and
broaden services.
Community Opinion
Staff notes that the inclusion of MH services in
CRNA initially caused non-Native clients to seek services elsewhere, believing
that they could not be served through a Native Association. This assumption is beginning to fade,
however, and 60% of clients are now non-Native, reflecting the ethnic make up
of the service area. The Director
described this change as moving from an image as an "available
agency" to that of a "utilized agency."
There remains a question on the part of some community
members whether CRMHC is truly open to and appropriate for them. CRMHC has attempted to address this issue,
advertising their presence, availability and specific services.
Opinion of Related Service Providers
The five related agency service providers
interviewed maintained a very positive relationship with CRMHC, acknowledging
that this had not been the case in the past.
One provider stated that, based on his collaboration with the program,
he "would be comfortable going there" for services should he need
them.
Others commented on the turn over of staff as a
problem, but added "the people they have had (Rob and Chris) were
excellent."
Accessibility
The MH center is accessible by ramp and the rest
room has handicapped access. Offices
can also accommodate wheelchairs. A
computer responding to voice is provided.
Signs are not in Braille; there is no telephone
service for the hearing impaired.
A study by ADA indicated that making the center
fully accessible was, at $600,000, cost prohibitive.
This portion of the narrative refers to the Quality
of Life Values and Outcome Indicators, as they relate to the specific services
offered by Copper River Mental Health Center.
The items listed below are those that the review team identified as
strengths. If the team concluded that
any of the indicators warranted improvement, they are listed in the Areas
Requiring Response section of the report.
The team identified the following strengths under
Choice and Self-Determination for all people receiving services from CRMHC:
+ CRMHC provides strong advocacy services; a
consumer commented "This agency has fought (for my rights). They backed me
all the way."
+ CRMHC maintains an active outreach effort that is
nonjudgmental and appropriately persistent.
The team identified the following strengths under
Dignity, Respect and Rights for all people receiving services from
CRMHC:
+ CRMHC supports their clients; a consumer stated
that "They're right there for us."
+ CRMHC staff is respectful, non judgmental and
responsive to consumer needs; Rob is described as "real easy to talk
to." A consumer is gratified by
the fact that "everyone there is really nice." Clarence, who provides related services to
MH consumers was described as "the only one who helps me." MH staff are praised because "they
treat me right." Another consumer
said, "Everybody knows me here" with a big smile. Yet another consumer stated in regard to MH
staff "They really help people.
They do their best for people."
+ CRMHC specifically and CRNA in general maintain
absolute confidentiality; this was stated by consumers, community members,
related agencies and CRNA staff.
The team identified the following strengths under
Health, Safety and Security for all people receiving services from CRMHC:
+ CRMHC staff have access to First Aid and CPR
training on site through CRNA; a class was scheduled two months ago and was
being repeated during the site review according to a posted calendar of events.
+ CRMHC consumers seldom require emergency
services; the consulting psychiatrist states that this is due to MH staff
having "a pretty good hold" on those consumers with chronic mental
illness.
+ CRMHC and CRNA provide excellent education
regarding medications: purpose, functioning, side effects; and provide
education on mental illness; when asked about his diagnosis, a consumer defined
schizophrenia including typical age of onset, listed his medications and
discussed side effects and the need to change medications based on the
appearance of specific side effects.
The consulting psychiatrist commented on the high quality of medication
education and attributed that to the CRMHC staff.
+ CRMHC consumers evidence increased stability and
reduced need to return for services according to other CRNA staff. One consumer noted "They have been
extremely helpful in making me safe."
+ CRMHC staff aid all consumers in accessing health
care including pharmacy services.
The team identified the following strengths under
Relationships for all people receiving services from CRMHC:
+ CRMHC and CRNA collaborate to provide classes in parenting and in anger management; one consumer commented on these services, saying "I didn't want to go at first but when I did, I made a one hundred and ten degree change in my life!" (for the better). Rob's involvement with these classes was also singled out for praise.
+ CRMHC and CRNA services collaborate with the
common goal of family preservation.
+ CRMHC and CRNA highly value education of
consumers and of the public; a CRNA staff member states "A knowledgeable
public is an aware public and an aware public is one that can protect
themselves."
The team identified the following strengths under
Community Participation for all people receiving services from CRMHC:
+The availability of CRNA transportation to CRMHC
consumers greatly aids the participation of these consumers in community
activities and, until recently, also allowed for regular trips to Anchorage for
shopping and other needs.
+CRMHC and CRNA staff model community participation
by a high level of community involvement and visibility, volunteering time for
a variety of activities.
It should be noted that all consumers stated that
they would refer others to CRMHC and, in many cases, had already done so
repeatedly and confidently.
The following recommendations were identified by
the team as areas that need attention from the organization:
1.
Neither the governing board of CRNA nor the CRMHC
advisory board meet the standards for State funded mental health centers. Document the balance of power and/or
responsibilities of each board in regards to the mental health program,
empowering the advisory board to the extent possible; continue with recruitment
efforts in order to fill board seats and strive for at least regular quarterly
meetings. (Administrative Standards 5, 6, 7, 8, 9)
2.
Accessibility to the program and its services is
somewhat limited. Document attempts to
provide equal access to all and seek low cost alternatives as possible.
(Administrative Standard 11)
3.
Consumer involvement in program planning,
evaluation and development is vital in light of the revised standards. There is evidence that this is accomplished
informally. Create policy and document
its implementation in regards to systematically surveying consumer opinion and
incorporate that perspective into the program. (Administrative Standards 12,
13,14, 22)
4.
Coordination of services with the area's schools is
not evident at this time). Document these attempts to add the schools to the
list of effective collaborations in light of the acknowledged need for services
to the school aged population. (Administrative Standard 17)
5.
Timely program information is not provided through
systematic use of one or more management information systems. Seek technical assistance with MIS reporting
and document these attempts.** (Administrative Standard 18)
6.
There is no documentation of policy regarding
efforts to increase community participation of consumers. Document the agency's efforts in this
regard. (Administrative Standard 26)
7.
Documentation of consumer involvement in the
development of treatment plans and in the revision of treatment plans is
uneven. Standardize documentation of
consumer involvement in treatment planning and the revision of those plans.
(Administrative Standard 27)
8.
No current Policy and Procedure Manual specific to
the mental health program is available as it is under revision. Complete revision of the Manual, making it
specific to mental health services while relating it to CRNA policies as
needed.
9.
*Services are reported by consumers as being
received, yet are not documented in their file. Systematize documentation of all services received by each
consumer.
10. *Treatment
plans are, in some cases, unchanged since 1995 although services continue to be
offered. Update all treatment plans in
open files; systematize updating of all treatment plans as cases are reopened;
systematize review and revision of treatment plans every 90 days.
11. *Acknowledgement
of the consumer's receipt of a copy of client's rights is not documented in all
files. Systematize use of this form and
include the signed form in all open or new files.
12. *Treatment
plans do not list specific goals and objectives, do not indicate measurable
outcomes, and do not include all services being provided. Seek technical assistance with the
development of treatment plans.
13. *All
but one consumer file reviewed lacked an assessment summary and none had
assessments regularly updated. Seek
technical assistance on the preparation of and regular review of assessment
summaries.
14. *CRMHC
staff and CRNA act as payee for certain consumers. Develop and/or document a policy for the safe handling of
consumer funds. Consider using a
neutral party rather than MH staff as payee.
15. The
relationship of CRNA Human Services and CRMHC, while beneficial to most
consumers and to staff, is not clearly delineated. It is unclear which services
are available to all and which to a defined Native population. With the
Director holding positions in both areas, it is especially important to
document the guidelines for and limitations on this relationship.
16. Incomplete
documentation inhibits billing as does frequent changes in billing
responsibilities. Systematize billing
in order to increase program income.
17.
The vast majority of clinical services are provided
by one individual. Seek a program design that allows for more equal division of
clinical services.
* Due to the potential for negative consequences
for consumers as a new clinician is sought, these items are considered by the
team to be priority items.
The team facilitator reviewed the charts of those
consumers interviewed during the site review.
It was noted that of the six files, one lacked a treatment plan, one had
a treatment plan dated 1995 and shown as completed in 1996, two had treatment
plans dated 8/98, one file had a treatment plan dated 5/99 updating a plan dated
8/96, a recently opened case had a treatment plan dated 5/99.
Treatment plans included a description of the
presenting problem, the client's stated goal, type of service to be provided
and length of time that service was to be provided. Goals were not itemized, numbered or broken down into
objectives. Progress notes did not,
therefore, refer to numbered goals on the treatment plans. Treatment plans were signed by clients in
all but one case. The degree to which
clients participated in the development of the treatment plans was not
documented.
Medical notes and medication records were extensive
and complete.
Case management services, including applications
for SSI, SSI appeals, mini-grants for individualized services, a referral to
DVR and payee arrangements, were documented in four cases.
A member of the State DMHDD QA staff conducted the
mental health file review portion of the integrated site review. A total of 9 files were reviewed, comprised
of 5 Medicaid cases and 4 non-Medicaid cases.
The Quality Assurance staff member will present a
separate and detailed report on the file review. He has asked this team to include here a brief summary of his
initial findings and recommendations: 1) files lack current assessment
summaries; 2) initial assessment is generally left to the psychiatrist and
forms part of his notes; 3) there is a low level of therapeutic services to
individuals and families evidenced in these files; 4) many useful, practical
services are provided to consumers that are not treatment and, while these
services are not billed, neither are they billable.
The State QA staff member's initial recommendation
is for DMHDD to offer technical assistance to CRMHC in the area of
documentation and develop a plan in conjunction with the Director of CRMHC for
the implementation of changes.
MH
|
Choice N=5
|
Dig&Res. N=5
|
Hth,Saf,Sec N=5
|
Relatns.
N=5
|
Com.Par.
N=5
|
||||||||||
Outcome
|
Yes |
Part. |
No |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Person/Parent/guardian
|
6 |
|
|
6 |
|
|
6 |
2 |
|
6 |
|
|
6 |
|
|
Staff Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person/Parent/guardian
|
4 |
|
2 |
5 |
1 |
|
3 |
3 |
|
6 |
|
|
6 |
|
|
Note: If an item is marked Un (Unknown) or Not
Applicable (NA) it will be entered in the No column.
CRMHC scheduled a public forum to allow for
community members not included on the interview list to air their concerns, to
comment and to question the site review process. The forum was advertised by posters widely distributed in the
service area and through announcements on two radio stations. The fact that refreshments would be provided
was included as an added inducement.
All MH staff were on hand, as was the secretary
serving MH. One member of the public
attended. A former board member, this
individual expressed concern about a lack of services for school aged children
and teens. Discussion centered on
contract services between the school district and the mental health center
which ended in 1994 and have not resumed to date. Counseling services within the school system are limited, with
only one person providing them for the entire district. The lack of prevention
services and the acute need for them was also highlighted.
The food, by the way, was great.
1.
CRNA, CRMHC, other agency staff and members of the
community all acknowledge a strong value regarding the next generation and a
high degree of need for services to youth including prevention, early
intervention, family, group and individual counseling and substance abuse
services. There is also a realization
that the time may be right for a healthy use of such services. CRMHC is encouraged to continue its efforts
to find funding for one or more clinical positions and additional program
funding targeting youth. Perhaps
private foundations could be approached.
2.
CRMHC does not currently bill Medicare which may be
a source of additional revenue. In
light of the aging of the population, CRMHC might wish to pursue training on
Medicare billing.
3.
Advisory board meetings might be facilitated by the
use of teleconference services available through the phone company or through
the use of the video conferencing equipment.
A policy could be developed in advance to allow for telephonic or
electronic participation and public access to these "meetings".
4.
Nearly every other agency and staff member noted
the high need for substance abuse services for all sectors of the population. A
DADA grant had been provided to the region in past but was lost in recent
years. Seeking funds for this purpose,
despite the difficulties involved, is a worthwhile pursuit and one clearly
supported by CRNA's statement of purpose. CRMHC and CRNA have a structure that
could incorporate such services and integrate them into many other activities.
5.
The recently eliminated trips to Anchorage which
involved several consumers were uniformly praised as "fun", useful,
providing good life skills training in comparative shopping and aiding in
developing interpersonal skills. One
consumer described the trips this way: "It was nice. They took you where you wanted to
go." It seems that the loss of
both federal and state funds for elder services forced this cancellation. This results in budget difficulties (given
the higher cost of items locally) and increased isolation for consumers. If possible, the continuation of these trips
would be of great service to consumers.
Perhaps these trips could be coordinated with other transportation
provided by CRNA.
6.
Some consumers live in HUD housing in the area of
the CRNA complex. In regards to the
Wrangell View Apartments, a consumer noted that in the past the building had
been rowdy, although it is now "quiet". This was accomplished by locking the building, thus limiting
access to residents. Also, consumers
living in separate homes near CRNA report fears related to drug and alcohol
use, violence by adults and teens and general anxiety about their safety. One consumer noted that he had kept his door
locked but "someone kicked in my door so I leave it unlocked now." Another consumer stated that he maintains a
"24 hour watch" in order to guard his residence. While not the responsible party, CRMHC might
advocate for improved living conditions for consumers in HUD housing.
7.
Itinerant MH services to villages have been
eliminated due to funding constraints.
Given the positive reception given these services, CRMHC is urged to
continue to seek funding to provide services throughout the service area.
8.
Emergency services are taxing, especially when they
are provided by full time providers.
Alternatives for emergency services and/or crisis line services may be
worth exploring.
The impact of the arrival of four persons into a
relatively small office space is enormous and the CRMHC and CRNA staff bore it
with flexibility and grace. The team
appreciates the warm welcome and aid provided by a very busy staff.
Special thanks to Crystal, Program Administrator,
for urging, cajoling and then scheduling interviewees and even, in one case,
providing transportation for a consumer.
You will receive a finalized report within 30 days
of this review, an overview of the agency's compliance with the standards and a
format for developing an action plan in response to items identified in the
review. CRMHC, in cooperation with DMHDD, will be responsible for developing a
plan addressing the issues noted in the Areas Requiring Response.
**NOTE: During the exit interview, CRMHC staff were
helpful in correcting factual and textual errors. In addition, they suggested the following adjustments for reasons
of clarification:
1.
Under the Service Coordination section, it would be
more factual to state that formal coordination between MH and the school
district no longer exists, but that the work of the separately funded FSFP
program meets this need in part.
2.
Under Areas Requiring Response #5, it should be
acknowledged that the providers of MH MIS have ceased to exist or ceased to
serve Alaska. This complicates a
grantee's ability to meet this standard.