October 19- 21, 1999
Fairbanks, Alaska
SITE REVIEW
TEAM:
Mary Lou Canney, Community
Member
Christine Butler, Community
Member
Leena Ongley, Peer Reviewer,
Barrow
Sherry Modrow, Facilitator
Connie Greco, DMHDD Quality
Assurance Staff
The Site Review Team reviewed DMHDD-funded Developmental Disabilities Supported Services provided by Crossroads Counseling and Training Services from October 19 to 21, 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.
The site review team met for three days at Crossroads’ office in Fairbanks. The team consisted of two community members, a peer reviewer, and a facilitator. A member of the Quality Assurance staff at DMHDD joined the site review part-time, participating in consumer file reviews and team discussions.
Team members conducted interviews with 10 consumers and 4 family members, 5 direct service employees, and the agency’s executive and administrative directors. The team also interviewed 6 individuals who work at related agencies: Division of Family and Youth Services, Fairbanks Community Mental Health Center, Family Centered Services of Alaska, Maniilaq (Native Regional Nonprofit), Alaska Division of Family and Youth Services, Fairbanks Resource Agency, and Dr. Larry Gooding. Interviews lasted between 20 minutes and one hour and were conducted by telephone or in person at people’s homes or at Crossroads.
Crossroads is a three-year-old nonprofit organization providing support for 19 adults who experience developmental disabilities. Crossroads has a five-member board of community volunteers. The board supports and supervises the executive director. The organization employs 15 full- and part-time staff members. The Fairbanks North Star Borough forms the service area.
Mission Statement:
“The mission of Crossroads Counseling & Training Services is to assure that developmentally disabled individuals are able to live, work and interact in their community in a similar manner as individuals in the community that do not experience a developmental disability. In pursuit of this mission: Services will be designed and implemented as directed by the consumer with the support of his/her family or other interested people the consumer desires. Services will be provided on an individualized basis at the cost necessary to provide high quality, long term support when approved by the consumer’s funding source.”
Crossroads planned and advertised an Open Forum on October nineteenth at the Noel Wien Library. Notices were mailed to the agency’s consumers, and businesses and related service agencies received faxed fliers describing the event. Two team members were present to receive comments, but no one attended.
Progress Since Previous
Review:
1. Recruit consumers for the Board.
The agency remains open to the concept
of identifying a consumer who could serve as a board member. There is not at present a consumer serving
as a board member. This item will
receive ongoing attention.
2. Develop an evaluation process for the executive director.
The executive director receives an
annual evaluation.
3. Develop a way to communicate with family members of consumers.
The intake process includes determination of
if, how and when family members will receive communication from Crossroads
about a consumer. This process is
different for each individual, and changes to meet changing circumstances.
4. Evaluate staff members in a timely manner.
The agency has written procedures for
regular evaluation of all staff.
Evaluation is part of an ongoing supervision process, and formal
performance evaluations occur on a scheduled basis at least annually.
Crossroads Counseling and Training Services has implemented a highly individualized and effective methodology that uses what consumers want as the framework to provide structured but flexible outcome-oriented services. The agency has achieved a remarkable level of success by integrating services that seek the balance between consumers' boundaries and needs.
Most of the consumers at Crossroads have had difficulty fitting into services offered elsewhere, and a significant number of them have been denied services by other agencies. Crossroads has successfully designed supports for these consumers, focusing particularly on residential services that will allow a consumer to live in the community with adequate assistance and limits. Crossroads collaborates extensively with other service providers to ensure provision of services such as vocational, mental health and educational supports for consumers.
Crossroads places high importance on the quality of the "match" between consumers and service providers. Consumers, family members and other agency people state that Crossroads uses a model of care that works very well for people with the variety of manifestations of FAS or FAE. Some characteristics of the Crossroads model include individualized services, a non-punitive approach and respect for choices.
Crossroads accepts difficult assignments; the agency doesn't screen out people with "hard" cases. People expect a lot from Crossroads, particularly consumers whose needs have not been met elsewhere, and they feel this agency comes through for them.
Staff all seem to be very knowledgeable and competent.
The agency and its staff have a strong belief in the humanity of everybody and demonstrate a commitment to providing the least restrictive environment with appropriate rules and safeguards to guarantee safety.
The team identified the following strengths under Choice and Self-Determination for people receiving DD services from Crossroads:
+ The services and coordination offered by Crossroads increase options for people, and this is particularly essential for high risk sex offenders who would not have choices without the involvement of Crossroads.
+Staff support consumer choices.
+ The agency doesn't fit people into a pre-existing program; the needs of a person are assessed and then the services are designed.
"We allow the consumers to be themselves, and not expect them to live like we want them to." Staff member
+ People choose the supports they need to help them live, work and have recreational activities in the community.
The team identified the following weakness under choice and self determination for those receiving DD services from this agency:
- There is a concern that the Department of Corrections limits the therapists with whom consumers can work on sex offender treatment; this is beyond the control of this agency, but of considerable concern.
The team identified the following strengths under Dignity, Respect and Rights for people receiving DD services from Crossroads:
+ Welfare of the consumer is the main goal of services.
+ At Crossroads, everybody is a part of a team.
"Rob and Teri are very open to suggestions." Staff member
Many of the people interviewed feel there is an attitude of mutual respect in the agency.
+ Providers feel respected by the administrators.
“Supervisors help problem-solve; they don't dictate.” Staff member
"(Staff have) a lot of autonomy." Staff member
+ Staff feel rewarded by the gratitude of administrators and consumers.
+ Consumers are treated with respect for their humanity, regardless of their behavioral history.
The team did not identify weaknesses in this area.
The team identified the following strengths under Health, Safety and Security for people receiving DD services from Crossroads:
+ Consumers trust Crossroads to support their safety and the security of the community.
"Crossroads is taking good care of me." Consumer
"They are there whenever I need them." Consumer
+ Consumers related instances of support that included transportation to medical appointments, therapy, and other providers; developing systems to assist consumers with charting medication usage; and tracking appointments.
The team did not identify weaknesses in this area.
The team identified the following strengths under Relationships for people receiving DD services from Crossroads:
+ New providers have a regular mentoring relationship with a long-time Crossroads employee.
"Nothing but positive relationships." Related service provider
+ Tenure of providers is exceptional, and results in continuity of services for consumers.
"My provider got me a job in 24 hours and helped me get to work on time every day." Consumer
+ Crossroads gives families information that assists their understanding of issues in a consumer’s life, helping them maintain ties to consumers under complex circumstances.
+ Consumers feel the staff are much more than paid providers.
"They are not only working for me, they are friends too." Consumer
"His provider is a friend to ___; before that, he just had a counselor." Family member
" Consumers are so much an important part of my life. I'm a lot more involved." Staff member
+ Teri has a knack for hiring well-rounded, emotionally mature providers.
+ Partnership between providers and consumers means there is giving by both.
"I threw away all my old phone numbers; I don't want to be going to jail the rest of my life." Consumer
"I feel they care about me; they keep in touch with my family too." Consumer
"Teri has tried to get funding for my son; she has gone out of her way. My son could have fallen through the cracks if it wasn't for Teri." Family member
The team did not identify weaknesses in this area.
The team identified the following strengths under Community Participation for people receiving DD services from Crossroads:
+ The visibility of Crossroads consumers in the community helps further community acceptance of the consumers.
+ Providers present options and encourage consumers to participate in community activities, while recognizing individual needs for privacy, time to be alone, and concerns about how others perceive them.
"Introduce, introduce, introduce…treat
people as if they are a part of the community." Staff member
+Transportation supports are available.
+ Crossroads offers an alternative for people who would otherwise be in jail or harming society: the program provides a safety net.
+ Staff advocate for the consumers to have access to all community activities.
"Special Olympics wanted to deny participation to a medically involved consumer, but were convinced to allow participation." Staff Member
+ Crossroads provides support for consumers' jobs at varying levels depending on the person's needs. Under the rubric of independent living, staff help consumers develop skills and confidence toward employment; coordinate with vocational providers and employers to ensure success; provide or coordinate transportation; assist with scheduling, money management, and a myriad of related issues.
The team did not identify weaknesses in this area.
DD
N = 14
|
Choice
|
Dignity & Respect
|
Health/Safety/Security
|
Relationships
|
Community
Particip.
|
||||||||||
Outcome
|
Yes |
No |
Partial |
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
|
Person/Parent/Guardian |
14 |
|
|
14 |
|
|
14 |
|
|
14 |
|
|
14 |
|
|
Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person/Parent/Guardian |
12 |
|
2 |
14 |
|
|
14 |
|
|
14 |
|
|
14 |
|
|
* Note:
parents of an adult consumer expressed concerns about a residential experience,
although Crossroads had already met the concerns and will continue to work with
the family on the choices available to this consumer, choices over which
Crossroads has no control.
Primary providers take responsibility for one consumer, providing extra safeguards and depth of service. Workers get to know the consumers particularly well and can learn to read their behavior. Cross-training occurs continuously, ensuring availability of alternate caregivers.
Staff members report that annual evaluations contain no surprises. Ongoing supervision develops methods of training as issues arise. Consumers and their families fully participate in employee evaluations.
Staff interviews indicate high levels of satisfaction with
the agency, their supervisors, the services they provide and the conditions in
which they work. One employee said, "I'm home. I have no desire to work
anywhere else."
Referrals go both ways, depending on client needs.
"They provide good services with
constant monitoring for clients who require it, at relatively low
expense."
"Crossroads collaborates and
cooperates 250%"
Standard #6. The agency does not have a consumer member of the board.
Standard #11. The Crossroads office is not fully ADA accessible.
As one staff member said about the methods of service delivery at Crossroads, "So much of what we are has to do with who Teri is."
Crossroads has a practice of hiring well-rounded, emotionally secure individuals and providing them with the support, supervision and training they need to be successful in direct service provision. Two parents indicated that additional training in individual behavior and emotional needs of consumers could be beneficial; however staff feel comfortable that they receive adequate training to perform their jobs well.
Outcomes are important; procedures are tailored to the desired outcome. Systems support good management and files appear well organized and comprehensive, while the basic structure of the organization is flexible and people support one another.
The agency has established new policies and procedures for governance. The initial board members will go off the board at the end of October 1999, and the new board will be seated at that time. One current member will continue. The administrative staff engaged in significant amounts of research since the last site review. They have developed and are implementing comprehensive policies and procedures that are intended to strengthen the board, assist it to function in a more active manner, and build the board’s quality assurance role.
Growth is an on-going issue at Crossroads, particularly since the agency's successful track record encourages people to expect continued expansion. Management appear to have instituted appropriate planning and evaluation methods to assure their ability to manage problems associated with growing or deciding against growth.
Files
accurately reflect what is going on in consumers' lives.
Treatment
plans, service plans and case notes are current, signed, and contain evidence
of timely implementation.
Administrative & Personnel Standards
1. Crossroads does not have a consumer serving on the board. If a consumer were identified who was willing, interested and capable of serving in the capacity of board member, such a person would be a welcome addition to the board. The agency plans to continue being observant of possibilities for this to occur. (Standard #6)
2. Consumers who need accommodations for accessibility have them. The office is located in a structure that does not fully meet ADA guidelines for accessibility. The staff has been seeking both funds and an appropriate building for relocation. A building has been identified that would meet the agency’s needs, including meeting accessibility requirements, but the funds are not yet in place to allow Crossroads to secure a lease. (Standard #11)
1. Crossroads should continue to seek opportunities to provide staff with appropriate training.
2. Several people expressed concerns about treatment of people with developmental disabilities within the Department of Corrections system. It seems that within DOC, procedures do not allow therapists to determine the course of treatment for sex offenders, nor do they allow consumers choices of therapists. As sex offender and substance abuse treatment for people with developmental disabilities is a specialized field, proper training for providers of these services is of extreme importance.
At present, DMHDD pays for sex offender therapy in Fairbanks, but DOC has not been using the services of the DD-funded therapist. The Parole Office declined to participate in this site review and it is alleged that DOC staff have not participated in training specific to working with people with developmental disabilities when it was offered in the community.
As this was a recurring issue in the review, the team wishes to bring this to the attention of the state.
“I have not received help for alcoholism because of what Department of Corrections wants." Consumer
The
site review team wishes to thank everyone at Crossroads. In such a small agency, the site review has
taken over offices and displaced workers.
For the disruption, we sincerely apologize. For the opportunity to observe your commitment to helping people
attain the lives they want, and for facilitating our access to consumers,
family members and others in the community, we thank you all.
The
final report will be prepared within 7 to 14 days and forwarded to DMHDD. Crossroads will work with the Regional
Program Specialist to develop and implement an action plan.