October 27- 29, 1999
Fairbanks, Alaska
SITE REVIEW TEAM:
Betty Taaffe, Community Member
Christine Butler, Community Member
Valerie Gifford, Peer Reviewer, Fairbanks
Sherry Modrow, Facilitator
The Site Review Team reviewed DMHDD-funded Developmental Disabilities Supported Services provided by Deaf Community Services from October 27-29, 1999 using the Integrated Quality Assurance Review process.
This report is the summation of impressions of a community team after interviewing consumers, staff members, board and 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. DMHDD Quality Assurance staff provided an informal review of consumer files during the site review.
The site review team met for three days at Deaf Community Services office in Fairbanks. The team consisted of two community members, a peer reviewer, and a facilitator. Team members conducted interviews with 6 consumers, 2 board members, and 8 employees (4 direct service providers in the Community Life Program funded by DMHDD and the receptionist, the bookkeeper, the operations manager, and the agency’s executive director). The team also interviewed 4 individuals who work or volunteer at three related agencies: Alaska Division of Vocational Rehabilitation, Fairbanks Resource Agency, and the Quota Club, a service organization that devotes resources to speech and hearing. Interviews lasted between 20 minutes and one hour and were conducted by telephone, in person at people’s homes or at DCS.
Deaf Community Services is a nonprofit organization providing supports for 15 individuals who experience developmental disabilities. Deaf Community Services has a nine-member board that sets policy and supervises the executive director. The organization employs 12 full- and part-time staff members, of which three provide supportive services for people with developmental disabilities.
Deaf Community
Services is dedicated to increasing personal and public awareness on issues
pertaining to deafness and disabilities: to working with Deaf, Hard of Hearing,
and other people experiencing a disability, as well as their families, friends,
employers, so as to ensure community access, integration, technical assistance
and opportunities for individual contributions throughout Alaska.
Deaf Community Services will act as a resource to parents, families, schools, and individual agencies so that we can build a network of support and services to provide education and understanding of Deaf culture, American Sign Language, and Deaf Education. Deaf Community Services will strive to provide support services, quality programs, and education to Deaf and Hard of Hearing Adults, Children, and their Families.
DMHDD funds support Deaf Community Services’ Community Life Program for individuals who experience developmental disabilities. The program provides individualized, wrap-around services aimed at supporting individuals in their own homes.
Other programs available at DCS include:
· Technology Connection
· Vocational Rehabilitation Program
· Independent Living Program
· Interpreter Referral Line
· Alaska Inclusive Recreation Program (AIR)
Deaf Community Services planned and advertised an Open Forum on October 27 at the Carol Brice Family Center. Notices were provided for the agency’s consumers and posted on the DCS bulletin board, and businesses and related service agencies received faxed fliers describing the event. No one attended.
Progress Since Previous Review:
1. All of the board needs to be oriented to the program structure of the agency, including the board's role and responsibility.
Board members receive thorough orientation to the programs.
2. Continue to find ways to have a balanced board of directors from a diverse background.
The board of DCS represents a diversity of people, including hearing,
hard of hearing and deaf
individuals.
3. Develop a policy for involving consumers in research.
This item will be developed during the revision of the policies and
procedures manual.
4. Document consumer participation in the hiring process.
The agency is in the middle of a major administrative transition.
Consumer involvement in hiring is
to be better documented in the future.
5. Make staff fully aware of client abuse, neglect and mistreatment laws, policies and procedures and reporting.
Direct service staff educate consumers about abuse laws, thereby
constantly updating their knowledge and awareness of these issues. More formal
staff training will be presented in the future.
6. They are not addressing volunteer orientation when it has to do with liability and insurance coverage.
Volunteers receive training for their activities with DCS. The staff
will implement a procedure for ensuring that volunteer orientation includes
liability and insurance coverage.
7. Clear documentation is needed for the consumer preferences for a work site.
Consumers are deeply involved in the planning process and have
interaction with the agency that
ensures they find meaningful jobs and have the supports they need to help
maintain their jobs.
8. While consumer vocational services are based on consumer abilities, these services are not adequately documented as such.
Files contain adequate documentation of vocational planning and
consistent follow-up.
9. Keep working on finding ways to support consumers in their planning efforts.
DCS provides consistent support for consumers in planning, although
details of how the
personal service planning meeting is set up could be better documented.
10. Need to develop measurable goals that include both paid and unpaid supports and are documented.
Documentation in consumer files indicates this has been done.
11. Document consumer decisions and choices within the process and the plan of action.
The Personal service plan is well documented. Goals and case notes are
well-written and quite complete.
As mentioned earlier, staff could improve documentation of steps taken to set
up the personal service plan
meeting.
DCS specializes in providing individualized supports to help people with a variety of disabilities and to try to make their goals and service plans match their desires, their lifestyles and their situations.
At DCS, a safe, inviting atmosphere includes everybody. The DCS building serves as a starting point, where other activities may generate informally, as in a clubhouse. The agency smoothly combines its roles as a provider of services for deaf people and as a cultural center for the Deaf community and other people.
Consumers of DD services feel very welcome among people who are accepting of differences; the focus at DCS is not on disabilities.
The board of directors of DCS includes people who are deaf or hard of hearing as well as hearing people. Accommodations for communication at board meetings include real-time projection of transcripted proceedings and interpreter service. This agency is to be commended for having included a person who experiences developmental disabilities on its board in compliance with Administrative and Personnel Standard #6.
The team identified the following strengths under Choice and Self-Determination for people receiving DD services from DCS:
+ Individualized services are the standard of operation at DCS.
“DCS doesn’t expect consumers to conform to the services.” Staff Member
“DCS helps individuals set individual goals and use holistic approaches to accomplish them.” Staff Member
+ Staff provide supports for consumers when they change residences, including assistance with locating new housing, moving, and exploring financial assistance and facilitating relationships with landlords.
+ Parents choose direct service providers and choose how much involvement staff have in their lives.
The team did not identify weaknesses in this area.
+ DCS applies creative approaches to helping consumers reach their goals.
“I like DCS; it’s a positive place.” Board Member
“They do a good job; I like it better here than other places.” Consumer
+ Staff at DCS help consumers with educational planning and advocacy, and assist people with learning about their rights.
+ Consumers' boundaries and wishes for privacy are respected.
+ Consumers are always treated with dignity and respect, and their comments and ideas are valued.
A staff member commented that he wants to continue supporting Deaf Native individuals.
He wants to teach them skills for independent learning and help them to learn to sign.
One consumer said “They give positive feedback to my questions,” and believed he was treated very respectfully.
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 DCS:
+ Consumers rely on DCS as a safe place.
“I can come here if I get into trouble.” Consumer
+ There is a superior level of assistance with access to health care, appointments and the financial aspects of health care.
One consumer reported particularly outstanding supports in his service plan for maintaining the health and well-being of his cat, and this was very important to him.
The team did not identify weaknesses in this area.
The team identified the following strengths under Relationships for people receiving DD services from DCS:
+ DCS makes a huge commitment to the well-being of all consumers and helps them lead fulfilling lives, including building and maintaining meaningful relationships with diverse people.
“People here have a good sense of humor.” Consumer
“Your ears aren’t muscles, but your eyes are; you work really hard at using your eyes all the time when you’re in the Deaf community, and you learn so much.” Staff Member
+ Social activities at DCS are inclusive, and include impromptu parties, potluck dinners, bowling, gathering for television.
The Community Life Program plans an outing once each month. Consumers attended the fair and have gone bowling and to movies.
One consumer indicated his excitement about a fishing trip to Chitina he took with DCS.
+ Consumers who are working seem to have meaningful jobs, and they speak with pride about friendships at work.
Consumers talked about relationships at their jobs and at DCS as being highlights in their lives.
The team did not identify weaknesses in this area.
The team identified the following strengths under Community Participation for people receiving DD services from DCS:
+ DCS has received funding to offer the Alaska Inclusive Recreation (AIR) program, providing Fairbanks residents with opportunities for highly integrated civic activities and recreational involvement.
+ Services are provided near where the consumer lives.
+ DD Consumers at DCS seem to feel comfortable in and included by the Deaf community.
+ DCS is dedicated to involving consumers in community activities.
+ Staff respect consumers’ choice to participate or not in activities at DCS or in the community.
“ I believe the DCS staff meet consumers where they are at, and provide service according to where the consumer is at.” Staff Member
The team did not identify weaknesses in this area.
Note: This chart applies only to consumer satisfaction with quality of life and supports that Deaf Community Services can impact.
DD
N= 6
|
Choice
|
Dignity & Respect
|
Health, Safety…
|
Relationships
|
Comm. Particip.
|
||||||||||
Outcome
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
|
Yes |
No |
Partial |
|
Person |
6 |
|
|
6 |
|
|
6 |
|
|
6 |
|
|
6 |
|
|
Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person |
6 |
|
|
6 |
|
|
6 |
|
|
6 |
|
|
6 |
|
|
"I love this job
a lot."
Staff see the strength of the agency as helping consumers set realistic goals and as approaching them holistically. Several mentioned positive feelings about the administrative changes and the vision of the executive director. Several staff members indicate Shelly is well-suited to her role, a new position for the agency, in overseeing all DCS programs. She seems to have good people skills, is approachable and easy-going, and facilitates communication between hearing and Deaf individuals.
Some people indicated some concern about communication within the staff although it should be noted that this is a period of transition as the agency gets used to the new administration. Roles and procedures are in flux, but appear to be headed in a direction that will improve overall performance and increase attention to detail. Staff meetings will be a key to building greater cohesion among all staff. The staff is attempting to schedule regular staff meeting times to help build attendance and participation.
Consumers at DCS celebrate a lot; staff could build "team spirit" by finding events to celebrate together during this period of transition. They are so willing to learn from the differences of the people they help and they might focus on the benefits of viewing their own differences as strengths.
People at other agencies recognize the challenge of transition for DCS with a new administration. They reported positive interactions and great support for consumers, with comments such as:
"Shelly and Doug have a lot of knowledge and interests; they are listening and trying to make things work better."
Successful services require people working together. Interagency cooperation and collaboration
support consumers, and that is happening.
One person commented, "Doug
has vision and energy; he's a great example for other agencies."
Staff at DCS will "take the ball and run" after a referral, and ask questions of the other agency as needed. Related agencies view the DCS direct service staff as committed and willing to find creative solutions for consumers.
#3. External audit. Agency budget is below requirements for external audits, although DCS plans to conduct one at the end of FY 00.
#10. DCS has a conflict of interest policy; however, the agency should seek legal advice to clear up questions involving a board member who derives income from fundraising activities for the organization.
#13. Systematic planning and evaluation: Informal communication includes constant feedback between consumers and staff about planning and evaluation of programs, but there is not a formal system for ensuring that this occurs on an annual basis.
#14. Informal activities provide inclusion of goals set by consumers and members of the community. There is self-evaluation by the agency, but the process has not been formalized.
#19. Staff have appropriate training and credentials; however, DCS does not have a system for ensuring that staff working with consumers in the Community Life program have and maintain current CPR and First Aid certifications, as requested by DMHDD.
#22. Consumers have opportunities to participate in hiring direct service providers, and in some cases make the determination independently. The agency does not have a procedure for involving consumers in evaluation of staff.
#29. Staff development plans: The performance evaluation tool includes an area for comments, which in some cases include goals or suggestions for staff development, but has been inconsistently used that way in the past.
#30. Staff development needs do not appear to always have resources identified to allow them to be met.
#31. Performance appraisals have not been conducted annually for all staff.
This agency is in the midst of major changes in its operation. With new administrators and changes in some of their programs, they are examining all areas of operational procedures. The team notes a trend toward greater attention to and general tightening of procedural details. It takes time both to accomplish a large set of changes and to meet the variety of staff needs within that atmosphere, and the site review team recognizes that much is being accomplished. With the change of administration comes gradual change in many areas of operation, and the overall impression is one of continued improvement in administrative functioning, while maintaining high standards for program delivery.
DCS faces unique challenges in that the agency combines programs for members of hearing and Deaf cultures within its staff and services. The agency has begun to implement supports to safeguard each staff member’s ability to participate fully and receive support and supervision, by creating a leadership team that combines a variety of modes of communication. The administration should facilitate discussions surrounding communication and cultural issues between staff members.
The team believes the agency is successful in meeting individual program goals, and staff members provide support for each other within programs. All staff need to subscribe to the agency mission and support each other's efforts across programs, developing cohesion of the staff as a whole. Consistent and sustained attention to supporting greater integration of all staff in the agency culture could decrease real or perceived isolation of staff who do not primarily serve Deaf consumers.
The environment of DCS opens avenues of communication for hearing people to interact with the deaf community. By recently re-instituting the American Sign Language class for staff at DCS, the agency provides opportunities for hearing staff members to learn sign language. The team sees this as a positive step, because it facilitates communication between staff members and provides additional access to supervision and mentoring; it also increases employees' interactions with the Deaf community.
File Review
All language in consumer files is very respectful, and files are well-organized.
The following suggestions do not indicate weaknesses, but are meant as ways staff could make further improvements to the consumer files:
Expand the description of how the personal service planning is set up, who is invited; specify if consumer requests or denies involvement of particular family members.
Service Plan--consider adding the number of hours the person will receive each week dedicated to the different goals, as one way to improve ability to measure implementation of the plan.
It could be helpful to implement a summary sheet with essential information about the consumer, including date of eligibility determination or referral or date of Medicaid prior authorization and types of funding.
Monthly or quarterly reports are not evident for some consumers' files.
Areas Requiring Response
1. Discuss communication and cultural issues among staff members. Consistent and sustained attention to supporting greater integration of all staff in the agency culture could decrease real or perceived isolation of staff who do not primarily serve Deaf consumers.
2. Develop a policy governing the participation of consumers in research during the current revision of the policies and procedures manual as requested in the prior review.
3. Provide formal staff training on client abuse, neglect and mistreatment laws, policies and procedures and reporting as requested in the prior review.
4. Document consumer involvement in hiring as requested in the prior review and to meet Standard #22.
5. Implement a procedure for ensuring that volunteer orientation includes discussion of liability and insurance coverage as requested in the prior review.
6. Admin Standard #10. The agency has a conflict of interest policy; however, since a board member derives income from fundraising activities for the organization, the site review team questions whether the policy has been accurately applied. The agency might seek legal advice about this situation.
7. Admin Standard #13. The agency informally involves consumers, staff and community members in agency annual planning and evaluation of programs on an on-going basis. Define a policy for inclusive planning and evaluation and a procedure for ensuring that this occurs regularly.
8. Admin Standard #14. Informal activities provide inclusion of goals set by consumers and members of the community, as well as through self-evaluation by the agency. Formalize the process.
9. Admin Standard #19. Implement a system for ensuring that staff working directly with consumers in the Community Life program have and maintain current CPR and First Aid certifications, as requested by DMHDD. As the Policy and Procedures manual continues to undergo revision, include this as a requirement, with provisions for ensuring annual renewals.
10. Admin Standard #22. Consumers have opportunities to participate in hiring direct service providers, and in some cases make the determination independently. Involve consumers in the evaluation of staff.
11. Admin Standard #29. The staff performance evaluation tool includes an area for comments, which in some cases include goals or suggestions for staff development, but has been inconsistently used that way in the past. Develop a standard for staff development plans and implement it in annual performance evaluations.
12. Admin Standard #30. Identify resources to meet staff development needs.
13. Admin Standard #31. Conduct annual performance appraisals for all staff.
Case file documentation appears to have improved considerably since the last review. The following are suggestions for continuing the improvement:
Expand the description of the methods used to set up personal service planning, identify who is invited; specify if consumer requests or denies involvement of particular individuals.
Consider stating the number of hours of service the person will receive each week dedicated to the different goals, as one way to improve measurability of the plan’s implementation.
It could be helpful to implement a summary sheet with essential information about the consumer, including date of eligibility determination or referral or date of Medicaid prior authorization and types of funding
Monthly or quarterly reports not evident for some consumers' files.
The site review team thanks all those who aided in the review. We appreciate the opportunity to meet with consumers, staff and others in the community about the services DCS provides. The inclusive atmosphere and friendly people at DCS are a great asset for ALL.
This report will be finalized in 7-10 days and forwarded to DMHDD. DCS can expect to receive the final report within 30 days. DCS and DMHDD will collaborate on creating the action plan for making needed changes.
Attached: Administrative and Personnel Checklist; Questions for Related Agencies (tallied), Report Card (tallied)