DMHDD Site Review

HOPE Community Resources-Kodiak/Aleutian/Pribiloff Region

May 17-19, 1999

Site Review Team

Diane Conway, Kodiak

Amy Reiff, Kodiak

Gail Spence, Peer Reviewer

Nancy Mathis, DMHDD

John Havrilek, Facilitator

Introduction

A review of the Developmental Disabilities (DD) services offered by the Hope Community Resources (HCR) in Kodiak, Alaska was conducted from May 17-19, 1999. HCR offers DD services that include respite (64), core services, supported living (15), assisted living (4), subsistence, employment (7), fund raising and foster care. HCR presently serves 83 funded clients through related and collaborative activities with the equivalent of 6.5 full time staff in Kodiak and Afognak Island villages, Alaskan Peninsula, Aleutian Islands and Pribilof Islands. In conducting this review, our team used the Integrated Standards and Quality of Life Indicators for Mental Health Developmental Disabilities Early Intervention/Infant Learning.

A team consisting of a facilitator, two community representatives, a peer provider and a representative of DMHDD met for three days in Kodiak. The team conducted interviews, reviewed individual consumer files and program and agency materials. The team interviewed 14 consumers and family members, 2 program staff, several community members, and 10 related service providers. Ten of those interviewed were randomly selected individuals and families who receive services from HCR (a total of 14 families were interviewed, 10 random and 4 walk-ins). Board members were not interviewed because the HOPE board of directors is based in Anchorage, however, 2 members of the Community Resource Team (CRT) were interviewed. The CRT is a 12 member advisory board, 9 members of the CRT are consumers of HCR services.

Interviews were conducted in person at families’ homes, in the community, at the HCR’s offices and by telephone. Interviews ranged from 30 minutes to an hour in duration. After gathering the information, the team members met to draft this report, which was presented to the staff on the final day of the review.

An important contribution is made to the State of Alaska’s understanding of the effectiveness of program services and supports, by monitoring and reporting the quality of life and the quality of services individuals and families receive. The review team’s findings are reported below. The report includes the following components:

1. Hope Community Resource’s response to the previous action plan

2. An Administrative Review, including a checklist

3. Comments from related service agencies, including a table of questions asked

4. Quality of Life Standards information, including a report card

5. Areas Requiring Response

6. File Review Summary

7. Consumer Satisfaction Table

Program Response to Previous Action Plan

1. Utilize and coordinate with other agencies/resources and develop methods to promote public awareness (1.3.4), (1.7.2). HCR has 5 MOA’s with KANA/ILP, KANA/VR, Providence Mental Health, Kodiak Women’s Resource and Crisis Center and Kodiak Youth Services.

2. Employees need to protect the privacy and confidentiality of all records and communications (2.3.2). HCR addresses this in new employee orientation and reinforces it in yearly training sessions.

3. Staff training should be a priority (2.3.4,2.3.5, 2.3.6).

HCR offers staff training in CPR, First Aid, and MANDT for all new employees and on-going training when specialists come to Kodiak.

4. Expand efforts to plan community activities for each individual to build community ties, moving them toward inclusion (3.6.6). HCR builds community activities into each consumer’s program plan. According to Patrick Kross this recommendation was in reference to 8 consumers living in the apartments, at this time 5 of those consumers have moved out into the community.

6. Families need to know of other services and options (6.4.1). Patrick reports that this area is an HCR priority in the respite program. Helen is meeting regularly with other agencies in outlying areas to promote and coordinate services. HCR services were focused on in November’s Ruralite publication. He also reports they are making quarterly site visits to respite consumers for yearly planning of anticipated services like transition and addressing the state wait list. HCR also wrote a grant to request additional services for consumers.

7. More friends and family members should be encouraged to attend planning meetings and this should be documented. HCR revised individual service plans to reflect family input and to document those in attendance. HCR has included the personal futures plan first in the ISP section of each consumer’s file and team members’ names are stated in the plan.

Administrative Review

HCR has met many of the areas in the Administrative and Personnel Standards Checklist. Employee personnel files, initial staff training, utilization of family and consumer input, accessibility issues and employee policies are adequate. Further work needs to be completed in the following administrative areas:

· Administrative and Personnel Standard #17 (The agency actively participates with other agencies in its community to maximize resource availability and service delivery). This area was also identified in the previous site review as an area that needed improvement. As the team conducted interviews with collateral agencies for this review, it became apparent that HCR must place more emphasis on actively participating with other agencies. Specifically this means following up when a referral is made, cooperating and collaborating on cases, contributing to positive outcomes for clients, facilitating regular communication when working with mutual cases, practicing consistent follow through on agreements/plans to serve mutual clients, and providing closure with the collaborating agency on casework.

· Administrative and Personnel Standard #19 (Staff who are employed by, contract with, or volunteer for the provider agency have appropriate training [credentials where required], experience, and supervision to perform their job functions and met all necessary legal, ethical, and regulatory requirements.) This area was also identified in the previous site review as an area that needed improvement. Related agency personnel, consumers and family members expressed concerns regarding a high staff turnover, insufficient skill level of providers of respite service and the lack of direct staff training.

· Administrative and Personnel Standard #30 (The agency identifies available resources to meet the assessed training needs of staff.) This area was also identified in the previous site review as an area that needed improvement. Although, HCR offers staff training in CPR, First Aid and MANDT for all new employees and on-going training when specialists come to Kodiak. The need for staff development and training continue to be major concerns at all levels. As stated in the previous site review report, staff, consumers, families and other related service agencies continue to express the need for staff development and training at all levels. For instance, staff needs to be educated on state service options, Medicaid services, the writing of waivers, development of wrap-around services (with related agencies), teaching of life skills and fostering opportunities for inclusion.

Related Service Agencies

10 related agency staff members were interviewed from the following agencies:

KANA/ILP, KANA/VR, Providence Mental Health, Kodiak schools, WIC, Public Advocacy, Kodiak Women’s Resource and Crisis Center and Kodiak Youth Service

Please refer to the table of questions asked (noting numerical responses), which is included as an attachment to this report.

Following are comments the team received from related service agency staff members who work with HCR:

Strengths:

“HOPE is doing a very good job in where people live, they are very happy with their housing situation”

“We have an excellent working relationship, our mutual cooperation is so good we are able to work together to fix problems.”

“They are much better, a 1000 times better than the old mental health program”

Weaknesses in services and requests for services:

· Poor communication between HCR staff and other agencies, along with a lack of training of direct staff was a reoccurring concern.

“Communication is an issue, it’s not a lack of caring, it appears to be a lack of staff training and skills. I have yet to see HOPE facilitate a training in this community.”

“ Untrained direct staff has been an on-going issue with HOPE, they tend to hire caring individuals but don’t support them with training, especially on-going training”

“The tragedy of their whole program here is not accessing the communities resources for training staff, HOPE is not well integrated into the whole community.”

“HOPE’s administration in Anchorage is not supporting Kodiak, it’s like a neglected step-child.”

“Staff needs training on when to call the guardian especially in emergency situations”

“I’d like to see more communication between the school and the agency, I feel I’m not getting the services from the agency I need.”

· There was a concern voiced that a member of the Community Resource Team represented HOPE in an inappropriate manner. The CRT member reportedly used their influence as resource team member to compromise a family’s services for personal reasons. In the process of doing this, the CRT member also breached confidentiality.

“This has soured my feelings in being able to work cooperatively with HOPE.”

Quality of Life

Choice

Strengths:

· Consumers generally said that they were given choices in services and providers. “Before Helen was on staff I was told I had to voucher respite services, I had no choice.”

“HOPE is helping me buy my own home”

Weaknesses in services and requests for services:

· Consumers would like HCR to develop a pool of providers to improve consumer choice in providers, provider services and times of service.

· Consumers requested pamphlets/brochures/education on HCR’s available services and how to access services i.e. Medicaid waivers, TEFRA options, accessing adaptive equipment, etc.

Dignity, Respect and Rights

Strengths:

Families/Children:

· The majority of consumers felt the staff to be very caring and felt they were treated with dignity and respect. They also felt their rights were protected.

Weaknesses in services and requests for services:

· There were a few comments about direct line staff treating some consumers in a disrespectful manner. It was reported that some of the staff didn’t know the consumers well (were unfamiliar with specific needs) and hadn’t read case notes before their shifts. It appeared they didn’t have sufficient training and education to meet consumer needs.

· A specific comment was “the person in charge didn’t know how to deescalate the situation”.

· Some direct service staff have been reported as unprofessional and as lacking training.

· A parent expressed concern that the CRT has a few very dominant members, which contribute to an uncomfortable atmosphere at the CRT meetings. The level of discomfort discourages others from speaking or making suggestions in these meetings.

Health, Safety and Security

Strengths:

Families/Children:

· Reported their health, safety and security were good and felt staff cared about them.

· Site review team members noted that consumers’ housing was clean, consumers were happy and the housing reflected the individuality of each consumer interviewed.

“HCR is not perfect but they are much better than the old mental health program, people are safer and getting out more”

Weaknesses in services and requests for services:

· A guardian was concerned about staff taking consumers into bars to play pool.

“ I’m concerned for their safety”

*Patrick Kross, Director of Kodiak HCR, showed the site review team a 60 hour study that was conducted regarding consumers actions and interactions in Kodiak bars. This study was conducted by off duty coast guard personnel.

· Several people reported staff to have insufficient training in working with consumers. A lack of knowledge of specific disabilities and the individual challenges that are a part of those disabilities was noted. Staff reportedly lacks training in age appropriate activities and interventions specific to individual challenges of consumers.

Relationships

Strengths:

Families/Children:

“ I’ve never had as much help and support as I’ve gotten from HOPE in working with my son”-Parent

”HOPE has done an excellent job, they may not know the answer right away but they find it out”- Foster Parent

“Helen is always ready to support me”-Parent

Weaknesses in services and requests for services:

· Some direct and respite staff turnover is having a negative impact on relationships with consumers.

· A parent felt that training in dealing with their child’s specific challenges would be a big help.

“A parent support group would be helpful”

Community Participation

Strengths:

Families/Children:

· Consumers and family members feel they are accepted and valued in the community

“Consumers enjoy going bowling, swimming and playing basketball”

· Seven consumers are on job sites

Weaknesses in services and requests for services:

· Consumers expressed a desire for more job options

· Consumers and family members would like summer activity program

· Pool tables in a safe environment (in a location other than a bar) *Note the 60 hour study on file at Kodiak HCR

· More collaborative efforts with the school and other agencies in transition activities

· Weekly social gatherings; a suggestion was weekly pot lucks

· Possible use of the teen center

· Outings/Camp outs

· Attending church of choice

Areas requiring response

The following recommendations were identified by the team as areas requiring attention from the organization:

1. Strengthen collaborative ties with related agencies (This area was also identified in the previous site review as an area that needed improvement):

a) Increase communication through regular contacts and interactions

b) Collaborate on providing consumer services (Admin Standard #17)

2. Strengthen and develop on-going monthly staff training. The staff needs additional consumer training. Access community resources and other available resources to train direct staff. Contact the regional program specialist to request care coordination training. (Admin Standard #19,#30) This area was also identified in the previous site review as an area that needed improvement.

3. Conduct training with CRT members to increase involvement/participation from CRT members and consumers.

4. Develop a pool of respite providers to allow families and consumers more choices of providers.

5. When developing individual plans with families, educate families on their options regarding respite and encourage families to have a stronger voice about where respite is delivered.

6. Distribute information regarding HCR services to consumers and community (refer to Choice section of review for suggested activities). This area was also identified in the previous site review as an area that needed improvement.

7. Determine if there is a need for a parent support group that meets regularly and offers support and training (possibly through a collaborative effort with ILP and Providence Mental Health).

8. Expand pre-vocational and vocational job options.

9. Through HCR and/or collaboration with other Kodiak agencies offer summer and yearly activity options to increase activities for consumers (refer to Community Participation section of review for suggested activities). This area was also identified in the previous site review as an area that needed improvement.

10. Provide community education regarding the lives and opportunities of people with disabilities.

11. Collaborate with other HCR offices and other Kodiak agencies in developing and providing on going training for direct service providers (group home, apartments and respite providers).

File review summary

Files were arranged in an organized manner and contained relevant information. Habilitation plans (IPP) were unique and individualized. All files reviewed contained current habilitation plans. All staff members, consumers and guardians participating in the development of the plan should sign the plan, documenting their participation. Goals on plans could be written in a more specific and measurable manner. Writing goals in a more specific manner will make progress toward the goals more evident.

Consumer Satisfaction

Each consumer interviewed by the team was asked whether or not they were satisfied with the quality of their lives as they relate to each of the five Outcome areas and with the quality of the supports and services they receive from HCR. The questions were taken from the Consumer Satisfaction section of the five Outcome areas, and the responses are presented according to type of service in the following table.

DD	Choice N=9			Dig&Res. N=9			Hth,Saf,Sec N=9			Relatns. N=9			Com.Par. N=9
Outcome	Yes	Part.	No	Yes	No	Part.	Yes	No	Part.	Yes	No	Part.	Yes	No	Part.
Person/Parent/guardian	9			9			7		2	9			6	1	2
Staff Performance
Person/Parent/guardian	6	3		8		1	6		3	9			5	1	3

Note: If an item is marked UNK (Unknown) or Not Applicable (NA), will be entered in the No column.

Public Comment

Only one person, an employee of a local related service agency, attended the community forum. As a staff member of a related agency, this person has had recent and consistent contact with people who have developmental disabilities, some of who receive services through HCR. This person expressed considerable concern about the insufficient amount of training staff at the group home and apartments receive. Reportedly, staff does not have sufficient training to teach consumers how to complete basic care and personal hygiene tasks. Further concern was expressed regarding direct service staff’s lack of training in interacting with specific consumers and the prevalent lack of awareness regarding specific challenges and how to best accommodate them. This person also felt that HCR direct service staff act as poor role models for consumers.

Incidents specific to two consumers were discussed. One consumer was reportedly sent on a trip with worn tennis shoes that were also urine soaked. According to this person, the consumer’s room/home was so dirty that staff would not enter the premises or help the consumer to clean the premises. The second consumer mentioned has appeared withdrawn and violent over the last year, which is a drastic change from previous years.

CONCLUSION

The team thanks the HCR staff, Patrick, Helen and Linda for all of their support and hospitality during this site review. The staff’s caring attitude and dedication to families is especially notable.

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. HCR, in cooperation with DMHDD, will be responsible for developing a plan addressing the issues noted as Areas Requiring Response. When writing the action plan, please refer to the body of the report as it contains many examples and details that will be useful to you.

The team recognizes that all programs, regardless of how good they are, can always get better. We trust the recommendations we have made will help you develop ways to improve your services.