Mental Health Site Review

Juneau Youth Services

Juneau, Alaska

April 12-15, 1999

Site Review Team:

Jan Guertin, Juneau

John Guthrie, Juneau

Dee Foster, Peer Reviewer

David VanCleve, Co-facilitator

John Havrilek, Facilitator

Dan Weigman, DMHDD

Nancy Mathis, DMHDD

Pam Miller, DMHDD

Introduction

A review of the mental health (MH) services offered by Juneau Youth Services (JYS) in Juneau, Alaska was conducted from April 12-15, 1999. JYS offers MH services to approximately 500 clients. Our team reviewed the “BASE Program” that serves about 100 clients and offers group therapy, individual and family therapy, activity therapy, family support services, home base services, tutoring and tracking for seriously emotionally disturbed youth. JYS is a multi-service agency and offers an array of services in addition to the above. Those services were not subjected to this review. This is the first review conducted of JYS using the Mental Health Developmental Disability and Early Intervention Program Integrated Standards and Quality of Life Indicators.

To conduct this review, a team consisting of a facilitator, a co-facilitator, two community representatives, a MH peer provider, and three representatives from DMHDD Quality Assurance Unit met for four days in Juneau. The survey portion of the team conducted interviews, reviewed agency material, personnel files and interviewed 18 consumers and family members, program staff, board members, community members and related service providers. Of those, 10 were randomly selected individuals and families who receive services from JYS. The file review portion of the team conducted a quality assurance review of 15 Medicaid files and 5 non-Medicaid files.

Interviews were in person at the JYS offices or by phone. The interviews lasted 20 minutes to an hour. 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. This report is based on the Department of Health and Social Services combined Mental Health (MH), Developmental Disabilities (DD) and Early Intervention (EI) program standards.

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 list of areas of excellence, an administrative review, areas of programmatic strength, specific services or procedures that are recommended for improvement, tables of consumer satisfaction with quality of life and services. File reviews were completed by the QA unit during this review. The findings of the file review will be shared in a separate briefing.

Our report is based on a random sampling of consumers served by JYS’s “BASE Program”.

Areas of Excellence

1. JYS’s intervention has successfully put students back on track academically. Parents reported that their children were once “A” students before they suffered mental health problems. Their children’s grades dropped drastically during emotional turmoil, but after JYS ‘s intervention, parents reported that their children were again successful academically. One parent was so proud, he brought in his daughter’s report card that showed excellent grades and a note from the teacher saying the child is a positive role model in school.

2. JYS is an excellent collaborator with other agencies. It is very active in Juneau’s Interagency Team and has current MOA’s with several agencies. It supports the philosophy of interfacing with any agency/program that can help children and meet the needs of the whole child/family to be successful.

3. JYS is consistently successful in moving students from the most restrictive environment through five different levels to the least restrictive environment. JYS follows a very consistent and well-delineated behavior plan to successfully move students from level 1 to 5 and that appears to generalize to the child’s home. Our team heard parents in interviews telling of their children being very successful in making positive changes in their behavior, decision-making skills and relationships.

“He doesn’t hang around with the bad crowd anymore.”

“His behavior is a model for the rest of the class.”

4. JYS has met accreditation standards with commendation from JCAHO, which is an excellent accomplishment for any MH agency.

Administrative and Personnel Standards Narrative

JYS is a leader in offering MH services to children in the Juneau area and sets a high standard to all MH agencies in the state. Its programs are showing exemplary success in meeting the needs of children. JYS’s mission of treating the whole child and of ‘it takes a village to raise a child’ is uniquely demonstrated in its interagency collaboration and in the success of children completing JYS’s programs. Their follow-up with children and families is also commendable. The QA file review team also noticed a marked improvement in the quality of the files, as well as the professionalism and positive attitude of the staff during this review. There are noticeable improvements compared to previous years, kudos to the staff and administration for all your hard work and improvements.

The site review team also found that JYS’s training of staff using job shadowing, intensive pre-training and on-going training options are excellent and should be commended. The only negative to this is that other agencies that can offer better salaries and benefits actively recruit JYS staff.

Quality of Life

Choice and Self-Determination

The team identified the following strengths under Choice/Self-determination for all people receiving services from JYS:

Families/people:

· JYS supports and helps children learn to make better choices.

· Parents consistently report that when their child entered the BASE Program he/she was making bad choices and when the child returned after six to 18 months he/she knew how to make better choices.

JYS staff:

· Encourage people receiving services from JYS to participate in treatment decisions and treatment planning. This, however, is not always possible because of families in communities distant from Juneau. In that case, teleconferences were scheduled to accommodate the scheduling needs of those relatives.

The following are examples of statements consumers/families gave to the review team:

“They (staff) were very validating and helped me set healthy goals for my child.”

“Him (child after BASE) and the kids (siblings), they also helped each other (make better choices).”

Dignity, Respect and Rights

The team identified the following strengths under Dignity, Respect and Rights for all people receiving services from JYS:

Families/people:

· Are aware of their rights, including the control of information.

· Consumer rights are posted in several places.

· Reporting is consistent that they are very kind, considerate and open when communicating with parents about a child’s progress.

JYS staff:

· Show respect and high regard for the consumer/family. Especially noteworthy are the sensitivity to and the recognition of the value of cultural difference demonstrated in opportunities to study indigenous culture.

· Clearly define boundaries and behavioral expectations so program requirements unambiguous.

The following are examples of statements received by the team:

“The staff were positive, cheerful and there for you.”

“He’s (my child) now interested in and has the opportunity to learn about native culture.”

Health, Safety and Security

The team identified the following strengths under Health, Safety and Security for all people receiving services from JYS:

Families/people:

· Are protected at Miller House (where some youth receive Base Services) with a sprinkler system, nurse on staff, and line staff who monitor the behavior and safety of residents and visitors. Nurse measures and labels medications. Staff observes and documents consumption in her absence.

· Report that the agency paid expenses of a life threatening medical emergency in Canada to facilitate prompt treatment when the parent refused responsibility for costs.

· Have psychiatrist available to meet medical needs of children.

JYS staff:

· Assure that services are provided in a safe manner.

· Monitor kids very closely for their protection and safety.

The following are examples of statements received by the team:

“We track kids all day and notify authorities if anything’s wrong.”

“My child (7-year-old) is closely monitored.”

Relationships

The team identified the following strengths under Relationships for all people receiving services from JYS:

Families/people:

· Are welcome at all times and family contact is encouraged at least once a week.

· Credit staff involvement for progress of child.

JYS staff:

· Facilitate improved relationships between parents and child.

The following are examples of statements received by the team:

“I am very thankful for the BASE Program. I believe they’re trying to help my child. BASE Program is like having me at school. It is a God send.”

“There were a couple of staff there that he really connected to. This was our last hope. I was amazed at the changes made.”

Community Participation

The team identified the following strengths under Community Participation for all people receiving services from JYS:

People/families:

· Felt welcome at monthly meetings.

· Can participate in monthly get togethers and at barbecues.

JYS staff:

· Helps kids get summer jobs, community service work, wilderness program activities, visits to the museum, work with ceramics, skiing and prevocational activities.

· Keep lines of communications between cooperating agencies and consumers.

The following are examples of statements received by the team:

“ They helped (my son) get into Big Brothers/Big Sisters.”

Areas requiring Improvement

The team identified areas that need attention from the organization and made the following recommendations:

1. Develop and formalize a Capitalization Policy.

2. Develop and formalize an Investment Policy.

3. Meetings are opened to the public, but need to be advertised. (Admin Standard #8)

4. Consumer and/or their families should be involved in hiring staff. (Admin Standard #22)

5. Assure that there is a policy for supporting the development of non-paid natural supports. (Admin Standard #26)

6. Parents/guardians need more options to participate in team meetings. Some parents reported they didn’t know about their child’s Tx plan and the record review only had one signature on Tx plans. Parents also reported Tx plan meetings were only offered during 8-4 time slots

7. Evidence of occurrences of family therapy is not evident in records.

Public Comment

JYS scheduled a public comment meeting for Tuesday, April 13, 1999 in the public library meeting room. No one attended the public forum.

Other suggestions and comments

The review team received some suggestions during the course of the review and these are listed below:

· Your possible movement to develop programs for younger children, pre-school to early elementary is a much needed as well as an exciting and logical extension to your array of services.

· Developing outreach programs and facilities in Southeast communities out of Juneau is also a much needed and exciting extension of your services.

· Expanding bed space and facilities in Juneau was asked for in a related service provider interview.

· Maintaining your high quality of communication and collaboration between children, parents, staff and agencies is paramount to your continuing high rate of success.

· Follow through with expressed concerns for transition services from child to adult through collaboration and cooperation of agencies.

· All staff, line staff, support staff, through executive director should be valued and clearly included in decision-making.

Conclusion

The site review and file review team thanks the JYS staff for their wonderful enthusiasm, professionalism and hospitality during the site review. We appreciate your patience and help.

You will receive a final 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. JYS, in cooperation with DMHDD will be responsible for developing a plan addressing the issues noted in the Areas Requiring Responses.

This review confirms that JYS meets or exceeds most of the basic guidelines of the DMHDD Integrated Standards. The team recognizes that all programs, regardless of how good they are, can always get better. We trust that the recommendations we have made will help you consider ways to improve services.

Once again, thank you for all your hard work and for your many successes with some very difficult challenges. As a related service agency person said in their interview, “We’d be in deep yogurt if it wasn’t for JYS”.