Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
October 16, 2000 –
October 18, 2000
Esther
Hopkins, Community Member
A review of the mental health (MH) services
provided by Kenai Peninsula Community Care Center (KPCCC) was conducted from October
16, 2000 to October 18, 2000 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.
KPCCC was founded in 1973 as a runaway shelter and became a non-profit in 1982. Since 1985, KPCCC has used a Teaching Family Model for their residential services modeled on Boys’ Town. That is the same year in which the agency received Division of Family and Youth Services (DFYS) funding for residential child care beds and DFYS continues to be the major source of funding for the center. Additional funding is obtained through the Department of Juvenile Justice (DJJ), USDA (breakfast and lunch program) and United Way.
While KPCCC is not a community mental health center grantee of DMHDD, it does provide AYI services and does bill for Mental Health Medicaid services. Medicaid payments provide approximately one third of the annual budget and fund MH services.
Services provided are residential services
(emergency shelter, long term treatment, community based treatment home),
therapy (individual, group and family), family preservation, parenting classes,
therapeutic foster homes and non-secure attendant shelter care in Homer, Seward
and Kenai. Substance abuse assessment and treatment are available through a
local provider or on site.
As all consumers are in State custody, all are
provided with medical, dental and vision care through Medicaid and the agency
provides transportation to appointments.
As a DFYS licensed Community Care Center and a DJJ grantee, KPCCC’s
facilities are governed by extensive safety rules. Health issues are addressed at intake with a thorough medical
history and physical examination.
Services are provided by 16 full-time and numerous
part-time staff. A consulting
psychologist provides clinical oversight to two Master’s level clinicians and
to trained residential staff. KPCCC has
the capacity to serve up to 15 youth in residential care and 6 in foster
care. In a typical year, some 48 young
people would receive services from the agency.
All consumers are referred by DFYS or DJJ. Admission to the program is limited to those referrals and to
those with no continuing nursing or medical needs and who are not a danger to
self or others. Youth from all over the
State of Alaska are served here.
The agency is governed by a ten member executive
board that meets monthly for nine months of each year.
Description
of Process
25 interviews with 8 randomly selected consumers
and parent/guardians; 7 representatives of 6 different related agencies; 7
staff members, an administrator and the Board president. The interviews lasted from 15 to 60 minutes
and were conducted by telephone or in person at the agency.
The team toured the long-term residential
facility. The facilitator reviewed the
agency’s policy and procedure manual, 3 personnel files, the agency brochure
and the financial audit.
The team wishes to note that this review is unique
in that two thirds of the budget of this agency is provided by DFYS and DJJ grant funds. We attempted to review only those portions
of the program funded through MH Medicaid funds, the mental health
services. If we have trespassed into
the area of DFYS’ or DJJ’s responsibility, that is certainly inadvertent.
Open
Forum
An opportunity for community members and others not scheduled for interviews to participate in the process was provided in the form of an open forum held the evening of the sixteenth. The agency had advertised this opportunity for three days in the local newspaper at considerable expense. The open forum was held in the Old Courthouse Building and hosted by the Board President and her husband. No members of the general public attended the forum.
The facilitator provided her local evening phone number for anyone wishing to comment on services but who were uncomfortable with an open forum. No one requested an interview.
Progress
Since Last Review
Areas
of Excellence
1. All related agencies report a superb relationship with KPCCC and great admiration for their work.
2.
KPCCC has a well organized and consistent system
for the collection of information including regular, frequent surveys of
consumer opinion, daily school reports of consumer behavior and ARORA MIS
reporting.
3.
The employees of KPCCC are uniquely committed to
their work, the agency and its philosophy.
4.
KPCCC has created a calm and home-like atmosphere
at their central complex.
5.
KPCCC facilities are remarkably well maintained,
neat and clean despite high use and limited space.
6.
The youngsters served by KPCCC are surveyed
quarterly (or more frequently as needed) as to their satisfaction with
services, their concerns and their requests for changes or additions. This information is utilized in evaluating
staff, in agency planning and in program and policy development.
7.
Staff are evaluated regularly with forms submitted
by administration, staff, community members and consumers.
Note: KPCCC’s behavior modification approach to
treatment and the conditions imposed on the youth referred to them, many of
whom are adjudicated youth, limit the number of possible choices for them.
Recognizing this limitation, the team still
identified the following strengths under Choice and Self Determination for
those receiving MH services:
+ Consumers
and their parent/guardians participate in treatment planning.
+ Consumers
state that they feel they are part of the treatment team.
+ Consumers
are allowed to set personal goals and are aided in identifying the steps toward
completion of those goals.
+ Consumers
are aided in making healthy choices with decision making and problem solving
skills training.
“I
have seen this program turn kids’ lives around.”
–guardian
“(KPCCC)
has been the best one.” – parent of treatment veteran
+ Consumers
are not restrained at any time, even when intent on leaving the facility;
rather, they are reminded of consequences and encouraged to make healthy
choices.
+ Consumers
make choices, within limits, in their residence, including menu choices.
The team identified the following weakness under
Choice and Self Determination for those receiving MH services:
- Consumers
reported a variation from one staff member to the next as to the choices
offered.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Regular
family meetings are held in the residences in which residents are encouraged to
express their opinions, differences are negotiated and plans are developed.
+ Some
staff members are repeatedly complimented by consumers for the degree of
respect they are shown in interactions.
+
Consumers, despite their youth, were given the option to sign or not the
release of information that allowed these interviews to take place.
+ Consumers
are well informed about the grievance process and use it.
+ There is
no use of physical restraint.
+ A booklet
explaining client rights is provided each consumer at intake.
The team identified the following weaknesses under
Dignity, Respect and Rights for those receiving MH services:
- One half
of the young consumers interviewed report variations in the application of the
point system by direct service staff.
- Some
consumers feel that the behavior modification system equates to “being treated like a little kid.”
(consumer comment)
- Some
consumers report disrespectful treatment and behavior by (recent) former staff.
- One
consumer reports feeling pressured to participate in a specific religious
activity by a staff member. (Note: This contradicts the agency’s policy on this
subject.)
- The review team is unable to determine the degree of individualization present (or possible) within a strict behavior modification approach.
- The
review team expresses concern as to the apparent degree of knowledge on the
part of board members of specific consumers.
As the Health, Safety and Security issues of consumers are governed by DFYS and DJJ and since those issues are addressed through the agency’s licensure as a Community Care Center, the team will not review this area. A licensure review is pending and will presumably focus on this aspect of services. The team supports the consumer-centered Health, Safety and Security values reflected in the Integrated Standards/Quality of Life Indicators and expresses the hope that the agency will make use of them.
The team identified the following strengths under Relationships for those receiving MH services:
+ KPCCC
maintains family reunification as a core value.
+ Consumers report improved
relationships with family members following treatment.
+ KPCCC offers family therapy.
+ The
agency provides an option of extended contact with consumers and their families
following reunification.
+ The
Teaching Family Model teaches relationship skills in a family-like context.
+ The
family meetings in residences teach relationship skills.
+ Staff are
clearly committed to developing healthy relationships with the youth in their
care.
+ Staff
assist consumers with developing appropriate boundaries.
+ Consumers
are supported in visiting their home villages.
+ Having
multiple funding sources allows for a broader continuum of care including the
provision of parenting classes.
+ Staff are
sensitive to potential conflicts among residents.
The team identified the following weaknesses under Relationships for those
receiving MH services:
- Staff
turnover, while beyond the control of the agency, results in broken
relationships.
- The
family aspect of the services is diminished by the point system.
- The
teaching family may not always have sufficient access to information to assist
in good decision making.
- The requirement
that church-attending consumers be accompanied by a sponsor, not a parent,
restricts family interaction.
- Some
restrictions placed on consumers inhibit their developing relationships with
peers outside of the treatment setting.
The team identified the following strengths under Community Participation for those receiving MH services:
+ All
residents participate in a weekly trip or activity.
+ Residents who earn the privilege may
participate in additional activities in the community.
+ All residents attend public school as
possible and receive the services of a tutor as needed.
+ The
agency teaches independent living skills.
The team identified the following weakness under Community Participation for
those receiving MH services:
- Some
residents report feeling “volunteered” (consumer comment) for community service.
+ Staff believe in the potential of the consumers to make healthy changes.
+ Staff
receive extensive in-house training including CPR, First Aid, the Teaching
Family model, ADHD, FAS/FAE, suicide assessment, legal rights of youth, etc.
+ Staff are
supported in their pursuit of further education including degree programs.
+ Staff
report enjoying going to work.
+ Staff have a shared value system.
+ Staff
operate as a team.
+ Staff are
treated with respect, support and “always
treated as professionals.” (staff member)
“I
have support here all the way to the receptionist.” -- staff member
+ Staff
stress is reduced by their trust in the treatment process.
+ Resident
staff’s reports of maintenance needs are responded to promptly.
+ Staff
have a commitment to the agency and its mission and take pride in the
consumers’ successes.
“We
treat each kid as a person, not like a broken thing.”
– staff member
+ Staff are
described as exhibiting a high degree of integrity.
-
Not all staff are aware of the staff evaluation
procedures.
-
While staff did not complain, the team feels that
agency salaries are low.
-
There are some lapses in communication within the
agency.
The team was asked to conduct interviews with DFYS, DJJ, the local Native association, the school district and law enforcement. All of those interviews were completed as well as an interview with a Guardian ad Litem.
+ All agencies are happy to work with KPCCC, feel secure in the agency’s ability to provide treatment and feel they go “above and beyond the call of duty” ( related agency staff) in serving the needs of their consumers.
“I notice increased stability with these kids and improved communication.” –related agency staff
“ I’m impressed; (KPCCC’s services) are comprehensive and effective. They have a great deal of success.” – related agency staff
“(We) couldn’t ask for more from (KPCCC).” – related agency staff
+ Agencies report that KPCCC staff are consistent in their planning, communication and collaboration.
“Communication is excellent. We discuss case plans and collaborate on planning.” – related agency staff
“Everyone (involved with the client) knows what is going on.” – related agency staff
+ Agencies repeatedly state that KPCCC is an invaluable resource and “highly regarded” (related agency staff comment) by other human service agencies.
“(KPCCC) makes my (job) so much easier!” – related agency staff
“Everything (KPCCC) has done has been fabulous.” – related agency staff
“(KPCCC) runs a quality program.” – related agency staff
+ Agencies are clear about KPCCC’s structure and know whom to call.
+ “Management is supportive of cultural considerations.” – related agency staff
- Some agency representatives feel that KPCCC may be more conservative than in the past, perhaps less willing to deal with difficult cases.
Note: The director states that she was unaware of the application of these standards to this agency until receiving them as part of the pre-review process. The agency’s level of compliance is quite good for an agency being reviewed for the first time within this process.
1. Standard #6, that the governing board include “significant membership” by consumers and family members, is partially met. Currently the ten member board includes a former consumer and a family member.
2. Standard #8, that governing board meetings are open to the public, is partially met in that some members of the public have attended in the past, but the board meetings are held in the secluded central location and attendance by those who are neither board members nor staff is discouraged.
3. Standard #10, that the agency have policies to deal with conflict of interest, is partially met as the agency has a policy to prevent conflicts of interest on the part of staff; the board does not have a specific conflict of interest policy.
4. Standard #11, that all facilities and programs provide equal access, is partially met in that two of the residences are wheel chair accessible. However, other facilities are not wheel chair accessible, signage is not in Braille and there is no TTY system available.
5. Standard #20, that there is a system for review and revision of all job descriptions, is partially met in that the board performs this review annually. As a formal written policy does not exist, the practice needs to be formalized.
6. Standard #24, that background, criminal and reference checks be conducted, is partially met in that staff have signed agreements to allow for that process and have provided references; two of the three personnel files indicate that letters were sent to references. However, the files reviewed did not document responses to the reference or background checks. (The agency has recently begun fingerprinting to facilitate the background and criminal checks.)
7. Standard #25, that employee orientation be conducted according to a written plan including policies and procedures, philosophy, confidentiality, reporting requirements, cultural diversity and work related hazards, is largely met. Cultural diversity issues are not included in written form in the orientation although religious diversity issues are addressed. The team notes, however, that the agency is especially sensitive to cultural diversity in practice and was complimented by those interviewed on this fact.
8. Standard #29, that a staff development plan be written annually for each staff member, is not met.
9.
Standard #32, that staff evaluations include goals
and objectives for the coming year, is not
met.
This agency is guided by a director with 14 years’ experience within it, having ascended through the ranks from a temporary worker to a full time permanent worker and eventually to the position of director. This is clearly a strength as she understands the tasks of all of her subordinates. Her obvious devotion to the agency and its mission also aid in the creation of a strong, unified team that provides mutual support. This atmosphere is another form of positive modeling for the young people served by KPCCC.
The governing board is an integral part of
management to a degree that, in a mental health agency, is unusual. The board has a proprietary interest in the
program and is protective of it to the extent of discouraging public attendance
at its meetings where sensitive matters may be discussed. The board concerns itself with the
day-to-day operation of the agency.
The role of the board in relationship to the
administration was somewhat unclear to the team. An exercise in defining
boundaries between the board and the administration may be of interest. Also, the board may wish to consider a
review of the Integrated Standards in order to increase their sensitivity to
consumer-centered values.
1. Seek to increase the representation of consumer and family members on the governing board. Standard #6
2.
Seek to encourage public attendance at board
meetings, limiting discussion to those items appropriate in that setting. Standard #8
3.
Extend the conflict of interest policy to include
board members and provide board training on that issue. Standard #10
4.
Seek to provide equal access to all facilities and
services. Standard #11
5.
Develop a written policy regarding your practice of
reviewing and revising job descriptions on a regular basis. Standard #20
6.
Document responses to background, criminal and
reference checks in personnel files.
Standard #24
7.
Enhance your fine new employee orientation with a
section on cultural diversity issues.
Standard #25
8.
At the time of staff evaluation, formalize a staff
development plan. Standard #29
9.
At the time of staff evaluation, formalize goals
and objectives for the coming evaluation period. Standard #32
1. Consider whether or not there is a conflict of interest in having the same firm conduct the audit and provide bookkeeping services.
2.
The team suggests increasing the role of the Youth
Services Officer given his interest, willingness to be involved and the
possibility of providing another positive role model.
3.
Consider studying the outcomes of your services
including a review of research into “best practices” with the population you
serve.
4.
Consider the manner in which to more closely link
clinical staff and residential staff in order to further enhance the
consistency of care.
5.
Consider maximizing the effectiveness of your
governing board by including longer range planning possibly tied to a
longitudinal study of the outcomes of your interventions.
6.
Consider the appropriateness of increasing the
individualized nature of services consistent with MH practices, for example
your approach to consumer relationships with peers outside of the program.
7.
Consider additional training on substance abuse
issues with staff, parent/guardians and foster parents.
8.
Find additional ways to integrate your newly
developed on-site substance abuse treatment with other program services.
9.
Consider an exercise between the administration and
the board to clarify boundaries.
10. Inform the board about the Integrated
Standards to enhance their sensitivity to consumer-centered values.
11. Consider
a review of your employee salaries and benefits (for example, sick leave,
vacation leave, etc.).
The final draft of this report will be sent to
Northern Community Resources. You will
receive the final report within approximately thirty days, including a Plan of
Action form listing the Areas Requiring Response. You will then have an
additional 30 days to complete the Plan of Action. The directions on how to
proceed will be included in a cover letter you will receive with the final
report and Plan of Action form.
Once NCR has reviewed the completed Plan of Action,
it will be sent to the DMHDD Quality Assurance Section. The QA Section will then contact you to
develop collaboratively a plan for change.
Attachments: Administrative and Personnel
Checklist, Interview Form for Staff of Related Agencies (tallied), Score sheet
(averaged)
NCR 8/00