INTEGRATED QUALITY ASSURANCE REVIEW
June
6-8, 2000
SITE REVIEW TEAM
Richard
Nault, Peer Reviewer
Robyn
Henry, Facilitator
A review of Mental Health services provided by Lynn
Canal Counseling Services (LCCS) was conducted from June 6th to June
8th, 2000, using the Integrated Quality Assurance Review process.
The contents of
this report is the summation of the impressions of the 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.
Description
of Program services
LCCS is a
non-profit community mental health services center that serves adults,
adolescents and children who live in Haines, Klukwan, Mosquito Lake and
Skagway. The total population of the area served is approximately 3,350 people
including 2,500 from Haines Borough (the Haines/Klukwan/Mosquito Lake area) and
850 people from Skagway. Mental health services provided by LCCS include
outpatient services such as individual, family and group therapy, psychiatric
evaluations, and consultations, education, medication management, crisis
intervention, case management and outreach services. The agency receives approximately 45 admissions a year and serves
a total of 30 active clients at any given time. The agency receives its funding
from a state grant, a small borough stipend and limited third party payments
including Medicaid.
The agency and
all staff are based out of Haines. The agency’s full time clinical director
serves as administrator and provides all clinical services in Haines. A part
time itinerant clinician provides services to Skagway residents two days a
week. The program also has a full time
office manager. An eight-member board of directors, who meet monthly, governs
the agency.
Description
of the Process
To conduct this review, an interview team
consisting of a facilitator, a community representative and a peer reviewer
conducted 19 interviews over three days in Haines, Alaska. Client interviews,
which included adults who receive services and parents of children who receive
services were determined from a list of 30 randomly selected clients. Of those
people successfully contacted from the list, 10 were scheduled for interviews
and 9 actually spoke with team members. Seven interviews were conducted with
related service professionals, 3 related service professionals were also board
members for the agency, and 3 interviews were with LCCS staff. Interviews
lasted from 15 minutes to an hour and were held in person, at the LCCS offices,
in the community and by telephone.
The team members also reviewed four personnel files
including the three current employees and one recent former employee. Also
reviewed were the agency policies and procedures manual and other
administrative documents. After gathering the information, all the team members
met to review the data and draft the report, which was presented to the agency
staff on the final day of the visit.
During this same period of time one member of the
DMHDD Quality Assurance Unit did a review of randomly selected client records.
The clinical chart review findings were presented under separate cover.
Open
Forum
An open forum was held in Haines at the
Presbyterian Church at 7:00 P.M. on June sixth. LCCS advertised the event by
announcing it in the two local papers.
One paper featured an article about the event and the site review. The
forum was also announced on the local radio station. Three community members
attended the event. The feedback received at the open forum is incorporated in
the findings of this report.
Progress
Since Previous Review
As this is the first review of LCCS using the new
program standards, there is no previous action plan for these integrated
standards.
Choice
and Self-Determination
The team identified
the following strengths under Choice and Self-Determination for those receiving
services:
+ Most people reported that they were
involved in the development of their service plan and that service goals
reflect their desires and preferences.
+ Most people reported that the services they
receive include ongoing problem solving.
+ Two people reported that they appreciated
the fact that staff were so flexible and noted that their counselor was
available any time they were needed, “even
on weekends”. One person explained “when
I called, they got us in right away.”
+ Many people reported that services were
very helpful to them. One person reported “(The
counselor) did so much for (my child)
just from talking…I would recommend (the counselor) to others ”
The team identified the following weaknesses under
Choice and Self-Determination for those receiving services:
- Several
people identified the need for more choice in counselors in both Haines and
Skagway.
- Several
people reported the need for separate services for children and the need for a
male counselor.
- One
person reported that they felt stuck in their current living situation because
of their current economic situation.
- One
person reported that they felt discouraged with therapy because they seem to be
lacking direction and didn’t know the “root
of the problem”.
- Several
people commented on the lack of adequate substance abuse services and the need
of integrated substance abuse and mental health services.
Dignity,
Respect and Rights
The team
identified the following strengths under Dignity, Respect and Rights for those
receiving services:
+ Most people reported that they felt very
respected and valued by staff. One person reported “(The therapist) is like a friend… a safe place to talk”. Another
reported “Johanna is the best therapist I have ever had.” And another
went on to say that the therapist is “so
much fun…we have a good time
together.”
+ One person, who commented on the
effectiveness of counseling, explained “Progress
is slower with this counselor than
with the previous one but the changes are more profound.”
+ All people reported that they were informed
about their rights and that staff protect their rights and confidentiality.
+ One person expressed their appreciation
for their therapist’s willingness to help them with paperwork and the things
that were important to them.
+ There
is a general feeling expressed that people who are receiving services are very
satisfied with those services.
The team identified the following weakness under
Dignity, Respect and Rights for those receiving services:
- Many
people identified the need for the program to move to another building. They cited problems such as parking,
especially in the winter, excessive noise, lack of accessibility and a
run-down, somewhat depressing building. One person indicated that they were
very uncomfortable walking through the Head Start program in order to get to
the Mental Health offices and saw this as a confidentiality issue.
Health, Safety and Security
The team
identified the following strengths under Health, Safety and Security for those
receiving services:
+ Many people reported that they felt they
had adequate resources to meet their basic needs.
+ Most people reported that they felt their
emotional and physical needs are appraised and that supports and services are
in place where help is needed.
+ One person expressed their appreciation
for the help they got in obtaining new glasses.
The team identified the following weaknesses under
Health, Safety and Security for those receiving services:
- One
person reported feeling unsafe in their home and neighborhood.
- A
couple of people indicated that they felt Haines was lacking the resources they
needed to meet their basic needs.
Relationships
The team
identified the following strengths under Relationships for those receiving
services:
+ A couple of people reported that they felt
that the services they received from the agency help them improve their personal
relationships. One person reported that as a direct result of therapy a parent
and child were reunited after a long, rocky relationship and that they now have
a very close bond.
+ One person indicated that services and
supports allowed them to stay in the community even after other family members
had left town.
+ Most people reported that staff are
knowledgeable about their natural support system.
The team
identified the following weakness under Relationships for those receiving
services:
- Many
people indicated that they felt very socially isolated and that they felt
Haines is a “ difficult place to live,
socially.”
The team
identified the following strengths under Community Participation for those
receiving services:
+ All people interviewed indicated that they
felt that staff viewed them as having something valuable to contribute to the
community.
+ One person reported that services really
helped their child with school and helped them get into the community.
The team identified the following weaknesses under
Community Participation for those receiving services:
- Many
people reported that they felt there was a general lack of community support
and at times, even a general feeling of hostility. One person explained, “Haines is an unforgiving town… (where people feel) claustrophobic, trapped”.
Another person explained how the atmosphere effects them by saying “I really feel the pain of the people at
times”.
- Several
people cited a general lack of community activities and things to do especially
for young people.
Staff
Interviews
The team interviewed all three of the LCCS staff.
All staff appeared to be very dedicated to their work and to the people they
work with. Staff was knowledgeable and competent in their work and about the
agency. People reported that they have received training, orientation and
regular supervision. Staff reported
that when they express concerns they feel their concerns are listened to and
addressed.
Concerns expressed by staff included the need for
more funding for the agency to meet service needs and to adequately compensate
their work, the need for a new building for the offices and the need for
increased substance abuse services, especially in Skagway.
Collateral
Agency Interviews
Seven people from seven collateral agencies were
interviewed including representatives from the Haines police, DFYS, Salvation
Army, the town magistrate, public health and both the Haines and Skagway
medical clinic. The Haines Borough School district was contacted for an
interview but because the school is on their summer break, no one was available
for the interview. Most of the people interviewed were very satisfied with the
services provided by the mental health center.
Areas of need identified by individual collateral
agencies include the need for a batterers’ program and increased services in
Skagway; the need for increased follow up and communication to the agency after
a referral is made; increased collaboration between agencies.
Administrative/Personnel
Narrative
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 26 of
which are completely met by LCCS. Those standards not fully met are:
1.
The agency has an identified governing body that establishes
policies about the operation of the agency and the welfare and rights of all
individuals served. (Standard #5)
While
the agency has a set of thorough policies and procedures developed by the
agency
Director, these documents have yet to be approved by the board.
2.
The agency’s governing body includes significant
membership by consumers (DD, MH) or consumer family members (ILP), and embraces
their meaningful participation. (Standard #6)
The
board currently has no consumers or family members of consumers.
3.
The agency maintains policies and procedures for
preventing and correcting conflicts of interest. (Standard #10)
While
the agency appears to have policies regarding employment conflicts of interest
for the
director
of the program, there are no over-all policies and procedures regarding
conflict of
interest involving other staff members.
4.
All facilities and programs operated by the agency
provide equal access to all individuals. (Standard #11)
The
agency’s current offices are on the second floor of an older building and are
not handicap
accessible.
5.
The agency develops annual goals and objectives in
response to consumer, community and self-evaluation activities. (Standard #14)
The
organization does not currently have a process for developing annual goals and
objectives.
6.
A staff development plan is written annually for
each professional and paraprofessional staff person. (Standard #29)
Of the four personnel
files reviewed, two employees had at least one year’s seniority. One lacked an evaluation.
7.
The agency identifies available resources to meet
the assessed training needs of staff. (Standard #30)
The four personnel files
reviewed did not contain this information.
8.
The performance appraisal system adheres to
reasonably established timelines (Standard #31)
Of the four personnel files reviewed two
people have been with the agency over one year and
are eligible to have an evaluation,
including the director and the office manager. To date the
office manager has not received an
evaluation.
Several people including related agencies and
consumers indicated a need for more mental health related activities in the
schools, citing a lack of receptivity to services on the school district’s
part.
Several people noted a lack of visibility and
integration of mental health services in the community. Site review team members noted that, when
asked, key community members did not know where mental health services were
provided.
A couple of the board members identified the need
for more board training and more structure and focus during meetings.
Areas
Requiring Response
1.
The governing body needs to review and approve the
agency’s written policies and procedures. (Standard #5)
2.
The governing body needs to increase its membership
composition to include significant representatives of consumers and family
members of consumers. (Standard #6)
3.
The agency needs to develop a policy and procedure
for preventing and correcting conflicts of interest. (Standard #10)
4.
The agency needs to address the issue of the
building not being handicapped accessible.
(Standard #11)
5.
The organization needs to develop a process for
developing annual agency goals and objectives in response to consumer,
community and self-evaluation activities. (Standard #14)
6.
All staff need an annual development plan. (Standard #29)
7.
The agency needs to identify available resources to
meet the assessed training needs of staff.
(Standard #30)
8.
The annual performance appraisal needs to be
completed for all staff. (Standard #31)
Other
Recommendations
1.
Explore ways to increase billable and needed
services including case management and skill building for children and adults
with more severe disabilities. This
increase should also help in addressing your revenue shortfall.
2.
Continue to work in ways to be more visible in the
community including increased advertisement of “Mental Health services” and
increased distribution of service resources and literature.
3.
When exploring options for addressing the building
accessibility issues, also consider issues such as building noise, parking, and
the appropriateness of the current building location.
Closing
The team wishes to thank the staff of LCCS for
their cooperation and assistance in the completion of this review. A process
such as this can be very disruptive to the office environment and your
hospitality was much appreciated by all of the team members.
Northern
Community Resources (NCR) will contact you within 30 days. You will receive a final report and Plan of
Action form. You will then have 30 days
in which to return the completed Plan of Action to NCR. Directions for doing that will be included.
Once NCR has reviewed the Plan of Action, it will be forwarded to DMHDD. DMHDD will then contact LCCS to develop
collaboratively a plan for change.
Attach: Administrative and Personnel Checklist;
Questions for Related Agencies (tallied), Report Card (tallied)