INTEGRATED QUALITY ASSURANCE REVIEW

 

SOUTHCENTRAL COUNSELING

JANUARY 24, 2000 TO JANUARY 28, 2000

ANCHORAGE, ALASKA

 

Site Review Team

Lola Reed, Community Member

Kelly Behen, Community Member

Judy Edwards, Community Member

Laura Hokenstad, Community Member

David Newell, Peer Reviewer

Dee Foster, Peer Reviewer

Barbara Price, Facilitator

Muriel Kronowitz, Co-Facilitator

Connie Greco, Lead QA staff

Pam Miller, QA staff

Dan Weigman, QA staff

 

 

INTRODUCTION

 

A review of the Mental Health (MH) services provided by Southcentral Counseling Center was conducted from January 24^th to January 28^th 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.  DMHDD Quality Assurance staff conducted the Clinical Record Review and provided that section of this report.

 

Description of Services

Southcentral Counseling Center (SCC), the name by which Anchorage Community Mental Health Services, Inc. has been known since 1985, has a twenty-five year history of providing services to the Anchorage area.  Its service area includes Anchorage, Eagle River and Girdwood and encompasses a population of approximately 260,000 people.

 

The largest comprehensive community mental health agency in the State of Alaska, SCC provides emergency services (through the Mobile Team, the Crisis Respite Center and Crisis Intervention Counseling). SCC also provides adult services for severely emotionally disturbed (SED) adults and other adults requiring brief treatment; senior services (Day Break, the adult day care program and the Senior Psychiatric Outreach Team); Continued Care Services (for adults with chronic mental illness).  SCC provides Family Services (for SED and other minors and their families including a school based program, On Target). These services are provided at six separate sites.

 

 In FY99, SCC intervened in 27,074 crisis situations serving 8,654 different consumers.  SCC also provided services through the Crisis Treatment Center to 244 adults; served an additional 661 adults; provided 4,651 client days of care to 52 members of Day Break and to another 89 seniors; served 248 adults requiring continued care.  In addition, SCC provided services to 631 youth and their families as well as 74 children in the On Target program in five schools. Another 350 children participated in psycho-educational groups.

 

 In FY98, the agency’s total revenue was $13,140,425 of which 61.4% was from State and Federal grants, 32.3% from client fees and the remainder from other sources.  Of interest is the auditor’s statement that SCI’s “charity care” (i.e. non-reimbursed services) amounted to $2,300,000 last year.  In support of that fact, a consumer expressed gratitude for SCC’s willingness to continue care even when those services could not be paid for.

 

SCC employs some 209 people, of whom 81.3% are involved in providing direct services.  The turnover rate of employees in FY99 was twenty percent.

 

The Executive Board is comprised of fifteen members of whom two are self identified as consumers and six as family members of consumers.  Programs within SCC have additional advisory boards.  Of the 30 members of these three advisory boards, 9 are consumers and 8 are family members.

 

Description of Process

The team of eight interviewers, including two peer reviewers, four community members and a facilitator and co-facilitator met for five days to interview consumers and their families, SCC staff and board members and staff of related service agencies.  Interviews ranged from 10 to 90 minutes and were held at SCC’s offices or by phone. Given the size of this particular review, 41 telephone interviews with related agencies were completed by the facilitator prior to arriving on site.

 

During the pre-review teleconference on the 28th of December, QA staff requested 40 consumer interviews to be determined by a random selection.  Forty-three interviews from that list were scheduled.  As 11 consumers did not appear for the interview, 32 consumers from the random listed were finally interviewed.  Also, 7 consumers requested to be interviewed and were.  The total of consumer interviews was 39 with 6 being parents or guardians of children and the remainder adult consumers.  Also interviewed were 8 board members, 13 SCC staff, a community member and an additional 9 staff of related agencies (for a total of 50 collateral agency interviews). The information gleaned from these 111 interviews is represented in the narrative.

 

Open Forum

In preparation for the site review SCC mailed letters to 1,400 consumers personally inviting them to attend the open forum.  In addition, an announcement of the forum was published in the Anchorage daily newspaper and was included on public radio’s list of community events.

 

The open forum was held at the NAMI office the evening of the 24th of January from 7 PM until 8:30 PM.  Despite a heavy snowfall and poor driving conditions, five of the team members attended along with 13 members of the community.  During the forum eight of these community members identified themselves as consumers.  Their history with SCC ranged from nine years to eighteen months.  Their opinions of SCC’s services ranged from extremely positive to negative. The specific information shared at the open forum is included in the narrative of the report.

 

 

FINDINGS

Progress Since Previous Review

This is the first review of Southcentral Counseling Center using the Integrated Quality Assurance Review process.  Therefore, there are no comparable findings on which to report.

 

Model Practices

The team feels that some of the Areas of Excellence noted below, particularly the Compeer program, may qualify for the recently redefined “model practice” designation.  However, given the intensity of this review, the team was unable to visit or focus on any single program in sufficient depth to meet the requirements of documenting the program description, cost effectiveness, positive outcomes and suitability for replication.  We regret our limitations in this area of the review.

 

Areas of Excellence

1.       The Compeer program successfully matches consumers and sponsoring individuals or families and has made demonstrable differences in the quality of life of the consumers involved in it.

2.       The agency’s mammoth effort to provide a computerized system to aid in case files, scheduling, billing, collection of demographic and similar data, etc. is admirable.  The efforts of Terry Helleck and the expertise that she brings to the agency should be acknowledged.

3.       The placement of a SCC clinician at the offices of the Division of Family and Youth services to provide assessments and triage is an effective and innovative use of resources.

4.       The Senior Psychiatric Outreach Team provides clinical services to seniors who reside in a variety of assisted living facilities.  Identification and provision of services to this often-neglected population is exemplary.

5.       The On Target program, providing services in five area schools, is another example of an effective and innovative use of resources.  In addition, team members noted that the presence of services within the school helps to decrease the stigma attached to receiving such services.

6.       The agency has a thorough and effective Board development program including local and out of state training opportunities and shares these trainings with staff from other agencies.  The result of this Board development is a professional, focused and effective Board.

7.       The agency’s mission, vision and values are presented in all agency publications, are posted in the agency and clearly guide Board goal setting and program planning.

 

Choice and Self Determination

The team identified the following strengths in the area of Choice and Self Determination for those people receiving MH services from SCC

_X         SCC provides a wide variety of services

_X         many consumers feel that SCC has helped them realize their dreams including independent living and home ownership

_X         repeatedly consumers voiced their belief that if they had not received services at SCC they would not or could not have chosen to live

“Without SCC I would have been dead.  No joke.”

“If is wasn’t for SCC I would be dead.”

          “Without them I would be dead.”

“It (SCC) has saved my life.”

_X         SCC provides a variety of group experiences for consumers

 

The team identified the following weaknesses in the area of Choice and Self Determination for those people receiving MH services from SCC

-          some schedules are experienced as inflexible and thus place limitations on consumer’s lives and activities

-         consumers feel that their choices are limited by their financial condition; while this is not necessarily the responsibility of this agency, it should be taken into account in assessing the quality of life of consumers

-         at times the choice of therapist is limited

-         consumers were not all aware that they could request a change of therapist

-         some consumers feel that there are few if any choices regarding medication

-         waiting lists and schedules that require consumers to wait for a service on a regular basis

-         changes in direct service staff require difficult transitions and reduced choices

                          “I know everybody and I’m sad when people leave.”

       Some consumers reported terminating treatment rather than adjusting to a new therapist.

 

Dignity, Respect and Rights

The team identified the following strengths in the area of Dignity, Respect and Rights for those people receiving MH services from SCC

_X         overall, the increased consumer focus of the agency has enhanced the self respect of consumers; a particularly disgruntled consumer still described Ken Taylor, Executive Director, as a “strong client rights advocate.”  Another consumer states that the case manager calls weekly and is “real concerned to see how we are doing.”  Another consumer was impressed by the therapist’s willingness to schedule around the client’s needs

_X         some staff were singled out for praise due to their genuine caring attitude toward consumers; the specifically named staff were Rose Sayre, Maria, Mike, Dr. Graber, Lisa Link, Kathy Loughlin, Sandra Word, Ann Stockman, Dr. Brown, Jean BogaA consumer commented “It’s heaven here (at SCC)” And another: “This is the only place that ever helped me”

_X         most face to face encounters between staff and consumers were described as courteous and respectful

_X         independent living is a cherished goal, is seen as achievable by consumers and staff alike and reinforces self worth

          “They took me in and helped me get my own apartment”

_X         several consumers felt that direct service staff showed genuine zeal in supporting consumers’ goals

          “They’ve gone beyond the call of duty”

_X         consumers reported with some amazement that they were served even when there was no payment source

_X         staff are patient and persistent in aiding consumers

          “Kathy Loughlin hung in there and hung in there and hung in there…”

_X         by and large, staff are seen by consumers as professionals

          “(They have) highly qualified people that other places don’t have”

 

The team identified the following weaknesses in the area of Dignity, Respect and Rights for those people receiving MH services from SCC

-         consumers complained that their telephone contacts with the agency were less than satisfactory

-         consumers self-described as “difficult” report being “demeaned” and “denied services”; one individual stated that a staff member said “Maybe you don’t deserve to be a SCC client”

-         many consumers stated they were not aware of their rights

-         specifically, many consumers stated that they did not have access to a grievance procedure although some felt free to complain directly to the Executive Director

-         also, many consumers stated they were not aware of their right to decline an interview and were not aware of the need to give written permission for both the interview and a cursory file review by the interview team

-         some consumers felt labeled and identified by their diagnosis rather than by their character

 

Health, Safety and Security

The team identified the following strengths in the area of Health, Safety and Security for those people receiving MH services from SCC

_X         staff is responsive to the need for safe housing

_X         many consumers felt that they received good medical care at SCC

_X         many consumers felt that their general health needs were addressed by SCC

 

The team identified the following weaknesses in the area of Health, Safety and Security for those people receiving MH services from SCC

-         the lack of safe, low income housing ( a community wide problem and not the specific responsibility of SCC)

-         some housing arrangements were described in detail as unsafe and unhealthy; while these are neither owned nor managed by this agency, the impact on consumers is considerable

-         dental services have declined (this is not necessarily the responsibility of this agency)

-         several consumers felt threatened by impending Medicaid cuts that would decrease groups and these groups provide a sense of security

-         some consumers reported being “overmedicated” and not listened to when describing their negative experiences with medication

 

Relationships

The team identified the following strengths in the area of Relationships for those people receiving MH services from SCC

_X         in more than one case, providers had gone “the extra mile” to reunite or reintroduce family members

_X         family oriented services aid in strengthening family ties

_X         groups provide sources of friendships and of support

_X         “My group keeps me grounded.”

_X         the Compeer program is especially valued for the relationships it provides with local volunteers

 

The team identified no weaknesses in the area of Relationship for those people receiving MH services from SCC.

 

Community Participation

The team identified the following strengths in the area of Community Participation for those people receiving MH services from SCC

_X         group excursions were enthusiastically described as fun and a welcome diversion with the sidelight that “Lisa and Kathy are hilarious together”

_X         increased vocational services allow more consumers to be involved in the community

_X         the Compeer program allows for greater participation in community events

_X         community participation was a goal for some consumers

          “They encourage me to do things, to get me out.”

 

The team identified the following weaknesses in the area of Community Participation for those people receiving MH services from SCC

-         limited transportation for all age groups impedes participation (not necessarily the responsibility of this agency)

-         limited finances of consumers impede participation (not necessarily the responsibility of this agency)

-         some consumers found their employment without meaning or challenge

 

Staff Interviews

The team felt it would have been more meaningful to interview more staff who work directly with consumers on a daily basis. However, the overall impression of staff is of a dedicated group of professionals.  SCC staff embodies the values and mission of the agency.  They believe in what they do and, for the most part, work with enthusiasm.  One staff member commented “(We) are really blessed at our program.” And another: “I love my job.  What we do is rewarding.  This is a great agency.  If I wasn’t working here I would volunteer.”  The highest compliment may have been this: “This is where I’d want my family member if they needed services.”

 

Treatment teams work well together and morale seems especially high within those groups.  One staff member commented that the SCC atmosphere was so consumer friendly that “clients often don’t want to leave.”

 

 The Executive Director was repeatedly described by staff as a man of vision and ideas and his “fireside chats” were especially valued by some.  The existence of the Human Resources Advisory Committee was valued and of aid with the many communication challenges faced by a large, diverse staff operating from six separate sites.  The availability of on site training and of access to other training events in the Anchorage area is highly valued.  This is especially true in the light of the staff’s awareness of the ever-increasing acuity of cases.

 

Staff stated they felt supported and valued by their supervisors.  The financial stability of the agency increased feelings of security.

 

Staff commented on the community’s lack of awareness of the services available through SCC.  One mentioned Crossover House having received a national award but that the community at large was not aware of this or confused SCC with SCF.  Staff suggested that self-promotion is warranted.

 

A repeated concern was the difficulty of communication.  The staff was said by one long-term employee to have doubled over the last decade and that, with that growth, the agency has lost touch with itself, becoming increasingly compartmentalized.  Staff do not know employees outside their immediate work area.  Staff does not feel that support services such as accounting or MIS are aware of the demands of direct service provision.  This lack of interaction had led, in some cases, to conflict or ill feeling and this impacts both on staff morale and, inevitably, on consumer care.  Staff noted excessive blaming occurring internally as opposed to healthy problem solving.  Communication problems and delays also impacted decision-making.  “There’s too much process and not enough results.”

 

Staff also expressed that the boundaries between administrative and support work as opposed to clinical work have been blurred.  More administrative duties have been shifted to clinical staff, in their view.

 

Collateral Agencies

The team interviewed three agencies providing services to veterans; DFYS; four representatives of the court system; five agencies providing developmental disabilities services; one tribal council; two representatives of the municipality’s social services; 2 representatives of corrections; 4 agencies offering services to the homeless; 3 substance abuse treatment centers; seven representatives of Providence, Alaska Regional Hospital, Alaska Native Medical Center, Charter and API; 5 mental health providers; two representatives of UAA; one domestic violence agency, two advocacy groups; two senior agencies and a church-related social service agency.  Despite repeated attempts, the team was unable to interview any representative of law enforcement or of the school district.

 

Collateral agency responses to specific issues of interaction with SCC are attached to this report.  In describing SCC’s services there is a great range of responses: from very pleased to very displeased.  In many cases the same service is described with these extremes.  For example, crisis respite was described by one respondent as “great” and by another as “horrible.”  Responses, both positive and negative, often seemed to be in response to a small number of dramatic cases.

 

The themes that emerge from these fifty interviews are: 1) there is increasing collaboration between some SCC programs and some other providers; 2) where collaboration and effective communication occur between agencies, the outcomes are positive for the consumer; 3) SCC is perceived as having too narrow a focus and several agencies suggest additional training; these include the court system, agencies offering developmental disabilities services, domestic violence services and homeless services; 4) the needs of the most challenging consumers are not being met; 5) waiting lists and other delays put consumers at risk; 6) lack of access to SCC physicians on weekends delays the transfer of cases and negatively impacts care; 7) it is difficult for many providers, especially non-degreed staff, to contact SCC, with many phone messages going unanswered; 8) services for the MICAA population are inadequate; 9) SCC provides insufficient outreach services; 10) emergency services need to be integrated to improve care and reduce risk to consumers; 11) case management services are of variable quality; 12) some housing placements are in “crime ridden” facilities; 13) services to those populations not prioritized by the DMHDD are too limited. 

 

The agency responds that specialized agencies have a high level of expectations of SCC.  The team, in turn, reiterates that the above represent what those agency representatives told us in our interviews and to judge whether or not their expectations are appropriate is beyond the scope of this team’s duty to decide.

 

Administrative/ Personnel Narrative

SCC had a recent administrative reorganization (5/99) with the unusual result of diminishing the administrative staff in proportion to the direct service staff.  SCC’s records show that only 18.7% of employees provide administrative or clerical functions.  While this is admirable in theory, the team’s interviews reveal that some staff feel they have been negatively impacted by the change.  This situation may be a temporary result of the change, but current communication issues seemed to loom large, a fact compounded by SCC’s size.  Also, some clinical staff felt strongly that some clerical duties were inappropriately delegated to them. The agency takes the view that a reduction in administrative positions frees more funds for the provision of services and that they are a leader in so doing.

 

A review of policies and procedures yielded very positive results.  Of the 34 standards set for community mental health programs, SCC was judged to fully meet 31 of them.  We would be remiss if we did not note the excellence of the personnel files, the quality of which exceeds the standards.  Not only are background checks completed for all direct service providers, they are completed for all employees, board member and volunteers and annual driving record checks of all employees are also completed.  The care taken to assure the safety of the therapeutic and residential environments is admirable and Marcy Noren and her staff are to be commended.

 

The agency’s mission and values are prominently featured in all publications, are posted throughout the main facility and clearly guide the Board’s planning process.  These values are consumer centered and show a concern for stability and continuity.

 

Three standards were not fully met.  Standard #18 states “The agency collects required data and submits it to the appropriate state agency.”  At the request of the regional coordinator, the facilitator and a team member focused on this issue.  SCC has documented its attempts to comply with the MIS requirements. They have modified their extensive computerized system in order to transfer data to the State’s ARORA system.  Indeed, this ability to feed into ARORA is a condition of SCC’s contract with their system provider.  Despite repeated efforts, the two systems do not, to date, transfer data completely or smoothly.  SCC does submit all required data on quarterly reports and has, within its own system, the data required.  The team feels that SCC has made a good faith effort to remedy this concern and reluctantly gauge this standard as partially met by the letter of the standard, while fully met in the spirit of the standard.

 

Standard #22 states “The organization has and utilizes a procedure to incorporate consumer choice into the hiring and evaluation of direct service providers, and to ensure that special individualized services (e.g. foster care, shared care, respite care providers) have been approved by the family or consumer.”  To date, SCC does not include consumer opinion in the hiring of direct service providers, although consumer opinion is used in the evaluation of providers.  Given the agency’s strong consumer focus, the team feels that this is a natural step for the agency to take in order to meet all of the consumer centered standards.

 

Standard #27 “The program obtains and documents informed consent from consumers (or ILP family members) before services are initiated and when services are changed or modified.”  The facilitators did not find evidence of informed consent in all of the files reviewed.  Either the documentation was not present or was difficult to find in the file.  As the agency questions this finding, it may wish to do its own random check and respond with those results.

 

Program Management

The team was provided with 8 board interviews.  Our impression of the board, its training, functioning, knowledge of the services, diversity, commitment to the agency and dedication to public service was very high (see Areas of Excellence).   Board members expressed extensive knowledge of the agency’s strengths and weaknesses and confidence that continual improvement will occur.  They support, as do SCC staff and the staff of other agencies, the leadership of Ken Taylor and feel confident that he will guide the agency with skill and professionalism.  Under the guidance of the Board and the Executive Director, the agency is financially stable.

 

Quality Assurance Clinical File Review

 

INTRODUCTION

The clinical chart review was conducted for the purpose of determining what information the agency needs to be able to generate documentation that reflects good clinical practice.  Another reason for the review was to conduct a mini-event audit for the Division of Medical Assistance (DMA) to determine that the services delivered are reflective of the services billed to Medicaid.  The charts reviewed were determined by a random sample taken from data supplied by DMA for Medicaid cases and by Southcentral Counseling for non-Medicaid cases.  The number of charts to be reviewed was determined by a Range Table based on the total number of cases supplied by DMA and Southcentral Counseling. The Quality Assurance file review consisted of a review of four areas, Assessments, Treatment Plans, Progress Notes, and Treatment Plan Reviews.  The team reviewed a total of thirty (30) Medicaid charts and eighteen (18) non-Medicaid charts.

 

STRENGTHS

An overview of ASSESSMENT MATERIAL indicates that the psychiatric assessments are well developed and provided good documentation of diagnosis, mental health problems and medication needs.  There were various Intake Assessments in file and one of them documented recommendations for services in a very comprehensive way.  The clinical review identifies which assessment was considered to be excellent.  The most current TREATMENT PLAN, which appears to be designed for electronic usage, has all of the necessary components of a strong treatment plan, including a signature line for the consumer or their guardian.   Southcentral is encouraged to use this plan or one similar to it for all clients. An overview of PROGRESS NOTES show that notes is consistently found in charts for billings.  Dates and units are being included, as well as signing and credentialing,

 

AREAS FOR IMPROVEMENT

Southcentral Counseling should ensure that a comprehensive ASSESSMENT is conducted by a Master’s level clinician annually.  There should be clear documentation of symptoms that support the given diagnosis.  All comprehensive assessments must contain a clear written summary of the mental health problems identified during assessment process and recommendations for services.  Please refer to the Mental Health File Review Checklist located in the Integrated Standards.  The current TREATMENT PLAN format needs to include staff interventions and be specific when recommending service modalities and frequencies. Treatment plans should address specific problems and then list the goals to address those problems in measurable and observable terms. You are encouraged to obtain consumer’s signatures or note attempts of staff to obtain the appropriate informed consent.  It is important that electronic PROGRESS NOTES be carefully monitored to ensure the delivery of services by qualified personnel.  Progress notes need to consistently identify the service modality being delivered and the specific goal being addressed as identified on client’s treatment plan (including group notes).   Staff interventions need to be clearly documented. Some notes were duplicative of multiple service episodes, rather than specific to the event.  Please refer to the Integrated Standards for a complete list of required components. The number of notes reviewed indicated the possibility of under utilization of Medicaid billing in some instances. The Integrated Standards require that TREATMENT PLAN REVIEWS be a separate document.  Please refer to the Integrated Standard for a complete list of required components.

 

SUMMARY:

The staff who assisted in obtaining the charts and making sure that we received our calls were extremely helpful and available answer our questions.  The proposition of electronic documentation at Southcentral Counseling is an exciting one and although it is a time consuming effort and a drive through uncharted territory, it appears to have tremendous potential.  It is recommended that there be a review of requirements for documentation.  It might be beneficial to include an internal quality assurance specialist, with knowledge of the current regulations and standards, in the planning and implementation of the computerized process.  Your agency may consider standardizing forms across programs for ease in training and utilization.

 

RECOMMENDATIONS:

It is recommended that the agency compare their current forms with requirements found in the Mental Health File Review Checklist that is located in the Integrated Standards Manual.  Southcentral Counseling is encouraged to provide on-going training to ensure that the staff is completing documentation correctly.  The Division of Mental Health and Developmental Disabilities Quality Assurance staff is available for technical assistance upon request.  DMHDD recommends a formal agency wide training in documentation for good clinical practice.

 

 

 

 

Areas Requiring Response

 

1.       Standard #18 Continue to press your computer system contractor for the appropriate link with ARORA in order to comply completely with the request for data. 

 

2.       Standard #22 Develop and implement a policy to include consumer opinion in the hiring of direct service providers.

 

3.       Standard #27 Clearly document in all files the informed consent of consumers or their families.  (The agency disputes this finding.)

 

4.       The team was concerned about the agency’s protection of consumer confidentiality as it related to this site review process.  Many of the consumers interviewed stated they were unaware of the need for their written permission to be given before their identity or records could be revealed to any party.  Most stated that they had not signed the release of information provided by this team.  The agency should review its guidelines in regards to confidentiality to assure that this is not a generalized problem.  (The agency disputes this finding.)

 

5.       The team found that many consumers were unaware of their rights, although they may have been informed of them during intake.  Given the importance of this issue, make an effort to periodically review rights with consumers.  (The agency disputes this finding.)

 

Other Recommendations 

 

1.       Interviews with other service providers indicate that some adult consumers with high levels of acuity may have been excluded from services at SCC.  The team encourages the agency to look into this concern and review its liability policies in regard to service delivery.  If this population is not the responsibility of SCC, the agency might spearhead an interagency effort to deal with this need.  (Note: This item was removed from the Areas Requiring Response at the vigorous behest of the agency.)

2.       The front desk area and personnel set the tone for the consumer’s experience at the agency. Ways might be found to create a more welcoming atmosphere.

3.       The vital task of intake may be delegated to too few staff members and those involved might benefit from additional training in this ever-changing field.  (The agency disputes this finding.)

4.       The automated phone system may present a barrier to services for callers.  Both consumers and staff of other agencies report leaving repeated messages without result.  Consider how to make this contact more user friendly.

5.       Both internal and external communications appear to be challenges for this large and diverse agency.  To better serve consumers, consider the ways in which communication might be improved both within the agency and between the agency and other entities.

6.       Given the complexity of SCC’s services and its consequent collaboration with diverse collateral agencies, consider cross training with other agencies in order to have a better mutual understanding of these vital resources, increase mutual understanding and better serve consumers.

7.       While not the responsibility of this agency, consider collaboration with other agencies to improve the means of transportation for consumers of all ages.

8.       Concern was expressed regarding the future of services to those consumers whose care is not prioritized by the State.  Continue to spear head interagency efforts.

9.       Physician availability on weekends and when a SCC physician is on leave is perceived as too limited.  Consider how physician and medical services might be available at all times including a possible on call system or shared services.  (The agency counters that this is a systems problem rather than one specific to SCC.

10.   Increase the agency’s interaction with advocacy groups to enhance even further the consumer focus of services.

11.   In those facilities having long blank halls, the use of consumer art or Native art might warm the environment.  (The agency took exception to this suggestion.)

 

 

Note: This team was unable to visit all of SCC’s sites and regret this limitation.  Therefore the team suggests that the QA staff consider that the size and diversity of SCC’s services requires a format different from that of other site reviews.  Specifically, the team suggests: 1) two open forum opportunities, possibly at two different locations, with one a daytime opportunity and one an evening opportunity; 2) mini-teams, each assigned to a different program within SCC, who would then meet as one large team and develop a more comprehensive report than is possible with the current format.

     Also, the team recommends that, in the future, the interview schedule be prepared no later than the first morning of the review as requested.  This would allow the team to plan its time and the use of its resources more efficiently.  The many additions to the schedule throughout the week disallowed the team’s visiting SCC’s other sites.

     The team wishes to note that some consumers felt uneasy with the chosen site for the open forum this year, as they associate it with a recent tragedy.  Also, the letters of invitation to the forum referred to it as an “open audit forum” which may have been an unclear or confusing description.

 

Closing

The team readily acknowledges the disruption our presence inevitably causes and is grateful for the tolerance and assistance of all SCC staff as we took up space and rooms and phones and space in the hall, as we wandered aimlessly in the building, lost.  Special thanks to Lois Welch, without whose Herculean efforts with the complex schedule this review would not have been possible.  Our gratitude also to Executive Director Ken Taylor for his personal involvement in the review and his frequent assistance to the team.

 

This draft report will be edited by NCR’s program manager and director and forwarded to DMHDD within 7 days.  Within an additional 30 days DMHDD will provide the final report to the agency along with a plan of action.

 

Attach: Administrative and Personnel Checklist, Questions for Related Agencies (tallied), Report Card (tallied)