Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
Seward, Alaska
Cynthia Goodrich (Community member)
Donna LeGerda (MH Peer Reviewer)
Ronda Stoebner (DD and EI/ILP Peer Reviewer)
Carol Manninen (EI/ILP Technical Assistant)
Sherry Modrow (DD and EI/ILP Facilitator)
Barbara Price (MH Facilitator)
Sarah McConnell (Facilitator-in-training)
A review of the Mental Health (MH), Infant Learning (EI/ILP) and Developmental Disabilities (DD) services provided by SeaView Community Services was conducted from October 2 to October 5, 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.
SeaView Community Services (formerly Seward Life Action Council) has provided services to this area since 1972 and evolved into a multi-service agency. The agency’s service area is 1500 square miles with a population of 5,300, nearly half of which resides in Seward. The other communities included in the service area are Hope, Cooper Landing, Moose Pass and Lowell Point. SeaView has provided some services in Chenega Bay but is phasing out of that community.
While SeaView Community Services (SVCS) provides a broad array of services, this site review looks at services offered in
- Mental Health (MH), (community support program, SED youth services, emergency services, psychiatric services, and individual therapy);
- Early Intervention/Infant Learning Program (EI/ILP), including respite;
- Developmental Disabilities (DD) services (including respite, core services and Medicaid waivers). SeaView also provides substance abuse treatment (out patient treatment, prevention), day care assistance, DFYS’ home based services, domestic violence/sexual assault services, and Alcohol Safety Action Program, which are beyond the scope of this review.
In order to provide this wide range of services, SVCS holds 13 grants from which is derived approximately one half of the agency’s funding. These grants include an EI/ILP grant ($121,320), a DD grant ($112,127) and a MH grant ($262,000). Client fees account for the other half of the agency’s income. SeaView staff write at least 20 different grant proposals, all due between January and May. This complexity, combined with growth in some programs, led SeaView to create a new position for a full time accountant.
SVCS employs thirty full- and part-time people. The agency prides itself on a high degree of collaboration with other agencies.
SVCS has restructured itself in the last year, changed names and moved to a new building. The agency structure centers on four team leaders: one for administration, one for MH, one for prevention and one for family services (DD, EI/ILP). The central offices are in an attractive building shared with medical providers and other public use offices. Additional sites include a four-plex and an assisted living facility.
SVCS serves 600-800 people (duplicated count) each year in all programs.
A nine-member executive board of directors, a majority of whose members are consumers, 4 primary and 2 secondary, provides agency governance, and includes specialized subcommittees.
Description of
Process
A team of seven conducted this consumer-centered site review. The team members included one community member (a scheduled second community member was unable to participate); two peer reviewers and an EI/ILP technical assistant; and three facilitators. Over the course of the four day review the team conducted 64 interviews: these include 2 Board members; 13 representatives of related agencies; 22 MH consumers or their parents or guardians (17 from the random selection and 5 volunteers); 8 DD consumers or their parents or guardians; 10 EI/ILP families; 8 direct service staff and 1 administrator.
The interviews lasted from 15 minutes to one and one half hours and were conducted by telephone or in person, in private homes or at one of the agency’s sites.
A file review was conducted during this review by the EI/ILP Technical Assistant and Peer Reviewer for the EI/ILP program. File reviews for MH and DD are conducted separately, although this team performed informal reviews of consumer files.
Open Forum
An Open Forum was made available to the community on the first evening of the review starting at 7:00 P.M. and was held at the public library. The agency had advertised this opportunity in the local newspaper and had requested that it be included in the community calendar posted on the local cable station. No one attended the Open Forum.
The agency also made available the local phone number for the facilitators in the event community members preferred a telephone interview. Three consumers were interviewed by telephone after requesting to be included. Two consumers were interviewed in person after requesting to be included.
Progress Since Last
Review
The last Integrated Quality Assurance review of SeaView (then Seward Life Action Council) was conducted in March 1999. At that time the following Areas Requiring Response were cited:
1. Continue efforts to recruit consumers for the Board of Directors. (Standard #6). Action taken: The Board of nine members includes four direct consumers and two secondary consumers. Standard met.
2. Evaluate the Executive Director annually. (Standard #9) Action taken: The Executive Director has been evaluated in the last year. Standard met.
3. The upstairs offices at SLAC (except for ILP) will remain inaccessible until they move into their new office building in June. (Standard #11) Action taken: Most of the new building is wheelchair accessible, with the exception of the administrative offices. The agency has a TTY system and signage in Braille. Standard partially met.
4. Develop ways to systematically include consumers and community members in agency planning and evaluation. (Standard #13) Action taken: The systematic survey of consumer opinion is in place and utilized in planning and evaluation. Standard met.
5. Complete the revision of the DD program brochures. (Standard #16) Action taken: All agency brochures use consumer-centered language. Standard met.
6. Create a procedure to incorporate consumers into the evaluating of direct service staff. (Standard #22) Action taken: A consumer satisfaction survey is in place and has been used to evaluate staff. Standard met.
7. Create a policy that addresses the development of natural supports for consumers. (Standard #26) Action taken: This policy is in place. Standard met.
8. Identify available resources to meet the assessed training needs of staff. (Standard #30) Action taken: The policy is in place to aid staff in meeting training needs. Standard met.
9. Assure that staff receive necessary training in Medicaid documentation and DD documentation. Action taken: Staff have received training in Medicaid documentation; forms have been modified to aid staff in meeting these requirements. Additional training or peer agency mentoring is recommended. Standard met.
10. Assure that treatment plans contain measurable goals and objectives. Action taken: Some treatment plans contain measurable goals and objectives. Standard partially met.
11. Assure that progress notes identify the treatment goals addressed in the sessions. Action taken: Case file forms have been modified to encourage identifying the treatment goals. Standard appears to have been met; refer to the DMHDD case file review report.
1. Two thirds of the governing board membership are or have been consumers or are parents of consumers of services. This is an extraordinary achievement and exhibits a true devotion to consumer-centered services.
2. SeaView has collaborated to develop the Baby Welcome Wagon, which has served 111 infants and their families. EI/ILP includes the extensive use of Ages and Stages, which has resulted in follow-up with 70 children. A quilt created by community members and consumers accompanies the information given to new parents. (EI/ILP)
3. Other human service agencies in the area extol SeaView’s interaction with them and with the community.
4. The progress in the development of policies and procedures since the last review evidences an extraordinary effort and a successful one.
5. The umbrella concept of services allows for providing services to the widest possible range of age groups and special needs.
The team identified the following strengths under Choice and Self-Determination for those receiving MH services:
+ Some consumers feel included in the development of treatment plans.
“They defer to me.” -- consumer
+ Some consumers feel adequately informed about the choices available to them.
+ Some consumers feel listened to when expressing their needs and goals.
+ Dually diagnosed consumers can access care more efficiently given the variety of services offered by SVCS.
The team identified the following weaknesses under Choice and Self-Determination for those receiving MH services:
- Some consumers feel that the cost of services is a barrier to receiving services.
- Some consumers feel that their treatment planning was handled in a rushed or insensitive manner.
- Some CSP consumers feel that therapeutic services have not been available to them when needed.
- Staff turnover has an additional negative impact when the lack of notice does not allow for either approval or choice of replacements.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+ Some consumers feel that staff honor their wishes.
“He listens to me good.” -- consumer
+ Staff help people develop strategies for self-control and self-respect.
“My case manager is a really good guy. He is always trying to get me motivated.” --consumer
+ Some consumers feel they can report their concerns to the agency.
“If I had a problem, I’d just come in and talk to them.” – consumer
+ Consumer reported that their right to refuse or modify their medications was respected.
+ Parents of consumers have been aided in understanding and accepting their child’s differences.
“(My child) is a puzzle, but is healthy and happy!” –parent
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving MH services:
- Some parents of consumers feel misinformed about the type of services being provided their child.
- Former staff members reportedly misled some consumers regarding their availability for providing continued services at SVCS and then reportedly left without notice to those consumers or follow-up from other agency personnel. Currently the damage lingers as distrust of the agency itself.
- Some consumers state they or their family members have been treated rudely by some direct service staff.
- Some consumers feel they have been treated abruptly by office staff.
- Some consumers feel that they are not credited by staff for their progress in treatment.
- Some consumers report negative predictions by direct service staff about the consumer’s ability to progress beyond a certain point.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+ While Seward is a
small community with limited services, SVCS works hard to connect consumers to
medical, dental, vision and other specialized services here and in other
communities, including arranging transportation to appointments in Anchorage.
+ Consumers state that this is a safe
community and that law enforcement is sensitive to adult MH consumers.
“The police are very
responsive, very, very sensitive and very supportive of people’s needs.”
+ SVCS has successfully worked to increase community awareness of mental health
issues.
+ SVCS has aided consumer with housing, ending, in some cases, years of homelessness.
+ SVCS conducts safety checks in housing where respite is provided and in agency-owned dwellings
+ Interagency health team meetings aid in coordinating health care.
+ Consumers report being well informed about their medications.
The team identified the following weakness under Health, Safety and Security for those receiving MH services:
- Staff turnover affects consumers’ sense of security.
The team identified the following strengths under Relationships for those receiving MH services:
+ Strengthening families is a core value at SVCS.
“I am very pleased
with the amount of support given to the family as a whole.” – parent of a
consumer
+ Consumers are aided with relationship skill building.
+ One consumer was able to visit her home village with
assistance from SVCS.
The team identified the following weaknesses under Relationships for those
receiving MH services:
- Consumers express concerns about the sudden departure of clinical and other staff without an appropriate bridge to new providers. This is of particular concern to parents/guardians of young consumers.
- Families expressed a desire for more inclusive relationship-building opportunities for their children.
The team identified the following strengths under Community Participation for those receiving MH services:
+ SVCS supports educational opportunities for consumers.
+ SVCS provides a summer youth day camp for consumers.
+ SVCS provides transportation for
consumers for shopping and community activities.
+ Consumers receive support to provide community service.
+ School-based services promote school participation and positive alternatives for youth.
The team identified the following weaknesses under Community Participation for
those receiving MH services:
- Some families report inadequate community participation for SED youth.
- Although the day camp was appreciated, it was exclusive to SED consumers, and some parents of consumers would like a more inclusive setting.
- Some consumers desire paid employment or volunteer opportunities, and report insufficient options or support for this goal.
The team identified the following strengths under Choice and Self-Determination for those receiving DD services:
+ Consumers feel
positive about the choices offered in the development of service plans.
+ Consumers feel informed about
changes.
+ Consumers feel informed about the
types of services or interventions.
+ Respite consumers have choices of providers and location, and are given support with scheduling.
+ Dually diagnosed consumers can access care more efficiently given the range of services available through SVCS.
The team identified the following weaknesses under Choice and
Self-Determination for those receiving DD services:
- Services are not in place for some consumers who receive care coordination from SVCS and other services from Hope Community Resources.
- Consumers report limited choices or unfilled respite needs because of staff shortages.
The team identified the following strengths under Dignity, Respect and Rights for those receiving DD services:
+ Consumers and
parents of consumers indicate a high level of satisfaction in their
interactions with office staff.
+ Staff are non-judgmental and helpful,
acting as a sounding board for consumers and their families.
+ “Each
consumer is treated individually, even though their disabilities are similar.”
–parent
+ The staff’s respect for an individual’s right to independence is an expression of respect.
“A lot of dignity is independence; people have the right to choose.” –staff
+ Consumers see staff as being available to help them and willing to make the time to do so.
+ Consumers are provided with good care.
“Our son has a good life; he is well taken care of.” – parent
The team identified no weaknesses under Dignity, Respect and Rights for those
receiving DD services.
The team identified the following strengths under Health, Safety and Security for those receiving DD services:
+ While Seward is a
small community with limited services, SVCS works hard to connect consumers to
medical, dental, vision and other specialized services here and in other
communities.
+ SVCS conducts safety checks in
housing where respite is provided and in agency-owned dwellings.
+ Consumer health issues are carefully monitored.
+ Interagency health team meetings aid in coordinating health care.
The team identified the following weaknesses under Health, Safety and Security
for those receiving DD services:
- Staff turnover negatively affects consumers’ sense of security.
- Incomplete service plans and inconsistent implementation of service plans may jeopardize consumer health and safety. (Shared responsibility with Hope Community Resources)
The team identified the following strengths under Relationships for those receiving DD services:
+ Strengthening families is a core value at SVCS.
+ Consumers are aided with relationship skill building.
+ One consumer was able to visit her home village with assistance from SVCS.
The team identified the following weakness under Relationships for those receiving DD services:
-- Some guardians report less personal contact than
stipulated in plans of care between consumers in Hope’s assisted living care
and SVCS staff.
The team identified the following strengths under Community Participation for those receiving DD services:
+ SVCS provides opportunities for participation by securing
passes to the Alaska Sea Life Center,
Seward Youth Center, etc.
+ SVCS provides transportation for consumers for shopping and community
activities.
The team identified the following weaknesses under Community Participation for
those receiving DD services:
- Some consumers desire paid employment or volunteer opportunities, and report insufficient options or support.
- Habilitation plans are not in place for some consumers and in some instances this results in limited opportunities for respite or community activities. (This is a shared responsibility with other service providers.)
The team identified the following strengths under Choice and Self-Determination for those receiving EI/ILP services:
+ Families feel
positive about the choices of services offered.
+ Families feel positive about the
types of services offered.
+ Families feel informed about the
options offered.
+ Families feel listened to and that their goals are respected.
“I got the results I wanted.” --parent
+ Services offer many alternatives and are admirable for their flexibility.
“I like that everybody makes it so easy to get services. They are flexible and bend over backwards for me and (my child).” --parent
+ Staff have an excellent knowledge of the resources in Seward as well as services available through itinerant providers.
+ Staff work hard to accommodate family schedules.
“They are wonderful people.” – family member
+ Respite services offer choices of providers, location and scheduling.
The team identified no weaknesses under Choice and Self-Determination for those
receiving EI/ILP services.
The team identified the following strengths under Dignity, Respect and Rights for those receiving EI/ILP services:
+ Staff are very good at explaining family rights.
+ Staff help families with goal setting.
+ Parents report the EI/ILP program is highly individualized.
“Each consumer is
treated individually, even though their disabilities are similar.” --parent
The team identified no weaknesses under Dignity, Respect and Rights for those
receiving EI/ILP services.
The team identified the following strengths under Health, Safety and Security for those receiving EI/ILP services:
+ While Seward is a
small community with limited services, SVCS works hard to connect consumers to
medical, dental, vision and other specialized services here and in other
communities.
+ The Baby Welcome Wagon kits contain
safety information for families.
+ Interagency health team meetings aid in coordinating health care.
The team identified no weaknesses under Health, Safety and Security for those
receiving EI/ILP services.
The team identified the following strengths under Relationships for those receiving EI/ILP services:
+ Strengthening
families is a core value at SVCS.
+ Consumers are aided with relationship skill building.
+ EI/ILP provides information about and
modeling of attachment and bonding.
The team identified no weaknesses under Relationships for those receiving
EI/ILP services.
The team identified the following strengths under Community Participation for those receiving EI/ILP services:
+ Services are provided in a variety of settings consistent
with the families’ choices.
+ The Baby Welcome Wagon is provided to all new parents in the service area.
+ The Baby Welcome Wagon is created with assistance from members of the
community and consumers of other services.
The team identified no weaknesses under Community Participation for those
receiving EI/ILP services.
Many staff members are very positive about this workplace.
+The executive director’s door is always open and staff feel she is accessible to them.
“(The administration) is responsive to suggestions.” – staff member
+ Most staff express pleasure in their jobs and working conditions.
+ The family services team is especially pleased with their location and how well their team members function together.
+ Several staff members have made positive, lasting impact on individuals and on the community.
+Staff helped to form and put into practice the agency’s mission statement.
“We’re here for the client.”
“I try to do what they want in their life and
promote self-sufficiency”
+ The agency is seen as aiding in the professional growth of employees.
“They encourage staff to
grow.” – staff member.
+ The agency is viewed as progressive and staff as adaptable.
“Every day is going to be different!” – staff member
Concerns of or regarding staff are:
- Some staff seem unaware of the existence of the employee grievance procedure.
- Staff express concern that the mental health staff are not functioning as a team and are in a reactive mode given the many staff changes and shortages. Some rigidity is noted in this team’s structure.
- Circumstances in Seward may contribute to staff turnover (seasonality of employment, isolation, limited recruitment base). While this impacts the agency and the consumers, it is not entirely within the control of the agency.
- Employment pressures may have resulted in some employees being inadequately supervised in their positions.
- The site review team’s perception is that the salary structure is inadequate.
The team was asked by the regional coordinators to interview DFYS, the local school district, local law enforcement, API, the prison, DVR and a substance abuse treatment staff member. All of these interviews were completed. In addition, the team conducted interviews with medical providers, the magistrate, and the Independent Living Center.
+ The vast majority of those interviewed were more than pleased with SVCS.
+ Consumers and other professionals see staff of SVCS as hard-working people.
“They get work done.” -- consumer
+ Among the many positive comments about SVCS staff and services were:
“I would rave
about this agency if I had the time!”
“They always do what they say they
are going to do.”
“I admire what they do.”
“Great follow-up!”
“There are many students who
wouldn’t have been successful without the services (at
SVCS).”
“Things get better in the lives of
kids with SED if they get services at SVCS.”
“Follow-up is outstanding, including
written reports, updates on goals and goal revisions.”
“They do a great job of
wrap-around services.”
+ There is an unusual and successful degree of collaboration among mental health, law enforcement and the court system in Seward.
“There’s a really good working relationship with SeaView” – law enforcement
+ Several agency personnel noted improvements in services within the last year.
+
“SeaView helps people live in the
community successfully. Without
SeaView, people would be at high risk for reinstitutionalization.”
Concerns noted by other agency representatives were:
- Service coordination between Hope and SeaView is inadequate to meet the needs of consumers.
- The presence of many part-time staff results in confusion for other agency representatives as to who performs what services and how and when to contact them.
-
Barriers to communication among agencies delay
services.
-
Some agencies note an apparent shift in SeaView’s focus
away from prevention with an exclusive interest in treatment.
The facilitators reviewed the agency’s policy and procedure manual, clinical procedures manual, three personnel files of direct service providers, agency-produced brochures, job descriptions, training records, a file of interagency efforts and the like. SVCS has been remarkably successful in meeting the standards, as the attached Administrative and Personnel Standards Checklist will show.
While the agency has improved markedly in accessibility, there remains only an issue of access to the administrative portion of the building. (Standard #11) This standard is largely, but not fully, met.
There are many management strengths to be noted:
+ Within the last year, SVCS has restructured to a four-team management style. The four teams are administrative, mental health, family services and prevention. Team leaders provide administrative and direct service guidance. Several family services and prevention line staff indicate increased ability to focus on direct services as a result of this restructuring.
+ The agency’s consumer-centered mission statement was developed and implemented by employee teams.
+ Consumers’ recommendations for respite staff receive high priority for hiring.
+ The agency has sought to recruit staff through creative, nontraditional means.
+ The level of attention to administrative detail is extraordinary. Policies have been revised and expanded and, as the Administrative and Personnel Standards and the response to the prior review indicate, agency staff have placed a high priority on compliance with these recommendations and expectations.
+ The agency has made herculean efforts to respond to community needs.
+ The governing board has a committee structure that allows for specialization, and has planned additional board training for this fall.
Concerns with program management are:
- As SeaView provides mandated services to an often resistant population, negative community perceptions about those services color the way the overall agency is viewed in the community.
- The community is unclear about the full range of services offered and how to access services.
- Staff turnover continues to be an issue, not unlike other human services agencies in Alaska. Recruitment for mental health positions seems especially problematic.
- Some consumers expressed concern about the sudden turnover of mental health staff and the subsequent lack of consumer notification about the turnover, involvement in staff selection, and lack of continuity of care related to this issue.
- DD service plans are incomplete. Technical assistance from the State would be helpful in that area. Staff have received training in Medicaid documentation and request additional training or peer agency mentoring.
- Within SeaView, inadequate communication among departments sometimes gets in the way of the services desired by consumers.
- Duplicative intake processes are burdensome to consumers who access more than one SVCS program type. (A single intake process is a goal of the executive director.)
- Agency management is complicated by the state’s delay in approving DMHDD waiver plans; there is a potential for negative financial consequences for the agency.
- Some consumers lament that the governing board is too focused on financial issues and is giving less consideration to quality of care issues.
1. Develop a procedure to ensure continuity of mental health care, including notification to consumers of impending direct service staff changes.
2. Develop consistency in providing quality MH services using a consumer-centered model for all consumers.
3. Strengthen the role of the SVCS care coordinator in relationship to Hope Community Resources to ensure appropriate types and amount of service provision.
4. Examine situations involving inactive or prematurely discharged MH consumers to determine the desire for services and identify barriers to services.
5. Assure that all treatment plans contain measurable goals and objectives.
6. Complete and equal access is a goal (Standard #11) Although SeaView has made great efforts to provide equal access, the one area of the agency not accessible is the administrative office suite. Seek to remove this sole impediment to equal access.
Note: See also the EI/ILP file review results.
Other Recommendations
1. Clarify uses of consumer information within the agency and between agencies in the community, as well as the use of releases of information to facilitate information sharing when consumers request it.
2. Consider developing a guide to your services for the community and other agencies.
3. Improve signage within the building. Current signage seems inadequate to help consumers find specific programs or offices.
4. Increase efforts at providing pre-vocational and supported employment for DD and MH consumers.
5. Continue to build communication among the teams, including agency-wide awareness of available services.
6. Review appropriate professional boundaries to avoid instances of blurred boundaries between staff and consumers. Consumers should not be exposed to personal issues or conflict within the agency.
7. Further education regarding consumer rights by posting those rights throughout the agency’s facilities. (Posting rights is a MH grant requirement, not a Standard.)
8. Parents do not feel aware of DD core services. The State could provide this information to SVCS who could then, in turn, more fully inform parents.
9. Continue to assist consumers to develop natural supports and take part in activities in the community.
The site review team wishes to thank the SeaView staff for their extra efforts in hospitality and superb organization of the review.
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 (tallied), EI/ILP File Review Results, EI/ILP File Review Checklist (tally).