MH/DD
Program Site Review
Seward Life Action Council
March 23-26, 1999
Seward, Alaska
Site
Review Team:
Karen
Glenn, Seward
Brandi
Douglas, Seward
Bob
Watts, Kenai
Karen
Stroh, Kenai
Barbara
Price, Co-facilitator
Carl Evertsbusch, Facilitator
A review of the mental health (MH) and developmental disability (DD) services offered by the Seward Life Action Council (SLAC) in Seward, Alaska was conducted from March 23 to 26, 1999. SLAC offers DD services that include respite, care coordination, adult foster care, shared care and core services. MH services include outpatient services, community support program, rural outreach for SED youth and family support for seriously emotionally disturbed youth. SLAC is a multi-service agency that also offers alcohol safety, day care assistance, family support and preservation, domestic violence and sexual assault counseling, and outpatient substance abuse services, which are not subject to this review. This is the first review conducted of SLAC using the Mental Health, Developmental Disability and Early Intervention Program Integrated Standards and Quality of Life Indicators.
To conduct this review, a team consisting of a facilitator, a co-facilitator, two community representatives, both of whom are parents of children who receive services from SLAC and peer providers from both DD and MH, met for four days in Seward. The team conducted interviews, reviewed individual family records and program and agency materials and interviewed 39 consumers and family members, program staff, Board members, community members, and related service providers. Of those, 12 were randomly selected individuals and families who receive services from SLAC.
Interviews were in person at families’ homes, in the community, at the SLAC’s offices, or by telephone. The interviews lasted from 30 minutes to an hour and forty minutes. After gathering the information, the team members met to draft this report, which was presented to the staff on the final day of the visit. This report is based on the Department of Health and Social Services combined Mental Health (MH), Developmental Disabilities (DD) and Early Intervention (EI) program standards.
Monitoring and reporting the quality of life and the quality of services for individuals and families makes an important contribution to the State of Alaska’s understanding of the effectiveness of program services and supports. The review team’s findings are reported below. The report includes a review of the previous findings, a list of areas of excellence, an administrative review, areas of programmatic strength, specific services or procedures that are recommended improvement, tables of consumer satisfaction with quality of life and services and individual file reviews.
During
the previous review of SLAC’s DD respite program, the review team made several
recommendations. Since then, the agency
has taken the following actions:
·
Regarding the recommendation that the program
follow through on the goal to provide timely orientation to new respite
providers, the coordinator is currently updating the provider orientation
manual. In addition, the staff nurse
will be receiving training in First Aid and CPR which will give SLAC the
capacity to train providers internally. (1.1.2)
·
Regarding the recommendation to monitor consumer
satisfaction through the use of a survey to assure that consumer feedback is
consistently received and utilized by the advisory committee, this
responsibility has been rolled into the coordinator’s regular contacts (1.4.1)
·
Regarding the recommendation to insure
accessibility to SLAC’s program offices, the organization has purchased a new
building that will be available in June 1999 and will be ADA compliant. (1.4.5)
(*See note in Other Suggestions and Comments)
·
Regarding the recommendation to analyze the needs
of current and prospective consumers in order to determine how the program can
best meet their needs, the respite coordinator currently includes this into her
regular contacts (1.5.1, 1.5.2).
·
Regarding the recommendation to assure that all
agency publications advance the dignity of person’s experiencing disabilities,
this has not been met (1.6.2).
·
Regarding the recommendation to create policies
that cover the use of aversive behavioral procedures, this has been met (1.6.3).
·
Regarding the recommendation to document new
employee’s orientation to client abuse, neglect and mistreatment laws, this is
now being done (2.6.1).
·
Regarding the recommendation to assure that all
respite providers’ homes meet basic health and safety requirements, safety
checklists are being utilized in all providers’ homes prior to respite
occurring (6.5.1).
*Note: The
items listed above are referenced to the previous DD program standards.
1. SLAC
epitomizes an organization whose services are universally person-centered,
responsive to the needs of the consumer and effective. This extremely dedicated staff are highly
involved with the consumers and truly believe in the importance of the services
they are providing. Consumers expressed
a high level of satisfaction with the services they receive, the people who
provide them and the impact those services have had on their lives. The
positive impact of the staff’s attitude can be seen in the high percentage of
consumers who expressed genuine affection and respect for staff. It is clear from what the review team heard
that the staff go out of their way to make consumers welcome to and comfortable
in the programs.
2. SLAC
has done a superb job of building awareness within the community regarding
people with differences and of supporting their inclusion into the community.
This agency-wide effort has contributed immensely toward fashioning a
community both accepting and supportive of consumers as valuable community
members. Successful placements of
consumers in employment and volunteer activities are indicators of Seward’s
acceptance of people who are different.
The successful collaboration of this agency with other agencies and with
community organizations indicates SLAC’s role in fostering an open, tolerant
community.
“They
carefully orchestrate placement of consumers in jobs and volunteer
opportunities with specific job duties that can be practiced prior to the
placement.” – community member
“This
community is dedicated to helping.” – community member
SLAC has a unique relationship with the
Seward community in that it has historically striven to be a true community
mental health center (See above). At times,
the organization has hesitated to add programs that appear beyond its capacity
but has typically acceded to the community’s wishes.
“Everything
my client needs is in this building.” (a reference from a related service
professional to the comprehensiveness of SLAC’s programs and services)
Several interviewees commented on the
professionalism that was established by the current director’s hiring.
“With
Melissa, professionalism came back.
I’ve always thought highly of her.” - a long time resident and related
service provider
“Some
incredible people work here.”- community member
The agency recognizes that the rapid
multiplication of services has strained the organizational structure to the
point that reorganization is underway, and there is optimism that the change
will relieve much of the stress experienced by staff. Some staff shared their perception that trends at the local and
at the state level have prioritized funding issues above the quality of services
and are feeling the strain of a demanding caseload. They continue to provide quality services, often, however, at the
expense of required documentation.
Staff feel torn between meeting the high demand for services or
thoroughly documenting them. This poses
potential risks to agency operations in the form of lost revenue. The creation of an employee association is
an effort by staff to improve access to agency planning and
decision-making. The team understands
the frustration that is being experienced at all levels and encourages SLAC to
resolve these issues in order to continue its important role in the Seward
community.
SLAC has a highly involved Board of
Directors. The Board recently amended
the bylaws to allow vacancies to be filled through Board action, replacing the
previous method of election by general membership. This is intended to facilitate their search for community members
who possess specific skills that would benefit the organization. The Board utilizes several advisory
committees, which consist of a Board representative, staff and community
members. They provide the Board current information regarding program
operations as an aid to planning decisions.
Retaining community members has been challenging and committees
typically consist of staff and Board members. The Board has broad community
representation, and includes one primary consumer. The Finance Committee receives a monthly financial statement
from the business officer, which is then reported to the full Board at the
monthly meeting. All checks written by
SLAC require a dual signature from one of four Board members. This allows the Board to closely monitor
agency finances. SLAC’s financial
accounting adheres to generally accepted accounting practices.
All new employees receive a general agency
orientation. Except for the Executive
Director, all employee files contained current performance evaluations and
corresponding work improvement plans.
SLAC provides significant training despite limited resources. Agency staff commented that the decrease in
state supported training has had an impact and would like to see that training
be restored. Some staff told the team
that they would appreciate additional training, but were aware of the budget
constraints that often make this unlikely.
The addition of the nurse to the DD services team has greatly enhanced
its ability to respond to consumers with multiple needs.
Concerns were expressed to the team
regarding staff (i.e., respite and group home workers) who they felt may be
inadequately trained.
“The
staff know very little about my son’s condition. I can get the most up-to-date information off the Internet, which
I then can pass on to the staff.”- parent
“There
are things I need to know about the medical condition of the person I provide
respite for, but I haven’t had any training.” – a provider
Families who receive respite provide
individualized training to the providers.
Families also have final approval over their selection. SLAC is very sensitive to the feedback they
receive from consumers regarding staff performance, however, this information
is gathered in a non-systematic and informal way and is not reflected in the
employee files. SLAC experiences the same challenges as
other organization throughout the state in the recruiting and retention of
staff.
SLAC enjoys good working relationships with
other related service agencies and professionals and is highly regarded by
members of the community. The following
are examples of comments received by the team from these professionals
regarding SLAC as an organization and toward individual staff members:
“Since
Melissa Stone took over, it’s much more professional and their image in the
community has risen dramatically.”
“What
they do, they do very well.”
“They
do an awful lot, with very little.”
“Linda
and her staff do an amazing job.”
“Virginia
is great.”
“Tom
and Dixie are on track.”
“Everything’s
fine. We have Gaby.”
“That
has worked very, very well.” – (relating to aides accompanying SLAC consumers
who attend AVTEC classes).
“Their
response is prompt and professional. – (a comment regarding crisis response).
“Faced
with reduced funding….. at SLAC, staff get creative.”
Quality
of Life
This portion of the narrative refers to the Quality
of Life Values and Outcome Indicators, as they relate to the specific services
offered by SLAC. The items listed below
are those that the review team identified as strengths. If the team concluded that any of the
indicators warranted improvement, they are listed in the Areas Requiring
Response Section of the report.
The
team identified the following strengths under Choice/Self-determination for all
people receiving services from SLAC:
Families/people:
·
play an important role in the development of their
individual plan.
·
are comfortable with and actively collaborate in
their care.
SLAC
staff:
Additional
indicators for families receiving Respite that were identified:
· choose the how/when/where respite is to be provided for their child.
· always are given the choice of provider.
The
following are examples of statements consumers/families gave to the review
team:
“I am always given the choice of who provides respite for my
son.”
“I’ve been in lots of treatment programs. I come here voluntarily.”
“I always decide what to do around the house.”
Dignity, Respect and Rights
The
team identified the following strengths under Dignity, Respect and Rights for
all people receiving services from SLAC:
Families/people:
·
are aware of
their rights, including the control of information.
·
are respected
as worthy individuals.
SLAC staff:
·
show respect and
high regard for the consumer/family.
The
following are examples of statements received by the team:
“They make me feel like a
person.”
“They make me feel like a
person, not a client.”
“When I have a problem,
they make arrangements to see me right away.”
The
team identified the following strengths under Health, Safety and Security for
all people receiving services from SLAC:
Families/people:
· are effectively linked with services to provide for their health, housing, transportation and similar needs and are well educated regarding their medications.
· know he/she is safe and secure with the support staff.
SLAC staff:
· assure that services are provided in a safe manner.
· provide excellent education to consumers regarding medications.
Additional
indicators for families receiving Respite that were identified:
The family:
· receives respite that promote the health and well being of the child and the whole family.
· know their child is safe and secure with the respite providers.
The
staff:
·
provide respite in accordance to the health needs
of the child.
The
following are examples of statements received by the team:
“I
feel good where I live.”
“Seward
is a safe city.”
“I
live in a safe place.”
“My
son has good mental and physical health.”
“We
have no danger of eviction. We feel
safe and secure.”
“I
am in good health.”
“We
are assured that his environment is healthy and safe.”
“I
get help with medical and dental services.”
The
team identified the following strengths under Relationships for all people
receiving services from SLAC:
Families/people:
·
describe stable relationships in which responsibility
is shared and are aware of the stages of their personal growth in this area.
SLAC staff:
·
develop trusting relationships with the consumer/family.
Additional
indicators for families receiving Respite that were identified:
Families:
· receive respite that enhances family relationships.
The
staff:
· provide services in ways that don’t weaken families’ natural supports.
· explore a variety of opportunities for how families can use respite.
The
following are examples of statements received by the team:
“We have good family relationships.”
“Respite has helped our
whole family.”
“I have a lot of friends
here (Seward).”
“At my job, I meet lots
of people.”
“She is afraid of her schoolmates. She is somewhat reclusive and would like to
‘start over’. The people here at SLAC have really helped her with her
self-esteem”
The
team identified the following strengths under Community Participation for all
people receiving services from SLAC:
People/families:
·
are accepted and are valued in the community.
·
actively participate in the community to the level
appropriate for them.
·
are aware of community organizations and events and
are effectively aided to initiate or expand their community involvement in both
supportive and practical ways.
· work/volunteer in an inclusive setting.
SLAC
staff:
· use creative means to get the person included in the community.
The
following are examples of statements received by the team:
The following recommendations were identified by
the team as areas that need attention from the organization:
1.
Continue efforts to recruit consumers for the Board
of Directors (Admin Standard # 6).
2.
Evaluate the Executive Director annually (Admin
Standard #9).
3.
The upstairs offices at SLAC (except for ILP) will
remain inaccessible until they move into their new office building in June,
(Admin Standard #11).
4.
Develop ways to systematically include consumers
and community members in agency planning and evaluation (Admin Standard #13).
5.
Complete the revision of the DD program brochures
(Admin Standard #16)
6.
Create a
procedure to incorporate consumers into the evaluating of direct service staff
(Admin Standard #22)
7.
Create a policy that addresses the development of
natural supports for consumers (Admin Standard #26).
8.
Identify available resources to meet the assessed
training needs of staff (Admin Standard #30).
9. Assure
that staff receive necessary training in Medicaid documentation and DD
documentation.
10. Assure
that treatment plans contain measurable goals and objectives.
11. Assure
that progress notes identify the treatment goals addressed in the sessions.
The DMHDD Quality Assurance Unit will
present a separate report on the file review.
Designated members of the team reviewed the files
of those consumers who provided their consent. Inconsistencies were found in
documentation, and some plans were out of date. As noted in a previous section, some staff have found it
increasingly difficult to keep pace with the demands of documentation. The team recommends that the organization
seek a proper balance between caseload and record keeping.
Consumer Satisfaction
Each consumer interviewed by the team was
asked whether or not they were satisfied with the quality of their lives as
they relate to each of the five Outcome areas and with the quality of the
supports and services they receive from SLAC.
The questions were taken from the Consumer Satisfaction section of the
five Outcome areas, and the responses are presented according to type of
service.
MH
|
Choice
N=6
|
Dig&Res. N=6
|
Hth,Saf,Sec N=8
|
Relatns. N=8
|
Com.Par. N=8
|
||||||||||
Outcome
|
Yes |
Part. |
No |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Person/Parent/guardian
|
5 |
1 |
|
5 |
|
1 |
5 |
|
1 |
2 |
|
4 |
2 |
1 |
3 |
Staff
Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person/Parent/guardian
|
6 |
|
|
6 |
|
|
6 |
|
|
4 |
|
2 |
3 |
|
3 |
DD
|
Choice
N=6
|
Dig&Res. N=6
|
Hth,Saf,Sec N=6
|
Relatns. N=6
|
Com.Par. N=6
|
||||||||||
Outcome
|
Yes |
Part. |
No |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Yes |
No |
Part. |
Person/Parent/guardian
|
6 |
|
|
5 |
|
1 |
6 |
|
|
4 |
1 |
1 |
4 |
1 |
1 |
Staff
Performance
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Person/Parent/guardian
|
5 |
1 |
|
5 |
|
1 |
6 |
|
|
4 |
1 |
1 |
3 |
1 |
1 |
Note: If an item is marked UNK (Unknown) or Not
Applicable (NA), will be entered in the No column.
The following are examples of statements the team received from
consumers and families regarding their satisfaction with their quality of life
and the quality of services.
“They (staff) have helped
me a lot.”
“They (staff) have been
good to us. It (SLAC) has worked for us.”
“They’re (SLAC) putting
forth their best effort.”
“They make me feel like a
person.”
“They have been very
supportive.”
“I was treated very well (during crisis services)”
“With staff, there is no
staff/client division.”
“I am entirely satisfied
with the people and the services at SLAC.
“On a scale of 1 to 10,
SLAC is a 10.”
“I’ve been here (SLAC) 12
years. They’ve helped me a lot, in a
lot of different ways.”
Public
Comment
SLAC scheduled a public comment meeting. The meeting was announced in the local
newspaper, on the local cable TV bulletin board, through community fliers and
through the agency newsletter. One
person attended the meeting, and gave the comment that she felt there were
insufficient services for an aging population that may be experiencing the
effects of a history of alcohol or other drug abuse.
The review team received some suggestions during
the course of the review and these are listed below:
·
The new offices at Sea View Plaza will greatly
improve access to SLAC’s offices.
However, the designated Handicap Parking spots that were formerly at the
main entrance of the building have been redesignated regular parking, thereby
taking away any handicapped parking near the offices. In addition, an unloading curb space is necessary to assure that
people who have mobility issues can gain easy access to the building. The back parking lot is inadequate for
handicapped access. The team really
encourages the City of Seward to reconsider the redesignation of the special
parking spots to guarantee that SLAC’s new offices are truly accessible.
·
The team encourages SLAC to be sensitive to the
privacy of their clientele through assuring that the new offices are configured
in such a way that their anonymity is preserved.
·
The team received several comments from staff and
consumers expressing frustration with changing expectations from DMHDD and
other state divisions and with slow responses from and unclear communication by
state agencies.
“We
believe the problem lies with the people working at the state level.” – a
guardian
“To
make it (DMHDD foster stipend) work according to what the state’s willing to
pay, you have to pinch pennies. My
house doesn’t work that way.” – foster parent
“The
process has been changed, and I haven’t been notified when waivers have been
denied.” – a staff member
·
SLAC expressed frustration with MIS and accounting
systems (ARORA and ECHO) that are promoted by state agencies and that, from
SLAC’s perspective, have proven costly and inefficient.
·
Based on concerns voiced by staff that were
interviewed, the team encourages SLAC to develop ongoing procedures that
incorporate staffs’ viewpoints and concerns (i.e., agency directions, planning
and day to day operations).
The team thanks the SLAC staff (especially those in the front
office) for their wonderful hospitality during the site review. Their generosity is especially notable given
the difficult timing of the review and the size of the teams involved. The team
would also like to thank SLAC for their willingness to be one of the first
programs to participate in a joint review using the new program standards.
You will receive a finalized report within 30 days of this
review, an overview of the agency's compliance with the standards and a format
for developing an action plan in response to items identified in the review.
SLAC, in cooperation with DMHDD and DPH, will be responsible for developing a
plan addressing the issues noted in the Areas Requiring Responses.
There is no doubt that SLAC is committed to developing and
providing supports in ways that people prefer.
The high regard staff have for the people they support adds to the
quality of service they deliver.
This review confirms that SLAC meets or exceeds most of the
basic guidelines of the DMHDD and DPH EI/ILP Service Principles.
The team recognizes that all programs, regardless of how good they are,
can always get better. We trust the
recommendations we have made will help you consider ways to improve your
services.
Once again, thank you for making us feel at
home and allowing us the opportunity to review your supports and services.