Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
Homer, Alaska
Kelly Behen (Community Member)
Jan O’Meara (Community Member)
Gloria Stuart (Community Member)
Yvonne Jacobson (DMHDD Consumer Affairs Administrator)
Brenda Knapp (MH Peer Reviewer)
Trish Walter (DD Peer Reviewer)
John Havrilek (DD Facilitator)
Sarah McConnell (MH Facilitator)
A review of the Mental Health (MH), and Developmental Disabilities (DD) services provided by South Peninsula Community Mental Health Center (SPCMHC) was conducted from November 13 to November 16, 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.
SPCMHC has provided services to this area since 1979. The agency’s service area includes approximately 15,000 people throughout the communities in the lower Kenai Peninsula: Homer, Ninilchik, Anchor Point, Nikolaevsk, Seldovia, Nanwalek, Port Graham, Voznesenka, Kachemak, Selo, Razdolna and Dolena. The agency has a 9 member board including one consumer member, and two parents of consumers. The agency serves an active caseload of 800-900 consumers, with 54 full time staff and 70-80 hourly/part-time staff.
Currently SPCMHC provides a broad array of services. This site review looked at MH services: community support program (CSP), SED youth services, emergency services, psychological therapy and counseling, outpatient rehabilitation, psychiatric consultation, psychological & neuropsychological testing, Specialists and Teachers in Partnership with Students (STEPS), Kachemak Quest, Alaska Youth Initiative (AYI), Bayside Services (a model of rural service delivery); and DD services: the PRIDE Program (Promoting Responsibility, Individual Development and Empowerment).
In order to provide this wide range of services, SPCMHC has a budget of approximately 4.4 million dollars in funding.
Description of
Process
A team of eight conducted the consumer-centered site review. The team members included three community members, the DMHDD consumer affairs administrator, two peer reviewers and two facilitators. Over the course of the four-day review the team conducted 70 interviews with 2 Board members, 17 representatives of related agencies, 22 MH consumers or their parents or guardians (nineteen from the random selection and three volunteers), 12 DD consumers or their parents or guardians (all from the random selection) and 17 staff members including the executive director.
The interviews lasted from 15 minutes to 90 minutes and were conducted by telephone or in person, in private homes, at SPCMHC or at other community agencies.
The agency made available the local phone number for the facilitators in the event community members preferred a telephone interview. The NCR Program Manager also received a detailed letter from a consumer and that information is included in the narrative.
An Open Forum was made available to the community on the first evening of the review and was held at the City Hall. The agency had advertised this opportunity by running a public announcement in the local newspaper on 11/2 and 11/9.
Five members of the community and six members of the review team attended the Open Forum. The weather was inclement with heavy rain throughout the evening, possibly affecting attendance. The Forum lasted for ninety minutes.
The following issues were raised at the Open Forum:
1.
Two consumers stated that they are treated very well by
SPCMHC and have excellent working relationships with their case managers, “I
can’t say enough about Dean, my case manager.”
“I
have a good case manager, I’m one of the lucky ones…. for her staying a long
time…really conscientious…helps with paperwork.”
2. One participant stated the concern that “…a year ago people bared their souls to speak out and nothing happened.” This was in reference to the previous site review. Concern was expressed that the composition of the site review team is entirely different from the last review, requiring considerable repetition.
3. Three participants stated that they have had difficulty accessing case management services. They state that without case management “…you miss out on many of the services.” Specific services accessed through the case managers that were noted were dental grants, housing grants, and winterization.
4. One participant expressed concern that not all consumers know about SPCMHC’s emergency on-call service and that they think there is little community awareness of this service.
5. One participant expressed concern about their understanding of the grievance procedure, which reportedly requires a consumer to go directly to the person their grievance addresses.
6. One participant stated that if a consumer wishes to change case managers they are asked to explain everything that has happened “…in the past eighteen months,” before their request is considered.
7. Three participants expressed concern about staff turnover, and hoped that something could be done to screen staff applicants who stay only a short time. One suggested outreach to universities to recruit applicants.
8.
One participant expressed concern that SPCMHC had not
applied for MHTA transportation funds. Two participants wished that
transportation services could be restored to the level existing “…before July 1, 2000.”
9. One participant encouraged more self-determination and consumer input in the hiring process. Serious consideration and respect of consumer applicants was identified as a need.
10. Two participants expressed concern about the adequacy of outreach efforts by SPCMHC.
11. Two participants discussed the importance of biochemical factors and nutrition relative to mental health. They expressed a desire for SPCMHC to give more attention to these factors in their treatment planning. The importance of the Annex lunch program and having at least one balanced meal a day available to consumers was emphasized.
12. One participant commented that there is inadequate information about client rights posted in central locations at the SPCMHC facilities, and there is no publication available listing the full array of mental health services, including emergency on-call.
13. One participant hoped that SPCMHC would “partner people up,” by promoting relationships within the community and facilitating more “person to person” support with “natural helpers.” A more holistic approach to mental health was encouraged.
14. One participant stated that “paperwork juggling is a poor use of an educated person’s expertise.” Two participants stated that compliance with paperwork and regulations takes time away from needed services, and, in some cases, leads to distrust.
15. One
participant urged SPCMHC to “stop spending so much on conference rooms and
offices …(rather) spend money on facilities for consumers, not staff.”
16. One participant would like compliance with the required quarterly treatment plan review. It was noted that when a consumer is in a crisis, they may not be able to fully participate in their treatment planning, and may benefit from more guidance.
17. One participant would like more clarity and improvement in the process of discontinuing services to consumers.
The team was appreciative of those who chose to attend and share their comments. As noted in the previous review, the Homer chapter of NAMI-AK continues to be a strong voice for mental health advocates on the South Peninsula. NAMI-AK has reportedly secured funding to open a drop-in center, and is hoping to have it open by early December. It is to include a TV/VCR, a computer, and retail space for consumers to sell products.
Progress Since Last
Review
The following recommendations were identified by the 1999 review team as areas that needed attention from the organization:
1. Assure that treatment goals are measurable and objective and that staff are trained to
implement and evaluate progress toward these goals. The team did not address this
issue. The Medicaid case file review will answer this concern.
2. Complete the revision of the mission statement to effectively focus the use of its diverse resources to empower the consumers of services and their families. (Standard #1) Action taken: None. This still needs to be addressed. Standard not met.
3. There is no documentation of a systematic agency-wide education and orientation about
mission, philosophy and values that promote understanding and commitment to consumer-
centered services in daily operations. (Standard #2) Action taken: Orientation and training
manuals are now available. There is no supporting documentation in personnel files.
Standard partially met.
4. Employee records are incomplete. Required documents are consistently missing from personnel files. Could you include checklists? ( Standard #4) Action taken: A database and checklist have been started, but files remain incomplete. Standard partially met.
5. SPCMHC’s governing body should increase its membership to reflect a more diverse representation for all consumer groups. (Standard #6) Action taken: The Board of Directors now reportedly includes one MH consumer and two parents of consumers. A vacancy on the Board is projected, with a plan to fill the vacancy with a DD consumer or family member. Standard met.
6. There is no documentation that SPCMHC actively solicits and carefully utilizes consumer and family input in agency policy setting and program delivery. However, Project PRIDE and the CSP programs do support a consumer advisory group and conduct annual satisfaction surveys. (Standard #12) Action taken: Project PRIDE conducts and places in personnel files consumer evaluations of respite providers. CSP has reportedly increased their emphasis on the consumer advisory board and increased the activities of this board in Annex governing and hiring procedures. Standard partially met.
7. SPCMHC should continue its strategic planning to develop a shared vision, identify core competencies and prioritize goals. Within this process, SPCMHC could explore ways for staff and consumers to provide mutual support toward a common mission. Could SPMHA include even the most severely impaired or those they choose to represent them, which would demonstrate an exemplary effort at inclusiveness and contribute to the effective use of scarce resources? (Standard #13) Action taken: Efforts occur within CSP and PRIDE programs but are not completed formally throughout the agency. Standard partially met.
8. SPCMHC’s personnel records are incomplete. Many records show no evidence of a thorough orientation, certificates documenting required training or training deficits, criminal background checks, oaths assuring adherence to expected standards of confidentiality. (Standard #19) Action taken: Personnel records continue to be incomplete. Most of the personnel records reviewed reflect a lack of documentation regarding criminal background check, training, nor evaluation. Standard partially met. The agency states that personnel files are indeed updated.
9. SPCMHC has no system for review and revision of all job descriptions. (Standard #20) Action taken: There is reportedly a mandatory annual review by supervisors for any alterations in the job descriptions, as well as review for accuracy of salary rate. Standard met.
10. SPCMHC has and utilizes a procedure to incorporate consumer choice into the hiring, but, except for Project PRIDE’s evaluation of respite providers, there is not consumer input into the evaluation of direct service providers. (Standard #22) Action taken: While this reportedly occurs in the PRIDE Program and CSP, it is not an agency-wide practice. Standard partially met.
11. There is no consistent documentation of criminal checks for case managers and coordinators. (Standard #24) Action taken: The majority of personnel records reviewed continue to lack documentation of criminal background checks. Standard partially met.
12. SPCMHC has no written plan to guide the timely orientation/training of staff that includes, as a minimum, agency policies and procedures, program philosophy, confidentiality, reporting requirements (abuse, neglect, mistreatment laws), cultural diversity issues, and potential work related hazards associated with serving individuals with severe disabilities. (Standard #25) Action taken: Orientation checklists and training manuals are now available. However, nowhere is there evidence of any cultural diversity training, and there is negligible information on confidentiality and potential work related hazards. There is no supporting documentation either in personnel files or in interviews with staff. Standard partially met.
13.
SPCMHC’s evaluation system provides performance
appraisal and feedback to the employees and an opportunity for employee
feedback to the agency. Employee
records show that these appraisals are not consistently scheduled from year to
year. Assure that all employees receive a timely evaluation and staff
development plan. Plans should include goals and objectives for the period of
appraisal and new or revised goals and objectives for the coming period. (Standards #28, #29, #31) Action taken: File
reviews and employee interviews reveal that annual evaluation is still
inconsistent at best. #28 Standard partially met. #29 Standard not met. #31
Standard partially met.
14.
Could the agency find ways for all eligible MH consumers
to be given the opportunity to participate in special projects (summer camps,
parenting classes) via the sliding fee scale and use of grant funds? This area
of concern continues to be reported by consumers. Standard not met.
1. Bayside Services provides model collaboration with the Alaska Native service organization Chugachmiut. The exquisite outreach and commitment of providers in the villages “across the bay” is a significant asset to the SPCMHC service area. This fiscally viable model has made considerable progress in extending culturally competent mental health services to children and adults in rural Alaska.
2. Kachemak Quest Program is an exemplary
summer opportunity for youth and their families to learn positive mental health
skills in a wilderness setting and explore new areas of Alaska while
experiencing cultural diversity. It provides real life experience in problem
solving, relationship, and group cooperation. The program offers short-term
interventions, assessments and counseling amid the splendor of Alaska.
3. DD/SED Provider Jim Kucera initiates the first known service by a mental health clinic in the state to dually diagnosed youth and adults.
4. STEPS (Specialist and Teachers Engaged in Partnership with Students) program is providing a bridge between children, families and school to assist children in being more successful within the school environment; skill-building services are provided in a school setting.
The team identified the following strengths under Choice and
Self Determination for those receiving adult MH services:
+ An adult male reported that life is much better because of
the structure in the Bear Creek home. After visiting, he moved there and
reports that he was lonely before moving and is not lonely now. “STRUCTURE
was really helpful!”
+ “I don’t think I’d be here today without the Annex” This client was referring to their suicidal thoughts and that support from people in the Annex saved her life.
+ “I don’t have to do anything I don’t want to.”
+ “Yes, they do give me choices and even if I make the
wrong one, they give me alternatives”
+ “Therapy and help at the Annex (have) enabled me to
manage my behavior, medication, and money and has made the telling difference
in my life.”
The team identified the following weaknesses under Choice and Self Determination for those receiving adult MH services:
-“The Annex tries to get you ready for long term
employment, but for elders with health concerns, that is not a reasonable
goal.”
- Consumer concerns exist about being cut off because they don’t have the same goals as the majority of CSP clients.
-A client felt that they would have a hard time getting a
different case manager if they wanted. “…(I) tried to change once and they
would not let me. I am fairly happy with my current case manager.”
- “I had to beg to the point of tears in order to get a case manager.”
- “(The) caseworker doesn’t help explain what services
are available to me.”
-“The staff does what they want to do and that’s what
you’re supposed to do.”
- It was reported that, at times, treatment plans become a barrier to full access to Annex resources. - Consumers feel that the Annex was better before transitioning into a business.
“When I first started going to the Annex it was like going to a good friend’s house; it was more cozy back then”
- It was reported that it is hard for consumers to have Annex access hours limited to 10:00 – 3:30. “Nights are hard sometimes, and it can be unbelievably hard on the weekends.”
- “The center gives me choices at first then turns around and does something different.”
- The Teen program has taken away the Annex for the evenings.
- Several consumers would like to see shuttle service restored.
Dignity, Respect and
Rights
The team identified the following strengths under Dignity,
Respect and Rights for those receiving adult MH services:
+ “Judy is wonderful and really tries to do things with
clients. She is always happy to see us.”
+ “Trish is very kind.
We don’t always get along, but she is very kind”
+ Privacy is respected.
+ Consumers report they feel good about coming. Staff really listens.
+ “95% of the time I feel respected, other times I feel I can talk to people and work it out.”
+ “I feel like people respect me, they listen to what
happened to me before and start from there.”
+ “New staff seems to have more respect than old.”
+ “Right from the beginning they have been very
respectful and kind to me.”
+ “The staff notice a new dress, haircut, and other positive changes in your life. (Staff) know your name.”
+ Four consumers noted good medication management, judged to be on the “cutting edge,” and felt well-informed about their medications.
+Many clients are impressed with Dr. Burgess’s skills and appreciate his presence at the clinic.
+One consumer talked about his positive sense of participation in Annex businesses and associated self worth.
+ Services are “not enabling, and dignified.”
The team identified the following weaknesses under Dignity, Respect and Rights for those receiving adult MH services:
- Parents expressed concern about complications in release of information when there are incidents of self-harm.
- “The evaluator grins a lot and that made me feel uncomfortable, but he’s the only person available.”
- At least three consumers don’t know that there is a grievance procedure.
-“I feel more accepted at AA for drinking problems than here for mental health. They don’t help me toward recovery or whatever that means here, I don’t know. I don’t have goals to reach recovery or help me get better.”
- “In the past I filed a grievance and it went directly
to the person that was the subject of the grievance and then it was on their
desk when I went in for my next appointment.”
- A parent of a consumer thought their child did not receive appropriate treatment by adequately trained staff. They thought that staff did not have sufficient training and supervision to treat the most severe mental illnesses.
- “If I didn’t like something I would just go away; other
consumers aren’t interested in ‘arguing.’ They just go away rather than
complain.”
The team identified the following strengths under Health,
Safety and Security for those receiving adult MH services:
+ A counselor reportedly talked with a client about birth control and options; the counselor offered to help the client access dental care.
+ “Twenty years ago there were a lot of people in Homer
with mental illness living on the street; with mental health services now
there’s not so many homeless.”
+ Consumers report that they are happy to have vision coverage back in Medicaid benefits.
+ Consumers report getting excellent psychiatric services.
+ Housing feels very safe in the Bear Creek housing unit. A client was formerly suicidal and housing has been reported to be a big help.
+ When recuperating from physical injuries, a consumer was
given access to swimming with free passes, received food delivered to the home,
was aided with rent payments and “it made all the difference.”
The team identified the following weaknesses under Health, Safety and Security for those receiving adult MH services:
- Meals at the Annex need to be better balanced, need to include vegetables rather than all starches that result in significant weight gain.
- A client reports gaining a lot of weight since a
medication change and thinks that they are not getting help, just being told “You
need to lose weight.”
The team identified the following strengths under Relationships for those receiving adult MH services:
+ “When I was going through very hard times I would just
go over to Annex and sit. Having other people around was very therapeutic for
me.”
+ “Staff facilitate natural helping; it’s a good thing,
but scary sometimes.”
+ Case manager support and know-how helped a parent to sustain a relationship with her children.
+ “I have parents, mentors and friends here (at the Annex).”
+ “They help me to feel more secure. Sometimes I don’t even open my mail because
I know it’s going to be so confusing and my case manager helps me understand.”
+ “Friends at the Annex understand me better than my family does.”
+ (The direct service staff) are unusually healthy, wholesome people and above all, role models!”
The team identified the following weaknesses under Relationships for those receiving adult MH services:
- Several clients consider the Annex their family, and those that can’t get in feel they’ve lost their family.
- Very few consumers report having any relationships outside the Annex.
Community
Participation
The team identified the following strengths under Community Participation for those receiving adult MH services:
+ “My counselor has given me lots of support this year for involvement in a play.”
+ The staff is very good about getting tickets for community events.
+ “The Annex is safe, out there is the stigma, of being poor and having a mental health problem.”
+ “I’ve been encouraged to participate in music
activities, community band and orchestra.”
+”It is rare that a mental health center is observed to
take an active part in building community.
I think that the centralization of services in the CMHCC is one of the
reasons it has proved so trustworthy and usable to members of our community.”
The team identified the following weaknesses under Community Participation for those receiving adult MH services:
- “If you’re not in CSP, then you don’t get any help in
getting involved in community.”
- “You never know when you’re discharged from CSP, they
just drop you.”
- Consumers commented on the need for jobs, supported employment in the community, practice interviewing and filling out applications.
- Some consumers state they would rather get pay instead of points and have personal choice in spending their earnings.
- Some consumers think their only choices for employment is in the three Annex programs.
The team identified the following strengths under Choice and Self-determination for those receiving Children and Youth MH Services:
+ “We feel counseling is good and the staff respond to
requests. I particularly liked the summer quest program.”
+ “I really like teen group.”
+ “I was offered choices.”
+ “Now I have a say in my children’s treatment plan.”
The team identified the following weaknesses under Choice and Self Determination for those receiving Children and Youth Mental Health Services:
- “There’s only one psychiatrist for children, I would like to have a second one, but I have no complaints about him; sometimes he’s not available.”
- “They do pretty much as I ask, then they fall
back. I say what I want and they
respond; they don’t always stay focused on our needs.”
- A parent of a client commented that agency staff turnover is so high, and they don’t like to tell their story over and over to every new person.
- A parent thinks they have not been informed of the full array of services available at SPCMHC.
- “The clinician is talking about decreasing services,
but (this adolescent consumer) is saying he’s not ready; doesn’t sound like
they’re listening to his choice.”
- Two parents of consumers would like to see the choice of male caseworkers for their sons.
The team identified the following strengths under Dignity, Respect and Rights for those receiving Children and Youth MH Services:
+ ”I love the way they work with kids. They put up with a lot and are very patient.”
+ “They use appropriate language and are consistent.”
+ “At first, services were awful, follow-through was very bad, and they couldn’t schedule around my work schedule. Now things are getting better with a new case manager.”
The team identified the following weakness under Dignity, Respect and Rights for those receiving Children and Youth MH Services:
- While a parent thought this area was “OK,” they stated that their son feels that his choices in treatment are not always respected.
The team identified the following strength under
Relationships for those receiving Children and Youth MH Services:
+ General satisfaction was reported.
The team identified the following weaknesses under Relationships for those receiving Children and Youth MH Services:
- A parent would like to see a more homeopathic approach to MH services.
- Most needs are reportedly met, but there is some trouble in accessing medically necessary orthodontics.
The team identified the following strengths under Community Participation for those receiving Children and Youth Mental Health Services:
+ One consumer reported that family counseling was available to help improve sibling relationships.
+ “He wouldn’t have any relationships at all if it weren’t for the teen program.”
The team identified the following weakness under Community Participation for those receiving Children and Youth MH Services:
- “Sometimes they keep the kids too busy.”
The team identified the following strengths under Community
Participation for those receiving Children and Youth MH Services:
+ “I think (the client is) being encouraged to be more outgoing.”
+ “Activity Therapists go along on community activities
at the Family Learning Center, movies, and the park.”
+ “The MH van provides transportation to activities.”
+ “There is community politeness, the schools welcome
mental health support; there’s good teamwork.”
+ “Kim has helped me fight a lot of battles.”
The team identified the following strengths under Choice and
Self Determination for those receiving Adult DD services:
+ Consumers feel positive about choice.
+ “It’s all my choice.”
+ Consumers feel able to choose their own provider.
+ Consumers are asked about what they wanted to have on their plan.
+ Consumers report that work choices offered a very positive community involvement.
+ Consumers report choosing where they want to go and what they want to do.
The team identified the following weakness under Choice and Self Determination for those receiving Adult DD services:
- Concern was expressed about the availability of sufficient staff resources in a time of accelerated program growth.
The team identified the following strengths under Dignity,
Respect and Rights for those receiving Adult DD services:
+ “We are very much involved in their treatment planning.”
+ Several DD/MH clients commented that they are very happy with Dr. Burgess.
+ “Sometimes I have to restate to the PRIDE workers what I want, then it’s Ok.”
+ “Before we got involved with PRIDE we had no help at
all. Susan is very encouraging and supportive.”
The team identified no weaknesses under Dignity, Respect and Rights for those receiving Adult DD services.
The team identified the following strengths under Health,
Safety and Security for those receiving Adult DD services:
+ “ PRIDE helped me get surgery when I needed it.”
+ Consumers reported that the doctors and clinicians are very good.
+ Staff is reported to be very good at getting notice out about mini-grants and helping consumers apply for them.
The team identified the following weakness under Health, Safety and Security for those receiving Adult DD services:
- One consumer reported that they don’t live in safe housing. (It is not agency housing.)
The team identified the following strengths under Relationships for those receiving Adult DD services:
+ “PRIDE staff assists me to go visit my mother on a
regular basis.”
+ “PRIDE staff facilitates and supports my visiting
family outside Alaska.”
+ “Even though my son is shy, he tells Jim everything
that is bothering him, things he won’t even tell me. I think it’s great.”
+ “Susan is incredible, so encouraging, so right-on.”
The team identified the following weakness under Relationships for those receiving Adult DD services:
- Few consumers reported involvement in relationships outside agency programming.
The team identified the following strengths under Community Participation for those receiving Adult DD services:
+ Consumers report going on outings with the PRIDE program – fishing, camping, shopping, and walking.
+ PRIDE and Kenai collaborate on activities like the clothing program.
+ “They always call to let us know about activities.
The team identified the following weaknesses under Community Participation for those receiving Adult DD services:
-
“I wish PRIDE staff and school staff would meet on a
regular basis.”
-
“You need to advertise your services more.”
The team identified the following strengths under Choice and Self Determination for those receiving Children’s DD services:
+ “Everybody loves the respite program.”
+ “I don’t know what I’d do without them.”
+ Parents choose their providers by voucher respite, PRIDE program employees, or the PRIDE program will train providers of their choice.
+ Consumers evaluate and hire the respite providers.
+ Parents set limits and guidelines, which are respected by respite providers.
+ “If it wasn’t for Susan, I would never have known that
I had any options for help with my child. She has been especially great.”
The team identified the following weakness under Choice and Self Determination for those receiving Children’s DD services:
- One consumer commented “She doesn’t know what I need,
she doesn’t listen well, maybe because staff is overworked (she) tries to force
things on us that we don’t need.”
The team identified the following strength under Dignity, Respect and Rights for those receiving Children’s DD services:
+ Consumers felt treated extremely well; “I don’t know
what I’d do without them.”
The team identified the following weakness under Dignity,
Respect and Rights for those receiving Children’s DD services:
- One consumer reported that the care coordinator sometimes treated them like they were retarded.
The team identified the following strengths under Health,
Safety and Security for those receiving Children’s DD services:
+ “PRIDE staff definitely helped us access medical
funding for holistic intervention and general health needs.”
+ PRIDE has been proactive in accessing Denali KidCare for clients.
+ “I hold Susan in high esteem. I would put her on a pedestal. She walks on water.”
The team identified no
weaknesses under Health, Safety and Security for those receiving Children’s DD
services.
The team identified the following strength under
Relationships for those receiving Children’s DD services:
+PRIDE staff supports keeping families intact; many complex medical needs children live with their own families.
The team identified the following weaknesses under Relationships for those receiving Children’s DD services:
- “They need to return phone calls better.”
- “They’re all doing a fantastic job but all staff are
overworked.”
- “The PRIDE building is bursting at the seams, they need
more space.”
The team identified the following strengths under Community Participation for those receiving Children’s DD services:
+ PRIDE staff facilitates participation in Special Olympics.
+ Consumers really appreciate the Monday music program.
The team identified the following weakness under Community Participation for those receiving children’s DD services:
- Most of the community involvement is with paid community providers and PRIDE group; it is rather segregated.
Staff Interviews
A total of 17 staff
members from SPCMHC were interviewed from both the MH and DD programs. The
staff interviewed had been with the agency from 6 months to 18 years. The
overwhelming attitude in response to the 5 life areas was that the staff felt
that services are very consumer driven and consumer responsive.
Most staff felt that
they are supported by the administration, especially by Susan in the PRIDE
program. The staff did feel there is a definite need for increased physical
space for consumer programs and staff in all areas of service, especially in
PRIDE areas. Paperwork, time to get it done and the volume required, is a
common complaint throughout.
One staff member
felt that the classification and compensation plan does not offer an incentive
to get further degrees or training. The pay structure is such that it contributes
to high staff turnover.
The team interviewed
seventeen staff members of related agencies including all those requested by
the regional staff with the exception of DFYS.
DFYS staff had been scheduled for an interview but did not appear. Several phone attempts were made to contact
the local office with no one answering at the DFYS office.
The overall
responses in interviews with staff that interface with SPCMHC are very
positive. Related agency staff report a high degree of satisfaction with the
mutual collaboration and cooperation, especially with the PRIDE Program. Comments included:
“The DD support is always willing to come
over”
“I have seen a
lot of improvement in working together especially in the last few years”.
“Susan at PRIDE
has shown herself to be very open and caring”.
“Staff have a
very heavy workload, (are) very busy”.
“We really like
having MH staff at the high school”.
Staff from related
agencies report that communication would improve if the agency used email.
One concern is that
the in-class care provider needs to inform the teacher of the consumer goals
and also that the provider needs to interact with other students.
In addition to the
items identified in the 1999 site review that remain out of compliance, the
team identified the following standards not met in this review:
1. The most recent audit report shared with the site review team was dated June 30, 1999
and contained suggestions for change. (Standard #3) Standard may or not be met. In the
exit review it was reported that a more current audit had just been completed and the
results are forthcoming.
2. The management letter dated January 19, 2000 noted a number of areas that needed to be addressed. Staff training is not consistently documented (Standard #4) Standard partially met.
3. Enhance the functioning of the governing board n the establishment of policies that protect the welfare and rights of all individuals served. (Standard #5)
4. Areas of both the PRIDE and Annex facilities are inaccessible. (Standard #11) Standard partially met. The agency wishes to note that all areas are accessible according to the agency’s interpretation of the Americans with Disabilities Act.
5. Annual goals and objectives should be developed in response to consumer, community
and self-evaluation activities. Efforts reportedly occur in PRIDE program and CSP but are
inconsistent throughout the agency and none are documented. (Standard #14) Standard
partially met.
6. While some consumers report satisfying relationships within the community, many do not.
(Standard #26). Standard partially met.
Program Management
The facilitators reviewed 10 personnel files of current employees, the agency’s Policy and Procedure Manual and brochures about the agency and about some of its programs. Additionally, the facilitators interviewed the executive director for approximately 90 minutes regarding the Administrative Standards and clarification of the agency overview.
The executive director wishes to note that, in regards to Standard #6, a Board vacancy is projected in the near future and the agency plans to fill it with a DD consumer or family member. Regarding Standard #13 the executive director describes the actions to address this standard within CSP and PRIDE but states that this is not generalized throughout the agency. Positive community collaboration efforts were extensively outlined, in particular with the local hospital, schools and criminal justice system. Concern is expressed regarding attempts at collaboration with the local DFYS representatives.
An annual retreat combining the Board and the management team at a site such as Alyeska Resort is reported as a primary activity toward meeting Standard #13. The executive director expresses reservations about documenting and generalizing the goals and objective from these activities. Attempts to complete a consumer satisfaction survey at discharge have reportedly met with only minimal success.
Regarding standards #19 and #24, the executive director notes the high cost of completing criminal background checks on all employees. In addition he is concerned about the significant cost of obtaining checks on employees already working when this standard was established.
Regarding Standards #29 and #30, the executive director cites multiple positive efforts to provide staff with appropriate training. On the other hand, he does not think that regular, documented staff development and training plans are the most effective way for meeting training needs.
1. The Mission statement needs to be rewritten to focus on consumer involvement. (Standard #1) (Noted in the 1999 review as well as the current review.)
2. Document systematic agency wide education and orientation about mission, philosophy and values that promote understanding and commitment to consumer-centered services in daily operations. (Standard #2) (Noted in the 1999 review as well as the current review.)
3. Document the conclusions of the most recent audit and the extent to which actions/remedies have been taken to correct previous problems noted in the 1999 audit. (Standard #3) (Current review finding.)
4. Staff training is not consistently documented and personnel files are incomplete. (Standard #4) (Noted in the 1999 review as well as the current review.)
5. Enhance the functioning of the governing board in the establishment of policies that protect the welfare and rights of all individuals served. (Standard #5) (Current review finding.)
6. Areas of both the PRIDE and Annex facilities are inaccessible. (Standard #11) (Current review finding.)
7. Formalize an agency-wide policy to actively solicit and carefully utilize consumer and family input in agency policy setting and program delivery. (Standard #12) (Noted in the 1999 review as well as the current review.)
8. Formalize an agency-wide policy to systematically involve consumers, staff and community in planning and evaluation including feedback from consumers regarding their satisfaction with services. (Standard #13) (Noted in the 1999 review as well as the current review.)
9. Formalize an agency-wide policy to develop annual goals and objectives in response to consumers, community and self-evaluation activities. (Standard #14). (Current review finding.)
10. Consistently document in personnel files staff training and credentials, experience and compliance with legal, ethical and regulatory requirements. (Standard #19) (Noted in the 1999 review as well as the current review.)
11. Formalize an agency-wide policy to use consumer feedback in the evaluation of direct service staff. (Standard #22) (Noted in the 1999 review as well as the current review.)
12. There is no consistent documentation of criminal checks for case managers and coordinators. (Standard #24) (Noted in the 1999 review as well as the current review.)
13.
Continue to enhance the employee orientation/training
including cultural diversity issues, confidentiality and work related hazards.
(Standard #25) (Noted in the 1999
review as well as the current review.)
14.
Increase the opportunities for consumers to develop
non-paid relationships with community members. (Standard #26) (Noted in the 1999 review as item #14 as
well as the current review.)
15.
Assure that all employees receive timely evaluations
and thus have an opportunity to respond.
(Standard #28) (Noted in the
1999 review as well as the current review.)
16.
Assure that all employees receive a timely staff
development plan. (Standard #29) (Noted
in the 1999 review as well as the current review.)
17.
Assure that all employees receive a timely
evaluation. (Standard #31) (Noted in the 1999 review as well as the
current review.)
Other Recommendations
The final draft of this report will be sent to Northern Community Resources for final review. 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 from there 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)
NCR 8/00