SITE REVIEW
January 25 -
27, 1999
Site Review
Team Members:
John Havrilek, Facilitator
Tess Bensussen,
Co-Facilitator
Jean Brown, Community Member
Beth LaCrosse, Alaska Mental
Health Board Member
Susan Ohmer, Mental Health
Service Provider
JoAnn Smith, D.D. Service
Provider
Pam Miller, DMHDD, Quality
Assurance Unit
Nancy Mathis, DMHDD, Quality
Assurance Unit
Connie Greco, DMHDD, Quality
Assurance Unit
This
is a site review of Wrangell Community Services (WCS), funded by the State of
Alaska, Division of Mental Health and Developmental Disabilities. The services provided by the agency include:
outpatient counseling, community support, psychiatric services, intensive
rehabilitation, grief and loss therapy, domestic violence batterer’s program,
peer helpers, treatment for seriously emotionally disturbed (SED) youth, family
support program, school truancy services, teen media messages, teen center,
parenting classes, supported employment, on-site assessment, job coaching, job
development, case management, respite care, advocacy, care coordination, social
services for long-term care, private pay coordination and smoking cessation
classes. The team interviewed
approximately thirty-seven individuals including local agency representatives,
consumers, parents, staff and board members.
Interviews lasted thirty to sixty minutes and were conducted primarily
in person.
Wrangell
Community Services serves approximately fifty-one individuals, 45 in the area
of Mental Health, and six in the area of Developmental Disabilities. This is its fourth site review since its
inception in 1989. Some recommendations
were made at the last site review and many positive changes have occurred and
are occurring to meet the changes and challenges in the Wrangell
community. WCS’s greatest strength is
its creative, innovative prevention and intervention programs, and staff who
are focused on meeting the needs of the community.
This
report is based on the Division of Mental Health and Developmental Disabilities
Integrated Standards and Quality of Life Indicators. 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 in the context of this report.
The findings include a review of the previous 1997 site review recommendations,
administrative review, exemplary practices, areas of excellence and strengths,
quality of life indicators, areas requiring response, suggestions, public
comments and conclusion.
During
the 1997 review of WCS DD programs, the review team made several
recommendations. Since then, the agency
has taken the following actions:
·
Regarding
the recommendation to write a mission statement and include it in the
orientation packet, a DD mission statement has been written and is in the
orientation packet.
·
Regarding
the recommendation to pursue significant consumer representation on the Board
of Directors, the current Board makeup exceeds DMHDD standards for consumer
representation (three of five Board members).
·
Regarding
the recommendation that Board meetings be open to the public and advertised at
least one week prior to meeting, this recommendation has not been met. While Board meetings are open to the public,
they are not advertised. Again, the
recommendation is that Board meetings are advertised at least one week prior to
meeting.
·
Regarding
the recommendation to establish a consumer evaluation survey, the survey was
conducted in September, 1998.
·
Regarding
the recommendation to conduct an agency self-evaluation, this recommendation
has not yet been met; however, the process to develop such an evaluation has
been started.
·
Regarding
the recommendation to implement an annual review form, the form has been
completed and implemented.
·
Regarding
the recommendation to develop an annual survey of family satisfaction of
services, this recommendation has been implemented.
·
Regarding
the recommendation to implement a DFYS checklist in all home environments, this
recommendation has been accomplished.
·
Regarding
the recommendation to include service providers in the annual client planning
process, progress has been made in this area but is implemented inconsistently
at this time. Further effort needs to
be addressed to this area.
·
Regarding
the recommendation to share long-term goals with the service provider, this
recommendation has been implemented.
WCS regularly meets or exceeds the majority of
administrative and personnel standards.
The director,
through his exceptional grant writing skills, has greatly expanded the scope of
services offered to the Wrangell community.
WCS demonstrates exemplary ability to meet the comprehensive needs of
the DD and MH consumers by its diversity of programming. The drawbacks of this rapid program
expansion, however, are twofold: 1) staff sometimes feel overwhelmed at the
introduction of new programs before old programs are firmly established,
and 2) staff sometimes feel
disenfranchised (i.e. they are unaware of what programs are offered by their
agency), and left out of the planning process.
These feelings were also echoed by some community members. One way of addressing this disparity might
be to include staff and community members in the development of an agency
mission or value statement. Another way
to ease staff’s feelings of anxiety and disenfranchisement would be to involve
staff in developing a system to revise and review job descriptions as new
programs are developed and implemented, and to involve staff in the program
development process.
WCS sets itself apart from other small community
service agencies by its ability to offer diverse and comprehensive programs to
individuals and families requiring mental health or developmental disability
services. The director’s ability to
provide program funding to eliminate service gaps in a community this size is
outstanding. Consumers are offered
services in Wrangell which one would expect to find only in communities of a
much larger size. The WCS staff also
deserves much of the credit for their ability to implement this comprehensive,
flexible, service delivery system.
1. The agency provides
comprehensive, flexible, service delivery.
Staff uses creative problem solving techniques to meet client
needs. Staff is able to provide a wide
array of programs to meet consumer service needs.
2. WCS consistently offers
consumers choices of services and service providers, whenever possible. Given the size of the staff and the community, WCS
“bends over backward” to provide consumers a voice in the establishment of
their own treatment plans.
3. Staff are absolutely
committed to accommodating the needs of their clients. Repeatedly community members, consumers and collateral agency
employees stated that staff were readily available to deal with crisis and
collaborate with other agency providers.
“Alice
does whatever is needed at the hospital.”
“Alice helps me with everything. I don’t know what I’d do
without her.”
It was
felt that help was available 24 hours a day, if needed.
4. WCS has done an excellent
job in promoting community acceptance of individuals experiencing various life
challenges. Through programs such as
community support, supported employment, the teen center, assisted living homes
and other social skills activities such as community potlucks, picnics and
“Mental Health Awareness Month”, Wrangell is a very accommodating community for
WCS consumers.
“Consumers are
productive and respected members of the community. They work, recreate,
live and flourish in this community.”
5. Services are provided in the
least restrictive environment. This agency and this town do
an outstanding job in supporting people in an integrated, natural environment.
“They place people
before numbers.”
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 WCS. The items listed below
are those that the review team identified as strengths. If the teams concluded that any of the
indicators warranted improvement, they are listed in the Areas Requiring a
Response section.
The team identified the following strengths under
the Choice/Self-determination for all people receiving services from WCS:
·
Consumers
have choice and flexibility of who they wanted on their team and in developing
their treatment plans.
·
Consumers
are aware of their treatment goals.
Some consumers carry their plans with them and some had them taped to
their walls.
·
Consumers
and families are given choice of types and frequency of services.
·
Even
though the population of Wrangell has dropped, more service hours are being
delivered to the community.
“This is the first place they let me have my
own feelings”
“They have a lot to offer people and don’t seem to force
anything on anyone”
“WCS doesn’t make me do things. I can say ‘no’”
“They offer so many different services to people”
“WCS excels at creative problem solving so it can give a
client options, ones that
will fit them”
The team identified the following strengths under
Dignity, Respect and Rights for all people receiving services from WCS:
·
Staff
functions with a high level of respect and regard for consumers
·
Staff
consistently attempts to put client needs as their foremost goal
“I trust Mark with my life”
“Sondra respects my dignity and rights”
“He really listens to get a sense of what’s going on,
what’s needed for me”
“They respect clients as people”
“Their approach is to put clients first”
“Our therapist, Sondra, has really brought us together as
a team”
The team identified the following strengths under
Health, Safety and Security for all people receiving services from WCS:
·
Within
a moments notice someone from WCS can be available to intervene in a crisis
situation
·
Most
clients reported feeling safe
·
WCS
has excellent communication with family and health care professionals
·
All
DD staff are trained in CPR and first aid
“Alice saved a comatose patient”
“People here go the extra mile. Alice does it all the time”
“WCS intervened with the furnace company...to keep my
family safe”
“At a moments notice they’re here”
“When we call they always come - no exceptions”
“If I skip a therapy session, Sondra always calls to make
sure I’m okay”
“Some people are in danger of suicide and WCS catches
them before they do
anything
drastic”
The team identified the following strengths under
Relationships for all people receiving services from WCS:
·
Consumers
are treated in the least restrictive environment
·
Consumers
maintain relationships with family and friends
·
Consumers
have opportunities to meet new people
·
Social
skills and social relationships are strongly encouraged and supported by WCS
treatment providers
·
Consumers
and families are well connected to natural supports
·
This
agency and this town do outstanding jobs in supporting people in an integrated,
natural environment
·
Every
consumer interviewed by the team was living in a home or community-based living
situation
“They encourage me to go out with people”
“They’re good about encouraging them to go out and do
things”
“My daughter loves her art group”
The team identified the following strengths under
Community Participation for all people receiving services from WCS:
·
Consumers
are productive and valued members of the community
·
WCS
staff use creative means to get consumers included in the community
·
Consumers
have necessary accommodations to allow them to participate in community
activities
·
WCS’s
diverse programs such as teen center, activity group, parent support, job
coaching, job development and others. promote community involvement and
acceptance
·
WCS
encourages other community groups to make use of their facility for various
activities
“They push you, in a nice way, to get out there”
“I got to go to the Olympics”
“My daughter works one day a week. It makes her feel proud”
“They do really well for the community. If it weren’t for them we wouldn’t have
a teen center
now”
“We all work together.
WCS is one of the puzzle pieces that makes everything fit together”
The
following recommendations were identified by the team as areas that need
attention from the organization:
1. Board meetings need to be accessible to the community and should
be advertised at least one week in advance (repeated from previous review).
2. Consistently include service providers in the
individual’s/family’s goal planning process and document the inclusion of all
team members present, including signatures.
3. Include staff and community members in the development of an
agency mission or value statement. (Admin. Standard #1)
4. Involve staff in developing a system to revise job descriptions
as new programs are developed and implemented. (Admin. Standard #20)
5. Develop a uniform policy regarding information sharing between
WCS and the hospital medical staff following crisis assessment.
6. Individualize training for paraprofessionals before placing to
work with MH /DD consumers.
The
following are suggestions received by the team during the site review process:
1. One consumer reported she did not know she had rights. The team suggests that all consumers be
given a copy of their rights at intake and that a signed copy of the rights be
included in the client chart.
2. One consumer reported a breach of confidentiality by a
paraprofessional. Confidentiality
should be a subject for regular training and review, especially since Wrangell
is such a small town and casual breaches of confidentiality are more likely to
occur in this setting.
3. The community expressed a need for more frequent psychological
and psychiatric services.
The
DMHDD Quality Assurance Unit will present a separate report on the file review.
WCS
scheduled the inaugural public comment meeting contained in the new review
process. The meeting was announced on
the local radio station and via scanner.
One individual attended the meeting.
Issues presented by this individual were:
1. Some individuals in the community will not seek services at WCS
due to prior contact with clinical staff in a former position as DFYS social
worker.
2. Some community members do not feel safe at the new community
service center due to the center’s response to a consumer who was involved with
litigation with the hospital last year.
Since
the issues presented were somewhat political in nature and not really under the
control of WCS, the individual was encouraged to assist those disenfranchised
consumers to empower themselves to feel more a part of the community services
center by establishing a NAMI (National Alliance for the Mentally Ill) support
group in Wrangell.
The
entire site review team would like to extend its sincere thanks, gratitude and appreciation
for WCS’s hospitality and support during the site review. We especially appreciate the agency
volunteering to be the first to field test the new standards in a combined
DD/MH review. We know how time
consuming and difficult it was to prepare for a process this comprehensive, and
really appreciate all the efforts of Mark, Alice, Sondra, Gloria and the rest
of the staff.
The site review team was very impressed with the quality and especially the quantity of services WCS provides. WCS’s services and staff are outstanding, well respected and praised by most consumers and related service providers in Wrangell. Keep up the great work!