May
9-12, 2000
Monica
Guzman, Community Member
Rita
Menzies, Community Member
Sharyl
DeBoer, Community Member
Margaret
Andrews, Peer Reviewer
Jean
Kincaid, Peer Reviewer
David
Sliefert, Peer Reviewer
Michele
Hansen, ILP State Representative
John
Havrilek, Facilitator
Robyn
Henry, Facilitator
A review of Developmental Disabilities (DD), Infant
Learning (EI/ILP) and Mental Health (MH) services provided by Community
Connections, Inc. was conducted from May 9, 2000 to May 12, 2000, using the
Integrated Quality Assurance Review process.
This report summarizes the impressions of the 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.
Description
of program services
Community Connections is a private, nonprofit organization that provides support to over 200 individuals in Ketchikan, Petersburg, Metlakatla and Prince of Wales Island. The populations served by the agency include children and adults with developmental disabilities, children with emotional disabilities, older Alaskans with Alzheimer’s and related disorders and adults with physical disabilities. Services provided by the agency include:
· Early Intervention and Learning Program (birth to age 3): Screening, assessment, education, therapy and service coordination.
· Children’s Mental Health (birth to age 21): Assessment; individual, family and group counseling; rehabilitation support; AYI services for children experiencing severe emotional disturbances (SED).
· Developmental Disabilities Services (Children & Adults): Short-Term Assistance & Resources (STAR); service coordination; supported, assisted and community living; respite care; employment services.
· Older Alaskans / Adults with Physical Disabilities: Respite, care coordination and supported living services. (These services are not part of this review.)
A 7-member Board of
Directors governs the organization. The Board meets monthly. The agency employs approximately 101 full
and part time people.
Description
of the process
To conduct this review, an interview team
consisting of two facilitators, three community members, three peer reviewers,
and a state representative from ILP conducted 83 interviews over four days. Forty
consumers or their parents/guardians were interviewed. Of these, 7 receive MH
services, 12 receive EI/ILP services and 21 receive DD services. Nineteen
interviews were conducted with related service professionals, two with board
members and 24 with Community Connections’ staff.
Interviews lasted from 15 minutes to an hour and
were conducted by telephone or in person in the community, in family homes and
at Community Connections’ offices. Interviews took place in Ketchikan,
Petersburg and Metlakatla and by phone to Prince of Wales Island.
The interview team members also reviewed five
randomly selected personnel files, the agency’s policy and procedure manual,
the agency’s annual report and other administrative documents. After gathering
the information, all the team members met to review the data and draft the
report, which was presented to the agency staff on the final day of the review.
Open
Forum
An open forum was held on May 9, 2000, at the
Resource Room in the Mall. The forum was very well advertised in the paper, on
the radio, in flyers and in the newsletter that is sent to families.
Refreshments were offered.
One family attended the forum. This family
expressed a great deal of praise for the Early Learning Program (ELP) staff,
especially Marggie and Patti. They reported that, because of ELP’s early
intervention, their child has made so much progress the he probably will not
require services when he gets older. They said that even the doctor is amazed
at how well their child is doing.
“Marggie and
Patti come in my home, make my baby feel great and teach me how to help my
baby. They taught me how to teach him to crawl. The program supervisor even
visited and told me if I ever have any problems or questions call her
personally.”
Progress
Since Previous Review
1. The previous site review in 1998 was a very limited review of the agency, focusing only on the DD program. The review resulted in one recommendation and the agency has met that recommendation.
2. The previous site review in 1996 included the ELP services. A recommendation was to continue to develop and implement Memoranda of Agreement with related agencies. This remains as a recommendation.
Choice/Self-determination
The team identified the following strengths under Choice and Self-determination for those receiving services:
+ Most
people interviewed said the staff does an exceptional job at focusing on the
individual needs of the client and family. One person reported a staff member’s
coming to the house every morning from 7:00 A.M. to 9:00 A.M. to support their
child. This service was described as a “life
raft” in a very difficult situation. Another person described services as a
“gift from God”. (MH, DD, EI/ILP)
+ Almost
all people interviewed said that they were involved in the development of their
treatment plan and that the goals on their plan reflected their own goals and
desires. (MH, DD, EI/ILP)
+ A number
of people commented on the staff’s flexibility and willingness to help at any
time. One person cited a staff person’s willingness to come to the house on the
weekend to provide support during their off hours. Another person commented, “No where else could I ever get such personalized care”. (MH, DD, EI/ILP)
+ One
family reported the positive effect of the transition of their child from
another service provider to Community Connections. (MH)
The team identified the following weaknesses under
Choice and Self-determination for those receiving services:
- A couple
of families reported the need for more independent living options for young
adults. (DD)
- A couple
of people interviewed cited the need for less third-party involvement in
coordinating services and more direct contact with the care workers; they
prefer not having to go through the case coordinator. (MH,DD)
- One
family reported that they had been helped with all that they asked for but they
did not realize that there were more options available to them. (DD)
- It was
discovered in one interview that, while hospital physicians were aware of ELP
services, they were not aware of MH/DD services. (MH, DD)
- Several
people cited the need for more concrete service goals so that activity therapy
is more focused and instruction-oriented. (MH,DD)
Dignity,
Respect and Rights
The team identified the following strengths under Dignity, Respect and Rights for those receiving services:
+ Most people interviewed said they felt respected and valued by direct service staff. Several people commented that they feel well listened to and supported. (MH, DD, EI/ILP)
+ Most of the ELP staff were specifically identified as being sensitive to the children’s needs and respectful of their moods. They also work well at “(serving the) whole family”. (EI/ILP)
+ Several people had high praises for Bill and his respectful work with the children in the MH program. (MH)
The team identified the following weaknesses under
Dignity, Respect and Rights for those receiving services:
- Several
people said that they did not always feel valued and respected by general
office staff or by staff not related to their case. (EI/ILP, MH, DD)
- One
parent identified one ELP staff member as needing further orientation/training.
- A couple
of people interviewed said that, while they feel that line staff are respectful
to them, the staff will talk to them about other clients, identifying the
clients by name. They are concerned
about confidentiality (MH/DD)
Health,
Safety and Security
The team identified the following strengths under Health, Safety and Security for those receiving services:
+ A couple of parents commented, “It wasn’t until the start of AYI and wrap-around services began that (our) safety (needs) decreased.” (MH)
+ Most people reported feeling safe in the community and having their basic needs met.
+ Several people attributed to Community Connections their ability to maintain the custody of their child. (ILP, MH, DD)
+ One family reported that because of ELP services their child is doing so well the doctor is amazed and feels their child may eventually not need services at all.
The team identified the following weaknesses under
Health, Safety and Security for those receiving services:
- Several
clients and at least two staff members reported that they felt uncomfortable
around some MH staff. They said the staff
people are not supportive of the family nor do they respect the family’s
wishes. This was brought up as an emotional safety issue. Reportedly, clients
and families have requested not to work with these staff members. (MH)
- One
person emphasized the need to do drug testing and background checks on direct
service staff based on a concern they had. (DD)
- Several
people reported a need for greater collaboration on unified plans involving
several agencies (i.e. school, DFYS, foster parent, other MH agency, etc.) (MH,
DD)
+ Several people indicated that their children had many friends and socialized a lot. (DD, MH)
+ One parent reported that staff are really helpful with teaching their child socialization skills. (DD)
+ One parent reported that Community Connections taught them basic signing so that they could better communicate with their child. (ILP)
+ One parent commented that “(staff member) Brenda is part of the family” (DD)
+ Several people
interviewed indicated that ELP program staff “(serve the) whole family”.
+ Many families expressed appreciation for the fact that staff have taught them how to do interventions that have enabled them to keep their child in the home. (EI/ILP, MH, DD)
+ Several people commented on the fact that the agency encourages open communication between families of origin and foster families. (MH,DD)
The team identified the following weaknesses under
Relationships for those receiving services:
- One
consumer reported that, while they had a lot of friends, they did not feel they
were part of the family with whom they lived. (DD)
- Several
people said that either they or their child did not have any friends. (DD)
- One
family expressed the need for more respite care that would include the child
and the siblings. (MH)
The team
identified the following strengths under Community Participation for those
receiving services:
+ Several families reported that Community Connections encourages and assists consumers to participate in community events and activities. (MH,DD)
+ One parent said that because of their daughter’s CLSA, she is doing everything others do. (DD)
+ Several parents said they felt the integrated playgroup is very helpful in getting their children involved in socialization and inclusion activities. (ILP)
The team identified the following weakness under
Community Participation for those receiving services:
- A
family reported that many employers in Ketchikan are closed-minded about hiring
people with disabilities. (DD)
Staff
Interviews
The team interviewed twenty-four agency staff. For
the most part, staff comments were positive. Several staff indicated that they
appreciated the caring and dedication of their colleagues and the fact that the
agency is so “personalized”. Staff
expressed their appreciation for receiving an award and recognition for good
service. Another staff member noted that the supervisor on Prince of Wales
Island is very helpful, especially given such limited resources. Several staff
members stated that the agency stressed good communication and maintained an “open door” policy.
Concerns raised by staff included the limited
availability of training, high staff turnover, lack of space and lack of
computer access, lack of job security (financial issue), inadequate pay and
late or incorrect paychecks. MH staff stated concerns about the agency’s view
of the viability of the MH program. In the past, the MH program had generated
considerable revenue.
Staff noted the need for increased understanding of
program dynamics (for example, the difference between MH and DD services), of
the unique work expectations, the need for flexible hours, etc. It was suggested
that the agency’s administrative make-up (with DD and EI/ILP background) seems
to understate the differences and uniqueness of the children’s mental health
programming and staffing needs.
Several staff said that they would like to see the
results of a consultant’s recent survey.
Collateral
Agency Interviews
Nineteen people from collateral agencies were
interviewed. They included
representatives from DFYS, DVR, several school districts, Head Start, Gateway
Human Services (SA/MH), public health, Ketchikan Hospital and Petersburg
Hospital. The overall responses from the agencies were very positive,
especially regarding the ELP and DD programs. Comments included:
“They
really live up to their name, Community Connections”.
“Laurie is great, always open and easy to get
a hold of. Community Connections is lucky to have her”.
Some agencies expressed concern about the lack of
collaboration and lack of follow-through, especially in regard to services that
might be shared with the local community mental health program. This has been
reported to be a hindrance to good quality, wrap-around services for MH
consumers.
Several agencies reported a long delay in getting
initial services under the AYI program and that this delay has put several
youth into crisis situations. Several agencies identified the need for more
groups addressing anger management, socialization and other interpersonal
skills.
One hospital staff member suggested that the agency
have a “physicians’ breakfast” or similar event to educate doctors about all
the services available at Community Connections.
Administrative/Personnel
Narrative
The Administrative and Personnel Checklist is included at the end of this report. It includes 43 items, 35 of which are completely met by Community Connections. Those standards not fully met are
1.
Budget controls, record keeping and staff training
support good business practices and conform to state requirements. (Standard
#4) The auditor’s management letter
identified two deficits in this area: the need for an improved system for
tracking Medicaid receivables and the need for computer back up of financial
records.
2.
The organization has and utilizes a procedure to
incorporate consumer choice into the hiring and evaluation of direct service
providers, and to ensure that special individualized services (e.g. foster
care, shared care, respite care providers) have been approved by the family or
consumer. (Standard #22) Families using
respite services hire their own providers, but other consumers do not have input
into the hiring and evaluation of staff.
3.
The agency evaluation system provides performance
appraisal and feedback to the employee and an opportunity for employee feedback
to the agency. (Standard #28) Among the
personnel files reviewed, not all included current evaluations, so no feedback
was documented..
4.
A staff
development plan is written annually for each professional and paraprofessional
staff person. (Standard #29) Among the
personnel files reviewed, not all included current plans.
5.
The agency identifies available resources to meet
the assessed training needs of staff.
(Standard #30) Among the personnel files reviewed, not all included this
information.
6.
The performance appraisal system adheres to
reasonably established timelines. (Standard #31) Among the personnel files
reviewed, not all met the established timelines.
7.
The performance appraisal system establishes goals
and objectives for the period of appraisal. (Standard #32) Among the personnel files reviewed, not all
included goals and objectives.
Note: The agency has a comprehensive system for evaluating staff
annually. This policy meets all
standards. However, standards 28-32 are not fully met because not all staff are
being evaluated annually. Of the five randomly selected personnel files
reviewed, three did not have a current evaluation although all had had an
evaluation within the last 18 months.
8.
Staffing ratios are adequate to ensure that
children and families receive the services and support agreed to in their IFSP.
(Standard #39) While staffing in
Ketchikan is adequate, there is a need for staff to provide services on the
IFSP in Metlakatla and in Prince of Wales.
File
Review
A total of six ELP files were reviewed. The files
included both newly enrolled families and those who had been in the program for
up to 1.5 years. Overall documentation was nearly complete.
·
A few files were missing signatures either of
parents or providers.
·
A few files were missing documentation of the time
gaps in services and of the reasons for delays over 45 days for IFSP
development.
·
The family
rights form was missing a few required items.
·
The IFSP 1999 form is missing one of the sections
(“Summary of Services”).
The team has the following recommendations:
·
Update Family Rights form.
·
Add “ Summary of Services” page to the IFSP.
·
Continue periodic file review to insure
completeness.
Program
Management
Many families talked about the changes in the
agency in the past year. They see many improvements and say they have every
confidence in the Executive Director’s ability to continue to lead and develop
the organization.
Areas
Requiring Response
1.
Follow the recommendations set out in the auditor’s
management letter regarding the tracking of Medicaid receivables and the
computer back up of financial documents.
(Standard #4)
2.
Develop a process of including consumers in the
hiring and evaluation of all direct care staff. (Standard #22)
3.
Update and maintain personnel evaluations as per
your policy, including an exchange of information between supervisor and
employee. (Standard #28)
4.
Update and maintain personnel evaluations as per
your policy, including staff development plans. (Standard #29)
5.
Update and maintain personnel evaluations as per
your policy, including identifying resources for the training needs of
staff. (Standard #30)
6.
Update and maintain personnel evaluations as per
your policy, adhering to timelines.
(Standard #31)
7.
Update and maintain personnel evaluations as per
your policy, establishing goals and objectives for the period of
appraisal. (Standard #32)
8.
Improve staffing ratios in the ELP program in
Metlakatla and Prince of Wales Island.
(Standard #39)
9.
Investigate and address reported personnel issues
including breach of confidentiality by line staff and complaints regarding MH
staff members.
Other
Recommendations
1.
Continue to
develop and implement Memoranda of Agreement with related agencies.
2.
Explore creating more independent living options
for adults and more choices for respite and back-up providers.
3.
Address collaboration issues between Community
Connections and the local community MH center.
4.
Consider accepting private insurance for MH
Services.
5.
Provide more staff training at all levels of the
agency and increase supervision at the direct service level.
6.
Increase public awareness activities to improve
public perception of people with disabilities and to make the community more
aware of all the services provided by the agency.
7.
Address the issues of perceived lack of support and
understanding of the children’s MH program.
8.
Address the issues associated with accurate and
timely staff payroll. (Prior review)
Closing
The team wishes to thank the staff of Community Connections
for their cooperation and assistance in the completion of this review. A
process such as this can be very disruptive to the agency environment. Your
staff clearly gave a lot of attention to the preparation of this review. Your
extra efforts and hospitality were much appreciated by all of the team members.
.
The final draft of this report will be prepared within 30 days and sent to you with a Plan of Action. Within 30 days you are to return the completed Plan of Action to NCR. NCR will review your response and forward it to the appropriate State Division. DMHDD and DPH will then contact you regarding your plan for change.
Attach:
Administrative and Personnel Checklist; Questions for Related Agencies
(tallied), Report Cards (3) (tallied)