DMHDD Site Review

Mat-Su Services for Children and Adults-SELS-Site Review

May 3-6, 1999

Site Review Team:

Sharry Grasmick, Wasilla

Sharon Orloff, Wasilla

Matt Jones, Peer Reviewer

Jeanette Gardiner, United Way

Chris Hunter, Wasilla

Pam Miller, DMH/DD

John Havrilek, Facilitator

Introduction

A review of the Developmental Disabilities (DD) and Mental Health (MH) services offered by Mat-Su Services for Children and Adults specifically Supported Employment and Living Services (SELS) in Wasilla, Alaska, was conducted from May 3-6, 1999. SELS offers DD services that include: Residential Assisted Living to 27 consumers, Residential Foster Care to 2 consumers, Residential In-Home Supports to 7 consumers, Residential Shared Care to 4 consumers, Respite Services to 86 consumers, Core Services to 59 consumers, Day Habilitation Services to 12 consumers, Supported Employment to 33 consumers, and Mental Health/AYI Services to 8 consumers. SELS presently serves 187 funded consumers and 178 consumers are presently on the wait list for services. SELS has a 9-member board composed of 5 consumers of SELS services, 2 community members and 2 positions are vacant, 36 full time staff and approximately 100 part-time staff. Our team is 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, two community representatives, a mentor, a related agency representative, a peer provider from DD and a DMHDD representative, met for four days in Wasilla. The team conducted interviews, reviewed individual family records, program and agency materials and interviewed 32 (15) consumers and family members, (7) program staff, community members, board member and (10) related service providers. Of those, 10 were randomly selected individuals and families who receive services from SELS, 1 “walk-in” SELS consumer and 4 AYI/SED consumers.

Interviews were in person at families’ homes, in the community, at the SELS offices, or by telephone. The interviews lasted from 30 minutes to an hour. 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.

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 program response to the previous action plan, 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 file review suggestions, conclusion, administrative checklist, report cards and related agency data.

Program Response to Previous Action Plan

Mat-Su Services for Children & Adults has addressed many of the May 1997, Site Review Team recommendations through specified task forces and advisory boards. As the agency has recognized in its implementation actions, the majority of the recommendations concern on -going issues and trainings.

· SELS involvement with transition staff at the schools increased since the last review, work is still on going with the administration. (1.4)

· Salary and benefit survey was done and a plan was developed to be more competitive. Two full time respite workers were hired to help with respite staff stability (1.1)

· Restroom accessibility at the 5050 Dunbar office was completed. (1.2)

· Guardians reported daily phone calls and or e-mails daily, but formalized records of contacts are not consistent, contacts need to be recorded in consumer files. (1.3)

· Consumers are involved in hiring staff, on-going process. (2.1)

· Frequency and the level of training has increased, on-going process. (2.2)

· Performance appraisals occur but are inconsistent, on-going process. (2.3)

· Staff training and communication occurred in this area to support consumer choice. (3.1)

· Guardians are notified, but the developed incident form is not being used consistently. (3.2)

· Training with staff and consumers in problem-solving, on-going area. (5.1)

· The number of work sites has increased, on-going area. (5.2)

· Employers use employee performance evaluations regularly. (5.3)

· Respite Advisory Board established and their recommendations are followed. (6.1), (6.2), (6.3)

· Safety checklist developed and given to families and all provider homes. (6.4)

· A grant was developed and a program to train providers put in place, this is ongoing effort. (6.5)

Areas of Excellence

Our team felt SELS excelled in two areas:

1. All the homes/living areas of consumers interviewed were neat, clean, safe, “regular” (like anyone else’s home), well equipped and culturally sensitive.

“Room reflects the individual’s culture, individual choice and personality.”

“Consumer was proud to show off his cabin. He considered himself part of the family. He had his own dog, did his own cooking, even wanted to give the care provider a Mother’s Day card.”(DD consumer)

“I would not have been able to keep my boys if it hadn’t been for SELS’ services.”(MH consumer)

2. Related agencies reported SELS as excellent in communication and getting the right paperwork to the right agency.

“Good follow through, they keep current on external and internal progress of clients.”

Administrative and Personnel Standards Narrative

SELS is experiencing tremendous growth especially in the last couple of years, administration and staff are being stretched extremely thin to keep up with the increased demand for services and supports in the Mat-Su area. Families, consumers and employees from related agencies consistently reported their satisfaction regarding interactions with SELS staff and administration.

The review of the administrative checklist indicated five areas of possible improvement:

Area #4) Address the letter to management related to the audit recommendation to develop an investment policy for excess funds.

#8) Board meetings are open to the public but need to be advertised.

#19) Try to hire respite providers with experience, this is a difficulty throughout the state and you are doing well training and supervising.

#27) Develop and use an informed consent form for new and changed services.

#29) A staff development plan consistently written for all staff.

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 SELS. The items 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 people receiving services from SELS :

Choice and Self-Determination

Consumers:

· Consumers and their families expressed they have input into their choices and plan where they live, work and recreate. One consumer the team interviewed lived in his own cabin that he furnished and decorated himself, had a puppy to care for, did his own cooking, cared for several other dogs at the kennel by his cabin and felt like he was part of the care giver’s family. This person had previously lived in a group home for over 20 years with little freedom and no pets or job. Needless to say he is much happier and productive now and has a lot of pride in his home and job.(DD consumer)

SELS Staff:

· Felt they supported consumer choice whenever and wherever possible.

Dignity, Respect and Rights

The team identified the following strengths under Dignity, Respect and Rights for people receiving services from SELS:

Consumers:

· Felt listened to and that their ideas were respected.

· Consumers’ homes and housing showed that their taste and culture was represented.

· Consumers and families felt SELS staff listens.

“Staff is well organized. They helped provide funding for what we needed and they are very non-judgmental, very understanding of our feelings.”(MH consumer)

Health, Safety and Security

The team identified the following strengths under Health, Safety and Security for people receiving services from SELS:

Consumers:

· Felt safe and secure in their homes and housing.

“I used to have to fight and hurt people and they hurt me when I was in the institution. Now I don’t have to fight or get hurt anymore. I even have a boyfriend.”(DD consumer)

· A guardian reported that due to SELS staff follow-up a consumer’s potentially serious medical condition was identified shortly after release from a medical facility. This condition had not been detected during hospitalization.(DD consumer)

The team consistently heard comments from parents, guardians and consumers that they were often looked in on. Some guardians/care-givers/parents reported being in daily communication with SELS staff either by phone, e-mail or visits.

The team was also very impressed with the quality and cleanliness of housing whether it was a cabin, apartment or other living area, it showed a lot of care, training and follow through.

Relationships

The team identified the following strengths under Relationships for all people receiving services from SELS:

Consumers:

· Felt SELS staff were very supportive of family.

· A parent said, “Without this program in place we wouldn’t have been able to continue raising these boys.”(MH consumer)

· Staff provided live-in caregivers to keep family together.

· One consumer wanted to give a Mother’s Day card to his caregiver and the interview team noticed how supportive and caring the caregivers were.

Community Participation

The team identified the following strengths under Community Participation for people receiving services from SELS:

Consumers:

· Are accepted and valued in the community.

· Actively participate in areas they have chosen.

· Have plans and options created to meet their goals and dreams.

· Are supported as a family to participate throughout the community.

· Are involved in jobs throughout the community and on base and post.

The team was impressed with SELS efforts to involve consumers in community activities given of limited transportation resources.

The team saw calendars in consumers’ houses noting bowling, bingo, banking, shopping and other activities planned for the month.

Areas requiring response

The following recommendations were identified by the team as areas that need attention from the organization:

1. Formalize and record contacts (phone calls, e-mail and other types) in consumer files. (1.3)

2. Consistent and timely performance appraisals. (2.3)

3. Need Incident form developed, used consistently and given to guardian/family. (3.2)

4. Address investment policy at board level.

5. Advertise board meetings. (Admin Standard #8)

6. Hire experienced providers if at all possible. (Admin Standard #19)

7. Develop and use an informed consent form for new and changed services. (Admin Standard #27)

8. Create a written staff development plan for each employee. (Admin Standard #29)

9. Work on timeliness, consumers report staff is often late picking them up.

10. Increase consumer awareness of possible service options.

File review summary

DMHDD's Quality Assurance staff conducted a file chart review as part of the larger integrated site review. The Chance to Enhance program, (CTE) is the only program at SELS delivering Mental Health services. CTE is a program that serves severely emotionally disturbed children.

There were a total of eight open cases, 4 of which were randomly selected for this review. All cases reviewed were Medicaid clients, as there were no non-Medicaid consumers receiving services.

There was progress noted from the last review in March of 1998. These improvements included the addition of intake assessments to the clinical files and the addition of multi-axial diagnoses in the assessments. Activity therapy goals and interventions are written in specific terms on treatment plans. It is recommended that these areas of strengths be generalized to other goals and interventions that are not delivered through AT.

Areas of concern were found in the progress notes. Notes indicated a general misunderstanding of Medicaid service categories and billable activities. In addition, there continue to be areas that have been out of compliance for the past three file reviews. These areas and other details of the MH file review are discussed further in the Medical Necessity Review Report enclosed with the final copy of this report.

File Review Recommendations:

Due to continued non-compliance with regulations and current standards, it is recommended that the CTE program be placed on a special status with DMHDD. This status requires that each open case be closely monitored for the appropriate documentation. This status also requires quarterly file reviews to occur until open clinical files are brought into compliance. DMHDD strongly encourages the use of the provider approved standardized clinical forms. DMHDD's QA staff will contact the clinical director to set up a schedule by which to have the documentation complete.

Progress notes indicate that there is confusion regarding the various rehab services billable through Medicaid. It is recommended that the clinical director schedule an appointment in our Anchorage office for technical assistance in this area.

A consultation with the billing department at the Division of Medical Assistance is also recommended to clarify any billing questions regarding Medicaid. This may occur on the same date as the previous recommendation.

It is recommended that Bob Hammaker, the Regional Coordinator, provide oversight and monitoring in the restructuring of the programmatic issues at CTE and with the AYI program.

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 SELS. The questions were taken from the Consumer Satisfaction section of the five Outcome areas, and the responses are presented according to type of service.

DD

Choice N=11

Dig&Res. N=11

Hth,Saf,Sec N=11

Relatns. N=11

Com.Par. N=11

Outcome

Yes

Part

Yes

Part.

Yes

Part.

Yes

Part.

Yes

Part.

Person/Parent/guardian

Staff Performance

Person/Parent/guardian

Note: If an item is marked UNK (Unknown) or Not Applicable (NA), will be entered in the No column.

MH

Choice N=4

Dig&Res. N=4

Hth,Saf,Sec N=4

Relatns. N=4

Com.Par. N=4

Outcome

Yes

Part.

Yes

Part.

Yes

Part.

Yes

Part.

Yes

Part.

Person/Parent/guardian

Staff Performance

Person/Parent/guardian

Note: If an item is marked UNK (Unknown) or Not Applicable (NA), will be entered in the No column.

Public Comment

Two consumers and a caregiver that are presently receiving services from SELS attended the public forum that was advertised through fliers. The consumers and provider were all very positive about SELS’s services and staff and had nothing but praise for the agency’s work.

Conclusion

The team thanks the SELS staff for all their support and hospitality during this site review. The staff’s generosity and dedication to families is especially notable.

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. SELS in cooperation with DMHDD will be responsible for developing a plan addressing the issues noted as Areas Requiring Responses.

There is no doubt that SELS is committed to developing and providing supports in ways people request. The high regard staff have for the people they support adds to the quality of services they deliver.

This review confirms that SELS meets or exceeds the basic guidelines of the DMHDD Service Principles. The team recognizes that all the 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 services, keep up the excellent work for families and children.