Northern Community Resources
P. O. Box 7034
Ketchikan, Alaska 99901
(907) 225-6355
FAX 225-6354
Tane
Skultka, Community Member
Robyn Henry, Facilitator
A review of the mental health (MH) services
provided by Islands Counseling Services (ICS) was conducted from October 30 to
November 1, 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.
Description of
Services
ICS is a non-profit community mental health center that provides services to children and adults who live in Sitka City and Borough. The agency is also available to provide telephone service to the surrounding communities but receives very few referrals from those communities.
The agency’s service area population is 8,500 people in the city and borough and an additional 1,000 people in the surrounding areas. A separate agency provides general mental health services to Native Alaskans with some limited services to non-Natives.
ICS currently provides services to approximately 30 outpatient clients, 19 children and their families, and 20 people served through the Harbor Lights Community Support Program. Adult services provided by the agency include outpatient individual and family therapy, and emergency services. Through the agency’s Community Support Program, Harbor Lights, the agency provides outreach, case management, employment/education and recreation services to adults diagnosed with a major mental illness and severe emotional disturbances.
Children’s services provided by the agency include activity therapy, family support services, home based therapy, intensive rehabilitation services, and crisis intervention services. Wrap-around services are offered to children with severe emotional disturbances in the Alaska Youth Initiative (AYI) program and a home based program offers services that focus on family preservation. The program also works closely with the Sitka School District to provide support to children in the school setting.
A seven-member board of directors, that meets quarterly, governs the organization. The agency employs twenty-five people, full and part time.
Description
of Process
To conduct this review, an interview team
consisting of a facilitator, two community members, and a peer reviewer
conducted twenty-five interviews
over a three-day visit in Sitka, Alaska.
Five interviews were with adults who receive
services including three in the Community Support Program. Three interviews
were with parents or guardians of children who receive services. Given the size of their case load, ICS had
been asked to schedule fifteen interviews.
The original schedule did include thirteen interviews from the randomly
selected list. However, five of those
scheduled did not appear for their interviews.
Ten interviews were conducted with related service
professionals and seven interviews were with program staff. Two of the
interviews were with people who serve on the ICS board of directors and another
was with the board president. Interviews lasted from 15 minutes to an hour and
were held in person at ICS offices and by telephone.
The interview team members also reviewed five
personnel files, the agency’s program policies and procedures, 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
administrative staff on the final day of the visit.
Open
Forum
A public
forum was held in Sitka at the Centennial Building at 7:00 P.M. on October
thirtieth. ICS advertised the event by faxing a Public Service Announcement to
service providers throughout the community, announcing it on the three local
radio stations and advertising it in the local newspaper. Five people attended
this event including a mix of related service agencies and people who receive
services. The feedback provided by attendees of this event is incorporated in
the findings of this report.
Progress
Since Last Review
This is the first review of ICS using these new program
standards. Therefore, there is no
previous action plan for the mental health program.
In-school Support – Several people interviewed, both
clients and agency representatives, indicated that the support ICS provides children
in the school is invaluable. It was noted that behavioral supports to the
children are positive rather then punitive (in contrast to the school). A guardian indicated that since ICS got
involved in supporting the child, improvement has been like “night and day”.
A school principal indicated that “there is always improvement when ICS is
involved in the case”.
The team identified the following strengths under
Choice and Self Determination for those receiving MH services:
+
Almost all people reported that they feel they have
choices about the services they receive and that they are happy with those
choices.
+
Almost all people interviewed said that they were
involved in the development of their treatment plan and that the goals on their
plan reflect their own goals and desires. One person said, “All (my) needs,
concerns and wants are in the plan”.
+
Many people reported that the agency provides
flexible and responsive services. One person explained that staff are “right
on top of things”.
+
One parent expressed her appreciation for the
support she got from ICS staff in trying to get TEFRA (Medicaid) support.
+
One guardian indicated that they were very
impressed with the support the ICS staff gave to a child who was moving to a
community across the state. That support included two escorted visits to the
new community prior to the move.
+
One parent expressed how pleased they were with ICS
staff when they created a crisis plan with the family when the child was having
problems.
The team identified the following weaknesses under
Choice and Self-Determination for those receiving MH services:
-
One person indicated the need for a support group
for veterans. (systems issue)
-
Several people indicated the need for dual
diagnosis services for people who have co-occurring substance abuse and mental
illness.
-
One person expressed their frustration when their
services were discontinued because their insurance did not cover the services
indicated in the treatment plan. Although a sliding fee scale was offered, they indicated they
could not afford the out of pocket expense.
-
Two people and the team members identified the need
for early intervention and prevention services for children. This would include
affordable services and supports for children who have behavior problems but
are not diagnosed as severely emotionally disturbed.
-
One person indicated and the team noticed that the
agency is serving a relatively low number
of children and adults with serious and
severe mental illnesses in relation to the overall
population of the service area. The
agency reported that although the numbers are
relatively low, in the last year they
have doubled the number of children they are serving.
The team identified the following strengths under Dignity, Respect and Rights for those receiving MH services:
+
Almost all people interviewed said they felt respected
and valued by staff. One person explained “It really feels like they listen
to me.”
+
Most people reported that they feel that staff are very
collaborative and responsive to their needs. Several people specifically said
that they feel they get “really good services”.
+ Most people interviewed were aware of their client rights including the grievance procedure.
The team identified the following weaknesses under
Dignity, Respect and Rights for those receiving MH services:
-
One person reported that they did not get
information about their client rights.
-
The team noticed that the current offices had walls
through which you can hear conversations. This was such a concern that team
members hesitated to interview in the offices for fear of a breach in
confidentiality. This situation also raised confidentiality concerns about
people who have therapy sessions and meetings in the offices.
The team identified the following strengths under Health, Safety and Security for those receiving MH services:
+
Most people reported that they feel safe and secure
in their current living environment.
+
All people reported that their health needs are
being met and that, when needed, the agency helps them access those services.
+
One guardian indicated that ICS staff went out of
their way to protect a child that was in an unsafe environment.
The team identified the following weaknesses under
Health, Safety and Security for those receiving MH services:
-
Several people indicated that they are in need of
dental services (system / agency issue)
-
Several people talked about the problems people
have in accessing services at SEARHC and the need for more coordinated
services. (community issue)
-
One person reported and the agency’s quarterly
report confirmed that one client experienced long delays in receiving needed
medication.
-
The team identified the following strengths under Relationships for those receiving MH services:
+
Most people reported being very satisfied with
their relationships and the agency support in this area.
+
Both a parent and a guardian indicated that ICS
staff were very supportive and encouraged their participation on the treatment
team.
+
Two adults indicated that ICS staff are very
supportive of their relationships with their family members.
The team identified the following strengths under Community Participation for those receiving MH services:
+
Two adults said that they were getting support by
ICS staff to return to school.
+
One parent said they felt positive about the
children’s in-school program and that the services helped their child stay in
school.
+
One adult expressed appreciation regarding the
support they get from ICS staff to access community services and activities
such as shopping, paying bills etc. Another person said that staff really
helped them reintegrate into the community after a period of isolation
+
Two clients indicated that they really enjoy the
recovery program at Harbor Lights. One added that they would like to see the
pool table accessible again.
The team identified the following weaknesses under
Community Participation for those receiving MH services:
-
One person identified the need to integrate
non-disabled children in activities to reduce stigma and singling out. The
program indicated that they have started several programs that do this.
-
One person reported that they really wanted to go
back to work but that no one was helping them with this goal, including lack of
support from DVR (system / agency issue)
- The
team noticed a need for community outreach and education about services
available both
to
reduce stigma and to increase the possible use of the services for those who
are
unserved.
Staff
Interviews
Most of the staff in the agency are new. Of the
twenty-five staff, only five have been with the agency for more than a year.
Seven agency staff were interviewed during the site review. Overall the staff
interviewed were very positive about their work environment and about the
clients and staff with whom they work. Staff appear to embrace the client
centered philosophy of the agency with a strong commitment to the people they
serve. One person summed it up by
saying, “we never give up on someone”.
Strengths of the agency reported by staff include
open communication or an “open door policy;” support and feedback from
supervisors; support for training; orientation during the beginning of
employment. Areas of need identified by staff include a new building which
would include windows; more training for direct care staff, especially those at
a bachelor’s level or below; more funding to hire additional staff and to help
provide more services.
The
Administrative and Personnel Checklist is included at the end of this
report. It includes 34 items, 30 of
which are completely met by ICS. Those standards not fully met are:
1.
The agency actively solicits and carefully utilizes
consumer and family input in agency policy setting and program delivery.
(Standard #12) The agency does not
currently have a formal process for getting consumer and family input for
policy setting and service delivery decisions.
2. The
agency systematically involves consumers, staff and community in annual agency
planning and evaluation of programs, including feedback from its current and
past users about their satisfaction with the planning and delivery of services.
(Standard #13) The agency currently does
not have a method for systematically including consumers in their annual
planning and evaluation process.
3. The
agency develops annual goals and objectives in response to consumer, community
and self-evaluation activities. (Standard #14)
While the agency does set agency
goals annually, the agency currently
does not formally include consumers’ input in its agency goal setting process.
4.
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) The agency does not have a process for
including consumers in the hiring and evaluation of staff.
Program
Management
The agency had been in transition for just over a year following the departure of the last executive director. The hiring of the new executive director was the result of a careful and thorough hiring process designed to select the best match for the position.
The current director has been with the agency for almost a year now and has implemented many positive changes. The organization appears to be well managed. There is an expressed feeling of optimism about the program when talking to almost all of those interviewed.
Areas
Requiring Response
1. The
agency needs to develop a process to actively solicit and carefully utilize
consumer and family input into agency policy setting and program delivery. Standard #12
2. The
agency needs to systematically involve consumers, staff and the community in
annual agency planning and evaluation of programs, including feedback from its
current and past users about their satisfaction with the planning and delivery
of services. Standard #13
3. The program needs to develop a process to
develop annual goals and objectives in response to consumer, community and
self-evaluation activities. Standard
#14
4. The agency needs to develop and utilize a
procedure to incorporate consumer choice into the hiring and evaluation of
direct service providers. Standard #22
Other
Recommendations
The team wishes to thank the staff of ICS for their
cooperation and assistance in the completion of this review. A process such as
this can be very disruptive to the office environment and your hospitality was
much appreciated by all of the team members.
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
(averaged)