Table of Contents
Project Methodology..........................................................................................1
Pre-Survey Results ...........................................................................................4
Site Review Summary .......................................................................................6
Conclusions and Recommendations ...............................................................10
Complete Pre-Survey Results: Cove Forge ...................................................11
Complete Site-Review Results-Cove Forge ....................................................14
PA Bureau of Drug and Alcohol Programs 2007-2008 Peer Review
Cove Forge Dual Diagnosis Program
Project Methodology
The Pennsylvania Department of Health, Bureau of Drug and Alcohol Programs
(BDAP) undertakes a Peer Site Review initiative on an annual basis. This
process, which is a requirement mandated by federal and state funding streams,
focuses on a different program type each year. During the process, a minimum
of 5% of sites offering this type of service must be reviewed by peers from like
agencies.
For the 2007-2008 fiscal year, BDAP chose to review Mentally Ill Substance
Abuse (MISA) Inpatient Rehabilitation Programs. Six sites originally agreed to
participate in the review process; however, one site dropped out prior to the site
visits. An additional site was able to be secured as a replacement, resulting in
the participation of the following six sites:
• Cove Forge Behavioral Health (Williamsburg)
• Deerfield Dual Diagnosis (Erie)
• Gaudenzia Common Ground (Harrisburg)
• Greenbriar Treatment Center (Washington)
• Roxbury Treatment Center (Shippensburg)
• White Deer Run (Allenwood)
Once BDAP representatives solidified participating sites, they recruited reviewers
to conduct site visits. One of the most interesting and unique aspects of this
initiative is that representatives from other agencies visit and conduct interviews
with their peers, affording them the opportunity to learn best-practices in a handson activity. Participants also develop network resources that can be used in their
professional careers. The following are the sites reviewed, with date of review
and site reviewers.
Site
Cove Forge Behavioral
Health System
Reviewers
Holly Martin and Kelly
Catherman
Date of Review
6-12-2008
Deerfield Dual Diagnosis
Marsha Zablotney and Donna
Bookhammer
5-16-2008
Gaudenzia Common Ground
Nancy Powell and Joy Evans
5-30-2008
Greenbriar Treatment Center
Robert Benacci and Stacie
Perez
6-17-2008
Roxbury Treatment Center
Jeb Bird and Fran McAndrew
5-1-2008
White Deer Run
Linda Tucker and Dave Wirick 5-8-2008
Prepared by the Mercyhurst College Civic Institute
1
BDAP first contacted the Mercyhurst Civic Institute (MCI) in the summer of 2006
to seek interest in overseeing the process for fiscal year 2006-2007. The MCI,
based in Erie, PA, has a history of conducting program evaluations for state and
local juvenile, family, criminal justice, and drug and alcohol programs. BDAP
representatives and MCI staff worked together to restructure the review process,
focusing more on qualitative information such as strengths, weaknesses, and
organizational behavior and placing less emphasis on statistics and demographic
data. Additionally, methods were developed in order to maximize the number of
program staff who could contribute their opinions to the review of their site.
Since the process worked well for the 2006-2007 fiscal year, the MCI utilized a
very similar methodology for the process in the 2007-2008 fiscal year.
The first step for gathering information from each of the sites was the distribution
of an in-depth tool referred to as the pre-survey. Participants were asked to
identify their level of agreement with each of the 80 statements by circling the
corresponding number on a five-point scale. A much smaller number of staff at
each reviewed site would participate during the actual site visit; however, the presurvey allowed for all program staff to have their input on how their facility and
programs operate. Pre-survey results were used as baseline data for the
development of the survey tool that reviewers utilized during the site visits. A
copy of the pre-survey can be found in the Training Manual, Appendix A. Results
of each site’s pre-survey can be found in each site’s individual report, and the
cumulative results of the pre-survey are located in the combined report. The site
that dropped out of the review, however, did return pre-surveys and therefore
were included in the cumulative pre-survey summary.
The actual site visits served as the second step for gathering information for the
Peer Site Review process. Utilizing the results of the pre-survey, MCI staff
designed a tool that would guide the reviewers in their interviews with agency
staff. Twenty main questions were identified and numerous suggested follow-up
questions were also included. Reviewers were expected to spend approximately
one hour on each interview that was conducted during the site visit. The
complete site visit survey tool can be found in Training Manual, Appendix C.
To help educate the reviewers on the process, an in-depth training manual was
developed and sent to participants. This guide included all materials needed to
conduct the review, contact information for all sites and corresponding reviewers,
reimbursement forms, interviewing tips, and a description for each question on
the site visit survey tool. Also, reviewers participated in one of two conference
calls (April 9th or April 15th) led by MCI staff. The focus of the conference call
was a review of the training manual and particularly the questions on the site visit
survey tool.
2
Prior to the conference calls, a letter was sent out to site contacts informing them
that a reviewer would be in contact within the next two weeks to set up a date for
the visit (Training Manual, Appendix B). In addition, the letter requested each
site to have the following documents available to the reviewers as applicable:
organizational chart, referral process flow chart, copy of strategic plan (or
organizational goals if utilized), written mission and vision statements, and a
program/facility brochure. Site contacts were also asked that reviewers have
access to interview six staff- three line staff and three management staff - on the
day of the site review.
Reviewers were asked to report back to MCI with review findings no later than
May 31, 2008. Once completed and sent back, MCI staff compiled final results
for each individual site as well as an overall analysis. A final report was compiled
and delivered to BDAP officials at the end of June 2008.
3
Pre-Survey Results
The first portion of the site review process was the administration of a pre-survey,
which all staff of the reviewed Cove Forge program were invited to complete. A
list of 80 items was distributed, and survey participants were asked to rate their
level of agreement using a 5-point Likert scale (1 = Strongly Disagree, 5 =
Strongly Agree) for each item. Topics included on the pre-survey focused on
organizational and operational behaviors within the facility. The survey served
two purposes. First, the pre-survey allowed all staff the opportunity to have input
in the review process, and second, results from the pre-survey across all
participating sites were combined to formulate the site visit questionnaire used in
the second portion of the review process.
Analysis of results consisted of ranking each statement by highest level of
agreement to lowest level of agreement. High agreement statements are those
that were generally supported by the respondents (those with more than 75%
that either Strongly Agreed or Agreed), while low agreement statements were not
supported by the respondents (those statements with less than 25% that either
Strongly Agreed or Agreed). These percentages were chosen only for sampling
purposes. The complete table of statements with the computed level of
agreement can be found at the end of this site report.
The following pre-survey statements had a high level of agreement among
survey respondents:
High Agreement Statements
• Our facility helps clients with their aftercare planning.
• Staff is willing to try new things to improve treatment.
• Staff meetings are held regularly.
• I clearly understand my job duties.
• Treatment goals are individualized for each client.
The following pre-survey statements had a low level of agreement among survey
respondents:
Low Agreement Statements
• Holistic treatment approaches are adopted by staff at our agency.
• Anger management is a core competency of our therapeutic interventions.
• Our organization employs a sufficient number of employees to cover the
workload.
• Our board of directors drives the direction of the programmatic offerings.
• Staff at our agency are encouraged to participate in the community in non jobrelated activities (volunteer, serve on boards, etc).
4
•
•
•
We have adequate staff in place to meet the needs of clients.
Staff turnover does not interfere with program effectiveness.
Staff are paid wages and benefits that would be deemed appropriate and
comparable with other similar agencies.
The summarized findings of the pre-survey are based only off of those
issues with high agreement, low agreement, or high disagreement. The
reader should recognize that other issues may weigh in on the
performance of the organization. The overall pre-survey results will be
combined with site-visit findings in the conclusion portion of the report.
5
Site Review Summary
The Peer Site Review of Cove Forge was completed on June 12, 2008. The
review was conducted by Holly Martin of Greenbriar and Kelly Catherman of
Gaudenzia Common Ground. The following is a summary of findings from the
survey. A consolidated version of the survey containing all of the answers can
be found at the end of this site report.
Relationships and Communication
Respondents noted that turnover causes increased frustration among staff
members, which can be a hindrance to building solid relationships with
coworkers. Though this is problematic, staff reported that they remain supportive
and cooperative of each other, and strive to work together to better client
services. Staff responded with mixed feelings about management; some view
them as visible and approachable, while others commented on a ‘we versus they’
dynamic within the agency. Some felt frustration regarding communication of
schedule changes, safety issues, etc. from management to line staff. Members
of management were said to have a solid relationship with each other, though it
was said that they work behind closed doors and aren’t willing to share
information with lower level staff. Line staff noted that they had no knowledge of
the Board of Directors and were unaware of their role and composition.
Cove Forge staff primarily utilize email, voice mails and memos to communicate
with each other. Some staff carry two-way radios since the campus is so large.
A company newsletter is distributed as well. Regarding communicating client
needs, shift report meetings, as well as departmental meetings are held every
two weeks. Though important to communicate effectively in order to run the
program successfully, interpretation of what is important enough to pass on is a
barrier to operating efficiently.
Staffing Issues and Behaviors
The most pressing problem regarding staff is centered around agency turnover.
There seems to be a core of staff that have been with the agency for a long time;
the rest of the staff tends to be transient, as counselors come and go quite
frequently. The turnover problem leads to increased workloads, which inevitably
impacts morale negatively. The issue of working overtime also causes
consternation for some, as it is offered at times but not at others. To account for
staff shortages, group therapies are frequently combined. Interviewees felt that
their pay and benefits are better than, or just as competitive as, other agencies.
To bring in new hires, the agency uses newspaper advertisements and job fairs.
There is an employee bonus program to entice staff to refer others to work at the
agency.
6
There are some reported problems with staff behaviors, most notably boundary
issues with clients. Fraternization with clients has been seen, and inappropriate
favors from staff to clients have been investigated by the agency. In the past
there have been counselors who have given personal information to their clients.
Some feel that there are too many negative attitudes within staff members. To
combat these problems, management is attempting to put in place a Spirit
Committee to promote higher morale.
Staff at Cove Forge have an intense and diverse selection of training
opportunities afforded to them. Additional training is not necessarily emphasized
except in cases required by regulations. Staff are responsible for obtaining a
minimum number of training hours, and to complete them within the facility.
There is financial reimbursement to those working on their continuing education
as well. Advancements and promotions are possible if the person is willing to do
the work and develop new skills.
Treatment
Respondents indicated that the agency is open to numerous clinical modalities.
The most noted one at Cove Forge was Reality Therapy. The rural outdoor
setting also allows for such programs as ropes courses to be offered.
Interviewees also reported many specialized group therapies are an important
part of treating clients. Cove Forge has a relatively new aftercare department,
which has been in place for about a year. This work was previously done by
clinicians. Now the counselors give input to this department to help line up
needed community services such as AA/NA, partial, outpatient/inpatient
programming, and halfway housing.
Referral Process and Inter-agency Relationships
Referrals to Cove Forge stem from a variety of sources. Many come from
agency funders and drug and alcohol providers. Others come from a marketing
department at the agency, as well as a number of self-referrals. External
sources send client history to intake staff to evaluate appropriateness. The
program will not admit those in violation of Megan’s Law or non-ambulatory
clients. Clients must be in the program for seven days before visitors are
allowed.
Cove Forge has solid relationships with several agencies in their region,
including probation, hospitals, housing agencies, case management agencies,
vocational rehabilitation offices, and drug and alcohol providers. Respondents
reported on strong relationships with churches (which offer bible study) and the
Salvation Army (which donates clothing). The issue of consent was brought up
regarding sharing information. It was felt that the master consent list is rarely
accurate, so staff does not always know who signs releases.
7
Working Conditions
Though space is limited, staff seem to be able to make the most of what they
have to work with both clinically and administratively. Recent expansion has
helped to alleviate some of the space issues, and office space was said to be
improving. Since the program is on a campus setting, outdoors are used when
the weather permits. Interviewees reported feeling safe in their workplace. Staff
have two-way radios on the campus, and work together to deal with aggressive
clients. Humorously, one staff noted the scariest part of work is the occasional
deer, skunk, or snake that wanders onto the campus. The most pressing
limitation of the work environment is that both adult and adolescent clients share
the campus and cannot interact; this set-up limits scheduling flexibility.
Technology
The interviewees noted that the agency utilizes computers and technology for
treatment planning and conducting assessments. Counselors and administration
have computers, and online access is available to all staff. Though technology is
utilized, full clinical records are not computerized. There are shared databases
used internally. Other examples of use of technology at the agency include a
program called ‘Qualifacts’, an admissions program to collect demographics on
the clients.
Culture and Diversity
Cove Forge accommodates diversity differences among its clients. Treatments
are adapted to account for clients’ needs based on religion, gender, medical
needs, and sexual orientation. Many comments were given regarding religious
considerations at Cove Forge. The agency does not currently employ any
bilingual staff, but materials are available in Spanish.
Research and Outcomes
Interviewed staff responded with limited knowledge of research based
programming at Cove Forge. There was also no knowledge of strategic planning
or goals within the agency. One person commented that they believed
management/administrative staff work on this issue, leaving clinical staff ‘out of
the loop’. All staff are afforded the opportunity, however, to give input to
management about agency strengths, opportunities, weaknesses and threats.
Regarding outcomes, exit satisfaction surveys are conducted during the aftercare
process. Though there is feedback given by clients, interviewed line staff does
not get feedback regarding this information.
Perceptions
8
Cove Forge was reported to be attentive to community concerns, as the agency
makes all efforts to ‘keep the peace’. Many in the community work for the
company as well. Cove Forge is attentive to community concerns, and in the
past has conducted community meetings for neighbors. It seems these are
needed because of the perception by some in the community that the clients are
criminals.
Strengths, Weaknesses, and Opportunities
When asked to identify what makes Cove Forge special, respondents made a
variety of statements about the treatment provided. There is strong belief in the
staff commitment, and the program offerings are client centered. Specialized
diagnosis groups are offered, and the rural, slow-paced setting is a wonderful
asset that helps to relax the clients. Scholarships are also offered to those
without insurance or the ability to pay by themselves. Respondents felt that
Cove Forge excels at their Real Talk sessions with clients, as well as mental
health group offerings that serve with diverse populations.
Though the majority of feedback was positive, the interviewees did note some
weaknesses within the program. The campus is shared by both adult and youth
programs, and the clients cannot intermingle. This provides a scheduling
problem regarding use of buildings. The geographic location of the program also
causes problems for those with physical mobility issues. There is also a limited
clinical workforce to recruit from due to qualification requirements. Better
screening at the call center may address this problem. Some reported that local
mental health services are not up to par, and that increased caseloads and
paperwork prohibit delivery of the best possible services. As with all agencies,
funding constraints are constantly causing struggles at Cove Forge.
Respondents also identified some areas of need and future opportunities for the
agency. Offering practical living skills such as parenting, budgeting, financial
management, etc would be beneficial to the clients. Many need banking services
as well. There is also a need for more halfway house beds in the area. Staff
would also benefit from having a residential housing unit for staff to use during
overtime periods or when there is inclement weather. It was also felt that before
the agency expands to offer more programming it should find adequate staff for
the existing programming first. Respondents also felt that all agencies would be
better served if there were less competition with other agencies and more
information was shared.
9
Conclusions and Recommendations
The peer review process of Cove Forge revealed some unique attributes about
the agency. The dual diagnosis program has many attributes that lend to
successful treatment of clients, as well as make it a positive, inviting workplace
for staff members. There were also some issues that arose from staff during the
site review and pre-survey that could be opportunities for improvement within the
program. The following section highlights some of these areas. Note: the
information that follows is based solely on the results of the pre-survey
and site reviews. Findings represent the feelings of those who participated
in the process and may not be representative of the agency as a whole.
What’s working
Overall, staff seems to believe that they work in a caring environment in which
everyone is dedicated to providing the best service possible to each client.
Respondents tended to feel that they were paid competitively for their work.
Programmatic offerings are also individualized and take into account specific
needs for each person. The rural setting also brings many opportunities to the
clients that other urban programs may not be able to offer. Compared to other
reviewed sites, technology seems more prevalent here which makes work more
efficient for many. Space issues tend to be reported as adequate compared to
other sties as well.
Areas to consider looking at
Staff shortages and the stress it brings was one of the most pressing areas for
interviewees. Respondents noted that though the agency has tried to address
the problem, the lack of qualified applicants and strict regulations continue to
prove a stumbling block. The fact that the program shares a campus with
adolescents makes it difficult to schedule. Staff had a difficult time identifying
specific ways in which outcomes are tracked or utilized. Perhaps interviewees
were not aware of this information or perhaps the programs are not sought and
the data is not collected. There were also no research-based programs cited by
staff that the agency offers. Similarly, some staff were not sure whether the
agency follows a strategic plan. At the very least, the agency should consider
familiarizing employees with these areas.
10
Complete Pre-Survey Results: Cove Forge
The items from the pre-survey were ranked in order of agreement (total number
of respondents who reported they either agreed or strongly agreed with the
statement) from highest to lowest. This number is found on the far right column
(SA & A) of the following chart. The total number of respondents who disagreed
with the statement (by marking the disagree or strongly disagree choices) are
indicated in the column labeled SD &D.
The percentage of respondents that rated each statement
Our facility helps clients with their aftercare planning.
Staff is willing to try new things to improve treatment.
Staff meetings are held regularly.
I clearly understand my job duties.
Treatment goals are individualized for each client.
Staff relies on each other’s expertise to offer the best treatment
available to each client.
Our programmatic therapy encourages clients to accept
responsibility for their own choices and actions.
Our agency does not have a difficult time maintaining a client base.
Staff shares ideas and thoughts regarding treatment modalities.
Clients are encouraged to develop social supports outside of the
program.
We place an appropriate amount of focus on relapse prevention.
Our clients are educated about their disorders.
Services are provided in accordance with the treatment plan.
Staff is able to build rapport with clients in a reasonable amount of
time.
Clients’ families are encouraged to participate and support clients as
relevant.
Our program meets both the mental health and the substance abuse
needs of our clients.
Staff has knowledge of the problems experienced by our client
population.
We typically adjust client treatment based on their changing needs.
Staff understands the mission of the organization.
The objectives and goals of treatment are understood by our staff.
Medication administration and documentation is accurate.
Clients view this program as being beneficial to their therapy.
Our staff does a thorough job of assessing client problems and
needs.
Management possesses a great deal of administrative knowledge.
Group sessions are effective in treating our clients.
Client placement is based on documented needs.
Program staff understands how this program fits as part of the
treatment system in our community.
Management possesses a great deal of treatment knowledge.
Our staff accurately assesses client needs and matches those
SD &
D
3.1
8.8
0.0
9.1
12.1
SD
3.1
0.0
0.0
0.0
3.0
0.0
8.8
0.0
9.1
9.1
N
6.3
8.8
22.6
15.2
9.1
A
56.3
70.6
54.8
39.4
66.7
SA
34.4
11.8
22.6
36.4
9.1
SA
&A
90.7
82.4
77.4
75.8
75.8
17.6
2.9
14.7
8.8
55.9
17.6
73.5
9.4
9.7
3.0
0.0
6.5
0.0
9.4
3.2
3.0
18.8
19.4
27.3
56.3
48.4
57.6
15.6
22.6
12.1
71.9
71.0
69.7
12.5
12.5
3.1
8.8
3.1
3.1
0.0
0.0
9.4
9.4
3.1
8.8
15.6
18.8
25.0
23.5
43.8
56.3
53.1
64.7
25.0
12.5
15.6
2.9
68.8
68.8
68.7
67.6
18.2
3.0
15.2
15.2
48.5
18.2
66.7
0.0
0.0
0.0
30.3
51.5
15.2
66.7
15.2
0.0
15.2
18.2
54.5
12.1
66.6
15.1
9.4
2.9
5.9
3.0
0.0
3.0
0.0
0.0
0.0
0.0
0.0
12.1
9.4
2.9
5.9
3.0
0.0
18.2
25.0
32.4
29.4
33.3
33.3
54.5
56.3
52.9
47.1
57.6
60.6
12.1
9.4
11.8
17.6
6.1
3.0
66.6
65.7
64.7
64.7
63.7
63.6
12.5
12.6
9.4
14.7
3.1
6.3
0.0
0.0
9.4
6.3
9.4
14.7
23.0
25.0
28.1
23.5
37.5
53.1
53.1
52.9
25.0
9.4
9.4
8.8
62.5
62.5
62.5
61.7
3.0
9.4
9.4
0.0
6.3
0.0
3.0
3.1
9.4
33.3
31.3
31.3
54.5
56.3
53.1
6.1
3.1
6.3
60.6
59.4
59.4
D
11
needs with services.
Staff members contribute to the team by doing their share of the
work.
Clients receive the best services possible at our facility.
Our facility tracks and evaluates performance of clients in a useful
manner.
Staff members are able to cooperate with one another in a way that
supports the organization.
Our agency is committed to providing the highest level of service as
possible.
Interventions are matched to the client’s current stage of change.
Reports, forms and files are available when needed.
There are ample opportunities for staff to attend trainings for new
therapeutic strategies.
Resources are available for me to perform my expected job duties.
I am satisfied with the training available to staff.
Clients participate in programs at the expected level.
Staff make exemplary role models for the clients in our program.
Use of technology is regular in assessing and treating clients.
There are open discussions about program issues.
I have complete trust in the professional judgment of my coworkers.
Upward advancement and professional growth are possible in this
environment.
Services offered by our facility meet the needs of the community we
serve.
Upper management treats all support staff with dignity and respect.
The use of technology for client records and billing is effective.
Staff is knowledgeable in techniques to improve behavioral
management of clients.
Mutual trust and cooperation among staff in this program are strong.
Staff adhere consistently to the policies and objectives of the
organization.
Our facility uses outcomes and program measurements to document
program effectiveness.
Our facility is physically secure for both clients and staff.
Our staff utilizes technological resources to monitor progress of
clients.
Counselors here are given autonomy in managing clients.
Staff has the backing of management.
Our facility is always clean and orderly.
Life skills training is an important part of our overall treatment
program.
Staff is given autonomy over their jobs.
Program staff is always informed of therapeutic decisions that affect
clients.
We are able to meet the needs of our clients with the services
currently offered.
There is an open line of communication at our facility between upper
management and line staff.
The external community feels safe among our facility.
SD &
D
SD
D
N
A
SA
SA
&A
15.6
21.9
3.1
9.4
12.5
12.5
25.0
18.8
43.8
56.3
15.6
3.1
59.4
59.4
11.8
0.0
11.8
29.4
50.0
8.8
58.8
15.1
3.0
12.1
27.3
45.5
12.1
57.6
15.7
9.4
11.8
6.3
0.0
0.0
9.4
9.4
11.8
28.1
34.4
32.4
50.0
50.0
50.0
6.3
6.3
5.9
56.3
56.3
55.9
30.3
18.2
39.4
19.4
18.2
23.5
12.6
18.2
6.1
0.0
6.1
0.0
6.1
2.9
6.3
6.1
24.2
18.2
33.3
19.4
12.1
20.6
6.3
12.1
15.2
27.3
6.1
29.0
30.3
26.5
37.5
33.3
42.4
42.4
45.5
48.4
45.5
50.0
46.9
30.3
12.1
12.1
6.1
3.2
6.1
0.0
3.1
18.2
54.5
54.5
51.6
51.6
51.6
50.0
50.0
48.5
30.3
18.2
12.1
21.2
42.4
6.1
48.5
9.1
30.3
11.7
3.0
12.1
2.9
6.1
18.2
8.8
39.4
21.2
32.4
45.5
39.4
41.2
3.0
9.1
5.9
48.5
48.5
47.1
11.8
28.2
0.0
9.4
11.8
18.8
41.2
25.0
41.2
40.6
5.9
6.3
47.1
46.9
18.8
0.0
18.8
34.4
37.5
9.4
46.9
11.8
34.4
0.0
18.8
11.8
15.6
44.1
21.9
35.3
43.8
8.8
0.0
44.1
43.8
15.1
12.2
30.3
30.3
3.0
6.1
6.1
12.1
12.1
6.1
24.2
18.2
42.4
42.4
27.3
27.3
42.4
39.4
39.4
69.4
0.0
3.0
3.0
3.0
42.4
42.4
42.4
42.4
29.1
12.1
6.5
3.0
22.6
9.1
25.8
48.5
35.5
39.4
6.5
0.0
42.0
39.4
30.3
9.1
21.2
30.3
36.4
3.0
39.4
31.3
0.0
31.3
31.3
31.3
6.3
37.6
42.5
15.2
15.2
0.0
27.3
15.2
21.2
42.4
36.4
33.3
0.0
3.0
36.4
36.3
12
Our clinical staff are highly respected in the community.
There is adequate space available for staff to conduct daily
administration.
Clients are treated as customers.
Staff spend an adequate amount of time with clients.
Clients are able to make a smooth transition back into their homes
and communities.
Our facility works with similar facilities to exchange ‘best practices’.
Our organization is highly regarded in the community.
We have an active board of directors.
Holistic treatment approaches are adopted by staff at our
agency.
Anger management is a core competency of our therapeutic
interventions.
Our organization employs a sufficient number of employees to
cover the workload.
Our board of directors drives the direction of the programmatic
offerings.
Staff at our agency are encouraged to participate in the
community in non job-related activities
(volunteer, serve on boards, etc).
We have adequate staff in place to meet the needs of clients.
Staff turnover does not interfere with program effectiveness.
Staff are paid wages and benefits that would be deemed
appropriate and comparable with other similar agencies.
SD &
D
19.4
SD
6.5
D
12.9
N
41.9
A
29.0
SA
6.5
SA
&A
35.5
47.1
28.2
48.4
14.7
6.3
22.6
32.4
21.9
25.8
20.6
40.6
22.6
32.4
31.3
22.6
0.0
0.0
6.5
32.4
31.3
29.1
9.4
15.6
15.7
6.2
0.0
3.1
6.3
3.1
9.4
12.5
9.4
3.1
62.5
53.1
53.1
62.5
28.1
28.1
28.1
21.9
0.0
0.0
0.0
3.1
28.1
28.1
28.1
25.0
18.2
12.1
6.1
45.5
21.2
3.0
24.2
27.3
18.2
9.1
45.5
24.2
0.0
24.2
56.3
25.0
31.3
21.9
21.9
0.0
21.9
18.7
3.1
15.6
53.1
15.6
6.3
21.9
45.4
57.5
71.9
21.2
24.2
37.5
24.2
33.3
34.4
33.3
27.3
18.8
18.2
12.1
9.4
0.0
3.0
0.0
18.2
15.1
9.4
66.7
30.3
36.4
27.3
6.1
0.0
6.1
13
Complete Site-Review Results-Cove Forge
The content in the following summary consists of the information shared in the
site review process. The bulleted statements were transcribed directly from the
notes taken by the site reviewers. In an effort to maintain any anonymity for the
interviewees, all information offered in the site reviews were consolidated
together in this document.
Q1. What makes your agency special? What program/treatment methods does your
agency typically use and which ones are your agency particularly noted for? What
is your agency doing that helps your clients be successful?
(possible follow up questions)
Is your agency open to numerous clinical modalities?
Do you utilize groups/group counseling? Is AA/NA incorporated in-house or in the community?
•
•
•
•
•
•
•
•
•
•
•
Non-traditional treatment setting –values the environment, outdoors, ropes course
Utilize Choice Theory (Glasser) – Reality Therapy
MISA Group- intimate group
Rural culture – pace is slowed/relaxed
Reality Therapy
Individualized/specialized diagnosis groups
Staff personal commitment – giving back to society a better person
Client-centered
Scholarships
Staff is always available and attentive.
Counselors have autonomy in counseling style.
Q2. Please describe issues pertaining to programmatic funding that you currently
face or will be facing in the near future.
How does your agency work within current funding streams?
What types of creative measures does your agency fulfill to make better use of resources at hand?
•
•
•
•
•
•
•
•
•
•
Always a struggle – never enough money
Some clients pay out of pocket
Public assistance/managed care
Help clients apply for MA assistance
Offer scholarships for motivated clients
County funding is most difficult to deal with
Money gets short at end of fiscal year
Scholarships for invested clients
Shortened length of stays
Length of staying is growing shorter – about 14 days inpatient, then transition to
partial – mostly due to MCO’s
14
•
•
Counselors deal directly with county funding
UR Department deals with MCO’s
Q3. What regulations or barriers (agency structure, governmental, legal,
transportation, etc) keep staff from performing at their potential?
How does your agency work within these regulations?
How do employees creatively handle those barriers?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Two programs on same campus that do not mingle
Can’t accept sex offenders
Schedules need to be coordinated with other program due to shared
buildings/grounds.
Limited clinical workforce pool to recruit from due to qualifications requirements
Physical location of program – terrain limits serving a physically impaired client
Terrain of the grounds – need better screening from the Call Center to avoid
medically impaired clients or dump jobs
Limited number of staff, qualifications of staff preclude hiring due to licensing
regulations
Communication with and access to psychiatrist
County mental health services are poor
Local hospitals give addictive medications to our clients
Too much clinical paperwork!!
A lot of case management demands take away from counseling time
Sicker clients, more complex cases
Increase caseloads – average 12-13
Q4. Please describe issues pertaining to staffing issues.
What is your staff turnover situation like?
How does your agency recruit new workers? Retain existing staff?
What happens when staff shortages occur? What is done to deal with the shortage if hiring more staff
is not possible?
How do you view staff benefits and pay compared to other local social service agencies?
•
•
•
•
•
•
•
•
•
•
Some longevity in staff – others come and go quickly
Advertise in newspapers, job fairs, word of mouth
Employee bonus program
Overtime is a major issue for staff – sometimes available, sometimes not
Benefits package is good/competitive to other agencies. On a scale of “0-10,” would
rank Cove Forge a “9”
Turnover for counseling is “horrible.”
Always feels like I have to give 150% just to cover routine program activities
Newspaper ads
Staff incentive to bring in someone they know for hire
Combine groups to cover staff shortages
15
•
•
•
•
•
•
Competitive salary and benefits
In three and a half years, I’ve seen 23 counselors come and go.
Morale is an issue – linked to increased workload
Recruit via newspaper and college fairs
Overtime
No knowledge of how benefits compare
Q5. What are some specific problems you have regarding staff behaviors?
Does your agency use incentives to increase positive behaviors?
Does your agency use ‘punishments’ to dissuade negative behaviors?
How is overall staff morale? How does agency go about increasing or maintaining morale?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Boundaries with clients – inappropriate favors investigated
Teaching/training for staff
Progressive discipline – generally staff are given benefit of doubt
Staff morale “9” on scale of “0-10”
Some more positive and committed, others not invested
Have a “Spirit Committee” to promote morale
Staff fraternization with clients
Verbal abuse toward clients or escalating situations
Negative attitudes
Progressive process of discipline
Thinks morale is poor
Management trying to enact a Spirit Committee, initiating a reward system for doing
good
Boundaries with clients – counselors give cell phone or personal information to
clients
Terminations for confidentiality violations or progressive warnings for documentation
deficiencies
Q6. Most agencies experience limitations within their environment (i.e. space
availability, safety, cleanliness). What limitations or difficulties have you
experienced in these areas? How do you work around these issues?
Is your work space conducive to completing your job responsibilities?
Does your building offer adequate space for the various aspects of clients’ treatment?
Do you feel safe in your facility? Do the clients? Visitors?
Are there other environmental stressors that inhibit your work or clients’ progress?
•
•
•
•
•
•
Space is always an issue – constantly growing and expanding
Periodically experiences overcrowding in buildings – use outdoors in good weather
Have separated male and female programs
Feel safe most days – occasional wildlife, deer, skunk, snake can be scary for some
The program has made an effort to be safety-conscious.
Have minimal incidents
16
•
•
•
•
•
•
•
•
•
•
Office space is improving.
Have to share buildings
Adolescents and adults share a campus but can’t interact, which limits schedule
flexibility.
Feels safe
Greatest threats: understaffing, lack of experience or training
Always short on office supplies
Have good office space due to expansion
Weather/winter is challenging due to campus setting
Feels safe – work together as a team to manage aggressive clients
Everyone has walkie talkie/radios due to campus setting
Q7. How does your agency bring new clients in? What is the referral process?
(please provide a flow chart if one is available)?
Do clients who are accepted for services typically “fit” the programming offered at your agency?
Are there any restrictions for new clients who are brought on?
What expectations do you set for new clients?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
External referral sources send client history for intake staff to evaluate
appropriateness
Established intake separated
Client-orientation
Some clients not permitted to return
Marketing department
Get continued referrals from satisfied referrals
Won’t take Megan’s Law
Must be here seven days before family can visit
Clients are told to be where they should be and when
Counselor job is to engage
Varied referrals – funders, self, other D&A
Provide transport
Detox nurse does triage assessment screening and client placement in community
orientation
Do not admit Megan’s Law or non-ambulatory clients
17
Q8. What role does your agency play in terms of continuing treatment care? What
types of after-care services are usually set-up for clients?
How is the transition back into the home handled? What’s the after-care approach?
Are there arrangements with other agencies to transition clients?
How are housing needs and education/vocational training needs addressed?
Who is responsible for coordinating after-care services? Do you have other departments/divisions
within your agency to offer services?
•
•
•
•
•
•
•
•
•
•
•
Aftercare for everyone – even if not completing successfully
Continuum of care – partial, halfway house, outpatient, and IOP
Designated aftercare department that coordinates plans
Aftercare department is new – been in place about 9 months to 1 year
Previously done by clinicians
Prepare clients with brochures and questions for interviews
Halfway houses, partial, IOP, outpatient
AA/NA
Intensive case management
Shorter, housing
Aftercare department with counselor input
Q9. How does your agency address culturally-sensitive issues relating to your
clients?
Does your agency offer services in languages other than English?
Are non-traditional ethnic holidays observed within your agency?
Are there any offerings targeted for specific ethnic/gender/racial/religious/sexual orientation groups
at your agency? If so, please describe.
•
•
•
•
•
•
•
•
•
•
Accommodate diverse religious practices – diets, prayers, services
Adjust schedules as able
Diverse population – HIV/AIDS, transgendered, criminal justice, youth, Muslim,
Catholic, race, gay
Discuss diversity in group – build common bonds
Counselors try to be non-judgmental.
Special holiday schedules and events
Religious/spiritual considerations – schedule accommodations
Church service/Bible study on grounds
Priest Eucharist coordination
No bilingual staff – use online translations, have Spanish materials
Q10. What external agencies does your organization have a relationship with (i.e.
probation/parole, hospitals, D&A, etc)?
Explain each relationship, including the general arrangements, the referral process, any strengths
or weaknesses of the relationships, or any other relevant information.
•
Church comes in to do Bible study
18
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Salvation Army for clothing
Home nursing does seminars
OVR
Altoona Regional Hospital for ER and crisis
AA/NA
C+ requests needs from counselor who coordinates via transport and medical
departments
Participate in local town meeting
Probation/parole – court
MISA case management
Housing
Medical appointments arranged via medical department/nurses
Hospitals –team meetings
Sharing information is limited by regulations/HIPPA/etc…
Need training for staff on consents to disclose information.
Master consent list is rarely accurate, so staff doesn’t know who releases are signed
for
Other D&A providers
Probation/parole
Two local hospitals
Psychiatrist here three times a week
Shelter and clothing
Dental
Q11. What are the main methods of communication between members of your
agency?
Describe the communication between staff-to-staff members. What barriers are there that prohibit
effective communication?
Describe the communication between staff and management. What barriers are there that prohibit
effective communication?
•
•
•
•
•
•
•
•
•
•
•
•
•
Carry two-way radios
Communication required to run program effectively
Department meetings every 2 weeks
Email for some
Memos
“Cove Forge Chatter” newsletter
Mandatory trainings – policy changes
Email, voicemail, walkie talkie, memos
Good communication between counselors and average with tech/support staff
Poor communication with nursing
Barriers are found in who interprets what is important
Phones
Shift reports – start and end of shift
19
•
•
•
•
Email Voicemail
Walkie talkies
Communication from management usually via memo or voicemail/email
Staff to staff meetings
Q12. Talk about the professional development opportunities available at your
agency. Is staff upward mobility possible? What are the opportunities for
training/continuing education?
How do you handle advancement of staff? Is it common policy to advance from within?
If mobility is not possible, how does your agency deal with morale issues?
What additional training topics might be useful?
•
•
•
•
•
•
•
•
•
•
•
•
If person is willing to do the work, you can be promoted, develop new skills
Receive tuition reimbursement – financial incentives
Promote and advance from within
Training is intense and diverse – a lot of topics available
No upward mobility for clinicians
Some flexibility in lateral or downward moves
CAC encouraged on performance evaluations
Limited training emphasis except as required by regulations
Staff responsible to obtain minimum hours and to do them on grounds. External
training is rare.
Very little professional advancement within
Education reimbursement
Financially supportive of CAC pursuit
Q13. How is technology/new technologies incorporated into your agency?
Used in developing Treatment Plans?
Used in Assessments? What assessment tools are utilized?
•
•
•
•
•
•
•
•
•
•
•
Treatment plans, assessments, etc. are computerized
Available to clinical/administrative staff
Paper clinical records
On-line access to all staff
No computerized clinical software
Share data banks internally
Voicemail
Email
All counselors have computer
Have “Qualifacts” – online C+ info, admissions demographics
Full clinical record is not computerized system but do use data processing
20
Q14. Are programs utilized within your agency ‘research-based’?
What theories do you apply in practice?
What research-based assessment tools are utilized?
Does your agency receive funding/grants for research-based programs?
•
•
•
•
Limited knowledge of this
Do Q.I. Survey – exit satisfaction survey
None known
Not aware of any
Q15. What types of Outcomes does your agency track?
Do you track client satisfaction? If so, how are the results utilized?
Has your agency ever undertaken a Strategic Planning initiative? (if yes, provide copy of Strategic
Plan). If yes, are you currently working off of one now? What are the goals?
•
•
•
•
•
•
•
Does not know the specific results of surveys but does get feedback on trends
regarding strengths and complaints
Follow up on aftercare
Not aware of strategic plans
Receive feedback from client exit survey but hear minimal stuff in busy clinical
department
Feel out of the loop
All staff give input to management about strengths, weaknesses, opportunities, and
threats
Management/administration takes care of strategic planning
Q16. How would you describe the relationships amongst
A) Staff to Staff
•
•
•
•
•
•
Considering turnover, can be frustrating
Have some trusted friends
Supportive/cooperative, except when stressed by staff shortages
Everyone works together for better client service
Good relationships – cohesion in clinical department
Unaware of other departments
B) Management to Staff
•
•
•
•
•
Management is visible, approachable, part of us, open door
Below average – staff don’t get the information they need sometimes like relates to
safety or history or schedule changes
“We” – “They” dynamic
Emails and memos
Less personal
21
•
Management has deaf ears about clinical.
C) Management to Management
•
•
•
•
•
•
•
No significant turnover
Limited knowledge but thinks they get along
Stability in staff
Good – they stick together
No idea
Behind closed doors
SHHH!
D) Board to Staff/Management
•
•
•
•
•
•
Totally unaware
Who’s the boss?
Board to staff – non-existent
Do we have a board?
“Is that who I occasionally get emails from?”
Don’t know them
Q17. What is the perception of your agency in the community? With staff? With
clients?
What issues are there regarding agency perceptions?
Does the community utilize the services?
•
•
•
•
•
•
•
•
Attentive to any community concerns
Have not disrupted service
Many community members work here – helps the economy
Not aware of any complaints
Cove Forge makes an effort to keep the peace.
Occasionally conduct neighbor meetings
Clients are viewed as criminals and bad.
Community just doesn’t know much.
Q18. What other potential services would be beneficial for your agency to offer?
Are these services available elsewhere in your community? Identify any other future opportunities
for your company.
•
•
•
•
ATM for clients (funding/banking for clients)
Local halfway house
Residential housing for staff for inclement weather or during overtime periods
Practical living skills – parenting, budgeting, balancing checkbook, anger
22
•
management
Need a better way to assure aftercare follow-through - compliance - attendance by
clients
Q19. What aspects of your agency could serve as a model for other agencies? What
can your agency do to improve?
•
•
•
•
•
•
•
Real talk
Reality Therapy
Straight talk with clients
Individualized mental health diagnosis groups
Bipolars not grouped with schizoaffective disordered individuals – allows more
personalized emphasis
Young opiate addict program with specialized service
Specialized caseloads – specific populations versus always so diverse so we could
concentrate efforts
Q20. Do you have any other additional comments or concerns that you feel would be
beneficial?
•
•
•
Feel competition with other agencies – would be nice if we could share more in the
field and compete less
Cove Forge needs to first get adequate staff and train them BEFORE expanding
another program.
Feels seen as an individual/person who matters – not just an employee
23

Table of Contents

Transcription

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