David & Margaret Assessment Report Conducted by WPM Consulting, Inc. and Lieberman Group, Inc. June 4th and 5th 2019
Consultants William Martone, MS from WPC Consulting Inc. and Robert E. Lieberman, MA LPC from Lieberman Group, Inc. conducted an on-site assessment of David & Margaret Youth and Family Services on June 4th and 5th of 2019. The purpose of the assessment was to assist David and Margaret in improving their Temporary Shelter Care Facility (TSCF) and Short-Term Residential Therapeutic Program (STRTP). The assessment consisted of a review of documents which including program statements, the mental health plan, clinical records, QA/I data, data on incident reports including police contacts and the agency’s training and orientation program. Additionally, face to face interviews were conducted with TSCF and STRTP Line Staff, STRTP Supervisors, TSCF Supervisors and Case Managers, TSCF and STRTP Youth, TSCF Overnight Supervisors, Clinical Staff, Training and Human Resource Staff, and Co-Located DCFS Staff. Phone interviews were conducted with family members of current clients.
This report will identify both agency strengths and challenges identified during the assessment process. The report will additionally make recommendations to David and Margaret on immediate, intermediate and longer-term steps they should consider taking to improve both their TSCF and STRTP programs.
Many strengths were identified during our record reviews, and interactions with staff, supervisor, youth and parents. The items below are a few that stood out to the consultants.
- A structured and carefully thought out orientation and training program
- Caring and dedicated staff committed to the youth served
- Parents who felt supported by the staff and program
- An awareness of the impact of trauma on the young people served and aspiration to be trauma-informed in practice and programming.
- Use of staff surveys to gather feedback.
- Well-supervised overnights
The agency also faces a number of challenges at this time and a few that were noteworthy include the following.
- The understanding of trauma-informed care is incomplete, leading to a misunderstanding of the practice implications.
- Structures, routines, and expectations in the units are not currently well established, particularly in TSCF, leading to dysregulated behavior and inconsistent staff responses.
- Communication is inconsistent and at times fragmented, leading to a feeling of disconnectedness between staff and leadership.
- Staff feel unheard, unsupported and unappreciated, despite efforts by leadership otherwise.
- Youth report feeling bored, without much to do, and at times disrespected.
- Youth report not feeling heard or safe.
- There is not a consistent program or structure in place in the TSCF unit.
Recommendations are grouped into three major categories which include Program, Staffing, and Communication areas for improvement. The recommendations are further broken down into what the consultants believe are steps that should be taken immediately, in the not too distant future and those that could be implemented over a longer period of time.
- Create a staff committee made up of invited staff from all levels of the organization to work with leadership to define the TSCF program model and structure
- Involve youth in this program development of expectations and structure
- Provide in depth training to all staff regarding the impact of overwhelming stress and trauma, including key principles and concepts of the brain science, with practical strategies for implementation
- Introduce Collaborative Problem Solving to clinical staff as a foundational interactive approach
- Enhance medical services and medication distribution through the use of nursing staff that can potentially be funded with mental health dollars
- Enhance the understanding of the importance of family driven practices, creating a sense of urgency in achieving permanency that results in positive long-term sustained outcomes for youth
- Create more opportunities for family involvement in the community, in the cottages and on the grounds
- Become familiar with and implement the Building Bridges Initiative framework and materials, utilizing the Self-Assessment Tool to guide strategic planning for implementation
- Evaluate program wide frameworks for trauma-informed practice, including Risking Connections, ARC, Nurturing Heart, Collaborative Problem Solving
- Facilitate coming together with all four TSCF providers in the county as a user group/learning collaborative to discuss the various models and approaches each program is using and jointly work with DCSF on practice and regulatory issues
- Clarify reporting on police contacts, both AWOL’s and Face to Face, and create necessary data sets to more precisely differentiate and track the information
- Enhance immediate program development with programming and interactional approaches and strategies that will eventually allow the elimination of point systems
- Establish practice guidelines which assure that youth can spend time at home as soon as possible upon entry to the programs and time at home is appropriately arranged
- Engage youth in identifying on-site and off-site activities they want to participate in as a regular part of the program
- Shorten response time to repair property damage, especially in bedroom areas when a new youth may be entering later that night
- Provide training in youth-guided care and peer support
- Review debriefing techniques after incidents to assure they occur as soon as possible and include the youth for at least part of the session.
Longer Term Steps
- Implement/enhance long term structures, routines, programs designed or selected through the immediate and intermediate processes
- Implement priorities/plans and training emerging from the BBI self-assessment process.
- Involve youth in exploring and adjusting social media and cell phone policies
- Clarify the messaging to youth and families in the STRTP and TSCF regarding length of stay
- Explore and provide training for staff on the CSEC youth that might extend beyond the current Saving Innocence training
- Immediately increase the physical presence of the Executive Director, Chief Program Officer and Supervisory Staff in the units across all shifts, interacting, role modeling, coaching and mentoring as appropriate by role.
- ·Consider increased staffing with a review of schedules so more reasonable shifts and hours work for staff might be developed, hopefully leading to increased morale and reduced turnover
- Engage staff in aligning the agency mission, purpose, values with program development changes; focus on staff relationships with youth
- Focus on staff-youth relationships based on the principles of the brain science in hiring interviews and supervision to improve communication between staff and youth
- Develop an effective, responsive IO Department that can immediately respond to crisis and provide safety to youth and staff
- Establish and uphold clear expectations for supervisors, managers, program managers regarding their responsibilities for staff performance and conformance
- Assure longer term staff and managers participate in the current orientation and training program all new staff receive so they can model and teach to it on the living units and not create a different set of rules and expectations
- Increase supervisor training to assure interoperation and consistency across all levels of supervision reducing differences between supervisors
- ·Analyze the current number of positions contrasted with identified program needs to determine future staffing requirements
- Develop and implement practice guidelines and expectations that involve youth in hiring processes
- Find ways to introduce self-care options and practices into the agency and explore opportunities available through insurance brokers to support these activities
- Explore ways to enhance teamwork between co-workers
Longer Term Steps
- Retrain on the use of the Core Practice Model to assure it is appropriately integrated into the overall treatment program
- Determine how staff in the future will be trained on Pro Act that assures within an expectation of no restraints and seclusions there may be rare exceptions, for the safety of the youth and staff, when a physical intervention is required to assure safety in the environment.
- Review hiring qualifications for staff in the TSCF program
- Engage staff regarding issues related to morale and establish realistic expectations for what the agency can address in any given year
- Assure all program supervisors have access to deidentified information from exit interviews and are required to explore strategies to address turnover
- Explore on-going ways staff can participate in all aspects of the agency and offer their input and suggestions, for example through content-specific committees
- Analyze current communication systems and mechanisms; find improved ways to effectively communicate necessary information assuring all levels of supervisory staff fully understand agency communications, while simultaneously assuring opportunity for effective communication to and feedback from staff exists at all levels.
- Establish a staff committee to analyze the current meeting structure and explore ways to more effectively structure meetings and differentiate decision making responsibilities, and to communicate their processes and decisions, while assuring processes and information are not unnecessarily redundant
- Train supervisors and leadership on the importance of messaging to both youth and staff and assure that inappropriate statements to youth or staff are immediately addressed
Longer Term Steps
- Determine what data to collect and analyze and determine how to more effectively communicate and display agency data to staff, leadership and the Board of Directors
- Explore the use of meeting charters that define the purpose, responsibility, authority, membership etc.
- Develop, in conjunction with the DCFS co-located staff, a protocol identifying differential roles, responsibilities, and lines of communications and develop an MOU to memorialize the decisions