2001-07-16 Regular Meeting717 E Rezanof Drive
Kodiak, Alaska
99615
MINUTES OF THE WORK SESSION MEETING OF
THE PROVIDENCE KODIAK ISLAND
MENTAL HEALTH CENTER ADVISORY BOARD
Monday, July 16, 2001
I. MEETING CALLED TO ORDER
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The meeting was called to order at 5:30 PM by Vice -Chairperson Pam Foreman in the
Providence Kodiak Island Mental Health Center Group Room (Jodi Burcham was a few
minutes late).
II. ROLL CALL
Members Present
Members Absent
Jody Burcham
Cecil Ranney
Romiegio Marasigan
Dave Davis
This Falcone
Pam Foreman
Steve Honnold
Lorri Doyle
Darlene Turner
Karen Perkins (KAMI Rep, ex-officio)
Staff Present:
Guests Present:
Matthew Stutes
Tambi Fields
Laura Perkins
Francis Cater
Linda Jackson
Etta Singleton
Betty Bergen
Susan Brockman
July 16 2001 Special Meeting (Site Review) Minutes
Public Comments:
Linda Jackson: curious about the site review plan
Robin: We're going to walk through the draft copy of the site review and a plan of improvement
to make this meeting go smoothly, point out problem areas, and see if these can be improved.
Linda expressed interest in recommendations being discussed and suggestions for plans and
recommendations, encouraged a plan for input from consumers, and stated her hope that the plan
will include way to include interaction with consumers, as they are in attendance and available to
give input. She noted her hope to nominate someone from NAMI for a consumer group.
Pam: This should be a very open discussion and let us know if you have an idea on any of these
issues.
Steve Honnold asked all present to identify and introduce themselves, which was accomplished.
I. Special Meeting by Jodi Burcham called to Order 5:44 P.M.
II. Roll Call was repeated.
III. 2001 Site Review
The site review and proposed plan of action were handed out by Robin; Jodi handed out fiscal
year 02-03 standards of care. Robin asked this be reviewed as a draft plan of improvement.
Robin — first recommendation: To ensure that the advisory board participates in the development
and monitoring of the program budget. Robin and Susan Humphrey Barnett went through and
drafted this without Board involvement which was probably a mistake, but time constraints did
not allow that. We work with two different budgets: Calendar year, which is Providence, and
the fiscal year, which is the grant. The process for the fiscal year will probably start in the fall,
and this year is a trial run. There are very specific guidelines and deadlines.
Pam: Suggestion for consideration: It may be beneficial for the Board to sit down and have
some goal discussions with the staff and see what goals the staff has and then sit down and do
the numbers. Some of these goals may be a five-year plan.
Robin: Two year process on a grant; we were lucky that funds weren't cut, so bottom line won't
change for this two years.
Thia: Is it possible to start the quarterly reports now?
Robin: Yes, probably can start soon; probably will have no meeting in August as both Robin and
Dr. Jensen will be on vacation in August, so maybe in early September.
July 16 2001 Special Meeting (Site Review) Minutes
Darlene clarifies this is the first year of the two-year grant and suggested bringing in clients and
finding out their needs and goals.
Robin: Second item: Devise a process to actively solicit and carefully utilize consumer and
family input in agency policy setting and program delivery. This deals with satisfaction surveys,
taking them and entering in a database; involves needs assessment process which would involve
consumers and staff. Not included in the written draft, which maybe should have been, is to
have one of the consumers appointed as a representative to the Advisory Board to report and give
feedback, so we may want to add that.
Karen Perkins: Good idea, but may not be going far enough as we're not getting the full
spectrum involving everyone. Perhaps we need an outreach — if we can't get them to come to us
-- by going to them individually as some may have trouble voicing their needs and wants.
Linda Jackson: Maybe this could be achieved by either personal or telephone interviews.
Robin clarifies what a "needs assessment" is: Advisory Board's responsibility to select whatever
method is useful to assess and determine need and bring back reports to the staff. Perhaps a
needs assessment committee should be organized.
Lorri: Expressed concerns about her privacy being protected as a consumer, and may be
offended by someone calling her.
Pam: Like the idea of a combined committee to come up with the needs assessment process with
all concerned groups involved.
Karen P: Asked Robin about results of input on the surveys
Robin: Yes, good input, but we need a change to include anonymity and a way to be contacted if
that is the consumer's wish.
Karen P: Opined the Coast Guard area doesn't feel comfortable about taking these surveys
because their transitory nature inhibits them.
Robin: Interviews all must be identical in order for results to be valid. Same person has to ask
each person the same questions in the same intonation of voice. It's human nature to have
inflection in your voice that may skew the response and invalidate the results.
Linda: We can contract an impartial interviewer or use good advertising to reassure them these
interviews will be confidential and help will be available to those who wish.
Robin: Both Welby and Robin are anxious to improve things and make them better. We don't
want the mentality of "us against them", so there needs to be an interactive discussion.
Linda: We need the spirit of cooperation.
July 16 2001 Special Meeting (Site Review) Minutes
Francis Cater: When a forum is "open" there is less griping and we get the feeling that ideas can
be incorporated.
Pam: Attended the consumer forum at Bayside, and that worked. Robyn Henry was a good
facilitator and that's what needs to happen in a broader form. It's key to figure how and who is
going to facilitate so people feel comfortable.
Robin: For second recommendation of the site review, Robin will add that a Consumer
Committee exists and that a request will be made to have a representative to the Board from that
committee - not as an official Board member but only as a representative to come and speak to
the Board during public comments.
Darlene: This Board will establish a committee? But there will need to be a staff person, also, to
make this a true representation of what is happening.
Pam: Need for consumer committee on an outpatient side as well as CSP side? Or is this what
NAMI serves?
Linda: Would like to see the Advisory Board is made up of at least 50% consumers and/or
family members.
Robin: There is no stipulation now of any certain percentage. The definite thing for No. 2 is we
need a board committee established with significant consumer involvement on the needs
assessment process and how to do that, and that we want to ask the CSP consumers right now to
appoint a representative to the Board.
Matt: Most of us don't know what's going on with this and don't understand it.
Robin: Moving on to #3: Systematically involve consumers; that's the crucial piece. We all
need to consider data and information obtained in site review. We can consider data and
determine priorities that we can reach during a certain time frame. March 2002 coincides with
that policy and is when this data needs to be completed.
Darlene: We might want to break these down and add to them, and because we're here maybe
we should pencil in some deadlines now so we don't forget it.
Robin: October, a committee should be established, and then go with the policy, December,
select, and January, conduct, and March, review results. We don't want to amend this policy,
we're going to use this policy and add that by October we'll establish this committee.
Matt asks for clarification of what a needs assessment is. Robin explains that it's getting out in
the community and talking to the community and to consumers, looking at the funds available
from whichever sources, looking at staff needs, and assessing what need is out there and trying to
determine if there should be changes. There also may be a whole series of needs in which case
they would have to be prioritized since there may not be a way to fund them all.
July 16 2001 Special Meeting (Site Review) Minutes
Tambi asks for clarification of the action plan; Robin agrees there were some negative issues
brought up and stated the staff is aware of trying to correct these.
Robin clarifies, with "areas of excellence"; the site committee admitted that no one is going to do
well since the standards are just too high, so what is one to do? Therefore the good things must
be stressed.
Pam reminds us that this is a site review meeting and this is probably not the place and time for
this conversation, and the logical place for those comments is not here.
Robin advises of the last time we had a review, and failed miserably on the chart audit section.
There was no training provided; we were the squeaky wheel and complained. "Don't hammer us
down; teach us, train us, talk to us". The following year training was implemented. All training
needs to be consistent in all communities, i.e., Kodiak to Seward, to Anchorage.
Darlene states staffs perception of this reality is completely different than the consumers'
perception, and we can use that in a constructive way.
Matt Stutes stated in his opinion if there is more interaction between the employees of Mental
Health and CSP, in meetings or any other way, it would probably improve the program.
Karen stated there is improvement to be made; we should not look as these things as adversarial
and take things personally.
Dr. Jensen stated that yes, there are perceptions, and if you look at the scores, the scores are
average; high scores for chart review and average scores for the rest of it.
Dave, referring to pg. 9, are areas requiring response, stated that these are the standards.
Robin notes that in addition to No. 2, to add as a prelude to the fiscal budget preparation and that
will make the process more clear.
Issue No. 5, Robin outlined some of the Board's participation, and stated these boards and task
forces that already have staff members appointed to them, and it becomes a matter of availability
and time; but there does come a point where the line has to be drawn. Ergo, the comment "as
time/staffing permits".
Thia reminded the Board that Kodiak Village Safety Services is not Kodiak Village Services
Network. She stated the score was low on the following -through on clients, and we need to
keep an eye on this aspect.
Karen P. feels like Providence Mental Health Center has been more or less abandoned by
KANA, and Robin agreed, especially since Providence took over from the Borough. Dr. Jensen
stated perhaps this was because of staffing changes also, and they have the grant so they need to
take the lead on this. Perhaps this is a funding issue through KANA and they need to select what
July 16 2001 Special Meeting (Site Review) Minutes
services they want to offer, i.e., dental coverage over mental health coverage, etc. Dr Jensen also
stated his appreciation for the extra mental health staff service that has been provided by KANA.
Thia stated that KANA members do receive a one-time $300 for alcohol treatment, but again, Dr.
Jensen stated this is a matter of funding priorities for them.
Darlene stated perhaps we could go after state or federal funding for bereavement or fire loss, or
any catastrophic and trauma related counseling.
Robin summed up that we changed to Kodiak Village Services Network, added Kodiak Safety
Net and the CISM team. Dr. Jensen brought up the Hispanic and Filipino medical and mental
health needs should be added, and Robin stated that is Project Health Access, so that should be
clarified also. Darlene stated for those community projects, perhaps the Rotary or Lions could
be solicited for small grants. In summary No. 5 should be broken up a bit from serving on task
forces and boards to special projects.
A ten-minute break was requested.
Meeting was resumed at 7 PM to Site Review No. 6. This is an area all mental health centers are
struggling with because there are very definite human resource laws that enter into the picture.
Robyn Henry suggested through Robin to put a spot on the survey where a consumer could enter
a positive or negative summary about a provider wherein Robin and Dr. Jensen could review.
Thia suggested an embellishment of a treatment team approach which definitely involves other
family members.
Darlene asked how we can incorporate a generic plan for a hiring process, and how we can
incorporate that since we don't hire by committee; this is a private process. The administrator
has to decide on a candidate, not the Board, so the State should be asked specifically for
guidelines. Robin sums up we need an elaboration of the treatment team we use and that is
designed by consumers, and address the hire issue in the comment letter.
Lorri stated that as a consumer and a family member, she has no business in the hiring selection,
because as a consumer, she potentially could be her own worse enemy! She stated she just does
not have the education and awareness to do that.
Darlene agreed the administrator should be the one to do the hiring process.
Karen suggested the needs assessment process is already ongoing, but we just aren't calling it
that. Robin will add a comment relating back to the needs assessments, and a notation about the
hiring process actually stems from the needs assessment determination of what everyone needs,
addressing that hire issue in the comment letter, and elaborating on the treatment team approach.
No. 7 of the Site Review was identified as a statewide thing as far as a smoother transition for
folks leaving API and coming home, and the transition from CSP to individual therapy.
Thia thinks moving from CSP to individual therapy is "bumpy", as far as not enough help to deal
with the transition as far as the continuity of care.
July 16 2001 Special Meeting (Site Review) Minutes
With Chuck as the new CSP team leader, issues may be more identifiable in time by him.
Comments were made by consumers Tambi and Matt and comparing the transition from both
API to individual therapy, and how to make the transition from CSP. Dr. Jensen stated there is a
gap, but no matter what people do come here and we scramble to get them housing, etc.
Thia said we may need another task force or committee on this issue; Darlene agreed with the
comment that the issues aren't being addressed now, and that we are looking for direction
perhaps from a statewide task force to achieve a successful outcome, consisting of providers,
consumers and family members. Robin stated she will add under No. 7 "immediate — already
being addressed as an ongoing concern", see comments for board recommendations, and add the
portion of not just working with API and other providers, but also CSP to out -patient as well.
As a consumer Matt stated he would like to learn how to become more independent by
maintaining his own benefits, i.e., more than funds, but needs such as social security, etc. Linda
and Tambi concurred with the addition of perhaps rehabilitation to return to the work force with
a transition group. Robin suggested we address in the letter that we recommend a statewide task
force be established to formulate standards, to include consumers' family members and
providers. Robin also made a comment that the management of the center and the Board
recognize the transition from CSP to out -patient can be a difficult process, and will pursue
developing some internal policies. Thia's closing comment on No. 7 was that it relates very
closely to the other numbered issues.
Site Review No. 8: (7:30 PM) Dr. Jensen is already addressing this issue with each individual
client as it concerns that client. The AMA and APA also have standards written out on the
"physician's right to choose" his professional relationships. Jody asked if this agency had an
ethical obligation to see clients as this is a community center, and not privately owned.
Dr. Jensen responded that perhaps those concerns should go to the governing board; however he
has already discussed these issues with Providence H.S., the Borough, the APA, legal services,
AMA and peer review, and they all concur in his decision. Dr. Jensen also stated that this policy
may be a hardship on some people, and was even a hardship on him, and he was ready to leave if
he had no rights. But that if his basic choices / decisions as a physician are taken away from him
(or from any provider), there probably will be no one willing to step into that position. Dr.
Jensen stated that he stands by his record, and stands by his ethics, and by his rights.
Additionally, he does not have to comment about what those are. Dr. Jensen stated that he stands
by the site review's plan of action on this issue.
Pam expressed perhaps there should be some sort of reassurance to the clients, and perhaps there
should be some discussion on the solution to that issue. Perhaps there should be a policy
established as to what a client's options are in a situation such as this.
July 16 2001 Special Meeting (Site Review) Minutes 7
Linda asked for clarification from Dr. Jensen on a blanket refusal to issue med management to
new clients (since 1997) who have seen the local psychologist, and what options these clients
would have — i.e., going off the island.
Dr. Jensen responded it would in fact be the client's choice, whether it be off island or to another
local provider. Robin clarified this issue further by stating that in her opinion Dr. Jensen is a
very highly ethical man, and that he believes very strongly in his professional responsibilities to
his clients to see that they are receiving the best care possible. Robin added that Dr. Jensen also
has his own professional liability to be concerned about, that as a psychiatrist who must bear
almost all the professional liability for perhaps a poor clinical choice that could have been made.
Robin summed up by stating that the consumer does have a choice — the consumer can see Dr.
Jensen and trust in his judgment, or to see another provider, local or not. This could be likened
to the hiring issue in that sometimes you just have to trust the persons you have hired to do their
job.
Lorri agrees that Dr. Jensen is making a professional choice in his decision, and as a consumer
she could "care less" about the legal details.
Jodi made the comment that there is only one psychologist in town. The point has been made,
and everyone is tired of it being rehashed, and added there is only one Ph.D. in town, which may
be a problem.
Thia suggested we state more how the choice making is done.
Robin clarifies this is only a professional decision on Dr. Jensen's part.
Matt asked if someone would be not admitted to CSP if they chose to see another provider, and
the answer was no; a CSP client could choose the provider they wished and still be a part of CSP.
Thia clarified this remark, and stated that if Ph.D. services were the wish of a consumer, the
choice would be the client's, and yes, having a choice is a good thing.
Darlene said that not all people will agree on all things, and that's the way it is. The decision has
been made, and it's Dr. Jensen's professional decision.
Pam compared this decision to an HMO; you either use your HMO or go elsewhere and not have
your insurance cover it; it's the client's decision. It's within the client's right to make those
decisions.
No. 9 of the Site Review: Robin stated we did revise the grievance policy to conform to the new
regulations. Information on grievance procedure is provided to each new client and is posted in
the reception area.
IV. Special Meeting Adjourned
July 16 2001 Special Meeting (Site Review) Minutes
IIl. Clinical Director's Comments
Since there were two meetings in July and since both Dr. Jensen and Robin are taking vacation
time in August, there will no August meeting; the next meeting will be held September 10, 2001
at 5:30 PM. There will also be another meeting next Monday night (July 23).
IV. Director's Comments
Robin commented on the good turn out and thanked all for attending.
V. Advisory Board Comments
Pam also thanked everyone for attending and expressed hope for more participation in the Board
meetings from consumers in the future. Pam also comments on how painful a site review can be,
but how helpful they are too.
Thia expressed pleasure on the productivity of the meeting.
Lorrie had no comment.
Karen thanked the Board for making the consumers so welcome.
Darlene expressed pleasure that so many consumers attended this meeting, and gave kudos to
Robin on her plan, and thought there was much improvement from the year before.
Rom had no comments other than he thought the meeting was very educational to him as a new
member.
Dave said he was very encouraged to hear the discussion on transition, as he believes this is the
key to recovery, and also commended Dr. Jensen on "making a stand".
Steve also thanked everyone for attending, and agreed with "everyone else"; and Jodi
congratulated all on the good work accomplished.
Linda Jackson reiterated her earlier comments about having the Board consist of 50% consumers
and families. She also expressed how impressed she is with the Board and their extensive
knowledge of the issues, citing her own inability to comprehend most of them. She also
expressed her belief that the Board has the consumers' interests at heart.
July 16 2001 Special Meeting (Site Review) Minutes
Meeting was Adjourned (8:00 PM)
Respectfully submitted by:
G�
Micky Cra ord, Adminis ativ Assistant
Jody B ham, Chairperson
PK Advisory Board
July 16 2001 Special Meeting (Site Review) Minutes 10