LOOKOUT MOUNTAIN COMMUNITY SERVICE BOARD
PERFORMANCE ANALYSIS FOR THE FISCAL YEAR 2007-2008
Background
Lookout Mountain Community Service Board is a public corporation created by State law to provide Mental Health, Developmental Disabilities, and Substance Abuse Services to persons residing within Catoosa, Chattooga, Dade and Walker Counties of Northwest Georgia. The governing board is comprised of a majority of consumers or family members and is reflective of the social and demographic characteristics of the area.
The local population is primarily Caucasian, with a small number of African-Americans, Hispanics, and other races. The table below indicates the numbers per county:
County Statistics 2006African-American / Hispanic / Caucasian / Other Races / TOTAL
Catoosa / 1,420 / 1,056 / 59,169 / 841 / 62,486
Chattooga / 2,695 / 855 / 23,366 / 128 / 27,044
Dade / 241 / 207 / 15,683 / 161 / 16,292
Walker / 2,581 / 759 / 60,917 / 512 / 64,769
Catoosa / 2.27% / 1.69% / 94.69% / 1.35% / 100.00%
Chattooga / 9.97% / 3.16% / 86.40% / 0.47% / 100.00%
Dade / 1.48% / 1.27% / 96.26% / 0.99% / 100.00%
Walker / 3.98% / 1.17% / 94.05% / 0.79% / 100.00%
The table below indicates the demographic numbers for employees of LMCS:
EEO-4 Job Category / Ethnic Group / Sex / # of EmployeesProfessionals / White / Female / 33
Professionals / White / Male / 23
Professionals / African-American / Female / 6
Professionals / Asian / Female / 2
Professionals / Asian / Male / 2
Technicians / White / Female / 4
Technicians / White / Male / 1
Paraprofessionals / White / Female / 81
Paraprofessionals / White / Male / 13
Paraprofessionals / African-American / Female / 15
Office/Clerical / White / Female / 36
Office/Clerical / White / Male / 1
Office/Clerical / African-American / Female / 2
Service Maintenance / White / Female / 22
Service Maintenance / White / Male / 14
Service Maintenance / African-American / Female / 2
Service Maintenance / African-American / Male / 1
Lookout Mountain Community Services (LMCS) strives to ensure it has a workforce that is representative of the cultural diversity of the community. As the numbers above indicate, 88% of employees are white, 10% are African-American and 2% are Asian. We currently do not have any Hispanic employees but realize as the Hispanic population in this area increases, there is a growing need to have employees who can meet the needs of this population. To better meet this need, we have developed a cooperative relationship with the Social Work Department at Dalton College. This department actively recruits Hispanic students and requires all students to develop a fluency in Spanish. Agreements have been made with Dalton College to provide practicum/internships to their students in an effort to create greater recruitment opportunities for employees who are either part of the Hispanic culture or who are fluent in Spanish.
LMCS currently has staff that is fluent in the following languages:
Homebased / Ken Brown / FrenchHorizons / Jennifer McConathy / German
Administration / Gwen Smith / German
Horizons / Johanna Gluck / German
Medical Director / Esteban Lim, M.D. / Tagalog (Philippines), Fookienese
Homebased / Angelina Forde / Spanish / Papiamentu
FOPC / Marlie Barrett / Spanish
Administration / Alice Phillips / Spanish
LMCS evaluated its turnover rates for the past three fiscal years. The results are represented in the following table.
LMCS Turnover RatesJuly 2005 – June 2006 / 28%
July 2006 – June 2007 / 34%
July 2007 – May 2008 / 23%
An analysis of the exit interview data did not reveal any consistent trends. However, in February 2008 the Board at the request of the Executive Director appointed a workgroup to review salaries of clinical and management staff to ensure that the starting and current salaries are consistent with other Community Service Boards in the state. Salaries for clinicians were adjusted upwards between 5 – 13%. Management salaries are still under review. In addition a workgroup was appointed by the Executive Director to consider incentives for staff. This is especially challenging as any incentive program must be approved by the State Personnel Administration before implementation. As the Community Service Boards must comply with state law regarding bonuses, developing an incentive program will require some creativity.
OUTCOMES (5,288 ADMISSIONS)
SEPTEMBER 2006 THROUGH APRIL 2008
The effectiveness measure applied for all children and adolescents receiving services at
Lookout Mountain Community Services was the comparison scores on the Child and Adolescent Functional Assessment Scale (CAFAS) at various times from entry into treatment until discharge. The goal is that at least 50% of the matched pairs for children and adolescents with serious emotional disturbance will show an improvement of at least 10 points. The following is the results for the past 18 months:
CAFAS ImprovementYear / Matched Pairs / Showed Improvement / Percent Improved
2006 / 9 / 5 / 55.55%
2007 / 158 / 80 / 50.63%
2008 / 84 / 47 / 55.95%
As indicated on the report, the goal of at least 50% of the matched pairs has shown improvement; however, the goal of at least 10 points was not reached. This expectation was set by the State and may not be a realistic goal. Another reason for the lack of change may be due to the subjective ratings of the clinical staff. Additional training on the administration of the CAFAS was recently completed to improve scoring reliability.
The effectiveness measure applied for all adult consumers is the Level of Care Utilization System Score (LOCUS). The expectation was that 50 per cent of adults for whom the LOCUS indicated the need for at least Level 3 -- “High Intensity Community Service” --upon intake will show improvement in functioning, as indicated by a reduction of at least one LOCUS level, from intake to discharge.
The charts indicate the change for consumers who were in Level 3 or above at the first LOCUS score. The first chart shows the change in mean score from 18.24 to 16.18. LOCUS scores greater than 16 require Level 3 or above treatment services. The second chart reveals that of the 125 consumers who were found to need Level 3 or above treatment services at the first LOCUS measurement, only 35 were at Level 3 or above one year later. While the scores were not at discharge the significant improvement shows that services have been effective. Many of these consumers will not be discharged for some time as they will continue to need medications provided by LMCS.
Effectiveness measures for Developmental Disabilities: Residential Services
Effectiveness Measure 1
Personal Care Homes and/or Community Living Arrangements will continue to integrate consumers into community activities to enhance community acceptance and awareness of individuals/consumers with Developmental Disabilities. The consumer’s will participate in civic events and exercise their right to elect and vote for public officials.
On reviewing all daily progress notes from Home Providers the consumers have averaged more then 10 community activities per month. Data for registered voters was not collected by an oversight. A question asking about voter registration will be added to the quarterly consumer survey.
Effectiveness Measure 2
All Personal Care Homes and/or Community Living Arrangements will improve their safety and compliance with all ORS regulations.
The LMCS Developmental Disability Residential Program has almost doubled the number of consumers in service during the past 12 months. The agency received four ratings of a 3 -- which require Corrective Action Plans -- from Support Coordination. Most of these were a result of documentation issues. Corrective action plans were completed for all issues which have resulted in a stronger and safer program for our consumers. We currently have a monthly safety checklist that is completed by the case manager on each consumer. No consumers were adversely affected by the ratings that required a corrective action plan. Our updated outcome and measures will reflect more realistic program goals.
Effectiveness Measure 3
The ANCOR Program will increase the number of consumers in the respite program.
Five consumers that have never had respite services did so during the past 12 months. Our current contract with the Division states we are to serve at least 20 consumers which were accomplished.
Effectiveness Measure for Developmental Disabilities: Organizational and Community Employment
Consumers enrolled in employment services will move to less restrictive employment opportunities.
LMCS has increased overall capacity by more then 30% during the past
12 months. A third activity center was opened in Trenton. This included adding four additional consumer jobs. LMCS currently has a total of 31 consumers working in a less restrictive employment.
Effectiveness Measure for Developmental Disabilities: Community Habilitation Services
Fifty percent of all consumers receiving Day Supports will be either served in 20/20 (20 hours in facility/20 hours on the community) or 30 hours in the community.
Due to current State mandated staffing patterns this has not been a realistic goal to achieve. The current staff ratio for facility is 1 staff to 6 consumers. The State requires that for Community activities ratios are at least one staff to no more than three consumers. LMCS averages across all three activity centers 23% of consumers being served in 20/20 or 30 hours of community integration. Program managers will look at additional ways to increase community integration while maintaining current staffing ratios.
EFFICIENCY MEASURES FOR DEVELOPMENTAL DISABILITIES: RESIDENTIAL SERVICES
Efficiency Measure 1
The Residential Coordinator will increase the number of Host Homes to meet the needs and demands of the Residential Program.
At close of the last fiscal year residential services had 32 Host Homes available for consumers. There have been three applications for new homes sent to the Division for approval. All requirements for two more homes have been completed and the residential program is in the process of completing the application to be sent to the Division. The application process has been done for four additional homes but LMCS is still awaiting walk through before the applications can be sent to the Division. Approval for all of these homes is expected by the close of the FY 08. If approvals are given on all these homes that will be a total of eight new homes, an increase of 25%.
EFFICIENCY MEASURES FOR DEVELOPMENTAL DISABILITIES: ORGANIZATIONAL AND COMMUNITY EMPLOYMENT
Consumers in the employment services programs will decrease their facility based hours to a
maximum of 20 hours a week. This will open up additional slots to maximize the number of
consumers served.
LMCS has surpassed this efficiency outcome. We currently have less then
10% consumers receiving more then 20 hours in our facility based programs.
Our focus is community employment and integration.
Efficiency Measure for Developmental Disabilities: Community Habilitation Services
Number of Consumer Facility based hours will decrease.
Less then 10% of all consumers attend the facility-based programs more than three days a week. The focus is to provide services in a community setting.
EFFICIENCY MEASURES FOR MENTAL HEALTH SERVICES
In 2006, the Georgia Department of Human Resources Division of Mental Health, Developmental Disability and Addictive Disease contracted with Behavioral Health Link to provide a single number for access to care for individuals from across the state. This initiative was created in order to accomplish five key principles of the Division:
· Consumer choice – Consumers and families shall have choice about which service providers are and what services will be provided.
· Comprehensive, integrated and easily accessible – The system shall be designed to allow easy access to a comprehensive array of services and supports.
· Service delivery competition – The public system shall increase the involvement of the private sector to allow for greater consumer choice and increase competition among service providers.
· Separation of planning and service delivery – The functions of service planning, coordinating and contracting should be separated from service delivery.
· Consumer-centered service delivery system – The service delivery system shall be consumer centered.
·
The contract between LMCS and the Division requires that all consumers scheduled at LMCS by BHL must be seen within an average of five (5) business days from the date appointment was requested. The table below indicates the efficiency measures in complying with this requirement:
INTAKE EFFECTIVENESSJUNE 2007 – MARCH 2008
AVERAGE BUSINESS DAYS TO APPOINTMENT (ABDTA)
County / Month / Number of Referrals / ABDTA Expectation / ABDTA / Difference
LMCS Total / June / 308 / 5 / 7.99 / 2.99
LMCS Total / July / 312 / 5 / 10.63 / 5.63
LMCS Total / August / 310 / 5 / 10.90 / 5.90
LMCS Total / September / 302 / 5 / 9.80 / 4.80
LMCS Total / October / 5
LMCS Total / November / 248 / 5 / 7.30 / 2.30
LMCS Total / February / 294 / 5 / 4.90 / -0.10
LMCS has taken a number of steps to ensure that the agency is in compliance with the requirement that appointments are made within five business days. During 2005-2007 LMCS had an Intake Team which was dedicated to completing all assessments for first time appointments. This involved traveling to each of the outpatient clinics. It was determined that it would be more time efficient to have intakes done by all clinicians and that these be done at the clinic which is the clinician’s primary work site. This change was implemented in November 2007 and there has been much improvement at all sites except for the Dade County Clinic. The Dade County site is the smallest outpatient clinic which is normally staffed by only one licensed clinician, who also acts as the manager of the clinic. Beginning May 16, 2008, an additional licensed clinician has been assigned to that clinic to assist with intakes. The appointment schedule will be monitored closely to ensure the five-day expectation is met.
(Insert Horizons Effectiveness and Efficiencies Measures Here)
Satisfaction Surveys
In August 2007, clinical staff was surveyed regarding satisfaction in support given in area of clinical training and supervision. Six areas were surveyed. The results of this survey are indicated below:
EMPLOYEE SATISFACTION SURVEY
AUGUST 2007