CROSSNORE school & children’s home
Performance and Quality Improvement Report 2016 - 2017
Committed to Growth and Change Not only is Growth and Change one of the Sanctuary Model’s Seven Commitments, but it’s also been our organizational “M.O.” since early 2016. At the very heart of the PQI process is change. As we study data from various programs and activities, we are able to see where changes are needed. We can then make informed decisions about the changes we make. While this report highlights PQI activities on the Crossnore campus prior to the merger, efforts are well underway to reflect PQI for the merged agency with two growing campuses. Our first “meet-in-the-middle” PQI Committee meeting was held on April 12, 2017 at Wilkesboro United Methodist Church with 20 staff from both campuses in attendance. We’re growing our organization, our campuses, and our PQI calendar too!
Did you know? The PQI Committee meets six times per year to monitor data, information, and ideas from across departmental lines. Meetings are open to any employee or community partner who would like to attend. During the 2016 PQI cycle, we heard from 24 different programs and initiatives. If you have questions about this report or ideas for future PQI initiatives, please contact the PQI Coordinators: Laura Laughridge at llaughridge@crossnore.org Johannes Steffin at jsteffin@crossnore.org
2016 PQI Committee
Community Participation
The following staff attended meetings, collected and shared data, compiled reports, assisted with meeting minutes, and made time in their busy schedules to participate in PQI activities:
Since the Town of Crossnore is closely connected to our Crossnore campus, three members of the Crossnore Community Enhancement Committee (CCE) have been joining us for PQI meetings: Ann Baker, Jesse Smith, and Clotta Smith. They bring insight and lively discussion to our meetings. In addition to making our Crossnore campus, and especially the clients we serve, welcome in the community, they are instrumental in helping share a taste of true small town life with those we serve. CCE includes our Crossnore campus in all of its community events, including its Christmas Bonfire, 4th of July Parade (complete with frog-jumping contest), and monthly music jams.
Dr. Cyndi Austin, Williams Academy Principal Ann Baker, Community Member Lisa Banner, Crossnore Weavers Manager Rosalia Bealer, Case Manager Kenny Cook, Director of Facilities Bobby Crenshaw, Business Office Heidi Fisher, Crossnore Fine Arts Gallery Manager Andrew Florence, Director of Recreation Gretchen Goers, Case Manager Caroline Hart, Chief Advancement Officer Jim Hart, Campus Pastor Tammy Henson, Medical Coordinator Kelly Holbrooks, Dietary Services Manager Teresa Huffman, Chief Financial Officer Adam Jarrell, Director of Residential Life Hannah Johnson, Business Office Laura Laughridge, H/R Generalist Bet Levine, Director of Case Management Brett Loftis, Chief Executive Officer Jimmy Mahan, After Care Specialist Traci Royster, Board of Trustees Clotta Smith, Community Member Jesse Smith, Community Member Kelly Smith, Director of Compliance & Sanctuary Mike Smith, Director of IT Angelina Spencer, Chief Program Officer Toby Stoetzer, Director of Clinical Services Logan Thrasher, Campus Pastor Alan Yawn, Community Member
We are also fortunate to include pastors from our local churches, Jim Hart (formerly of the Altamont United Methodist Church and now our Campus Pastor/Director of Spiritual Life) and Alan Yawn from the Banner Elk Christian Fellowship. These community members help strengthen our organization—and the services we provide—by providing a positive off-campus presence in the lives of those we serve.
Case Record Reviews As part of our regular PQI process, we look at a representative sampling of case records. This review is completed quarterly with respect to the following programs: Group Living Services (GLS), Clinical, and Adoptions. Monitoring these records for completeness is important because the documents in the files provide the infrastructure necessary for us to provide care. For example, without an insurance card, a resident is not able to receive required or necessary medical check-ups or treatment. Corrective measures are taken as needed to obtain any missing documentation. For GLS, two areas showed improvement from July 2016 to October 2016: • Out-of-Home Family Services Agreement and Reviews in record improved from missing 12 in July to missing 6 in October - a 50% improvement. • Copies of written orders for medications/special treatment procedures (MAR) improved from missing 10 in July to missing 2 in October - an 80% improvement. Also for GLS, two areas did not show improvement from July 2016 to October 2016: • Comprehensive Basic Assessment is culturally responsive - four did not speak to the child’s culture in July and seven did not speak to the child’s culture in October. • Current Insurance card in record - four files were missing current insurance cards inJuly and seven files were missing current insurance cards in October. Additional program areas, including Foster Care, Intensive In-Home Services, and Day Treatment will be added to our Case Record Reviews as part of PQI, post-merger.
Student Work Program To help assess the impact of the Student Work Program, staff conducted a telethon to survey former students who participated in the Student Work Program. Going back 5 years, 255 students were identified and contacted; 115 agreed to participate in the survey. Of those, 22 responded. 16 of these 22 were not in college; 4 graduated college; and 4 are holding careers in their fields of study. Half of the respondents did not know aftercare assistance was available; the other half said it was helpful. Some 30 of our former students are currently enrolled in college. The Student Work Program needs more campus jobs! There are 25 Student Work Program positions available on the Crossnore campus, and 20 of these are filled. As our campus has expanded to serve bigger numbers of residents, more campus jobs are needed. Efforts are underway to implement a version of the Student Work Program on the Winston-Salem campus. 16 Not in College
30 Enrolled in College
College Status of Former Students 4 Holding Careers in their Field of Study 4 College Graduates
After Care Forty-five former students have been assisted with After Care Services in the last year! After Care covers a range of services including these services offered last year: • • • • •
Roadside assistance for vehicle repair Finding safety from an abusive relationship Driving across country to help a student pursue school and work opportunities Resume and interview coaching Rent assistance
Now that the After Care program has been in place for more than a year, new guidelines are being developed for the future of the program.
Assessments The Comprehensive Clinical Assessment (CCA) is completed on the first date of service with the resident/client and is the basis for establishing the service plan and goals. There were areas of improvement in completion of assessments as follows: • Completion of CCA’s grew from 82% in June 2016 to 97% in September 2016 • Completion of Trauma History Screening grew from 58% in June 2016 to 85% in September 2016 • Completion of Crisis Plans grew from 65% in June 2016 to 83% in September 2016 One area showed a decline: • Completion of Calocus declined from 68% in June 2016 to 63% in September 2016
Grievances No grievances were reported for staff or for clients and families served during the 2016 PQI year. Committee discussion raised two questions: 1. Do staff really know they can file a grievance? 2. Is it possible that Red Flag Meetings, a Sanctuary tool, are helping address issues before they reach grievance-filing levels?
Cost Analysis Cost analysis is completed by our Finance Office once every two years and is reported to the state of North Carolina. We receive reimbursement from the State for food, clothing, and shelter. Of those funds, 87% go directly towards program support. We receive no reimbursement for spiritual development, recreation programs, trips, Student Work Program, scholarships, Pet Nurturing Program, the horse barn, and other programs and amenities. Private contributions fund these items. Our goal is that the cost of $5,500 per child per month will be covered by State reimbursements and charitable contributions.
Incident Reports Incident Reports (IRs) are completed on 31 categories of health, safety, and welfare of the children in our care. These include physical aggression, verbal aggression, defiance, minor physical injury, medication error, runaway, just to name a few. Of significance, at the end of the 4th quarter of 2015, there were 69 IRs for defiance, which is defined as a child refusing to follow instructions. An IR is submitted when a child repeatedly refuses to follow instructions. To address this concern, we implemented Love & Logic parenting training for all direct care staff in November 2015. By the end of the 1st quarter in 2016, defiance IRs had decreased to 49 reports. The IR Policy and Procedure, definitions of incidents, reporting template, and tracking process were updated in early 2017 as part of the integration and merger process.
Student Survey Trips, getting the help they need, receiving counseling, feeling supported, games, free time for play, the YMCA, having their own bike, and Cottage Parents are some of the FAVORITE things named by the children who live at Crossnore School & Children’s Home. We also know our students report that their thoughts, feelings, and opinions are valued by their therapists. This was the top-scoring item on the last two student surveys in November 2015 and May 2016, with a weighted score of 3.71 in May. In the May survey, 59 of 78 residents (75.64%) completed the survey. Five pre-school-aged children were not offered the survey. “I feel that I, as an individual, am treated fairly” and “I feel that I am listened to and that my feelings are taken into consideration” remained the two lowest scoring items on both surveys, with weighted scores of 2.68 and 2.85, respectively. Note: The same survey is used for all of our students, regardless of their age or comprehension level. Staff read the survey and record responses from younger children and those that need additional help. Plans are underway to revise the survey to reflect various age and/or comprehension levels.
Review of Risk Management As an agency, Crossnore School & Children’s Home adheres to a schedule of Risk Management review on an array of topics, from Licensing and Mandatory Reporting to Insurance, Financial Risk, and Conflicts of Interest. At the PQI Committee’s June 2016 meeting, the Risk Management presentation led to a discussion on cottage van safety, confidentiality of files, and changes to our employee drug testing procedure. Any of these topics would be ideal PQI-focused initiatives for future reports.
Intake Growth = Much-needed Room! A long-standing statistic at Crossnore School & Children’s Home was that we typically turned away some 30 children each month, simply because we had no space for them. Consequently, we built three new cottages on the Crossnore campus, which opened in the fall of 2016. From January to April 2016, we received 113 referrals: 78 femals and 38 males. Of these referrals, 21 females and 9 males were accepted. That means 83 referrals were not accepted, and 62 of those were declined because there were no beds available. In 27 instances, there was no suitable program for the children; in 10 cases, no final application was submitted; in 7 instances, the county withdrew the application; and in one case, the student withdrew their application.
Staff Survey At Crossnore School & Children’s Home, staff report receiving satisfaction from their jobs. Crossnore School & Children’s Home has used the same Sanctuary-based staff survey for three years (2014, 2015, and 2016). While a new survey will be used to measure staff satisfaction as we move forward as a merged agency, data across these three years reveals that most categories showed an improvement. Most recently, in September 2016, 78 of approximately 130 employees on the Crossnore campus participated in the survey. Of these, 56.25% of the responses strongly agreed that they receive satisfaction in their work.
Spiritual Life Quantifying spiritual development was a question for 2016 study, and is an issue we will define and build as we go along. We look to engage BOTH residents AND staff in a non-denominational way. Measuring progress is a challenge, but wherever people are spiritually supported, they feel safe and can thrive. We currently host chapel services once per week on the Crossnore campus, and we have relationships with partner churches in the local community where our cottages attend Sunday services each week. Young Life is a presence on our campus with 35 teens participating monthly. Discussion on spiritual life focused on how we support students from other faiths, as well as varying theologies, and we work to make accommodations when possible. We have a new Campus Pastor on the Crossnore campus, effective January 2017, and we are currently reviewing the way cottages are assigned to local churches.
Staff Turnover Listening = Improved Staff Retention In 2015, staff turnover among direct care employees was 57%. As a result, staff turnover became a targeted PQI initiative, and a number of strategies, all centered on listening, became part of the solution. This reduced our rate of direct care staff turnover to 25% in 2016. We began holding live exit interviews, where responses initially reflected burnout and frustration. These interviews now reflect “I don’t want to leave” responses instead. We held meetings to talk about why people leave and where/how best to recruit Cottage Parents. To accommodate additional staff in the new cottages and to give Cottage Parents more support, we added two additional Directors of Residential Life (both of whom were Cottage parents with 17 years of experience on our Crossnore campus). We added Love & Logic as our parenting model, giving staff tools to diffuse issues. We also listened to our residents: feedback from the Student Mission Team told us what they want in Cottage Parents. This information helps us be more intentional in our hiring process. 60 50
%
57%
40 30 20
25%
10 0
2015
2016
MEET OUR BOARD OF TRUSTEES
Officers: Carolyn S. Moretz, Chair
Pfafftown, NC
Hickory, NC/Linville, NC
Kathy Izard
Katheryn Northington, Vice-Chair
Hunter M. Peak
Charlotte, NC
Winston-Salem, NC
Gastonia, NC
Marilyn Williams, Secretary
Robert A. Quick
Governance
Orlando, FL/Linville, NC
New by-laws were in the draft stage when we heard our annual Governance report pre-merger in August 2016.
Charlotte, NC/Linville, NC
PQI for our Board of Trustees will take on new initiatives post-merger. Stay tuned for more information!
Redge Hanes
Ted LaPorte, Treasurer
Trustees:
Winston-Salem, NC
David P. Riggins Charlotte, NC
Traci Diane Royster Boone, NC
Kim Barnhardt
Jean Ann Rushton
Charlotte, NC/Minneapolis, NC
Hendersonville, NC
John Blackburn
Dr. William Satterwhite
Linville, NC
Winston-Salem, NC
Bick Cardwell, Jr.
Alex Stacy
Atlanta, GA/Linville, NC
Winston-Salem, NC
Pamela Corbett
John Stone, Jr.
Winston-Salem, NC
Kernersville, NC
Carol B. Dabbs
Iris Sunshine
Charlotte, NC/Blowing Rock, NC
High Point, NC
Rush S. Dickson, III
Buddy Thomas
Charlotte, NC/Linville, NC
Winston-Salem, NC
Ray Edwards
Peggy Troxell
High Point, NC/Linville, NC
Hillsborough, NC
Elizabeth C. Graham
Philip P. Vineyard
Asheville, NC
Charleston, SC/Linville, NC
B. Kelly Graves
Quincy Foil White
Charlotte, NC
Martha Guy Newland, NC
Charlotte, NC
Service Planning and Delivery Each service/program bases their service planning and delivery document on the assessment that is conducted when a resident or client enters the program. The services that are to be provided to the individual, as well as their goals, are documented. These are reviewed periodically to determine growth and the level to which goals are met.
Crossnore, NC Campus
Winston-Salem, NC Campus
LME Review There are several Local Management Entities/Managed Care Organizations in the state. Most of these LMEs approve Crossnore School & Children’s Home to bill for specific Medicaid-funded services. In turn, the LMEs monitor Crossnore School & Children’s Home by reviewing records and doing site visits. No monitoring visits were conducted during this PQI cycle.
JCPC Reviews Crossnore School & Children’s Home has program agreements with the Juvenile Crime Prevention Council (JCPC) in Avery, Mitchell, Yancey, Watauga, and Forsyth Counties. Each county refers residents to our group living program. Each county monitors the agency and does site visits. The state JCPC Area Consultant conducts and organization-wide review every three years.
HOLISTIC Health Care & Spiritual Development
COMPREHENSIVE ENRICHMENT Life Skills, Work Experience, Travel, Arts
COORDINATED, HOLISTIC Case Management
RESEARCHED BASED Therapeutic Services
WORLD-CLASS Education
SAFE, LOVING Home
Sanctuary 2016 was an active year for the Sanctuary model on our campus. We continued campus-wide traning for all employees on Sanctuary’s Four Pillars. These trainings were conducted quarterly. Mission Team meetings were held monthly in 2016, except for the month of June. The inimitable David McCorkle, our Sanctuary trainer from the Andrus Institute, brought Train-the-Trainer to the Winston-Salem campus at the end of March 2017. Part of this training was a 1-day refresher course on the Crossnore campus. At the end of these sessions, the Crossnore campus now has 27 trainers and the Winston-Salem campus has 16 trainers. To accommodate our merger and implementation of the Sanctuary Model on the WinstonSalem campus, we requested an extension for our Sanctuary re-certification from October 2017 to April 2018.
Licensing The licensing of the residential, foster care, and adoptions programs by the North Carolina Department of Health and Human Services, Division of Social Services occurs every two years. The Crossnore campus was re-licensed in November 2016 and the Winston-Salem campus was re-licensed in December 2016. When the merger occurred in January 2017, the organization’s license was combined with an effective date of January 2017. The soonest expiration date of November 2018 remains in effect.
Residential Students 62%
Williams Academy Williams Academy has an enrollment of 120 students for the spring semester of the 20162017 school year. Forty-six of these students are community students. 100% of our immunization records are valid. This is an important statistic for the health and safety of all our students. Community Students 38%
Wellness A number of recreation and physical fitness initiatives were underway in 2016. Whitewater rafting was the favorite summer trip in 2016 for residents and staff alike! Other activities included trips to the Doe River Gorge and to the Barter Theatre. Andrew Florence, Director of Recreation, started a catalog of bikes in our Bike Program. He also routinely surveys staff and residents to measure their interests for planning and effectiveness. Swim Club, Girls on the Run, and Junior Naturalists (with help from Grandfather Mountain staff) are a few of the spring and summer initiatives in development for the 2017 summer season. We also noted there are instruments available to measure residents’ resiliency and protective factors as a result of engaging in physical activity. Use of these tools will show us how providing options for physical activity are directly related to the quality of care we provide our children. Regarding child nutrition, a study is underway between Dietary Services and the Finance Office to make cottage meals more cost effective. The goals of the study are: 1. To make meals for our children a healthy part of their environment, 2. To make meals as cost effective as possible, and 3. To give Cottage Parents more control/latitude in meal preparation.
Achievement of Budgetary Objectives Teresa Huffman, Chief Financial Officer, shared a Statement of Operations at our February 2017 meeting. Based on the numbers, Crossnore School & Children’s Home is meeting its financial obligations. We are generating sufficient revenue through contributions and our income-producing entities to provide support for the programs that serve our children.
Fundraising - Cost vs. Benefit For the last three years, the focus of our Advancement Team has been less on costly events and more on building relationships with groups and individuals. One of our events, the Beech Mountain Fashion Show and Luncheon, is planned and staffed by volunteers. In 2016, our costs were limited to food and centerpieces only and, nearly four times that cost was raised by the event to benefit our children. The Advancement Team sets goals based on needs and priorities outlined in the organization’s strategic plan.
Medication Errors The medical clinic’s Plan, Do, Check, Act worksheets revealed just how much time and effort goes into a PQI initiative. This one had astoundingly positive results! Medication errors were down significantly with the quality improvement steps put in place, with little or no cost to the agency. Because there were 25 med errors in the first quarter of 2016, we began a weekly review of med errors. Tammy Henson, Medical Coordinator, visited cottages to review Medical Administration Records as well as medicine administration procedures. Tammy also attended weekly Cottage Parent training for Q&A sessions. This promoted open communication and the development of positive relationships. The staff understood they could report errors without fear of negative consequences. Best of all, med errors decreased from 25 in the first quarter of 2016 to 5 in the last quarter of 2016. These five errors occurred while residents were on home visits and not on campus.
CROSSNORE school & children’s home
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Crossnore Campus: PO Box 249 | Crossnore, NC 28616-0249 | (828) 733-4305 Winston-Salem Campus: 1001 Reynolda Road | Winston-Salem, NC 27104 | (336) 721-7600 info@crossnore.org | www.crossnore.org
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