Issuu

Performance and Quality Improvement Report 2017-2018

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. We continue to work within and across all locations to make sure that we are offering the best services possible to our clients.

Did you know? The PQI Committee meets throughout the 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 2017 PQI cycle, we heard from 16 different programs and initiatives. If you have questions about this report or ideas for future PQI initiatives, please contact: Meredith Martin at mmartin@crossnore.org

Introduction In September 2017, Crossnore School & Childrenâ€™s Home was re-accredited by the Council on Accreditation (COA), an international, independent, nonprofit accreditor of human service organizations. For months prior to our re-accreditation, Crossnore staff worked together to evaluate all of our programs and administrative functions to ensure we are meeting or exceeding best practice standards, as outlined by COA. Our agency received high scores in all 15 areas of review. In between our three-year cycles of re-accreditation with COA, Crossnore pursues best practices and excellence through participation in our Performance and Quality Improvement (PQI) process. This year, Crossnore grew its PQI practices to meet the needs of an expanding organization that now has regional recognition across Western North Carolina and a broader service scope.

Council on Accreditation (COA) Standards Administration and Management Standards

Ethical Practice Financial Management Governance Human Resources Management Performance and Quality Improvement Risk Prevention and Management

Service Delivery Administration Standards

Administrative and Service Environment Behavior Support and Management Client Rights Training and Supervision

Service Standards

Adoption Services Day Treatment Services Family Foster Care and Kinship Care Group Living Services Services for Mental Health and/or Substance Use Disorders

PQI’ing the PQI Committee As we near the end of the 2018 fiscal year, Crossnore has expanded to nearly 300 employees across three locations (Winston-Salem, Avery County, and Hendersonville). Our staff serve in five programs and numerous administrative functions across the state. With these changes, our PQI committee has experienced growth and change. Over the past year, community Foster Care services have expanded at the Avery and Hendersonville sites. As a response to this growth this year, our PQI was intentional in including a foster parent as a part of the committee who could speak to that stakeholder group’s perspective. Our committee also evaluated its structure for optimal efficiency. As a result, we have created a rolling co-chair model for the committee whereby staff from throughout the agency serve in one year terms as co-chairs of the committee. Over the past year, leaders have served from both the Avery and Winston-Salem campuses and from the Human Resources, Clinical Services and Dietary Services departments. Compliance and Program Excellence staff provide support to cochairs in preparation for each meeting. Our committee also set an annual calendar with meeting dates and topics to be discussed. This structure provided our staff with adequate time to plan and prepare for PQI meetings. In order to increase participation in the PQI process throughout the organization, PQI meetings have been held in both main campus locations and at our partner church in between, Wilkesboro UMC. The committee has also decided to shift the PQI year to align with our agency’s fiscal year so that data-informed changes may be implemented alongside budgetary shifts. All of these shifts were made through a shared-decision making model, consistent with our organizational value of democracy.

2017-2018 PQI Participants Tanya Blackford, Regional Director Jane Bumgardner, Director of Finance Lisa Carr, MSW intern Kacy Carter, Training Manager & Data Analyst Brandon Cathey, Senior Advancement Officer Debbie Dean, Referrals & Admissions Coordinator Caleb Evington, Case Manager Heidi Fisher, Director of Crossnore Fine Arts Gallery and Student Work Program Andrew Florence, Adventure Based Counselor Deborah Garrison, Case Manager Gretchen Goers, Assist. Director of Foster Care Jennifer Gonzalez, Director of Residential Jessi Harris, Recreation Coordinator Caroline Hart, Chief Advancement Officer Jim Hart, Director of Christian Education & Campus Pastor Mary Anne Helm, Clinical Services Manager Tammy Henson, Director of Medical Services Kelly Holbrooks, Dietary Services Manager Teresa Huffman, Chief Financial Officer Adam Jarrell, Director of Residential Hannah Johnson, Accounting Manager Becky Keener, Program Excellence Coordinater, PQI Recording Secretary

Adam Keener, Farm Director Laura Laughridge, Human Resources Manager Naomi Leslie, Medical Director & Psychiatrist Bet Levine, Director of Case Management Chatty Majoni, Training Coordinator Meredith Martin, Director of Program Excellence Amber Matthews, Assist. Director of Residential Karon McKinney, Director of Youth in Transition Matt Miller, IT Systems Administrator Sarah Norris, Child Welfare Division Director Melissa Parlier, Child & Family Therapist Kelly Riley, Assistant Director of Foster Care Meribeth Robinson, Chief Clinical Officer Kasshema Samuels, Director of Day Treatment Sandy Sauer, Director of Foster Care & Adoptions Kelly Smith, Director of Compliance & Sanctuary Holly Solomon, Director of Communications Angelina Spencer, Chief Program Officer Lauren Staley, Lead Therapist Michelle Stanfield, Foster and Adoptive Parent Johannes Steffin, Clinical Director Jenny Taylor, Chief People Officer Mariea Tountasakis, Senior Advancement Officer

Decreasing Staff Turnover Rates The people who staff our programs are integral pieces of the success of our work. Over the past year, PQI spent significant time in meetings having solution-focused conversations about staff retention. As a result of these conversations, Human Resources and Agency leadership developed and implemented new practices in programs with high staff turnover rates. In two departments, Residential Childcare and Day Treatment, HR and leadership team members conducted stay interviews, small focus groups, and department-wide forums to gather feedback from direct care staff on how best to meet their needs. These meetings were framed around The Sanctuary ModelÂŽ, particularly the SELF Pillar which creates space to discuss safety, emotions, losses, and the future. Over the past year the HR team also completed a new employee manual that was distributed to all employees. This new manual includes the staff grievance procedure and Employee Assistance Program resources.

Program

Turnover Rate August 2017

Turnover Rate August 2018

Percentage Points Decreased

Overall

28.89%

20.63%

8.26% points

Cottage Parents

44.16%

28.92%

15.24% points

Day Treatment

54.55%

22.58%

31.97% points

Centralization of Referrals and Admissions Department When our PQI received a report on admissions and referrals in June 2017, four different staff persons presented; this was due to our agency having several entry points for new clients. The PQI and Agency leadership felt we could do better. In order to streamline internal practices and make navigating admissions easier for external partners, Crossnore launched a centralized Referrals and Admissions team in September 2018. The mission of this team is to connect children, youth, young adults, and their families quickly to the most appropriate service(s) for their current needs. Between April 1, 2017 and March 31, 2018 Crossnore received nearly 1500 referrals. It is our goal that a parent or legal guardian call one Crossnore team member and receive comprehensive matching services for any of our five programs at any of our three locations. Values of Referrals and Admissions Team: • Customer service (internal and external) • Organization • Open communication • Broad knowledge of programs and services • Appropriate Matching • Self-determination of Client and Legal Guardian

Client Grievances Each of our clients has a right to make a grievance, should they feel that their rights are being restricted. Over the past year, the PQI reviewed several client grievances that were made through external entities; no clients used our internal grievance process. Because of our commitment to open communication, the PQI made a recommendation that the client grievance procedure be displayed in all programs in a more overt manner. As a result, nearly 40 new compliance posters were made for and hung in all our programs. These posters outline client rights, responsibilities, and the grievance procedure. Posters that outline Foster Parent rights, responsibilities, and grievance procedures were also created. Because our Clinical Services program serves many Spanishspeaking families, these posters were also translated into Spanish and displayed. It is our hope that wider exposure to these opportunities to share concerns will empower clients to openly communicate with staff.

Case Record Reviews In the past year, Crossnore School & Childrenâ€™s Home has worked to integrate Case Record Review practices across the agency. The agency began uniformly using Google Forms as a tool to collect data and analyze it across campuses, quarters, and peer programs. While most of the Agencyâ€™s programs began using this common practice in 2017-2018, there are plans to for full implementation of the Google Form tool in 2019. With the implementation of any new process, the Agency experienced growth and change. While challenging in the beginning, all programs are seeing peer reviews take less time and the data is available more quickly for analysis and program improvement. In addition to conducting quarterly Case Record Reviews on program records (Clinical Services, Day Treatment, Foster Care-Child and Foster Parent, Adoption, and Residential Case Management), the Human Resources and Training teams also conducted monthly record reviews to ensure compliance. All personnel records are now kept in a uniform manner across the Agency. Training records for Avery campus staff are created at the Avery campus and streamlining continues across this program area.

Streamlining Forms Over the past year, staff from all programs and campuses worked together to align paperwork (forms, handbooks, documentation, etc.). A Forms Committee was established with representation throughout the agency to exercise shared governance in creation, editing, and layout. Through this process, programs learned from one another and engaged in social learning. For example, the Community Foster Care programs began using a Comprehensive Basic Assessment (CBA) tool that was formulated from the CBA tool already in use by the Residential Child Care program. Program teams coordinated with the Communications department to brand all forms using Crossnoreâ€™s branding style guide.

Implementation of New Electronic Health Record In January 2017, Crossnore began using a new Electronic Health Record, Evident. The Evident system is a hospital-based electronic health record that houses all of the agency’s financial software and client records in one system. Prior to its implementation, we were using six different systems for these purposes. In late 2017, a new position was created on the Crossnore team, IT Systems Administrator. This position was tasked with becoming the Evident “guru.” This staff person, Matt Miller, led the Agency into fuller utilization of the system. In the true spirit of PQI, Matt led the Agency through the plan, do, check, act process. Evident successes over the past year include: an increased ability for staff to use the system effectively to document client contact, streamlining of billing for mental health services, ability to use system for external monitoring visits, and increased consistent connectivity.

Safety-Care Implementation In late 2017 Crossnore adopted a new crisis prevention and management program, Safety-Care Behavioral Safety Training. Staff from across the Agency met to review several curriculum options and made the recommendation to Agency leadership that this program be used. The review team felt Safety-Care met our program and service needs as well as dovetailed nicely with our Sanctuary Model of Care. Safety-Care incorporates Applied Behavior Analysis and Positive Behavior Interventions and Supports which help staff and foster parents not only prevent and manage behaviors but also effectively teach replacement behaviors. Ten staff became in-house trainers in Safety-Care, representing the Avery and Winston campuses as well as the Training, Residential, Foster Care, Clinical Services, Youth in Transition, and Day Treatment departments. The Agency has seen positive results from Safety-Care implementation. Most significantly, the number of times staff in Day Treatment have had to use physical management (restrictive intervention) has decreased significantly. See chart on the next page - All Day Treatment staff were trained in Safety-Care in December 2017 and January 2018.

Monthly Comparison of Physical Management Techniques Used 9 8

8 7

6 5

K-2 5-Mar

MS/HS 3

3 2

2 1

1 0

2 1 0

SEP

OCT

NOV

2017

0 DEC

1 0

JAN

1 0 0

FEB

MAR

2018

0 0 APR

Incident Reporting In the 2017-2018 PQI year, the Agency also experienced growth and change in how it documents and reports out incidents with clients in our programs. The Incident Reporting Policy and Procedure was updated this year as well as three versions of the Incident Reporting Form. As a part of these updates the Agency began parsing out data more effectively so that trends could be identified more easily. For example, incidents that occured with students at Kingswood School who were not Day Treatment clients, began to be tracked independently from Day Treatment clients. This allowed the agency to provide information to school personnel about how much Crossnore staff were being called upon to support students not enrolled in our services. This year, PQI requested data be reviewed monthly in order to more quickly react to trends. A huge area of improvement related to incident reporting included significant improvement in timely filing of IRIS reports to LME/MCOs. DHHS requires incidents requiring IRIS reporting be made via the IRIS system within 72 hours of our agency becoming aware of the incident. In the first quarter of 2017 (January to March) Crossnore had an overall compliance rate of 57% with timely filing of IRIS reports; the Day Treatment program had a compliance rate of 18%. In the final quarter of 2017 (October to December) the overall Agency compliance rate was 61.11%; Day Treatment had a compliance rate of 62.5%. There has been continued positive trajectory in this area of compliance. In 2018: Quarter 1 (January to March): overall compliance was 91.84%; Quarter 2 (April to June): overall compliance was 100%; and, in Quarter 3 (July to September): overall compliance was 97.62%. This positive trend is definitely a PQI success to celebrate! Another interesting trend that was noted this year by our PQI was an increase in disclosures that resulted in Child Protective Services reports by our Clinical Services department. This year, the Clinical Services team implemented Sanctuary psychoeducation into its sessions. As a result of reviewing SELF with clients, more children made disclosures of times they felt unsafe. By children feeling safe with our therapists to make these disclosures, our Clinical Services team was able to connect children and their families with appropriate services.

New Client Survey Tool This year our agency took a deep dive into evaluating our client survey tool. An MSW intern who spent the summer of 2018 with the Program Excellence team conducted focus groups with programs and clients, individual interviews with leaders, and qualitative research into best practices on client surveys in order to craft a tool that would gather information in an effective way. The Agency plans to roll out this new tool at the end of 2018 or beginning of 2019. Continued evaluation of this tool will be championed by the PQI committee.

Staff Survey In 2018 Crossnore School & Childrenâ€™s Home conducted its first staff survey across all locations. The Crossnore School tool which centered around The Sanctuary Modelâ€™s Seven Commitments, helped leaders identify what areas each campus excelled in and where there was room for growth and change. Interestly, there were similar trends across campuses. Human Resources and the Executive Team were able to respond to many of the areas of need over the following year. As a new staff survey is distributed, Leadership plans to report out on areas of growth to help staff identify how their feedback was incorporated into agency goals.

Fundraising Every staff person at Crossnore School & Childrenâ€™s Home is on the Advancement Team; we are all challenged with championing our mission in the community. Those whose job title aligns them specifically with this team continue to excel in fundraising goals, helping the rest of us live into our mission. The Advancement Team continues to focus primarily on fundraising through individual gifts. We continue to be very effective in fundraising with this strategy: $7,849,381.50 was raised in 2018, which is 47% of our annual operating budget.

Client Rights Committee Due to mental health regulations that govern our agency, we are required to have a Client Rights Committee that meets quarterly to review client grievances and any possible restriction of a client’s right (this includes any time a client is searched or physical management is used to de-escalate a child in our Day Treatment program). In 2017, Crossnore re-launched its Client Rights Committee to incorporate staff, former clients, and other relevant stakeholders from all its locations. The Client Rights Committee has faithfully met each quarter since its inception and monitored Crossnore’s compliance with its client rights policy and procedures. We are happy to report there have been no identified violations of a client’s rights.

Cultural Competency Plan In 2017 Crossnore updated its Cultural Competency Plan in order to align more effectively with Culturally and Linguistically Appropriate Services Standards. In an effort to identify where our Agency currently is relating to cultural and linguistic competency, our Chief People Officer administered a staff survey. As a result of this survey, Human Resources has set several goals for the coming year to increase staff competency relating to diverse populations. We are also updating our policies and procedures to better reflect language accessibility for clients in all our programs.

Sanctuary Model® Re-certification In April 2018, Crossnore School & Children’s Home was re-certified in The Sanctuary Model® for the third time at our Avery campus and for the first time in our Winston-Salem campus. The agency received high marks on all standards. In the wake of this success we are continuing to pursue excellence in implementation of our Model of Care. Kelly Smith, Director of Compliance and Sanctuary, is leading the unification of our Core Team, which now includes members across the Agency. There are representatives from all three locations and all five programs.

Student Work Program The success of the Avery campusâ€™ Student Work program has been an initiative we seek to replicate across the organization. In 2018 the Student Work program began on the Winston-Salem campus through jobs at the Farm and Farm Store. These employees across the Agency were brought under Human Resources purview, which has given clients the opportunity to learn how to navigate employment practices within the safety of our agency. The continued expansion of this program is an active conversation for PQI with hope for continued growth and expansion in 2019 to other programs.

25%

Spiritual Life In 2018 Jim Hart, Director of Spiritual Life and Campus Pastor, expanded the Spiritual Life program to encompass Residential programs on the Avery and Winston-Salem campuses. Jim truly lived into his heritage as a Methodist pastor riding the circuit up and down Highway 421 to distribute Bibles, lead Young Life-type youth group activities, and provide pastoral care to our nearly 150 youth in Residential Care. Continued expansion of our Spiritual Life program is a discussion for the Agency as we know that spiritual health is a significant protective factor for individuals who have experienced trauma.

@CrossnoreSCH

@Crossnore_SCH