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07/01/2018 - 06/30/2019
Outcome Management Report
Skookum Community Employment Services
Skookum's Community Employment Services (CES) department is dedicated to supporting the organization's mission of Creating Opportunities for People with Disabilities by helping people with disabilities obtain & maintain employment. CES serves clients from the Developmental Disabilities Administration (DDA), Division of Vocational Rehabilitation (DVR), and the Department of Services for the Blind (DSB). Clients have a range of skills, strengths, abilities, and disabilities, and CES staff work diligently to provide person-centered services which emphasize clients' strengths, skills, abilities, and preferences while also taking into account input from guardians, parents/family, Vocational Rehabilitation Counselors (VRCs), and Case Resource Manager (CRMs), as well as local employment trends and community business needs. All clients are placed into integrated jobs in the community which pay at least minimum wage.
OVERVIEW
OUR MISSION STATEMENT
Creating Opportunities for People with Disabilities
Updates
The 2018 - 2019 contract year marked a number of significant changes for the CES department. CES underwent significant restructuring over the past year. Due to changes in DVR, which led to a decrease in referrals, Skookum chose to downsize the department in Kitsap County, which had been heavily servicing DVR clients. Skookum also chose not to renew its DDA contract in Kitsap County at the end of the 2018 - 2019 contract year. All Kitsap County DDA clients were transitioned to new vendors, and Skookum's last billable month for Kitsap County DDA was May 2019. The CES Supervisor also left Skookum towards the end of the contract year, and the Vocational Director took over all supervisory tasks, with other tasks being dispersed among the remaining CES staff as necessary. This contract year marked the first full year of CES staff utilizing SETWorks to maintain client case notes & documentation. CES staff spent much of the year learning the new software and how to implement SETWorks capabilities to streamline documentation, billing, and client file maintenance. Staff additionally attended an all-day training in October 2018 to improve knowledge & understanding of SETWorks. CES has also worked hard over the past year to improve processes, policies, and procedures to continue meeting county requirements, CARF accreditation standards, and best practices. To continue to meet CARF requirements, CES staff began conducting follow-up phone check-ins with DVR clients who had ended services with Skookum. CES added SMART goal training to required staff annual training. One other significant change which occurred going into the 2018 - 2019 contract year was a change in surveys. The longer surveys were condensed down to 5 key questions with room for comments. This change was made in part due to recommendations made during & after Skookum's CARF re-accreditation survey in October 2017.
Recently, CES added services for beneficiaries of Social Security (SSI/SSDI) through the federal Ticket to Work program. Skookum has been providing Ticket to Work services to Skookum employees since 2013 but began serving external ticketholders in January 2019. Members of the CES department spent a portion of the contract year learning the requirements for Ticket to Work, obtaining necessary training, undergoing the Suitability background clearance process, and ensuring Skookum was compliant with Social Security's requirements prior to expanding services to external ticket holders. One other change which occurred during the 2018 - 2019 contract year was a transition in the way CES management tracks the CES budget. The CES budget has moved towards being tracked on a fiscal year basis (1/1 - 12/31) to align with the way Skookum manages other contracts. Similarly, CES management is setting a new target of achieving at least 12% operating percentage during each fiscal year. Over the course of the contract year, the CES department worked on expanding involvement with local, state, and national organizations & advocacy groups for employment-related disability issues. The Vocational Director joined the WA State Governor's Advisory Committee in January 2019 and Accessibility Sub-Committee in February 2019. In addition, the Vocational Director became more actively involved with the Community Employment Alliance (CEA), a WA-based advocacy group designed to strengthen employment opportunities for people with disabilities, and was involved in planning the CEA conference which took place in May 2019. During the 2018 - 2019 contract year, CES also began preparing in earnest for the CARF re-accreditation survey which is due to occur on or around October 2020.
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Performance measurement & MANAGEMENT SYSTEM
To provide quality services to our customers, ensure best practices, and maintain compliance with all state, county, and CARF requirements, CES collects data and measures performance in a number of ways. Surveys: Surveys are sent to clients, employment/volunteer sites, DVR Counselors, DDA Case Resource Managers (CRMs), parents/guardians, and other stakeholders on a regular basis. DDA clients are given surveys during 6-Month Reviews. DVR clients are given surveys during services and/or after ending services. CES staff track which clients & stakeholders have received surveys during the contract year, and at least once per year, surveys are additionally distributed to clients and stakeholders who have yet to receive a survey during the year. To decrease barriers to participation, surveys are provided with a pre-addressed, pre-stamped envelope when sent via mail and (where necessary) when provided in person. Surveys are collected and maintained on-site at the Skookum Home Office, and results are used to measure customer satisfaction, possible trends, and areas for improvement. Focus Groups: In addition to surveys, CES collects information on performance & customer satisfaction through focus groups scheduled each contract year. Generally, separate DVR and DDA focus groups are held. Clients, DVR Counselors/DDA Case Managers, parents/guardians, and other stakeholders are invited to participate. Skookum asks questions such as "What are we doing well?" and "What could we do to improve?" to elicit feedback and spark discussion during the focus groups, and CES staff take minutes so the feedback can be reviewed as a department to determine areas for improvement.
Demographics: CES staff collect demographics on all persons served to analyze and track the diversity of the client base. Characteristics CES staff track include: Acuity Level (DDA) Age Gender Race Disability Education Level Finances: The Vocational Director develops a budget for each CES contract year with the input of the Executive Steering Group (ESG). The Revenue Administrator tracks outgoing invoices and incoming payments, and the Vocational Director reviews Profit & Loss statements on a monthly basis to track financial performance and determine whether the CES department is operating within its budget. Outcomes: CES staff additionally track a variety of data regarding client outcomes. Data collected includes: Job placement rates (DVR) Job retention rates (DDA/DVR) Clients working preferred # of hours (DDA) Work hour increases (DDA) Wages and wage increases (DDA) Reasons for ending services (DDA/DVR)
Megan Mason-Todd Vocational Director
Analyzes, tracks, & inputs data Handles, analyzes, and stores all surveys received Compiles & distributes Outcome Management Reports (OMRs) Oversees & schedules internal auditing Helps oversee & support CARF surveys, documentation, & accreditation
Performance measurement & Management Responsibilities
Tonya Brinkley Employment Specialist
Hand-delivers & mails surveys to current clients, stakeholders, and employers Gathers & inputs individual client demographics, outcomes, etc. Oversees external (county) audits, documentation, & compliance Organizes & leads annual DVR/DDA/DSB focus groups
Hand-delivers & mails surveys to current clients, stakeholders, and employers Gathers & inputs individual client demographics, outcomes, etc. Oversees data collection & reporting requirements for Foundational Community Supports (FCS)
Provides oversight for CARF accreditation, survey process, strategic plans, and performance plans Authorizes modification of any method of data collection Oversees business performance indicators, including budget & financial management
Robin Burdick Employment Specialist
Brynn Souders Vocational Coordinator
Amanda Riddle Employment Specialist
Hand-delivered & mailed surveys to current clients, stakeholders, and employers Gathered & input individual client demographics, outcomes, etc.
Debra Fa'aita Community Employment Supervisor
Anna-Lisa Ginoza Administrative Assistant
Dawne Kieser Employment Specialist
Provided oversight for CARF accreditation, survey process, strategic plans, and performance plans Organized & led annual DVR/DDA/DSB focus groups
Analyzed, tracked, & input data Handled, analyzed, and stored all surveys received Compiled & distributed Outcome Management Reports (OMRs) Oversaw & scheduled internal auditing Helped support CARF surveys, documentation, & accreditation
The 2018 - 2019 contract year saw a relatively even spread of age ranges served across DVR and DDA, with a total of 53.6% of clients served ages 18 - 44 and 46.4% clients served ages 45+.
Age
DEMOGRAPHICS
Gender
Clients served during the 2018 - 2019 skewed male, with almost two thirds (64.3%) of clients served being male and a little over one third (35.7%) of clients served being female. This represents an area for improvement.
Race
83.9% of clients served during the 2018 - 2019 were white, with a combined total of 16.1% of clients representing other races, including African-American, Asian, Hispanic, Mixed Race, Native American, and Other.
Education Level
The majority (75.0%) of clients served during the 2018 - 2019 contract year possessed either a High School-level education (Diploma or GED/Equivalent) or a Special Education Diploma. A handful of clients (12.5%) had completed college-level education (Associate's Degree or higher), and a small number (8.9%) had completed some high school education without receiving a diploma/GED. Information on education level was not appropriately gathered for two (3.6%) clients, which represents an area for improvement.
Disability
The 2018 - 2019 contract year saw CES serving clients with a wide array of disabilities. Nearly half (49.1%) of clients served were diagnosed with an intellectual/developmental disability (ID/DD). Mental health was the second most common diagnosis with over a third of clients (34.5%) diagnosed with a mental health disability, and autism spectrum disorders were the third most common at 20.0%. More than half (55.6%) of clients had two or more comorbid diagnoses.
Acuity Levels
Over two thirds (67.8%) of Jefferson County DDA clients served during the 2018 - 2019 contract year were Medium Acuity, with the remaining one third (32.2%) being High Acuity. No (0.0%) Low Acuity clients were served in Jefferson County during this contract year.
NEWS AT SKOOKUM
The majority (71.4%) of Kitsap County DDA clients were Medium Acuity, with an equal amount of Low Acuity (14.3%) and High Acuity (14.3%) clients. CES staff in Kitsap County served fewer High Acuity and more Low Acuity clients than CES staff in Jefferson County.
Finances
During the 7/1/2018 - 6/30/2019 contract year, the CES department earned a combined total of $270,649.87 in revenue over the year while spending a total of $244,470.23 in costs. CES staff earned a net income of $26,179.64 over the contract year for an operating percentage of 10%. CES only achieved $20,709.30 in net income during the 1/1/2018 - 12/31/2018 fiscal year, for an operating percentage of only 6.17% under the new fiscal year system. CES management worked hard to decrease spending after DVR announced it would be significantly limiting the number of clients referred to employment vendors.
OUTCOMES
DVR Job Placements
Less than half (41.2%) of DVR clients served during the 2018 - 2019 contract year were successfully placed into jobs. Of those who were not placed (58.8%), half of the clients (50.0%) continued services with Skookum into the 2019 - 2020 contract year. Of the clients who did not continue services with Skookum, two (2) transferred to another agency, two (2) refused further services, and Skookum determined one (1) could not be served for VR services and was referred back to DVR. One (1) of the DVR clients who transferred to another agency was a dual-service DDA client who transitioned to a new vendor towards the end of the contract year when Skookum decided not to renew the DDA contract in Kitsap County.
DVR Job Retention
All (100.0%) of the DVR clients who received Job Retention services from Skookum successfully completed their services and retained their job for at least 90 days after hire with the help of CES.
CES staff helped clients achieve all (100.0%) of the goals set in their Service Delivery Outcome Plan (SDOP) to help them reduce barriers to employment.
DVR Independent Living Skills (IL)
Of the meetings set with DVR clients during the 2018 - 2019 contract year, only an average of 1.1% of all scheduled meetings were canceled or rescheduled by CES staff in Bremerton and 4.0% in Port Townsend. Across both locations, the average was 2.6%. In comparison, 11.2% of all scheduled meetings were canceled by DVR clients in Bremerton and 17.3% by DVR clients in Port Townsend, for an average of 14.3% across both locations. Client no-call/no-shows were included in the totals.
DVR Client Meetings
CES achieved & maintained high levels of DDA client employment rates for Jefferson County during the 2018 - 2019 contract year. 91.8% of Medium Acuity and all (100.0%) High Acuity clients were employed during the contract year, for a combined average of 95.9% across all Acuity Levels.
DDA Employment Rates
CES staff in Kitsap County overall achieved & maintained high levels of employment among DDA clients. All (100.0%) Low Acuity and High Acuity clients employed and most (81.4%) Medium Acuity clients were employed, for a total combined average of 93.8% across all Acuity Levels.
In addition to high levels of employment among Jefferson County DDA clients, CES helped most (99.2%) Medium Acuity and all (100.0%) High Acuity clients maintain their employment , with only one (1) client job loss (0.8%) due to a contract with the school district not being renewed. This adds up to a combined average across all Acuity Levels of 99.6%.
DDA Job Retention
CES staff in Kitsap County were also highly successful in maintaining DDA client employment, with all (100.0%) Low, Medium, and High Acuity clients maintaining employment during the 2018 - 2019 contract year and no (0.0%) job losses.
DDA Client Wages
All DDA clients (100.0%) who were employed received earnings of at least minimum wage during the 2018 - 2019 contract year. While minimum-wage or higher level earnings were not specifically tracked for Kitsap County DDA, Skookum does not place clients into sub-minimum wage jobs. Due to the WA state minimum wage increase on 1/1/2019, all DDA clients (100.0%) received a wage increase during the year.
DDA Client Hours Worked
Nearly three quarters (74.7%) of Medium Acuity DDA clients and less than half (47.2%) of High Acuity DDA clients in Jefferson County were working their preferred number of hours during the 2018 - 2019 contract year, for a combined average of 61.0% across all Acuity Levels. This represents an area for improvement. No (0) Jefferson County DDA clients had an increase of hours.
All Low Acuity (100.0%) and High Acuity (100.0%) Kitsap County DDA clients were working their preferred number of hours during the contract year. Nearly three quarters (74.7%) of Medium Acuity clients were working their preferred number of hours. The combined average across all Acuity Levels was 91.6%.
For the 2018 - 2019 contract year, Jefferson County CES staff utilized between 46.6% and 70.0% of available billable service hours for Medium Acuity DDA clients each month, for an average of 55.9% throughout the contract year. CES staff overall utilized more billable service hours for High Acuity DDA clients, with the monthly average ranging from 46.6% to 70.0% and a contract year average of 67.8%. Across all Acuity Levels, CES staff utilized 61.9% of available service hours on average. This represents an area for potential improvement.
DDA Service Hour Utilization
During the 2018 - 2019 contract year, CES staff in Kitsap County utilized available billable client hours to a varying degree, with High and Medium Acuity clients overall showing a higher level of billable hour utilization over Low Acuity clients. CES staff utilized between 13.9% and 69.4% of available monthly hours for Low Acuity clients, for a contract year average of 38.9%. For Medium Acuity clients, that number ranged from 32.9% to 100.0%, with a contract year average of 61.8%. High Acuity clients received more consistent support, with service hour utilization ranging from 75.0% to 100.0%, for a contract year average of 91.7%. Across all Acuity Levels, CES staff in Kitsap County utilized 64.1% of available service hours on average throughout the contract year.
DDA Client Continuation of Service
During the 2018 - 2019 contract year, CES staff saw 88.9% of Medium Acuity DDA clients in Jefferson County continuing services with Skookum. One (1) Medium Acuity client's services (11.1%) ended due to the client passing away. A lower number of High Acuity clients continued services with Skookum, with only 40.0% continuing services. Of the 60.0% of clients who ended services, two (2) changed to another vendor for services and one (1) was transitioned to another vendor after Skookum staff determined they were unable to support the client in an unsafe work environment. DDA Kitsap clients were not included in the total. All DDA Kitsap clients were transitioned to new vendors due to Skookum's decision to not renew the DDA contract in Kitsap County.
DDA SMART Goals
Of the total number of goals set for DDA clients in Jefferson County during the 2018 - 2019 contract year, CES staff helped clients achieve over a third of them (35.7%), with 22.3% of the goals being revised and 42.0% being continued as ongoing goals. The average per client was similar, with 34.6% goal completion, 20.9% goal revision, and 44.5% goal continuation.
Of the total number of goals set for DDA clients in Kitsap County during the contract year, CES staff helped clients achieve over half of them (56.3%), with 15.6% of the goals being revised and a little over one third (28.1%) being continued as ongoing goals. The average per client was similar, with 56.9% goal completion, 13.8% goal revision, and 29.3% goal continuation. Overall, goal completion for DDA clients in Kitsap County was higher than in Jefferson County.
DDA SETWorks Files
An initial internal CES audit was conducted two weeks after client files were migrated to SETWorks. Of all DDA client files audited, 65.4% were error-free, while 34.6% had at least one mistake present & only one of which had two errors present. Errors found included Date of Birth (3), Ethnicity (1), and Address (6). All incorrect information was corrected, and CES staff conducted monthly audits of DDA client files throughout the rest of the contract year to ensure ongoing accuracy. Additional errors found were addressed and fixed promptly after being discovered.
DVR SETWorks Files
An initial internal CES audit of DVR client files was conducted two weeks after file migration to SETWorks. Of the files audited, 70.0% were free from errors, with 30.0% having at least one error. Most errors identified were incorrect client addresses, which were promptly corrected.
CES Staff Retention
Due to the CES department downsizing and restructuring, only third (33.3%) of CES direct service & administrative staff were overall retained. Of the remainder (66.7%) who were not retained, three (3) employees were laid off due to a Reduction in Force (RIF), one (1) staff member resigned to spend time with family, and one (1) staff member accepted a lateral transfer into the Skookum Vocational department. None (0) of the positions of CES staff who left Skookum were backfilled. A new position was created to absorb the Administrative Assistant duties as well as supporting other Skookum departments, and the Vocational Director took over direct supervision of the CES department.
CES received only four (4) survey responses from Port Townsend clients and four (4) responses from Bremerton clients out of a total of 54 clients served during the 2018 - 2019 contract year, making it difficult to know how accurately the responses measure satisfaction with CES services. This represents an area for improvement. Of the clients that responded, two (2) Port Townsend clients and three (3) Bremerton clients offered the following additional feedback in the comments section: What do you think Skookum Community Employment Services is doing well? "Placing people in jobs" "Supporting clients through the process" "Putting clients' needs first!" "Helping me find a job in a kind way" "Finding people employment that [they] enjoy"
Clients were asked to mark whether they Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree with the following statements: I am satisfied with the services provided by Skookum staff. Skookum staff keep me informed. Clients are treated with dignity and respect. Clients have an opportunity to voice their preferences. Clients are included in the planning of their goals. Clients were also given the opportunity to add comments by answering the following questions: What do you think Skookum Community Employment Services is doing well? What do you think Skookum is NOT doing well?
Client Survey Results
Client Surveys
CUSTOMER SATISFACTION
What do you think Skookum is NOT doing well? "I think Skookum's weakness is P. R. and getting the Skookum name & mission more well-known in our community. We are an important part of helping the disabled community. Make more noise!" "Can't think of one thing!" "Why can't they ask Social Security about my hours? Why can't they get ahold of people that can do stuff?" "N/A"
All (100.0%) CES clients in both Bremerton and Port Townsend reported overall satisfaction with the services provided by CES staff, with half (50.0%) of clients in each area indicating a high level of satisfaction (Strongly Agree) and half (50.0%) expressing a moderate level of satisfaction (Agree). Across both locations, the average satisfaction rate was 100.0%.
All (100.0%) CES clients in Port Townsend reported they were satisfied with how well CES staff kept them informed, with three quarters (75.0%) reporting a high level of satisfaction (Strongly Agree) and the rest (25.0%) reporting a moderate level of satisfaction. Most (75.0%) CES clients in Bremerton reported they were satisfied with how well CES staff kept them informed. The satisfaction rate for Bremerton was overall lower, with only one quarter (25.0%) reporting a high level of satisfaction (Strongly Agree) and half (50.0%) reporting a moderate level of satisfaction (Agree). 25.0% of clients in Bremerton reported dissatisfaction (Disagree) with how well CES staff kept them informed. Overall, CES attained an average 87.5% satisfaction rate for keeping CES clients informed.
Port Townsend clients reported overall 100.0% satisfaction with treatment by staff, with half (50.0%) indicating they strongly agreed that clients are treated with dignity and respect, and half (50.0%) indicating they agreed. Bremerton clients also reported overall 100.0% satisfaction, with one quarter (25.0%) indicating they strongly agreed that clients are treated with dignity and respect, and three quarters (75.0%) indicating they agreed. Overall, clients across both locations indicated 100.0% satisfaction with the way they were treated by CES staff.
All (100.0%) Port Townsend overall felt that they were given an opportunity to voice their preferences, with half (50.0%) strongly agreeing that was true and half (50.0%) agreeing. In addition, all (100.0%) Bremerton clients overall felt that they were given an opportunity to voice their preferences, with half (50.0%) strongly agreeing that was true and half (50.0%) agreeing. On average, all (100.0%) clients across both locations expressed satisfaction with their ability to voice their preferences.
Overall, all (100.0%) Port Townsend clients felt they were included on the planning of their goals, with half (50.0%) strongly agreeing that was the case and half (50.0%) agreeing. All (100.0%) Bremerton clients also felt they were included on the planning of their goals, with half (50.0%) strongly agreeing and half (50.0%) agreeing. On average, all (100.0%) clients across both locations expressed they felt they were included on the planning of their goals.
Parents, family, and guardians were asked to mark whether they Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree with the following statements: I am satisfied with the services provided by Skookum staff. Skookum staff keep me informed. Clients are treated with dignity and respect. Clients have an opportunity to voice their preferences. Clients are included in the planning of their goals. Parents/family/guardians were also given the opportunity to add comments by answering the following questions: What do you think Skookum Community Employment Services is doing well? What do you think Skookum is NOT doing well?
Parent/Family/Guardian Surveys
Parent/Family/Guardian Survey Results
CES received only three (3) survey responses from Port Townsend parents/family/guardians and no (0) responses from Bremerton parents/family/guardians, making it difficult to determine how accurately the results measure satisfaction. This represents an area for improvement. Of the Port Townsend parents/family/guardians who responded, all three (3) provided the following additional feedback in the comments section: What do you think Skookum Community Employment Services is doing well? "[Employment Specialist] connects with my son in an effective and caring way" "I absolutely [Employment Specialist]. She is so great with my brother [Client Name]. I could not ask for a better job coach." "Keep client informed" What do you think Skookum is NOT doing well? "Not sure" "Nothing!"
All (100.0%) Port Townsend parents/family/guardians reported overall satisfaction with the services provided by Skookum staff, with all (100.0%) reporting a high level of satisfaction.
All (100.0%) Port Townsend parents/family/guardians were overall satisfied with how CES staff kept them informed, with all (100.0%) reporting they strongly agreed they were kept informed.
Parents/family/guardians in Port Townsend reported overall (100.0%) satisfaction with treatment of clients, with all (100.0%) indicating they strongly agreed that clients were treated with dignity and respect.
All (100.0%) parents/family/guardians in Port Townsend reported overall satisfaction with clients' ability to voice their preferences, with all (100.0%) strongly agreeing clients were able to do so.
Overall, all (100.0%) parents/family/guardians in Port Townsend expressed satisfaction with clients being included on the planning of their goals, with all (100.0%) strongly agreeing that was the case.
Employment/Volunteer Site Survey Results
CES received only one (1) survey response from Port Townsend employer/ volunteer sites and one (1) response from Bremerton employer/volunteer sites, making it difficult to determine how accurately the results measure satisfaction. This represents an area for improvement. Of the employer/volunteer sites who responded, the Port Townsend employer/ volunteer site provided the following additional feedback in the comments section: What do you think Skookum Community Employment Services is doing well? "[Employment Specialist] is the best"
Employer and volunteer sites were asked to mark whether they Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree with the following statements: I am satisfied with the services provided by Skookum staff. Skookum staff is/was respectful and professional at all times. Clients are treated with dignity and respect. Clients have an opportunity to voice their preferences. Clients are included in the planning of their goals. Employer/volunteer sites were also given the opportunity to add comments by answering the following questions: What do you think Skookum Community Employment Services is doing well? What do you think Skookum is NOT doing well?
Employer/Volunteer Site Surveys
All (100.0%) Port Townsend employer/volunteer sites reported overall satisfaction with the services provided by staff, with all (100.0%) reporting a high level of satisfaction. All (100.0%) Bremerton employer/volunteer sites reported overall satisfaction as well, with all (100.0%) reporting a moderate level of satisfaction. Across both locations, employers/volunteer sites reported an overall average of 100.0% satisfaction with CES services.
All (100.0%) Port Townsend employer/volunteer sites reported overall satisfaction with the professionalism displayed by CES staff, with all (100.0%) reporting a high level of satisfaction. Likewise, all (100.0%) Bremerton employer/volunteer sites reported overall satisfaction as well, with all (100.0%) reporting a high level of satisfaction. Across both locations, employers/volunteer sites reported an overall average of 100.0% satisfaction with CES staff respectfulness & professionalism.
All (100.0%) Port Townsend employer/volunteer sites agreed that clients were treated with dignity and respect, with all (100.0%) strongly agreeing. Similarly, all (100.0%) Bremerton employer/volunteer sites reported overall agreement as well, with all (100.0%) indicating they strongly agreed. Across both locations, employers/volunteer sites reported an overall average of 100.0% satisfaction with the treatment of CES clients.
All (100.0%) Port Townsend employer/volunteer sites overall agreed that clients were given an opportunity to voice their preferences, with all (100.0%) strongly agreeing that was the case. In addition, all (100.0%) Bremerton employer/ volunteer sites overall agreed that clients were able to given the opportunity to voice their preferences, with all (100.0%) strongly agreeing that was true. Overall, employer/volunteer sites across both locations expressed 100.0% agreement that CES staff gave clients the opportunity to voice their preferences.
Focus Groups
CES conducted a focus group for Port Townsend clients in December 2018. Although both DVR and DDA clients were invited, only two (2) DDA clients attended. CES staff asked two questions during the focus group to elicit feedback: "What is Skookum doing well?" and "What can Skookum improve on?"
All (100.0%) Port Townsend employer/volunteer sites overall agreed that clients were included on the planning of their goals, with all (100.0%) strongly agreeing that was the case. In addition, all (100.0%) Bremerton employer/volunteer sites overall agreed that clients were included in goal planning, with all (100.0%) strongly agreeing that was true. Overall, employer/volunteer sites across both locations expressed 100.0% agreement that CES staff included clients in goal planning.
Feedback provided included the following: What is Skookum doing well? "Getting jobs for people" "Keeping our contracts" "Making the county happy" "Making us feel like family" "Being flexible and understanding" No feedback was provided in response to to "What can Skookum improve on?" but a client stated he takes pride in his job and appreciates his coworkers. Due to the Bremerton CES department's downsizing and restructuring, no focus groups were conducted in the Bremerton area during the 2018 - 2019 contract year.
ANALYSIS
Performance Plan Goals
CES staff set the following goals for 2018 - 2019: Business Functions: Operate within set CES annual budget (All) Effectiveness of Services: Improve effectiveness of employment services (DVR) Provide effective Independent Living Skills (IL) services (DVR) Ensure clients are working preferred number of hours per week (DDA) Monitor and increase the percentage of clients employed (DDA) Efficiency of Services: Improve/maintain CES staff retention (DVR, DDA) Train staff to utilize SETWorks for client records & files (DVR, DDA) Use of effective SMART goals (DDA)
Service Access: Ensure clients receive timely, continuous services (DVR) Effectively use service hours allotted to each client (DDA) Satisfaction: Maintain customer satisfaction (DVR, DDA)
Operate within CES Annual Budget (All)
Target: CES set a target of achieving 12.0% operating percentage. Means & Measures: The CES annual budget for 2018 - 2019 was compared with Profit & Loss information maintained by the Skookum Financial Department. Targets for costs & revenue as well as net profit were compared. Results: Contract Year: 10.0% Operating Percentage Fiscal Year: 6.2% Operating Percentage Despite higher overall revenue than projected, costs were higher as well. CES fell short of projected net earnings, with neither the 7/2018 - 6/2019 contract year nor the 1/2018 - 12/2019 fiscal year achieving the target operating percentage.
Means & Measures: Job placements were tracked by comparing clients with DVR authorizations for Job Placement during the 2018 - 2019 contract year with job placement data from SETWorks, SDORs, and billing spreadsheets. Results: 58.8% Job Placement rate CES staff fell short of the Job Placement target for DVR clients.
Improve Effectiveness of Employment Services (DVR)
Target: CES set a target of 75.0% successful Job Placements for DVR clients.
Target: CES set a target of 75.0% Job Retention for DVR clients. Means & Measures: DVR Job Retention rates were measured by comparing clients enrolled in DVR Job Retention services with Job Retention Outcome invoices, as CES is only able to bill for Job Retention Outcome once clients have maintained stable employment for at least 90 days and received a favorable report from their supervisor. Results: 100.0% Job Retention completion CES staff both attained and surpassed the goal for Job Retention.
Target: CES set a target of completing 90.0% of clients' goals as established in their SDOPs. Means & Measures: Goal completion was measured by reviewing SDORs for IL clients in comparison with descriptions of goal progress/completion from SDOPs. Results: 100.0% SDOP goal completion CES staff both achieved & surpassed the target set for IL services.
Provide Effective Independent Living Skills (IL) Services (DVR)
Ensure Clients are Working Preferred Number of Hours (DDA Jefferson County)
Target: CES set a target of 75.0% for DDA clients in both Jefferson and Kitsap County to be working their preferred number of hours. Means & Measures: CES staff tracked the number of clients employed, and client hours worked on a monthly basis by Acuity Level. Clients indicated their preferred number of work hours at 6-Month Reviews, and a checkbox on SETWorks was implemented to better track whether clients were working their current preferred number of work hours.
Ensure Clients are Working Preferred Number of Hours (DDA Kitsap County)
Target: CES set a target of 75.0% for DDA clients in both Jefferson and Kitsap County to be working their preferred number of hours.
Results: Medium Acuity: 74.7% of Clients Working Preferred # of Hours High Acuity: 47.2% of Clients Working Preferred # of Hours CES staff fell just shy of the target for Medium Acuity clients, while less than half of High Acuity clients in Jefferson County were working their preferred number of hours.
Means & Measures: CES staff tracked the number of clients employed, and client hours worked on a monthly basis by Acuity Level. Clients indicated their preferred number of work hours at 6-Month Reviews, and a checkbox on SETWorks was implemented to better track whether clients were working their current preferred number of work hours. Results: Low Acuity: 100.0% of Clients Working Preferred # of Hours Medium Acuity: 74.5% of Clients Working Preferred # of Hours High Acuity: 100.0% of Clients Working Preferred # of Hours CES staff in Kitsap County were overall more successful in ensuring DDA clients worked their preferred number of hours per week. However, the smaller sample size for DDA Kitsap County (7) likely contributed to the higher percentages. Despite an overall higher level of success, CES staff fell just short of the target for Medium Acuity clients.
Monitor and Increase Percentage of Clients Employed (DDA Jefferson County)
Target: CES set a target of 90.0% employment for DDA clients in both Jefferson and Kitsap Counties. Means & Measures: CES staff tracked client information by Acuity Level, including the number of DDA clients currently employed, on a monthly basis. Results: Medium Acuity: 91.8% Clients Employed High Acuity: 100.0% Clients Employed CES staff in Jefferson County both met & exceeded the target for DDA client employment rates.
Target: CES set a target of 90.0% employment for DDA clients in both Jefferson and Kitsap Counties. Means & Measures: CES staff tracked client information by Acuity Level, including the number of DDA clients currently employed, on a monthly basis. Results: 100.0% Low Acuity Clients Employed 81.4% Medium Acuity Clients Employed 100.0% High Acuity Clients Employed CES staff in Kitsap County were overall successful in meeting the target, falling short only for Medium Acuity clients.
Monitor and Increase Percentage of Clients Employed (DDA Kitsap County)
Target: CES set a target of 75.0% CES staff retention for the 2018 - 2019 contract year. Means & Measures: CES tracked the number of CES staff who provided direct service or administrative support to the department. Results: 33.3% CES staff retention CES fell far short of its goal, with overall only one third of direct service & administrative staff being retained. However, all (100.0%) of the four (4) positions of staff who left Skookum were ultimately eliminated, and none of the positions were backfilled. Adjusting for this fact, 100.0% of CES staff in maintained positions were retained.
Improve/Maintain CES Staff Retention (DVR, DDA)
Target: CES staff set a goal of 100.0% accuracy for DVR/DSB client SETWorks files. Means & Measures: The CES Supervisor audited all DVR files in SETWorks two weeks after all files were migrated to SETWorks to ensure accuracy of client demographics, contact information, authorization(s), and all other important/necessary information. Results: 70% DVR client file accuracy CES fell short of the goal for client accuracy. After the initial audit, the CES Administrative Assistant conducted audits of SETWorks files periodically to ensure ongoing accuracy.
Train Staff to Utilize SETWorks for Client Records & Files (DVR)
Target: CES staff set a goal of 100.0% accuracy for DDA client SETWorks files. Means & Measures: CES staff conducted an initial audit of all DDA client SETWork files two weeks after all files were migrated to SETWorks to ensure accuracy of client demographics, contact information, guardianship status, authorization(s), and all other important/necessary information. Results: 65.4% DDA client file accuracy CES staff fell short of the target after the initial audit. DDA client files were audited on a monthly basis throughout the rest of the contract year, with all errors being corrected immediately when found.
Train Staff to Utilize SETWorks for Client Records & Files (DDA)
Use of Effective SMART Goals (DDA Jefferson County)
Target: CES staff set a target of 75.0% completion for all DDA clients' SMART goals during the 2018 - 2019 contract year. Means & Measures: Goals were set during clients' 6-Month Reviews. Progress towards goal completion was tracked in SETWorks case notes, and goals were continued as-is, revised, or marked as completed during the client's following 6-Month Review. CES staff were also able to mark goals as completed in SETWorks, along with the date completed. Results: 35.7% Jefferson County DDA Client Goals Completed CES staff in Jefferson County fell short of the target, attaining less than half of the target goal completion rate.
Use of Effective SMART Goals (DDA Kitsap County)
Target: CES staff set a target of 75.0% completion for all DDA clients' SMART goals during the 2018 - 2019 contract year. Means & Measures: Goals were set during clients' 6-Month Reviews. Progress towards goal completion was tracked in SETWorks case notes, and goals were continued as-is, revised, or marked as completed during the client's following 6-Month Review. CES staff were also able to mark goals as completed in SETWorks, along with the date completed. Results: 56.3% Kitsap County DDA Client Goals Completed CES staff in Kitsap County also fell short of the goal completion rate, by about 20%.
Ensure Clients Receive Timely, Continuous Services (DVR)
Target: CES set a target for CES staff to cancel/reschedule fewer than 10.0% of scheduled meetings with clients. Means & Measures: Client case notes were utilized to track the number of meetings scheduled with each client and the number of times CES staff requested to cancel or reschedule meetings. Meetings which clients, VRCs, or other stakeholders canceled/rescheduled were not included. Results: 2.6% of scheduled client meetings canceled by CES staff CES staff stayed well below the target maximum, indicating an overall high level of reliability & consistent accessibility to clients.
Target: CES staff set a target of 90.0% DDA client retention for the 2018 - 2019 contract year. Means & Measures: CES staff tracked the number of billable hours authorized by each client's CBA(s) and compared that number to the number of billable hours to obtain a percentage utilization for both DDA Jefferson County and DDA Kitsap County. CES staff also tracked whether DDA clients remained with Skookum or chose to work with another vendor to determine whether billable hours had been used effectively. Results: Medium Acuity: 88.9% client retention High Acuity: 40.0% client retention
Effectively Use Service Hours Allotted to Each Client (DDA)
CES staff in Jefferson County fell just shy of the target for Medium Acuity clients. However, the one (1) Medium Acuity client who did not continue services with Skookum was due to the client passing away. Adjusted for this factor, the percentage of Medium Acuity clients choosing to continuing services with CES was 100.0%. CES staff in Jefferson County were less successful with High Acuity client retention. However, one (1) of the High Acuity clients who ended services with Skookum did so on Skookum's request. Adjusting for that factor, the percentage of High Acuity clients choosing to continue services with CES was closer to 50.0%. CES did not track DDA Kitsap client retention due to choosing to end the contract and transition all clients to other vendors.
Maintain Customer Satisfaction (DVR, DDA)
Trends
Target: CES staff set a target of 90.0% customer satisfaction based on high levels of customer satisfaction during the previous contract year.
Demographics indicate Skookum is serving a relatively diverse group of clients with regards to age and type of disability. However, a disproportionate number of CES clients are male, and most racial groups are poorly represented. Outcome data shows a high level of achievement in most areas, with possible room for improvement in DVR job placement rates. DDA clients showed overall high levels of employment and job retention. However, Jefferson County DDA clients had comparatively low levels of clients working their preferred number of hours, with less than half of High Acuity clients in Jefferson County working their preferred number of hours. This suggests CES staff may have room to improve their efforts in advocating for High Acuity DDA clients.
Means & Measures: Surveys were provided to DVR/DSB and DDA clients, parents/family/guardians, and employer/volunteer sites. Surveys were also provided to DVR VRCs and DDA CRMs, although none of the surveys sent to funding sources were returned. Results: Bremerton Clients & Stakeholders: 97.5% Overall Satisfaction Port Townsend Clients & Stakeholders: 100.0% Overall Satisfaction CES staff achieved & exceeded the goals set for customer satisfaction. However, the results were based on a limited number of surveys and may not fully represent all clients served.
PERFORMANCE IMPROVEMENT
The 2018 - 2019 contract year brought upheaval to the Skookum CES department, with significant adaption becoming necessary only partway through the year. Nevertheless, CES staff & management identified the following areas for improvement: Additional funding sources needed: With DVR significantly reducing the number of referrals and Skookum choosing not to renew its DVR Kitsap contract, additional funding sources are needed for CES to continue to thrive. Operating percentage: On a related note, CES fell significantly short of the target for operating percentage. Survey delivery: A limited number of surveys were sent during the contract year, and even fewer returned. This was in part due to the uncertainties within the department, decrease in referrals, and restructuring. However, limited surveys means the department can't be sure of customer satisfaction levels. DDA clients working preferred hours: A fairly low number of DDA clients in Jefferson County, particularly High Acuity clients, were working their preferred number of hours during the 2018 - 2019 contract year. DDA client retention: CES staff had a fairly low level of client retention among High Acuity clients in Jefferson County. SMART goal completion: CES staff fell short of the target for SMART goal completion. This may mean that CES needs to set a more reasonable target and/or that clients' goals did not fully meet SMART criteria.
Areas for Improvement
In addition, no DDA clients received an increase in hours worked, and no clients received any increase in wages for reasons other than WA state minimum wage increasing. Data collection for customer satisfaction was relatively poor for the 2018 - 2019 contract year, making it difficult to draw meaningful conclusions. Despite this, the responses Skookum received for both Bremerton and Port Townsend clients suggest clients are overall satisfied with CES services. Other stakeholders also reported a high level of overall satisfaction.
Going into the 2019 - 2020 year, CES staff & management plan to work on the following areas: Explore additional funding options: CES plans to continue to expand Ticket to Work services for external ticketholders and is already looking into the possibility of signing a Partnership Plus Agreement with DVR. CES has also begun exploring the Foundational Community Supports (FCS) program through Amerigroup and hopes to begin serving FCS clients shortly. In addition, CES plans to look into providing Community Guide services through DDA. Increase operating percentage: To achieve a better operating percentage in 2019, CES needs to increase revenue and/or decrease costs. Obtaining additional funding sources, such as FCS (which allows hourly billing) may help with this. Continue community involvement & advocacy efforts: CES plans to continue developing partnerships with other agencies through participation in CEA. FCS will offer an additional opportunity to develop partnerships with mental health and/or substance abuse recovery agencies. Improve SETWorks utilization: CES staff have only begun to explore SETWorks' capabilities for data management and reporting and hope to continue to learn the best ways to utilize SETWorks for streamlining of processes and data collection.
Action Plan
SETWorks client file accuracy: A number of errors were found in CES client SETWorks files, suggesting a need for more frequent internal/external audits and/or improved staff training. Internal audits: CES staff was inconsistent in conducting audits of all client files during the 2018 - 2019 contract year. Record keeping was minimal for the audits which were conducted within the CES department. In addition, few audits were conducted by the Skookum Quality Control (QC) department, and the QC department received inadequate guidance for conducting audits of files within SETWorks.
Improve & update policies, procedures, & other documentation: CES works to update policies, procedures, client handbooks, and other documentation on at least an annual basis. All policies & procedures will be reviewed & updated as needed. CES plans to continue to incorporate input from funding sources, clients, other stakeholders, and suggestions given during the 2017 CARF re-accreditation survey to maintain best practices. Improve survey process: A limited number of surveys were given during the 2018 - 2019 contract year. CES plans to set clearer guidelines for handing out surveys to clients. CES will also be looking at the surveys themselves to determine if changes need to be made to the survey questionnaires. Improve internal auditing processes: CES plans to take another look at the criteria which the Skookum QC department has used to review CES files, modify the criteria as needed to ensure QC audits involve relevant items, and provide additional training and guidance to the QC department to ensure they are able to navigate SETWorks successfully. Increase preparation for CARF: As CES heads into the 2019 - 2020 contract year, staff will be working diligently to prepare for re-accreditation. CES management hopes to hire a CARF consultant to improve Skookum's understanding of CARF requirements and ensure CES gathers & completes all necessary documentation for the 2020 re-accreditation survey.
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