Appalachian Research and Defense Fund...Appalachian Research and Defense Fund This project was supported by Grant No. 2014-FW-AX-K001 awarded by the Office on Violence Against Women,

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Appalachian Research and Defense Fund

This project was supported by Grant No. 2014-FW-AX-K001 awarded by the Office on Violence

Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and

recommendations expressed in this publication/program/exhibition are those of the author(s) and do

not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

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Needs Assessment Report

Table of Contents

Introduction ....................................................................................................................................3

Executive Summary .......................................................................................................................3

Vision Statement ............................................................................................................................4

Mission Statement .........................................................................................................................4

Overview of Collaboration Members ..........................................................................................5

Overview of Planning Phase to Date ............................................................................................6

Description of Needs Assessment ..................................................................................................9

Purpose and Use of Information ...................................................................................................9

Needs Assessment Goals ................................................................................................................9

Brief Overview of Methodology ..................................................................................................10

Who Did We Engage? .................................................................................................................11

Methods and Numbers ................................................................................................................12

Challenges, Data Collection and Analysis .................................................................................14

Key Findings and Implications ...................................................................................................15

Key Findings ........................................................................................................................................... 14

Key Findings #1 ..................................................................................................................................... 16

Indicators .................................................................................................................................... 16

Implications ................................................................................................................................ 17

Possible Solutions ...................................................................................................................... 18

Key Findings #2 ..................................................................................................................................... 19

Indicators .................................................................................................................................... 19

Implications ................................................................................................................................ 20


Key Findings #3 ..................................................................................................................................... 21

Indicators .................................................................................................................................... 21

Implications ................................................................................................................................ 22


Key Findings #4 ..................................................................................................................................... 23

Indicators .................................................................................................................................... 23

Implications ................................................................................................................................ 25


Key Findings #5 ..................................................................................................................................... 27

Indicators .................................................................................................................................... 27

Implications ................................................................................................................................ 28


Conclusions ..................................................................................................................................29

Next Steps ....................................................................................................................................29

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Bridging Safe Access to Big Sandy (BSABS) is made possible by the Training and

Services to End Violence Against Women with Disabilities grant funded by the Office of

Violence Against Women (OVW FY 2014). Our Technical Assistance is provided by Vera

Institute of Justice. With OVW and Vera, Bridging Safe Access to Big Sandy is working to make

our services more accessible for individuals with behavioral health and/or

developmental/intellectual disabilities who have experienced interpersonal violence. To gain

more perspective of how we are currently providing services, BSABS conducted a needs

assessment. This assessment included survivors of interpersonal violence and individuals with

behavioral health and/or developmental/intellectual disabilities, as well as direct service staff,

advocates, therapists, SANE Nurse, and leadership from each partner agency. The needs

assessment provided information needed to ascertain outcomes for Bridging Safe Access to Big

Sandy and the data collected will guide our work as we begin to develop our Strategic Plan.

In our Needs Assessment, we designed specific questions related to the following

four goals:

Goal 1: What are barriers survivors with behavioral health and/or

developmental/intellectual disabilities face when trying to access advocacy, safety-

planning and services?

Goal 2: What are the entry points, if any, into the violence response system for

individuals with behavioral health and/or developmental/intellectual disabilities, and how

can we improve access to these entry points?

Goal 3: Assess the ability of our staff to provide a safe, accessible, and welcoming

environment to individuals who seek/receive services within our agencies.

Goal 4: Identify the strengths and weaknesses in the existing policies, procedures,

practices, and programs at each of our organizations.

This Needs Assessment Report explains our methodology, the purpose, and analysis of

data gathered from our partner agencies to reveal the following five key findings:

Key Finding #1: There is a lack staff capacity with all collaboration partners to

serve individuals with behavioral health and/or developmental/intellectual

disabilities at the intersection of interpersonal violence.

Bridging Safe Access to Big Sandy Needs Assessment Report

Introduction-Executive Summary

4

Key Finding #2: There is a lack of awareness about the resources and/or services

provided by collaboration partner agencies.

Key Finding #3: All agencies need clearer policies and procedures at the

intersection of behavioral health and/or developmental/intellectual disabilities and

interpersonal violence.

Key Finding #4: There are safety and accessibility concerns at all agencies for

individuals with behavioral health and/or developmental/intellectual disabilities at

the intersection of interpersonal violence.

Key Finding #5: There is a lack of knowledge within all agencies about

guardianship roles at the intersection of interpersonal violence.

Along with the data collected from the performance indicators, the information collected

and shared in this report will guide our strategic planning, as well as lead us into the

implementation phase of our project.

Vision Statement

“We envision a safe and accessible community that will bridge services within The Big

Sandy Region, which will be tailored to the distinct needs and circumstances of individuals with

behavioral health and/or developmental/intellectual disabilities, who are survivors of

interpersonal violence1.”

Mission Statement

Bridging Safe Access to Big Sandy seeks to educate and create a community encompassing

safe and accessible resources that are available to individuals with behavioral health and/or

developmental/intellectual disabilities. Our collaborative seeks to achieve this by way of:

Identifying gaps, barriers, strengths, and resources within our agencies.

Empowering and welcoming survivors.

Educating and cross-training within our agencies to share resources.

Creating changes within our agencies to enhance our collaboration.

Creating changes within our agencies which result in more welcoming and accessible

services for survivors.

1 Interpersonal Violence is an umbrella term that encompasses domestic violence, sexual assault, dating violence, and stalking. www.thepca.org/what-is-ipv/


Vision and Mission Statement

http://www.thepca.org/what-is-ipv/

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Mountain Comprehensive Care Center (MCCC), established in 1963, is a 501(c)(3),

CARF accredited, non-profit corporation. MCCC is one of Kentucky’s 14 regional mental

health and mental retardation boards serving the Big Sandy district. As part of its mission,

MCCC serves individuals with disabilities which stem from behavioral health needs such as

behavioral health and substance use diagnoses, as well as developmental and intellectual

disabilities. Key adult services provided by MCCC include, but are not limited to: victim

services; outpatient group, individual or family therapy; psychiatric services; crisis stabilization;

peer support services; outpatient and residential substance abuse treatment; jail-based mental

health and substance abuse treatment programs; offender re-entry services; safe haven and

supervised visitation programs; transitional housing for victims; transitional housing for

homeless veterans; Homeless Veterans Registration Program (employment); community support

and rehabilitation services; therapeutic rehabilitation program for adults with severe psychiatric

disabilities; a day training and residential program for individuals with

developmental/intellectual disabilities (D/ID); and DUI program. In 2012, MCCC instituted the

Homeplace Clinic, health care for the homeless center located in Johnson County and serving

Floyd, Johnson, and Pike Counties. In addition, MCCC’s Healing Program is Big Sandy’s only

Rape Crisis Center, which offers comprehensive services for victims of rape, sexual assault,

domestic violence, and child abuse.

Established in 1974 as a private, non-profit corporation, Big Sandy Health Care, Inc.

(BSHC) remains committed to providing access to quality health and dental care to individuals

of all ages. BSHC enhances patient care by promoting disease prevention and health education.

Behavioral health care is also available through its Licensed Clinical Psychologist and Licensed

Clinical Social Worker providers. BSHC earned national recognition for the treatment of its

patients with diabetes and cardiovascular issues during the organization’s participation in the

HRSA-sponsored Health Disparities Collaborative. In, the Bureau of Primary Health Care


Overview of Member Agencies

Mountain Comprehensive Care Center

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recognized BSHC for innovative technology through its use of the web-based Patient Electronic

Care System. BSHC currently operates five community health centers and one dental clinic

throughout Big Sandy Region.

Appalachian Research and Defense Fund (AppalReD), is a private non-profit law firm

which provides free civil legal representation to low-income families and individuals in a 37

county region including the Big Sandy Region. AppalReD began in 1970, and today is the

largest legal aid organization in Kentucky with a staff of 33 attorneys, 3 paralegals, and 24

support staff and is housed in 5 offices throughout the region with its administrative office

located in Floyd County. AppalReD’s primary focus is to assist individuals with obtaining the

basic necessities of life (e.g. income, adequate food and health care); decent, safe, and sanitary

housing and the protection of assets; guarding the rights of children; and the protection of family

members from violence and abuse including protecting populations with special vulnerabilities.

The U.S. Department of Justice, Office of Violence Against Women (OVW) awarded

Mountain Comprehensive Care Center with the discretionary grant, “Training and Services to

End Violence Against Women with Disabilities” in September 2014. The purpose of this three

year project was to establish and strengthen multidisciplinary collaborative relationships and

increase organizational capacity to provide accessible, safe, and effective services to individuals

with disabilities and Deaf individuals who are victims of sexual assault, domestic violence,

dating violence, and stalking. Foundational work began when Appalachian Research and

Defense Fund (AppalRed), Big Sandy Health Care (BSHC) and Mountain Comprehensive Care

Center (MCCC) committed to a Memorandum of Understanding that detailed the responsibilities

of each agency for the period of the grant.

The initial phase of this project began as we chose members from each agency to serve

on our Core Team. First, a Project Director was hired in October 2014 by the lead agency,

Mountain Comprehensive Care Center. Next, AppalRed’s two representatives, a Legal Aid

Attorney and Domestic Violence Coordinator came on board. A Patient Care Coordinator (RN)

was chosen to represent BSHC on this team. Finally, Mountain Comprehensive Care Center’s

two representatives, the Director of the Healing Program (dual domestic violence/sexual assault

Appalachian Research and Defense Fund


Overview of Planning Phase to Date

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victim service program) and the Director of the Developmental/Intellectual Disabilities Program

were added to the team.

In March 2015, we attended a “Virtual Orientation” through the New Grantee Orientation

Webinar Series sponsored by Vera Institute of Justice. This was a three day event in which each

Core Team member attended from their remote locations. This series included, “Overview of the

Disability Grant Program”, “Overview of Planning and Development”, and “Fundamentals of

Successful Collaborations”.

Our Vera Technical Assistant provided a two day retreat in April 2015. She met with our

Core Team, as well as Executive Team, which included the President/CEO and Executive

Director’s from each agency. After this retreat, the Core Team began to meet weekly for

approximately two hours. This team chose to name our collaboration, “Bridging Safe Access to

Big Sandy”. We came to this choice as the West Prestonsburg Bridge is a historical landmark in

the Big Sandy Region. As we were brainstorming ideas, we kept talking about “bridging our

gaps”. At this point, it became an obvious choice to use a photograph of the bridge as our logo,

as well as to name our collaboration, “Bridging Safe Access to Big Sandy”.

During this time, the Core Team also attended the monthly webinar series provided by

way of Vera Institute of Justice, “Building the Foundation and Promoting Effective Practices”.

Each webinar offered foundational insight critical to creating the optimal collaboration to better

serve survivors at the intersection of disability and interpersonal violence.

The core team met weekly to develop the first key deliverable, the Collaboration Charter.

Each member of the team worked and talked through the mission, vision, values, contributions &

commitments, confidentiality, decision making process, conflict resolution, communication,

work plans, key terms, and contact information. During this time, our first Executive Team

meeting was held in July 2015. The Charter was nearly complete. Each Executive received a

copy, reviewed it, and was given the opportunity ask questions and make recommendations.

With guidance from leadership and our Vera Technical Assistant, our Collaboration Charter was

submitted to OVW and approved in September 2015.

Work quickly began on the next deliverable, the Needs Assessment Proposal Plan

(NAPP). The NAPP components provided an expansion of our Collaboration Charter, a brief

history of our collaboration partners, mission, vision, values, as well as the need for and the

methodology of data collection essential to continue our work.

The NAPP detailed the process, responsibilities of members of Bridging Safe Access to

Big Sandy (BSABS), and their agencies in gathering information. This proposed plan consisted

of questions to be asked to individuals, survivors, staff, supervisors, therapists, advocates, and

executive leadership within each of our agencies through focus groups and interviews. BSABS

spent significant time and effort in creating questions for each level within our agencies and had

these questions reviewed by our Vera Technical Assistant.

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The next step in the assessment consisted of results from the Performance Indicators,

which were recently introduced by Vera Institute of Justice. These indicators were used to help

determine whether, and to what degree, progress is being made toward a certain objective. This

comprehensive tool was used, in collaboration with our Key Findings, to track and improve our

capacity to serve survivors with disabilities, as well as a step-by-step guide to implementation.

These indicators were collected in two primary areas: commitment and capacity. MCCC was the

only agency who participated in this measure. The Developmental/Intellectual Disability

Program completed the “Measuring Capacity to Serve Domestic Violence and Sexual Assault

Survivors with Disabilities: Disability Organizations Indicators”. Indicators included a

document checklist, observation guide, staff interview guide, Component A: Commitment

Progress, Component B: Capacity Progress, and scores at a glance. To date, these indicators were

completed in April and October 2015.

MCCC’s Healing Program completed the “Measuring Capacity to Serve Survivors with

Disabilities: Domestic Violence and Rape Crisis Dual Agency Indicators”. These indicators

included a document checklist, observation guide, staff interview guide, Component A:

Commitment Progress, Component B: Capacity Progress, and scores at a glance. To date, these

indicators were completed in April and October 2015.

With guidance from our Vera Technical Assistant, our NAPP was submitted and

approved by OVW in October 2015. At this time, we were given permission to begin our focus

groups and/or interview sessions. The flow chart below summarizes this process. A

comprehensive, in depth description of our Needs Assessment, as well as key findings and

performance indicators follows in this report.

Bridging Safe Access to Big Sandy’s Planning Process to Date:

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The purpose of our Needs Assessment was to collect data on existing policies,

procedures, practices, knowledge and attitudes of AppalRed, BSHC and MCCC. We used this

data to evaluate the services our agencies provide and how these services are received by

individuals with behavioral health and/or developmental/intellectual disabilities at the

intersection of interpersonal violence. Data was collected from individuals, survivors, staff,

supervisors, advocates, SANE Nurse, therapists, and executive leadership to inform us of

strengths, barriers, and/or gaps in service delivery. The indicators proved to be very informative,

as we learned not only strengths, but also areas in need of improvement in the Healing Program

and Developmental/Intellectual Disability Program. This combined data will in turn guide the

development of our Strategic Plan.

The foundational work BSABS created through this Needs Assessment will ensure that

our services are better meeting the needs of the individuals we serve. As we continue our work

into the Strategic Plan, we will implement changes identified during the Needs Assessment.

BSABS intends to share the Needs Assessment Report findings with the Executive Team

during our April 2016 meeting. The development of the Strategic Plan will be the next piece in

our plan to create systemic changes within our agencies, as well as addressing both the strengths

and barriers that were identified in the Needs Assessment. Together, the Needs Assessment

Define expectations and roles through

Collaboration Charter

Create and implement Needs Assessment Planto understand gaps and/or strengths in services and

organizations.

Assess data, qualitative and quantitative, and

create Needs Assessment Report.

Create Strategic Plan to implement changes identified in Needs

Assessment findings.

Implementation of Strategic Plan for

sustainable systemic chanage.

We are currently

here.


Description of Needs Assessment-Purpose and Use of Information

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Report and Strategic Plan will ensure accessible service delivery for individuals with behavioral

health and/or developmental/intellectual disabilities at the intersection of interpersonal violence.

The purpose of Bridging Safe Access to Big Sandy Needs Assessment was to gather

information on current policies and procedures from Appalachian Research and Defense Fund,

Big Sandy Health Care, and Mountain Comprehensive Care Center, as well as information from

individuals with behavioral health and/or developmental/intellectual disabilities who are

survivors of interpersonal violence. Bridging Safe Access to Big Sandy identified opportunity for

change at each partner agency with the assistance of the Needs Assessment. The data collected

will be used to develop our Strategic Plan while seeking to fulfil the following goals:

Goal 1: What are barriers survivors with behavioral health and/or

developmental/intellectual disabilities face when trying to access advocacy, safety-

planning and services?

Goal 2: What are the entry points, if any, into the violence response system for

individuals with behavioral health and/or developmental/intellectual disabilities, and how

can we improve access to these entry points?

Goal 3: Assess the ability of our staff to provide a safe, accessible, and welcoming

environment to individuals who seek/receive services within our agencies.

Goal 4: Identify the strengths and weaknesses in the existing policies, procedures,

practices, and programs at each of our organizations.

Bridging Safe Access to Big Sandy used focus group and interview sessions to collect

Key Findings in this part of the Needs Assessment. Our questions were created to address staff

capacity, education and training needs, safety and accessibility, as well as address policy and

procedure.

Bridging Safe Access to Big Sandy conducted focus groups with survivors, individuals

with developmental/intellectual disabilities, staff, supervisors, advocates, and therapists. These

sessions were held in locations that were accessible, comfortable, and provided the least amount


Description of Needs Assessment-Needs Assessment Goals


Overview of Methodology

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of disruption to everyone’s daily routine. A counselor and safe room was available during each

session that included individuals.

Interviews were conducted with staff at BSHC, AppalRed, SANE Nurse, and with

Executive Directors. We chose interviews for these groups due to the nature of their job

responsibilities, as well as to accommodate the schedules of each Executive Director. These

interviews with BSHC and AppalRed were held in conference rooms at each agency. We

traveled to the SANE Nurse to provide the least amount of disruption in her daily schedule. Each

of our Executive Directors were interviewed in their respective offices.

Both focus groups and interview sessions utilized a facilitator to lead the discussion and a

recorder to take notes. An introductory script was read to each participant prior to the beginning

of each discussion. This introduction addressed confidentiality, mandatory reporting, safety

issues, as well as our goals and needs for the session. Samples of these scripts were included in

the Needs Assessment Proposal Plan. A debriefing session was held immediately after each

session to identify key thoughts, quotes, or themes that stood out in the session. This information

was entered into a binder that contained the data collected from each focus group and/or

interview. Core Team members then reviewed the data and grouped it according to goals. That

list then became the key findings.

The Performance Indicators were used to collect data from Mountain Comprehensive

Care Center’s Healing Program and Developmental/Intellectual Disabilities Program. This

information is collected every six months. We collected our second round of data for indicators

during the Needs Assessment. The indicators measured both commitment and capacity. As we

collected data from focus groups and/or interviews, we also were noting the results of the

indicators. When all data had been charted, the indicator results matched those key findings from

the focus group and interview sessions. Full details follow in the Key Findings section of this

report.

Interviews with AppalReD included:

o Executive Director

o 1 Staff attorney

o 1 Directing attorney

o 1 Managing attorney

o 1 Intake attorney

o 2 Legal secretaries


Overview of Methodology-Who Did We Engage

12

Interviews with BSHC included:

o Founder

o CEO

o Clinic Director

o 1 Therapist

o 1 Physician

o Patient Care Coordinator

Interviews and/or focus groups with Mountain Comprehensive Care Center’s

Developmental/Intellectual Disabilities Program (D/ID):

o President/CEO

o Director of D/ID

o 2 Administrative Supervisors

o 1 Residential Supervisor

o 1 Residential Support Staff

o 3 ADT Supervisors

o 12 ADT Staff

o 10 Residential Individuals

o 15 Non-Residential Individual

Interviews and/or focus groups with Mountain Comprehensive Care Center’s

Healing Program (Dual DV/SA):

o President/CEO

o 3 Supervisors

o 6 Advocates

o 1 SANE Nurse

o 4 Therapists

o 10 Survivors

Methods and Numbers:

Appalachian Research and Defense Fund (AppalRed)

Interviews Breakdown

AppalRed Method of Collection Number of

Groups

Proposed

Participants

Actual

Participants

1. Executive Director Interview 1 1 1

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2. Legal Staff Interviews:

4 Attorneys

2 Legal Secretaries

1 Intake Attorney

1 7 7

Big Sandy Health Care (BSHC)

Interviews Breakdown

Big Sandy Health Care Method of Collection Number of

Groups

Proposed

Participants

Actual

Participants

1. CEO Interview 1 1 1

2. Direct Staff Interviews:

Patient Care

Coordinator

Nurse Manager

Therapist

Physician

Office Manager

5 5 6

Mountain Comprehensive Care Center (MCCC)

Interpersonal Violence Focus Group Breakdown

The Healing Program Method of

Collection

Number

of

Groups

Proposed

Participants

Actual

Participants

1. President/CEO

Interview 1 1 1

2. Supervisors

Focus Group 1 3 3

3. Advocates

Focus Group 1 8-10 6

4. SANE Nurse

Interview 2 2 1

5. Therapists

Focus Group 1 4 4

6. Survivors



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Developmental/Intellectual Disability Non-Residential

Focus Group Breakdown

Developmental

Intellectual Disability

Program

Method of

Collection

Number of

Groups

Proposed

Participants

Actual

Participants

1. President/CEO

Interview 1 1 1

2. Supervisors

Focus Group 1 3 3

3. Day Training

Supervisors Focus Group 1 3 3

4. Day Training

Staff Interview 3 12 12

5. Day Training

D/ID Individuals Focus Group 3 24-28 15


Developmental/Intellectual Disability Residential

Focus Group Breakdown

This was by far the most productive part of our grant project to date. Representatives

from each agency participated in each of the sessions, as well as data analysis. Our team decided

that interviews were needed at BSHC and AppalRed to create the least amount of disruption in

the routine and daily schedule of staff. After much deliberation with team representatives from

each agency, we chose to proceed with interviews. This proved to benefit us in the way that staff

could have privacy when answering questions; thus allowing for more honest feedback, as well

as limiting the interruption of service flow to individuals.

Developmental

Intellectual Disability

Program

Method of

Collection

Number of

Groups

Proposed

Participants

Actual

Participants

1. House Coordinators

Focus Group 1 4 1

2. Support Providers


3. Residential D/ID

Individuals Focus Group 1 8-10 10


Overview of Methodology-Challenges, Data Collection and Analysis

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We did not experience challenges, only scheduling conflicts. We had scheduling

conflicts in getting staff together for a second day at AppalRed. In the end, it was just set back by

one day. This did not interfere in the process of interviews or the feedback received. To avoid a

change in the routine of individuals at the ADT in Auxier, we conducted 3 separate groups with

staff in the same day. This allowed for less disruption and/or change in the daily routine of

individuals. The ratio of individuals to staff is so large at this facility, it was necessary to make

this accommodation.

Each focus group and/or interview session followed the same format. The Project

Director was facilitator; a representative from each agency was recorder. In the beginning, the

recorder took notes by longhand. Midway during the needs assessment, the Project Director

received a laptop, which allowed for electronic recording. This created a simple note taking

process and eliminated the step of typing notes at the end of each session. It was not the

intention to capture statements verbatim, rather to capture highlights of the conversation. The

recorder would transcribe direct quotes from individuals, as well as staff. These quotes or

comments were key insights to strengths or areas in need of improvement. At the end of each

session, the facilitator and recorder would debrief and discuss key ideas, quotes, and themes

identified in the session. This information was entered into an electronic file, printed, and put

into a Needs Assessment notebook. As each agency or department’s session was completed, the

Project Director would transfer key ideas, themes, and quotes into a power point. This allowed

Bridging Safe Access to Big Sandy to examine each agency and/or department’s information in

one easy to access document.

Overall, we found it difficult to continue weekly meetings during this time. We did,

however, meet monthly to review the data collection, discuss findings, and identify common

themes. The Project Director would have this information prepared and each representative

would review it for additions, changes, or comments.

Themes began to emerge after the very first session of focus groups. These included: a

lack of awareness with staff capacity to better serve individuals with behavioral health and/or

developmental/intellectual disabilities at the intersection of interpersonal violence, lack of

awareness about the resources and/or services provided by collaboration partner agencies, clear

policies and procedures within each agency at the intersection of behavioral health and/or

developmental/intellectual disabilities and interpersonal violence and, safety and accessibility

concerns within all partner agencies. Other themes centered on guardianship and consent,

trauma-informed care training, cross-training between programs and agencies, and strengths

between our agencies. These themes overlapped and intertwined throughout our sessions. In the

end, four key findings emerged. The next section of this report details our findings, the results of

our performance indicators, their implications, and possible solutions.


Key Findings and Implications

16

As we continue our project and focus our work to move toward implementation, these

key findings will help us to prioritize our work and to focus as we prepare for our strategic plan.

As we reviewed these key findings, we purposely included multiple perspectives and provided

quotes to illustrate both the fruitfulness of our Needs Assessment, and the insight of our

participants.

Key Finding #1: There is a lack of staff capacity with all collaboration partners to serve


intersection of interpersonal violence.

The following table reflects the scores achieved on the performance indicators for our

disability program, as well as the Healing Program (dual program).

Disability Program Indicators: Score:

1.1 Recognizes Violence Against People with Disabilities as a Priority 25.00%

1.4 Includes in a Budget 0.00%

2.1 Partners with DV Agency 25.00%

2.2 Partners with Rape Crisis Center 0.00%

2.6 Inclusion of Persons with Disabilities 0.00%

5.4 Practical Learning Opportunities 0.00%

6.1 Mandatory Reporting Procedures 25.00%

6.3 Immediate Safety Planning 0.00%

6.4 Informed Referrals 0.00%

6.6 Serving Victims and Perpetrators 0.00%

Dual Program Indicators: Score:

1.1 Recognizes Violence Against People with Disabilities as a Priority 25.00%

1.3 Raises Funds 0.00%

1.4 Includes in a Budget 25.00%

1.5 Collects Data 25.00%

1.6 Uses Data 0.00%


5.5 Volunteer Training 25.00%

6.1 Community Outreach and Education 0.00%

6.2 Case Management 0.00%

6.3 Legal Advocacy 0.00%

6.4 Skill-building 0.00%

6.5 Crisis Intervention 0.00%

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7.1 Community Outreach & Education 0.00%

7.2 Consent for Services 0.00%

7.3 Counseling Services 0.00%

7.4 Medical Advocacy 0.00%



What we heard in our focus groups and interview sessions supports the data collected in the

indicators, as well as the key findings.

One of the greatest needs that came from our sessions in all three agencies was lack of

awareness among our staff capacity to better serve our individuals. We found that within

AppalRed and BSHC there are substantial gaps in how to communicate with individuals who

have behavioral health and/or developmental/intellectual disabilities at the intersection of

interpersonal violence. Other gaps included; consent for an individual with a guardian, as well as

what resources and information were available. Most all of the staff within our partner agencies

have a general understanding of D/ID individuals, with that said; most all of the staff at each

partner agency indicated they want cross-training with MCCC’s D/ID department.

One staff interviewed at BSHC made a statement that resources such as Case Managers and

patient advocates (in house) are greatly needed. Although staff uses a “person centered

approach”, there are still communication and/or guardianship barriers, lack of knowledgeable

referral resources, and that the system feels “broken” for these individuals. It was also noted

during the interviews at BSHC that a lack of resources is available for our elderly within the Big

Sandy Region.

Even within the Healing Program and the Developmental/Intellectual Disabilities

Department at MCCC, there is a lack of staff capacity. Each department has specific and

“I have not had any formal

training with patients who are

developmental/intellectual

disabled. When interacting

with them, I look for normal

day to day functioning. I

would love to have training

with MCCC so I may better

serve our individuals.”

- BSHC Staff

18

specialized training for staff. However, rarely do these trainings

cross. All staff in both programs acknowledged that there is a lack

of awareness of resources that each program offers. One Healing

Program staff indicated that upon intake, there needs to be an

assessment for D/ID and that all intake staff is trained

accordingly.

Implications:

Without ongoing education and training opportunities, we

cannot provide effective services within our agencies. It

became evident to us as our collaboration was writing our Charter, that we were in need of cross-

training. It was indicated that both AppalRed and BSHC need training, as well as awareness

about the issue of interpersonal violence at the intersection of behavioral health and/or

developmental/intellectual disabilities. We need to cultivate a sense of competency for staff

members and enrich services for our individuals.

Cross-training and educational opportunities are vital for building lasting relationships

among our collaboration partners. We concluded that MCCC’s D/ID and Healing Programs need

to share their expertise within our partner agencies. Staff within both agencies identified a need

for knowledge about how to better serve this population and exactly what resources are available

to assist them.

An internal gap exists within MCCC between our Healing Program and D/ID Program.

Direct care providers, ADT staff, and house staff were unaware of services the Healing Program

offers to domestic violence and sexual assault survivors. As the advocates, therapists, and

support staff indicated their lack of knowledge about the

D/ID program. Through this process, we realize that we

need a harmonized or balanced system for individuals with

behavioral health and/or developmental/intellectual


We must build our staff capacity within all partner

agencies in order to improve our systems of service

delivery. Without education and training for staff, the

safety and comfort levels for everyone within our agencies

will weaken. We must continually learn and share our

expertise.

Possible Solutions:

“I am always going to do

my best to advocate for a

client, regardless of their

intellectual abilities,

however, I do not have the

proper training to interact

appropriately.”

- AppalRed Staff

“We need to create some

educational opportunities in

Person First Language. This

will let survivors know about

ways the Healing Program can

help them. ”

- Healing Program Staff

19

The conclusion of this Needs Assessment revealed that staff members within all of our

agencies recognized there are gaps in their staff capacity and services provided by partner

organizations in Bridging Safe Access to Big Sandy. Staff also voiced their readiness to

participate in educational opportunities in order to better serve individuals with behavioral health

and/or developmental/intellectual disabilities. This Needs Assessment plainly indicates there are

many ways we can build, improve, and purposely develop deeper partnerships between our

agencies. Some of the ways to begin eliminating these gaps, as well as moving toward

improvement in this area are:

Strengthen the referral process among our collaboration partners to better serve



Identify and prioritize gaps in education, resources, and training for all staff members.

Identify and utilize cross-training, as well as existing resources among our collaboration

partners.

Develop training, resources, and better intake questions to improve knowledge,

understanding, and services for individuals with guardians.

Key Finding #2: There is a lack of awareness about the resources and/or services provided

by collaboration partner agencies.




2.1 Partners with DV Agency 25.00%

2.2 Partners with Rape Crisis Center 0.00%

2.3 Partners with Law Enforcement 25.00%

2.5 Inclusion of Persons with Disabilities 0.00%

2.6 Participates in Multi-Disciplinary Collaboration 0.00%

5.4 Practical Learning Opportunities 0.00

6.4 Informed Referrals 0.00

20

Dual Program Indicators: Score:

“I knew the Healing Program

was for domestic violence and

sexual assault, but I had no

idea that they actually had a

shelter that someone could go

to for an exam.”

- D/ID ADT Staff

21

2.1 Partners with Disability Agency 0.00%

2.2 Builds Relationships with Deaf Community 0.00%

2.4 Includes People with Disabilities 0.00%

2.5 Participates in Multi-Disciplinary Collaboration 0.00%

What we heard in our focus groups and interview sessions supports the data collected

in the indicators, as well as the key findings.

We discovered that staff within AppalRed and BSHC had considerable gaps in their

knowledge and understanding of what MCCC’s D/ID and Healing Programs offer, who key

contacts were, and what information is available to their individuals. Many of the direct care

staff from the D/ID program were familiar with the Healing Program itself, but unfamiliar with

all the services provided by advocates and therapists. Many staff did not realize that The Healing

Place is an actual Rape Crisis Unit with a SANE Nurse who can do the SAFE Exam on sight, as

well as provide a safe haven until it is safe to return to their environment. As well as, the Healing

Program therapists, advocates, and nurse indicated a lack of knowledge about resources available

to D/ID individuals.

During our survivor group, one individual mentioned how much she relied upon social

media to find resources and information. She said that since she had moved into this region,

social media was vital to her being able to locate services that were available. Most individuals

within that session and focus groups at the ADT’s also indicated a need for sharing resources in

multiple formats: person first language friendly outreach brochures, social media and online

resource guide.

Implications:

As a collaboration, we must be aware of resources that each agency provides.

Without this awareness, there will be gaps in the services and information we share with our

individuals. Staff within AppalRed and BSHC indicated that they do not have the knowledge

“Mountain Comp. really needs

to create a Facebook page to

share information with us. We

all have internet and smart

phones. When we need to

know something, we turn to

social media.”

-Interpersonal Violence

Survivor

22

about resources, training with, and how to understand individuals with behavioral health and/or

developmental/intellectual disabilities. Therefore, they are unable to efficiently inform and

support individuals who are in need of those services.

Considerable gaps exist among our agencies due to most D/ID staff and individuals

with behavioral health and/or developmental/intellectual disabilities being unaware of all the

services provided at the Healing Program. As well, we learned that advocates and therapists lack

knowledge about services available to behavioral health and/or developmental/intellectual

disabled individuals.

Possible Solutions:

Staff within all collaboration agencies indicated gaps within their knowledge base and

communication with one another, as well as with individuals with behavioral health and/or

developmental/intellectual disabilities. It was also indicated that all staff is willing to learn and

share resources within our inter agencies. The data collected during this Needs Assessment

clearly indicates several ways we can improve our services and develop stronger relationships

among our partner agencies. Some of the ways to make improvements toward this area are:

Develop and/or track referrals made among collaboration partners, as well as strengthen

this process to better serve individuals with behavioral health and/or

developmental/intellectual disabilities at the intersection of interpersonal violence.

Cultivate a system among our agencies for delivering existing materials about services

and/or resources to one another.

Educate all staff within each partner agency in “Person First Language”. This will allow

for all resources, including intake forms, paperwork, online services, and outreach

brochures to be written in plain language, accessible, and in multiple formats.

Key Finding #3: All agencies need clearer policies and procedures at the

intersection of behavioral health and/or developmental/intellectual disabilities and

interpersonal violence.




3.4 Service to Victims and Perpetrators 0.00%

6.1 Mandatory Reporting Procedures 25.00%

6.3 Immediate Safety Planning 0.00%

6.4 Informed Referrals 0.00%


Dual Program Indicators: Score

23

3.1 Eligibility 0.00%

3.2 Accommodations 25.00%

3.4 Service Animals 0.00%

3.5 Guardianship 25.00%

3.6 Resident Handbook (Residential Only) 0.00%

3.7 Medications (Residential Only) 0.00%

What we heard in our focus groups and interview sessions supports the data collected

in the indicators, as well as the key findings.

Depending on the focus group and/or interview, ranging from direct care staff to

leadership, we heard the need for policy and procedure review and clarification within each

agency. In the state of Kentucky, we are all obligated to mandatory reporting. All partner

agencies have a generalized policy in place to address these reports. Leadership at AppalRed

and BSHC indicated they are well aware of “work to do” around policy and procedures of



It became clear that leadership is aware of the need to review policy and procedures

relating to abuse and neglect, accessibility, client rights and confidentiality, as well as the D/ID

Program’s Sexual Assault policy. One staff from the Healing Program indicated that our policies

and procedures need review to be certain they address the needs of our individuals and not just

"blanket policies” that unintentionally leave gaps in access to services.

During the Healing Program therapy staff group, one

therapist indicated that all counseling staff needs to become

familiar with policy and procedures for individuals with

behavioral health and/or developmental/intellectual

disabilities. She indicated she has these policies at her

disposal; however, she would like someone from the D/ID

department to meet with them during a scheduled counselor’s

meeting to address questions about and clarify these policies

and procedures.

“We know we have work to do

around policies and procedures

regarding accessibility for this

population.”

-AppalRed Leadership

“Our confidentiality needs to be

protected.”

-Interpersonal Violence

Survivor

24

We had one survivor focus group in which those individuals with behavioral health

and/or developmental/intellectual disabilities were asked about policy and procedure as related to

their services. This group was overall comfortable with policies in place. One individual voiced

an opinion that there are times in which she feels confidentiality should be better protected.

Implications:

Policies and procedures are the foundation for providing reliable, safe, and accessible

services for our individuals. All agencies in our collaborative continually meet the accreditation

standards and strive to maintain consistent, safe, and accessible service delivery. We do realize

that as diligently as we work, there are still gaps in our policies and procedures that can be a

potential barrier to services. Without clear and effective policies and procedures, our agencies

are unable to create safe and accessible environments for staff, leadership, or survivors with

behavioral health and/or developmental/intellectual disabilities.

MCCC ensures every new hire attend “New Employee & HIPPA” training within one

month of hire date. During this training, staff becomes familiar with policies and procedures, as

well as confidentiality and HIPPA (Health Insurance Portability and Accountability Act)

regulations. Ongoing training is essential, as policies and procedures change over time.

Possible Solutions:

Some of the areas that were specifically addressed during

focus groups and interview sessions included review and/or

clarification of policy and procedure in the following areas

relating to abuse and neglect, accessibility, client rights and

confidentiality, as well as the D/ID Program’s Sexual Assault

policy. Some possible ways to make our policies and

procedures more efficient and to begin our work toward

making improvements in this area:

Clarify and review policy and procedures relating to abuse

and neglect, accessibility, client rights and confidentiality, as

well as the D/ID Program’s Sexual Assault policy.

Conduct a policy and procedure review regarding all areas that are relevant to

the intersection of behavioral health and/or developmental disability.

Determine the need for establishing any new policy and procedures as relating

to behavioral health and/or developmental/intellectual disabilities at the


“Our policies do not address

the issue of interpersonal

violence. Being a part of this

collaborative will give us the

information and knowledge we

need to begin work in this

area.”

-BSHC Leadership

25

Key Finding #4: There are safety and accessibility concerns at all agencies for


intersection of interpersonal violence?




1.2 Assesses for Safety and Responsiveness 0.00%

4.3 Victimization-Oriented Communication Boards 0.00%


1.2 Promotes Accessibility 0.00%

26

4.1 Accessible Modes of Communication 0.00%

4.2 Accessible Location 25.00%

4.3 Alternative Formats 25.00%

4.4 Inclusive Materials 0.00%

4.5 Accessible Transportation 25.00%

“I worry about the accessibility

for people getting into our

building and the size of our

hallway.”

-Healing Program Staff

27

What we heard in our focus groups and interview sessions

supports the data collected in the indicators, as well as the

key findings.

Throughout the needs assessment process, safety and

accessibility gaps were identified in all partner agencies.

Gaps in these areas are barriers to service. As stated in our

mission, Bridging Safe Access to Big Sandy seeks to educate

and create a community encompassing safe and accessible

resources that are available to individuals with behavioral health and/or

developmental/intellectual disabilities at the intersection of interpersonal violence. As part of our

mission, we must address these gaps and barriers in services to ensure our survivors feel safe and

have accessible services. Data analysis from the sessions fit into two main categories: physical

environment and programs and/or services.

A: Safety and Accessibility for Physical Environments

As our focus groups and interview sessions evolved, physical environmental safety

and accessibility issues were often mentioned as needing improved upon. Our survivor group

indicated they have a need for automatic opening doors at their center. This group also indicated

they would like the windows in the door to be tinted to help

them feel “safe” in the event someone “should be upset and

stalking the place”.

Our therapists indicated automatic doors are

needed at all locations within MCCC. Other physical and

environmental concerns this group addressed, included

physical accessibility within and getting to some of the

counseling and/or case management offices, unlocked

doors within the buildings allows random people to enter

the building without notice, general concerns that not all

facilities are as physically accessible as they could be. It is

also noted that there is construction underway at one of

these locations and that physically accessible issues are being addressed in that current

construction.

Advocates in the Healing Program indicated the thresholds have a “lip” that may be an

issue for a person in a wheel chair or for someone on a walker. Other safety concerns for this

“We have all we need here;

however we do need a shower

here for accidents or if our

power is off during the

winter.”

-Interpersonal

Violence Survivor

“It makes my day when staff is

waiting for me when I get off

the bus at work!”

-D/ID Day Training

Individual

28

program are the narrow hallways and the small office

sizes. The signage needs to be updated to make locating

advocates easy upon entering the building.

During our D/ID residential focus group, most

of the individuals felt that their environments were very

accessible. They made mention that although they have to

step up and over the bath tub; they do have bars to hold

onto to help them in and out of the tub. Someone even

made mention of wanting a bath mat in the tub to make

them feel safe. One individual indicated that he is in need of a new bed and/or mattress. The only

other mention of physical safety was a night light.

Staff and/or leadership with BSHC facilities have appropriate physical accessibility,

with the issue of a more private patient check-in room noted. The room at the Mud Creek clinic

may be a little difficult for a wheel chair to navigate. However, staff indicated their ability to

accommodate any patient with physical needs in the more open area just outside the check-in

room.

During the interview sessions with staff and leadership at AppalRed, the physically

accessible issue continued. There is no handicap access ramp to the sidewalk in front of the

building; it is at the other end of the block. Although the building does not have an elevator,

there is a chair lift at the stairway leading to the second floor. Staff indicated that to meet the

needs of any individual with physical needs, the entire ground floor is accessible.

B: Safety and Accessibility in Programs and/or Services

We heard from many individuals in all groups, just how important an aesthetically

welcoming environment is. They believe that lobbies to clinics, to their homes, and their center

should be comfortable, welcoming and create a sense of safety. They indicated that it makes their

day to be greeted, welcomed, and acknowledged when they arrive.

In our survivor group, the idea of having to “wait too long” when at the clinic was

disturbing. While these individuals said they feel very comfortable when asking for help, they do

not like the idea of appointments being delayed. Other issues this group discussed as a barrier to

services: lack of resources in one place (resource guide), better access to online services,

transportation, and better communication. We heard from some of the individuals in the day

training facilities that just being able to communicate their need can sometimes be a barrier.

Implications:

“Sometimes it is hard for me to

say what I need in a way that I

can get help. I’m glad I have

support staff to help me.”

-D/ID Day Training

Individual

29

It was clear from the data collected, safety and accessibility is an area we need to

make improvements. For the most part, individuals with behavioral health and/or

developmental/intellectual disabilities said that they felt comfortable and welcomed when

receiving services. They also presented very specific examples of when they do not feel safe or

our facilities were not as accessible or welcoming as could be. We have barriers to our entrances,

unlocked doors, case managers and therapists in locations that are not physically accessible for

individuals in wheel chairs or walkers. With these barriers in place, we do not want the

individuals we serve to feel re-traumatized due to lack of awareness of physical environment.

Communication, respect, and individually acknowledging the concerns of our individuals will be

crucial to this process.

As noted earlier, MCCC has construction underway in many locations to make

changes to physical accessibility barriers for individuals we serve. Having said this, we know

physical accessibility will continually be reviewed for

any potential new barriers. Automatic doors have

already been installed in a building under construction.

As a whole, Bridging Safe Access to Big Sandy is

committed to addressing these gaps and barriers, as well

as to improving environments in our agencies for all

individuals and staff members.

Possible Solutions:

The mission of Bridging Safe Access to Big

Sandy is to educate and create a community

encompassing safe

and accessible

resources that are available to individuals with behavioral

health and/or developmental/intellectual disabilities at the

intersection of interpersonal violence. Analyzing the feedback

from the individuals we serve gave us a snapshot of how they

felt about safety and accessibility issues; therefore bringing

raising our awareness of situations and areas in need of

attention. As a collaboration, we are devoted to ensuring the

individuals we serve understand our commitment to their

safety and service accessibility. While we realize some of our

existing buildings and/or programs may never be perfect,

improvement is an ongoing process and we can begin by:

“We realize there are physical

accessibility barriers in our

building; however we make

accommodations as best as we

can to meet the needs.”

-AppalRed Staff

“Although we may have

physical accessibility issues in

our buildings, we

accommodate our individuals

by meeting them in easily

accessible parts of the

building.”

-Healing Program

Therapist

30

Conduct safety and accessibility reviews to identify specific ways to improve

the programs and/or services at our agencies.

Identify and adopt a safety and accessibility tool for reviewing services in our

agencies.

Identify specific barriers to safety and accessibility at each agency, as well as

develop a plan to eliminate them.

Review and/or clarify existing safety and accessibility policies within our

agencies.

Key Finding #5: There is a lack of knowledge within all agencies about guardianship roles

at the intersection of interpersonal violence.




3.4 Service to Victims and Perpetrators 0.00%


6.3 Immediate Safety Planning 0.00



3.5 Guardianship 25.00%

7.2 Consent for Services 0.00%

7.3 Counseling Services 0.00%

7.4 Medical Advocacy 0.00%



31

What we heard in our focus groups and interview sessions

supports the data collected in the indicators, as well as the

key findings.

In the responses we heard from staff focus groups and

interviews, there is confusion surrounding guardianship at all

agencies. It was articulated that training is needed within our

partner agencies around guardian roles, authority, consent

process, and types of guardianship.

We heard advocates and therapists articulate the need for

training on how to better serve individuals with guardians. Both groups expressed confusion

about the roles of guardians; if the guardian is payee only, medical, or legal. With this confusion,

these groups conveyed the message that at times it is difficult to determine if the guardian is

involved in the correct way for the individual. We heard some staff say that at times, some

guardians can be “too protective”, “too lenient”, and that “we know guardians only want what is

best” for our individuals. We do; however need to create a balance for the sake of our

individuals.

Staff with AppalRed and BSHC has more clarity in the roles of guardianship as they

see individuals for medical and legal services. With that said, there are times that staff sees the

roles of guardians differently or have confusion around their roles, especially at the intersection

of interpersonal violence.

Implications:

As we heard in our focus groups and interview sessions, there is some confusion

surrounding roles of guardianship, especially at the intersection of interpersonal violence. This

confusion has indicated a need for training for staff

members. It is imperative that we do not falsely create

barriers to services for our individuals by not having a clear

understanding of the intricacies of guardianship and how it

applies to individuals with behavioral health and/or

developmental/intellectual disabilities.

Possible Solutions:

It is clear to us that our programs view

guardianship roles differently. In order to eliminate barriers surrounding guardianship, we must

address this issue. Bridging Safe Access to Big Sandy has determined that all partner agencies

can improve in the area of understanding of the role and complexities of guardians and the

impact that may be made upon the services individuals receive.

“Dealing with a legal guardian

doesn’t create a barrier; it may

be more along the merits of

the case may be weak, or the

guardian may not make the

best witness.”

-AppalRed Executive

“I think we need a workshop or

some training on roles of

guardians for individuals.”

-SANE Nurse

32

MCCC’s Developmental/Intellectual Disability Program has the expertise regarding

the intricacies of guardianship. This creates further opportunities for cross-training among our

partner agencies. Some possible ways in which we can create solutions are:

Cross-training with staff in all agencies to better understand the complexities in the roles

of guardianship for individuals with behavioral health and/or developmental/intellectual


Review existing policies and procedures and/or possibly develop policies and procedures

around the scope of guardianship roles.

Create a guardianship policy guide book for use among all partner agencies.

Create a flow chart surrounding scope and understanding of guardianship roles.

Bridging Safe Access to Big Sandy heard many voices during our needs assessment. These

groups, ranged from survivors to Executive Leadership, all raised awareness about services at the

intersection of behavioral health and/or developmental/intellectual disabilities and interpersonal

violence. The needs assessment served as a reflective tool for each partner agency to not only

identify our gaps in services, safety and accessibility, and in resources, but to also recognize our

strengths. It allowed us to achieve a greater understanding of each other’s agencies, as well as

build upon and deepen the longstanding partnerships we have together. The data we collected is

fruitful and provides a more in-depth perspective of our individuals, survivors, and leadership. Our

work, together, creates a comprehensive network of service delivery for behavioral health and/or

developmental/intellectual disabled individuals at the intersection of interpersonal violence.

Creating change requires a strong foundation. The work we are doing together allows

Bridging Safe Access to Big Sandy to build that foundation for improving safety and accessibility,

service delivery, as well as systemic change for individuals. This report provides a beginning for

our implementation phase as to assess the impact of our actions. We realize the scope of this report

and commit our efforts to building upon our foundations in every way to sustain our collaborative

work to bridge safe access to the Big Sandy region.


Conclusions


Next Steps

33

With OVW’s approval of this Needs Assessment Report, Bridging Safe Access to Big

Sandy will work closely with our Vera Technical Assistant to prioritize our key findings and

performance indicators to develop our strategic plan in order to improve our service delivery,

enrich our knowledge of resources, as well as training and education. This continued work will

guide us toward creating systemic changes within our agencies to provide a network of service

support for individuals with behavioral health and/or development/intellectual disabilities at the

intersection of interpersonal violence. As we build upon this strong foundation, we will also

develop a sustainability plan for continuation beyond this project period.

This needs assessment is a collaboration of our partner agencies, our Vera Technical

Assistant, OVW, and most importantly, those individuals we serve.

“We don’t learn by doing, we learn by reflecting on what we’ve done.”

-unknown

Documents

Appalachian Research and Defense Fund...Appalachian Research and Defense Fund This project was supported by Grant No. 2014-FW-AX-K001 awarded by the Office on Violence Against Women,