Fremont Counseling Service
Annual Management Report
Fiscal Year 2010 (July 1, 2009 – June 30, 2010
Fremont Counseling Service, a community-based, non-profit organization exists to meet the
needs of all peoples of Fremont County in all areas of mental health and substance abuse; our
mission is to provide accessible, affordable, high quality services through education, counseling,
treatment and crisis intervention.
Mission
To provide high quality mental health and substance abuse services to enhance people’s lives and
enrich our communities.
Vision
 We practice caring for all individuals.
 We generate success stories.
 We practice teamwork.
 We generate smiles!
Belief Statements
 We believe Fremont Counseling Service (FCS) has a caring, highly skilled staff.
 We believe Fremont Counseling Service provides our clients prompt, thorough, attentive
care.
 We believe Fremont Counseling Service maintains the highest level of services in the
area.
 We believe Fremont Counseling Service generates many successes.
 We believe Fremont Counseling Service’s efforts produce healthier citizens and thus a
healthier community.
Fremont Counseling Service Values
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Strive to create environments that promote professional, safe and accessible services for
those served.
Advocate for programs where those served, their significant others and staff feel respected
and valued.
Recognize and value each team member’s gifts offered.
Support the need for agency growth
Maintain a unified vision that enhances partnerships.
Maintain consumer-friendly attitude and services.
Strengths
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We are a highly skilled, well trained staff.
Fremont Counseling Service has a positive image in the community for providing other
services that enhance the therapeutic process.
Fremont Counseling Service staff is committed, experienced and pro-active.
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Fremont Counseling Service provides quality care accessible to those in need of mental
health and substance abuse treatment services.
Fremont Counseling Service is dedicated to developing and maintaining partnerships with
other community agencies.
Fremont Counseling Service provides services in the community as well as in the office.
Fremont Counseling Service provides consultation and education services to many
community programs.
We use supportive data to make wise (management and service) decisions.
Challenges and Opportunities
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Maintaining CARF accreditation and State Certifications.
Retention and Recruitment of qualified staff.
The Riverton location is out of office space for staff.
Continue developing a local/regional system of care for all populations served.
Strengthen the commitment of community collaboration.
Management of Information.
Increasing cost of doing business.
Increased local competition for resources (Local, State and Federal).
Increased competition locally for funding.
Fremont Counseling Service Goals
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Recruit, hire and retain quality staff and dehire staff who do not meet Fremont Counseling
Service standards.
Establish and maintain regular contact with the legislative delegation representing Fremont
County.
Spend less money than generated or generate more money than spent.
Maintain safe, comfortable and efficient facilities.
Service Locations
Fremont Counseling Service provides services at four office locations as well as communitybased services in most Fremont County communities. Fremont Counseling Service’s main
locations are:
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748 Main Street
1110 Major Avenue
Lander, WY 82520
Riverton, WY 82501
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Fremont Counseling Service
Board of Directors
Organizational Chart
Effective: July 1, 2010 (04.20.10)
FY11: Approved for 45 positions
Executive Director
001
Data/Records
Manager
007
Human Resources
Manager
009
Controller
008
Billing Clerk
050
IT Specialist
061
Assistant
Bookkeeper
059
Intake Specialist
066
SA Services
Manager
005
MH Services
Manager
003
Lander MH Staff
Traveling MH Staff
Riverton MH Staff
Traveling Med Staff
Lander SA Staff
Community
Services Mgr.
006
Prevention Staff
Lander CS Staff
Riverton CS Staff
Clinician /
SA Assessor
022
Prevention
Tobacco
038
Certified Case
Manager
028
Certified Case
Manager
026
Certified Case
Manager
029
Certified Case
Manager
027
Rec/Soc Provider
043
Supported
Employment
046
Riverton SA Staff
Clinician
004
MH Case Manager
Lander
025
Clinician
010
Psychiatrist
Regional Contract
Clinician
SA/MH (50/50)
020
Clinician
013
Mentor
Lander
032
Psychologist
015
APN
Regional Contract
Clinician
021
Clinician
024
Prevention
041
Early Intervention
Clinician
065
MH Case Manager
Riverton
071
Clinician
016
Registered Nurse
Regional Contract
064
SA Case Manager
042
Clinician
039
Prevention
062
Support
051
Mentor
Riverton
072
Clinician
018
Support
052
Support (PT)
056
SA Case Manager
038
Rec/Soc Provider
044
Support
053
Manager
Color
Legend
Support
054
Clinical Staff
(Medicaid Billable)
Prevention Staff
3
Regional Contract
Staff
Support Staff
Non Clinical Staff
Direct Service
Positions Pending
Recruitment /
Hiring
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Accomplishments
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Fremont Counseling Services was able to exceed the direct service hours as required by
the State of Wyoming.
Fremont Counseling Services was able to hire and maintained a full staff (Substance
Abuse & Mental Health) through FY10.
Fremont Counseling Services added an Intake Specialist to schedule all intake
appointments and this has helped shorten the time from first call to intake.
Concurrent documentation was implemented as a result of the Access Redesign Initiative
Implemented the DLA20
The Intensive Outpatient Treatment program is fully functioning in both Lander and
Riverton.
The occupancy rate of the SIP apartments was 97%.
Program Sustainability
During Fiscal Year 2010 the funding streams for the mental health and substance abuse service
areas remained stable. Fremont Counseling Service exceeded service hour expectations for the
mental health contract.
Expectations for Fiscal Year 2011 include continued review and implementation of operations;
fine-tuning and improving outcome measures; increasing input from those served, their family
members and stakeholders regarding satisfaction with services; improving access and continued
improvement in clinical documentation.
Accessibility Plan FY10
Access Issue – Attitude:
 Annual Customer Service training for all clerical staff - ongoing
 Sponsor or Co-sponsor community events - ongoing
 Speaking to groups - ongoing
Access Issue - Financial: Those served have difficulty understanding the FCS insurance billing
procedures.
 Those served can receive individual assistance to better understand the billing procedures
- ongoing
Access Issue – Financial: State budget cuts for FY2010 with increase in direct service hours
required.
 Increase productivity requirement - accomplished
 Decrease purchases - ongoing
 Cut staff by attrition - ongoing
 Access Redesign Initiative - completed
Access Issue – Employment: Recruiting is more difficult due to incomparable salaries, housing,
licensing and geographical location.
 Continue internet advertising, using WAMHSAC and I Hire Mental Health.com – fully
staffed
Access Issue - Architectural: Confidentiality issue in the Lander Center reception area
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Enclose the reception area to prevent consumers overhearing conversations via phone,
etc. - completed
Access Issue – Architectural: Riverton office space and restrooms
 Remodeling plan and costs –continuing to develop plan and look for funding
Access Issue – Other: Long wait for next appointment for psychiatric medication services.
 Collaborate with primary care physicians in the Community - ongoing
Risk Management
Fremont Counseling Service has insurance coverage that adequately protects all the agency’s
assets including coverage for professional liability, Directors and Officers, buildings, equipment
and inventory, worker’s compensation and vehicles. Fremont Counseling Service maintains
coverage against claims from persons served, personnel, visitors, volunteers and other associates.
When, upon investigation, issues of risk to persons served, personnel, visitors and the
organization are found to exist, FCS will act as quickly as possible to take corrective actions and
make changes so the identified risk is minimized (or removed) and the potential for loss is
decreased. Corrective actions will be reviewed to ensure that the actions are or will be effective.
All staff adhere to the confidentiality rules outlined in 42 CFR, part 2 and 45 CFR (HIPAA).
All risks continue to be assessed and updated on a regular basis. In all instances, FCS has done
everything within reason to ensure that all risks to the agency are minimized.
Persons Served this Fiscal Year
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A total of 1,385 persons received clinical services; 894 persons received mental health
services and 491 persons received substance abuse treatment services.
Of those served, 609 were female and 779 were male.
Of those served, 75% were Caucasian, 15% were American Indian, and 10% were of other
race or nationality. Of those served 8% were also of Hispanic origin.
Of those receiving Mental Health and Substance Abuse Services 291 were under the age of
18 and 1097 were 18 and older.
The need for substance abuse treatment services continues to greatly exceed service
availability.
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Breakdown of State Mental Health Direct Service Hours Provided
Service Type
Clinical Assessment (Intake)
Agency Based Therapy
Community Based Therapy Psychiatric Services - Psychiatrist
Psychiatric Services – APN/PA
Medication Case Management - RN
Group Therapy
Case Management
Individual Rehabilitative Service
Group- Recreation/Socialization
Individual Recreation/Socialization
Emergency Services
Supported Education/Employment
Total Hours of MH Services Provided
State
Contract
1,097.00
4,641.00
59.25
289.00
74.25
489.50
3,680.50
5,034.00
794.00
3,488.75
808.00
113.75
73.50
20,642.50
Breakdown of State Substance Abuse Direct Service Hours Provided
Service Type
Clinical Assessments
Client Engagement Services
Agency-based Individual/Family
Group Therapy
Intensive Outpatient Treatment
Medication Management- Dr.
Medication Management – APN
Medication Case Management
Case Management
Total Hrs of SA Services Provided
State
Contract
653.00
1.25
677.00
2,763.75
8,441.00
3.00
1.25
1.00
450.75
12,992.00
Outcome Measures
The State of Wyoming and Fremont Counseling Service have implemented a consistent way to
gather outcome measures from persons served and/or parents/guardians of those served. The
WYPOMS (Wyoming Performance Outcome Measures Survey) is administered to all persons
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receiving mental health and substance abuse services (including psychiatric medication
management services) at intake, every ninety days while receiving services and at discharge.
The WYPOMS assess client improvement or lack thereof over their period of treatment in the
following areas: living situation, education, employment, hospital services for mental health
and/or substance abuse problems, legal status, social connectedness and perception of services,
and alcohol/ drugs.
Prevention Services
Prevention Block Grant services were provided in five Centers for Substance Abuse Prevention
(CSAP) strategic areas (information dissemination, education, alternative activities, community
based process and environmental), serving the majority of school districts and county
communities, including those on the Wind River Reservation. A total of four hundred fifty-nine
(459) received direct services and eighty-two thousand six hundred and seven (82,607) received
indirect services from the Prevention program.
Fremont County Prevention Framework
2010 Contacts
Elected officials
Govt. Admin
Civic
Business
School Admin
Students
Youth Gr. Sponsors
Law Enforcement
Preventionists
Liquor Lic. & Staff
Parents & Citizens
Total
Lander Riverton Dubois Pavillion Shoshoni
7
7
2
6
3
2
2
2
26
35
8
12
6
5
7
3
6
7
3
8
4
76
62
80
89
110
2
2
5
3
3
4
5
1
1
1
1
1
23
150
18
250
5
153
278
122
371
129
County
& State
4
2
5
15
102
128
Total
26
11
92
15
28
417
15
12
17
102
446
1181
Tobacco Prevention:
During the quarter; April, May and June, 2010, the potential of 87,500 potential viewers for the
newspaper and other ads that were in circulation during this period. These included Press
Releases, news articles, Wyoming Quit Tobacco ads; Everyone deserves the Right to Breathe
Clean Air, Chamber of Commerce inserts for the quit tobacco program and dangers of
secondhand smoke, posted signs, Maternal Child Health Ads, Youth Change Attitudes Now Ads
and the ad for the dangers of secondhand smoke printed in the State Little League Tournament
Brochure.
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In addition, Coalition Building & Advocacy, Community Planning, County Evaluations and
direct community educational calls regarding tobacco prevention can account for hundreds more
direct and indirect contacts for the Tobacco Prevention Program. Youth and Adult education at
health fairs, Intensive Outpatient Treatment, Drug Court tobacco prevention education and the
Senior Wellness Day at Central Wyoming College totaled over 600 direct service tobacco
prevention educational training opportunities during this quarter. This does not include the direct
and indirect education through Coalition Partners, Community Partners, State Strategic Planning
Team Meetings, Direct Mail to Healthcare Providers, Dentists, Nurses, Physicians Assistance
and other community members in the Fremont County community. School districts also receive
tobacco prevention educational materials by mail and E-Mail.
The number of direct and indirect tobacco prevention education contacts for the Fremont County
Community could add up to potentially to over 350,000 direct and indirect tobacco prevention
contacts for a year.
PATH Services
Services were offered through the PATH (Projects for Assistance in Transition from
Homelessness) Program in most Fremont County communities to assist those persons with a
mental illness that are homeless or at risk for becoming homeless. Collaboration with
Reservation housing programs is a component of the PATH program. Eighty-five (85) people
had direct contact with the PATH program of which forty-one (41) received services during
FY2010.
Drug Court Programs
The Juvenile Drug Court Program had twenty (20) clients enrolled throughout Fiscal Year 2010;
of this number ten (10) completed the program and eight (8) were discharged from the program.
Juvenile Drug Court clients receive clinical assessments, individual therapy, intensive outpatient
therapy, case management and outpatient groups
Consumer/Stakeholder Input
Fremont Counseling Service has a systematic method for gathering input from those served
and/or their family members at intake, discharge and post discharge. The data gathered is
analyzed and discussed by the Consumer/Stakeholder Satisfaction Committee and the
results/conclusions are brought before the Leadership Team.
Fremont Counseling Service also participates is the State of Wyoming Consumer Satisfaction
Survey which is completed once a year. WICHE tallies the results and forwards them to
participating agencies. These results are given to the Consumer/Stakeholder Satisfaction
Committee and then presented to the Leadership Team.
Stakeholder Satisfaction Surveys are mailed to Stakeholders on a yearly basis. The data gathered
is analyzed and used to improve services.
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Suggestions boxes are available at all office locations. Staff, persons served and visitors are
invited to provide feedback via the suggestion boxes. The Leadership team reviews the
suggestions and the information gathered is used to improve services.
Financial Operations
Financial operations consist of policies and procedures that insure the continued financial
success of Fremont Counseling Service through prudent financial management. Financial
management is the process of controlling and utilizing resources to best achieve agency goals.
This type of management consists of the following principles:
1. liquidity (ability to meet short-term financial obligations such as monthly agency expenses)
2. solvency (ability to meet long-term obligations)
3. stewardship (use of assets, specifically public funds, in compliance with grants and contracts
and in the best interest of the community and our clients)
4. efficiency (ability to obtain the maximum output possible from our limited resources)
5. fidelity (any appearance of conflict of interest will be identified and reported immediately to
the Executive Director).
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Human Resources
Trends Assessment
Incident Reports
FY10 Quarter 4
July 2009 – June 2010
Thirty-four (34) incident reports have been filed at Fremont Counseling Service from July 1,
2009 through June 30, 2010.
In comparison, filed to date:
Quarter 1
FY10: 9
FY09: 4
FY08: 1
FY07: 1
FY06: 5
Quarter 2
FY10: 7
FY09: 8
FY08: 9
FY07: 0
FY06: 4
Quarter 3
FY10: 10
FY09: 10
FY08: 6
FY07: 5
FY06: 5
Quarter 4
FY10: 8
FY09: 4
FY08: 9
FY07: 6
FY06: 9
Summary of Incident:
1. Non Specific
2. Employee fall
3. Transport Client to ER
4. Transport Client to ER
5. Threatening behavior by client in group
6. Employee fall
7. Inappropriate comments by client in jail
8. Client seizure on outing
9. Employee fall
10. Client seizure
11. Contact with community provider
12. Notification of request of former employee
13. Client fall
14. Employee injury due to client fall
15. Vehicle Accident
16. Employee fall
17. Employee fall
18. Employee fall
19. Employee fall
20. Employee slip
21. Employee fall
22. Employee fall
23. Employee fall
24. Lost vehicle keys
25. Incident requiring contact of law enforcement
26. Suicidal client on phone with Intake Specialist
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Total Filed
FY10: 34
FY09: 26
FY08: 25
FY07: 12
FY06: 23
Forwarded to:
NA
Health and Safety – Lander
Quality Assurance
Quality Assurance
Quality Assurance
Health and Safety – Riverton
Quality Assurance
Quality Assurance
Health and Safety – Lander
Health and Safety – Lander
Quality Assurance
Non Specific
Quality Assurance
Health and Safety – Lander
Health and Safety – Lander
Health and Safety – Riverton
Health and Safety – Lander
Health and Safety – Riverton
Health and Safety – Lander
Health and Safety – Riverton
Health and Safety – Lander
Health and Safety – Riverton
Health and Safety – Lander
Health and Safety – Lander
Quality Assurance
Quality Assurance
27. Attempted forced entry at apartments
28. Client confused about relationship with staff
29. Client seizure on outing
30. Client attempted overdose in lobby
31. Employee injury (reportable to WC)
32. Client made threat against staff
33. Agency vehicle damage (hit deer)
34. Child got caught in bathroom door
Health and Safety – Riverton
Quality Assurance
Quality Assurance
Quality Assurance
Health and Safety – Riverton
Quality Assurance
Health and Safety – Riverton
Health and Safety - Lander
The seizure incident (#29) involved the same client that had seized while going for a walk on
two (2) separate reported occasions. Staff who was participating in and supervising the outings
with the client identified possible triggers to the seizures and made a point to inform the client
that she would ask about the client’s stress level before leaving on the walks in order to prevent
future events. Since that time, there have been no further reports of seizures by the client during
walking activities.
The employee injury (#31) was due to an employee while moving heavy boxes of files. This
resulted in a re-injury of an injury that occurred while doing the same task last fiscal year. The
employee was told that they should avoid this type of task and other heavy lifting to avoid
additional injuries of this nature.
Beyond these incidents, there are no obvious trends, patterns, or areas of concern noted in the
reported incidents that need to be further addressed.
Trends Assessment
Complaints/Grievances
FY10 Quarter 4
July 2009 – June 2010
Six (6) complaints/grievances have been filed at Fremont Counseling Service from July 1, 2009
through June 30, 2010.
In addition, an informal investigation performed by the State of Wyoming, Department of
Health, Division of Mental Health and Substance Abuse Services was initiated by a complaint
filed with the Division in May 2010. As of this date, the investigation has not been concluded.
In comparison, filed to date:
FY10:
FY09:
FY08:
FY07:
FY06:
Quarter 1
1
5
3
6
0
Quarter 2
FY10: 0
FY09: 1
FY08: 4
FY07: 9
FY06: 2
Quarter 3
FY10: 2
FY09: 3
FY08: 2
FY07: 1
FY06: 6
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Quarter 4
FY10: 3
FY09: 3
FY08: 5
FY07: 9
FY06: 6
Total Filed
FY10: 6
FY09: 12
FY08: 14
FY07: 25
FY06: 14
Summary of complaints/grievances to date:
Submitted by:
1. Consumer
2. Client
3. Client
4. Client
5. Client
Regarding:
Fees
Services
Confidentiality
Staff, Customer Service
Staff, treatment provider
6. Family of client
7. Client
Emergency Services
Emergency Services
Resolution:
Reviewed, no changes
Founded, letter of apology
Founded, employee disciplined
Founded, recommendation made
Founded, discussion letter provided
to employee
Unfounded, letter of apology
State investigation – pending completion
As of February 2010, complaints/Grievances are allotted twenty-eight (28) days for completion
of the investigation/determination process. (Prior to this date, the allotted amount of time was
thirty-seven (37) days.) To date, finalized investigations have been completed within thirty (30)
days, an average of two (2) days over the allotted deadline.
In regard to the above complaint/grievances, there are no obvious trends, patterns, or areas of
concern noted.
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Substance Abuse Services Objectives
July 2009 to June 2010: 95.45% of the SA clients had 28 plus days clean and sober. This
exceeds our optimal expectation.
July 2009 to June 2010: 67.85% of the SA clients were gainfully employed working or attending
school 14 plus days a month. This takes into account the clients working on the rigs. This does
not take into account students off for summer break. This exceeds our expected goal but is
2.15% shy of our optimal expectation.
July 2009 to June 2010: 95.6% of the SA clients were not incarcerated. This exceeds the optimal
expectation.
In FY10 a total of 116 clients enrolled in IOT and IOTA. 51.7% of the clients completed a
program while 30.1% were discharged treatment incomplete. At the end of the year 21 clients
were still enrolled in the programs. This does not meet our expected goal of 75% however it
exceeds our minimal expected.
Community Services Objectives
Objective 1: Occupancy rate for SIP apartments will be 90% for the year.
The occupancy rate for the SIP apartments this year was 97% (1060 weeks out of a possible
1092 weeks).
Objective 2: Individuals receiving case management services will report satisfaction with
their lives.
A measure of life satisfaction, the Quality of Life Inventory (QOLI) was administered in the late
fall of last year. 22 individuals who received case management responded.
The average T score (T scores have a mean of 50 and a standard deviation of 10) for this group
was 40.14 which is one standard deviation below the mean.
Additional analyses indicated that substance abuse status had no impact on these scores nor did
town (Lander or Riverton). However, whether individuals lived in FCS housing or in the
community at large did. Individuals living in the FCS apartments (N=14) had a mean score on
this instrument of 47.2 which is near the standardization sample average whereas individuals
living in the community at large (N=8) had a mean score of 27.75, nearly two standard
deviations below the FCS apartment group. While the sample sizes are small this finding has
been replicated in previous years.
Summary
The occupancy rate of the SIP apartments was 97%. While there is not an extensive waiting list,
whenever an apartment came open there was always at least one person on this. Most (15 of the
21) apartments were occupied by the same person all year long.
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Life satisfaction was comparable to what it was in previous years using the QOLI, about one
standard deviation below the population mean. However, as in previous, satisfaction for
individuals living in the FCS housing was near the population average.
Fremont Counseling Service Quality Control
There were 90 charts reviewed for the fiscal year of '09-'10. Of these charts 73 were from
Riverton and 17 were from Lander. Charts were reviewed from 68 were Mental Health, 20 were
Substance Abuse, and 2 were dual diagnosis. All 90 charts reviewed were Medicaid.
All the charts with Major errors were addressed with the clinician by the supervisor and then
corrected by the therapist. Some charts with minor errors were just corrected by the therapist.
In the January a new QA from was implemented to assure that all CARF standards were being
monitored. Also in January the QA operation was changed to only Managers reviewing the
charts. Training for all staff was done in January and February to notify staff of changes and
needs that were being missed in charts.
Megan Peterson reviewed medical charts from both offices. She reviewed 31 charts, all were
Medicaid. Errors were all corrected the medical staff.
Emergency Services
The FCS on-call responded to a total of 530 calls for this year. Of the total calls, 438 were
evaluated under Title-25 and 22 reassessments. Of those evaluated or reassessed, there were 208
were detained.
Of the 208 detained, 152 went to Pine Ridge, 31 went to WBI, 22 went to Fremont County Jail
and 3 went to Wind River Police Department.
The average response time to emergency calls for FCS this year is below the 15 minutes required
under the state contract. Four hundred and thirty-seven of the Title-25 forms were review and
attempt to correct errors as they occur.
An on-call staff meeting was held quarterly to staff problems and update staff on any changes in
procedures or forms.
Technology
In Fiscal Year 2010, Fremont Counseling Service added a new terminal server, a new sequel
server, Tandberg and Polycom video conferencing hardware/software.
We were able to update our server to Windows Server 2003 Standard and Enterprise. This has
allowed a much more secure and functional system. It also positions us for more advanced
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technologies that are coming out in the next few years that our previous server environment
(Server 2000) wouldn’t have been able to address.
Fremont Counseling Service Goals for Fiscal Year 2011
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Retain quality staff and dehire staff who do not meet Fremont Counseling Service standards.
Establish and maintain regular contact with the legislative delegation representing Fremont
County.
Continue the Capital Improvement Account-work towards enhancing the Riverton facility.
Spend less money than generated or generate more money than spent.
Maintain safe and efficient facilities.
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