A review of the Farmville-based Crossroads Community Services Board by the Virginia Department of Behavioral Health and Developmental Services netted 40 recommendations to the agency.

In a letter dated Feb. 18 from Dr. Jack Barber, the department’s interim commissioner, recommendations were listed for board operations, clinical programming, finances, communication, decision-making, clinical oversight and high-risk situations, accessing those with decision-making authority and human resources management.

The letter comes after Crossroads Executive Director Dr. Susan Baker dismissed four people shortly after she arrived at the organization.

Since then the former workers — and some current employees — have pushed for their rehiring, and for Baker’s dismissal.

Baker said the dismissals were a “reduction in force,” but the former employees said they were dismissed for challenging some of Baker’s decisions.

The board recently gave Baker a vote of confidence, renewing her contract, which was set to expire in July.

“Let me just say that they are recommendations,” Baker told The Gazette, “and that we are reviewing them and seeing what recommendations actually apply to crossroads and we will be taking action to implement those things that move Crossroads forward.”

According to the report, concerns raised during the preliminary review included a reported lack of trust in executive and clinical leadership, a pattern of unresponsiveness and delayed communication from executive leadership, an executive leadership style that is perceived as reactive, chaotic and confusing by many clinical staff, absence of a clear channel of supervisory oversight for managing high risk individuals and high risk situations, including supervision required by the department of health professions and lack of consistent availability of executive and clinical leadership to address urgent operational issues, including consultation around high risk individuals and high risk events.

“While these concerns are subjective in nature, the clinical staff interviewed provided detailed information about patterns of executive decision making that have eroded their trust in CSB leadership,” the report noted.

According to the report, Stacy Hamilton Gill, the department’s behavioral health community services director, conducted a review of the impact of the recent organizational changes in clinical leadership on clinical program integrity. The review was conducted on Feb. 3-5.

“During this review, many of the clinical staff reported that they were operating in a context of uncertainty and in the absence of the type of clinical supervision and administrative support they needed,” stated the report.

“Given the high risk nature of the individuals receiving services, the complexity of their clinical and medical needs and the ever present potential for a negative outcome, it is urgent for the board and executive director to begin restoring clinical staff’s trust in CSB leadership and to provide strong administrative support and consistent clinical supervision for behavioral health services.”

“When staff are left uninformed and are not included in the process, this may breed mistrust and lack of follow through on directives related to the decision.”

The report stated that employees at all levels need access to those in the CSB with decision-making authority regarding both urgent operations and clinical matters. “The lack of accessibility to those in decision making positions leads to confusion and lack of trust in leadership.”

“Some employees perceive that due to the recent layoffs their positions are now in jeopardy,” the report stated, “which is causing stress and a potential lack of focus on service delivery. The Employee 11 Assistance Program should be used to help employees process their reactions to these changes … As there is a perceived division between administrative and clinical services, the executive director and senior management team should take steps to identify and address the divisions that may exist.”

“In order to demonstrate that both of us are exercising our responsibilities in a serious, effective and collaborative manner, I would appreciate receiving an update from you within the next 90 days regarding any steps the CSB may have taken or plans to take in response to these recommendations,” Barber stated.