Mayjune2010

AWARE

May/June 2010 Volume 4, Number 3

INK

“The Right Services...To the Right People...At the Right Time!”

AWARE earns praise from Board of Visitors

H.E.L.P.

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By Tim Pray n January 28 and 29, the Montana Mental Disabilities Board of Visitors conducted a site review of AWARE’s services in Butte and Anaconda.

The Board of Visitors serves at the pleasure of Gov. Brian Schweitzer and conducts reviews of Montana’s public mental health programs and the Montana Developmental Center in Boulder. It also assists individuals receiving services from these programs.

The Mental Disabilities Board of Visitors was created in 1975 by the Montana Legislature to provide independent oversight of publicly funded mental health services and Developmental Disabilities residential facilities. The Board consists of six persons appointed by the governor for two-year terms.

See Board of Visitors on Page 6

Study finds services lacking for people with dual diagnosis H.E.L.P. instructors demonstrate a two-person assist move. Left to right, they are Tim Hahn, Randy Street and Larris Allick. Photo by Jim Tracy

H.E.L.P. (Healthy Employees Leading People in Need) trainers have begun using a revised manual with clearer language and better illustrations. The new 24-page manual includes more detailed photographs and easier-to-follow instructions. As before, H.E.L.P. trainers use the manual as a guide for one-onone instruction. See story on Page 4

Inside...

Note to staff and friends

— Page 2

By Jim Tracy nadequate community services for people with a dual diagnosis of mental illness and developmental disability could result in a more restrictive placement than necessary.

That’s one of the conclusions in an April report to the Legislature’s Children, Families, Health and Human Services Interim Committee prepared by legislative research analyst Sue O’Connell.

After a study that lasted several months, O’Connell concluded that the potential for inappropriate placement is particularly evident at the Montana Developmental Center, where 73 percent of residents are dually diagnosed.

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News Briefs — Page 8

See Dual Diagnosis on Page 22

Making Dream Catchers — Page 12

Book Marks — Page 14

Coming Events — Page 18

On all fronts, we’re excited to get moving Dear Staff and Friends,

To make the most informed decisions possible regarding this new direction we’re heading, we’ve formed a committee that will guide this process in its infancy. The committee is made up of professionals from around the state, each one representing bodies with experience in helping the population of people who will be served; the group will include advocacy organizations, law enforcement, legislation and healthcare. We’re eager to get their thoughts on making this a successful service and then implementing those thoughts.

I hope this finds all of you well.

I wanted to again take this opportunity to fill you in on recent progress and opportunities.

Last January, we responded to a request for proposals from the Department of Health and Human Services’ Addictive and Mental Disorders Division. The subject of their request was the provision of transportation to people undergoing involuntary commitments to the state hospital.

Currently, that role is filled by local law enforcement officers. They have been providing the service in an orderly and efficient manner, and they have been mindful of the magnitude of the situation for people undergoing this huge Larry Noonan change in their lives.

In April, members of our own development committee traveled to Washington to visit with that state’s department of health and human services officials. We met with representatives from their developmental disabilities program to talk about systems they have in place and how those systems work. We also told them about many of the things that we’re up to on this end, particularly in reference to Apostrophe magazine. We talked about the ways in which we might be able to offer services there and what those services would be. This is clearly a budding relationship, but it was worthwhile to hear about systems they have in Washington that we don’t have in Montana.

But a problem remains, despite their efforts.

Someone who is told by a judge that they must leave their life behind for an indefinite period and spend it in an unfamiliar and intimidating place, any stigma on top of that can be debilitating. So when they leave the court or are picked up at their home in a marked police vehicle and handcuffed, the situation becomes even more distressing …and embarrassing.

For instance, Washington uses an intensity-based payment system that assesses the requirements of the individual (necessary staffing, treatments, etc.) and sets up an appropriate rate.

AWARE is prepared to transport these people in unmarked vehicles to the state hospital and back to their respective courts for hearings, etc. When we provide that service, we will do it with staff who are trained in mental health and understand the nuances of different kinds of mental illness. The ride will be comfortable. Their thoughts—should they feel like sharing them—will be respected and, perhaps most important, they won’t be viewed as a criminals being handcuffed and hauled away in a squad car.

We wouldn’t have responded to the state’s request if we weren’t certain we could do this in a way that exceeds everyone’s expectations, so we’re excited to get moving.

We also had some good conversations at the University of Washington regarding their wraparound Lawrence P. Noonan, CEO Geri L. Wyant, CFO Jeffrey Folsom, COO Mike Schulte, CHO Board of Directors

John Haffey, President John O’Donnell, Vice President Al Smith Teresa Marshall Cheryl Zobenica Russell Carstens Stephen Addington Editor: Jim Tracy Staff writers: Tim Pray Bryan Noonan

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AWARE Ink is published bimonthly

by AWARE, Inc., a 501(c)3 non-profit organization at 205 E. Park Ave., Anaconda, MT 59711. Copyright ©2009, AWARE, Inc. All rights reserved. No part of this newsletter may be used or reproduced in any form or by any means without prior written permission of the publisher.

Please send correspondence to: askaware@aware-inc.org.

fidelity system, which assesses the quality of the wraparound services being provided to families in their state. As you know, we have placed a significant amount of attention on both our unconditional care principles and the wraparound concept that goes with it.

understanding of our principles of unconditional care. Almost every staff member they talked to could recite and, more importantly, explain what those principles mean in terms of the people they are serving. That is important, and I wouldn’t expect anything less from our staff. Congratulations on your high marks.

We were happy to discuss their method of measuring the level of wraparound that is being provided, not focusing on the specific outcomes of a family, rather the adherence to the important details of providing services that depend on so many outside parties and stakeholders. Although the meetings were informal, it was heartening to find out that we’re on the right track and developing services on par with an agency that serves ten times as many people.

On another front, Jeff Folsom, AWARE’s chief operating officer, recently testified before the Legislature’s Interim Children, Families, Health, and Human Services Committee, about a study conducted by the state on community services for people with a dual diagnosis of mental illness and developmental disability.

The study found a lack of community services for people with that dual diagnosis and noted that 73 percent of the people at the Montana Developmental Center at Boulder have such a diagnosis. A third of them are awaiting placement in communities.

Finally, we met with several families about their impressions of the services they’re receiving. There’s a common denominator with families: no matter where they live. Families who have children with disabilities have dedicated inordinate amounts of time navigating various systems and meeting with dozens of people and organizations in order to get the best for their children. Parents are more informed than ever. The states know that, and it behooves providers to keep it in mind, too.

As always, AWARE is working to find homes for those people. We believe — as the Supreme Court does ­— that they are entitled to live in a home in a city or town of their choosing rather than in an institution.

AWARE, meanwhile, has completed a revision of its H.E.L.P. manual. H.E.L.P., of course, stands for “Healthy People Leading People in Need.” We developed the manual and the techniques described in it and believe it meets our needs better than cookie-cutter approaches to therapeutic holds. The training and the manual place the emphasis on de-escalating stressful situations before they become a crisis.

H.E.L.P. insures the safety of the people we serve until they can gain control of themselves.

The parents we met with had questions about the ways we provide services in Montana. As I just stated, parents are always eager to hear about a new twist on the ways someone is serving people with disabilities, no matter how small that twist is. We offered whatever suggestions we were able to offer, and took a few suggestions from them.

So, the trip was a good one. We’re not sure where the connections we made will take us, but we went to Washington with open minds and confidence in our services. We left with the same confidence, new ideas to pursue and new possibilities.

People notice the work you’re all doing. Even in other states. You’re getting results for adults, children and families who are depending on them. Keep it up.

With best regards,

In this issue of Ink, you’ll read about the Board of Visitors site review that occurred in January. The Board’s response was positive, and the general sense was that, although they found our services to be of the highest level, they were impressed by the consistency of the staff and their knowledge and 3

Revisions keep H.E.L.P. training up to date

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By Jim Jim Tracy Tracy By

Advice from a wrestling coach WARE’s WARE’s In In the the summer summer of of 2003, 2003, H.E.L.P. trainH.E.L.P. trainNoonan, searching for Noonan, searching for an an ers have have begun begun ers expert outside of AWARE, expert outside of AWARE, using aa revised revised manual manual with with using recruited recruited retired retired Butte Butte High High clearer language language and and better better clearer School wrestling coach School wrestling coach illustrations. illustrations.

Jim Jim Street Street to to the the project. project.

The new new 24-page 24-page manmanThe The Montana Hall The Montana Hall of of Fame Fame ual includes includes more more detailed detailed ual AWARE, Inc. mat mentor was an expert mat mentor was an expert photographs and and easiereasierphotographs in in movement movement and and balance, balance, to-follow instructions. instructions. As As to-follow having led the Bulldogs to having led the Bulldogs to before, H.E.L.P. H.E.L.P. trainers trainers use use before, 13 13 straight straight state state AA AA chamchamthe manual manual as as aa guide guide for for the Healthy Employees pionships (1980-92). pionships (1980-92). one-on-one instruction. instruction. one-on-one Leading People in Need “We “We didn’t didn’t want want to to invent invent “People train train every every year,” year,” “People aa new new restraint restraint system system or or said Training Training Director Director Tim Tim said new holds,” Hahn said. new holds,” Hahn said.

Hahn. “We’re “We’re always always in in Hahn.

“That’s “That’s where where Jim Jim came came the process of revising the the process of revising the into the picture.

His into the picture. His experexpermanual to to keep keep itit fresh. fresh. We We manual tise with movement and baltise with movement and have new new programs. programs. We We have ance fit in withwith what balance fitwell in well are working working with with younger, younger, are we wanted.” what we wanted.” smaller-statured kids. kids. There There smaller-statured Driving Driving the the need need for for aa will always always be be aa need need for for will new system, meanwhile, was passage of the Children’s new system, meanwhile, was passage of the Children’s new therapeutic therapeutic holds.” holds.” new Health and with Health Act Act of of 2000, 2000, and with it, it, new new restraint restraint and and As in in judo judo and and jitterbugging, jitterbugging, its its takes takes leverage leverageand and As seclusion seclusion rules rules for for agencies agencies receiving receiving federal federal funds fundsto to balance to to master master H.E.L.P. H.E.L.P. balance care for children. care for children.

“It’s not not strength. strength. It’s It’s how how you you move,” move,” said saidHahn, Hahn, “It’s The The Act Act states states that that facilities facilities such such as as group group homes homes who helped helped develop develop the the trademarked trademarked system system for for rerelievwho must guarantee children the right “to be free from must guarantee children the right “to be free from ing stressful situations andand supervised thethe manual lieving stressful situations supervised manual physical physical or or mental mental abuse, abuse, corporal corporal punishment, punishment, and and revision. revision. any any restraints restraints or or involuntary involuntary seclusions seclusionsimposed imposedfor for “We place place the the emphasis emphasis on on de-escalating de-escalating stressful stressful “We purposes of discipline or convenience.” purposes of discipline or convenience.” situations before before they they become become aa crisis,” crisis,” Hahn Hahn said. said. “In “In situations Restraint Restraint can can be be used used only only to to ensure ensure the the physical physical situations where individuals lose control and pose an situations where individuals lose control and pose an safety of a group home resident, a staff member, or immediate risk risk of of physical physical harm harm to to themselves themselves or or othoth- safety of a group home resident, a staff member, or immediate others.

The Act also requires agencies like AWARE to others.

The Act also requires agencies like AWARE to ers, H.E.L.P. H.E.L.P. (Healthy (Healthy Employees Employees Leading Leading People People in in ers, provide “appropriate “appropriate training.” training.”

Need) insures insures their their safety safety until until they they can can gain gain control control of provide Need) “The Act listed a comprehensive set “The Act listed a comprehensive set of of skills skills and and of themselves.” themselves.” competencies competencies that that all all staff staff needed needed to to have,” have,” Hahn Hahn said. said.

AWARE first first began began using using aa form form of of crisis crisis prevenprevenAWARE “That was our guideline.

That was the outline we used tion and and intervention intervention when when itit opened opened several severalchildren’s children’s “That was our guideline. That was the outline we used tion to go go by.” by.” group homes homes in in 1991.

1991. The The industry industry standard standard at at the the time to group Hahn Hahn and and fellow fellow trainer trainer Larris Larris Allick Allick waded waded into into the timeawas a system developed the Crisis Prevention was system developed by thebyCrisis Prevention Instiproject in the summer of 2003. the project in the summer of 2003.

Institute in Brookfield, tute basedbased in Brookfield, Wis. Wis. “We “We had had to to do do aa lot lot of of research,” research,” Hahn Hahn said. said. “I “I spent spent That worked well enough, Hahn said, said, but but AWARE AWARE That worked well enough, Hahn hours on the Internet plugging in terms like ‘de-escalahours on the Internet plugging in terms like ‘de-escawanted aa system system that that would would better better fit fit its its own ownneeds. needs. wanted tion’ lation’and and‘restraint.’” ‘restraint.’”

“It was was (CEO) (CEO) Larry Larry Noonan’s Noonan’s vision,” vision,” Hahn Hahn said. said.

“It It It helped helped that that he he and and Allick Allick were were certified certified as as aa traintrain“We’re aa credible credible company, company, and and he he felt felt confident confident we we “We’re ers in the Mandt System of physical restraint, which is ers in the Mandt System of physical restraint, which could put put together together our our own own training training program.” program.” could

Healthy Employees Leading People in Need

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used by by many juvenile corrections andand is used many juvenile corrections behavioral health facilities. behavioral health facilities.

“That “That gave gave us us the the foundation foundationto toget get started,” started,” Hahn Hahn said. said. “We “We began beganmapmapping ping out out both both the the physical physical skills skills required required for for aa new new system systemand andstarted startedwriting writingaa manual.” manual.”

They They also also moved moved furniture. furniture.

“We “We moved moved into into new new offices officesatatGalen Galen and and made made sure sure we we had had aa room room without without any any furniture,” furniture,”Hahn Hahnsaid. said.“And “Andwe we 1 started practicing.” started practicing.”

Once Once they they felt felt confident confidentin intheir theirnew new system system and and had had finished finishedthe themanual, manual,they they looked looked to to the the Montana Montana Department Departmentof of Public Public Health Health and and Human Human Services Servicesfor for approval. approval.

“They “They were were skeptical skeptical of of what whatwe wewere were trying trying to to do,” do,” Hahn Hahnsaid. said.“It “Ittook tookfour four or or five meetings, and those meetfive meetings, and allall of of those meetings ings involved demonstrations in Helena. involved demonstrations in Helena.

It Itwas wastough toughand andstressful, stressful,but buteventually eventually they they gave gave us us the the thumbs thumbsup. up.As Asfar faras as we we know, know, this this isis the the only onlystate-approved state-approved training training curriculum.” curriculum.”

4 Hahn Hahn credited credited Jeff Jeff Folsom, Folsom, chief chief of of opoperations, erations, in in part part with withwinning winningover overstate state regulators. regulators.

Today Today all all AWARE AWARE direct direct care care staff staff and and case case managers managers must mustpass passthe theH.E.L.P. H.E.L.P. course, course, which which isis taught taughtby byHahn, Hahn,and and training coordinators Allick, Randy training coordinators Allick, Randy Street Street and and Scott Scott Galle.

Galle.

AWARE AWARE also also requires requires staff staff to to take take aa yearly yearlyrefresher refreshcourse. er course.

“We “We do do local local training training at at Galen, Galen, but but we wetrain trainin inevery every community,” Hahn said.

“Once a month we’re in every community,” Hahn said. “Once a month we’re in every community community in in Montana Montanawhere whereAWARE AWAREhas hasan anoffice.” office.”

While While the the course course teaches teaches physical physicalskills, skills,ititalso alsoememphasizes phasizes the the need need to to develop developaa“therapeutic “therapeuticattitude,” attitude,” which which meshes meshes with with AWARE’s AWARE’sphilosophy philosophyof ofuncondiunconditional care. tional care.

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3 J. Individual grabs from the rear in a headlock.

1. Reduce the length of neck by bringing ears and shoulder together as the chin is tilted to the chest.

2. Pull down on the individual’s arm by placing both hands on their wrists and upper forearm.

(The thumbs should be adjacent to index fingers and not around wrist or forearm). This is necessary to maintain air and especially blood to the brain.

3. When slack around the neck is felt, quit pulling down and immediately adjust the hand on the individual's forearm to push up. At the same time, sag (lower) hips and step behind individual with inside foot. This would be the left foot if individual has a headlock with their right arm.

The goal of the maneuver is to get under and behind individual’s shoulder.

4. As soon as hips rotate through the “hole,” hips should be brought into the individual.

This position will negate the individual’s ability to become a threat. We can now separate or go to the classic hold. (Adjust classic hold depending on size and physical stature of individual).

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staff to understand their role as caregivers.

We want We want staff to understand their role as caregivers. them to bethem aware, be aware, alert, but ‘cool.’”

We want to be be be alert, but be ‘cool.’”

The The course course takes takes six six to to eight eight hours. hours.In Inorder orderto toget get certified, trainees must show physical competency certified, trainees must show physical competencyand and pass pass aa written written test. test.

Since Since AWARE AWARE started started using usingH.E.L.P., H.E.L.P.,“We’ve “We’veseen seena significant reduction in in thethe useuse of of restraint,” Hahn said. a significant reduction restraint,” Hahn “I attribute that tothat ourtostaff buying said.

“I attribute ourand stafftheir andmanagers their managers into it.” buying into it.”

Word Word about about H.E.L.P. H.E.L.P. has has also also spread spread outside outside the the corporation. corporation. AWARE AWARE trainers trainershave havetaught taughtthe thecourse course to to teachers teachers and and staff staff in in the the Butte ButteSchool SchoolDistrict, District,for for example, example, and and have haveconducted conductedseminars seminarson onthe theH.E.L.P. H.E.L.P. philosophy for other groups. philosophy for other groups.

‘Emotional ‘Emotional distance’ distance’ “A “A ‘therapeutic ‘therapeutic attitude’ attitude’means meansyou youtake takecare careofof yourself so you can be as calm, flexible, and yourself so you can be as calm, flexible, andeffective effective as as possible possible at at work,” work,” Hahn Hahnsaid. said.“It “Italso alsomeans meansthat thatyou uncritically accept the person you serve, whichwhich helps you uncritically accept the person you serve, you beyou realistic about him and gives helps be realistic about(and himyourself) (and yourself) andyou some him or her.him We or want gives emotional you some distance emotionalfrom distance from her.

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Board of Visitors

Continued from Page 1

The board reviewed AWARE’s Butte and Anaconda programs to learn about the services in those communities, assess the degree to which the services provided are humane, consistent with professional standards and incorporate Board of Visitors standards for mental health services, to recognize excellent services, to make recommendations to AWARE for improving services and to report to the governor regarding the status of the services AWARE provides.

Mental health professionals The board is made up of a cross section of mental health professionals from around the state, including Executive Director Gene Haire, Mental Health ombudsman Alicia Pichette, Board Chair JoanNell Macfadden, pharmacology consultant Jacki Ulishney, clinical consultant Pat Frawley, LCSW and consumer consultant Glenn Porte.

Normally, site reviews by the Board of Visitors occur over the course of one day.

Early on, though, it became clear that a review of AWARE’s services would take more than that, so the review was extended to a two-day visit.

“It takes a comprehensive site review to fully understand all that we do in just one community,” said AWARE medical director Dr. Len Lantz. “The site review allowed the Board of Visitors time to form their own opinions and to meet an entire cross-section of staff and clients— not just a select few.”

During the review, the board interviewed AWARE staff at every level, observed actual treatment activities, reviewed written descriptions of treatment programs, con-

Board of Visitors Mission

Provide independent oversight of the Montana Developmental Cen-

ter for people with developmental disabilities and mental health facilities for people with mental illnesses.

To assure that the treatment of all people admitted to the Montana Developmental Center and mental health facilities is humane, is consistent with established clinical and other professional standards and meets the requirements in state law.

To advocate for and protect the rights of people receiving services from the Montana Developmental Center and mental health facilities.

To advocate for full development of effective, evidence-based, compassionate treatment services within Montana’s developmental disabilities and mental health systems.

The Board reviews are designed to be comprehensive, and the general categories of a provider’s services that are being reviewed are: Organizational planning and quality improvement Client rights and responsibilities and safety Client and family member/caregiver participation Cultural competence Staff competence, training, supervision and relationships with clients Treatment and support, including: • Evidence-based services • Housing (safety and quality) • Education (access to continuing education in the community) • Co-occurring psychiatric and substance use disorders • Crisis response and intervention services • Medication protocols and procedures Access and entry (convenient to the community and linked to primary care providers) Continuity of service through transitions ducted informal discussions with clients, inspected offices and homes and reviewed treatment records in depth.

The review was exhaustive and was intended as a measure of quality control for the governor and state, but it also serves the same purpose for AWARE. “We have a very aggressive quality management process,” said AWARE COO Jeff Folsom. “critical part of it includes the consistent use of external evaluators to provide objective feedback on our services 6

and programs.”

The services that were reviewed by the board included Adult Case Management, the Intensive Community-Based Rehabilitation program (Mercury Street home for adults), Therapeutic Family Care, Outpatient Clinical services, Youth Case Management, Youth Residential services, Psychiatric services, Early Head Start and AWARE’s emergency services such as the crisis line.

The review was overwhelmingly positive, and for each mental health

service in Butte, strengths were listed. A strength that was noted throughout, though, was the clarity of staff responses. During the course of each interview, staff were able to talk to the board member about unconditional care and wraparound service concepts in a clear and thoughtful way.

Two residential programs were surveyed during the review: The Mercury Home mental health program for adults and the Renz home for youth. Both of the residential programs received high marks for the attitude and patience of the staff and the comfortable, clean and peaceful environments that made both programs feel like true homes.

During the reviews of both homes, members of the Board of Visitors conducted one-on-one conversations with some of the residents to get a gauge on how they feel about where they live and the services they’re receiving.

Community connection In both homes, the board members said, the residents appear to be engaged and that a strong connection to the community at large exists, which is one of the top priorities of AWARE’s residential programs.

The community-based services in Butte (for both adults and children) were also reviewed favorably over the course of the two-day site visit. Those community-based services included AWARE’s Therapeutic Family Care, Youth Case Management, Adult Case Management, Outpatient Clinical and Psychiatric services, Early Head Start and AWARE’s emergency services such as the crisis line.

For the Board, one of the highlights of the Therapeutic Family Care program is the ‘OOPS’ (Out-

of-State Placement Staffing) process, which was viewed as an innovative way to identify and intervene in situations that result in children being shipped out of state to various residential programs that are far from their home communities and the supports that surround them.

The reviewers were impressed with both AWARE’s Outpatient Clinical and Psychiatric services, noting that, in the case of the outpatient services, the staff are well-trained and familiar with their treatment methods in a way that comes from a wealth of experience.

They noted that AWARE’s psychiatrists value the professional opinions of the therapists and other involved staff, frequently involving them in the psychiatric appointments when appropriate and creating a collaborative and wraparound environment.

“I was proud to explain our unconditional care approach, as well as how AWARE has made a commitment to increase the availability of psychiatrists, which benefits our clients, but our communities, as well,” said Dr. Lantz.

The Youth and Adult Case Management services were highly rated in large part because of the strength of the staff. The Board noted that staff are eager to meet clients on their home turf, where they are most comfortable. They appreciated the fact that all who are enrolled in case management services, whether children or adults, are consistently encouraged to play the most significant role in the development of their service plans and formation of goals.

Finally, the Board of Visitors reviewed Butte’s Early Head Start program and found it to be quite solid and of the highest quality.

Their feedback in the report stated 7

that “AWARE deserves much credit for pursuing and establishing this accredited program for the Butte community.”

The last review occurred in 2002 and focused solely on the Galen program. Much has changed since that time; the number of staff and clientele have almost doubled and the services offered are more dynamic and advanced.

“There’s a lot that we wanted them to see,” said AWARE CEO Larry Noonan, “we’ve worked hard to make these services as all-encompassing as they can be. I’m sure we’ll be eager to show them something new for their next review, too.”

An objective party Comprehensive site reviews like this one and the CARF review that occurred in February are taken quite seriously by AWARE staff.

Though receiving positive feedback is encouraging, constructive criticism from an objective party is valuable, too.

“We take evaluative feedback very seriously and, along with all of the other data we collect, utilize information to make organizational decisions that will ideally improve the services we provide for people across the state,” said Folsom.

“I’m encouraged by the review,” said Lantz, “I think the high praise confirmed what other independent reviewers have been saying, which is that AWARE delivers quality, comprehensive services.”

“No printed word, nor spoken plea can teach young minds what they should be. Not all the books on all the shelves - but what the teachers are themselves.” — Rudyard Kipling (English short-story writer, poet, and novelist.

Nobel Prize (1907), 1865-1936)

NEWS BRIEFS stated it did anything wrong in the settlement, they are accused of marketing Zyprexa to people with dementia, autism, Alzheimer’s disease or depression, even though the medicine was never approved for those conditions.

Warner said in a news release he hopes to begin evaluating requests for the money in the next few months. Some of the money in the settlement went to cover the costs of bringing the suit, leaving $9.5 million in a special account to be spent on mental health programs in Montana. The money will go to either public or private groups working with the mentally ill, including training for law enforcement, crisis intervention services, children’s mental health programs and money to help metally ill patients live on their own.

Malmstrom plans to hire more people with disabilities Peter Johnson, Great Falls Tribune

Malmstrom Air Force base recently awarded SKILS’ KIN, a Spokane based non-profit, the contract to operate the Elkhorn Dining Facility. SKILS’ KIN will run the facility with at least 75 percent of the employees having a disability. This decision comes after the contracting office did research and established that the Air Force is required by federal law to hire an “AbilityOne contractor” when possible to handle certain roles, including food services, janitorial work and grounds maintenance. “[AbilityOne] is a great program that serves the community, “ says Laree Shanda, chief operating officer for SKILS’ KIN. “It allows people with severe disabilities to find work, get off state and federal benefits, turn into taxpayers and become active members of the community, if they aren’t already.”

The company has posted job listings at local agencies serving people with disabilities, such as Vocational Rehabilitation, Easter Seals and Quality Life Concepts. They are also looking for people to help the new employees. Some will require assistance in learning their duties from employment support specialists or job coaches.

Autism, Asperger’s Syndrome expert to present conference at UM KECI Missoula

Tony Attwood is a world-renowned expert on autism and Asperger’s syndrome, and he recently scheduled a presentation at the University of Montana titled “A complete look at the autism spectrum.”

The conference will take place July 19 from 7:30 a.m. to 4:30 p.m. in the University Center Ballroom. It will cover many aspects of the autism spectrum, such as relationships, emotional management and social skills.

The conference is sponsored by UM’s Neuro Networking Club, a social group for adults with autism or Asperger’s syndrome and their friends. For more information on the club or the conference, call Treva Bittinger at (406) 543-0003 or email treva.bittinger@ umontana.edu.

Seven-member committee named for mental health trust fund Jennifer McKee, Lee State Bureau

John Warner, a former Montana Supreme Court Justice, who now oversees a $9.5 million mental health trust fund, has announced the members of the committee to help decide how the state spends the money.

Committee members are Pam Vies of Havre, Marcia Armstrong of Helena, Robert Runkel of Helena, Dan Tronrud of Sweet Grass County, Gary Mihelish of Helena, Robert Ross of Billings and William Docktor of Missoula.

The $9.5 million comes from the state’s share of a $13 million settlement payment from drug maker Eli Lily & Co. In 2007, the state sued the company on behalf of Montana consumers who were prescribed the anti-psychotic medication Zyprexa for illnesses the drug was not designed to treat. Eli Lily & Co. never

Senate introduces Equal Access to 21st Century Communications Act Coalition of Organizations for Accessible Technology

On May 5, Sens. Mark Pryor (D-Ark.) and John Kerry (D-Mass.) introduced the Equal Access to 21st Century Communications Act (S.3304). The bill would take a major step forward in ensuring people with disabilities have access to technology. It would modernize disability accessibility mandates in the Communications Act, bringing existing requirements up to date as 8

adopting exactly the right voice and perspective. The film avoids cutesiness or sympathy, and shows the two exactly as they are.

The director of the documentary is Monica’s cousin, so she manages to be present during key, private moments, and the behavior of the people onscreen feels captured rather than staged. The film definitely has a home movie feel, but that familiarity is vital and valuable. The documentary debuted at the 2010 Tribeca Film Festival.

television and phone services connect via the Internet and use new digital and broadband technologies.

“Much of S. 3304 would lead to greater accessibility for people with disabilities, such as more accessible video programming, including captioning and video description, regardless of distribution mode; and video programming equipment, such as televisions and other display devices, would also be accessible.” Said Eric Bridges, Director of Advocacy & Government Affairs at the American Council of the Blind.

“We stand together as a coalition,” said Jenifer Simpson, senior director of Government Affairs at the American Association of People with Disabilities. “We are confident that these issues – scope of accessible communications and the standard for compliance – will be resolved.”

Virginia introduces standardized test for students with disabilities Michael Alison Chandler, Washington Post

Virginia education leaders introduced a standardized test for students with disabilities in April. The test is proposed to phase out a widely used alternative that many officials say undermines the state’s accountability system. The test is a modified multiple-choice test and is expected to be more objective than the flexible, portfolio-style exam now taken by thousands of students in Northern Virginia. Critics of the current portfolio test say it inflates passing rates and obscures data the public relies on to understand gaps in student achievement. “[The test] is the first step in carrying out the will of the General Assembly and addressing my own concerns about overuse and misuse of the Virginia Grade Level Alternative,” said Virginia’s superintendent for public instruction, Patricia I. Wright.

Group puts one million books online for people who are blind or dyslexic Brooke Donald, Associated Press

The nonprofit Internet Archive in San Francisco recently launched a new service. The Archive has hired hundreds of people to scan thousands of books into its digital database – more than doubling the titles available to people who aren’t able to read a hard copy. Organization founder Brewster Kahle says the project will initially make one million books available to people with visual impairments, using money from foundations, libraries, corporations and the government.

“We’ll offer current novels, educational books, anything. If somebody then donates a book to the archive, we can digitize it and add it to the collection,” he said.

Common criticism about current online books available is that they are expensive, often abridged and they don’t come in a format that is easily accessed by the visually impaired. The collections are also limited to the most popular titles published with the past several years. The Internet Archive looks to change that by scanning a variety of books in many languages. The organization has 20 scanning centers in five countries, including one in the Library of Congress.

— Compiled by Bryan Noonan

Documentary explores the marriage of couple with Down syndrome media–dis-n-dat.com

“Alexandra Codina, Monica & David” is a documentary that follows the life of a young couple with Down syndrome – their romance, marriage, first year together and more. Critics have applauded the documentary for 9

BOOK MARKS Each issue of AWARE Ink includes books, articles, documents, texts, and even movies recommended by staff, covering a range of topics related to the work we do.

Autism and the Transition to Adulthood Success Beyond the Classroom

the most of SSA disability benefits; assisting students with college preparation, from choosing a college to managing academic and social demands; using supported and/or customized employment strategies to help young people establish satisfying careers that play to their strengths; helping young people develop critical life skills they’ll use across settings; and unlocking the benefits of community services and programs, such as vocational rehabilitation programs and Centers for Independent Living.

Paul Wehman, Ph.D., Marcia Datlow Smith, Ph.D., and Carol Schall, Ph.D.

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utism diagnoses in young children increased dramatically in the 1990s—and now those children are young adults on the verge of a challenging transition to the real world. Every school and program will be ready to help with this groundbreaking practical guide, straight from the author of the acclaimed bestseller Life Beyond the Classroom and two community-based autism experts.

Professionals who work with young adults will get hard-to-find information on how specific social, behavioral, and cognitive characteristics of people with autism affect the transition to adulthood, exploring potential challenges and traits that can be powerful assets. Then they’ll get a complete guide that walks them through every aspect of transition planning, including planning for employment and postsecondary education: conducting skillful assessment to determine a young person’s individual career goals, job-related strengths, and independent living skills; using well-designed instructional supports, routines, and spaces in inclusive classrooms; implementing positive behavior support to help young adults with autism succeed in school and at work; providing community-based instruction at naturally occurring times, so it’s easier for students to learn and generalize new skills; showing students and their families how to make

Compelling stories throughout the book illustrate how successful transition planning improved the lives of three diverse teenagers, and the practical forms, checklists, and suggested resources and links help readers put the proven strategies into action. A must for every member of the transition team— including general and special educators, transition specialists, employment specialists, and counselors—this is the ultimate resource for supporting the goals, dreams, and future success of young adults with autism Help young people with autism develop critical life skills in key areas: social skills health and safety work habits money management mobility recreation and leisure personal appearance

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Open House

Photos by Jim Tracy

Newly remodeled Hope Thrift Store in Anaconda re-opened for business the second week in May, culminating with an open house on Saturday, May 15. Brandy Wilson, at left, staffs the register for the thrift store during the open house. Wilson rang up sales all day for customers who commented positively on the new store. Above, Russell Carstens tosses a load of paper into a bin at AWARE Recycling, which is adjacent to the thrift store. The Recycling Center also was open for business on May 15.

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Dream Catchers Boundardies students spent a morning making dreamcatchers at AWARE’s main office in Anaconda. They are, left to right, Drake Massey, Troy Miller, Billy Plummer, Aimee Roberson, Jay Arensmeyer and Heather Arnaud.

In the photos below, Arensmeyer (at left) wraps a hoop with rawhide the first step in creating a dreamcatcher, while Roberson looks through the hoop to show off her handiwork.

Photos by Jim Tracy

It’s an American Indian tradition to hang a dreamcatcher above a bed as a charm to protect sleeping children from nightmares. At a recent crafts session at AWARE’s main office in Anaconda, Billy Plummer, who fashioned the dreamcatcher above, showed Boundaries participants — with help from Jamie, Knott, Henry Huot and Jennifer Krumm — ­ how to make the decorated hoops. Dreamcatchers come from the Ojibway (Chippewa) tribe.

Ojibway people would tie sinew strands in a web around a small round or tear-shaped frame in a pattern similar to the way they tied webbing for their snowshoes. Legend says that bad dreams get caught in the web while good dreams pass through the hole in the center. Above right is a plate full of colored beads the Boundaries students used to make their dreamcatchers. Photos by Jim Tracy 12

Boundardies students spent a morning making dreamcatchers at AWARE’s main office in Anaconda in April. They are, left to right, Drake Massey, Troy Miller, Billy Plummer, Aimee Roberson, Jay Arensmeyer and Heather Arnaud.

In the photos below, Arensmeyer (at left) wraps a hoop with rawhide, the first step in creating a dreamcatcher, while Roberson peeks through the hoop to show off her handiwork.

Photos by Jim Tracy

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Shrink wRap thus placed initially see it as a punishment for their bad behavior rather than as a “treatment” aimed at helping them.

Lastly, we take children and place them in a setting in which they have to adapt to living with a bunch of children all of whom have had the worst behavior problems…not the most helpful or settling milieu. Do you still think that residential placement is the best place to settle down?

So the recommendation is for residential treatment?

Let’s meet about this!

By Ira S. Lourie, M.D. Senior Medical Consultant

Another frequent reason we want residential treatment is to place children away from their families so that we can help those families work better with their troubled children.

Have you ever seen this happen? How can we help families work with their children when the family is in Kalispell and the child is in Helena, Butte or Billings, or maybe even Texas or Colorado? Our therapeutic family care staff often struggle to get this job done even when the families and children are near each other.

S

o the recommendation is for residential treatment?

Everything else has seemingly been tried and the family is at its wits end. There are no new ideas… we have been defeated in our quest for community-based care! Or have we? This turns out to be a much more complicated question than it seems. When we hold an Out Of State Placement Staffing (OOPS) meeting, we do our best to come up with exciting fresh ideas to help kids at home or in their community. However, there are times when there are factors that force a child toward a residential placement. One of those is lack of the resources that the child needs. Another is the lack of funding for these resources if they are available. In addition, we are Dr. Ira Lourie often faced with community partners, including parents, who are strongly advocating residential treatment; this is especially true with our hospitals.

How do we expect this to happen through at best weekly visits, sometimes held on the phone because of transportation problems? Are you going to transport the parents for more frequent visits? Are we going to reimburse the family for the wages lost by these visits? Or are we just going to blame those parents for not participating well? Do you still think that residential placement is the best place for families and children to learn to work together?

You say, “But, children do settle down over time when they are away!” While this maybe true, we need to look at the reality of the situation. I was once the Medical Director of a really good residential program and we invited a consultant in to help us get ready for an accreditation site visit.

When this happens it becomes real easy to give in and say, “Maybe in just this case a residential placement seems appropriate!” I’ll be honest, even I the great wraparound advocate, feels this way on occasion. But, I can always talk myself out of it. First, I ask the most important question, “What do I expect a residential placement will do for this child?” Some of you may even have heard me ask this question of you. Most of the time the answer to this question is, that it would be helpful to have a stable neutral setting in which the child can settle down. But is this really true?

We proudly showed him all of our data demonstrating how well the kids settled down in our program. He responded by saying, “Of course they do well here, this is a really nice controlled place. But that’s not the issue. The real issue is how well they do when they get home.” Even if there is some magic the program has worked to help a child settle down, when is the last time the program staff taught you or the parent how to apply that magic at home? Most of the time they don’t even send a discharge summary home with the child, no less teach us what they have learned.

While a residential program is most likely stable, is it truly the best atmosphere to help children settle down?

First, children placed in a residential program have to adjust to being pulled from their home and community most often against their will. Then you have to deal not only with their discomfort but also with the fact that almost all children

Of course another way that kids settle down in residential programs is the frequently used “treatment strategy” of over medication. We most often see these kids come back to our services highly medicated with sedating antipsy-

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chotic medications. That is the part we see. The part we don’t see is the chemical restraints frequently used in which powerful sedating medications are used in “PRN,” as necessary, doses.

tions, such as CARF which accredits AWARE. Although some of the accredited programs were good, others were mediocre and some were even awful; this range of quality was also true for the non-accredited programs. Let’s look at treatment planning.

We often agonize over the decision to use similar overmedication practices in order to keep kids in their communities and when we don’t, those kids at times end up in residential care because we have chosen to minimize the medications we use. Then when those kids enter the residential programs, they are given the high doses of medication that we have refused to give. My usual reaction to this situation is to say, “Heck, I could have done that!” and kept the kid at home.

Twenty-two percent of all children did not have specific treatment goals aimed at the specific problems that prompted placement; what they did have were what we often refer to as “cookie cutter” goals, where every child has the same goals. Worse than this, only 66 percent of the residential staff (those people who had the most contact with the children) knew what the treatment goals were, nor did their residential supervisors. Additionally, only 23 percent of the treatment plans reflected input from the social service or juvenile justice caseworker who had placed the child and was responsible for his or her care and over 50 percent of the charts did not contain a copy of that caseworker’s case plan for the child. So much for a special program for your kid.

Another popular reason for suggesting a residential placement is one that is promulgated by the marketing departments of the institutions. “We have a special program tailor made for your child,” they say. This would be great if they actually did tailor make their programs, but more likely than not, this is not true. There seems to be a popular fantasy that these residential programs have all of the magic answers that we don’t have. We think that when we send kids there the problems will be efficiently dealt with and solved. If this were true we would have fewer kids who bounce in and out of placements and one residential stint would be enough. Yet even when kids do well there, when they come home the problems quickly reemerge.

When it came to discipline, 10 percent of all the facilities visited were found to have what reviewers felt were cruel or harsh, emotionally or physically abusive, humiliating, or frightening disciplinary practices. The children in one program reported that a major form of punishment utilized there was comprised of making the children sit facing the wall in a public hallway for long periods of time. When confronted with this fact, the program administration pointed out that this was indeed their policy and this practice was condoned. In another facility, reviewers observed the psychiatric diagnosis of all of the children posted outside their room doors as part of their “therapy.” In one facility, reviewers actually witnessed deliberate psychological abuse to a young girl in care.

The truth is that most residential programs are not particularly artful in their development of treatment plans.

In fact, kids need to fit into these programs rather than the programs adapting themselves to meet the kids’ needs.

Much of the time, they won’t even accept our most troubled kids. And, when kids don’t fit in, they kick them out…oh, what I really meant to say was, “When they are no longer making progress here, we feel that ‘they have maximized their stay’ and we send them home.”

Another facility was found to have used handcuffs on foster children during their transport to court. Still another staff secure facility was found by reviewers to be on “lock down” for a duration of approximately 30 days. More frightening was the fact that the social service workers who placed these children did not know about these disciplinary practices until our monitoring project informed them.

Do you really know what the treatment practices are at the programs you want to send kids to? Do you know what the disciplinary practices are?

A few years ago I was involved in a study that is just being published this spring. In this project we monitored all of the residential programs used by one Mid-West county which had 750 kids in placement. e did serial site visits in these 35 programs in 6 states monitoring how well they were taking care of the kids the county had placed there.

During these visits we interviewed a random selection of kids, along with the residential, therapy and medical staff who worked with those kids. Each kid’s chart was also reviewed. The results of the initial site visits were startling at best, if not criminal.

These results are just a small sample of the 115 items that the monitoring study looked at and these results are not confined to those programs served by this Mid-West county. In the period from 2008 to 2009, two federal agencies issued major reports on residential care, documenting the many problems with this popular treatment modality.

In 2008, the Government Accounting Office (GAO) issued a report that highlighted several startling findings. They

What we found was very depressing. While there were some really excellent programs, most were mediocre at best and some were downright awful. What really surprised us was the fact it made no difference at all that some of the programs were accredited by one of the national organiza-

Continued on Page 16

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Shrinkwrap

the residential program or the fact that a program is accredited, or what other workers’ experiences have been. You need to find out for yourself. You should visit and look at a sample of charts to make sure that the treatment goals are not the same for all of the children and that they are truly individualized to meet the unique needs of the children.

Continued from Page 15 reported that in 2004 an estimated 200,000 youth were placed in facilities, one in which they found “mouse droppings, dead roaches, and cobwebs.” Additionally, the GAO reported that facilities in 34 out of 49 states had documented incidents of physical abuse, sexual abuse, and neglect and in 2006 alone 175 facilities across 34 states had been investigated by the Department of Justice for alleged youth maltreatment.

You need to read the charts to see if the services in the treatment plans were actually performed. You need to find out how well the families have been involved and if the aftercare plans have been coordinated with the communities to which the children will return. And, if you are still convinced that the program will fit the unique needs of your child, you need to have frequent contact with that program and kid to make sure that the program is doing its job…oh, I forgot, Montana’s Medicaid system does not allow you to follow the children when they are in residential programs. Therefore, you will have to rely on faith that the program will do its job the way it needs to in order to serve the purpose you sent the kid there for, and given the track record of residential institutions, I wouldn’t have much faith in them. Would you?

Facilities in 28 states reported at least one death. Another concern within the GAO report was the failure of some states to effectively address issues of critical importance such as the incidence of suicide in their licensing protocol.

They also reported the deprivation of educational services and the haphazard and unnecessary administration of psychotropic medications. Lack of staff experience, training and supervision were thought to have compromised the treatment process and are suspected to have played a major role in the maltreatment of residents.

The 2009 report from the federal Office of Juvenile Justice and Delinquency Prevention similarly blasted residential treatment as utilized for children involved with the juvenile justice system. They stated that 35 percent of residents reported that staff used excessive force, while 59 percent reported staff using inappropriate control strategies (e.g. handcuffs, pepper spray, strip searches). At the same time these institutionalized children were victimized by other children in the institutions: 17 percent having admitted to being physically or sexually abused, harassed, or having had their possessions stolen by other children and 75 percent of the residents stated that fights occurred within their facility, while 32 percent admitted to participating in fighting. It is not surprising that they also report that 34 percent of residents had difficulty sleeping, even though in the report they suggest that this is due in part to the large number of roommates they shared quarters with.

Two years ago, AWARE instituted our now well-known staffing for avoiding out-of-state placements called OOPS. The purpose of these meetings is to come up with community-based wraparound alternatives to sending children to out-of-state facilities far from their homes. This process has been a great success and at the time of the writing of this article, AWARE Youth Case Management only has three children so placed.

The success of this process in the reduction of out-ofstate placements has prompted us at AWARE to extend this process to all residential treatment placements. We are doing this because we feel that children should be treated in their homes and communities. And further, for all of the reasons presented in this article and more, we feel that residential treatment is not a useful alternative.

Therefore we have expanded the placement review process to include a new similar type of staffing called a Residential Placement Avoidance Staffing. And just like the earlier motto we used when stating our opposition to out-ofstate placements “Just Say No to Texas,” our new motto is, “Just Say No to Residential Treatment.”

The good news in the Mid-West study I was involved with was that with the close monitoring of the style we performed every six months in these institutions their performance got much better and the care that the children got improved markedly. That said, the bad news was that the monitoring project was considered too expensive by the state and was ultimately discontinued after four years. My thought is that over the last four years since the study ended all of the poor institutions have gone back to the way they operated before.

Do you still think you want to send that kid to residential treatment? If so, let me give you a few jobs. First, I want you to do research on the program(s) you are thinking about. But, you can’t rely on the marketing material from

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COMING EVENTS May 22 Child and family resource fair: Education, discussion, networking and family fun 11:00 – 3:00 pm 512 Logan st., St. Paul’s United Methodist Church, Helena

June 7 Get a Job? A national conversation on employment 1 p.m.

Teleconference Contact: Jennifer Negus (503) 924-3783 x10, jnegus@hsri.org

May 25 Montana Youth Transition Project regional meeting 10:00 am 2121 Rosebud, Room C26, Billings Contact: MYTP (406) 442-2576

June 11 – 12 Parent/Caregiver Leadership Training 3 p.m.

Fairmont Hot Springs Contact: Kandis Franklin (406) 444-6018

May 26 Montana Youth Transition Project regional meeting 10 a.m.

2200 Box Elder, DEAP Conference Room, Miles City Contact: MYTP (406) 442-2576

June 12 Mason’s Mountain Run 10 a.m.

South of Red Lodge Register at www.umdf.org/faf/home

May 25 – 27 Fort Peck Tribes’ State & Federal Benefits Workshop IV All day events Fort Peck Community College, Greet the Dawn Auditorium, Poplar Contact: Carla Lovan/Mickey Failing (406) 768-3491, Wilfred Bear (406) 7683488, Lori Brengle 1-800-551-3191, Karen Bradway (406) 357-2294, Tiffany Kelker 1-888-866-3822, Roger Ala 1-800-545-3054

June 13 – 15 Indian education for all advocacy institute 8:30 a.m. – 5 p.m.

Hilton Garden Inn, Great Falls Contact: Teresa Veltkamp, OPI--July 1 Billings Autism Parent Support Group meeting 7 – 8 p.m.

1537 Ave. D, Suite 150, lower level Contact: Kelly Melius (406) 252-9600, Karla Starr (406) 425-2036

June 1 Deadline: Disability Mentoring Day application All day Contact: Carol Lawton (406) 868-6655 June 3 Billings Autism Parent Support Group meeting 7 – 8 p.m.

1537 Ave. D, Suite 150, lower level Contact: Kelly Melius (406) 252-9600, Karla Starr (406) 425-2036 June 3 Equality Alliance 2010 summer webinar series: Train your team in research-based best practices Time TBA Webinar Register at www.equityallianceatasu.org/ea/webinar/ June 3 – 4 MT Mental Health Oversight Advisory Council 9:00 am 2401 Colonial Drive, Wilderness Room, Helena Contact: Marlene Disburg Ross (406) 655-7660, mdisburgross@mt.gov

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Bridget Kelly (left), Kaley Fornelli and Jillian Kelly embrace children at an orphanage school in Hyderabad, India. The eight girls all have short hair to help in the battle against lice. The women have their hair pulled back in head bands for the same reason. The little girl on Fornelli’s lap is actually 8 years old. Her development has been stunted because of malnutrition. Photos courtesy of Mike Kelly

Passage to India

Former employees’ trip is part mission, part adventure

L

ast summer, Bridget and Jillian Kelly, daughters of service director Mike Kelly of Kalispell, visited India on a trip that was part humanitarian mission and part adventure. Both are former treatment service technicians for AWARE support staff in Kalispell.

“Bridget had become aware of the need for volunteers to work with children living in the slums of India while in her senior year at Saint Mary’s College,” Kelly said. “Bridget initiated the trip, and thought it was important that Jillian go along as well — a sister trip experience that might not present itself again for a long time.”

A friend, Kaley Fornelli, who had recently graduated in nursing, accompanied them.

Jillian had received a degree in English from Saint Mary’s College while Kaley graduated in nursing from Saint Mary’s. Bridget earned a degree in communications/ journalism from Saint Mary’s College and anthropology

from the University of Notre Dame. Their purpose in travelling to India was to assist the Order of Salesian Sisters of Don Bosco at their convent and school and to shelter and teach orphans (living in the convent) as well as kids who lived in an orphanage or had families living in the slums of Hyderabad.

“The decision was made to go with a sense of duty and obligation and an opportunity to experience another culture and its diversity,” Kelly said.

They paid their own travel expenses and arrived in India in July 2009. Housing and meals were provided by the Sisters. They lived on a convent on the edge of the slums.

Jillian, 26, spent about eight days in India, while Bridget and Kaley, both 22 at the time, were there approximately five weeks. Jillian is back at her position working in downtown Chicago with an association management company called SmithBucklin (she used her vacation time to make 18

the trip). Kaley is in graduate school at the University of Michigan, pursuing her certified nurse practitioner degree, and Bridget is now a Peace Corps volunteer in Ethiopia. Kelly recently visited her there.

Bridget and Jillian continue to communicate with the sisters, some families and the kids at the orphanage regularly. Both plan to return and have been able to get others to assist with sending supplies and donations to help build a new orphanage.

“Jillian just heard the orphanage is a go,” Kelly said.

“They became very attached to the nuns and children, and to the Indian culture as well.”

Here are excerpts from Bridget Kelly’s e-mail messages home from India: July 26th Sister Lucy took us to the orphanage today. 48 girls total. We walked into a small room about the size of my bedroom at home where all of them were waiting patiently for us. At first glance of the Americans, the girls began singing a welcoming song in Telagu; The orphanage of the Salesian Sisters of Don Bosco, about a block from this passageway, skirts the slums of Hyderabad. and before the last word of the song was finished, the girls flocked to us with open American accent and teach an English lesson. The English hands trying desperately to touch ours. language lesson was put to a halt when I stupidly brought up the topic of Michael Jackson. “No, I didn’t know him July 27th personally.” “No, I didn’t go to his funeral.” “No, I have …My first day teaching made me appreciate all the never seen any imitate his dance moves quite like you, Ravi. teachers I have ever had. During break, Jillian, Kaley and I will now call you MJ.” I were basically the center of a mob. Every child wanted to shake our hands and for us to remember their names, all July 28th 1,500 of them. At one point, I was knocked to the ground …The girls at Navageevana (New Life) Home are teachin one desperate boy’s attempt to get my attention. Aning me Telagu. I now know: other time, I realized it wasn’t only students grabbing for amma ...........mother my hand, but also a teacher named Mary. I went to Mary’s nana .............father classroom of upper level students to let them hear my akka..............older sister (what they all call me) 19

Bridget Kelly holds bright-eyed Gautum, a 4-year-old boy who lives with his family in the slums of Hyderabad. Gautum and his schoolmates come to class each day impeccably dressed and clean.

cheli .............younger sister anna .............older brother aco ...............leaf And the most important: aoo ...............cow July 30th I was asked today by one of the girls, Chandini, why I don’t have lice.

Yesterday, Sr. Alice took us to the slums, which are only a block away; however, that block makes all the difference.

A man named Charles met us at the school to be our guide around the streets. I was unaware at the time that he was actually a resident. As we walked through the slums, children ran to us, grabbing our hands. I played a mean game of badminton with a group of boys, until I was mobbed by parents rushing toward me with their children, forcing them upon me as if my touch would bless them for a lifetime.

We arrived at Charles’ “house,” or rather a one-room lean-to where his wife Maria offered us milk straight from a goat whose time looked like it was fast approaching. At first we kindly refused, but Sr. Alice told us that was “very bad manners.” Even those with nothing want to give us something. We all accepted with wary thoughts that we may become ill. We watched as they washed the cups in contaminated water before pouring the warm milk into them. I smiled and graciously threw back the milk as if it were a shot of tequila.

What I have found interesting about the slums is that despite the extreme poverty, the residents are still happy,

welcoming and proud people. Not one person, young or old, asked any of us for money. They all just wanted to merely meet an American.

August 2nd Today was friendship day. It is a custom in India to tie bracelets on your friends’ wrists to publically show your bond with that person. Kaley and I received so many bracelets from the school kids that we decided to tie some on the girls at home. After Kaley tied a bracelet on Isha, she in turn came to me and re-tied it on my wrist. She told me that it made her very happy to be able to give me something and to also be able to show everyone her special bond with me. Giving is indeed more important than receiving in this culture.

August 3rd Chandini asked me why I wasn’t wearing my “specs” as I was earlier on in the day. I told her and the rest of the girls (including Sr. Rosily) that I was wearing contacts instead.

They all (including Sr. Rosily) looked extremely confused so I took one out of my eye to show them. Isha’s eye grew big in terror and Chandini attempted to take a layer of her own eye out. I then explained what contacts were and that I got them from my eye doctor. All of them (including Sr. Rosily) continuously asked me to take out one contact and put it back throughout the course of the day. They were all completely fascinated by my magic trick.

August 4th Some things I have learned about India — India is an assault to your senses:

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smell of urine constantly; taste of spicy food creating lovely canker sores in your mouth; the sight of beaten children, hollow and boney strangers sleeping in the streets and countless men urinating in public; overwhelming amount of people touching your hands, making them sticky and dirty — not to mention the smell again; constant music of the rickshaws dangerously weaving into any small opening on either side of the road while honking their horn at on-coming traffic — if you honk, you are in the right.

Only I can come to India and gain weight.

Don’t ever say you like something or you will either be forced to eat a hamburger made of mystery meat or a poor teacher will buy a strand of pearls for you the next day.

I knew I didn’t really have a choice.

The kids at school are learning about what freedom means as their Independence Day, August 15th, is closely approaching. While more serious discussions about freedom are talked about at school, I still feel my freedom was violated by the fact that my body forced me to use those restrooms. I may also selfishly blame the Sisters for forcing liquids upon me before the 7-hour journey. Either way, Kaley and I daringly ventured into those godforsaken stalls.

The flooring, surprisingly made of marble and dirt, was completely drenched in what I had hoped was water. While I know better, it was easier for me to fake ignorance and pretend it was only water. I was wearing flip-flops and depending on the hills and valleys of the floor, “water” would rise above the souls of my shoes and onto my unsuspecting feet. I opted to walk on my tip-toes for obvious reasons.

There wasn’t a toilet in the stalls, only a hole in the ground. You were to stand over the hole in a squatting manner and hopefully (key word) make it all in. There wasn’t toilet paper, only a can collecting dripping water – for purposes I am still unsure. Perhaps to wash the floor with afterward? Oh how we love traveling in India!

Things I didn’t think I would do: Grow out my armpit hair and be mildly proud of its progress.

Kill a cockroach the size of my finger.

See a little boy in LKG (pre-school) have dance moves that would make Usher envious.

Walk down Marredpally (main street) unsupervised looking for a memory card for my camera (no luck!).

Be proud and embarrassed to be an American several times throughout the course of a five-minute speech on human rights.

See the swastika on every corner and no one else thinks it’s strange (apparently it is a Hindu symbol meaning “hand print of God” as well as a political symbol for a major party in India).

August 7th …I am tutoring a little girl named Usha. Miss Hira told me of the first-grader who has dyslexia and is being made fun of in the classroom by both the students as well as the teacher. Knowing too well how hard it is, I decided to take her out for an hour a day to work on the ABC’s. We are now up the letter “P” and she is able to sign each letter to me after teaching her sign language for an hour.

She may be the sweetest little thing I have ever met.

She is a bit disfigured, which makes her all the more endearing. Usha is extremely nervous because she is beaten at home for being “stupid” and made fun of at school for the same thing. She doesn’t have an ear on her right side, only a small flap of skin (which of course, is still pierced).

Apparently, her mother set herself on fire during an argument with her husband while she was pregnant with Usha, something not out of the norm here in India. Her older brother is my age and suffered enormously just to graduate from the University; however, he has given up his degree to take care of Usha and tells me he can’t believe God sent me from America to help his sister and that his prayers have been answered.

August 6th Kaley and I traveled with Sr. Rosily to what we call Bananapolis. This is a very incorrect pronunciation of the village name, which we knew; however, Kaley and I found humor in the renaming of the town while most others (Sr. Rosily) did not. We took a seven-hour bus ride to the small village out in India’s countryside to get a different view of life in India.

We had to stop to use the restroom ever since the moment the bus’s engine started. Luckily, the bus stopped only 3 hours into the trip; at which point my bladder was so mad at me, it was either going to embarrass me, or up and jump out of my body for good. For my benefit, and the benefit of everyone on that bus, I was able to hold out until we reached the bus stop.

Immediately upon walking off the bus, the stench of urine mixed with B.O. flooded my nostrils. Now, I think the general smell of India is one of urine mixed with B.O. yet masked a bit with incense – it’s not always overwhelming, but it’s constantly there. Anyway, the awful smell made me think twice about setting foot into the public restrooms, but

August 8th …There are now 80 girls in the orphanage. 80! And they are all cared for and sent to school. All of them.

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Dual Diagnosis

Continued from Page 1 O’Connell prepared the study in response to House Joint Resolution 39 approved by the 2009 Legislature.

The resolution called for a study of the development of additional community services for people with developmental disabilities and mental illness.

The Committee reviewed O’Connell’s draft white paper and took public comment on the report during its April 26 meeting.

Representatives of two agencies contributed public comment: Anita Roessman, a staff attorney with Disability Rights Montana whose clients are primarily adults and children with mental disabilities, including cognitive disabilities, brain injuries and mental illnesses, and Jeff Folsom, chief operating officer for AWARE Inc. The Committee approved the report and agreed to forward it to the Department of Public Health and Human Services so the department could review the recommendations it contains. The department may pursue any of the recommendations without further committee action.

410 adults and 30 children O’Connell’s review of services found that some 410 adults and 30 children are known to have a dual diagnosis in Montana.

“The numbers may seem small and represent only a fraction of the total number of Montanans receiving DD and mental health services,” she said. “However, the consequences of inadequate community services for those individuals could be significant and could result in a more restrictive placement than necessary.”

In conversations with stakeholders, O’Connell identified several barriers to providing adequate and appropriate community services, “with many hinging on the unfamiliarity of providers in one service system with the needs of the other system.”

“The simple shortage of mental health providers in Montana also was cited as a key barrier,” she said.

Stakeholders proposed a number of ideas for alleviating some of those barriers and moving to a better system of delivering services in the least restrictive setting possible.

Those ideas ranged from offering incentives to draw mental health providers to Montana and more rural areas of the state to increased reimbursement rates for serving the dually diagnosed, better training of both mental health and DD providers, a designated depart-

ment liaison between the two systems in each DD region, and increased reimbursement rates for a number of services.

“At a time when Montana is experiencing a downturn in state revenues, stakeholders acknowledged the difficulty of putting some of the ideas into action,” O’Connell said.

If the committee or future legislatures were to contemplate taking action on any of these ideas, O’Connell said it may be helpful to note that the proposals most often mentioned by stakeholders were: training, particularly for mental health providers; services to help stabilize people who are approaching a crisis situation, so they are able to remain in the community and avoid commitment to MDC; increased reimbursements for mental health or DD providers who serve dually diagnosed individuals; and improved or mandated cooperation among the state programs that provide mental health and DD services.

There is no simple solution to providing community services to people with dual diagnosis, O’Connell concludes.

“As with so many of the topics with which policy makers grapple, no single quick and easy solution appears to exist for improving services to the dually diagnosed population — except, perhaps, for money,” she said.

Limited funds “With unlimited funds, the state likely could attract mental health professionals, add temporary crisis beds and crisis teams to the DD system, improve reimbursement rates, and make sure all individuals who work with the dually diagnosed are familiar with the two systems that serve them. The reality, however, is that the state faces possible revenue shortfalls and budget constraints into the next few fiscal years.

“Given that scenario, few significant expansions of any types of state services are likely to occur. But many stakeholders discussed the importance of training and awareness for both mental health and DD providers. The department could take steps on its own to require more cross-training of its own staff members.”

Stakeholders also felt the department should take the lead in providing or arranging for training for providers. This option, O’Connell suggested, may provide a relatively low-cost solution that could be financed through the pooling of existing state resources, including those federal funds allocated to the Montana Council on Developmental Disabilities.

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O’Connell noted that Robert Fletcher, founder and executive director of NADD, “an association for persons with developmental disabilities and mental health needs,” stressed that training could have a big impact on services to the dually diagnosed.

Even when a state may be unable to mix mental health and DD funds to provide services, state agencies usually have the ability to share their training funds, she said, adding that “cross-training state agency staff members in dual diagnosis would lay a good foundation for improving services,” according to Fletcher.

mission has not evolved and the report noted that the department was better at planning the plan than at actually creating plans to help it keep up with this changing world.”

Citing O’Connell’s report, Roessman said staff at Montana Developmental Center are no better trained than people in the community to provide services to people with a dual diagnosis.

She said Disability Rights Montana questions whether DPHHS is living up to it side of the Travis D. settlement. The Travis D. litigation ­was a class action lawsuit filed by the Montana Advocacy Program (now Disability He believes training for Rights Montana) in 1996 mental health and directon behalf of people with care workers would break developmental disabilidown attitudinal barriers. ties. The lawsuit sought — Anita Roessman, to protect the civil rights ‘A great map’ of people with disabilities Anita Roessmann, a Disability Rights Montana and ensure the provision lawyer with Disability of appropriate community Rights Montana, called services for them.

O’Connell’s report “a Roessman said Disability Rights is pushing for great map across” both the mental health and developmore money to be put into community services and mental disability systems. professional staff. She pointed out that MDC is the “The recommendations in the report are excellent,” most expensive institution in Montana at a cost of she said. $267,000 a year for each patient.

At the same time, she suggested that the interim “But I’m a civil rights advocate,” Roessman said. committee look in depth at the need for training at the “I’m looking at the 48 people at the MDC who are Montand Developmental Center.

Roessman referenced a 2007 study by the Pennhurst there only because they have those complex needs.”

“We know that fully a third of them are ready to Group that found many of the same deficiencies noted leave and can’t,” she added. “Targets have been getting

by O’Connell. pushed further and further out.

“I think this is a good opportunity for this com“Maybe this is the moment that the policy-makers in mittee to ask the department what progress has been the state represented by the folks around this table take made against the deficiencies identified in that (the a look at Montana Developmental Center and question Pennhurst) report,” Roessman told the committee. what its mission is and what it should be doing. Is it in “Strikingly, one of them was poorly trained staff who were not equipped to serve the relatively high-function- the right place?”

She concluded by challenging DPHHS to begin ing but complex population that are now populating the downsizing the Center in an orderly way and transferMontana Developmental Center.” ring resources into the community.

The Montana Developmental Center has not kept

‘

Maybe this is the moment that

the policy-makers in the state

represented by the folks around

this table take a look at Montana Developmental Center and ques-

’

tion what its mission is and what it should be doing. Is it in the right place?

pace with the times, according to Roessman.

“It’s a really different place than the place that the state built many, many years ago,” she said. “The

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AWARE, Incorporated

205 East Park Avenue Anaconda, Montana 59711 1-800-432-6145 www.aware-inc.org

Printed on recycled paper

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