March/April 2009 Volume 3, Number 2
Reactive therapy model
Day Activity Center celebrates anniversary By Tim Pray
t took a significant amount of patience to get the project up and running in a permanent location, but AWARE’s Day Activity Center in Butte will celebrate its one-year anniversary this April. The center, which operates out of the former rectory of St. Joseph’s parish at 944 South Wyoming St. in Butte, is managed by Leslie Robertson, and serves eight men and women with developmental disabilities. Though the customers’ degree of disability may require more assistance in certain areas of daily life, the goal of the house is to take a step back and let people do whatever they happen to be interested in doing at the moment – a service model known as reactive therapy. See Day Center on Page 27
Day Activity Center Director Leslie Robertson. Photo by Tim Pray
Magazine reaching beyond Montana borders Apostrophe, AWARE’s quarterly magazine by, about and for people with developmental disabilities, has a reach beyond Montana. As of the first week in March, subscribers in 16 states and one Canadian province were receiving the magazine. Subscriptions totaled 128, according to circulation manager Bryan Noonan. AWARE printed 9,000 copies of the latest issue, mailed 4,500 copies and distributed thousands more at locations around Montana. Most of the distributing is being done by Noonan and Dan McClafferty, ad director, who have been welcomed at stops all over Montana. Apostrophe has also received ink in other publications. Great Falls Tribune writer Richard Ecke featured the quarterly in his “Spray of the Falls” column on Feb. 23 under the headline, “Woman’s story of living with fetal alcohol syndrome graces cover of magazine.”
See Apostrophe Page 28
Note to staff and friends
— Page 2
AWARE begins work on jobs grant — Page 3
Progress at the Legislature — Pages 8-13
Bozeman man takes ‘road to home’ — Page 14
ShrinkWrap with Dr. Lourie — Page 20
AWARE’s version of no child left behind The kids who are living in Texas right now did not need to be present at a hearing to get the clear impression that they are not welcome in their homes and communities. They did not need to be present to receive every indication that their situations are too far gone to be fixed. By viewing it as acceptable to get these kids as far away as possible, we’re telling them to try and get better and lay the foundation for a successful future, but to do so with no reference to all that may have been positive in their respective communities. Through all of the obligations we have to the systems of checks and balances in the human services field; through all the forms, the plans, the meetings, and the legislation, there is the individual. It is our unit of measure, and the place we all started. We want to help an individual succeed in his or her life, and the greatest thing - what allows for that success to occur – is that everything is based on what is important to a person. It is not our place to tell someone what is important in his or her life, and it is certainly not our place to take him or her away from one of the few places that presents the opportunity of success. The individual is our unit of measure, if we had to name it. It’s not a waste of time to always consider how we are helping – or not helping – an individual to succeed, and it’s not a waste of time or effort to make sure we have everything in place here at home to do so. We will continue to consider the individuals who are not here at home to be a priority.
Dear Staff and Friends, In July of 2007, there were 187 children in out-of-state facilities, deemed “too difficult to serve” in Montana. It’s been an almost constant point of contention since that number was made public. Since that time, 171 of those children have returned to Montana or have aged out of youth services and are no longer counted towards the total number out of state. There’s been a great deal of discussion on the topic, and even a bill written to address it. You’ll get the whole story in this issue of Ink. During a recent hearing, there was a degree of excitement on the part of the state for having brought home those 171 kids over the course of the last two years, and there were Larry Noonan a number of different factors in the homecoming. Whatever the reasons, we’re glad to have the kids home, being served in – or at least closer to their home communities and families. But what about the other 16? The state has said that there will always be certain children who must be served in out-of-state facilities, and that’s a reality in their view, but not mine. All the treatment that occurs in Texas can occur here. In fact, we can provide the service in a better and more targeted manner with people who understand and care about what makes the place we live special. Community is defined as a group of people working towards a common goal. Depending on where you are in Montana, that definition means something entirely different and manifests itself in a number of different ways. What is most important, though, is that the emphasis is placed on working towards the goal, and not always the end result. In doing that, every member of a community is important. The slightest unique contribution to one’s community or family has the power to change everything. Every connection and teachable moment is crucial. So when it is said that the fact that there are 16 children being served 1300 miles away from their support networks of home is acceptable, it flies in the face of everything we’ve found to be true and great about Montana.
With best regards,
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 Keith Colbo Editing and layout: Jim Tracy Staff writers: Tim Pray Bryan Noonan
AWARE Ink is published bimonthly by AWARE, Inc., a 501(c)3 non-profit organization at 205 E. Park Ave., Anaconda, MT 59711. Copyright ©2008, 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: firstname.lastname@example.org.
Medicaid Infrastructure Grant aims to reduce employment barriers for people with disabilities ity Navigator. These representatives will serve as liaisons between the business, provider and bureaucratic fields and employers throughout the state who may be considering hiring people with disabilities. Further, to bridge the gap between those seeking employment and those who are able to offer it, this network of businesses must have the ability to connect with the populations around the Resource-mapping state. For that pur-
By Tim Pray
or people with disabilities, the barriers to gainful employment are seemingly countless: stigma, transportation, scheduling and education, to name a few. With the unemployment rate hovering at near 8 percent, finding a job isn’t easy for anyone, let alone people who have to battle with misconceptions just to get in the door or be taken seriously. But some headway may be gained through a Medicaid Infrastructure Development Grant (MIG) entitled: Montana Medicaid for Workers with Disabilities—A Ground Level Attack on Montana’s Employment Barriers. The MIG is an ongoing process, operating in threeyear cycles. The last grant was written by the University of Montana’s Rural Institute and included the creation of a coalition comprising stakeholders across the state, an assessment of the Medicaid infrastructure and barriers to employment for people with disabilities, the development of an action plan for the elimination of those barriers and the involvement of Montana’s Native American populations throughout all its objectives and goals. This cycle, the grant was written by AWARE staff under the supervision of Barbara Kriskovich, Montana DPHHS’ director of the Medicaid Infrastructure Grant as a call to action using the information gathered by the last cycle’s efforts. Those calls to action are: The development and implementation of a Medicaid buy-in program for Montana. A Medicaid Buy-In allows states to expand Medicaid coverage to workers with disabilities whose income would normally make them ineligible for Medicaid. People with disabilities risk losing their health coverage benefits if and when they get a full-time job, or the amount of their earnings pushes them to pay so much into Medicaid that there’s nothing left to live on. A buy-in program allows for people with disabilities to work and not have a fear of losing health coverage. Senate Bill 119, sponsored by Sen. John Esp (R–Big Timber), was written in order to usher in a buy-in program for the state, and has seen great success in both chambers of the Legislature. A hearing for the bill on March 4 included more than a dozen vocal proponents of the measure including the director of the DPHHS Anna Whiting Sorrell.
is meant to enable a specific group, state, community, or corporation to identify and inventory existing resources and match them to a specific purpose.’
pose of connection between the network, people who are looking for work, and the businesses with job vacancies, the grant has called for the DPHHS to hire a business liaison to recruit businesses and cement them into a growing network of opportunity. An increased emphasis on changes in Montana’s work incentives infrastructure. The DPPHS is contracting with AWARE for the purposes of this emphasis, and that contract has begun manifesting itself with the recent hiring of two work incentives benefits counselors. The job duties of the counselors, Jessica Karjala and Margaret Sampsel, will be: To provide information and counseling regard-
ing insurance and public entitlements to people with disabilities, most importantly being the work incentives described in the Medicaid and Ticket to Work programs. Evaluate work skills and capacities and assist clients in identifying employment-related barriers and formulating work-ready plans. To refer clients to employment-related workshops, schools, skill training centers, work experience assignments or other training programs. Maintain liaison with other agencies in the field in order to coordinate work and cooperate in programming. Provide technical assistance to other organizations in regards to work incentives programs and protocols.
Development of a statewide business leadership network In its infancy, the network consists of AWARE, a representative of the NorthWestern Energy Corporation, a representative of a major department store chain throughout the state and a former Disabil-
Continued on next page 3
whelmed with information, making it difficult to perform the job duties in the most efficient manner. Therefore, DPHHS will contract with the firm Health and Disability Advocates to provide technical assistance at job offices around the state. Continuation of the work of the Governor’s Youth Transition Task Force. The group, which includes a vocational rehabilitation bureau chief, a Department of Labor workforce services division administrator, an administrator from the Department of Corrections, legal counsel for Montana’s Protection and Advocacy chapter, the special education director for the Office of Public Instruction, and the director of Montana’s Youth Leadership Forum. The task force has identified the major barriers to employment and education for youth with disabilities and has set out to eliminate those barriers by implementing a standard of transition for Montana. Significant work with the Native American populations of the state. The grant contracts with five reservations in the state to expand the knowledge of work incentives and assist Native Americans with disabilities in becoming employed. Montana will continue to partner with three reservations in particular – Fort Belknap, Rocky Boy and Blackfeet to continue to provide job development opportunities. Health and Disability Advocates, the technical assistance firm noted above, will also provide technical assistance to the tribes. The overall goal of the grant has been to seek out and eliminate as many barriers to employment for people with disabilities in Montana as possible, primarily through the Medicaid Buy-In program. For Montana citizens to no longer have fear of losing health benefits, the hope is that many will seek and secure employment all over the state. Once those jobs have been secured, the efforts of the grant that focus on networks, educational transition, and transportation will be made much more tangible.
Provide both community and customer transit/
mobility evaluations and trainings.
An aggressive resource-mapping project. Montana DPHHS will contract with Montana State University’s Center on Disabilities for service/resource-mapping activities in order to assess existing infrastructures, in addition to analyzing how well existing systems are working or could improve, and to identify concrete policy direction for future program implantations. These activities will assist the state in understanding the myriad of programs and supports that exist in the state. Resource-mapping is meant to enable a specific group, state, community, or corporation to identify and inventory existing resources and match them to a specific purpose. It is designed to assist Montana’s communities in identifying valuable resources, ensure that customers have access to the resources they need, avoid the duplication of services and resources, enhance services, identify flexible funding strategies, align youth and adult services and supports, cultivate new partnerships and relationships, and provide information across agencies. Providing technical assistance to Department of Labor Navigators. Montana’s Department of Labor received a grant from the federal government to implement a “disability navigator” program. The position is designed to assist people with disabilities in obtaining and retaining employment. Complex rules surrounding entitlement programs, along with the fear of losing financial assistance and health benefits can often discourage people with disabilities from working. The disability navigator position was created to better inform those people and their families about any available work supports. Most agree that this position is an excellent addition to community workforce centers, however the individuals actually working on site are oftentimes over-
Pair’s job duties: referral, liaison, technical assistance Jessica Karjala and Maggie Sampsel have been hired to be AWARE’s work incentives benefit counselors, as specified by a contract with the Department of Public Health and Human Services’ Medicaid Infrastructure Grant that went into effect on Jan. 1. Read more about their duties, and the goals of the grant itself in the above story. Karjala, from Billings, graduated from the University of Montana with degrees in English literature and nonprofit administration. Prior to beginning her work with AWARE, she was a copywriter for an advertising agency in Billings and the owner of her own business in Colorado. Sampsel, who lives in Missoula, graduated from Montana State UniversityBillings with an advanced degree in public relations, and a law degree from the University of Montana School of Law in Missoula. Prior to working with AWARE, Sampsel spent time with Rural Employment Opportunities, Inc. as a case manager and interned at the Montana Department of Public Health and Human Services’ Child Support Enforcement Division. 4
AWARE Bozeman staff will celebrate their move to spacious new quarters with an open house April 22. Details will be announced. The new offices are at 1811 W. Koch St. on the northeast corner of 19th and Koch across the street from the Westbrook Center. Left to right are: Michael O’Neil (director of the Montana Home Choice Coalition), Steve Francisco (chief facilities manager), Marcy Martin (youth case manager), Shauna Baker (youth case manager), Melissa Mitchell (treatment service specialist), Leann Down (youth case manager), Jennifer Smith (administrative assistant), and Mark Sherkenney (family support specialist). Staff not shown are: Shawna Schaar (lead clinician), Mary DuVernay (service administrator), Tiffany Bartolomei (treatment service clinician), Lindsey Killham (treatment service specialist), Rusty Jones (treatment service technician), Kylie Izzi (TST),Marta Jackson (TST), Kristin Killham (TST), Taylor Hensen (TST), Shannon Maroney (youth case manager), Casey Wagner (adult case manager), and Renae Jones (Candlelight Initiative director and residential service specialist). Photos by Geri Wyant “Our new building provides great meeting spaces for working with customers, colleagues, and community partners,” says Mary DuVernay, service administrator for AWARE in Bozeman. “Kids and parents really enjoy our larger waiting area, and staff are happy to have more private spaces to meet with families.” “We look forward to welcoming many people from the Bozeman area to our new workspace and continuing to expand and improve our service in the community.” The new office also features web-conferencing capacity, two private conference room, a work-space for visiting guests, a large reception area, a kids’ playroom, two offices set-up for counseling sessions, and a small kitchen (no stove) and full bathroom (with shower) for staff use and for helping customers learn necessary life skills.
‘Webinar’ gives AWARE five-state audience Internet-based conferences provide information about how to prepare young people for adult life By Jim Tracy
EO Larry Noonan told more than 40 people from five states about AWARE services at a Feb. 2 seminar hosted by the Rural Institute. What was remarkable about the event was that the presenters and participants all took part via computer or telephone from their own locations. Noonan made his presentation from the second floor conference room at AWARE’s administration offices in Anaconda. The Web-based seminar, or “webinar,” was the latest in a series hosted by the Montana Transition Training, Information and Resource Center, which is part of the University of Montana-based Rural Institute. The Center has expanded its resources and services in response to needs identified by young people with developmental disabilities, their families, schools, and providers. Those include the Montana Developmental Disabilities Program, Disability Rights Montana, Parents, Let’s Unite for Kids, or PLUK, and the Office of Public Instruction. Kim Brown, project coordinator and co-director of the Rural Institute’s Transition Project, says the webinars provide information about how to best prepare young people for adult life while they are still in school. They also explain what adult agencies do and how to access their services and provide help in navigating the adult system, and information, ideas and technical assistance “to create unique, individualized and inclusive adult lives for young people with developmental disabilities.” Lengthy waiting list In Montana, because of lengthy waiting lists for DD adult residential and employment services, many students with significant disabilities are not even considered for community employment, housing, or recreation because of the severity of their disability. The general training theme of the webinar AWARE participated in was “Adult DD Service Providers – Who Are They and What Do They Do?” Noonan was asked to share “the creative and inclusive things AWARE is doing, especially with respect to residential and employment services.” He spoke about the corporation’s history and the Anaconda and Butte recycling plants and Billings work services and the jobs they provide. He also discussed the efforts AWARE is making to inform people about jobs and job opportunities through Apostrophe magazine.
Samples slides from AWARE’s webinar presentation.
Other presenters were Susanne Meikle, an employment consultant and owner of the Bitterroot Valley-based Montana Work Solutions, and Michelle Pickell, owner and director of Job Opportunity Based Services in Missoula. Meikle described the services her company offers using community supports money, while Pickell focused on 6
community supports and developmental disability waiver funds. The 90-minute session featured slides that were available to people who accessed the webinar by computer. It concluded with a brief question-and-answer session. Participants included agency representatives, teachers, family support specialists and transition trainers. To access the audio of the webinar and a pdf of the slide show, visit: http://ruralinstitute.umt.edu/transition/ trainingcalend.asp. The Transition Center has divided the webinars into two tracks: a youth track for young people with disabilities, their families and those who provide services to them,
and a customized employment track for teams that will be implementing customized employment with students and other job seekers. Seminars still to come on the youth track are: Graduation – Ideas for Rich, Full Days, April 6; Creative Housing Options, June 1; and Self-Awareness, Self-Advocacy and Self Determination, Aug. 3. Employment track seminars on the schedule are: Representational Portfolio, March 16, and Job Development and Negotiation, April 20.
Changes made in health insurance plan year AWARE will switch its health insurance plan to a calendar year at the end of December 2009. Participation in and contributions to the Medical Flexible Savings Account, or flex plan, will be for a prorated period of seven months – June through December 2009. “One of the major benefits to the participants is that now the deductible year and the MFSA year will run concurrently and that should be less confusing to participants,” said Geri Wyant, chief financial officer. “In addition, there are a ton of accounting benefits.” Wyant noted that even though claims for the past year exceeded expectations, AWARE is not projecting an increase in premiums to employees for the claim period June 1 through December 31, 2009. The corporation will absorb the cost for this period, she said. A new flex plan for calendar year 2010 will begin in January 2010, with pen enrollment in December. “At that time, plan design and premium change, if any, will be known and disclosed,” Wyant said AWARE renegotiates its coverage with Colorado-based Great-West Healthcare (www.greatwesthealthcare.com). “In survey after survey, Americans rate health insurance and health care as a high priority, and AWARE workers are no different,” Wyant said. “Many of the questions the payroll department receives concern insurance.” Questions frequently arise about AWARE’s bi-level insurance plan, which allows employees to match their coverage to their needs. The “Price Plan” meets the needs of about 56 percent of AWARE employees who have few medical risks and want the lowest possible premiums, basic catastrophic and drug coverage and good first-dollar coverage for office visits, dental, vision or other routine expenses that come up. The “Value Plan” is tailored to the needs of about 44 percent of employees who are concerned with the best coverage for high medical risks and chronic medical conditions and want the lowest deductibles and co-insurance possible, the best drug coverage and fewer restrictions on the selection of providers.
Eligible employees may choose between the two based on how they evaluate their individual situations. “There is no underwriting—you are free to choose either the Price Plan, the ‘base’ plan or ‘buy up’ to the Value Plan,” Wyant said. “And you can change your mind each new plan year. Employees are insurance consumers free to choose.” Low-risk individuals can select a low-price option and high-risk individuals can select greater value and pay a higher premium. “Our employees can act as consumers, making value and price decisions in medical insurance just as they do with any other consumer product or service,” Wyant said. In the face of rising health insurance costs (rates climbed by 26 percent in 2008) AWARE developed the current plan rather than simply cutting benefits. A partial self-insurer, the corporation expects to contribute $1.7 million in planyear 2008 to help cover premiums. “Enrollment has increased, and we now have 225 eligible employees enrolled in the insurance plan, many with dependents enrolled,” Wyant said. Still, she’d like to see that number grow. “If we could get more healthy bodies on the plan, it would help contain costs and could even lower premiums,” she said. Enrolled employees receive another direct benefit since they pay their premiums with “pre-tax dollars. “Wouldn’t you rather be paying yourself for health insurance than paying taxes to the federal government?” Wyant asked. AWARE’s insurance plan also includes a “wellness benefit” that covers the cost of an annual medical exam. To learn more about the insurance plan, log in to the corporate Intranet web site, click “PDF Manuals” and then “Health Insurance.” You can also email questions and concerns to Wyant any time at email@example.com. By Jim Tracy 7
AWARE tracking bill progress in 2009 Legislature Some pet measures modified, but still alive By Bryan Noonan
he 61st session of the Montana Legislature is more than half over, and AWARE’s hopes to get key legislation passed are still alive. Chief Operating Officer Jeff Folsom, registered as AWARE’s lobbyist, has testified 11 times, while CEO Larry Noonan has testified once about a measure aimed at keeping more atrisk children in Montana rather than sending them out of state for services. Sen. Jesse Laslovich’s Senate bill (SB) 399, despite opposition from the Department of Health and Human Services (DPHHS) and others, passed the Senate 50-0, and moved onto the house floor. “We were pleased to see the bill pass, Folsom said. “It demonstrates that the Senate understands the unfortunate plight of children forced out of state to receive treatment.” Although the Senate Public Health, Welfare and Safety Committee changed the bill significantly, the goal of requiring quarterly updates on all of the out-of-state children survived. (See story on SB 399 on Page 10.) DPHHS had requested $2.5 million to fund Kids Management Authorities (KMA’s). Since the session began, the request has been trimmed to $2.3 million over the next two years. The Appropriations Committee will ultimately decide funding. KMA’s have come up in more than one bill. House bill (HB) 111, sponsored by Rep. Teresa Henry (D-Missoula) was a “housekeeping” measure to form a special subcommittee to define KMA’s and describe their function. Due to the inability to define what a KMA does, the bill was tabled. It would have provided for an advisory council that collaborates with
DPHHS and local advisory councils to plan and evaluate public mental health care. It also would have provided an interagency system for tracking children in need of mental health services and established membership of local advisory councils. And it would have allowed the department to establish separate advisory councils for youth and adult mental health systems. “Even though the state cannot properly define a KMA and its function, the department is still asking for roughly $3 million over the next two years,” Folsom noted. With that much money going into this program, Folsom said, AWARE believes KMA’s should make clear how they will deliver services to children and families, and move away from the idea of establishing full-time equivalent positions and infrastructure within the government. Folsom said the money the department requested could go toward creating 10 new KMA’s across the state. House Bill 65, introduced by Rep. Diane Sands (D-Missoula), provides details on the requested $2.3 million, while House Bill 66, also introduced by Sands, requests an additional $250,000 from the general fund to be placed in a “Children’s system of care 8
special revenue account” to use as the KMA’s see fit. Initiative-155, the Healthy Montana Kids Plan, associated with the Children’s Health Insurance Program, has become a hot button topic. Seventy percent of Montana voters cast ballots for the initiative last November to expand the Children’s Health Insurance Program and Medicaid. These two government-funded insurance programs are aimed at lowand middle-income families. The state and federal governments share the costs of the programs. Republicans on the Joint Appropriations Subcommittee on Health and Human Services have refused to fund the voter-approved expansion of health insurance for 30,000 Montana children. They want to delay the program for two years because of fiscal concerns. Sen. Dave Lewis (R-Helena) said with the state’s finances worsening, Republicans don’t want to launch an expensive new program — even if voters OK’d it. Lewis and three other Republicans on the budget panel voted against funding the Healthy Montana Kids program, resulting in a 4-4 vote that blocked the money. That was only a first step in the lengthy budgeting process, however, Democrats say the CHIP program is not the right place to start cutting the budget. Money cannot be appropriated by a ballot initiative. Only the Legislature can do that. Legislators who support the initiative point out that Montana’s two Democratic senators along with Republican Rep. Denny Rehberg voted for expanding CHIP. A bill introduced by Rep. Pat Noonan (D-Butte) asks for more travel reimbursement for case managers to transport people to unavoidable medical appointments. House Bill
453 has been slightly modified, asking the state to do a study in order to determine if there is a problem with reimbursement and how to fix it. “It won’t change the issue this session,” Noonan said. “But it does shine light on the problem, and the study will keep the department focused on the issue.” The bill passed the House 52-48 on the third reading and is on the Senate floor. House Bill 369, carried by Edith McClafferty (D-Butte), asks for increased funding for early childhood services. This bill is a “pure appro-
priation” bill and therefore will not be voted on by itself. Folsom said AWARE hopes the bill gets proper attention and makes its way into the budget. Michael O’Neil, director of AWARE’s Home Choice Coalition, has assisted in drafting a housing bill that would cap mortgage deductions to assist low-income people to buy houses of their own. AWARE is a strong supporter of this bill (LC2124) since it will allow more flexibility in AWARE’s mission of helping people with disabilities buy their own homes. Another bill that has full support
from AWARE is Senate Bill 234. The primary sponsor is Kim Gillan (D-Billings), but the bill enjoys strong support on both sides of the aisle. The measure would require insurance companies to cover the diagnosis and treatment of people under 18 with Autism Spectrum Disorder. Currently, insurance companies are not required to cover expensive treatment for autism, leaving families to fend for themselves. To follow any of these bills, visit: http://leg.mt.gov, click on “Bills” and “Current Session.”
Bozeman Candlelight Initiative loses, regains funding AWARE’s Candelight Community Living Initiative and another state program for children with autism temporarily lost their funding in the House Appropriations Committee in early March. The story of how the Legislature taketh away and giveth back is detailed in the March 10 Bozeman Chronicle. Reporter Daniel Person describes how the Candlelight home and another program came under the microscope of lawmakers on the House Appropriations Committee who believed the state Department of Health and Human Services overstepped its authority by creating the programs without consent from the Legislature. Upset by the Department of Health and Human Services’ action, the House Appropriations Committee, in an 11-12 vote, pulled funding from the state budget for the autism programs. The committee of 10 Democrats and 10 Republicans later restored the funding by “siphoning the money from elsewhere in the health agency’s budget,” Person wrote. The Candlelight Community
Living Initiative, which opened last summer to much fanfare, can house up to four children between the ages of 10 and 16. Gov. Brian Schweitzer attended an open house at the home, which gives low-income Montana families a place in state to take their children for 24-hour treatment. Legislators contended that DPHHS should have received their permission before spending state money to create the group home, as well as a program to help families treat children under 5 years old diagnosed with autism. “Both programs come with ongoing costs to the state, and the health department was asking for about $900,000 from the state’s general fund to keep the programs going in the coming year,” Person noted. “It’s an excellent program. I never had a problem with the autism program. But what DPHHS did was outside their authority,” said Rep. Bill McChesney, D-Miles City in an committee meeting. “They burdened the taxpayers with a new program that needs to be funded in the coming years.” 9
McChesney was the lone Democrat to vote to pull funding from the programs. According to Person, the controversy stemmed from the 2007 Legislature. “In order to have adequate funding for Medicaid, the state must estimate how many families are going to request help from the entitlement program and ask the Legislature for enough money to cover those predicted needs,” he wrote. He quoted DPHHS director Anna Whiting Sorrell who told legislators the health agency overshot in 2007 and wound up with about $30 million more than necessary. The department returned $20 million to the state general fund but kept about $10 million to cover health service needs in the state. One of those needs, Sorrell told the committee, was autism services. The home in Bozeman allows four high-needs children to receive 24-hour care from professionals. The other program makes Medicaid dollars available to a limited number of low-income families for early-intervention autism treatment. See Candlelight on Page 13
‘A voice on the phone’
Bill requires details on kids sent out of state By Jim Tracy
ost children who are sent out of state for psychiatric services feel unwanted, says Peter Bovingdon, a Montana Legal Services lawyer assigned to handle child neglect cases. “We send them a powerful message that they always seem to get — they feel thrown away,” Bovingdon told a Montana Senate Public Health, Welfare and Safety Committee panel at a hearing Feb. 13. He said he often takes calls from clients who have been sent to Texas, Idaho, Nebraska, Colorado, Maine, North Dakota, Utah or Georgia – to places like the Woodward Academy, St. Mary’s Home for Boys or the Texas Oaks Psychiatric Hospital. ‘A scratchy little voice’ “It’s a voice on the phone for me, a scratchy little voice,” Bovingdon told the senators. “They are away from family and friends and support. When I talk to my clients, they always want to come back.” Bovingdon was one of a halfdozen people who testified in favor of Senate Bill 399, which would have required the state to seek in-state alternatives to placing kids in out-of-state facilities. Opposing the bill were Steve Nelsen, executive director of the Montana Childrens’ Initiative; Kimberly Gardner, a social worker at Intermountain Children’s Home in Helena; and Jani
AWARE offers to bring 50 kids home Often lost in the discussion about placing at-risk children in out-of-state facilities are the kids themselves, says AWARE CEO Larry Noonan. To illustrate the point, Noonan told the Senate Public Health, Welfare and Safety Committee at the hearing on Senate Bill 399 about a boy he talked to last fall who was told he could return to Montana from an out-ofstate facility in November. “But for a number of hitches, vacations and that sort of thing, the kid didn’t get back to his home until February,” Noonan said. “It was frustrating for me to have people not concerned about trying to get this kid home for Thanksgiving and Christmas and try to get his therapy started.” Such delays by the bureaucracy to bring children home only reinforce the self-image many at-risk children have, he said.
Big people in kids’ lives “The kids I talk to understand this better than we do because they’ve already been convinced that except for them the world would be a perfect place, except for them everything would be wonderful,” he said. “That type of action from the big people in these kids’ lives only confirms that for them.” “We can have a tendency to forget,” Noonan added, “just what that (outof-state) placement can mean to that child.” He said he had lots of examples of children who had been affected in a negative way by being sent to places out of Montana. That personal knowledge and alarm at statistics presented to an interim committee last summer, he said, prompted AWARE to propose a plan to dedicate 50 slots in its facilities for children sent out of state. “We felt we were in a position to open up 50 new beds for kids who were out of state… and bring back between now and July 1 some number of children if not all 50 of them,” he said.
A plan in place He said AWARE’s board of directors agreed with the plan and was ready to put it in place. In a letter sent last June to Bonnie Adee, chief of the Children’s Mental Health Bureau, AWARE offered to take as many as 50 new children into its community and Galen group home system. “AWARE is prepared to do this through the development of new group homes located within the State of Montana and utilization of available placements in our current system,” wrote Carter Anderson, mental health residential service director. “I am holding beds open across our system in an effort to locate and place children who are currently in out-of-state placements.” The bureau didn’t reply. “To this day,” Noonan told the committee, “I’ve never been responded to by the state. They’ve never asked me a question about the plan.” “Why they wouldn’t be interested in that plan is news to me and would be news to my board of directors. We still don’t really know what the answer is.” 10
McCall, lobbyist for Yellowstone Boys and Girls Ranch in Billings. They urged the panel to allow the state to continue to rely on a state network of Kids Management Authorities to work with families of children with serious emotional disturbances who would be at risk of being sent out state. “I don’t have a problem with the intent and what is included in the bill,” said McCall. She added that the bill raised “valid issues.” “We need to continue to do a better job of bringing kids home from out of state,” she said. “But I don’t believe we need legislation to do this.” While proponents didn’t get all they wanted, they won an important point, according to Jeff Folsom, chief operating officer and AWARE’s lobbyist in the 2009 Legislature. Raising the issue “This was a success,” Folsom said. “We got 98 percent of what we wanted. It was important for us to bring attention to children who we believe are unnecessarily placed in out-of-state facilities. Our hope in raising the issue of out-of-state placement is that DPHHS will be required to focus on efforts to reduce or eliminate the practice of sending children suffering mental illness away. “We also hope through this effort to bring some accountability to the process through direct reporting to the Montana legislature. Not only do we bring greater trauma and send a message of rejection to these children, but we also, frankly, have no oversight authority and no idea about the
native before sending any child to an out-of-state facility. At the very least In its amended form, the meaI’m hoping it will help sure calls for quarterly reports on with multi-agency needs keep more kids in state. children receiving services out of state. We have to dig a little Laslovich said he expected the committee to amend the bill deeper. It just seems after DPHHS attached a fiscal backward to me. If note showing it would have cost we’re truly concerned the state general fund about $1 about a child’s best in- million a year over the next four years. terest, we need to find a In its pared-down version, way to keep the child in with an attached cost of only Montana. — Sen. Jesse about $9,000 in Fiscal Year 2010, Laslovich hopes the bill will sail Laslovich (D-Anaconda) through the Legislature. It passed the floor of the Senate by a 50-0 quality of the services these chilvote on Feb. 24. dren receive in other states.” “At the very least I’m hoping it The bill requires the departwill help keep more kids in state,” ment to establish a pool of qualiLaslovich said. “We have to dig a fied in-state providers “identified little deeper. It just seems backas willing and able to meet the ward to me. If we’re truly consignificant needs of high-risk chil- cerned about a child’s best interdren with multi-agency service est, we need to find a way to keep needs who are currently placed or the child in Montana.” may be placed out of state.” Laslovich believes the reportThe department must also ing requirement in SB 399 may design a process in which licensed help do that. He also hopes it will providers qualify for the pool lead to a clearer accounting of the by demonstrating their ability to number of children who are sent provide mental health services for out of state. children using federal and state DPHHS spreadsheets special revenue and state general Last summer, Mary Dalton, fund money. Medicaid services director for Another key part of the bill DPHHS, presented the Senate’s requires the state to do all that Law and Justice Interim Commitusing a “wraparound philosophy tee with a series of spreadsheets of care.” that showed Medicaid had paid In its original form, SB 399, drafted by the late George Groes- for 187 youths, including children under the Department of Correcbeck and sponsored by Sen. tions, to be placed in out-of-state Jesse Laslovich of Anaconda, facilities in Fiscal Year 2007 (July would have required the state to increase, and in fact define, its ef- 1, 2006, to June 30, 2007). Those included children in forts to identify an in-state alter-
Continued on next page
SB 399... hospitals, psychiatric residential treatment facilities and therapeutic group homes. Dalton’s spreadsheet noted that the total number – 187 – was “un-duplicated,” meaning it did not reflect children who were receiving services in more than one category or receiving multiple services. Of the 187 individual children, 26 were placed out of state through the Montana Department of Corrections. Medicaid payments for out-ofstate services for the 187 children totaled $9,946,834. Laslovich’s data, taken from a DPHHS report, showed that the number of children placed in residential treatment out of state jumped from 97 in 2003-04, to 130 in 2005-06, to 197 in 200708. He said he was “alarmed” by those numbers. As of January 2009, however, Dalton’s numbers showed only 25 children in out-of-state treatment receiving Medicaid payments through DPHHS. Those included 14 in psychiatric residential treatment facilities and 11 in therapeutic group homes. A dramatic decline Those numbers reflect a dramatic drop in children placed out of state since 2007. In January that year, 65 children were in out-of-state psychiatric residential treatment facilities and 42 children in therapeutic group homes out of state. Dalton told the public welfare committee that the numbers she presented last summer might have been confusing because they were numbers for an entire fiscal year.
She said she hoped the “point in time numbers” she presented recently would clear up the confusion. Dalton later told AWARE Ink that the steep decline in the number of children placed out of state can be explained by a combination of factors. “For one, we worked really hard with the help of AWARE and other providers to bring children back in state,” she said. At the same time, Acadia, one of only three psychiatric residential treatment facilities (the others are Shodair Children’s Hospital in Helena and Yellowstone Boys and Girls Ranch in Billings), was released from sanctions that prohibited the facility from accepting new admissions, Dalton said. The sanctions amounted to a freeze on new admissions. They were imposed by the DPHHS Licensure Bureau when the company was known as Kids Behavioral Health before it was
Current law specifically states that outof-state placements should only be used as a last resort. Our concern has been that current efforts do not come close to leaving no stone unturned or otherwise meeting a last resort standard.
— Jeff Folsom, AWARE Chief Operating Officer 12
acquired by Acadia. “We didn’t have the licensed capacity in the state to take the number of kids needing services,” Dalton said. Other factors accounting for the decline, Dalton explained, included an overall drop in the number of children eligible for Medicaid who might have been candidates for placement out of state; the work of the Kid’s Management Authorities; and the work of an intra-departmental work group. SB399 would have the state working even closer with providers when it comes to making in-state service alternatives to out-of-state placement available to children with mental health needs. A last resort The bill says the 1993 Montana Legislature recognized that some Montana children have mental health and other needs that require services from multiple agencies and expresses a desire to provide services to these children in their homes or communities whenever possible and to use outof-state providers only when there is no other alternative. “Current law specifically states that out-of-state placements should only be used as a last resort,” Folsom said. “Our concern has been that current efforts do not come close to leaving no stone unturned or otherwise meeting a last resort standard. Mary Dalton’s testimony before the Senate Health and Safety Committee and the large fiscal note attached to SB399, we believe, affirms our notion that a standard other than last resort is the department’s current practice.”
Subsequent legislatures have strengthened “last resort” policy by encouraging development of an array of in-state services so that children placed out of state may return home and children in the state can remain in their homes, communities, or Montana. In addition, the state has sought and obtained federal funds to help plan for local services that can keep children with multi-agency service needs in their homes and communities. Despite all that, the bill says, information from DPHHS “indicates that out-of-state placement of children continues and has increased in recent years.” As amended, the bill requires the department to develop and use an in-state pool of providers “identified as willing and able to meet the significant needs of high-risk children with multiagency service needs who are currently placed or may be placed out of state.” It says further that through use of available federal and state special revenue and state general fund money and in keeping with the state’s goal of using a wraparound philosophy of care, the department shall establish quarterly reporting requirements regarding high-risk children with multi-agency service needs. The department must identify: the number of children placed out of state; the reasons each child was placed out of state; the costs for each child placed out of state; the efforts the department made to avoid out-of-state placements, including:
the number of in-state
providers the department contacted about developing service alternatives for a child in or at risk of being placed in an outof-state facility; whether any in-state providers submitted a plan for service alternatives for the child to the department; and if a plan for service alternatives was submitted, the reasons the plan was not implemented and the out-of-state placement was determined to be necessary; the number of children for whom plans for service alternatives were developed, implemented, and resulted in the return of a child from an outof-state placement or prevented a child from being placed out of state; and other planning efforts to prepare for a child’s return to the state. Each quarterly report must also analyze the efforts the department made to reduce out-ofstate placements and establish goals and objectives for improvement in the following quarter. The department has to provide the quarterly report to the Children, Families, Health, and Human Services Interim Committee. “My biggest frustration was that the numbers were always changing, and not just a little bit but dramatically,” Laslovich said. “In statute we’re now mandating the department has to come with numbers.” “There just needs to be a simple way to say how many kids are out 13
of state each quarter,” he added. “That doesn’t seem like it would be very hard.”
continued from Page 9 Sorrell said that legislative interim committees were told of the new programs. But for some legislators that wasn’t enough. “Constitutionally, the Legislature holds the government purse strings, and some legislators said they saw creation of the programs as usurping that power,” Person wrote. One of those was Rep. Penny Morgan, a Billings Republican who sits on the Appropriations Committee. “I’m a little bit unhappy with the chain of events,” she said “Why do we have this committee if they can (spend money) on their own?” McChesney joined Morgan and the committee’s other nine Republicans in cutting funding for the two programs but, after a conversation with fellow Democrats, then introduced an amendment to restore funding at the expense of other parts of the DPHHS budget. “… The media does not represent society truthfully and keeps ‘difference’ largely invisible, and this means it is not seen as a normal part of life. Anyone can become disabled — the fact is, we will always be people first, with things we can and can’t do second. I think everyone in life has their own ‘disability’ — something that challenges them — whether it is visible or not.” — British comedian and actress Francesca Martinez, who recently reflected in an article in the (UK) Telegraph on her life with cerebral palsy.
Bozeman man travels road to home By Jim Tracy
so, Schmierer, 45, lived in various other houses and apartments, always hoping some day to have a home of his own. In 2004, that dream started to take shape after he attended a talk by AWARE Inc. Montana Home Choice Coalition Director Michael O’Neil, who was at the time working on a pilot program to help people with disabilities buy homes, including through the federal Housing Choice Voucher Program, or Section 8, which provides assistance to low-income renters and homebuyers. Section 8 helps make mortgage payments for qualified first-time homebuyers. Schmierer inquired about how he might participate, and O’Neil encouraged him to put his name on the Section 8 waiting list.
eople who know David Schmierer describe him as steadfast, persistent, determined. He comes by those qualities honestly, having learned from his mother, Margaret Schmierer, that you get out of life what you put into it. She died last fall, but her words are still with him on four four-inch square plaques he keeps on a bookshelf, each inscribed with an inspirational saying: “It doesn’t matter where you’re from, it’s where you’re going.” “The road to success is always under construction.” “If your ship doesn’t come in, swim out to it.” “Never, never, never give up.” The last one, Schmierer said in a recent interview in his living Homeownership classes room, “is my favorite.” To qualify a person must be That shouldn’t surprise anya first-time homebuyer, have one. a household income of at least Homeowner David Schmierer of Bozeman “Dave is a living example of $10,300, been continuously emsteadfast determination in the face of adversity,” said Kelly ployed for one-year (except for elderly or disabled persons), Wiseman, general manager of Community Food Co-op in attend a homeownership counseling course and meet any Bozeman, where David works. other restrictions imposed by the local housing authority. “He has never allowed any disability to hold him back If the person is disabled or elderly, the household inand has gone far beyond most folks’ expectations, becomcome is equal to the annual SSI amount. The employment ing a person who owns his own house. He was fearless in requirement is also waived. People with disabilities and the the face of very scary medical procedures (major surgery elderly have the advantage that they can receive assistance in 1998) and refused to back off his goal of not just owning through the full term of their loan. a house, but being a functional and contributing member “I told David, ‘Just keep working at it,’” O’Neil said. of our community.” Schmierer persisted. He filled out forms, answered
questions and followed the steps outlined by Section 8, including attending homebuyer education classes offered by the Human Resources Development Council in Bozeman. Three years later, he had moved far enough up the list to start thinking seriously about buying a home. “In the meantime, he’s saving money for a down payment and he’s lined up to have his savings matched,” O’Neil said. Federal Home Loan Bank of Seattle Home Start Savings Program provides a match of up to $3 for every dollar a person saves up to a certain amount.
Dawson High School grad The oldest of three children of Harold and Margaret Schmierer, he arrived in Bozeman in September 1986, three years after graduating from Dawson County High School in Glendive. He was moved to western Montana at the suggestion of a state agency for people with developmental disabilities and was placed in a group home operated by Reach Inc. on 15th Avenue. He lived there for nine months, then moved into an apartment on Black Avenue, where he lived with a roommate for nearly three years Over the next 10 years or 14
David Schmierer’s preferred mode of transportation around Bozeman is a high-end Kona mountain bike. Photos by Jim Tracy
David was able to take advantage of that opportunity through his primary lender, Stockman Bank of Bozeman. In addition to meeting home assistance requirements, Schmierer also had to contend with one of the tougher markets for homebuyers in Montana. “Bozeman is one of the hardest places to buy a home because of rising housing prices,” O’Neil said. Still, when the time came, Schmierer was ready. Two years after putting in an offer, he became one of the first Section 8 homeowners in the Bozeman area. “David put himself on a strict budget for years, preparing for homeownership,” said Tracy Menuez, a HUD counselor with HRDC. “He’d stop in and update us on how he was doing.” Schmierer received loan assistance through the HRDC’s “Road to Home” and then critical final support with a loan through the AWARE Montana Home Choice Coalition DDP Homeownership Initiative.
He’s obligated to repay the loans when he sells his home, plus a share of the appreciated value of the property – a one-bedroom condo he shares with his cat Delilah on Durston Road, near Bozeman’s bustling new business district on 19th Avenue. The décor reflects his range of tastes and interests: a pair of posters of jazz musicians, a collection of plates with paintings of Corvettes, framed, vintage album covers of Buddy Holly and Nat King Cole, photographs of family and friends, a television (he gets six local channels) and an XM radio receiver for music and talk radio. “I love talk news,” he says. “ I’m a talk news junkie. That’s also where I get my jazz music.” Above the door to his bedroom he has hung another important memento – a metal plate with a photograph of the Community Food Co-op at 908 W. Main. The plate was his invitation to the Co-op’s 23rd General Membership Meeting on the occasion of the completion of a major expansion in 2002. Schmierer has been with the Co-op at almost every milestone. He was there in the early 1990s when the enterprise was run mostly by volunteers on College Street near the Montana State University campus. In 2007, the Co-op reported total sales of more than $12 million. When he started at the Co-op in April 1991, he was among the store’s first non-management paid employees. “We knew that Dave rode a bike everywhere, and were told by the Reach representative that he was very detail oriented and would follow instructions closely,” store manager Wiseman recalls.
‘The job fell through’ Schmierer was working at Safeway in Bozeman at the time and had lined up a job as a janitor at St. Mary Catholic School in Livingston, “but the job fell through.” It didn’t seem so at the time, but that may have been the best thing that could have happened since he landed permanently at the Co-op shortly thereafter. He took over doing the stuff the volunteers didn’t want to do — washing dishes in the back and other cleaning chores. Now he spends more time working outside. “He bales cardboard for us, cleans and mops our entryway and warehouse, patrols and cleans up the grounds outside the co-op, and helps with recycling and trash duties in three of our four buildings,” Wiseman said. Continued on next page 15
After nearly 20 years on the job, Wiseman said Schmierer is identified with the Co-op.
“I keep the place clean,” he said. “I get my work done. I try to get there right smack at 10.” “I like the people Friendly attitude there,” he added. “Dave is famous “That’s why I’ve with our membership,” been there for he said. “He is known nearly 20 years.” for his down-to-earth He rides the mile modesty, his great or so to work on a sense of humor, and his David Schmierer’s invitation to the Community Co-op’s 23rd General Membership high-end Kona, one meeting was engraved on a steel plate fine, friendly attitude.” of two mountain bikes he uses for transportation in and “Staffers love Dave as he is sort of a fixture around around Bozeman. here, and one who never shirks a task and never comHe also stays in shape by skiing, hitting the slopes as plains,” he added. “As for me: He is as dependable as the often as he can through Eagle Mount, which provides sunrise. Also, I think he is very brave.” therapeutic recreation opportunities for people of all ages Schmierer also gets high marks from his supervisor, and disabilities. Chris Berman, operations manager at the co-op. His active social life includes membership in People “David is one of our most cheerful and pleasant employ- First of Bozeman, where he serves as vice president and ees to work with,” Berman says. “He always has a smile on represents the local chapter in the People First Senate. his face even while baling cardboard in sub-zero weather. I Still, the accomplishment he’s most proud of is his think we all have something to learn from David’s positive home. attitude.” “It took me nearly 20 years to get it,” he said, relaxing Berman described Schmierer as “a problem solver.” in an easy chair in his living room. “He doesn’t let a challenge stand in his way.” “I told David, ‘If you prepare, opportunities come your Asked what he would tell a prospective employer if way,’” O’Neil said. “He focused on going about what he Schmierer were to seek a recommendation for another job, needed to do to buy the condo and he got it. It took him a Wiseman had a simple answer: “’You can’t have him’ is while, but he did it.” what I would say.” Margaret Schmierer would have appreciated that. Schmierer, himself, is modest about his work.
Section 8 Homeownership Voucher Program ing if the household meets minimum income requirements, except in the case of elderly or disabled families.
The Homeownership Voucher Program allows households receiving rental assistance through a Section 8 rental voucher to apply that assistance to homeownership. Listed below are some of the basic requirements for the homeownership option. Interested households meeting the basic requirements should visit with local homeownership teams to make final eligibility determinations.
At least one or more adults that will own the home
must be employed at least 30 hours a week, and have been so continuously for at least one year. Family must have completed at least one year of participation in the Section 8 rental voucher program. Families on the waiting list are not eligible. Family must participate in Homeownership Education and Counseling.
Eligibility Requirements: Family must qualify as a first-time homebuyer. Minimum Income Requirements:
Employment requirements do not apply to elderly or disabled families If you are interested in the homeownership option, and meet the above requirements, please call Tracy Menuez at The Road to Home in Bozeman at 406/5854878 (e-mail: firstname.lastname@example.org). Or contact Michael O’Neil at the Montana Home Choice Coalition 406/4493120 ext. 11 (email@example.com).
for a disabled family, monthly federal Supplemental Security Income (SSI) benefit for an individual living alone multiplied by twelve for non-disabled families, the Federal Minimum Wage multiplied by 2000 hours (currently $10,300) Public assistance may not be considered in determin-
NEWS BRIEFS Human services shopping mall opens
By Nicholas Ledden, Daily Inter Lake Kalispell is attempting to centralize its many human service agencies by moving 15 into the long-time vacant Gateway West Mall. Many companies are planning to be moved in by the end of the year. “The existing Gateway West Mall facility provides a unique opportunity to bring together nonprofit and county service providers to better meet the needs of clients who currently have to search for services which are scattered throughout the greater Kalispell area,” said United Way Director Sherry Stevens Wulf. Current occupants of the mall will remain, and organizers intend to re-open, and run, the food court using the revenue to benefit the non-profit agencies. “The concept is to make the Gateway Community Center truly a location where people of all income levels, backgrounds and needs can access services and participate in the work and activities of the non-profit community,” Wulf said. For more information on the Gateway Community Center, call the United Way Volunteer Center at (406) 752-7266.
Parents of disabled more stressed, ill
Raising a child with a disability causes more daily stress and long-range health problems than parenting a child without disabilities, U.S. researchers say. The report was noted in redOrbit Knowledge Network, an online community for people with an interest in science, space, health and technology. According to the report, stress and health ills were greater among parents of disabled children, U.S. researchers found. The study, published in the Journal of Health and Social Behavior, found parents who had children with disabilities — that included attention-deficit hyperactivity disorder and bipolar disorder — reported having at least one stressor on 50 percent of the study days compared with 40 percent among other parents. The parents of disabled children also had a greater number of stressors and a greater number of physical health problems. When researchers evaluated saliva samples from the parents to measure the changing patterns of a biologi-
cal marker linked to stress — cortisol — they found parents of children with disabilities showed patterns of chronic stress much higher than normal on days when the parents spent more time with their children. “Our findings indicate the magnitude of the additional daily stress that these families face, lead study author Marsha Mailick Seltzer of the University of Wisconsin in Madison said in a statement. Researchers used data including telephone interviews from the “Midlife in the United States” study. The study looked at 82 parents — average age 57 years — of children with disabilities and a similar group of parents of children without disabilities.
Missoula project raises breast cancer awareness for women with disabilities
By Betsy Cohen, Missoulian Women with disabilities are less likely to get ongoing testing for breast cancer, according to researchers. That’s why a Missoula multimedia project, “Every Woman Matters: Portraits of Montana Women Living With Disabilities,” has taken steps to raise awareness of this issue. In order to encourage health care providers to break down barriers of inequality the project is planning an exhibit with photos of breast cancer survivors in Montana, mostly with disabilities, and their stories. The exhibit is planned to launch Friday, March 6, in Missoula. Once premiered, the exhibit will travel the state to various communities, health conferences and other professional events.
People with intellectual disabilities see better chances of going to college
U.S. News and World Report An increasing number of students with intellectual disabilities are attending college, thanks to programs that are tailored to their needs. In December 2008, the Higher Education Opportunity Act was established along with two multimilliondollar federal grants to give incentives for colleges to create college-based transition programs. Experts are expecting the number of post-secondary programs to expand dramatically from its current number of 150. Research shows that people with intellectual dis-
abilities that complete a post-secondary education program earn 1.7 times more per week than their peers. For a list of existing programs go to www.ThinkCollege.net.
ral tube defect than those with the highest levels, the researchers wrote in the journal Pediatrics. “Neural tube defects can lead to lifelong disability or death,” the report said. “The two most common ones are spina bifida, in which the spinal cord and back bones do not form properly, and anencephaly, a fatal condition in which the brain and skull bones do not develop normally.” The report quotes Dr. James Mills of the U.S. National Institutes of Health, one of the researchers. Mills said the study showed that vitamin B12 deficiency was a risk factor for neural tube defects independent of folic acid, another B vitamin.
Film starring man with disability tops Australian Tropfest
ABC News Australia The world’s largest celebration of short films, Tropfest, awarded “Be My Brother” its top prize. Gerard O’Dwyer, a man with Down syndrome, was also awarded the shows best actor award. The movie tells a story of Gerard’s character facing obstacles with optimism, even in the face of prejudice and misunderstanding. “The film is saying that you shouldn’t have prejudices,” says Genevieve Clay, the film’s director, “everybody has something to offer. My lead actor demonstrates that.” Clay won a prize package worth $100,000, including a trip to Los Angeles to meet with film executives. O’Dwyer won a $3,000 cash prize that was donated by actress Nicole Kidman.
MCDD releases 2009 directory
The Montana Council on Developmental Disabilities has released the 2009 edition of its popular Directory. The directory is to provide a telephone and address list of organizations and agencies that provide services and/or support to people in Montana with developmental disabilities. The directory is a telephone and address directory only. MCDD suggests that people contact individual organization for specific information on the services they offer. The directory is divided into sections, including national, state, and community programs and resources. A downloadable copy of the directory is available at: www.mtcdd.org
Vaccine scare started when doctor faked and misreported data
By Brian Deer, Sunday Times (UK) Investigators say the study that sparked fear of autism being caused by vaccines was based on changed and misreported data. Andrew Wakefield, the doctor who published the 1998 study in The Lancet said that the children developed autism symptoms and inflammatory bowel disease shortly after getting MMR vaccines. Later investigations found, that although the research paper claimed that problems came on within days of the jab, “in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated.”
Montana Hall of Fame for Leaders with Disabilities accepting nominations The Montana Center on Disabilities is seeking nominations for the Montana Hall of Fame for Leaders with Disabilities. Persons nominated should meet the following criteria: A person with a disability who has been an agent of change within Montana is eligible for the Hall of Fame. Agents of change will have made a significant positive impact in the state or community through activities such as volunteering, mentoring, coalition building, legislative activities, fundraising, program development, or advocacy. The person need not be involved in change related to disability issues. We are seeking nominations of individuals who are leaders in any area that benefits the state or local communities. Nominations should include a specific statement of nomination. For more information, visit: http://www. msubillings.edu/mtcd/index.htm.
Vitamin B12 can prevent birth defects
By Will Dunham, Reuters Before becoming pregnant, women need enough vitamin B12 in addition to folic acid to cut their risk of having a baby with a serious birth defect of the brain and spinal cord, Reuters news agency reports. Irish women with the lowest vitamin B12 levels were five times more likely to have a baby with a neu-
— Compiled by Bryan Noonan 19
What the heck is Wraparound?
ask ourselves, “How did we fail to meet that child’s needs,” and we must revise our intervention approach so that it might be more effective. In order to offer unconditional care one must practice several other principles:
hat is wraparound, and are we doing it at AWARE? These are very interesting questions. Let me start my answer by talking 1. To focus on children’s strengths rather about just what wraparound is. In writthan their weakness ing this article I was going to begin by 2. To see families as a most important giving you the definition of wraparound resource and focus on the family’s strengths that I used in my book on wraparound, rather than their weaknesses which I wrote with Karl Dennis. 3. To be flexible— thinking out of the Karl is known as the father of wrapbox— in the way we look for solutions around which was developed at Kaleidoto meeting people’s needs and be able to scope, his agency in Chicago. However, change the course of intervention when I was surprised to find that we hadn’t necessary even attempted to define wraparound in 4. To be truly individualized in our apDr. Ira Lourie the book. proach to intervention—not always focusing When I think about it, the reason it was on “which program should I use?” omitted had to do in part with how difficult it is to define 5. To use the full range of resources available in the wraparound. I once went to an entire meeting in which community rather than just those resources that our fundwe tried to come up with a definition and ultimately ing mechanisms support. failed. So to define it, we need to go back to its origins at We have talked about these from time to time in other Kaleidoscope, where a number of years ago when I read ShrinkWrap articles. their staff training manual I could not find the word “wraparound.” Rather, they taught several concepts Over the last twenty years, these early underlying princistarting with three basic ones. ples of wraparound have been turned into a practice model for wraparound based on ten similar principles. But more The original and primary concept had to do with importantly, people are being trained in the use of these Unconditional Care, which tells us that we need to treat practice models. As a result there have been quite a number people under our care with the same degree of responsiof successful demonstrations on how effective wraparound bility that we give our own children. Under the principle is in helping kids and families do better. of unconditional care we are urged never to give up on a Thus, wraparound has become widely disseminated as a child. To do this, we must do what it takes to meet their practice, which has led to the development of some rather needs. John VanDenBerg, another of the early pioneers in rigid rules as to how to do wraparound. This is strange wraparound services would often state the ten principles because wraparound was created to get around all the rigid of wraparound as: rules that made more traditional interventions so limited in 1) Never Give Up, 2) Never Give Up, 3) Never Give the first place. Up, 4) Never Give Up, 5) Never Give Up, 6) Never Give As a result of this rigidity many people now have come Up, 7) Never Give Up, 8) Never Give Up, 9) Never Give to think of wraparound as something that happens when Up, and 10) Never Give Up. you merely perform certain functions such as including When a child is not doing well in our care, we must families in case planning, writing some strengths in a not blame him or her for those behaviors. Rather we must
nated with these principles from the start of their employment. Our treatment planning documents were changed to reflect these principles. Our yearly corporate awards are now based on these principles. Over the span of five years, we have gotten to the point where our staff eat, drink and sleep these principles. A very important point is that these are our principles, not those that are specifically espoused by the leaders of wraparound. If one looks carefully, one can find all of the official ten principles of wraparound in our UCC principles, but our staff does not even know that what they are doing is anything like “wraparound.” They think they are doing “AWARE.” However, if you look at our treatment plans and listen to our internal case discussion, our plans are looking more and more like what one would conceive of as a wraparound plan. Only after these UCC principles were accepted as vital by our staff did we begin to add some more traditional wraparound practice to our model. We trained our staff in the development and use of the Child and Family Team. The Child and Family team is the case-level mechanism used in wraparound programs. It brings together the child, family members, agency personnel, and other community-based individuals who are resources for the family as a team to work together to develop a strength-based plan for helping the child and family. Important aspects of this team are that the family is seen as the most important members and the team meets as often as necessary to change the plan if it is not working. Another vital aspect of this team is the development of crisis plans so that everyone knows what to do when expectable and unexpected problematic events happen. (I plan to write an article just on Child and Family Teams in an upcoming issue of AWARE Ink.) Are we creating Child and Family Teams as proscribed by wraparound programs? Probably not. But, we are using a Child and Family Team-like mechanism to give our workers a vehicle for putting into action the UCC principles they are striving to perfect. And, most importantly, it is working! In addition, we created our OOPS, or Out of state placement staffing to help case managers and intensive family service workers hold to our UCC principles when things weren’t working out. While these are not true Child and Family Team meetings, they do offer support to our teams struggling with their desire never to give up.
treatment plan document, adding an aide to an ongoing program-oriented treatment plan, and/or using two or more funding streams to pay for care. They then call this “wraparound,” even though the basic principles of wraparound are being ignored or forgotten! We tried a traditional wraparound approach at AWARE and it just didn’t work. AWARE brought in Karl Dennis to train its staff in wraparound and it hired me to be a member of the staff. We did get to the point that many people do of being able to talk the wraparound talk, but we were not walking the wraparound walk. There were a couple of reasons that this happened. First, we were just too big. How do you train over 700 employees to do something as difficult as wraparound. Almost all wraparound programs have a small concentrated staff who work with a relatively small population of kids. We were trying to do this with a huge agency that covered the whole state of Montana. Secondly, the cost of constant training and coaching necessary to do the current wraparound practice models were way too high to apply to such a large agency. Thirdly, these models of wraparound required outside help in the form of interagency cooperation and support that has not been available in Montana, even after the system-change models that have become Montana’s KMAs. But we at AWARE did not give up. Our CEO, Larry Noonan, demanded that we change our approach and become unconditional in our care and give a mandate to our now well known Unconditional Care Commission (UCC) to do something about it. True to the underlying concepts of wraparound, we felt that we should not focus on organizational structure or practice. Rather it was felt that we should start where the original wraparound agency, Kaleidoscope, started 25 year before — with a concept. We asked, “How could we at AWARE come to accept the principle of Unconditional Care?” First, we defined unconditional care, not as a theoretical concept, but as it could be applied to AWARE. We brought in staff at all levels to discuss unconditional care concepts and what that meant to people. We then came up with ten principles that we felt could represent AWARE’s unconditional care; we had no idea how those principles would translate into a practice model. We then asked a wider range of staff to work on refining those principles by making them the focus of one of our yearly Corporate Congress meetings at which staff help administration plan for the immediate future and longer term. We brought in families to help us do this. These ten UCC principles have become the backbone of our treatment philosophy. All of our staff are indoctri-
These teams are led by our Lead Clinician, Pandi Highland, and myself. In these telephone consultations, a group of clinicians, administrators and a wraparound specialist—me—talk about the case and its frustrations and come up with plans to allow kids to remain in their Continued on next page 21
Shrink wRap... families and communities rather than being sent out of state. If you listened to one of these staffings, you would most likely think you were in a traditional Child and Family Team. Early in March of this year, three AWARE employees, Jeff Folsom, Meghan Gallagher and myself presented a paper at a professional scientific conference at the national Research and Training Center for Child Mental Health. The purpose of this paper is to show off how successful we at AWARE have been at keeping kids in Montana and their communities rather than going out of state to residential institutions. We want to demonstrate that even though we do not do formal wraparound, our non-traditional approach to creating an unconditional care environment in our agency is working as well as formal wraparound programs to prevent kids from being sent out
of state-placements and keep them in their communities with their families. We want to demonstrate that even though we donâ€™t have a formal wraparound program we are still doing a job which is only based on wraparound principles and works just as well. We also want to demonstrate that we can create a wraparound atmosphere that will affect our entire agency of over 700 employees rather than just a small piece we would call a wraparound program. We want to demonstrate that basing services on the underlying principles of wraparound is more important than the use of some specific wraparound practice. We want to demonstrate that in order to do something called wraparound one has to live the principles before one can do it. And, that is what we are doing! Dr. Ira Lourie of Hagerstown, Md., serves as AWAREâ€™s senior medical consultant. He is the author of Everything is Normal Until Proven Otherwise.
Dressed for success Administrative staff in Anaconda show off their stylish AWARE jackets. For Christmas, full-time employees across the state received a black-and-gray jacket embroidered with the corporate logo. Left to right are Barb Wilson, Donna Kostelecky, Anne Wentz and Lisa Huber. Jim Tracy photo
Book Marks Book Marks Each issue of AWARE Ink includes a collection of books, articles, documents, texts, and even movies recommended by staff, covering a range of topics related to the work we do. This issue features titles suggested by Pandi Highland, MSW, LCSW, lead clinician and program officer. Thinking In Pictures: And Other Reports from My Life with Autism Expanded Edition: Including the most recent research, therapy, and resources. Temple Grandin, 2005 This is such a wonderful text! In order to develop a better understanding of another’s behavior, it is helpful to see it through that person’s eyes. This is precisely what Temple Grandin has done. In addition to her original text, the 2005 version is full of newer research, therapies and resources. Every chapter is a gold mine. At the end of each chapter are the updates. In these updates, I especially appreciated her words regarding emphasizing positive teachings, developing shared interests, learning social skills, tools for helping your career, the importance of mentoring, and her trouble-shooting guide for challenging behavior of those that are nonverbal. There is an incredible reference section, by chapter, as well as a resource list for further reading and education. Getting to Peace: Transforming Conflict at Home, at Work, and in the World William Ury, 1999 “When you don’t believe there is much you can do to stop the fighting, you don’t do much.” Ury describes this book as being “about how and why we may now, if we choose, learn to get along.” In a typical conflict, there are two sides. Ury believes there is a third side to any conflict that consist of outsiders and the inner voice that urges us to heal old wounds, to listen and to show empathy. Beyond his theory, Ury provides us with “the how” of solving conflict. He defines the 10 roles we can choose from, to be an effective third side in order to contain, resolve and prevent conflict.
COMING EVENTS March 12 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena Contact: Mary Dalton, (406) 444-4084
April 9 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena Contact: Mary Dalton, (406) 444-4084
March 16 Rural Institute Transition Project: Representational Portfolio Webinar Contact: Kim Brown, (406) 243-4852
April 14-16 2009 DPHHS Spring Public Health Conference 9-5 p.m. Crown Plaza, Billings MT Ann Hagen-Buss, (406) 444-4119 April 14-16 Public Health: New Frontiers for a Healthy Montana Rural Institute Billings, MT Contact: Gail Brockbank, (406) 442-4141
March 19 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena Contact: Mary Dalton, (406) 444-4084 March 21 Understanding Developmental Disabilities 9-4 p.m. MSU Billings, Student Union Building, Beartooth Room Contact: Debra Miller, (406) 657-2312
April 15-17 2009 Conference on Diverse Abilities Missoula Contact: Nancy Marks, (406) 728-2400 ext. 1088
March 23 Public Health System Improvement Task Force 2-3:30 p.m. Teleconference Contact: Sue Miller, (406) 444-3624
April 16 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena Contact: Mary Dalton, (406) 444-4084
March 25 Disability Service Public Hearing 3-4:30 p.m. Video conference in nine Montana cities Contact: Mike Hermanson, (406) 444-3833
April 21-23 27th Annual Conference of Montana Gerontology Society Rural Institute Butte, MT Contact: firstname.lastname@example.org
March 26 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena, MT Contact: Mary Dalton, (406) 444-4084
April 23 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena, MT Contact: Mary Dalton, (406) 444-4084
April 1 Lead Local Public Health Officials Meeting 1:30-3 p.m. Conference Call Contact: Sue Miller, (406) 444-3624
April 27 Public Health System Improvement Task Force 10-3 p.m. TBA Contact: Sue Miller, (406) 444-3624
April 2 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena Contact: Mary Dalton, (406) 444-4084
April 30 Healthy Montana Kids Workgroup 8-10 a.m. Arcade Building, 111 North Jackson St Helena, MT Contact: Mary Dalton, (406) 444-4084
April 3 Cardiovascular Health, 2009 Summit Rural Institute Missoula, MT Contact: Gail Brockbank, (406) 442-4141 April 3 Eagle Fest 2009 Billings Contact: Eagle Mount, (406) 245-5422
April 28-May 1 Wraparound Process Training Mariott Missoula Contact: Lorrie Biltoft, (406) 444-5905. â€” Compiled by Bryan Noonan
Meagan Gallagher, former AWARE youth case manager, attended the 22nd Annual Research Conference – A System of Care for Children’s Mental Health: Expanding the Research Base at the Research and Training Center for Children’s Mental Health at the University of Southern Florida. Also attending were Jeff Folsom, left, chief of operations, and Dr. Ira Lourie, senior medical consultant. Courtesy photo
‘Wraparound’ AWARE’s services address needs of rural communities By Tim Pray
raparound service, wraparound philosophy, wraparound systems and wraparound care. As time goes on, it has become increasingly difficult to be a part of the human services field – children’s mental health, in particular – and not hear “wraparound” used as an adjective for a model of mental health care. Through a federal grant, the state of Montana has joined a national effort to embrace the wraparound movement, attracted to the positive outcomes that go hand in hand with a parallel movement towards com-
munity-based services. More than five years into the process, there continue to be varied definitions of the movement, and different interpretations, each, though, described as “doing wraparound.” AWARE has approached wraparound from several perspectives and used several strategies in implementing it over the past decade. Working from a base of offering strong, individualized and communitybased unconditional care in group home programs, and witnessing the good that it was capable of doing for people, AWARE became interested in moving to a wraparound philosophy of care as other services Continued on next page 25
and putting the focus on being wraparound, not doing wraparound. AWARE argues that, in the midst of nationwide trends that point towards making wraparound an evidence-based practice, we are finding a workforce steeped in a wraparound philosophy generates good outcomes for children and families. By implementing AWARE’s 10 principles of unconditional care throughout the organization – from official documentation to awards banquets – staff are increasingly seeing more success by children and families in their respective communities, inherent in wraparound. “Even though all of our interventions don’t always fulfill all of the traditional wraparound-based ‘rules,’ we’re still getting wraparound-like outcomes,” said Gallagher. Jeff Folsom, AWARE chief of operations, who was present at the conference, was eager to gauge peoples’ reaction to AWARE’s unconventional and rural model of wraparound. “It would have been easy for people to give simple lip service to our principles of unconditional care, our efforts to create a wraparound-ready workforce, but they didn’t.” “People were genuinely curious about what we’re doing in such a unique way in such a unique place…it’s well received by these national leaders, and lets us know that we’re in the forefront of mental health services in rural areas. We were excited to hear from leaders in the field that few organizations have had the temerity to take the challenge of an approach wherein the entire organization adopts a wraparound philosophy.” Gallagher agreed, “I think our presentation added to the conference because we were the only topic on the agenda that specifically addressed rural service provision with a wraparound value-base. People were curious about this because wraparound is not often discussed in this context, especially across such a large geographic area and workforce. We presented on our own unconditional care approach, which happens to be successful for us in our large rural environment. People appreciated this perspective.” Nationally, wraparound is receiving more acclaim, in part because of presentations such as the one attended by Gallagher and Folsom, but primarily because it works. The challenge faced in Montana is to move past the definition of wraparound as an event or a mere extension of a child and family team, but rather to see the possibility of bureaucratic and institutional adoption of a philosophy that is proving to help kids. AWARE, however, will continue to adhere to its ‘nonwraparound-wraparound,’ (see this issue’s Shrink
were expanded. National experts on the subject were brought in to provide intensive staff training, followed by technical assistance and on-site coaching. Further, AWARE hired one of the nation’s foremost leaders of the wraparound school, Dr. Ira Lourie from Baltimore, to lead our own effort. However, after several years, it was clear that this approach in its basic form was not able to meet organizational or – more importantly – the clients’ goals. It was at this point that AWARE shifted to a value-driven, organization-wide approach that required addressing the significant challenges of providing services with a wraparound philosophy to children and families around the expanses of Montana and the demands of training almost 1,000 staff every year. The notion of approaching wraparound as an organizational effort instead of an organizational event was recently validated on a national stage at the 22nd Annual Research Conference – A System of Care for Children’s Mental Health: Expanding the Research Base held by the Research and Training Center for Children’s Mental Health at the University of Southern Florida. At the conference, UM graduate student and former AWARE youth case manager Meghan Gallagher presented her paper: “A Rural Nonprofit Model for Workforce Wraparound Readiness in a System of Care.” For many in attendance – researchers and providers from around the country – it was the first glimpse into the methods used in providing services to people who are spread out over 147,000 square miles, and preparing a workforce to do so. “Wraparound studies so often focus on very specific interventions across a small number of clientele and staff,” Gallagher said. “What we have done as an agency, however, is orient a large company that serves many, very different communities across Montana to serve clients unconditionally. We have been able to do this without the specific tools that many others use to become a wraparound provider.” AWARE’s definition of wraparound, to quote Dr. Lourie, is “never give up, never give up, never give up.” We have to provide the flexibility necessary to treat every client, every child, every family, and every situation unconditionally; and the flexibility is crucial to providing this care in a place like Montana. To ensure that all who are providing a service are in tune with the methodologies, strengths, and risks of wraparound, it requires that the workforce be “wraparound ready,” 26
continue, ensuring that children and families are the backbone to service delivery and increasing their level of participation is paramount to wraparound services. These efforts and risks are fortunately ones that AWARE and its staff are accustomed to making and taking.
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wRap on Page 20) keeping in mind that every intervention is unique, while meeting the needs of children and families. Efforts to educate and prepare the workforce in the principles of unconditional care will
Denny Bowen of Anaconda works on a puzzle book at the Day Activity Center. Photo by Tim Pray
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“Reactive therapy is a treatment modality that allows individuals to engage in activities at their pace… not staff’s,” said Knute Oaas, AWARE behavioral services coordinator. “It presents a unique opportunity for staff to learn how non-verbal individuals communicate, and what their needs and wants are without putting demands on them. The goal each and every day is to have a stimulating, fun environment that will present opportunities 27
for each customer to engage in at all times of the day.” Those activities range from working out on the treadmill, to reading, to spending time in the sensory room listening to country music amidst purple lights or taking walks around the historic neighborhood. “Most of these men and women lived in Boulder all their lives,” said Robertson, “so we’re trying to allow for comfortable daily life that’s got some options. It’s as simple as letting people do what they want, not what we want.” The building was used for years as a busy rectory. With its many rooms, the building presented the perfect space for reactive therapy, allowing for the necessary variety of environments to be set up at all times. Each room is painted a different color, each with its own collection of books, games, puzzles, paper, and musical options. Also, it allows for day center customers to spend time alone if desired. The center has been in constant flux since the day it opened last April, thanks in large part to Bob Taylor (Butte maintenance) and Robertson, who have spent untold hours painting and customizing. “The inside of the building today looks nothing like it did when we started, and a year from now it could look completely different than it does today,” said Oaas. “That’s what’s unique about reactive therapy, it’s always in constant adaptation.” The men and women who spend their days at the center do so from 9 to 2:30, and most live in adult group homes in Butte, although several travel to the center from Anaconda a few days a week. “Any given day may have its successes, or it may be just an ordinary day,” said Robertson. “But the majority didn’t have much to laugh at when they lived at Boulder, so when someone’s laughing here, you know it’s genuine, and that’s when we know that we’re at least on the right track here.”
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Author, movie critic and historian Tony Shea of Anaconda was featured in a story titled “Renaissance Man” in the Winter issue of Apostrophe. Photo by Tim Pray
“I loved it,” Melissa Clark told Ecke when asked how she liked being on the cover of the magazine’s winter issue. The article noted that Clark, a member of the Gros Ventre Assiniboine Sioux tribe, keeps occupied. “Between speaking engagements, Clark keeps busy with her Luv Yums business (with foster mother Sister Johnelle Howanach) and takes intermediate classes in sign language,” Ecke wrote. He noted that the issue was full of Great Falls connections. The cover photo was taken by Great Falls photographer Scott Fairbanks. The magazine also included a feature story on Great Falls artist Jennifer Bodner. And it mentioned Special Olympics Montana, headquartered in Great Falls, in several stories. The spring issue of Apostrophe is set for publication in early April. It will feature articles on Bozeman homeowner David Schmierer, a Helena cheerleading squad, Eagle Mount, and the Autism Self-advocacy Network. By Jim Tracy
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