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AWARE

May/June 2008 Volume 2, Number 3

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Inside... Notes to Staff and Friends ­— Page 2

AWARE, Head Start Sponsor Conference — Page 3

IT Team Delivers New Computers — Page 4

Montana Facing Senior Boom — Page 6

Shrink wRap with Dr. Ira Lourie — Page 8

Providers, DPHHS Settle Wage Suit — Page 10

Book Marks

— Page 16

Miles City Elks Open Lodge to Kids — Page 18

HR Director Takes Seat on FSSAC — Page 20

Turning Bills into Policy — Page 24

Photo by Tim Pray

Tim Spring, 18, left, and Michael Gage, 16, indulged their fascination for space exploration with their Galen School science project, “Rockets and the Solar System.” More photos on Pages 14 and 15.

Arts and sciences

Galen students shine at school fair By Tim Pray If you were struck with the urge to ride a hovercraft, throw a boomerang, launch a rocket, or otherwise immerse yourself in science and art theory on Friday, April 11, the campus at Galen would have been a perfect place to be.

The third annual Galen Science and Art Fair featured projects and artwork by students in grades 4-12 who participate in AWARE Inc.’s therapeutic residential program. On what turned out to be the first beautiful spring day of the year, the See Fair on Page 12

AWARE opens autism center in Bozeman Montana families struggling to provide the intensive level of care required for their children’s developmental and behavioral needs will now have another option available. The Candlelight Community Living Initiative in Bozeman will serve four

young people from across the state who are challenged by developmental disabilities, including autism spectrum disorders. Some of the children who will be served have been participating in AWARE’s Intensive Family Education and Support services for See Candlelight on Page 22


Autism center, FSSAC appointment signal progress Dear Staff and Friends, This issue of AWARE Ink is — in no uncertain terms — robust. Several factors have come together at the same time that it seemed almost impossible to keep this newsletter under 30 pages. Following are thoughts on some of the events and plans that you’ll read about in this issue. After significant preparation, we are set to open our newest Larry Noonan program, AWARE’s Candlelight Community Living Initiative in Bozeman. The program — a center, to be exact — will be the first of its kind in the state, and will serve four young people who are dealing with the challenges of autism spectrum disorders, among other possible developmental disabilities. The service is new, to be sure, but our familiarity with this population and their families is not new, and is certainly what propelled us to submit our proposal to the state with confidence. Immunization debate rages There is so much happening on a national stage right now in regards to autism. A fierce debate is raging as we speak on whether childhood immunizations are partially responsible for the recent spike in the numbers of children being diagnosed as autistic. To date, there are no confirmed answers from either side of the argument. There is, however, a growing population of children and families who are simply not equipped to handle the stresses that autism spectrum disorders — or

other developmental disabilities — throw their way. So, while the two (probably many more) sides to the “what causes autism” argument duke it out, we’re busy doing everything we can to make sure that children and families are getting the help they need. The new program in Bozeman is an extension of our efforts to offer the community of Montana a caring, educated and qualified team. Providers: part of the solution Early in April, I testified before the Law and Justice Interim Committee at the Capitol in Helena. On the agenda was a state proposal to build a 24-bed secure residential facility that could house Montana children currently being served out of state, yet not under the care of the juvenile courts. I was there, in principle, to talk about what the state could and should expect from the 54 providers of disability services in Montana. It’s important for state officials to know that they have a resource: a collection of organizations that work on the ground level, day in and day out, and know — or at least have a really good idea — what the people looking for support want from their government and their providers. On page 27, you’ll read about these children and what is being considered to bring them back to Montana. We’re set to hold the first annual Montana Mental Health — Head Start Consortium in Billings at the MSUBillings College of Technology. Again, a partnership has led to further extension. In the December 2007 issue of AWARE Ink, you read about the partnership between AWARE and the Yellowstone County Head Start, a relationship for which we add a mental health component to the solid efforts of the state’s largest preschool program. The consortium, a one day conference open to all in the state 2

who are involved with the Head Start program, will bring four talented professionals to Billings for the day to offer their expertise in the intricacies of childhood mental health to those who spend their days working with Montana children. As our staff and our services become more diversified, we’re able to reach out further into the community in a very dynamic and healthy way. There will be a lot more of this sort of outreach, and I’m very much looking forward to seeing how staff, families, clients, and the communities at large participate. AWARE wins FSSAC seat A member of the AWARE staff, George Groesbeck, was recently appointed to the Governor’s Family Support Services Advisory Council. You’ll read about that appointment in this issue (see page 20). This is the first time a member of the AWARE staff has been asked to sit on the council, and it is a big deal. Aside from the obvious honor of having the governor choose someone who

Lawrence P. Noonan, CEO Geri L. Wyant, CFO Jeffrey Folsom, COO Mike Schulte, CHO Board of Directors John O’Donnell, President Allan Smith, Vice President Teresa Marshall Cheryl Zobenica Keith Colbo John Haffey Editing and layout: Jim Tracy Staff writer: Tim Pray AWARE Ink is published bimonthly by AWARE, Inc., a 501(c)3 non-profit organization at 205 E. Park Ave., Anaconda, MT 59711. Copyright ©2007, AWARE, Inc. All rights reserved. No part of this newsletter may be used or reproduced in any form or by any means without prior written permission of the publisher. Please send correspondence to: askaware@aware-inc.org.


is so steeped in the issues of human services to be on his advisory council, it is an honor for me to again be reminded of the people who work in this organization. With all that’s going on right now, all the advancements, all the progress, and frankly, all the controlled chaos, I’m astounded every day with the ability of the AWARE staff, on every level, to keep in mind that we are dedicated to the community on both a micro and macro level. In the midst of proposals, programs, outreach, and, most important, services to those who require them, we are fully mobilized and ready to offer what we can. With best regards,

A conference you can use. A conference of peers. A conference of professionals.

Plant the Seeds for a Secure Future.

Introducing the 1st annual Montana Mental Health - Headstart Consortium. Brought to you by Montana’s leaders in mental health services and early education, A.W.A.R.E. and Yellowstone County Headstart.

Consortium brings together familiar team con·sor·tium: an agreement, combination, or group (as of companies) formed to undertake an enterprise beyond the resources of any one member.

Health insurance open enrollment runs through May 31 Eligible AWARE employees may sign up for health insurance or change their plans during open enrollment from May 1 through 31. “It’s a great benefit and a great deal, and we encourage everyone who can to participate in the health insurance plan,” said Chief Financial Officer Geri Wyant. Less than half, or 220 of AWARE’s employees, take advantage of the insurance. Some 420 employees are eligible. Wyant has been traveling to AWARE offices across the state explaining the plan AWARE introduced last summer, including several recent changes, and the procedure for enrolling. Each employee was slated to receive a package in the mail at the end of April explaining the medical benefits and rates for the plan year June 1, 2008, Here’s a brief explanation of AWARE’s two-tiered insurance plan, See Insurance on Page 7

In a further development in their relationship, AWARE and the Yellowstone County Head Start program joined forces to sponsor the first annual Montana Mental Health – Head Start Consortium May 6 at the Montana State University’s College of Technology in Billings. AWARE began its relationship with Head Start in 2006, offering outpatient therapy, evaluation and assessment, therapeutic family care, and communitybased rehabilitation and support services to supplement Head Start’s federally funded programs for children living in families under the poverty line (for more background information on the Head Start/AWARE relationship, please see “Head Start, AWARE Partnership Expands,” AWARE Ink, Volume 1, Number 3). When the partnership first began, Colleen Bosch, Family Services Supervisor at Head Start; Mindy Davis, lead clinician and director of AWARE’s early childhood services in Billings; Mike Kelly, service director for AWARE’s support services and therapeutic family care; and Jeff Folsom, AWARE’s community operations officer, were talking about the lack of training available for people in the state who are working with children under the age of six. This initial conference/training was intended to cover the fundamentals of childhood development, skill/strength building for children, play therapy methods, and the importance of wraparound services. “We’ve talked about having follow up conferences and trainings that will go much more in depth, but, this is the first one, and we kept it pretty introductory,” said Mindy Davis. The conference’s introductory nature was due in part to the fact that adding a mental health aspect to an already enormously successful program is not the norm, but based on the number of registrants, interest was been overwhelming, and staff of the Yellowstone County Head Start have spent two years watching their program become more accessible to more families because of the supplement. In an earlier AWARE Ink article, Bosch spoke of the advantage for children with emotional or developmental challenges who, without the early intervention See Consortium on Page 5 3


At their assembly line, Nick Rub, left, and Wendall Smith prepare six of the 118 new computers that are being distributed to AWARE offices across the state. Photos by Jim Tracy

Assembly men

IT team makes statewide computer delivery By Jim Tracy

Once they completed that task, they performed the equivalent of an information technology copy and paste, duplicating, or as Rub calls it, “ghosting,” the configuration on multiple DVD’s, which they then used to set up other computers on the assembly line

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endall Smith and Nick Rub, AWARE’s information technology team, converted a corner of the basement conference room at the Anaconda administration offices in April into a computer assembly line. Well, a computer configuration line, anyway. For five straight days they sat huddled at a table readying 118 new Dell computers, including three lap-tops, for deployment to AWARE offices around the state. The corporation bought the equipment in March as part of a company-wide effort to make it easier for staff to manage local operations and deliver services. With six computers at a time on their assembly line, Smith and Rub completed 24 machines a day.

Ready to be repacked and labeled, new Dell computers line the wall at AWARE's administration building.

The first step in the process was to set up the operating system and software on a single computer. Using Windows XP operating system, they installed Microsoft Office (Word, Excel, PowerPoint, Outlook), and McAfee antivirus software on single machine, explained Smith, IT database administrator. 4

Rub, an IT specialist, was already familiar with the procedure, having set up dozens of classrooms and computer labs while he was a student at the University of Cincinnati. Smith and Rub went through the marathon session in Anaconda in order to save time later when they go on the road to deliver the computers. “The work we’re doing here will eliminate set-up time in offices and group homes where the computers will be placed,” Smith said. See Computers on Page 5


Computers...

Consortium...

“It’ll make the swap-over to new computers a lot quicker and easier.” The new computers, purchased in bulk at a discount, replace old, outdated and, in some cases, broken equipment identified last year in a corporate-wide inventory. “We used that inventory to determine which computers would be swapped out,” Smith said. Once the computers were configured, he and Rub re-boxed them and attached labels indicating their final destination. None of the new equipment was slated for the Anaconda administration offices. The two planned to rent a van and visit AWARE offices around the state, trading new computers for old ones. Rub’s first scheduled trip was to one of AWARE’s farthest flung outposts – tiny Westby in the far northeast corner of the state. “We’re anticipating all the new computers will be in place by the end of May,” Smith said.

by AWARE mental health staff, might not be able to fully utilize the benefits of the Head Start program. The program for the conference included a talk from Dr. Ira Lourie, AWARE’s medical director, who introduced participants to the principles of the wraparound approach to services. Dr. Lourie, author of “Everything is Normal Until Proven Otherwise,” is a national leader in the field of child psychiatry, and his work has cemented AWARE’s community and strength-based practices with those of the wraparound approach. The director of the Lewis and Clark County Children’s Advocacy Center of AWARE, Dana Toole, offered a presentation entitled “The Language of Childhood.” Her work requires careful attention to the movements, he hope is that this speech, and emotions of children as gathering will have they are interviewed during abuse an effect in the classrooms investigations. Her presentation provided insight valued by anyone across the state, as well as in who works with children, particularly the daily lives of kids who while they are in early developmental spend so much time with stages. Special attention is placed on how children use language differently their early educators. than adults. — Lead clinician Mindy Dr. Len Lantz, AWARE child psychiatrist practicing throughout Davis southwest Montana, conducted a talk entitled “Building Skills and Adding Strengths.” Dr. Lantz has extensive experience in serving families and children throughout the state and is able to provide insight into the distinction between normal child development and challenges requiring special attention. As one of the few practicing community child psychiatrists in Montana, Dr. Lantz brings a wealth of skill and experience to the conference. Jan Thompson, licensed clinical social worker from Billings, offered her expertise into the methods of play therapy. A member of the International Association for Play Therapy, Thompson is a veteran workshop presenter who has significant hands-on experience with all aspects of both out- and in-patient adult, child and family therapy. “The hope is that this gathering will have an effect in the classrooms across the state, as well as in the daily lives of kids who spend so much time with their early educators,” said Davis. Folsom, AWARE COO, feels that this partnership and the conference that has resulted from it are examples of AWARE’s fundamental commitment to wraparound services. “Our commitment to the communities of the state is vital,” he said. “We continually think of ways to provide top tier information and support to those who require and benefit from it: teachers, families, and, most importantly, the children being served.” For information or materials from the event, please e-mail Mindy Davis at mdavis@aware-inc.org. By Tim Pray

80-gig hard drives The new Dell Optiplex 330 computers are all Intel powered with two gigabytes of RAM and 80-gig hard drives. “They’re powerful machines that are more than adequate for AWARE’s offices and group homes,” Smith said. CEO Larry Noonan said the new computers demonstrate a commitment to provide staff with the technology and resources they need to do their jobs efficiently and better serve consumers. “We’ve been working on this technology upgrade for about nine months,” Noonan said. “The delivery of the computers represents the final step in the process .” Smith and Rub planned to remove hard drives containing sensitive data from the old computers and then either recycle the old components or throw them away.

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Even in literature and art, no man who bothers about originality will ever be original: whereas if you simply try to tell the truth (without caring twopence how often it has been told before) you will, nine times out of ten, become original without ever having noticed it. — C. S. Lewis (1898 - 1963)

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Montana facing boom in senior citizen population Montana is expected to see a population explosion in the next 18 years — an explosion of seniors. In 2000, 13.4 percent of Montanans were 65 or older. By 2025, it is expected to be 24.4 percent, an 82.1 percent increase. It is predicted that from 2000-2025 Montana will leap in ranking from 14th to 3rd in the nation for proportion of the population age 65 and older. Montana will see a 123 percent increase in the share of the population age 85 and older from 2000-2025 (from 1.7 percent to 3.1 percent). It is expected that from 20002025 Montana will leap in ranking from 17th to 4th in the nation for proportion of the population age 85 and older. Studies show that more than 72 percent of persons over 75 experience physical limitation due to aging. Given the link between aging and limitations, we can expect our current level of persons with disabilities (nearly 20 percent in 2000) to greatly increase as the aged population greatly increases.

The percentage of Montana citizens who will absolutely need accessible housing to support their sustained independence and their safe daily functioning will be close to a majority of our residents. As to who benefits from enhanced accessibility, given these numbers clearly we all do. By Michael O’Neil

Acclaimed behavioral specialist to train AWARE staff issues, and case examples. This first day of training is intended for AWARE’s direct care staff. Day two, which will address AWARE supervisory staff, will again highlight the principles of ABA in addition to training on data collection and analysis, the functions and causes of behavior problems, assessment of behavior problems, identifying reinforcers, developing and modifying treatment plans, best practice/ethical issues, and case examples. Day three, a summary of ABA methods, will be open to community partners and stakeholders, offering a glimpse into the level of care that will be provided in the Candlelight Community Living Initiative in Bozeman and other services. (Please see story on the Candlelight Initiative on Page 21). By Tim Pray

Dr. Sung-Woo Kahng, Ph.D., BCBA of Johns Hopkins University School of Medicine’s Kennedy Krieger Institute, will bring his expertise in “Applied Behavioral Analysis” to AWARE staff on May 12, 13 and 14. Applied Behavioral Analysis (ABA) has gained credibility and notoriety in recent years as a preferred method when working with children affected by developmental disabilities such as autism and autism spectrum disorders. The Kennedy Krieger Institute, from which Dr. Kahng hails, is considered by many to be the leader in ABA, and the upcoming event marks the first training of its kind in Montana. Day one of the training will focus on the principles of ABA and include details on data collection, summarizing data, the functions and causes of behavior problems, treatments for behavior problems, best practice/ethical 6


ON-LINE RESOURCES — Accessible Housing Design Universal Design and Visit-Ability Concrete Change is an international advocacy effort led by Eleanor Smith to make all homes visitable. http://www. concretechange.org/

http://www.huduser.org/Publications/PDF/ FAIRHOUSING/fairfull.pdf - HUD’s guide to building housing that meets Fair Housing Act standards. Accessible Building Products http://www.toolbase.org/Home-Building-Topics/ Universal-Design/dabp – Directory of Accessible Building Products for the home-a treasure trove of accessible housing products.

“Accessibility and Visitability Features in Singlefamily Homes: A Review of State and Local Activity” AARP Report http://research.aarp.org/il/2002_03_homes. html The Rehabilitation Engineering and Research Center on Universal Design (RERC UD) site has a listing of visitability initiatives across the nation as well as a visitability booklet and on-line tutorial. http://www. ap.buffalo.edu/idea/visitability/

Ramps http://www.wheelchairramp.org/ — This site offers a comprehensive manual on designing and constructing modular ramps for your home. For assistance regarding developing housing that is accessible, usable, and marketable to the maximum extent possible across the age and ability spectrum, please contact Michael M. O’Neil, State Director, Montana Home Choice Coalition, AWARE Inc. at (406) 449-3120 ext. 11. Montanahomechoice@aware-inc.org. AWARE and the Home Choice Coalition are leaders in promoting increased accessible housing in Montana.

EasyLiving Home is the nation’s first voluntary certification program that specifies criteria in everyday construction to add convenience in your new home and to welcome all friends, family and visitors regardless of age, size or physical ability. http://www.easylivinghome.org/ homebuyers.htm Universal Design: http://www.design.ncsu.edu/cud/pubs_p/phousing.htm The Center for Universal Design at North Carolina State University is the leading organization on Universal Design. The site is a comprehensive resource on Universal Design offering research, information, technical assistance, design ideas, links to additional resources, and more.

Insurance... which allows employees to match their coverage to their needs. The “Price Plan” meets the needs of about 62 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 “just crop up, Wyant said. The Value Plan is tailored to the needs 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, the best drug coverage and the fewest restrictions on the selection of providers. Eligible employees may choose between the two based on their evaluation of their individual situation, Wyant said. Enrolled employees receive another direct benefit since they pay their premiums with “pre-tax dollars.” AWARE’s insurance plan also includes a wellness benefit that covers the cost of an annual medical exam. Links to the health insurance plans are on the AWARE Intranet. First log in, then select PDF Manuals, then Health Insurance. The two plans as well as our InterWest Preferred Provider list are listed: http://www3.aware-inc. org/awareinc. You can e-mail questions about the plan to or Jerrid Burk at jburk@aware-inc.org or Karen Girardot at karengirardot@aware-inc.org. By Jim Tracy

http://www.huduser.org/Publications/PDF/remodel. pdf - “Residential Remodeling and Universal Design: Making Homes More Comfortable and Accessible” an article available from HUD (large file) with pictures and instructions showing how to make a home Universally Designed. It gives examples of features of Universal Design for the whole home, ranging from the most basic to the most extensive. http://www.aarp.org/life/homedesign/ — This is the Universal Design main page for the AARP website with links to information about Universal Design and ideas, tips and checklists to make your home’s design safe and barrier free. Below are links to resources on accessible design and construction: Resources for Building Housing that Meets Federal Accessibility Requirements http://www.fairhousingfirst.org/index.asp — Fair Housing Accessibility FIRST (Fair Housing Instruction, Resources, Support, Technical Guidance) web site offers training, education, and legal materials on ADA and Fair Housing Act compliance. 7


Shrink wRap My #&@$#% Computer

from my back. I was happy, I sang, I made jokes and my wife thought that I looked as though I’d just won the Lottery.

By Dr. Ira Lourie

Many of us are so active and busy in our lives, that small inconveniences can throw our lives into chaos. The car breaks down, a family member gets the flu or something similar happens and suddenly our ability to function decreases markedly. We feel hopeless and depressed and maybe we even swear a little. But we know that things will get better and we move on.

There I was sitting at my computer. On that day it was my #&@$#% computer because it was not working so well. To get stuff done I had to stop and restart the computer once in a while when my programs froze up, so it was taking me a long time. This problem had started over a month ago with a small glitch, then a bigger glitch and finally the system got overwhelmed and came crashing almost to a halt. I don’t think I’m particularly unique in today’s world, and I’m not the only person who feels completely helpless when our computers are on the fritz.

Now let’s look at a family living with a child or adolescent whose circuits are working about as poorly as my computer’s Dr. Ira Lourie were. Just like my computer, the problem most likely started slowly, maybe when the child was a toddler (or earlier). Year after year the problems grew and grew. And then, all of sudden, something happens and But there I was swearing at my computer, when I got the whole system goes haywire. This can be an incident, a call from Tim Pray at the AWARE Anaconda office a family crisis, or even just reaching adolescence which telling me that it was time for another ShrinkwRap is a developmental crisis. article, and I was responding, “Sure Tim, I can get that to you....aah....if my computer starts working again.” The family members respond the best they can So I swore at it...fiddled with it...swore at it again... but things keep getting worse. So just like me with my fiddled with and swore at it again. I didn’t hit it or kick it, computer, they begin to fiddle and adjust, hoping that because I’ve learned that, unlike those old mid-twentieth things will get a bit better, but often the fiddling and century TVs, a physical approach just doesn’t work and adjusting just makes things worse. The effect of this on usually makes things worse. So my only recourse was the family is often catastrophic, and the family’s progress to throw something else, like a.....golf club....yeah, a golf grinds to a halt. club. I’m good at throwing those. They get paralyzed. Chores of everyday life get harder and each individual’s nerves are on edge, leading to a tension that in itself causes more family problems, which in turn can worsen the condition of the child who started the whole thing. Sometimes folks get to the point where their “Sweet Little Baby” becomes “That #&@$#% Kid.” At times the family’s response might come down to hitting, but just like with computers and TVs it never helps and most likely will make things even worse. Continued Page Continued on on next page9

Oh how lucky I was. I Googled “Computer Repair Hagerstown” (I live in Hagerstown, Maryland) and found “The Computer Guy” who could come and fix my computer...I hoped. When he showed up, I was awed by his expertise and his gentle way of handling my baby and within a half hour he had diagnosed the problem, researched and effected the cure. Not only did he fix my computer so that it wasn’t #&@$#% any more, but he cleaned up some things and it works better than it has in at least a year. I felt like a huge weight had been lifted

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Shrink wRap...

work to help families remember their “Sweet Little Baby” feelings. We realize that parents are the most important resource that a child has, even when the realities of life and living with a troubled child make family life appear pretty ugly. We accept parents as a vital part of the treatment team. We know there is no magic answer and that we must work with families to find out how we can support them in working with their child — struggling together to find workable solutions. We funded a parent conference in Butte in 2001, partnered with the Family Support Network to further develop and formalize ongoing efforts to create community family support groups in 2002 and brought out Karl Dennis to provide direct training and support to families in an effort to mobilize family advocates.

Of course, at times during the process families reach out for help. They’ll go to their family doctor or pediatrician, or a counselor, or a psychiatrist. Sometimes the help comes from outside the family as the result of some incident(s) which brings the social service or juvenile justice system to their door. If problems extend into school, that system gets involved. Each time a family reaches for help, just like me with the “Computer Guy,” they see a ray of hope, they relax and things might get better for a few days. But unlike the “Computer Guy’s” magic, the helpers more often as not have no magic answers. And worse, the answers they do give can be ineffective, wrong, more damaging and/ or, worst of all, blaming of the parents.

In 2004, we hired Melanie Martin Dent, a parent of a child with troubles to work within AWARE and with our families to help them be included as meaningful members of our team. After successfully developing parent teams across several communities, the “HOPE abc” program was launched in 2005 from AWARE to stand together with another state-wide family advocacy group. In 2005 AWARE invited parents to participate in our Corporate Conference. We changed our treatment planning process in 2007 so it now flows from Child and Family Team meetings and primarily focuses on strengths.

As parents feel increasing besieged by their child’s illness and the helping community’s ineffective response to it, they become more and more helpless and cynical about their ability to get meaningful help. Finally, they get to the point that the only answer is to, “...get this #&@$#% kid out of here!” Many community helpers, also frustrated by not being able to help, agree and conspire with the family to institutionalize the youngster. We at AWARE recognize the dynamics of this struggle to help kids with broken circuits. Our strengthbased and unconditional approaches force us to look past the ugly looking struggles that families have to what is working right in those families, or at the very least, what has worked for them in the past. We understand that there is no magic and that the circuits won’t get fixed, even at some place called a “Neuro Rehab Center.” Rather our approach is to help kids and their families discover ways of making the best use of the parts that are working and then adjust their approach to allow the child to reach his or her highest potential.

Indeed, people are not like computers. And although we have no magic answers, we do know that if we accept families as partners and work with them as a team ascertaining their strengths and coming up with solutions, we can do wonders to improve the lives of both the children and their families. And that’s #&@$#% good! Dr. Ira Lourie serves as Medical Director to AWARE, Inc. He is the author of Everything is Normal Until Proven Otherwise. He lives in Hagerstown, Maryland.

We accept that when families say, “That #&@$#% Kid,” it is just an expression of their frustration, so we

AWARE coordinating with ‘Cleanup Days’ for recycling center open house Anaconda Local Development Corp., the county Extension Service and Anaconda Disposal Co. “The emphasis on recycling education is a perfect match for what we’re doing at AWARE,” said Wendy Dyer, work services coordinator for the recycling center and Hope Thrift Store. Dyer and crew have been involved in their own spring cleaning in preparation for the open house. The center will get new signs and a new vinyl fence to replace the one that blew down during a windstorm last fall.

AWARE will show off its new 12,000-square-foot recycling center at an open house on Saturday, May 17. AWARE Recycling and Hope Thrift Store will be open from 10 a.m. to 4 p.m. Hamburgers, hotdogs and refreshments will be served from 11 to 1, with live music by guitarist and singer Jack Hatch of Anaconda. AWARE is also coordinating with organizers of the annual community spring cleaning this year to emphasize the importance and value of recycling. AWARE is coordinating the event with Anaconda Deer Lodge County, 9


Providers, DPHHS agree to settle wage gap lawsuit Parties agree to put pay disparity questions on Legislature’s agenda By Jim Tracy

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arties in a class action lawsuit that pitted people affected by developmental disabilities against the state have agreed to a settlement. Once approved, the agreement should make it easier for developmentally disabled people to remain in their communities. “The result of the lawsuit is an improved financial situation for the providers, their employees, and ultimately the consumer,” said Helena lawyer Julie Johnson, who along with Ron Waterman of the firm of Gough, Shanahan, Johnson & Waterman, represented the plaintiffs. “However,” Johnson added, “this effort to assure improved wages and benefits to employees and services to consumers has to continue until the state adopts an aggressive program of assuring that individuals who receive services can do so within their own communities in the least restrictive setting.”    Suit filed six years ago The settlement agreement comes nearly six years after developmentally disabled Montana citizens and disability service providers filed suit in state district court alleging that the Department of Health and Human Services was violating their rights under various federal and state provisions. The plaintiffs included MAIDS, the Montana Association for Independent Disability Services, since renamed the Montana Association of Community Disability Services, or MACDS, along with several individuals receiving developmental disabilities services. AWARE is a member of MACDS and signed on as a plaintiff.

The complaint generally challenged the gap in wages and benefits between state employees at state institutions, such as the Montana Developmental Center (MDC) at Boulder, and employees of community organizations that provide services to people with developmental disabilities. The wage disparity, the plaintiffs contended, made it difficult for providers to make support services available to people in a community setting. The lawsuit also alleged that the inequality forced providers to close homes and shut down services and thus required them to send people with disabilities back to institutions. Most at risk were people living in group homes operated by providers who are funded by the state or people living in private homes and receiving services funded in by the state. Johnson said MACDS providers reported that 15 individuals had been committed or recommitted to MDC over the last several years because the provider had insufficient staff to support the individuals. “One provider reported an individual who had been selected by screening committees to leave MDC, but the provider lacked the funding to adequately staff the person’s needs, so he remained at MDC,” she said. “Another provider reported that it had served an individual who had been placed in its supported living program. Due to his behavior of waking in the middle of the night and destroying

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s wages are increased, the ability to recruit and retain quality employees is expected to improve. — Helena lawyer Julie Johnson 10

his apartment, he required 24-hour supervision. The consumer’s cost plan was therefore much more expensive than anticipated and he had to return to MDC.” The agreement with the state could reduce the reoccurrence of such situations, Johnson said.   “However, there still may be times when the complex needs of an individual may exceed the services available in a community setting,” she said. “These instances should occur less frequently under the agreement.” Under the terms of the settlement the state has agreed to work with MACDS to boost funding to allow its members to offer competitive salaries to direct care employees. “As wages are increased, the ability to recruit and retain quality employees is expected to improve,” Johnson said. “Additionally, increased wages will help community-based services to stabilize their work force, which provides a consistency of care to the clients.” Narrowing the gap Johnson stressed that the settlement itself only narrows, but does not close, the gap in wages. “This can only be achieved through legislation such as Maryland has adopted, which requires wage parity,” she said. “It will be necessary for MACDS to advocate for wage parity before the Legislature. DPHHS can urge the state to raise funding for those wages, but it cannot obligate the state without the agreement of the Legislature.” While the settlement should boost pay, it does not grant wage parity between private and state direct care employees. “Wage parity is an issue that MACDs will continue to advocate in upcoming legislative sessions,” Johnson said. See Lawsuit on Page 11


Lawsuit... In reaching the settlement, the parties agreed that was in their best interest to work together to achieve common goals. They also agreed that prolonging the suit would damage working relationships. In the end, they agreed on several basic points, including funding. Here are other key points of agreement: The parties “recognize that the Department has engaged in, and continues to engage in long-term planning for developmental disabilities services through collaborative public processes” such as ones triggered by the 1999 Olmstead decision, which affirmed the right of individuals with disabilities to live in their communities. The two sides also agreed that any settlement is subject to the Legislature’s Commission on Providers Rates and Services monitoring provider services, costs, and reimbursement rates, including the services, costs and reimbursement rates of developmental disabilities service providers “and to make recommendations and reports based upon the results of its review.” Plaintiffs also agreed with the department’s four “over-arching goals”: ƒƒ all Montana children are healthy, safe and in permanent loving homes. ƒƒ all Montanans have the tools and support to be as self-sufficient as possible. ƒƒ all Montanans are injury free, healthy and have access to quality health care. ƒƒ all Montanans can contribute through community service. Consistent with those goals, the parties say they share the following further goals specifically affecting people with developmental disabilities: ƒƒ Services provided to persons with developmental disabilities shall be responsive to their needs. ƒƒ Community integration of

persons eligible for state-administered developmental disabilities services is desirable when such placement recommended by appropriate treating professionals and appropriate community services are available. ƒƒ The Department’s rate systems for providers of developmental disabilities services shall incorporate, among other things, consideration of service costs inclusive of direct care wages. ƒƒ Service costs may also include the costs of non-traditional services. Cost of doing business “The parties recognize that in order to accurately consider service costs, the providers’ cost of business shall be reviewed periodically,” the settlement says. It concedes that providers should pay competitive wages and benefits to their direct care staff in order to meet the needs of people affected by developmental disabilities. The parties also agreed that planning for developing services in the future should consider development of community-based services, including supported living and supported work “that offer services to persons in integrated community settings and that foster the movement of persons to the least restrictive service setting appropriate to serve their needs.” DPHHS has agreed to coordinate meetings involving planning for future developmental disabilities services. The agreement says DPHHS “shall involve consumers, providers, and others in the meetings, inclusive of setting the agendas for the meetings.” The department has also begun planning for the 2009 Legislature. DPHHS would include providers and people with developmental disabilities in that planning, according to the agreement. The department would factor in the settlement agreement as it prepares budget documents for lawmakers. District Judge Jeffrey Sherlock of Helena will make a ruling on the agreement after a May 7 hearing. 11

“At that time, the Court is anticipated to approve the order and it may take a few days after the hearing for the court to issue the order,” Johnson said. “Children and families receiving services and adults receiving services deserve nothing less than the full cooperation of all parties as we work on the issue of pay equity,” said Jan Cahill, MACDS executive director, Cahill noted the 2007 Legislature approved an increase in direct care staff salaries that helped some providers recruit and retain staff. At the same time, he said, “There were providers who paid direct care staff at a higher rate than what eventually resulted by action of DDP and thus recruitment and retention was not increased in those agencies.” “Much needs to be accomplished in the next session to make sure that providers are able to offer direct care staff comparable wages and benefits paid employees at MDC,” he added. “This must include provisions for salary and benefits for long-term staff that are paid at a higher hourly rate than the rate that was eventually set by DDP following legislative action.” Cahill said MACDS providers “look forward to working with the legislature issues facing DD services, including pay equity and also look forward to working with DDP staff on a collaborative effort to mitigate a variety of issues including pay equity involving the new rate system as required in the settlement agreement. “MACDS providers appreciate the work done by DDP staff on formulating a re-basing methodology for addressing the actual costs of doing business and we look forward to working with DDP on re-basing as the executive planning process is finalized for submission to the governor’s office.” “Confidence comes not from always being right but from not fearing to be wrong.” — Peter T. Mcintyre


Fair...

DJ Sullivan, 14, and Kadden Clark, 15, spent three weeks building Galen Campus’ first fullyfunctioning hovercraft.

students, dressed in formal attire, stood next to their respective projects, and prepared to defend them to any questioning layman. Brian Schmitz, 14, conducted research on crystals and their different forms. Brian has spent time growing crystals as a hobby, and says that he “knew right away that this would be my project” when it was announced that it was time for the students to begin working on their projects. Among Brian’s observations into the historical significance of crystals is that the ancient Egyptians may have used the crystal’s form as an inspiration for the great pyramids.

“We thought it was a cool idea,” said Sullivan. The hovercraft consisted of a circular piece of plywood about three feet in diameter with a hole toward an outer edge, allowing a leaf blower to be inserted downward. Surprisingly, the leaf blower produced enough force to lift a grown person several inches off the gymnasium floor. “It’s just the basic idea of a hovercraft,” said Kadden.

DJ Sullivan, 14, left and Kadden Clark, 15, combined science and invention with their hovercraft project. Photo by Tim Pray

Michael Bradford, 15, presented his project entitled “The Human Eye.”

The presentation included an explanation of the relationship between optical illusions and hypnosis – “they’re both based on constant rhythm,” Bradford explained – and an in-depth history on the life and work of Louis Braille, the inventor of the Braille method of reading for the blind.

Michael Gage, 16, and Tim Spring, 18, teamed up for a project that introduced guests to the foundations of rocket propulsion and rockets’ place in exploring our solar system. Michael and Tim have become adept in the art of launching rockets, once launching one so high that – when the parachute deployed for landing – the wind carried the rocket over the neighbor’s property line, several hundred feet from the launch point.

“It was based on Morse code,” said Michael, “and people didn’t think it would work, but Louis Braille knew that the human finger can detect differences as small as one-sixteenth of an inch.”

Kaleb Young, 14, and Shannon Mathre, 15, displayed a vast collection of polished rocks along with the equipment used to transform what looks like an ordinary stone into a smooth and shining addition to their collection. Shannon said that he “picks up everything” he finds and gives it a whirl in a rock tumbler, which uses small pebbles and, eventually, sand to wear away and polish the rock. On display were examples of obsidian, jade, amethyst, bloodstone, tiger’s eye, and emerald vein.

Christina Eagleman, 14, presented her project that explained the life of butterflies. “They’re my favorite,” said Christina. Her project included detail on the life-cycle of butterflies and their daily struggles to find food. Christina’s project was displayed complete with a collection of exquisitely detailed plastic butterflies from around the world. Elizabeth Robinson, 15, presented a stark reminder of the consequences of marijuana use. Elizabeth’s project contained significant research into its side effects. The project was dedicated to a personal friend of Elizabeth’s who suffered by using the drug.

Troy Miller, 18, spent over a week constructing a sturdy and useful birdhouse. “I would love to make more,” said Troy. With plans for the construction coming from a manual of various birdhouses, Troy committed to building the perfect bluebird house that would complement his already huge interest in birds.

“It’s in memory of him,” said Elizabeth, “and I just want kids to know that it’s all right to talk to an adult about drugs.” See Fair on page 13 12


By Jim Tracy

Showing off their dinosaur dioramas, left to right, are Xavier LeDeau, Cheyenne Leaf, Matt McInis, Alex Osier, Tina Wright and Travis Condo. Photos by Jim Tracy

Fair...

part of their science curriculum under their teacher Karen Johnson. For their projects, they constructed dioramas of scenes from the life of the dinosaurs millions of years ago. The students also compiled a coloring book featuring the scientific names of the animals and were careful to note their diets and habits.

Also presenting a hard-hitting project was Sireena Oberweiser, 17, who worked on a wrenching display of the side effects of methamphetamine use. Her project included “before” photos of users when healthy coupled with the “after” photos showing the extreme wear that the drug can put on the human body. Sireena’s presentation also included a touching poem written about the impact of the drug on the user’s loved ones.

Also on display on vertical panels throughout the gymnasium were pieces of art created by the students that ranged from charcoal to paint to colored pencil and reflected the students’ ability to blur the lines between science and art. Kari Hoscheid is the Galen school art instructor.

Chase Glover, 15, presented a very hands-on project entitled “Boomerang.” From two wooden paint stirring sticks, Chase fashioned a fully-functioning boomerang and demonstrated the methods involved in properly throwing the Australian tool in the large lawn behind the gymnasium. Glover prepared the boomerang according to instructions found on the Internet, and finely tuned its aerodynamics by sanding the blades on the proper slope.

Great Divide Education Services instructor Dan Sletton organized the event, stating that “in a community public school, this would be a standard part of the curriculum, and it’s important that it be standard here, too.” Sletton said he was pleased with the pride with which each project was put together, and is eager to see more people come and be a part of the fair next year.

“The key,” said Glover, “is to hold it over your head when you throw it.”

Starting with a partial photograph in a magazine, Brittany Jessen, 17, finished this image of a model, complete with a glittercovered eyelid, for the Galen School art fair.

The younger students at the school had been studying dinosaurs as a 13


Photo by Tim Pray

Kaleb Young, 14, left and Shannon Mathre, 15, delved into "hard" science with their project on rocks.

Galen School Science & Art Fair

Photo by Jim Tracy

Monkey and flower by Cheyenne Leaf.

Photo by Jim Tracy

Photo by Tim Pray

Michael Bradford, 15, studied the science of “The Human Eye."

14

Chase Glover, demonstrates the technique he uses to throw his hand-crafted boomerang. Glover studied the aerodynamics of the ancient Australian weapon for his science project.


Photo by Tim Pray

Fourteen-year-old Christina Eagleman researched butterflies and their habits.

Photo by Jim Tracy

Troy Miller, 18, studied birds and their habitats and fashioned a bluebird house based on a design he found in a book. He also entered his crane in pastel (inset) in the art fair.

Photo by Jim Tracy

Photo by Tim Pray

Travis Condo shows his dinosaur diorama to Helena Youth Services case worker Natalie Solomen.

For his project, Brian Schmitz, 14, became an expert on crystals, the building blocks of the universe.

15


Book BookMarks Marks Nobody Nowhere By Donna Williams This book is the extraordinary autobiography of Donna Williams, who happens to be autistic. This book is a masterpiece and really is an insightful journey into the world of autism, through the eyes of someone who has experienced it. Donna Williams has written a couple of books and all are great!

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 Teresa Rivenes of Great Falls, AWARE's Intensive Family Education and Support services administrator. In February of 2007 the Centers for Disease Control released a study that stated one out of every 150 children is born with autism.

Autism Spectrum Disorders By Richard L. Simpson, Brenda Smith Myles, Brenda Smith Myles, Lisa Garriott Adams, Josefa Ben-Arieh Comprehensive in scope, this resource briefly evaluates over 40 commonly used interventions and treatments for individuals with ASD, as well as detailed evaluations of their utility and efficiency. It will assist readers in critically evaluating and choosing those methods that have the highest probability of yielding benefits for this special population.

This information resulted in increased media and public awareness of autism as AWARE is developing a “Center of Excellence” for Montana and will be unveiling new and better resources for people with autism than ever before, I thought this might be a great topic for AWARE Ink. Coinciding with this, and since April was Autism Awareness Month, I thought this might be a great time to share some of my favorite autism resources! I hope you enjoy them as much as I have.

Relationship Development Intervention with Children, Adolescents, and Adults By Steven Gutstein and Rachelle K. Sheely With so much going on with ABA (Advanced Behavior Analysis) I throw this resource in so that we remember that there are varying interventions for people with Autism and likely it will take a whole “tool box” for best results. RDI is an intervention that focuses on developing and maintaining social bonds. This book is contains over 150 activities applicable to anyone but of particular value for those on the autism spectrum. The exercises run the gamut of social and emotional development and can be easily used by therapists, teachers, friends and family.

Autism Through A Sister's Eyes By Eve B. Band and Emily Hecht When young people have questions about a brother or sister with Autism or Asperger’s Syndrome the answers can be hard to find. “Why does he do that?” is the question 10-year-old Emily recalled asking her parents as a young child when she first sought to understand her older brother and his differences. Written by Eve Band, Ph.D., a clinical psychologist, this book gives voice to Emily's actual story: her questions about her brother, her search for answers about autism, her exploration of her feelings as a sibling of an individual with high functioning autism. Told in her own voice, Emily's story is as uplifting as it is filled with valuable information for parents and siblings, or any individual whose life is touched by a person with autism.

Engaging Autism By Stanley Greenspan and Serena Wieder This is another autism intervention book different from RDI and ABA. Known as “Floortime,” this approach was designed to help children with Autism relate, communicate, and problem solve independently. This book addresses ASD (Autism Spectrum Disorder), how families can use the Floortime approach, what Floortime is, assessment, intervention, overcoming difficulties, and resources.

Emergence: Labeled Autistic By Temple Grandin and Margaret Scariano If you have ever explored autism at all you may have Toilet Training for Individuals heard of Temple Grandin, a well known Ph.D., who also with Autism & Related Disorders happens to have autism. Temple has written several books, By Maria Wheeler but this one is her personal story of emergence. This is a great resource for developing toileting This book details how Temple went from a fear-gripped child with autism to a professional, world leader in her field. programs for people with Autism or developmental disabilities in general. It is a true story that gives hope and new insight into what living with autism is really like. See Book Marks on page 17 16


Miles City staff moving to spacious new location By Jim Tracy

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WARE Inc.’s Miles City staff will move into new offices on South Fourth Street at the end of April. The move illustrates the company’s growth in Eastern Montana. When AWARE first opened its office in Miles City in 2006, the location at 1709 Batchelor St. was large enough to accommodate a staff of three – Service Administrator Jeff Regan and adult case managers Eileen Dey and Keith Polesky, who started with AWARE in 1991. Today AWARE employs 14 people in Miles City, including eight who need permanent offices. “We just quickly outgrew our space,” said Regan. “Our two-year lease was up in March, so it worked out almost perfectly.” Common space Regan said the new location at 305 S. Fourth, which formerly housed the Bureau of Land Management, provides 2,200 square feet of office space, compared to only 1,200 in the old location. Another 800-square-foot common space, including a conference room, makes it ideal for staff meetings and training. The new location also comes with private offices. “The landlord put up inside walls for individual offices, so now we have three individual offices for staff who provide services to youth,” Regan said. They also have a table and waiting room “and way more privacy,” he said. Staff will use another separate office as a therapy room. The space affords users privacy for therapy and activities, such as arts and crafts. Other staff doing targeted case management, meanwhile, have separate offices in another area of the building, plus a waiting room and storage area. There is also enough

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e just quickly outgrew our space. Our two-year lease was up in March, so it worked out almost perfectly — Jeff Regan, service administrator, Miles City space for the clinical supervisor Mindy Davis who visits from Billings twice a month. AWARE’s Miles City operation also got a technology upgrade in the move. The office is slated to receive several new computers and a new phone system with a separate fax line. “We use that fax line for everything, so that will help out a lot,” Regan said, noting that Kristie

Connolly, executive assistant in Anaconda, coordinated changes in phone leases. The new office also comes with more parking for staff and visitors, plus a picnic area and an empty lot next door. “We want start a garden in the lot this spring for our kids to work in,” Regan said. AWARE staff in Miles City besides Regan, Dey and Polesky are: Trista Muraoka, youth case manager; Jennifer Preble, treatment service specialist; Bill Hill, treatment service technician; Anna Rapson, treatment service clinician; Beth Tunnell, treatment service technician; Joe Jerrel, treatment service technician; Lou Straub, adult case manager; Caleb Samuelson, treatment service technician; Jamie Fischer, treatment service technician; and Curtis Fillefer, treatment service technician.

Book Marks... It includes readiness, real case studies, and it is applicable for individuals of all ages. The book includes reproducibles for charting and even social stories for toileting. It is a great resource. My only issue with it is the word “tee-tee” but you have to read the book to find out what that means! Practical Ideas that Really Work for Students with Autism Spectrum Disorders By Kathleen McConnell and Gail R. Ryser This book is an entire curriculum for children with Autism. It includes an assessment tool, “lessons” for independence, games, sensory activities, communication ideas, choice cards, daily schedules, and more. This is one-stop shopping! Web Resources: www.autism-society.org www.autismspeaks.org www.autism.org www.autism.com The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. But no price is too high to pay for the privilege of owning yourself. — Friedrich Nietzsche

17


Elks Lodge opens doors to kids in Miles City By Tim Pray

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he Benevolent and Protective Order of the Elks, founded in 1868, claims the membership of former Presidents Warren G. Harding, Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Gerald R. Ford, countless members of Congress, astronauts, and pillars of the American community. It is in their company that 40 youth from Miles City unwind after a hard day of school at the local Elks Lodge No. 537. Bill Hill, a treatment service technician who spends the majority of his working days in the halls and classrooms of Miles City’s Washington Middle School (See AWARE Ink, Volume 1, Number 3), has been a member of the Miles City Elks Lodge for three years, and in 2006, when AWARE began both its Community Based Psychiatric Rehabilitation and Support services and Comprehensive School and Community-based Treatment services, he thought that an arrangement between the Elks and the kids could be worked out. Lodge leader approached Both Hill and Jeff Regan, service administrator for Miles City’s Support Services, thought that an after-school spot could be a place for continued therapeutic approaches, and the relationship that could build between city elders and youth would be a fruitful one. The two approached the local lodge’s leader about the idea. “When AWARE approached us with this, they said that this situation would be for the benefit of the youngsters of the community, which is one of the most important things we do, and we want to help them out,” said Gary Holm, exalted ruler of the lodge. “We do this on numerous occasions, for no charge. It’s a part of being a member of the community.”

The Elks Lodge has become an after-school haven for kids in Miles City. The Elks have also involved kids in community events. Photo by Trista Muraoka

The kids, aged 4 to 17, usually head to the lodge after school with Hill, and spend the remainder of the afternoon shooting pool, playing air hockey, doing homework, or just relaxing after the activities of the day. On a more involved basis, however, the arrangement with the Elks lodge provides the children with the opportunity to be a part of community events, tournaments, and the civic life of the Miles City area. They deliver dinners around

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n a lot of cases, these kids haven’t had the chance to do things like this…things like helping others.” — Bill Hill, treatment service technician. 18

town to those who aren’t able to get out. They play an integral role in the organization and production of an annual Christmas auction. The proceeds benefit the local food bank, provide four scholarships each year, fuel sports programs for which the winners compete at state and national levels and support community youth programs. They take full advantage of the things that many within the community take for granted, explains Hill. “In a lot of cases, these kids haven’t had the chance to do things like this…things like helping others.” He continues, “I know kids who couldn’t otherwise approach a stranger, but you give ’em a basket full of food that needs to be delivered, and they’re just great at that.” According to Regan, this sort of arrangement goes a long way in the development of age-appropriate See Elks on page 19


Elks... relationships, social skills, and community involvement. “It provides a well-rounded component of the therapeutic environment we try to provide in the home, the school, and the communityat-large.” Hill agrees. “It gets them out there into the community in a teamwork capacity that provides some recognition…to put on a spaghetti dinner for the whole town, there’s a certain amount of teamwork and order that’s involved with that…they’re really into it.” Membership declining Numbers in fraternal organizations such as the Elks have been declining in recent years due to the country’s shift in thinking about social capital in general. “We have weakened,” said Holm, “but we keep encouraging people to join, and it’s great to have such an influx of young people getting to know us and what we’re all about.” The Elks’ mission of community involvement, particularly in support of youth, is made clear when Holm is asked about how this sort of arrangement could possibly grow into other communities. “All Elks lodges are the same. They’re all out to help people. If AWARE approached any lodge in the state, the situation would be identical to this.” “Really, both the Elks and AWARE adhere to a wraparound philosophy,” said Regan. “We both invest in all segments of the community.” Holm agrees. “We don’t differentiate,” he said. “If we have someone who is trying to work with kids, provide them with opportunities, and get them going in the right direction, we will always support that.”

‘A frightening experience’ worth sharing By Teresa Rivenes I had a frightening experience last month and, after recovering, thought that the information I learned would be worth sharing with others. During training in Anaconda I took two Advil Liquid gel caps for a headache and almost immediately went into anaphylactic shock. Due to some very quick thinking from co-workers, I was given benadryl and rushed to the hospital. The doctor said that these two actions, done as quickly as they were, without a doubt saved my life. What is anaphylaxis? Anaphylaxis is a severe allergic reaction that occurs rapidly and causes a life-threatening response involving the whole body. This reaction can lead to difficulty breathing and shock, ultimately leading to death. For an anaphylactic reaction to occur, a person must have been exposed in the past to the substance that causes the reaction, called the antigen. This is called “sensitization.” A bee sting, for example, may not cause an allergic reaction the first time. Another bee sting may produce a sudden, severe allergic reaction known as anaphylaxis or anaphylactic shock. These reactions usually occur within seconds to minutes of exposure. Occasionally, they are delayed. A person may develop sensitivity and anaphylaxis to a substance that they have been exposed to many times in the past without a reaction, and often people don’t recall the previous exposure. What are the signs and symptoms? The symptoms of anaphylaxis can vary. In some people , the reaction begins very slowly, but in most the symptoms appear rapidly and abruptly. The most severe and life-threatening symptoms are difficulty breathing and loss of consciousness. While some symptoms are life threatening, others are merely uncomfortable. Generally, a reaction must involve at least two different body systems, such as skin and heart, to be considered anaphylaxis.

Skin: Most anaphylactic reactions involve the skin. ƒƒ Hives, welts, or wheals (raised bumps): Hives can cause severe itching ƒƒ Generalized redness ƒƒ Swelling in the face, eyelids, lips, tongue, throat, hands, and feet Breathing: Swelling of the surrounding tissues narrows the airways. ƒƒ Difficulty breathing, wheezing, chest tightness ƒƒ Coughing, hoarseness ƒƒ Nasal congestion, sneezing Cardiovascular : Blood pressure may drop to dangerously low levels. ƒƒ Rapid or irregular heart beat ƒƒ Dizziness, faintness

19


Groesbeck takes seat on support services council

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uman Resources Director George Groesbeck has been appointed to a panel that advises the state on developmental disability services. Groesbeck, who represents House District 74 in the Montana Legislature, was appointed to the Family Support Services Advisory Council, April 9 by Gov. Brian Schweitzer. His term ends in April 2010. He is the first AWARE employee to sit on the council. The Family Support Services Advisory Council provides consumer and professional guidance to local and state agencies who plan and provide services that support families in raising their children with developmental disabilities at home within Montana’s communities. Groesbeck replaces Sen. Gerald Pease of Lodge Grass as the legislative representative providing George liaison to the state Legislature. Groesbeck Sen. Pease will continue to serve on the council as a parent representative. “It was an honor to be appointed by Governor Schweitzer,” said Groesbeck. “The Schweitzer administration understands the challenges faced by Montana families and the vital importance of supporting community-based services. I look forward to the opportunity to serve on the council as the legislative representative.” The advisory council was formed in January 1987 in response to the state’s commitment to a federal program that established early intervention services for infants and toddlers with disabilities and their families. Ten-year history In 1986, Montana already had a 10-year history of providing services to children with developmental disabilities and their families. The Individuals with Disabilities Education Act was established at the federal level in 1986, partly in response to the national move toward liberating people affected by with disabilities from institutions. The program opened a window of opportunity through which states could access federal dollars to develop and support services that would help families raise their children at home. The driving philosophy behind the federal legislation was the belief that a child, with or without disabilities, is better off raised within a family. The federal legislation also recognized the immense cost benefits of helping families rather than supporting

institutions. Best of all, the federal program requires no state match in funding. Montana’s Legislature has maintained a commitment to the program since 1989, through several changes in state administration. During fiscal year 2005, the program touched the lives of more than 1,300 Montana families whose children have disabilities such as Down syndrome, autism, cerebral palsy, epilepsy, fetal alcohol syndrome, and a host of other disabling conditions. Implementing Part C The Family Support Services Advisory Council advises and assists the lead agency for disability services in Montana – the Developmental Disabilities Program of the Department of Public Health and Human Services – in implementing Part C early intervention services statewide. Under Part C, a federally funded entitlement program, a child who meets the eligibility requirements, will receive the services. To qualify for Part C services, a child must be between 0 and 3 years of age and have a diagnosed physical or medical condition that has a high probability for developmental delay or have significant delays in at least two of the five areas of development: cognition, gross and fine motor skills, communication, social-emotional development, or self-help. Services include parent coaching, service coordination, advocacy and support, assistive technology, audiology, assistance with transition to school at age 3, therapies (such as speech, physical and occupational), medical, psychological, vision, special instruction, transportation, nutrition, and other services based on the child’s needs and the family’s concerns and priorities. The advisory council consists of 25 members appointed by the governor who have an and expertise in providing services to families of children with disabilities. Council members meet in Helena quarterly. Members include six parents of children with disabilities, six representatives of provider agencies, a legislative liaison, and several state and local agency members who represent local, state and federal government services (Head Start, Early Head Start, Medicaid, Child Care, Office of Public Instruction) that have an interest in providing services to children with disabilities. Committee members are: ƒƒ Diana Colgrove of Eureka, parent, Chair ƒƒ Novlene Martin, parent, Vice Chair ƒƒ Ted Maloney of the Rural Institute in Missoula, personnel preparation representative ƒƒ Mary Huston of Richland, parent ƒƒ Dan McCarthy, pre-school specialist, state agency representative See FSSAC next page 20


FSSAC... ƒƒ Sandy McGennis of Butte, Montana School for the Deaf and Blind ƒƒ Gerald Pease of Lodge Grass, parent ƒƒ Sylvia Danforth of Miles City, provider representative ƒƒ Paula Sherwood of Missoula, state quality improvement specialist ƒƒ Sandi Marisdotter of Helena, provider representative ƒƒ Cindy Sinclair of Havre, Early Head Start representative ƒƒ Cris Volinkaty of Missoula, provider representative ƒƒ Barbara Stefanic of Laurel, special education representative

ƒƒ Priscilla Halcro of Great Falls, family support specialist representative ƒƒ Lucy Hart-Paulson of Missoula, language therapist representative ƒƒ Ron Herman of Helena, state agency representative ƒƒ Laurie Frank, parent representative ƒƒ April Ganser, parent representative ƒƒ Michelle Danielson, health care representative ƒƒ Mary Runkel, agency representative ƒƒ Erica Swanson of Helena, Developmental Disabilities Program ƒƒ Rep. George Groesbeck, legislator The council’s next scheduled meeting is May 8 in Helena. By Jim Tracy

State Fund taps AWARE as workplace safety ‘champion’ When it comes to worker safety, AWARE plays like a champion, according to the Montana State Fund. The quasi-public agency that governs workers compensation, has recognized AWARE as a WorkSafe Champion and invited the corporation to participate in a special training program. “Because you have demonstrated a commitment to safety in the workplace, your participation in this program will lead the way toward changing the way employers and employees think about safety in Montana,” State Fund President Laurence Hubbard wrote in a letter to Human Resources Director George Groesbeck on April 10. AWARE also earned high praise for its support of safety efforts from Wayne Dillavou, director of Safety Services for Montana State Fund. Describing the corporation as “proactive when it comes to safety,” he cited AWARE’s attendance at State Fund quarterly workshops, cooperation with the fund’s safety management consultant, Herb Byers, and development of the H.E.L.P. program. Dillavou also noted that AWARE has earmarked funds for staffing the training department, established proactive safety committees throughout the organization with the corporate committee meeting quarterly, and established an acceptable “Return to Work” program. “We have recognized those companies that have shown a willingness to foster a safety culture and who are willing to promote safety throughout Montana,” Dillavou said. “The goal is to create WorkSafe Champions who will be instrumental in creating a safety Montana.” Dillavou said the WorkSafe Champions training program was designed to allow attendees “to take their safety programs to the next level of safety excellence.” “The training curriculum provides new ways to motivate workers to think how to get from Point A to 21

Point B safely...all the time,” he said. “We will provide attendees with additional information on selling safety to management as well as workers. We will talk about how to inspire and obtain results from safety committees, and how to create a ‘culture’ of safety in their respective companies. This will be a great opportunity to learn from fellow attendees on what works and what doesn’t when it comes to lowering the risk of injury on the job.”   The WorkSafe Champions training program consists of 10 training modules that will be presented over one year. The program will be presented in six locations: Helena, Bozeman, Billings, Great Falls, Kalispell and Missoula. Trainings will be conducted beginning in May, June, September, December, March, April and May 2009. “Training will be conducted by Montana State Fund’s Safety Services staff and our safety management consultants,” Dillavou said. “We will have two nationally known speakers who will conduct the training via interactive web casts in December and April 2009.”

Topics to be presented will include:

ƒƒ Why safety? ƒƒ How to motivate workers to work safe ƒƒ Workers’ Compensation 101 ƒƒ Controlling losses ƒƒ Safety training with pizzazz ƒƒ Return to Work ƒƒ Accident investigation ƒƒ compliance requirements ƒƒ What Causes Accidents The first class has 83 employers represented with a total of 87 attendees. Montana State Fund functions as an autonomous insurance entity supported solely from its own revenues. By Jim Tracy


AWARE's Candlelight Home in Bozeman is the first step in serving the needs of families of children challenged by autism.

Candlelight... some time, however their particular challenges pose such a great and specific level of attention that services in their own homes are not as effective as those coming from a residential program. In January, the Montana Department of Public Health and Human Services’ (DPHHS) Developmental Disabilities Program (DDP) announced their request for proposals from the providers – 54 in all – of the state. While it is not known how many providers submitted proposals, AWARE was granted the contract to offer intensive residential services to children affected by developmental disabilities such as those arising from autism spectrum disorders. ‘A complex disability’ Autism is defined by the Autism Society of America as “a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills.

Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism is a spectrum disorder and it affects each individual differently and at varying degrees.” The opening of the home represents an increasing need felt by some Montana families overwhelmed by the high level of care and attention that their children require. “DDP has many children waiting for services, and some of them are requiring out of home placements,” said Jeff Sturm, DDP Director. “Group homes are one alternative that we needed to expand to meet the needs of those children.” Teresa Rivenes, who will act as the Candlelight Community Living Initiative’s service administrator, states that “AWARE firmly believes that every individual can be, and should be allowed to access, enjoy, and contribute to their community.” The children living at the Candlelight home will participate in every level of community life, including attendance at the appropriate public schools and recreational activities. A typical school day 22

experience for a child enrolled with the program will vary according to the degree of challenge presented by disabilities of behavioral issues, and the majority of their day will typically be spent in a special education class with other supports such as adaptive physical education and some adaptive electives. Goal is independence “In addition to education,” Rivenes said, “many of the children receive some speech, physical, or occupational therapy in the school setting, but all of them will have Individual Education Programs that outline their specific goals, and their education is often very skill/practical in nature and the goal is as much independence as possible.” Through its Intensive Family Education and Support program, AWARE has been providing services to this segment of the population since 2002. Based on the relationships that we’ve built during the course of the time we’ve been providing those services, it has become increasingly clear that some of these kids and their See Candlelight on Page 23


Candlelight... families need more intensive care,” said Larry Noonan, AWARE CEO. “That’s the reason we jumped at the opportunity to submit our proposal to the state when they put out their request.” The Candlelight Community Living Initiative is considered to be a “center of excellence” in the treatment and education surrounding autism spectrum disorders, the first of its kind in Montana. “The spotlight shone on autism as a result of the prevalence (according to Centers for Disease Control, 1 in 150 children, 1 in 94 boys) increases opportunities for the nation to consider how to serve these families facing a lifetime of supports for their children,” said Rivenes. The “center of excellence” concept is supported by the intensive level of staff familiar with both the community and the detailed needs of the children being served. All staff, some of whom are master’s level, will be trained in Applied Behavioral Analysis by the Kennedy Krieger Institute of Johns Hopkins University in Baltimore, considered to be the nation’s leader in behavioral analysis. Through the knowledge and experience gained from this level of training, significant outreach to the community is expected, and there are plans for more programs in Bozeman in the near future. By this time next year, AWARE hopes to have another home operating in Gallatin County, followed by another. “It is our goal to have three homes running in the next two to three years,” said Noonan, “and this would make it clear that this is a center of excellence with all the professional relationships and staff that would be included in the Gallatin County network of homes.” This initial phase of the centers of excellence, the Candlelight Community Living Initiative, will create 14 new jobs with benefits, resulting in more than $400,000 in annual Gallatin County on-going sustainable long-term direct economic activity, including direct wages and local purchasing. That goes along with $400,000 in additional immediate short-term economic activity, including real estate purchases, training, renovation construction, program development wages, and purchases for furnishings, appliances, and adaptive medical equipment. Over the next 10 years, it is estimated that the direct impact for Gallatin County and the Bozeman area will be more than $5 million.

Learn more about autism XX Autism Society of America http://www.autism-society.org XX Autism Speaks – It’s time to listen http://www.autismspeaks.org/ XX Families for Early Autism Treatment – FEAT http://www.feat.org/ XX Autism Research Institute http://www.autism.com/ari/ XX About Autism http://autism.about.com/ 23

AWARE CEO named chairman of statewide Medicaid coalition Larry Noonan, AWARE CEO, has been named chairman of the Medicaid Infrastructure Grant (MIG) Coalition. The Coalition’s purpose, according to its Web site, is “to enhance state Medicaid programs and services, promote links between Medicaid and other employment-related services agencies, and develop a comprehensive system of employment supports for people with disabilities.” Objectives of the coalition – also according to its Web site – include: ƒƒ Solicit proposals from Native Americans for outreach and training on work incentives for Native Americans with disabilities. ƒƒ Develop and conduct presentations on benefits planning. ƒƒ Fund employment tracks at five state disability-related conferences. ƒƒ Develop a data collection system to track employment outcomes. ƒƒ Develop and support a business leadership network in Montana. ƒƒ Collaborate with the National Consortium for Health Systems Development. “AWARE’s roots lie in employment opportunities for Montanans who are challenged with disabilities, so it’s a great fit, and one that both myself and organization take very seriously,” said Noonan of his appointment. By Tim Pray


AWARE's leadership has been working to turn bills from the 2007 Corporate Congress in policy. Team members, left to right, are Terry Galle (front row), Donna Kelly, Jodee Barkell, Jeff Regan, Gale Evans, Tom Richards, Mindy Davis, Teresa Rivenes, Terri Waldorf, Leighanne Fogerty, Meagan Gallagher, Pat Noonan and Pandi Highland. Photo by Jim Tracy

Leadership committee turning Corporate Congress bills into policy On December 5, 2007, the 22 Corporate Congress delegates representing all the services and districts of AWARE convened their session at the Fairmont Hot Springs Resort. They had spent three long days debating, amending, and defending their respective bills on the Congress floor. All of the bills were written with input from staff, consumers, community stakeholders, and the delegates themselves; keeping in mind that the purpose of the session was to improve the ways in which AWARE delivers services, allows staff to efficiently deliver those services, and responds to the needs of the community. In all, 23 measures were approved on the final day, and each delegate left with the trust that their Bills — many looking much different than they did on the first day – would be taken seriously and that action would be taken. The bills have been taken seriously, and action is most certainly being taken by AWARE’s Leadership Committee, a collection of service

administrators — many of whom provided staff support throughout the session in December — who have been charged with making the Bills tangible policies and procedures in the everyday workings of AWARE. The Leadership Committee, chaired by Human Resource Specialist Leighanne Fogerty, meets once a month to work on many of the ground level priorities of the organization. The Leadership committee has developed an executable plan surrounding all of the past measures of the 2007 Corporate Congress. The “2008 Workplan” was reviewed by AWARE’s Management Team and then fully approved by the Board of Directors. Thinking inside the box The “Suggestion Box Act” was written in hopes of providing a more informal way to make suggestions within the group homes around the state, encouraging more discussions in regards to the details of daily life. As it stands, the boxes have been placed in Great Falls, Missoula, and the 24

homes of Galen. In June of this year, service director Carter Anderson will gather all program directors to assess the value of the boxes. The “Administration-Facility Cohesion Act” was written to ensure that the relationship between administration and those in the field becomes clearer, allowing for all AWARE staff to understand the complexities of each other’s work. The leadership committee is developing a survey that will identify and define areas of misunderstanding and, based on the results of the survey, a training program and implementation plan will be developed. In addition, plans are well underway for the implementation of a video conferencing network, addressing the need for equalization of services throughout the state and travel-free training. The “Adequate Modern Technology Act” was centered on the popular desire of many field staff to have their technology updated, allowing them to work more See Congress on Page 25


Congress... efficiently. The resulting actions have been swift and sweeping. At the time of this writing, AWARE is in the process of distributing more than 120 new computers, monitors, and printers across the state. Also being upgraded are bandwidth, network, security and other capacities as part of a comprehensive technology plan. The “Parent and Family Communication Act” stresses the importance of maintaining clear and constant communication with the families of the clients AWARE serves. Currently, the plan is to develop and implement a strategy to focus on the Unconditional Care value — “Families are Our Most Important Resource,” as it is consistent with this Bill’s message. A family preparation tool has been developed and is being utilized in all family service planning efforts. The Early Head Start service continues to refine and improve its efforts in bringing families together for support and education. Efforts are underway to replicate the Early Head Start’s success across other service areas. Youth in transition The “Transitional Services System Act” recommends services that will address the level of stress that a client goes through when he/ she is approaching the transition from youth to adult services. The Leadership Committee is designing and implementing a process that assures special attention is provided to youth who are approaching adulthood, and will improve the transition to necessary adult service systems. The team will convene and meet regularly until a clear process is in place to track and better meet the needs of youth in transition. The “Increasing Services Throughout Each Community Act” pushes AWARE to make more of an effort to provide a balanced offering of services in each of the state’s communities. Several courses

of action are in place to address this Bill’s requirements. For one, a demographic map of services will be developed in an effort to define community need and prioritize new service development. Second, AWARE management is discussing methods to approach more ongoing community assessment of several of the communities in which we provide services. Lastly, the telecommunications plan that is underway will act as an equalizer for many of AWARE’s mental health services that can be made accessible remotely. The “Orientation of Community Services Act” emphasizes the need for more awareness surrounding AWARE’s service offerings throughout all of the communities of the state. This awareness would allow for a family or client to know exactly what services are offered in the community aside from the service(s) they are utilizing. With the help of the newsletter, upcoming brochures, and a brand new website designed to be vastly more user friendly, it is thought that many instances of misunderstanding as to the services provided in a community will be cleared up. The “Continuation of Training Act” represents an effort to bring to light the work being done in the field and in the administrative offices through a forum, offered quarterly, updating supervisors and field administrative assistants on all administrative changes and/or updated policies and procedures. A survey is being developed by the Human Resources department in order to identify specific training needs. A training program is being developed to include a plan that will address ongoing and regular communication between Anaconda and supervisory staff and administrative coordinators. Further, a tremendous amount of focus has been placed into behavioral intervention skills, additional staff have been identified and trained 25

as training providers to increase AWARE’s overall training capacity. Additional training modules are in development to address specialized needs of children with autism, to support AWARE staff in writing measurable goals and interventions, and to support staff in facilitating client and family team meetings. Paying for respite care The “IFES Respite and Purchasing Act” was written to suggest a training for families that explains AWARE policies in regards to purchasing items and paying respite providers. It was suggested in the Bill that the policy could be addressed within the presence of a Family Support Specialist and given to families upon enrollment in the service. Currently, a payment calendar has been developed and implemented in order to establish and document deadlines, and a report is being filed to management in regards to the effectiveness, community satisfaction, and administrative ease and accuracy of the current reimbursement system. From this report, policies can be updated and explained to families upon entry into services. Related efforts include a comprehensive review of all aspects of respite care including reimbursement policies and procedures. The “Cohesiveness between Support Services and Case Management Act” stresses the need for more consistent communications between the services, as much in the way of similar work. The Bill recommends a focus on working collaboratively while keeping the obvious privacy factors in mind. Support services and Case Management are regularly sharing information and getting input on issues affecting both teams through monthly conference calls, shared trainings, and generally more regular communication. The “New DD Direct Care Employee Introduction Act” See Congress on Page 26


Congress... implements a system for direct care staff where an experienced employee introduces a new one to various stakeholders throughout the community, facilitating a seamless transition in which continuity of care is not compromised. Necessary process improvements are being made by reviewing the current efforts across communities and services to meet existing orientation guidelines related to orienting staff to community stakeholders. The “Responsibility Brings Independence for Quality of Life Act” increases the focus on adult treatment plan goals attending to independent living skills with special emphasis on bridging clients with the community. Currently, program policies, practices, and procedures are being reviewed to assure that goals in this area are being addressed. Outcome data are currently being collected that specifically measure the factors related to independence and quality of life. Pre-vocational opportunities The “Expanding Work Services Act” was written to spread the offerings of AWARE’s Work Services across the communities of the state, and the plans to address this are quite extensive. The development of a Job Developer/Work Services Manager position is underway, and, before an expansion of services can be implemented, the Committee will document work site job task analyses for jobs as they exist and are created. Once these data have been collected, a work group will convene and develop specific recommendations for the expansion of work service options. Other efforts are underway to expand work services into other day activity and pre-vocational opportunities for clients who may benefit. The “Staff Retention Act” seeks to make the staff situations across the organization more permanent. The Bill acknowledges that — given the nature of the work being done — there will always be those who choose not

to continue on. The Committee has developed and submitted proposals for the use of flexible work schedules, employee incentive programs, crises system improvements, and is evaluating administrative coordinator positions, training, communication and support that will enhance recruitment and retention of all staff. The “CSCT Training Act” was written to keep AWARE’s school program staff abreast of all the changes that occur within the school environment. Trainings, the Bill suggests, will be the tool to keep staff sharp. The trainings would serve as a refresher course for the returning staff, and as an introduction for the new staff, going over the methods of effectively working with the designated population. Beginning this June, at the suggestion of CSCT staff, annual three-day trainings will be held at the conclusion of the school year. The “Community Outreach Specialist Position Act” suggests the benefit that could be achieved through a community/regional representative. In an amendment to the Bill, it is recommended that public relations staff go through trainings and workshops relating to the specifics of each service in order to become more well-versed. An organized public relations and community assessment study is about to be undertaken that will examine AWARE’s relationship with communities and the effectiveness of outreach efforts. In addition, the management team has been reviewing staff positions and duties related to meeting the objectives of this act. The “Emergency Respite Care Act” provides a larger pool of emergency respite providers or families that can be accessed on short notice during a time of crisis. A respite care workgroup has convened with an agenda to establish current practices, review current data, and use all pertinent information to create a proposal to the Management Team, which will determine a course of action. 26

Finally, the “Training Act,” one of several variations of training measures, carries with it the goal of developing, implementing, and making available specialized training opportunities to address the needs of specific service populations. Applied Behavioral Analysis There are specific plans to implement several service specific trainings, as well as the addition of some more comprehensive curriculum such as early childhood training, working with autistic children, Applied Behavioral Analysis, a “CAN” like curriculum, and Quality Management/Unconditional Care training. All further service specific training opportunities will be forwarded to Human Resources, included in the monthly training calendar, published, and posted on the web site. For an example of this bill in practice, please see the article in this issue of AWARE Ink regarding the Montana Mental Health — Head Start Consortium. “It’s very exciting to see that, after such a tremendous effort put forth by the delegates at the Corporate Congress, their work has been embraced at all levels of management and that we’re exceeding our greatest expectations in our ability to implement so many of the great ideas that came forward,” says Jeff Folsom. “This speaks highly of how well AWARE is functioning and how committed our staff is to consistently and constantly try to make things better for the clients, families, and communities we serve. For questions regarding the progress of any particular Bill’s implementation progress, please contact Leighanne Fogerty at lfogerty@aware-inc.org. By Tim Pray

You have to know how to accept rejection and reject acceptance. — Ray Bradbury (1920 - )


Bringing kids home State seeks solutions to out-of-state placements treatment centers and therapeutic ontana group homes for could 211 Montana kids do more to keep who were deemed children at home untreatable here. who are receiving “Medicaid treatment out of doesn’t place – state for mental we reimburse,” illness. Dalton said. At least that's “The kids the view of state have a variety of officials and people who might other experts who have placed Photo by Jim Tracy testified before – including CEO Larry Noonan testifies before the Law and Justice Interim Committee in Helena April 10. the Law and DPHHS foster Justice Interim care, probation, Committee April 10 in Helena. biological parents, adoptive parents, guardians, etc.” Charts prepared for the committee by the Department The cost for out-of-state treatment ranged from $160 a of Corrections and the Department of Public Health and day for 43 children sent to Normative Services therapeutic Human Services show the state spends millions every year group home in Wyoming to $954 a day for one child to send children to facilities in Texas, Idaho, Nebraska, admitted to St. Alexius Medical Center in Bismarck, N.D. Colorado, Maine, North Dakota, Utah, and Georgia – Often lost in the discussion of money, though, are places with names like the Woodward Academy, St. Mary’s bigger questions about the most effective setting for Home for Boys or the Texas Oaks Psychiatric Hospital. treatment and fairness. Children end up at those and other out-of-state One boy’s treatment odyssey recently took him from facilities for a variety of reasons. One is the lack of options Pine Hills School in Miles City, to Acadia in Butte, to in Montana. Another is the law. Deaconess Hospital in Billings, back to Miles City, then State statutes prohibit mentally ill juvenile offenders back to Acadia and back to Billings. from being placed in a youth correctional facility. As of April 10, the state was scrambling to find a place Adults with serious mental illness who pose a danger for him in Virginia, Steve Gibson, administrator of the to themselves or others may be committed to the state Youth Services Division of the Department of Corrections, hospital for treatment or diverted to a crisis center (if told the committee. available), but Montana has no state-contracted or state“Many times kids have been at the bottom of the list operated secure residential treatment facility for juvenile when it comes to mental health treatment,” Gibson said in offenders. an interview later. Consequently, the state relies on private providers of He know those situations first hand after spending 34 residential treatment, such as Shodair, Yellowstone Boys years of his adult life working with children in various and Girls Ranch and Acadia. capacities in corrections and human services, including 10 Those private providers may reject very difficult or years as superintendent at Pine Hills Youth Correctional aggressive children or they may not choose to accept a kid Facility in Miles City. at the Medicaid rate, which happens routinely. “We’re sending 210 kids out of state each year for Data compiled by Mary Dalton, administrator of the services, but how many adults are sent out of state for Health Resources Division of the Department of Health and services either through corrections or the mental health Human Services, show that 47 Department of Corrections system?” Gibson asked. “I would say zero.” (probation) kids were housed out of state some time in “I just want to see the majority of Montana kids back in Fiscal 2007. Of those, 26 were covered by Medicaid. Montana receiving the care they need,” he added. “I think The children in these placements had a variety of it’s ridiculous to send all these kids out of state.” diagnoses and not all would have required hospital-level Dalton agrees more could be done to keep troubled psychiatric treatment. kids in Montana. Dalton’s data also show that in 2007, the state paid out “There are many, many different ways kids can be $9.9 million in Medicaid dollars to out-of-state hospitals, See Out of State on Page 28 By Jim Tracy

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Out of state... treated,” she said. “There are kids who will do better in different kinds of tailored treatment that can be done at home.” She also believes the state would do a better job of monitoring the progress of children if they were receiving therapy in Montana. “An advantage of treatment in Montana is that someone can see the child – a social worker or probation officer, for example,” she said. “We have different groups that can monitor for quality.” Still, she conceded, the state does not have enough dedicated beds now either in homes or more intense mental health facilities. “The thing that is hard about projecting the need for instate beds is that the numbers can fluctuate pretty wildly,” she said. “In Jan-March 2007 we had between 54 and 57 kids out of state in residential treatment centers in a given month. In January-March 2008, we had 21 to 25 kids out of state in a residential treatment center in a given month.” One option for legislative action would be a statecontracted or state-operated residential treatment facility or center in Montana for mentally ill youth. Montana hasn’t had such a facility for more than 15 years. The state closed its youth psychiatric hospital at Warm Springs in 1989, built a new facility in Billings and turned it over to Rivendell Behavioral Health Services to run. Rivendell closed the facility in the early 1990s and the state converted it into a women’s prison not long afterward. Since the youth facility closed, the state has been

shipping children who become involved in the juvenile justice system and need psychiatric treatment out of state. Gibson told the committee the state would have to spend $2.5 to $4 million to build a new secure 24-bed facility in Montana and another $2 million each year to run it. esources that already Whether children have been have been invested sent out of state by by the people of Montana the courts after a brush with the law should be brought to bear to or because of lack of facilities, the experts solve this problem — Larry who testified before the committee agree Noonan, AWARE CEO that most would benefit from being closer to home – near families and personal support systems. AWARE CEO Larry Noonan suggested a solution that would involve the state’s 54 providers of disability services. Most providers already are familiar with the legal and logistical requirement for managing group homes, including therapeutic facilities, Noonan told the committee. Plus, he said, they have the resources, including real estate and staff, to operate such facilities. Such a community-based solution would save the state money and provide a therapeutic setting closer to home. And it would serve more than 24 kids. “Resources that already have been invested by the people of Montana,” he said, “should be brought to bear to solve this problem.”

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

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