November/December 2008 Volume 2, Number 6
Plans under way for 2008 Congress
BIS trainers, left to right, are Mary-Graham Rasco, Barbara Mueske, Lisa Thiel, Pandi Highland, Julie Thilmony and Donna Kelly, with George Groesbeck, human resources director. Photo by Jim Tracy
AWARE will hold its 2008 Corporate Congress December 3 through 5 at Fairmont Hot Springs Resort near Anaconda. For those three days, representatives of each of AWARE’s services and districts will debate, rewrite and pass initiatives written to improve the ways in which services are delivered to customers throughout the state. Corporate Congress represents the unique way in which AWARE’s Board of Directors forms its directives for the upcoming year, taking suggestions and listening to input directly from the non-managerial staff and AWARE customers throughout the state. On the second night of Corporate Congress – December fourth – a banquet will be held to honor AWARE staff members that have embodied the spirit of unconditional care throughout their work. Awards will also be presented to those outside the organization who have displayed
Basic intervention training emphasizes consistency By Jim Tracy Consistency. Accountability. Communication. Those words come up again and again when you talk with the women charged with training AWARE staff in basic intervention skills, or BIS
Note to staff and friends
— Page 2
See Corporate Congress on Page 3
Forget can’t and don’t Second issue
— formerly known as module training. Whether you work in a group home, a day center, or a school, you’ll be learning the new approach to basic intervention skills beginning in January.
of Apostrophe on sale now. Story on Page 3.
See BIS on Page 18
Opponents tackle marriage penalty — Page 6
Home-ownership: Closing the gap — Page 10
Legislature studies mental health care — Page 15
Access to Justice topic of forum — Page 21
Climate changes, AWARE adapts of the new administration, the new Congress, and the Montana State Legislature, but the Medicaid program will remain.
Dear Staff and Friends, The Dow Jones Industrial Average is down five points. By the time I’m finished writing this, God knows where it will be. In a general sense, I’m aware of what the market is doing on a fairly regular basis, but have never been the type to watch a ticker on the bottom of a computer or television screen. As each day of our economic crisis goes by, though, I’m turning into that type.
We are not expecting to make changes at AWARE. That’s the most important thing. Any changes that we do see should be for the positive. All of our growth, for example, requires an extraordinary level of staffing. As you know, we are committed to finding the best and the most qualified candidate for any particular job. That’s the primary reason that we are able to remain competitive. We hope that the higher level of unemployment throughout Montana and the country will lead to fully staffed programs throughout our organization. There may, however, also be some negatives.
Over the course of the last month, I think most people have been able to sense the shift in people’s thinking and reaction to the downturn in the economy. It began – for me, at least – as a point of serious concern.
We own homes. There is reason to believe that the values of some of those homes aren’t what they were when we bought them. The fact is, it’s for this reason that we decided long ago that we wouldn’t buy every home intended to be used to provide services. We own half of the homes we occupy and rent the balance. When we rent a home, its owner pays property taxes to the community, thereby strengthening it in a financial way. Because we are a nonprofit organization, we do not pay property taxes to the community when we own the home, instead contributing the community through the jobs and services we offer. This economic compromise to the communities we serve is our business model known as “Nonprofit Plus.”
Like many issues that are brought up on the news each night, it was something to note, but not something that truly affected the lives of people in Montana, especially. But with these daily drops in the market and the amplified coverage, most people that I run across have been forced into a position of having to take the whole thing personally. People who may be close to retirement, people with families; this thing affects us all in different but very real ways. In October of 1987 the stock market crashed. Stocks rebounded quickly, but the savings and loan institutions did not, spawning a two-year-long global recession. I remember people’s attitudes during that time, and remember thinking about the sacrifices that I and those around me would have to make. I thought about the industries and sectors that would be insulated from economic problems. It was clear, though, that when the fundamentals of credit and inflation are the primary forces of an economic downturn, everyone is affected. Whether it’s a family, a business, a nonprofit organization, a church, someone with a disability or a person putting himself or herself through college, the days of not feeling as though the market has a direct impact on our lives ends quickly with deep and broad economic problems.
The ‘Nonprofit Plus’ model has worked for us. Nonprofit organizations are traditionally viewed as having to react, as being so dependent upon others’ good nature and the whims of volatile markets that they are forced to bend when times get tough. By doing this, non-profits are unable to offer the core of their missions, whatever they are. With Nonprofit Plus, we are not being forced to take a reactionary stand through crisis. We can handle fluctuations in the market while providing the same or better level of services that we always have.
Lawrence P. Noonan, CEO Geri L. Wyant, CFO Jeffrey Folsom, COO Mike Schulte, CHO
As most of you know, AWARE’s income is based in large part on Medicaid reimbursements. Nothing is guaranteed when you depend on a giant pool of money for your source of income, but the fact that these are federal dollars that get passed on to state governments provides – at the very least – an increased degree of security. There may be adjustments to these dollars, and the rates may not increase for a while; it will depend on the budgets
Board of Directors John Haffey, President John O’Donnell, Vice President Al Smith Teresa Marshall Cheryl Zobenica Keith Colbo Editing and layout: Jim Tracy Staff 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 ©2008, AWARE, Inc. All rights reserved. No part of this newsletter may be used or reproduced in any form or by any means without prior written permission of the publisher. Please send correspondence to: firstname.lastname@example.org.
of the human services world would be all but over. But things change. People become empowered. Families demand change. The courts make what they consider to best decision given the information at hand. The concept of choice – and what that choice means to people…it changes. Things that we were certain of became no more, and we adapted. We will continue to adapt.
We know that things change. For us, it’s best to strike a balance between good business practices and state of the art human service technology. That way, in economic times like this, we aren’t saddled with the burden of a slumping market. Every day, we do our best to help people, and in return, the government pays us for the help that we give. That money – the money that feeds your families and makes your car payments – is not going anywhere. Our customers, the individuals and families we serve are increasingly aware of the fact that they have a choice in where they get their services. Our job is to leave no question in those peoples’ mind as to who provides the services they may need in the most professional, responsible, and caring way.
Right now, the market is down 17 points. About 20 minutes ago it was up 176. I have no idea how or when our economic climate will improve. But I know that it will. I also know that – as an organization – we have trudged through crises that many thought would be our end. They weren’t. We are blessed with an intelligent, dynamic and caring staff who know that the first priority is always to provide the best services possible to people who may have problems far greater than the value of the dollar. We do that better than anyone.
In 1988, when I began working with AWARE, there was no Americans with Disabilities Act. There had been no Olmstead decision requiring that people with disabilities be served in the least restrictive setting. At that time, the institutions of the state were full and it seemed incomprehensible that – 20 years later – their complete dominance
With best regards,
Mental Health Parity Act tucked into bailout bill Law bans health insurance companies from discriminating against people seeking treatment for mental illness
passing the senate, it was submitted back to the House with the amendments, where it was passed by a vote of 263-171. Within hours the bill was signed into law by President Bush. The magnitude of this law is overwhelming, and will likely dictate the way our marketplace does business for years and generations to come. We are a country built upon free enterprise and – although out of necessity – the fact that the federal government is now the owner of hundreds of billions of dollars worth of bad debt and private bank assets will most certainly change the roles of hundreds of bureaucrats and reinvent – for better or for worse – the place of government in the capitalist market. Tucked deep inside the juggernaut Economic Stabilization Act, though, is a piece of legislation that has been struggling to be passed for 10 years. The Pete Domenici and Paul Wellstone Mental Health Parity Act will – in January of 2010 – make it illegal for any health insurance companies to discriminate against a person who may be seeking treatment for a mental illness. The new law will require health insurance companies to charge the same deductibles, co-payments, and other administrative expenses for mental health procedures and treatments as for any other sort of ailment. The bill as written reads: (i)The financial requirements applicable to such mental
By Tim Pray The first week of October witnessed the most expensive bill ever brought forth by Congress. The Economic Stabilization Act of 2008 allows the United States Secretary of the Treasury to purchase up to $700 billion of assets from the nation’s banks. The majority of the assets being purchased will be in the form of borderline worthless mortgage-backed securities from the banks of the country. The original bill was written by President George Bush and Secretary of the Treasury Henry Paulson. The intent was for the federal government to purchase the bad debt and get it out of the market where it was thought to be gumming up the credit and securities processes. When the President and Secretary of the Treasury submitted the proposal to the House, it was a three-page request to Congress for the authority to spend the money. After adding 107 pages of amendments and earmarks, the bill was not passed, having been defeated 228-205. The Senate, however, did pass an amendment to the original bill 74-25, but only after adding approximately $150 billion in additional spending and 341 pages. After
Parity Act continued on Page 4 3
ployer currently offers mental health coverage through their health plan, that the coverages (physical and mental) need to be equal. Employers who do not currently offer mental health coverage will not be forced to buy it, which begs the question “will employers keep offering mental health coverage?” It appears, though, that proponents of the act are busy celebrating the success of its passage for the moment, and not worrying about the ramifications down the road. Sen. Edward Kennedy who, along with Montana Sen. Max Baucus has been a long-standing advocate and supporter of the bill, told the Boston Globe “the miracles of modern medicine make mental illness just as treatable today as physical illnesses.” He continued, “after 10 years of debate, Congress has finally agreed to end discrimination in health insurance coverage that plagues persons living with mental illness for so long.”
health or substance use disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan (or coverage), and there are no separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits; and (ii) the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan (or coverage) and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits. There are certain points of concern throughout the new law, the most notable being those of enforcement. What incentive, for instance, will an employer have to keep their mental health coverage? The new law states that if an em-
Corporate Congress Delegates
an extraordinary willingness to build and foster relationships that benefit individuals, families, and communities. Awards will also be given for community achievement. All AWARE staff are encouraged to nominate a colleague for one of the Unconditional Care Awards. AWARE’s principles of unconditional care are:
This year’s Corporate Congress delegates and the groups they represent are: Administrative Field Representatives, Blanca Markwordt Administrative Services, Janis Zeier Residential Services for Adults with Developmental Disabilities, Lorna Stutz
Building on our strengths is the key to our success We take on—and stick with—the hardest challenges We are agents of change Everything is normal until proven otherwise Families are the most important resource I’m OK, you’re OK It takes a team Our connection with our communities is vital We strive to the highest quality of care Lighten up and laugh To nominate a colleague, describe in a paragraph or two how he or she represents a principle of unconditional care. Please submit the nomination(s) as soon as possible, but no later than Friday the 14th November. Nominations can be submitted to your service administrator, program director, service director, or Gale Evans at the Helena office via mail (616 Helena Ave, Ste. 305, Helena, MT 59601), email (email@example.com), or fax (406.449.3125). By Tim Pray
Work Services for Adults with Developmental Disabilities, Michelle Dolan Adult Mental Health Services, Casey Wagner Anaconda Customer Representative, Judy Armbruster Anaconda District Representative, Marianne Maes Billings Customer Representative, Dave Caldwell Billings District Representative, Jen Flemming Bozeman-Livingston District Representative, Rusty Jones Butte-Dillon District Representative, Kelly McGrath CSCT Service Representative, Carey Hamrick Targeted Case Management Service Representative, Leann Westgaard Early Head Start Service Representative, Jenna Ebner Eastern Montana District Representative, Eileen Dey Galen District Representative, Mona Fergerson Helena-Great Falls District Representative, Flannery Harpole IFES Service Representative, Kalen Zier Missoula-Kalispell District Representative, Stacy Fortner Support Services Representative, Jamie Knott Transportation Services Representative, Ed Hennelly Youth Case Management Service Representative, Brittany
I never guess. It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts. – Sir Arthur Conan Doyle (1859 - 1930), The Sign of Four, A Scandal in Bohemia
Schmeck Youth Group Homes Service Representative, Joe Schlegal
Positive people, positive stories
Magazine helping erase apostrophes F
or years, Connie Lewis has wanted to get a driver’s license, buy her own car and drive where she wanted to go. Now she can. Using PASS — or Plan for Achieving Self-Support — Lewis set aside money to buy a car that meets all her needs, a 2002 four-wheel-drive Honda CRV that offers safety, good gas mileage, a dash-mounted gear shift and a left-foot gas pedal that accommodates her disabilities. Lewis, who lives in Missoula, is featured in the second issue of Apostrophe, AWARE’s new magazine aimed at turning “can’t” and “shouldn’t” into “can” and “should,” The 72-page quarterly was mailed to more than 4,400 potential subscribers in October. The magazine also is being distributed at outlets throughout Montana. Apostrophe, a concept developed by AWARE Inc. CEO Larry Noonan, advocates for people with developmental disabilities and gives them another way to advocate for themselves. Every story, column and section in the magazine relates to “can” and “do” and eliminating apostrophes in peoples’ lives.
Buddy Walk. In early September, between 350 and 400 buddies walked a one-mile loop together around Missoula’s Playfair Park to promote acceptance and inclusion of people with Down syndrome. Since it started in 1995, the Buddy Walk has become the premier advocacy event for Down syndrome. More than 350,000 people live with Down Syndrome in the United States. Here’s something we all can do — change the conversation about the “R-word.” Timothy Shriver, chairman of Special Olympics, writes about the degrading use of the “R-word” — “retard” — and how we can put a stop to it and the mockery and bullying that go with it.
They’ve got game
Special Olympics (“dedicated to empowering individuals with intellectual disabilities to become physically fit, productive and respected members of society through sports training and competition”) is also featured in a story by sports reporter Harrison Lipsieia of the Sidney Herald. Lipsieia writes about the Diamond Cutters, the Sidney basketball team favored again to win the annual Special Olympics Montana hoops tournament Nov. 6 and 7 in Butte. Tom Dooling, a lawyer with Disability Rights Montana, writes about end-of-life issues in a section called “It’s the Law,” while Chris Clasby of the Montana Rural Institute explains the value and use of low- and high-tech memory devices in our “Access” section. On other pages you’ll learn how to prepare a turkey with all the trimmings, where to go for fall fun, how to become a savvy grocery shopper, how to prepare to vote in the Nov. 4 election and where to find a job. Apostrophe added to its staff in October with the arrival of Bryan Noonan, who has taken over as circulation manager. Noonan graduated in 2007 with a bachelor’s degree in economics from Montana State University. To learn more, call 406/5638117 (Jim Tracy ext. 38 or Tim Michael Campbell of Missoula, a violin student at the Cen- Pray ext. 15) or write to editor@ ter for Music by People with Disabilities, takes a bow during apostrophemagazine.com. a recent lesson. Campbell and the Center were featured in
Can-and-do attitude Students and teachers at the Center for Music by People with Disabilities in Missoula provide a perfect example of the can-anddo attitude in a story by freelance writer Ginny Merriam. In a sidebar to the story, Merriam recounts the experiences of musician Michael Campbell (on the cover), a young man with autism who has found a new way to communicate through his violin.. A home. A fulfilling job. Standing in the community. Lisa Howard of Hamilton, who has eliminated many of the apostrophes in her life, has all of that. The 43-year-old, who once spoke so quietly other people had to strain to hear her, is the leader of the Hamilton Kiwanis Aktion Club and president of the local chapter of People First. You can read about Lisa’s successes in a story by Holly Michels of Butte. In the magazine you’ll also find a story and photos from the the Fall issue of Apostrophe. Photo by Kip Sikora 5
People First takes on marriage penalty Opponents offer video testimony
ontana People First members and guests, with U.S. Senate Finance Committee staff linked in by phone, offered personal video testimony Sept. 26 about the pain and suffering caused by the SSI “marriage penalty.” Following the testimony, they presented more than 2,500 petition signatures they had collected from citizens all over Montana to a local staff member of Sen. Max Baucus, who chairs the Senate Finance Committee. The event took place in a packed room at Jorgenson’s in Helena on the opening afternoon of the annual People First Senate. The half-dozen or so people who testified, including several couples, spoke about the monetary penalty suffered by SSI recipients who marry. Those presenting testimony cited additional penalties such as: Not being able to openly celebrate their love and commitment to one another in the company of friends and family Not being able to inherit one another’s estates as a spouse Not being able to get information when their partner is in the hospital Not being able to make end-oflife decisions for their partner when necessary Not being able to make funeral arrangements for their partner Not being able to live openly as husband and wife Most people who testified did so anonymously with their backs to a video camera while Bernie OngoyFranks, director of Disability Rights Montana, interviewed them.
Just like everyone else “Just because I am disabled and live on a disability, I feel singled out,” said one woman, who spoke on the
Recording testimony at the Sept. 26 meeting of People First of Montana are Tony Anderson, left, and Chuck Council , both of Video Express of Helena. In the background, Bernie Ongoy-Franks, director of Disability Rights Montana, interviews a couple who oppose the SSI “marriage penalty.” Photo by Jim Tracy
condition of anonymity. “Other people can get married, but disabled people and old people can’t. Why? Because they’re normal and we are not, according to you guys. We are stupid and are different. According to God, we are all
re we supposed to feel sad and lonely the rest of our lives? You have taken our happiness and freedom away. — Witness at People First Senate meeting 6
the same in every way so for me being disabled I am speaking on behalf of of everyone else when I say I would appreciate it if you guys would treat us like human beings instead of being stupid and disabled. We are just like everyone else. “Are we supposed to feel sad and lonely the rest of our lives? You have taken our happiness and freedom away.” So what is the marriage penalty? Many people with disabilities live on a $637/month federal SSI benefit, an amount that is about 75 percent of the poverty level. When two unmarried SSI recipients live in the same
household and share expenses, each continues to receive a full $637/month SSI benefit. However, when two people with disabilities marry, and one or both receive SSI, their combined benefit as a couple is only $956/month, or only 75 percent of the total of their two individual benefits — $637/mo + $637/ mo = $1,274/month. As a result, SSI recipients hesitate to marry like their typical peers, in accordance with social convention and/or their faith, or choose not to marry rather than risk the loss of precious dollars for basic food and shelter, as well as for disability related expenses. Seeking to challenge this policy that treats people who share households differently based on their marital status, People First of Montana enlisted the help of several other groups to form a Montana Marriage Penalty Task Force. Members of the Task Force come from Disability Rights Montana, Montana People First, the Montana Advocacy Coalition, the State Independent Living Council, the disability rights organization ADAPT, the Rural Institute at the University of Montana, and the general citizenry.
Why is there a marriage penalty? The original reduction in benefits for a married couple, or a couple deemed to be married under Social Security rules, was put into place on the premise that there are “economies of scale” when two or more people live together. This “economies of scale” premise in SSI was patterned on the “economies of scale” present in the TANF program (originally ADC/AFDC) for families. When Congress implemented this “economies of scale” concept for married SSI recipients, they did so with no consideration for the extra costs faced by people with disabilities because of their disabilities. And since SSI monthly benefit amounts have not kept up with the
steadily rising costs of food, shelter and transportation, etc., an SSI dollar buys less and less every year. “Priced Out in 2006,” a national housing study published in 2007, found that the national average rent for a studio/efficiency apartment was less than a full SSI monthly benefit. A further complication exists for people with disabilities because the definition of “married” under the SSI program is broader than the common definition. The Social Security Administration (SSA) may deem a couple to be “married” for SSI purposes if they “hold themselves out as husband and wife to their community,” even though they do not meet the legal definition for marriage in the state in which they live. The expanded definition of marriage applies to situations where either one or both members of a couple are receiving SSI. Typically when applying for SSI, proof of marital status is not required if the person does not live with an unrelated person of the opposite sex, and claims not to be married. However, if a person lives with an unrelated person of the opposite sex, each must explain their relationship and answer certain questions. Some of these questions include what names the two are known by, whether they introduce themselves as “husband and wife,” what names they use on their mail, who owns or rents their home, and if there are any bills, installment contracts, tax returns or other papers that show them as husband and wife. How people answer those questions, along with other factors, is used by SSA to determine whether two individuals have “held themselves out to the community as married.” Therefore, SSA can consider a couple to be married even if the couple has never legally married. Too often, people with disabilities who rely on SSI choose to live secretly with a partner to maintain vital benefits at amounts that barely cover basic food and shelter costs. 7
The U.S. Supreme Court has found that SSA’s marriage penalty does not violate the due process clause of the Fifth Amendment, which prevents the government from depriving citizens of property, without due process. Unless another avenue for legal challenge emerges, Congress is the remedy for any potential “fix” that would change SSA regulations so that each beneficiary is treated as an individual. Montana People First members say they hope their efforts will inspire others around the country to join them in asking their senators and representatives to take legal action to remove the marriage penalty. For more information, contact Raylynn Lauderdale, Disability Rights Montana, at (406) 449-2344, E-mail: firstname.lastname@example.org.
Rules of Civility
1. Pay attention 2. Acknowledge others 3. Think the best 4. Listen 5. Be inclusive 6. Speak kindly 7. Don’t speak ill 8. Accept and give praise 9. Respect even a subtle “no” 10. Respect others’ opinions 11. Mind your body 12. Be agreeable 13. Keep it down (rediscover quietness) 14. Respect other peoples’ time 15. Respect other peoples’ space 16. Apologize earnestly 17. Assert yourself 18. Avoid personal questions 19. Care for your guests 20. Be a considerate guest 21. Think twice before asking for favors 22. Refrain from idle complaints 23. Accept and give constructive criticism 24. Respect the environment and be gentle to animals 25. Don’t shift responsibility or blame From Choosing Civility, The Twenty-five Rules of Considerate Conduct, by P. M. Forni, 2002.
“May you grow up to be righteous, may you grow up to be true. May you always know the truth and see the lights surrounding you. May you always be courageous, stand upright and be strong. May you stay forever young.” — Bob Dylan
BIS... Mary-Graham Rasco, Pandi Highland, Donna Kelly, Barbara Mueske, Lisa Thiel and Julie Thilmony spent two days in October in Anaconda learning how to implement BIS and the changes that go with it. Rasco, an AWARE trainer from Kalispell, explained that the major changes in BIS I and II, to be finalized by the end of 2008, are: making training manuals user friendly; creating systems of accountability for all staff to demonstrate their use of the principles outlined in the training; and training trainers who can be models of the BIS I and II principles as well as effective teachers. “AWARE is working with the BIS trainers and the leadership team to continually follow up with staff after they have received the training and to evaluate their effective and continued use of the concepts,” Rasco said. “BIS training assists in the development and execution of proven skills that are essential to good communication necessary for any relationship to grow, which is what AWARE is all about,” added trainer Julie Thilmony, program director in Billings. Thilmony explained that BIS breaks skills into these smaller steps that are easier to grasp: How to be a good communicator Positive reinforcement works wonders Good techniques to avoid or escape a power struggle The importance of consistency Choices are important Everyone doesn’t learn the same way Why consequences work Everything is not about control Objectives must be observable and measurable According to Mueske, AWARE’s adult mental health service adminis-
trator based in Butte, the old names, “Module I and II,” did not define the skills staff were learning. “Now,” she said, “anyone picking up the training manual will have clearly defined guidelines for presenting the material and for evaluating the group being taught.” She said AWARE and BIS trainers, along with the leadership team, will continually follow up with staff after they have received training to evaluate how well they use the concepts. “BIS is critical to AWARE as it provides standardized instruction for all staff and encourages a strengthbased, wraparound, measurable approach that we owe the people we serve,” Mueske said. Consistency emphasized One key difference between module training and BIS, is the emphasis on consistency. Now all trainers are certified by AWARE to teach the same material in the same format. Trainers are observed after they have been trained to assure they present the material as they were taught. “This change was needed because BIS I and II were not being taught consistently and regularly,” Mueske said. “The course is now offered monthly so all staff have an opportunity to be educated in BIS I and II and to use it in their service to the individuals we serve.” “This change is extremely important in that AWARE wants to assure that the concepts are being used correctly throughout the organization,” added Rasco. Thiel, a service administrator based in Kalispell, noted that all trainers are available to anyone who needs help incorporating what they have learned into their daily work. “Sometimes, the new employee hears all this new information, but once they get out into the field they get ‘stumped,’” Thiel said. “We encourage staff to e-mail or call any trainer with questions.” Highland, lead clinician and pro8
gram officer, noted that training is faithful to AWARE’s 10 Unconditional Care Principles. “Basic intervention skills are inherently critical to AWARE’s mission,” Highland said. “This is our effort to make sure we are striving to provide the highest quality of care. The training focuses on skill development of staff who work one on one with children and adults we serve, teaching them how to identify their needs and strengths, and how to provide the right service to the right person at the right time.” Mueske echoed that sentiment. “In order for individuals to achieve maximum independence, productivity and integration, we must always know what they want to achieve and how best to assist them to achieve it.” “Working with families and communities from a strength based plan and focusing on their strengths, we assist people to work on the goals they choose, and we measure their success toward achieving their goals,” she said. “This measurable information is essential to the person so that we may celebrate their successes with them. BIS I and II educate all AWARE staff about the importance of strength-based plans and measuring and celebrating success.” Teachable moments The terms “teachable moment” and “role playing” appear frequently in the manual and come up repeatedly during training. Highland defines teachable moment as “a naturally occurring time to teach.” “Such occasions,” she said, “are unique opportunities for staff to model appropriate behavior, model specific skills, or facilitate learning through a variety of means, that could include, but are not limited to visual aids, experiential learning, which can assist the person served in experiencing something in a new way.” Teachable moments occur at times when the person’s attention is focused
on an activity or situation and an interaction occurs between the person served, the care giver/staff, and the environment,” said Rasco. “A teachable moment is any time someone is open and interested in what you have to share,” said Thilmony. Role playing important She also emphasized the importance of “role playing” in training. “Role playing is good because everyone needs opportunities to try out a new pair of shoes before they take them home for good,” she said. “Role Playing is important because it burns into our minds the fact that just talking about it isn’t good enough,” said Rasco. “Acting and visual instruction are so helpful for our
consumers. The most basic principle of using a teachable moment is recognizing a naturally occurring moment to teach. Role playing is important in BIS I and II training because people learn in different ways. “The more opportunities that we can present individuals to learn in different ways and with different teaching methods, the more effective we are. Some people learn by listening, some people learn by observing and some people learn by doing.” Role playing provides structure and allows students to learn new skills versus stopping negative behavior and reinforces positive behavior, Rasco said. It also makes expectations clear and helps staff set limits, avoid power struggles and de-escalate difficult situations.
Ten Lessons for BIS Trainers
Learning can be fun Try new techniques It is not OK to teach/use “jargon” You can measure behavior and success You need to measure beh aovir and success There is a template on how you provide services to the people we serve You need to use the template in providing services to to the people we serve Don’t just “talk about” things with the people we serve, Plan Keep track of someone’s learning
Compiled by Mary-Graham Rasco
COMING EVENTS Nov. 17: National Provider Conference Calls/Question and Answer Periods To attend call, go to: http://www2.eventsvc.com/palmettogba/111708 10:30 a.m. – 12:30 p.m.
Dec. 4: System of Care Community Planning Committee Meeting Brondel Center, Helena 9 a.m. – 4 p.m. Dec. 5: Stroke Workgroup tele-health meeting* Telehealth 9 a.m. – 12 p.m. * Helena members will meet at Cogswell Building
Nov. 17: TASH web conference series, “Asset Building for Individuals with Disability” To attend visit TASH web site 12 p.m. – 1:30 p.m. Nov. 19: Montana Partnership Transportation Meeting State Capitol, Room 172 10 a.m. – 4 p.m.
Dec. 9: Montana Learning Collaborative III site visit Cogswell Building, Room 205-207 8 a.m. – 4 p.m.
Nov. 21: *CFSD State Advisory Council Cogswell, Room C-205 8:30 a.m. – 2 p.m. *Agenda available at mt.gov
Dec. 11: “Rural Health Care Outreach” Conference Call, 1-800-240-9939 and enter 6772932# 12 p.m.
Nov. 24: TASH web conference series, “Asset Building for Individuals with Disability” To attend, visit TASH web site 12 p.m. – 1:30 p.m.
Dec. 12: Statewide Independent Living Council Helena Wingate Inn, 2007 North Oakes 9 a.m. – 5 p.m. Dec. 13: Statewide Independent Living Council Helena Wingate Inn, 2007 North Oakes 9 a.m. – 12 p.m.
Dec. 3: Easter Seals Audio Conference, “Sensitivity Training” Contact Kristi Ross at 800-659-6428 12 p.m. – 1 p.m.
Assuring housing choice for people with disabilities
mericans overall have a home-ownership rate of nearly 70 percent, while only 10 percent of households headed by a person with a disability are homeowners. The Montana Home Choice Coalition commits itself to closing this home-ownership gap for Montana citizens with disabilities. The Coalition works through direct home-ownership services and partnerships with existing community home-ownership programs, resource development, advocacy, and education efforts to make home-ownership a more attainable housing choice for people with disabilities. To date, the Montana Home Choice Coalition has assisted 75 individuals and families with disabilities to become homeowners in Montana. With the assistance of the Montana Home Choice Coalition, these homeowners now control more than $5.6 million in housing assets, providing themselves a permanent, stable, affordable homes of their own. Changing false perceptions Home-ownership rates for persons with disabilities have been low for a number of interrelated reasons. Because of limitations due to their disability, the lifetime earning potential of many people with disabilities is severely limited, resulting in annual incomes that are too low to afford home-ownership. New efforts are being made on a federal, state and local level to make available greater resources to close the home-ownership affordability gap for people with low incomes.
The lack of education and knowledge about home-ownership has often been a barrier as well â€“ you cannot take advantage of opportunities unless you know they exist. Individuals with disabilities have often been viewed as not wanting to be homeowners or not being able to handle the responsibilities of home-ownership. People with disabilities in Montana and across the country have been proving these stigmatizing perceptions wrong for years. Montana citizens with disabilities want the same life opportunities available to all Montana citizens, including home-ownership. Home-ownership provides a positive valued identity for all homeowners. People with disabilities particularly are attracted to the greater level of independence and self-determination that home-ownership offers. Historically, too often people with disabilities were served in systems that kept them away from involvement in communities and took away control of making decisions about their own life goals and aspirations. The American Dream of home-ownership has proven to be an important vehicle
he thinking had always been that people with disabilities with low incomes could not afford to be homeowners. 10
for people with disabilities, giving them greater access to the American promise of life, liberty and the pursuit of happiness. In communities across Montana, citizens with disabilities have expressed clearly their desires to be homeowners and their willingness to take on the responsibility and advantages that home-ownership offers. General perceptions about the affordability of home-ownership for persons with disabilities are now being re-examined. The thinking had always been that people with disabilities with low incomes could not afford to be homeowners. When we look at the generally accepted historic practices in providing for the housing needs of people with disabilities primarily through subsidized development and subsidized rent for apartments, and specialized segregated living, we begin to discover that the affordability argument does not stand up to careful scrutiny. New construction subsidies of affordable rental units around the state are regularly averaging well over $100,000 per unit in new developments. In many situations, these units will need additional lifetime rental subsidies to make them affordable to peoples with disabilities with low incomes. Home-ownership freezes many aspects of lifetime housing costs in comparison to rental situations where rents increase each year. Financial advantage This financial advantage is what makes home-ownership so attractive to most Americans. Making
home-ownership more available and attainable to people and families with disabilities through increased home-buyer assistance and development of lower cost home-ownership options have the advantage of saving significant money over a lifetime housing cost in comparison to renting. Affordable rentals continue to be a critical and important need and housing choice for people with disabilities. Still, home-ownership needs to be an expanded option if we are to judge what is most economical and provide people with disabilities the advantages and responsibilities of home-ownership. A fundamental reason to make home-ownership a more readily attainable housing choice for people with disabilities is that in many cases it offers a much more affordable option for meeting the lifetime housing needs of a person with a disability. Home-ownership becomes particularly important when people with disabilities have mobility impairments and other physical accommodation needs. A home of your own allows you to set up the design and features that meet your specific accessibility needs, with the stability of knowing that you will have a home that works for you as long as you want to live there (and of course as long as you pay your mortgage). Family and community stability are the great advantages of homeownership, which is especially attractive to people and families with disabilities. The power to say you are a homeowner and participate in neighborhood and community life on that basis, with no uncertainty as to a landlord’s ability to displace you from your home, cannot be underestimated.
Have you decided that you want to settle down in a specific f you or member community or neighborhood and of your family accept the responsibilities of homehas a disability, we ownership, or do you prefer the flexibility of renting? can work with you Do you have a history of paying your bills on time? If you have to see if homedebt or credit problems, do you ownership can be know where to find assistance in cleaning up your credit history and an option for you. putting yourself on a financial path that could lead to home-ownership? Home-ownership opens the door Do you have the required to a fuller participation in commufinancial resources? Do you know nity life. Children of homeowners about existing, new and expandperform better in school and have ing community resources that may lower rates of at-risk behaviors. make home-ownership more attainFamilies, regardless of income, who able for you? What specific help is are homeowners have much greater available to you in buying a home? net worth and exhibit greater long Are houses available for sale term family stability. in your community in your price The Montana Home Choice Corange? Which specific mortgage alition can help people and families product is the best option for you in with disabilities achieve homefinancing a home purchase? ownership The Montana Home Choice CoPre-purchase counseling alition works for you in the homeownership process The Coalition provides educa The Coalition provides individtion, pre-purchase counseling, comual pre-purchase home-ownership munity resource referral, resource development, and home-ownership counseling, community resource referral, and home-ownership advocacy services with the goal of advocacy services to help people helping families with disabilities with disabilities explore homeachieve home-ownership. ownership opportunities and obtain The Coalition works with comreferrals to and information about munity partners throughout Monhome-ownership resources in their tana. If you or member of your family has a disability, we can work own communities. The Coalition works to idenwith you to see if home-ownership tify all potential resources that can be an option for you. can assist a family buying a home, Is home-ownership the right providing accurate and complete choice for you? information to allow families to Buying a home is an important decide which housing choices work decision and can be a complex best for their own unique needs. and challenging process. Patience, The Coalition provides links to realistic expectations and a willinghome-ownership education, homeness to work hard to achieve your buyer assistance, home-ownership goal are required. Learning about and preparing for home-ownership savings, credit counseling, and lenders. is the important first step. See Homes on Page 20 11
Keesha Newbreast, a fifth-grader at Emerson School in Butte, launches herself in the standing long jump competition in the standcompetition at the Special Olympics area games in Butte in Septbember. Photo byJim Tracy
All smiles, Hank Semenow enjoys the sunshine and the competition at the Special Olympics area games in Butte in September. Photo by Tim Pray
AWARE Special Olympics athletes and coaches gather at the Hope Thrift Store after the event. They are, left to right, kneeling front row, Dean Rollins and Hank Semenow; middle row, Billy Palmer, Joyce Ebel, Linda Weer, Karen Blume, Aimee Roberson, Troy Miller, Terri Rodden, Lisa Vidrine, Bill Massey, Judy Armbruster, Jeanne Klima, Dan Schlangen; back row, Norman Tholstrom, Jay Arensmeyer, Wally Newrobe, Brandi Wilson, Heather Arnaud, Steven Addington, Henry Huot, Dan Bowen, Russ Cartstens, Mike Kopp, Denny Bowen, Marty LeClaire, and Jen Krumm. Photo by Jim Tracy
Aimee Roberson, photo above, has concentration written all over her face as she prepares to toss a bocci ball at the Special Olympics area competition in Butte. Behind her, left to right, are teammates Brandi Wilson, Jay Arensmeyer and Dan Bowen of AWARE. Next to them are Lisa Johnson, Clyde Dodd, Lori Hipp and Kristen Johnson of the Butte team. Photo by Jim Tracy At left, Brandi Wilson takes in the action at the bocci court. Photo by Tim Pray
Athletes in Action Athletes from Anaconda, Butte and Dillon competed in track and field and bocci ball at the Special Olympics area games in September at East Junior High School in the Mining City. 13
Impossible become possible
Coalition helps woman find ‘right home’ By Anita Rutland For several months I searched the Internet, combing through all the listings of homes for sale, looking for one that would be appropriate for my mother, Patricia Warren, and myself. I have a rare hereditary condition, porphyria. Because of that I could not live in a house with lead paint, for example, or in an area where I would be exposed to toxins or chemicals. I had to find a home outside of an industrial area and one where I would not have a neighbor who used chemicals on their lawn. I also rely on a wheelchair, so any home would have to be accessible. Combine these things with limited financial resources and it seemed to be impossible to find the right home for us. Michael O’Neil with Montana Home Choice Coalition went through all the frustration with us.
also rely on a wheelchair, so any whome would have to be accessible. — Anita Rutland
works. The class was very informative, and they were instrumental in the financing of this deal as was the Bank of the Rockies. I would like to add that the Medicaid waiver program built a wheelchair platform for me to have access in and out of home. All of these organizations worked together flawlessly and fervently. Without their assistance we would have never succeeded in having “The Right Home.” I would like to sincerely thank everyone for doing such an outstanding job and for making this possible:
He suggested we considered doing a package deal, [land, home, utilities all in one deal]. We then searched for land first to find a “safe” environment for my condition that wasn’t too far from medical treatment. Then we found a manufactured home that was open and accessible. Once we found the land, Michael Michael O’Neil – AWARE put us in touch with Rural Develop Tom Atkins and Connor O’Keefe ment. The Bozeman office brought RD Bozeman this deal together. Neighborworks staff Tom Atkins and Conor O’Keefe Bank of the Rockies – Helena oversaw the entire process and Karla Egan, Nancy Svenson made sure all the requirements and and Nancy Mortag specifications were met. Contractor Mike Castellano Michael O’Neil had also spoken to us about the home-buyers educa- and crew tion course offered by Neighbor-
Anita Rutland of Ryegate and her dog, Wolfee, enjoy their new home. Rutland was able to build the home and make it accessible with help from the Montana Home Choice Coalition. Photo courtesy of Anita Rutland
Report to the Legislature Study called ‘road map’ to improved mental health care system efforts to expand Medicaid eligibility and develop and coordinate more comprehensive community-based services for adults, children and special populations such as Native Americans, veterans, and youth and adults in Montana's corrections system. The changes would ultimately reduce the use of highcost residential, hospital and corrections facilities, DMA says. The report says that Montana, with its strong foundation and track record eport for change, shows great criticizes potential for being a leader among frontier states in state’s fragmented mental health system of care system of service transformation. But it won’t be easy. delivery, financial The study, paid for with a reimbursement $200,000 appropriation from the 2007 Legislature, notes and tracking, and that Montanans face “significant access challenges” that data reporting. include a mostly rural and frontier character, limited mental health workforce, a large population in poverty and numbers of under- and uninsured people. In order to transform the system, DMA says the state would need: intensive coordination of services, funding and information; creative approaches to expanding eligibility; development of new and expanded services for children and adults that also meet the needs of special populations such as Native Americans, veterans and those in the corrections system. coordination of services, payments, funding streams and data; eligibility, access and underlying funding mechanisms; improvements in community-based care. Change would require input and support from local advisory groups – the people that DMA says are best qualified to know the needs of their communities, the report says. Under coordination of services, the report recommends “an overarching structure” to direct service, make and track reimbursements by funding stream, and provide regular data reports consistent across state agencies. In the area of eligibility, access and underlying funding,
By Jim Tracy
consultant hired to study mental health care in Montana praises the state for some of its practices, criticizes it for others, and recommends sweeping changes in the way services are delivered. In a 140-page report to the Legislature released in early October, DMA Health Strategies of Lexington, Mass., explains its key findings, options for improvement and recommends short, medium and long-term strategies for changing and improving the state’s mental health system. DMA applauds Montana for being “creative and proactive in piecing together multiple state, federal and local sources of funding to serve as many of its citizens as possible, wherever they live.” It praises the state for building its children’s mental health system on Medicaid and SCHIP (State Children's Health Insurance Program), “creating a comprehensive mental health system with relatively generous eligibility standards.” And it credits the state for using a waiver that created a legitimate way for Medicaid to pay for services that had historically been funded entirely with state money. The so-called HIFA (Health Insurance Flexibility and Accountability) waiver freed up state dollars to use as leverage for more federal Medicaid dollars. (See related story).
Patchwork of funding But like many other states, DMA’s report concludes, Montana's mental health care system is flawed by a patchwork of funding and services that do not consistently provide equal access or types of service across populations and payer systems. The report also criticizes the state for having a fragmented system of service delivery, financial reimbursement and tracking, and data reporting. DMA, hired last summer by the Legislature’s Children, Families, Health, and Human Services Interim Committee, was charged with identifying ways to coordinate Montana’s publicly funded mental health services to better serve children and adults with mental health needs. Six months later – after poring over mountains of data, interviewing dozens of health care providers, including AWARE staff, consumer organizations, local and regional planning groups and other stakeholders, visiting corrections facilities across the state, and reviewing the results of a survey that yielded more than 700 responses from stakeholders – DMA recommends changes in five areas, including an ambitious suggestion to develop a “Care Coordination Organization” to address fragmentation. DMA argues that such an organization would support
Continued on next page 15
A flood of admissions at Montana State Hospital at Warm Springs has stressed the facility, according to a recently released report by a consultant hired to study Montana’s mental health care system. Photo by Jim Tracy
the report notes imbalances in service access and reimbursement between: the child and adult systems; levels of severity of mental illness; income levels; and Medicaid vs. state payer systems. It also notes imbalances across urban, rural and frontier areas. DMA contends that limitations in Medicaid eligibility, especially for adults, can compromise access and make their symptoms worse, thereby creating a need for more intense and costly services. Limitations in Medicaid eligibility can also shift costs from potential federal matches to state funds, it says. “There is potential for making better use of federal funds through Medicaid Waivers and expanded eligibility,” the report says. Although adult and child mental health service systems are relatively comprehensive in Montana’s Medicaid plan compared to other states, the report says, some services “need expansion, with attention to specific regions of the state, rural areas in particular.” The report also discusses Montana State Hospital at Warm Springs.
psychiatry services supported by more attractive rates and tele-psychiatry, and the deployment of trained “peer recovery support specialists” in the community. “Further efforts to expand community-based acute inpatient capacity as alternatives to reliance on Montana State Hospital should be considered (in the context of an overall reduction in Montana State Hospital beds),” the report says. “This would be aided by efforts to increase housing options for the chronically mentally ill as well as by expansion of Montana's telemedicine initiatives.” DMA says the Legislature should also reconsider allowing the hospital to refuse admission to individuals who can be safely and appropriately served elsewhere as crisis capacity is developed. The state should then monitor hospital denials and how people who are denied admission are served elsewhere, it says. The DMA report suggests that the state could use videoconferencing for discharge planning that includes providers and family members, and compensate providers for travel time to the hospital to attend discharge planning meetings, particularly for consumers who have been hospitalized for long periods where face-to-face meetings may be particularly important. It also suggests that the state should measure the performance of the hospital and providers in participating in discharge planning and outcomes for discharged clients, and commit to ongoing appropriations to fund flexible services and supports in the community to facilitate timely discharge. In addition, it recommends that the state address barriers to the creation of additional community behavioral health inpatient facilities
Overusing Warm Springs Despite efforts to control admissions, overuse “is clearly stressing hospital capacity and resulting in unnecessarily high costs to the state,” the report says. “Utilization data suggest that many adults with serious and disabling mental illness are not receiving the services they need.” The report suggests an array of improvements for controlling use of the state hospital. It says key community services for hospital diversion should include more accessible crisis services, expanded 16
“The state should clearly commit to providing this service for its population on an ongoing basis,” the report says. It says the state should also expand the Department of Public Health and Human Services Extraordinary Case Review initiative and consider more extensive chronic disease management. Community crisis services as well as psychiatry would be key target areas for both adults and children. While residential placements for children have been reduced through recent initiatives, the report says they could be further controlled by improving intensive community-based family services and supports and by making greater use of tele-medicine. In the area of services for special populations, the report notes that Indian Health Service provides basic mental health and social services in its facilities but faces challenges in maintaining mental health staff but “too often sees people when their problems have reached a crisis.” Third-party revenues The system needs more resources, potentially through expansion of thirdparty revenues, the report says. In adult and juvenile corrections, the report notes well-documented increases in the criminal justice system of mental illness, substance abuse and co-occurring disorders, “yet mental health expenditures represent a very small portion of the corrections budget.” The report says the standard of mental health care in corrections could be improved by expanding case management for people who are diverted or released. Among veterans, Montana’s National Guard has made improvements in identifying and referring guardsmen with mental health needs, and the VA has expanded its mental health treatment and trauma training for eligible veterans. But, the report says, capacity for outreach is limited, and children of
discharging veterans are often not immediately eligible for Medicaid and may lack other forms of health insurance. The development of responsive community-based systems of care, the report says, depends on the input and effectiveness of local advisory groups. While Montana has Local Advisory Councils, Service Area Authorities and Kids Management Authorities, “the advisory process suffers from confusion regarding the definition of their respective roles, memberships and relationships with the state, inconsistent dissemination of needed systems information, and limited resources for statewide development.” The report says the state could better coordinate administration of the mental health system through “co-location,” improved coordination and consistent leadership of the Adult Mental Disorders Division and the Children’s Mental Health Bureau, with more effective financing rules and other changes. In addition, it says, the Department of Public Health and Human Services should develop a plan for a quasipublic Care Coordination Organization to manage mental health services for children and adults. This organization would coordinate services now overseen by different state agencies and make reimbursements for state-funded services as well as Medicaid fee for service. The organization would track expenditures by funding stream and disseminate standard reports across state agencies. Rep. Edith Clark, R-Sweetgrass, chairman of the Children, Families, Health, and Human Services Interim Committee suggests that even studying the creation of a managed care system may be unpopular. “I would expect a lot of opposition, especially from the providers still involved in litigation with the former managed care company (Magellan),” “There are a lot of programs that have just begun to function and so far have had some success,” Clark said. “I would advocate support for these types 17
of programs to continue while other avenues are being explored.” DMA says the state should also consider whether to include substance abuse services. For children, access to child psychiatry “must be improved” through aggressive recruitment and the consideration of higher rates for psychiatry services, the report says. “Wraparound service planning with intensive care coordination should provide more coordinated access to a broadened range of intensive community-based services and supports that should include para-professional family support, respite and flexible funds to purchase needed goods and services that fall outside of definitions of Medicaid medical necessity.” Out of home placements The child system would benefit from improved outcome reporting that holds providers responsible for maintaining children in the community rather than in out-of-home placements. All of DMA’s recommendations are aimed at fixing Montana's public mental health system based on goals outlined in President Bush's New Freedom Commission on Mental Health. That commission pinpointed three main obstacles that have prevented Americans with mental illnesses from getting the care they deserve: the stigma that surrounds mental illnesses, unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance, and the fragmented mental health service delivery system. Based on the DMA study, it appears Montana faces the same fragmentation and gaps in its mental health system and the same challenges. The full report, as well as smaller breakout sections, are available on line at the Montana Legislature web site (http://leg.mt.gov) under Children, Families, Health, and Human Services Interim Committee. For more information on the study, contact Sue O'Connell at soconnell@ mt.gov.
Two views Sen. Dan Weinberg
Rep. Edith Clark
“The most compelling item in the DMA report to the Montana Legislature is their recommendation to consider a quasi-public Care Coordination Organization,” says Sen. Dan Weinberg, D-Whitefish, a member of the committee and sponsor of legislation to pay for the study “Although many Montanans still have a bad taste for managed care organizations, due to the problems with Magellan in the1990s, it is conceivable that a CCO would give the state the flexibility they need to provide a broader range of services to targeted populations. “It is generally recognized that, when appropriate and possible, mental health services are best provided in the consumer’s own community. In this way, the person is not isolated from familiar people and surroundings. Sen. Dan Weinberg “Families can stay involved and the potential trauma of a trip to Warm Springs is eliminated. Improving community mental health is a stated objective of the legislature, DPHHS, and consumer groups. It has also been the conventional wisdom of mental health providers nationwide, since the 1950s. An additional benefit would be a diminished reliance upon the state hospital. “Having a CCO would not necessarily mean more dollars for the state, but it would provide the flexibility in resource management to make possible the construction of several Behavioral Health Inpatient Facilities, Weinberg said. “BHIFs represent the most important missing link in our extensive, and somewhat convoluted, chain of current mental health services. “The federal government provides a significant amount of mental health dollars, but with those dollars come loads of regulations. A CCO would require a waiver to depart from federal requirements, thus giving Montana the flexibility we need to serve our people better. “Transforming our system will take hard work and political courage. If bold steps are taken, there must be an absolute commitment to properly fund the system for the long term. We know that the status quo is not good enough. I hope that the legislature, DPHHS, and the governor’s office are up to the task.”
Rep. Edith Clark, R-Sweetgrass, Children, Families,
Health, and Human Services Interim Committee presiding officer, says her panel supports four proposed bills from Law and Justice Interim Committee aimed at improving mental health care for people in corrections. Those bills have a chance at success. But another proposal does not, Clark says. “There is a proposed study bill from the CHF committee to study a managed care system,” she said. “However I would expect a lot of opposition, especially from the providers still involved in litigation with (Magellan) the former managed care company. “There are a lot of programs that have just begun to function and so far have had some success,” Clark said. Rep. Edith Clark “ I would advocate support for these types of programs to continue while other avenues are being explored.” Among those are the 72-hour presumptive eligibility, peer support training and family support groups, continuing to expand discharge planning from the state hospital and the prison systems, continuing to supply and monitor drugs for the folks unable to secure their own medication, support communities statewide in their efforts to provide care locally. Clark also supports continuation of training for law enforcement and support for their efforts in crisis intervention. “The Department of Health and Human Services has been working very hard to start and continue to expand these services,” Clark said. “It will require funding to continue these efforts and it will be imperative that the mental health community providers, families, consumers and interested persons come together and remain focused on the forward movement.” “There are many special needs and special programs. There will be a limited amount of funding during this economic downturn. The mental health study provides a snapshot of where we are now. It gives many avenues for improvement. “The mental health community must come together and advocate as a solid front to the Legislature for the programs that will lead Montana into a directed, goal-oriented successful future for mental health.” 18
Retirement plan manager’s advice: remain invested will weather the difficult times,” she said. “Your company trustees perform their due diligence to ensure that the 401(k) offers the best of class investments with long performance histories at reasonable levels of risk.” Harris said investors – especially young investors like most people participating in AWARE’s retirement plan – can survive the downturn by sticking with their long-term investment strategy. They can also look at history for perspective on the current downswing. Here are a few comparisons she makes between the Great Depression and today’s economy: In 1933, unemployment was near 25 percent; today it is roughly 6 percent. The economy, as measured by GDP in 1933 had fallen over 25 percent; over the last 12 months (through 9/30/08) it had grown by 2 percent. Home foreclosures then were at about 40 percent; today they are around 4 percent. If a person were to have invested $100 in the largest 500 US companies in 1933, it would have been worth $442,000 on 12/31/07—an 11.9 percent/year return. Continued on next page
401(k) investments outperform peers ‘at reasonable levels of risk’ By Jim Tracy
oreclosures and delinquencies rise. Banks writedown assets. Banks call credit lines. Borrowers sell to meet margins. Asset prices decline. Banks tighten credit. It’s all part of a vicious cycle investors are caught in, says Elizabeth Harris, founder and owner of Intermountain Financial Group Montana, the Bozeman-based firm that has managed AWARE’s retirement plan for the past 10 years. “Conditions have just been so ugly,” Harris told AWARE Ink. “You superimpose the economic downturn on a bitterly contested election and an energy crisis the likes of which we haven’t seen since the ’70s, and you’ve got trouble.” And it’s likely to continue for a while. The Emergency Economic Stabilization Act, also known as the bailout, may keep stock and bond markets volatile for many months or longer, Harris said. “However, there are still outstanding companies, worldwide that appear in your 401(k) investment accounts that
Harris said 401(k) investors can take comfort in looking at investment accounts offered in the AWARE plan. “While stock and bond investment accounts do not guarantee your principle, you will see no distressed companies among the top holdings of any of our investment options,” she said. “You will also see that our investments outperform their peers consistently at reasonable levels of risk. These investments are ‘on sale’ now and may be purchased at a deep discount.” Investors should also keep in mind that bear markets historically and naturally run their course—regardless of investors’ fears and gloomy press. Harris advises staying in the market and taking advantage of the current window of opportunity. After all, such windows don’t open often. Using a chart prepared by Oppenheimer Funds, one of the largest mutual fund managers in the United States with more than 60 mutual funds and more than 6 million shareholder accounts, she explains why staying in the market may be the wisest choice. According to Oppenheimer, a hypothetical $1,000 investment over 20-year period (12/31/87 – 12/31/07), would have resulted in an 11.5 percent return, or a total of $8,860 for the person who stayed invested. (See the chart on Page 19.) That same investment would have resulted in a 10.1 percent return, or $6,851, if the person had missed the five highest performing market days. The same investment would have returned only $4,554, or 7.9 percent, had the investor missed the top 15 days, and only $3,304, or 6.2 percent, had the investor missed the top 25 days. A $1,000 investment in bonds over the same period would have returned 7.6 percent, or $4,298. “Most of us will only see a handful of buying opportunities like this current one in our lives,” Harris said. She believes efforts made worldwide to reverse the economic crisis will begin to bear fruit soon, but it will take time to stabilize world markets. Bailouts of the past have actually repaid taxpayers, Harris said. “The EESA package is an infusion of liquidity designed to unclog financial markets. The probability of recovering taxpayer funds is good as long as we correct the problems that caused the financial crisis.” If you want to talk more about current market conditions in light of how your 401(k) account may be affected, Harris would welcome your calls and e-mails (1-800-888-4068 or email@example.com). “We want you to feel confident that the investments you select in your 401(k) account are suitable for your risk comfort and for achieving your long-term retirement goals,” she said. Meanwhile, if you’ve been with AWARE for at least six months and want to begin saving, call or e-mail Kelsie for enrollment forms. She may be reached at 1-800-888-4068 or firstname.lastname@example.org.
Homes... The Coalition works with families as a guide, coach, and problem-solver as families move through the process of obtaining home-ownership. The Coalition shares its expertise and knowledge of options working with other agencies, real estate agents, and lenders to help a family achieve homeownership. The Coalition assists families in overcoming barriers that arise in the process of becoming a homeowner. The Coalition works every day to expand the resources available to support home-ownership for individuals and families with disabilities. NeighborWorks Montana The Coalition works closely with partners such NeighborWorks MT, the Montana Board of Housing, HUD, Rural Development, Montana Department of Commerce, Section 8 programs, Public Housing Authorities, HRDC’s and other community partners throughout Montana to open new opportunities for home-ownership and remove historic barriers to making home-ownership available as an attainable housing choice for Montana citizens with disabilities. Do you want to find out if home-ownership may be possible for you? If you or a member of your family have a disability and want to see if home-ownership is an attainable housing choice, please contact the Montana Home Choice Coalition today at AWARE Inc.: Michael M. O’Neil, State Director, 449-3120 ext. 11 (office); 4493125 (fax); or email@example.com (email). Visit the Coalition’s web site at www.montanahomechoice.org.
Kids in trouble Approximately 30,000 children in Montana between the ages of 9 and 17 are estimated to have a diagnosable mental health condition during the year. An estimated 16,500 children of all ages were estimated to have a Serious Emotional Disturbance (SED) in 2006. Of that group, 8,900 were estimated to be under 200 percent of poverty. The estimated rate of SED among children under 200 percent of poverty, the group most likely to be eligible for and in need of public mental health services, varies relatively little between the regions of the state, but varies as much as 15 percent between the highest and lowest prevalence counties. This is primarily due to economic and ethnic differences in county populations. From DMA Strategies report to the Montana Legislature on the state of mental health care in Montana
AWARE participates in Access to Justice Forum
n 2005 access to justice entities commissioned the homeless and has no money. She has been moving around Montana Comprehensive Legal Needs Study to exam- and living with relatives and people who would take her in. ine the legal needs of Montanans living in poverty. She is currently living with her boyfriend's parents, but the The conclusion: there is a substantial unmet need for team identified that these parents have concerns about her civil legal services resulting in a profound impact on those and her boyfriend living under the same roof. without the opportunity to address those legal needs. Child Protective Service’s solution is to put her on a bus Significant steps have been taken to address those needs to Idaho where the father who abandoned her can legally through creation of programs aimed at providing legal asabandon her. She wants to be emancipated and needs an sistance to Montanans living in poverty. The Forum Series attorney to assist her with this legal process. Of course, will highlight some of these programs. she has no money for rent or food, so obviously she has no More than 131,000 Montanans live at or below the money for legal fees. When you consider Maslow’s hierarpoverty level and tens of thousands are barely above the chy and that none of her basic needs are being successfully poverty line. Many Montanans living met, it is amazing that she can even below or just above the poverty line contemplate seeking emancipation. experience substantive civil legal What I learned from the Access to nfortunately, the problems ranging from employment security and servic- Justice listening panel was that more and housing to family law issues. than 131,000 Montanans (about 15 peres of our legal system are cent) live at or below the poverty level. While not all of these legal problost to most people living As many as 150,000 more are perched lems are unique to the poor, others are exacerbated by poverty, such as on the edge of poverty. Many of these in poverty only because livable housing. The legal problems citizens have acute legal needs like our they are poor. Unmet of low-income Montanans most 16-year-old client. Unfortunately, the legal needs definitely often involve essential human needs security and services of our legal system contribute to the cycle like food, shelter and health care. are lost to most living in poverty only According to the Legal Needs Study, because they are poor. Unmet legal of poverty. a low-income household is more needs definitely contribute to the cycle likely to have a legal need, and it is of poverty. much less likely that such a household will receive meanThe listening panel, which met at the Butte Public Liingful legal access. brary, was chaired by Justice Brian Morris of the Montana “The purpose of the Access to Justice Forum is to high- Supreme Court. light the civil legal needs of Montanans living in poverty The objective of the listening panel was to learn about and to demonstrate we care,” said Patty Fain, the Supreme and participate in increasing access to justice in the state Court’s pro bono coordinator. and in the Butte community. Fifteen forum speakers from “We’re making progress,” she added, “but there is so the state and the local area presented information to the lismuch more we need to do.” tening panel about the people they serve, and their access to Barbara Mueske, adult mental health services program justice needs. The majority of the presenters were attorneys administrator, represented AWARE on a listening panel at working in services that provide legal services to people an Access to Justice Forum Oct. 8 in Butte. who live at or below the poverty level. The Montana Supreme Court, Office of the Court AdEach organization discussed the fact that there is a ministrator, is sponsoring the forums as part of an effort significant need for access to justice and limited resources to expand access and eliminate barriers to the civil justice to meet the need. As a result of this unmet need, many of system for low- and moderate-income Montanans. The the people who live at or below the poverty level are not forums bring together community programs and access to afforded the justice we all deserve. justice leaders to discuss the legal, social and ethical issues “Legal Needs of Low Income Households in Montana, that bear upon accessing the legal system and its effect on Executive Summary,” a study completed by D.Michael Montana communities. Dale in 2005, found that there are “far too many low-income families who cannot find legal representation.” Here is Mueske’s report on the Butte forum: The study analyzed data from a survey of the legal During clinical consultation with the team in Helena that day I asked the team for an example of issues they have had needs of low- and moderate-income households collected throughout Montana by the Montana Bar Association with with access to justice for the people we serve. the assistance of Portland State University. They told me the story of a 16-year-old girl whose
parents had both left the state and abandoned her. She is
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The survey asked whether the household encountered certain situations that typically give rise to a need for civil legal services within the last year. If so, respondents were asked additional questions about how the household dealt with the issue — whether they obtained legal help, the reasons for not seeking assistance, and attitudes about the legal system as a result. The targeted group included people with mental or developmental disabilities, people with physical disabilities, domestic abuse survivors, seasonal agricultural workers, homeless people, senior citizens over 70, incarcerated people, Native Americans living on a reservation and Native Americans living in a non-reservation setting. Surveys were taken in all areas of the state. What are the legal needs of lower-income households in Montana? Housing issues — 38.2 percent Family law issues — 35.2 percent Consumer problems — 29.7 percent Employment issues — 28.9 percent Issues with public service — 27.5 percent More than half of the problems were rated to be “extremely important.” One of the striking observations in the analysis of legal needs of lower-income families in Montana is the significant role played by perceived discrimination in the reported legal needs of the respondent households in this survey. Discrimination was cited as a factor in fully 32.8 percent of the legal issues identified by the respondents in this survey. For low-income households in Montana, not only do they face discrimination when a legal issues arises, but overwhelmingly legal needs identified were not addressed with the assistance of counsel. In 83.6 percent of the legal need situations, the household was not assisted by a lawyer at all. Why were so few respondents represented and where did they turn for help? One of the key reasons that many of the respondents who reported legal needs did not receive legal help is that they did not seek it. Nearly a third thought that nothing could be done about the problem; almost one quarter didn’t think of the problem as a legal issue. About 20 percent did not know who could help with the problem or were worried about the cost. Also, 16.6 percent of respondents said the process of getting a lawyer was too difficult. One citizen felt intimidated. A majority of respondents did not know that there was a program that provided free legal services, and slightly more than half thought that they would be ineligible for free legal services. Resulting attitudes from having had a legal problem Overall encounters with legal problems were a “very negative” experience for respondents in this survey. Of those who experienced legal problems, 68 percent were
dissatisfied with the outcome. However, if a household had received some level of assistance, they were much more positive. On the other hand, if a household had tried to get help but did not succeed, the resulting attitudes were extremely negative. How large is the unmet need for legal services in Montana? The central finding of this survey is that there is an enormous unmet need for legal services among lower-income households in Montana. From the data generated, it is possible to estimate the size of that need — roughly 207,051 unmet legal needs each year in Montana. This widespread inability to obtain representation is creating negative attitudes with respect to the legal system. The study and the listening panel opened my eyes to the need of people at or below the poverty level — to wit, the people we serve at AWARE — lack access legal services when they need them. It reinforced our role as advocates and emphasized the fact that we must help people we serve to access legal services when they require them. As identified in the study, people at or below the poverty level are often not aware that services are available, that the services are free, and that they have a right to receive these services. It was clearly identified by the legal organizations that presented at the listening panel that when people seek these services, they are most often placed on a waiting list. The 16-year-old girl I discussed at the beginning of the article has an AWARE case manager who advocates for her and who called legal aid. The legal aid organization told the case manager that, in fact, there was a waiting list for her to receive legal assistance. However, the attorney said he would take the case pro-bono and begin working on it immediately. This was an example of excellent advocacy by the youth case manager and extreme dedication on the part of the attorney. The Butte Pro Bono group of Montana Legal Services Association, an award-winning organization, has arranged for services for people at or below the poverty level from every Butte attorney. All Butte attorneys participate by taking pro-bono cases. Ellen Donohue of the Montana Legal Services Association in Butte said in her presentation that this has eliminated a waiting list for services in Butte. For AWARE staff persons who are seeking pro bono services for the people you serve, you may call Patty Fain, Statewide Pro-bono Coordinator of the Supreme Court, at 406-794-7824. Her e-mail address is firstname.lastname@example.org. Patty will direct you to the legal services in your community. To provide the best quality services to the people we serve, it is paramount that we advocate for and with them to get access to legal services when they need them. It is our responsibility to educate them about this right. “Never ascribe to malice that which is adequately explained by incompetence.” — Napoleon Bonaparte
NEWS BRIEFS Report calls for more treatment of persons with dual diagnosis
Parents in Georgia worry: What happens when I’m gone?
Private hospitals and community agencies that serve people with autism and other developmental disabilities also must be prepared to deal with mental illness, which affects more than one-third of their patients and clients, according to a report released Oct. 10 in New Jersey. The Star-Ledger, quoting a report by the Dual Diagnosis Task Force, says hospitals should create more short-term treatment facilities and train more mental health professionals and direct care workers to treat “dually-diagnosed” people, who too often don’t get help for severe behavior problems. In New Jersey, developmental disability is defined as a chronic, life-long condition, like mental retardation, autism or cerebral palsy, that may interfere with language, mobility, learning, self-help, and independent living. A mental illness is medical condition, like major depression, schizophrenia, bipolar disorder, that disrupts a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. New Jersey Human Services Commissioner Jennifer Velez called the report a “landmark effort” that will help the state prevent disabled people from being wrongly institutionalized. Velez said she would use the report “to enable individuals to fully participate in community life through the support of a service system that delivers appropriate treatment.” The task force recommend that professionals be cross-trained in both fields, and that hospitals make accommodations for the patients.
As of 2006, more than 716,000 adults with developmental disabilities were living with caregivers over the age of 60 in the United States, according to David Braddock, a psychiatry professor and director of the State of States Developmental Disabilities Project in Georgia. The Atlanta Journal Constitution, in its Oct. 13 issue, reports that this causes concern for many caregivers. “Family members and advocates say this concern is magnified by a system with limited safety nets and the prospect of impending cuts in services for adult with developmental disabilities,” the paper says. In Georgia 17,000 adults are developmentally disabled and roughly 50 percent live in the greater metro area of Atlanta. Unfortunately the states facilities and services are steadily full, with about 6,300 people on waiting lists and some have been waiting for years. This is a problem becoming more significant in recent years, greatly accredited to the increase in technology and progressive modern medical practices. These practices are helping disabled individuals live much longer than previous projections. The story quotes Pat Nobbie, deputy director of the Georgia Governor’s Council on Developmental Disabilities. “Elderly parents have cared for their children their whole lives without support,” Nobbie said. “When they need it, the state needs to be there to help them.”
Cross-country skier going for the gold
For some parents, $100,000 per year out of pocket is the cost to educate their autistic children, according to a story in the Sept. 16 Boston Globe. This expense is wearing down families scrambling to come up with ways to give their children the most help possible, the newspaper says. Autism Speaks, the nation’s largest autism advocacy group, is pushing for 20 states to require private insurance companies to pay a portion of the expensive education for autistic kids. Autism is difficult to treat because of vague causes and the trouble in finding decisive research on what
Fourteen-year-old Montana Riehle is preparing to stretch her legs in the 2009 Special Olympic World Winter Games, according to the Great Falls Tribune. Riehle, who is from Great Falls, is a cross country skier and will be competing in the 1 kilometer, 3 kilometer, and relay race for Team USA. She has been training for the games since she was five. She will get to compete for her everyday coach, Chuck Kohut, because he was chosen to coach Team USA. The games will be in February in Sun Valley, Idaho.
Parents of children with autism look for help with out-of-pocket expenses
one,” she told the newspaper. “Jack (her son) was diagnosed by a neurologist, not a schoolteacher.” An agreement needs to be made soon as struggling parents become increasingly desperate for financial assistance. Some intensive therapy classes can cost from $25 to $50 an hour.
works, the paper says. Some researchers feel that educational treatment is more important for autism rather than medical treatment. “Many medical professionals say a child’s best chance to overcome, or just learn to cope with, profound and lifelong developmental and learning disabilities are these expensive educational treatments,” the news story says. Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, disagrees with the proposal. She feels insurers paying for educating autistic children would “drive up costs for everyone.” “In a sense, it’s asking for a blank check for therapies that we’d want more evidence to prove are really effective.” Parents who are trying to give their children the best life and education available don’t buy those arguments. “If my son couldn’t hear and needed a cochlear implant, we wouldn’t be asking the school system to take responsibility,” said Judith Ursitti, coordinator of the New England lobbying effort for Autism Speaks. “As a society, we have to acknowledge that autism crosses a line from an educational issue to a medical
New vocational rehab center planned
The University of Northern Colorado has received funds for a new regional center for vocational rehabilitation services. $3.5 million over the next 5 years has been granted for the center, according to an Oct. 16 story in the Greeley Tribune. This facility will be one of 10 centers in the nation, and will serve agencies in Montana among others. “The center will be designed to improve vocational rehabilitation services, enhance organizational operations of agencies, broaden professional development for rehabilitation staff, enhance regional capacity of rehabilitation professionals and fulfill the mission of rehabilitation services administration.” Compiled by Bryan Noonan
205 East Park Avenue Anaconda, Montana 59711 1-800-432-6145 www.aware-inc.org
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