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AWARE

October/November 2007 Volume 1, Number 2

Inside...

Notes from the tour ­— Page 2

Quality Assurance update — Page 5

Shrink wRap with Dr. Ira Lourie — Page 6

Automated Incident reporting — Page 8

AWARE IFES available statewide — Page 9

CEO named Behavioral Health Champion — Page 10

Book Marks — Page 11

‘Windshield time’ in Eastern Montana — Page 12

Employee Handbook review — Page 14

Psychiatry crisis?

INK

Recycling plant expands By Timothy Pray A million pounds of recycling are getting a new 12,000-square-foot home in Anaconda next to its previous home, the much smaller “Jim Dandy” building. The move, which opens up the former to renovations of the Hope Thrift Store and AWARE’s Day Activity Center program, means easier recycling for people living in Anaconda. Steve Francisco, AWARE’s Corporate Facilities Manager, who is in charge of the project, climbs out of his truck at eight in the morning at the construction site. “Wasn’t it just summer two weeks ago?” he asks. He walks up to the 12,000 square foot steel building and begins his rounds with the myriad of contractors who have already shown up on site, ensuring that the work being done is all according to plan and on schedule. “There are always small fires to put out. That’s the nature of contracting,” Francisco says. “This project, though, has gone exceptionally well, and everyone involved has done their best to ensure that we stay on budget and on time. That’s all you can ask for when you’re undertaking a project of

Photo by Sheila Horsley

Danny Bowen poses in the fork lift at Anaconda Recycling. Photo by Tim Pray

this magnitude.” Most of Francisco’s days are filled with facility management on a much smaller, but no less important, scale, overseeing every single one of AWARE’s homes, working with each community’s maintenance coordinators. See Recycling on page 18

‘My forever home’

Former nursing home residents enjoying family life in Glendive

By Jim Tracy Families come in all sizes and shapes. No one understands that better than Maureen Wildin and her housemates at the Grant Home in Glendive. Maureen used to live with 31 other people behind a high security fence in the Montana

Mental Health Nursing Center in Lewistown, a state institution with more than 100 residents. Today she and her housemates have private bedrooms in a tastefully decorated fourbedroom home on a tree-lined street in a quiet neighborhood on the southeast edge of Glendive. See Grant Home on page 4


Great Falls staff gather at Black Eagle Park in August to hear a report on AWARE from CEO Larry Noonan. Photo by Jim Tracy

Notes from the tour

Hundreds of pieces of chicken, countless hamburgers and hotdogs, pounds of potato salad, enough soda to fill a pool, thousands of angry bees, and a chipmunk. That about sums up my experience in August visiting AWARE offices around Montana. I criss-crossed the state attending picnics from Franklin Park in Missoula to Makoshika State Park just outside of Glendive, putting 2,565 miles on my truck, a lot of “windshield time,” as case manager Eileen Dey in Miles City calls it. Makoshika means “land of the bad spirits” in Lakota. Glendivers describe themselves as “good people surrounded by bad lands.” But I’ve found that even Montana’s bad lands beat the good lands in most other states. I followed a loose framework, knowing that each community would add something different to the discussion and agenda. With the state as large as it is, it would have been foolish to expect that everything be the same in every community. That’s part of what made this so enjoyable… not only getting the chance to connect with the people who work so hard, but connecting with them on their home turf, with all the subtle differences that exist from place to place…it was a great and informative trip. Attendance was good. The purpose of the tour was to speak to a few of the new things that are occurring organization-wide, a few things that are returning, such as Corporate Congress, and to speak generally about an

emphasis on communication. The “communication element” was threaded into everything that came up during the discussions, as the tour itself was based on trying to improve communication. More specifically, though, here are some notes from the tour: AWARE has brought on three new board members, bringing the number serving on the board to six. There is still an effort underway to fill two more slots, and when filled, the board will improve upon its already tireless work and be running on all cylinders. Board members, all volunteers, come from all walks of life and have agreed to take time away from their personal ventures to collaborate on ways to help AWARE continue as a leader in the services it provides. “AWARE Ink,” this newsletter, is another new development in improved communication. We have published newsletters before, and most versions of it have been put on the back burner. Tim Pray and Jim Tracy, both relatively new to the AWARE staff and introduced at the picnics, have come on board to work on various projects relating to both the public and staff, and one of those projects is to relaunch the newsletter and see that it remains a constant. Tracy has a background in newspapers, having been a reporter for the Montana Standard (Butte), publisher and printer at the Philipsburg Mail, and, most recently, editor

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of the Anaconda Leader. Pray moved to Montana from Los Angeles one year ago, and has a background in television and film, both producing and overseeing publicity for projects he worked on. Tim and Jim were brought on to wrap their arms around AWARE’s growth statewide. With so much happening, new positions were needed, ones that would relay new information to staff, friends of the organization, government bodies, and partners. Along with the newsletter, they are working on revamping the AWARE website and handling media inquiries, special projects, and community outreach. A major reason for the tour was to kick off this year’s Corporate Congress. The Board of Directors, now strong as ever, will issue its goals and directives at the time of printing, which signifies the official start to the Corporate Congress process, most importantly giving us a theme to work with for the year. Corporate Congress is a tool that genuinely sets us apart from other providers…other organizations as a whole, as a matter of fact. What form it takes is entirely up to us. More specifically, it’s up to the delegates involved to make arguments, ask questions, and provide enthusiasm

Lawrence P. Noonan, CEO Geri F. 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 Written and Edited by Tim Pray and Jim Tracy AWARE Ink is published bi-monthly 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.

that will shape the ways that AWARE works with communities. Ninetynine percent of the suggestions that delegates have given to me and to the management team over the years have, in one form or another, been implemented into AWARE policies and procedures. Our training program, HELP, is a product of such input from Corporate Congress. Coverage of this year’s event should be excellent, due to both Tracy’s and Pray’s backgrounds, and the entire staff of AWARE can expect to be filled in on exactly what happens day to day. The hope is that those who are shy or not interested in participating this year will get a better view of how Corporate Congress operates and will garner some newly rekindled interest in the event. State and contractual news was discussed as well. First, AWARE will now be providing targeted case management in Missoula, Billings, and Columbus due to the hard work of Jaci Noonan, who wrote the proposal to the Department of Public Health and Human Services. Jaci’s time, which was, until the beginning of August, primarily dedicated to Eastern Montana, will now be spent entirely across the state. AWARE is also the first statewide provider of Intensive Family Education and Support for children’s DD services. Considering the number of other providers, it’s a big deal. It’s also important to note that this adds a level of complexity to our services. When we serve a child, we can, if the individual so desires, make a seamless transition into our adult services. It can be a good thing for the consumer, and, of course, it can strengthen our professional credibility. The Montana Home Choice Coalition, a partner agency of AWARE that helps families and individuals with disabilities secure home loans and coaches them through the entire process of purchasing a home, has secured an additional $200,000 in funding from the state. This money is available to all agencies like the

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Coalition, but year after year, it has been Michael O’Neil, director of the project, who seeks to secure the dollars. The “picnics” involved a lot of speaking, more than some people preferred. For instance, a gentleman from the Little Belt Home in Great Falls who had to wait an hour for lunch, observed—when he got a chance to get a word in—that “a speech is like a wheel—the bigger the wheel, the longer the spoke.” It’s hard to pass up an opening like that, so I stopped talking and we had lunch. A debate topic that emerged from the tour was what’s better—chicken from the supermarket deli or grilled burgers and hotdogs? We had burgers and hotdogs in Miles City, Glendive, and Kalispell and chicken in Billings, Great Falls, and Missoula. I can tell you that the chicken from the Missoula Broadway Street Safeway, hands-down, was the best. In Butte and Anaconda, which as everyone knows is different from the rest of the state, they served sandwiches. I’d like to start doing these trips more often. As the organization continues to grow, it becomes increasingly important to keep in touch on a face-to-face basis, although remembering everyone’s name will be virtually impossible. I always tell people that, if they see me at the mall or at a restaurant or something, please say hi…I always enjoy seeing AWARE folks in random spots around the state. When I started working at AWARE in 1987, I never could have imagined it would take me a month to get around to the different communities and meet all the people who are doing all this amazing work. It was a great trip. I hope all is well with everyone,


Grant Home...

area economy is nearly $500,000. Before they even The construction moved in, Maureen of the duplex added and her housemates an additional shortwere deeply involved in term impact with making decisions about local contractors and their new home through suppliers. focus group design Fannie Mae meetings. provided project They made it clear, financing through for instance, that they local lender, Action wanted to share their Mortgage, using home with only three the Fannie Mae other housemates, Community Living avoiding the stress of Loan for the first living in the typical Grant Home in Glendive complements a new Senior Center across the street in Glen- time in Montana. eight-bed adult group dive. Photo by Codi Newton The Community home. Living Loan provides They wanted advantageous residential rate financing bathrooms with spacious baths and hey tell us they feel for small, community-based homes for showers that allow staff to help them safe here, and that has adults and children with disabilities who with their daily hygiene and bathing a lot to do with our success. cannot live independently. routines if necessary. They wanted full AWARE contributed significant accessibility so that medical or mobility — Natalé Adorni, Grant financial and organizational resources impairments no longer required that Home to build the home. they be in a hospital or nursing home The Montana Home Choice setting. They wanted private space Coalition directed development of combined with shared space, including Development, Fannie Mae, AWARE, the project. AWARE coordinates this a patio where they could sit outdoors. and the Montana Home Choice statewide coalition of Montana citizens, But more than anything else, they Coalition, a statewide collaboration led advocates, providers, federal, state, wanted their own bedrooms since many by AWARE that creates better housing tribal, and local agencies, the housing adult group homes and adult foster care choices for people with disabilities. finance community, Realtors, and the programs where they had lived before HUD HOME Investment home-building industry, all working required them to share a bedroom. Partnership Program funding together to create better community The Supportive Living duplex administered by the Montana housing choices for all people with design they agreed on meets all their Department of Commerce was key disabilities. The Coalition works on needs. It incorporates private rooms to making the project affordable. A housing issues across the housing and and shared living space, innovative $276,776 grant allowed the partners to accessibility features throughout, design and build a home truly tailored to disability spectrum. Developing new community living options for people the needs and wishes of the residents. outdoor sitting areas and landscaping— with disabilities in institutions is among The City of Glendive donated the overall a place where Maureen and her its priorities. project land. In return, the community housemates feel secure. In accordance with Americans with gained eight new residents and the “They tell us they feel safe here, Disabilities Act and 1999 U.S. Supreme services AWARE provides to them. and that has had a lot to do with our Court Olmstead decision, AWARE In addition to providing a quality, success,” said Natalé Adorni, program and the Coalition pulled together the affordable, and safe home for people manager at the home. with severe disabilities, the duplex made partners to successfully transition “You watch them grow,” Adorni residents of the Nursing Care Center added. “You invest in them. You witness a significant economic contribution to to community living. This is part of the area. them being able to have a quality of life an overall effort by AWARE and the Residents, ages 47 to 65, receive they would not have had without this Coalition to close a wing at the Nursing support 24 hours a day, seven days experience. Every day we let them do a Center and open up 22 community a week. The total direct job creation little bit more” associated with the program was 14 full- living opportunities for its former Maureen and her housemates were residents. time jobs with total estimated salaries able to move into their new home in All of the residents—adults with and benefits of $400,000 a year. 2005 thanks to a partnership of city, serious disabling mental illness with The total annual estimated state, and federal governments, the long histories of institutionalization economic contribution to the Glendive Department of Housing and Urban

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and frequent hospitalization—now have the chance to live successfully in a community while at the same time having their health and safety needs met with individualized on-site intensive supportive services. AWARE provides these services through the Montana Department of Public Health & Human Services and the federal Medicaid program. Adorni explained that the Grant Home uses strength-based strategies, emphasizing what residents have rather than what they do not have, what they can do rather than what they cannot do and what that have been successful at rather than past failures. “When you go to strengthbased, you really need to rely on the community,” Adorni said. “The community is an external caregiver to our clients.” Glendive has filled that role nicely, she said. The city was chosen as the site for the home for four main reasons: preference of future residents for a home in Eastern Montana; Glendive’s welcoming attitude toward people with disabilities; a trained, experienced direct-care workforce; and the city’s active participation in the project. The site where the partners chose to build is across the street from a new, HUD-funded Senior Center. City officials felt that the duplex would complement the Senior Center and improve the neighborhood at the same time. The lot where the home sits was previously the site of an abandoned house the city had demolished in an otherwise well-kept neighborhood. Now after two years of success in community living (all other original duplex residents have been successful as well), Maureen loves to tell visitors about how much she loves where she lives now. She calls it “my forever home.” “We have pushed that families come in all sizes,” Adorni said. “And we are family here.” Michael O’Neil, Director of the Home Choice Coalition, contributed to this story.

Building AWARE’s quality assurance system Program officer Pandi Highland, a licensed clinical social worker based in Butte, has been traveling the state after helping revise charts and clinical material to assure that AWARE continues to deliver the highest quality services. By Pandi Highland

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o date, I’ve traveled the state from Miles City to Helena, Kalispell to Butte, from Dillon to Bozeman, from Great Falls to Anaconda, and from Deer Lodge to Missoula. There is one city left! I will travel to Livingston in October to audit Support Services and to provide training regarding the new forms. This is just the beginning! This servicewide quality assurance audit is part of a continuing effort to deliver quality service, and we are building a system to utilize in the future. Each service is responsible to schedule quality assurance audits, and I will provide assistance as needed to complete the audits. This is our first step in formalizing the process. At the same time, quality assurance is just one aspect of how we are assuring that we are following our values of strength-based, familydriven services. Pandi Highland The quality assurance audits have been a joy! I’ve had the opportunity to visit multiple AWARE offices across the state and meet the fantastic teams who provide our comprehensive and coordinated services! As part of this process, I’ve been able to train staff regarding the new forms for Strength-Based Service Plans, Outcomes, and Assessment Tools, teaching new skills, celebrating successes, and supporting our teams’ practice. New forms developed for Strength-Based Service Plans, Outcomes, and Assessment Tools have been implemented with positive results from staff and families. We sincerely believe that building upon strengths is the key to success! By using the new forms, which focus on identifying individual and family strengths, we are helping families create responsive, dynamic, and flexible approaches to accomplish individual goals! Quality Assurance helps AWARE deliver the highest quality of care available! This is a challenging opportunity, but each of the communities and the individual staff that I’ve worked with during the last 90 days embody the value of providing high quality care and are up for the challenge.

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SI hrink wRap say, “This is what we have always done!,” or “This is what the KMA (Kids Management Authority) is doing!” But, there are some major differences that make this Child and Family Team process special, producing unique and more pertinent responses that work better than what has been tried in the past with this same family. (For an explanation of KMA, please see Page 15.)

n the last issue of AWARE Ink this column focused on AWARE’s Unconditional Care Commission (UCC). In that article I told how AWARE’s management had made a recommitment to unconditional care and how the UCC had been created to define what Unconditional Care at AWARE actually means. A lot has happened since that original article was written over a year ago and that is what I’ll be talking about in this article.

The first difference is the concept of service planning being strength based. Again, you might say, “We’ve always been strength Dr. Ira Lourie based! How is this different?” What The UCC was an exciting and makes this different is that this time we are not dynamic process that included a wide range of only going to make a list of strengths that the AWARE employees on the Commission itself, individual has, we are going to use those strengths input from groups providing children’s case in coming up with solutions for their problems. management, therapeutic family care, group For example, when we identify that being a good homes, and finally a focus on the UCC values at fisherman is a strength that a particular individual Corporate Congress last fall. has, we will find a way in which his or her interest and expertise in fishing is used in helping to get Since that time, AWARE has moved ahead past that person’s needs and problems. toward full implementation of the UCC values, especially in our child and adolescent services. A closely related second difference is that the All of our case managers and therapeutic family Child and Family Team will not only focus on the care staff have been trained in planning services strengths of the individual who is in our services, for children and adolescents by using Child and but also the strengths of his or her family. Often Family Teams. Using this approach, a family we can find ways in which these strengths can becomes partnered with AWARE staff and other providers and agency workers involved with their be used to overcome not only the individual in our services’ problems, but also family problems case, to collaboratively create an intervention that might be complicating the problems of their plan what will best help the child or adolescent family member or hindering solutions. involved. The AWARE staff member (a case manager or a TSS) works with the family to help Both the using of strength-based approach and them elucidate their needs, to figure out with Child and Family Teams is being accomplished then what has and hasn’t worked in the past, by the use of new assessment and treatment and to then develop intervention strategies to planning processes developed within AWARE help alleviate the problems. Some of you might

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under the leadership of Pandi Highland from Butte. Our new assessment process is focused first on strengths and only later on needs. And this assessment doesn’t just list a few strengths that people have identified off the top of their heads. Rather, it goes through all aspects of people’s lives to systematically discover strengths where they might otherwise be overlooked. Then it is the team’s job to use those strengths to meet the needs that have presented themselves. If we add these family strength-based interventions along with our more traditional program related resources, we ultimately end up with a more powerful and useful intervention plan within which the family has a prominent role in the solution to individual and family problems.

and haven’t even asked about the past. The job we have in helping individuals and their families is a very complicated and difficult one. When we do it without considering the wisdom of the individual and the family we are blocking out a major resource and trying to do the job alone both with blinders on and an arm tied behind our back. Things work best when we have true professional and family collaboration. A fourth difference is between the AWARE Child and Family Team and the state’s KMA process. Yes, the KMA does bring many of the same people to the table. But, it is less personal and more formal with decisions often being made out of the context of the child and family strengths. The KMA has regular members who gather together, listen to a presentation about a child and his or her family and make recommendations. On the other hand, the Child and Family Team is made up of family members and individuals who are working closely with the family, some who are agency representatives and some who are folks from the community, including family friends. Unlike the KMA, which is a static one-step process, the AWARE Child and Family Team is a dynamic ongoing process that works with family members over time, constantly revising the treatment plan as needed. Our AWARE Child and Family Team approach is based on the national model of providing “wraparound services” as the vehicle for providing true interagency supported care.

The third major difference in our new Child and Family Team approach is that of Family Voice and Family Choice. Over the last 20 years we have progressed more and more as a field in being more family friendly. This has meant that we do a better job of encouraging individuals and their family members to be aware of and participants in the treatment planning process. But more recently, there has be a shift from this approach, in which we have struggled to make families more included in the decision-making that professionals direct, to being first family centered or focused, in which families have a greater role in the treatment planning to where we are today with Family Voice, Family Choice. This is based on the strength-based approach in which the family’s strengths are recognized and utilized. In recognizing family strengths, we come to the understanding that a family’s ideas about what needs to be done and what might help are important and have a great deal of validity. Yes, professional opinion about what needs to be done has a very important place, but if the professionally driven ideas don’t have acceptance by the family, they probably won’t work. Often I ask families of children, “What has worked in the past, and what hasn’t worked?” They always have an answer. And when they are asked further, why aren’t we doing the things that have worked, the answer is that the current professionals in the case have their own way of dealing with problems

Making our services more strength based, family driven and team oriented will improve our services. AWARE’s Unconditional Care Values bring us closer to providing services in this family and strength-inclusive ways. When we are fully successful in making these values the basis of our service delivery we will reach the goal of delivering the best and most appropriate services that we can, along with the individuals we serve and their families. Dr. Ira Lourie serves as Medical Director to AWARE, Inc. He is the author of “Everything is Normal Until Proven Otherwise.” He resides in Hagerstown, Maryland.

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Automated system speeds up reporting of incidents By Jim Tracy

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onna Kelly remembers the days when reporting incidents required hours on the telephone taking notes. Like other AWARE staff charged with investigating and resolving incidents reported at group homes, work areas and adult day centers, Kelly had to communicate on paper and send correspondence through the mail, waiting days sometimes to get a response. Today communication about incidents travels at cyber-speed thanks to an automated reporting system developed by AWARE information technology specialist Nick Rub in Billings. “He’s got it set up so that if two people sign off on a report it gets sent off automatically to the state and to the consumer’s case manager,” said Kelly, supervisor of supported living services. “It’s really good because it gets out immediately to the people who need it.” Staff used to wait until the mail brought them reports written on paper. “Now I come in in the morning, turn on my e-mail and if there was an incident report during the night, it’s already there internally for me to see,” Kelly said. The automated system also makes it easier for staff to discuss incidents.

Friday meetings Kelly sits on several AWARE incident management committees that gather every Friday morning by conference call. Meetings are kept to about an hour and a half. Members of the committee, which handles incidents involving adults affected by developmental disabilities or mental illness, are Chief Habilitation Officer Mike Schulte in Anaconda; Program Director Julie Thilmony in Billings; Training Director Tim Hahn in Galen; Case

Manager Gloria Glaser in Miles City; Service Administrator Barbara Mueske in Butte; adult mental health Group Home Manager Tommy Walker, also in Butte; and Kelly. Another separate committee handles incidents involving youth receiving mental health services. The committees establish what happened and what measures are needed to prevent further occurrences. They also review all internal investigations surrounding critical incidents. In some cases, outside agencies become involved, such as law enforcement when a crime has been alleged. Providers have 15 working days to complete the investigation. The automated incident report form includes details such as the names of the parties involved, dates and times, type of group home, a written account of the incident, names of witnesses, type and location of injury if there was one, injury causes, and comments by supervisors and committee members.

State regulations In the case of people affected by developmental disabilities and mental illness, Montana requires providers to report deaths, emergency room visits, allegations of abuse, neglect or exploitation, medication errors, police involvement, injuries, missing persons, property damage, restraint, and suicide threats and attempts.

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ow I come in in the morning, turn on my e-mail, and if there was an incident during the night, it’s already there internally for me to see. — Donna Kelly 8

Providers must submit both “reportable” and critical incidents, each requiring separate procedures. When an incident occurs, the supervising staff member typically logs into the network and answers questions on an automated form, Rub explained. Some questions are simple check boxes while others feature drop down menus. “Once you start, it’s very easy to get through,” Rub said. “Once you hit ‘submit,’ all the parties who need to know have been sent an email with the report.” Depending on whether an incident is tagged as critical or not, supervisors of the facility where the incident happened review the report and add comments and suggestions. The reports are sent automatically to the consumer’s case manager and to a quality improvement specialist, or QIS, at the state. The QIS oversees contracts with provider agencies like AWARE that serve persons affected by developmental disabilities and mental illness. The QIS’s job is to monitor and review programs. Usually incidents are resolved by changing practices or providing training or counseling, said Mike Schulte, who chairs the weekly incident management team sessions. A key advantage of the system, he said, is that it helps keep staff throughout AWARE’s service areas informed. “If a staff member at a group home comes on in the afternoon and there has been an incident in the morning, they’ll know about it,” he said. It also takes advantage of staff experience. “With this system, committee members can enter their own comments about an incident,” Schulte said. “That’s very helpful because they have a wealth of knowledge and Continued on page 11


Family Support Service consumers can now choose AWARE in all five Montana DPHHS-DD regions “Almost everyone uses respite. For many families it’s a Godsend,” Kelly said. The service can also provide coaching in parenting in addition to medical care. AWARE Support Specialists already certified in IFES are Deb McGrath in Livingston, Renae Jones in Bozeman, and Mary Graham Rasco in Kalispell. Kelly is also working on certification for Emily Pray, also in Kalispell, and Jenne Peterson in Butte. The specialists have 14 people on their caseload of eligible consumers, but that list should grow e have a with the expansion huge array of of AWARE’s IFES services. And if we don’t certification in all five regions. Across have a resource, we have the state some 323 enough connections consumers are receiving the service, to get that resource. with a long waiting list — Mike Kelly, IFES of people who have Director applied. With AWARE now a statewide provider, families needing IFES everywhere in Montana have at least two provider choices. “They really are in the driver’s seat when it comes to choice,” Kelly said, noting that consumers can “port,” or carry, their eligibility with them within a region and from region to region.

By Jim Tracy People across Montana can now access Intensive Family Education and Support services through AWARE. “We are now a recognized provider everywhere in the state,” said Mike Kelly, IFES service director who is also in charge of therapeutic family care, community support and outpatient therapy services. “After nearly five years of effort, we are the first and to date only service provider to be authorized to provide IFES in all five regions of Montana instead of only the two regions where we formerly were allowed to operate.” Kelly explained that IFES services are intended for families with children—from infants through age 21—who have extraordinary needs and a developmental disability. “Intensive Services is a Medicaid Waiver program that provides case management and an array of other support services,” he said. “The service is aimed at families whose children have uncommon medical or behavioral needs as well as a developmental disability.” IFES can curtail out-of-home placement for children now living with their natural families or allow children living in more restrictive environments, such as group homes, to return to their natural families or to be placed with foster families. “The program is required to have a strong case management component,” Kelly said.

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Keeping families informed AWARE’s four family support specialists (or case managers) assure that eligible families know about and use appropriate services. Such services include respite care, minor modifications to a home, physical therapy, occupational therapy, speech therapy, adaptive equipment, and habilitation aide services. Each family’s needs are considered when developing an “Individualized Family Service Plan” and personalized cost plan, Kelly said. “It’s very similar to the therapeutic family care services we offer,” he said. “With the right training and support, we can provide an excellent service.” Kelly gave this hypothetical example of a person who might benefit from IFES: a child with autism who is “medically fragile and has frequent mood swings, someone who needs one-on-one supervision, someone who is selfabusive, someone the school system has identified as too much work, too much trouble, too disruptive and unsafe to himself and unsafe or others.” Parents of such children often become frustrated and need respite, or relief from the day-to-day pressures of care-taking, he said. IFES can help cover respite care.

Choosing AWARE for the service, he suggested, makes sense. “We have dedicated, trained staff who have a tremendous amount of resources available to them to assist families,” he said. “We have medical expertise. We have people with mental health backgrounds. We have people with developmental disability experience. We can put a team together like no other provider in the state by virtue of who we are.” “We have a huge array of services,” he added. “And if we don’t have a resource, we have enough connections to get that resource. The consumer really is our priority. We look at what is working and how we can further support that by using what works with kids and their families to make sure their needs are met. We turn those needs into strengths. “People talk about teams, but I really think AWARE takes it very seriously.”

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PROUD OF THEIR EXPANSION, the Anaconda Recycling Center crew poses in front of an aluminum can baler that was used at the 2002 Winter Olympics in Salt Lake City. Front row (left to right), are: Lisa Vidrine, Judy Armbruster, Terri Rodden, Aimee Roberson; back row: Norman Tholstrom, Denny Bowen, Jerry Micheletti, Wally New Robe, Dean Rollins, Danny Bowen, Dan Schlangen, Hank Semenow, Dan Ramsey, Linda Weer, Jay Arensmeyer, John Micheletti, Russ Carstens, and Dave Venturelli. Photo by Jim Tracy

National publication names Noonan ‘Behavioral Health Champion’

Larry Noonan

AWARE CEO Larry Noonan has been named one of the year’s Behavioral Health Champions by Behavioral Healthcare magazine. He will be featured as part of the cover story in the November issue. The Cleveland, Ohio-based monthly describes itself as “the practical resource on technology, reimbursement, and treatment trends for managers and clinicians in the mental health and substance abuse fields.” In the cover story of the August issue, titled “Opportunity born from tragedy,” writer Ronald A. Allison argues that the Virginia Tech tragedy should motivate changes in Virginia’s mental healthcare system According to Allison, executive director of the Cumberland Mountain Community Services Board in Cedar Bluff, Va., and a member of the Commission on Mental Health Law Reform in Virginia, the Virginia Tech tragedy has placed the nation’s mental healthcare system under the microscope “with Virginia’s public system being examined under high magnification.” After the shootings, the American public was justifiably upset, he writes. “People who normally don’t think about mental healthcare wondered, ‘How can something like this happen in rural America?’ ‘Could someone have stopped this from happening?’ ‘Is the mental healthcare system broken?’” Allison says responsibility for the tragedy is unfairly being placed “squarely on Virginia’s public mental healthcare system.” “The general public’s reaction is understandable, but from a realistic point of view, this condemnation is totally unjustified,” he says. “After all, the public mental healthcare system lacks adequate funding and the necessary resources to be able to prevent incidences like the Virginia Tech tragedy.” You can read the entire article at www.behavioral.net.

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Book Marks Book Marks

Each issue of AWARE Ink includes a collection of books recommended by staff, covering a range of topics related to the work we do. This issue features titles suggested by Barbara w who has worked for AWARE as a service administrator in Adult Mental Health Services for the past 2½ years. She has worked with people with mental illness for the past 30 years. Barbara holds a bachelor of arts degree in English, a master’s degree in counseling and a nursing degree. Saving Millie By Tina Kotuski This heart-wrenching account of a daughter’s reactions to and life with her mentally ill mother gives powerful insights into what children experience when they have a mentally ill parent. It is a difficult book to put down once you begin the read. Shock By Kitty Dukakis and Larry Tye I recommend this book to all professionals, not only to inform themselves about the history of and current states of ECT, or electroconvulsive therapy, but also so they can recommend it to patients. Any patient considering ECT would do well to read Dukakis’ and Tye’s take on this intervention. Kitty Dukakis has battled disabling depression for more than 20 years. Coupled with drug and alcohol addiction that both hid and fueled her suffering, Kitty’s despair was overwhelming. She tried every medication and treatment available. None worked for long.

Incident reporting... can use their experience in assessing a situation and suggesting ways to resolve it.” The system also makes it easy to spot factors that may be contributing to recurring incidents—time of day or location, for example. For training director Tim Hahn that automated trend analysis is a big plus. Before the new system came on line he had to sort through reams of paper reports to analyze incidents and try to identify trends. “This is much easier and faster,” he said. According to Rub, the automated reporting system is unique to the industry. “We’re the only company that has this system in place,” he said.

It wasn’t until she tried electroconvulsive therapy, or ECT, that she could reclaim her life. This book became available in paperback on Sept. 6. The Boy Who Couldn’t Stop Washing By Judith L. Rapoport, M.D. Having a family member myself who is diagnosed with obsessive-compulsive disorder fuels my hunger for information about the mysteries surrounding this irrational disorder. Dr. Judith Rapoport shares the extraordinary experiences of her patients to give their first -hand accounts of living with a disorder where people spend six hours a day washing their hands and still cannot believe they will ever be clean. New breakthroughs in the diagnosis are discussed in the book. His Bright Light By Danielle Steel I am not a Danielle Steel fan and, in fact, I don’t believe I have ever read one of her books before this one. His Bright Light is a personal story of Danielle Steel’s son’s life. It is an account from a parent’s perspective of raising a child with bipolar disorder. She chronicles his life and the progression of the disorder and its effect on her and the entire family. She describes her interaction with and reaction to professionals with whom she worked to treat her son. It is a depiction of a devastating illness and a harrowing portrait of a masked killer called bipolar disorder.

Other providers use a program developed by the state. Rub, a 2003 graduate in computer and information technology from the University of Cincinnati, spent about a month writing the first draft of the program. First he broke down the paper incident reporting forms provided by the state. “Basically what I did was to take what I know about what computers can do for people and applied that to the paper form. First I wrote the program in English, then I wrote it programmatically using data diagrams to see if everything was going to flow.” “Everything has to link together,” he said. “I had to write a lot of different things to make this work.”

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Even now he’s making fine adjustments so that supervisors will be able to change information about staff and consumers. While the program is more convenient, Rub said its real value is that it frees up staff time for other jobs. “Doing manual tasks usually requires hours of paperwork,” he said. “With the automated system, not only is it faster, but you have more face-to-face time with your clients. You get to do other things that are even more important sometimes.” AWARE staff who use the program agree. “We love what Nick did,” Kelly said. “It’s really working well for us.”


Road work

Case managers brave blizzards, ‘windshield time’ to serve consumers By Jim Tracy

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ome days AWARE case manager Eileen Dey sets out at 5 a.m. from her cozy office in Miles City to visit clients on unmarked back roads 150 miles away. It’s not out of the ordinary for Dey to log 300 miles or more on a day trip in her 2004 Chevy Suburban and to return home long after dark. “Generally I take off very early in the morning,” Dey told AWARE Ink. “It’s common to be gone for 12 to 14 hours, especially on days when I visit clients on the Crow and Northern Cheyenne reservations.” Dey and her counterparts in Miles City, Glendive and Westby – Keith Polesky, Gloria Glaser, Patrick Roe and LeAnn Westgard – travel circuits across a 10-county area in Eastern Montana that is bigger than the state of South Carolina. They regularly visit outposts that aren’t even listed on the state highway map. Dey’s stops include small towns like Lame Deer, Wyola and Busby, but also places with only a handful of people and no services – places like Jim Town and Muddy Cluster and Teepee Town. Case manager Gloria Glaser’s twice-a-month circuit takes her to small towns, smaller towns, and wide spots in the road. She has clients in Wibaux, Baker, Richey, Circle, Terry and Fallon and stops in the country “that are in between those places.” Directions to those in-between places are sometimes sketchy. “To visit one of my rural places between Wibaux and Baker I was told to turn by the feed lot, take a left by the supper club, go five miles and take a right by the roping arena,” she said. Long hours on the road (“windshield time,” Dey calls it) gives the traveling case managers an appreciation of the vastness and beauty of Eastern Montana. Among the breathtaking sights on the eastern flatlands are the

towering storm fronts that fill the sky in late afternoon, creating a backdrop like a giant projector screen for lightning and rainbows. Summer thunder clouds may be a sight to behold, but it’s best not to get caught gazing at an Eastern Montana winter storm. AWARE’s circuit riders have learned to take winter storm warnings seriously—if they know about them ahead of time, that is. “A couple of times I’ve been caught in horrible blizzards,” Dey said.

White-knuckle drive On one occasion, she spent a several white-knuckle hours in her Suburban crawling back to Miles City on Interstate 94 after it had been officially closed because of a snow storm. “I made it home on a wing and a prayer,” she said. “The biggest trouble out here is you never know what the weather will be like,” said Keith Polesky of Miles City, who has been plying eastern Montana roads as an AWARE case manager for nearly 16 years. One of his weekly trips takes him 200 miles north to Glasgow and back with stops in between. “You may see four vehicles in a 200-mile stretch of the highway in the middle of the week. You may … and I repeat may … see four vehicles,” he said. “You usually see one car an hour—a car about every 75 miles.” So don’t count on a lot of help if you get stranded.

Sun rays burst from a cloud bank east of Miles City on a summer afternoon. Photo by Jim Tracy

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“If it starts to blow, ride or we would have there are no hills or sat out there and froze,” trees to stop the wind,” Westgard said. Polesky said. But that was nothing He recalled a storm compared to the storm he ran into on the way that stranded her in back from Glasgow last Plentywood for four spring. days in 1996. “It crept up on She was returning me. I was driving, and home after visiting everything was fine. consumers and heard a There was a little snow warning on the radio. blowing. All of sudden “It said the weather I topped a hill and it was going to get bad, so was a white-out. It I took off out of town,” was like driving into a she said. different world.” Highway 5 climbs With snow pelting from the valley where Walls of snow line Montana Highway 5 between Plentywood and Westby in the his windshield, he Plentywood is to a high far northeastern corner of the state. Photo courtesy of LeAnn Westgard pulled over at a farm plateau where Westby is house about 50 miles outside of Miles City. located, just 26 miles away. In good weather, the trip takes “I just pulled into a driveway,” he said. “I couldn’t even about a half hour. see the road.” “By the time I got to the top of the hill, I could barely An elderly couple took him in until the storm cleared see,” Westgard said. “If you can’t see in Plentywood, you enough to continue. know Westby is going to be way worse.” He had to stop again farther down the road at the home She had driven only about a mile out of town, so she of a friend. The storm finally let up three hours later. turned around, drove back to Plentywood and got a room at “It took me eight hours to get home from Glasgow that a motel. day,” he said. “It should have taken three hours.” “I was stuck over there for four days,” she said. “Everybody was stuck there. The stores weren’t even open LeAnn Westgard has had lots of blood-pressure-raising because those who got out of town, including many of the experiences driving on snowy roads in the northeastern business owners, couldn’t get back in.” corner of the state. For three days she attempted to return home on various For a storm story, though, it’s tough to top her yarn back roads with her brother-in-law, who works for the about the time she spent four days in Plentywood waiting telephone company and was driving a one ton pick-up. for the road to open so she could return home. “Every day we would try a different road to see if we An AWARE case manager for 14 years in Westby on could get back,” she said. “We ended up coming home on the North Dakota border, Westgard regularly drives 180 the fourth day on a seldom-used back country road that a miles from there to Glasgow at least three times a month, farmer had plowed.” often staying overnight to complete her rounds. She has White crosses 45 people on her list of consumers, about half of them in Even when the weather is good in Eastern Montana, Plentywood. roads often are not. Hilly, curvy Highway 313 between “I just like to spend the time with the consumers,” she Saint Xavier, which dead-ends at the Yellowtail Dam, and said. “I’ve known many of those people for 14 years. For Fort Smith, is littered with white crosses—reminders of a lot of them, we are their families. You’re basically what deadly accidents. they have.” There are lots of other scary roads on and off the Thirty below reservations. Among those, Dey includes Blue Creek Road, She’s had a few close winter calls, like the time in Lynch Road, Cow Creek Road and Highway 212. 2000 when she and a fellow case manager broke down on But there are scenic byways that more than make up Highway 2 between Glendive and Sidney. It was about 9 for those, she said, like “the Little Horn Road, between at night and the temperature had plummeted to 30 below. Wyola and Lodge Grass.” Traffic was a trickle and most of the vehicles that passed “It’s an incredibly beautiful drive,” Dey said. “Every them didn’t stop. time I go down that road I’m filled with awe.” “Thank goodness someone finally did and gave us a Continued on page 14

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She’s also been awestruck by wildlife that share the roads. One day she was driving from Miles City to Muddy Cluster on the Crow Reservation. Her young passenger kept saying “Deer! Deer! Deer!” “All of a sudden there was the biggest, handsomest whitetail buck I’d ever seen standing in the middle of the road staring at us,” Dey said. On his road trips, Polesky has seen “a lot of deer, elk, antelope, even bobcats.” “I’ve seen pretty much about anything you can imagine, but I haven’t seen a bear yet,” he said. His most memorable wildlife experience occurred in the winter on Interstate 94 north of Miles City. “A herd of antelope was crossing the highway,” he said. “They followed the leader in almost single file over the fence. I had to wait for a long time for them to cross the highway. There must have been 150 antelope stuck between two fences on the interstate. It was pretty wild.” Case manager Patrick Roe doesn’t have as many wild tales to tell but give him time. He has been with AWARE for a year, making trips from his office in Glendive to visit consumers in Sidney, Culbertson and Bainville, a round trip of a couple hundred miles. Roe said he routinely dodges turkeys and pheasants in the AWARE minivan. For Roe and the other case managers, the job makes the long trips worthwhile. “I like working with the people,” said Roe. “It’s the best part of it.” “They depend on you to be their family, to be their outside link to the world, to access services and assistance and to advocate for them,” said Polesky. “A lot of our clients don’t have family involvement. It’s our job to insure they have the best quality of life possible. It takes a lot of work to make sure their quality of life is enhanced.” For some of the people they serve, case managers are their lifeline. “There are some that I am their only support system,” Glaser said. “Some have no family or no close family. They look at me as their link to the outside world.” Glaser numbers among her successes a woman who bought her own home with AWARE’s help.

“Now they hug me and have even offered me sweet grass braids (a prairie grass used as incense),” she said. “It’s taken almost a whole two years for them to let me in.” Jaci Noonan, DD case management director, worked as a case manager in Glendive for eight years, serving clients in small towns in Dawson and Richland counties. Here’s how she summed up her trips while supervising the rest of the counties providing coverage: “Bad weather, blizzards, other harsh weather, critters in our path including pigs, wild turkeys, cow herds, skunks and the other animals our state has to offer, the miles between, vague directions to travel on gravel roads, broken windshields, being snowed-in, eating way too much gas station food, different cultures, no cell phone reception, late nights, should I go on?” But the blessings, she said, far outweigh the hardships: “Getting to know the clients and their families, the ability to work with a variety of service providers and community and state resources, the incredible scenery we view with each trip, the books on tape and singing to myself, getting to see others on our team, getting to know other cultures and history, and hearing and assisting with the success stories of the folks we are honored to serve.”

Bad wiring, leaky roof “She was living in substandard conditions in a mobile home,” she said. “The steps were dangerous, especially for a person with physical challenges. It had bad wiring, poor heating, and the roof leaked. It was just kind of falling apart.” Today the woman has her own home and keeps it up with the help of AWARE and her neighbors and natural supports in Glendive. Dey counts among victories just being accepted by consumers and their families on the Crow Reservation.

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Employee Handbook review underway Here’s your chance to review AWARE’s employee policies and procedures, make comments and suggest changes. The Human Resources Department has been revising the Employee Handbook for the past year. The handbook is designed to acquaint staff with AWARE and provide information about working conditions, employee benefits and policies affecting employment. It covers such items as equal employment opportunity, open door policy, orientation, benefits, time keeping and payroll, work conditions and hours, leaves of absence, and employee conduct and employee discipline. Please take a few moments to review the draft revisions, located on AWARE’s Employee Web Site, and forward any questions about the policies in the handbook or suggestions for policy changes to your immediate supervisor or to the Human Resources Department. Or send your questions and suggestions to “Ask AWARE” at ask@aware-inc.org and we’ll pass them on.


Hail! Hail!

AWARE trainers recall hellish storm By Jim Tracy

For 20 minutes they sat while hail stones the size of golf balls and baseballs pelted the front and driver side of Imagine sitting in a car while being bombarded by their car, a 2005 Ford Taurus that is by now familiar to baseballs and golf balls. AWARE drivers because of the dents left by the hail. Tim Hahn and Scott Yebba went through just such an “It shattered the windshield,” Hahn said. “Shards of experience two summers ago while driving from Miles glass were coming inside the car. City to Billings. “We stuck our Hahn, AWARE training briefcases up against he e were in no man’s land. The director, remembers the day windshield to avoid being well. It was June 12, 2006. next exit was, like, 15 miles showered by the broken He and training coordinator glass.” Yebba were returning in late down the road, and we had just passed a Hahn also remembers afternoon to Anaconda. the storm. “We saw this huge, rest area 10 miles back. — Scott Yebba, hearing “The sound as the hail ominous-looking black cloud was hitting the car was coming from the southeast,” Training Coordinator intense – very scary,” he Hahn said, said. Almost simultaneously, an alert blared over the radio “It sounded like shotgun blasts inside that car,” said warning them of a severe thunderstorm “with grapefruitYebba. sized hail,” Hahn said “We were laughing, too,” he added. “You get to the “There’s no way there could be hail that big,” he point where you just start laughing.” remembers joking to Yebba, who was driving. “It was Hahn said other vehicles, including a truck and semi the first time I’d ever been in a car and actually heard a that had pulled over behind them, sustained “significant weather warning.” damage.” Within minutes, the warning became reality. A storm News reports at the time said the storm damaged crops they’ll never forget forced them to pull over on Interstate and buildings throughout southeastern Montana. After the 94 near Hathaway, about 25 miles west of Miles City. hail let up, Hahn and Yebba limped back to Miles City. “We saw the cloud, but there was no where to go,” The next day they drove to Billings, driving slowly while Hahn said. “We were in no man’s land,” said Yebba. “The next exit peering through the broken windshield. A repair shop there replaced the windshield, but deep was like 15 miles down the road and we had passed a rest dents remain – a conversation starter for anyone who drives area 10 miles back.” the dimpled silver Taurus, also known as AI 55.

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What is a KMA?

From “An Introduction to Montana’s Kids Management Authorities,” by the DPHHS Children’s Mental Health Bureau

The KMA, or Kids Management Authority, is the infrastructure that supports a comprehensive and statewide system of care. The KMA has two primary functions: development of a continuum of care within their respective communities, and case planning and coordination for individual youth with serious emotional disturbances and their families. This system of care is child-focused and family driven. It also provides wraparound services to youth and their families within their communities. Characteristics of the system include: „„ „„ „„ „„ „„

A service design and delivery based upon the strengths of the youth, family, and community; An awareness of familial, cultural, racial, and ethnic differences; A focus on prevention/early intervention; An orientation toward outcome/results; and A funding mechanism that blends available resources.

The SOC Committee (Children’s System of Care Planning Committee, born out of Senate Bill 94), together with community KMAs, identifies training needs, service gaps, funding, and other barriers to service delivery. Together, they implement responses to identified needs.

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‘A Good Enough Reason to Do It’ Down and out in Montana’s mental health crisis, and what AWARE is doing about it By Tim Pray health services. “Social Isolation, Guns, and a ‘Culture of Suicide” The President’s New Freedom Initiative, one of many is an article written by New York Times reporter Fox attempts at diagnosing and treating the problem of rural Butterfield in 2005. It tells the stories of three people: an health shortages, was made up of a bold, aggressive team of adolescent, a middle aged man, and an elderly man. They mental health experts who identified what they considered all have two things in common. They all lived in rural to be the major barriers to an efficient and helpful rural Montana, and they all ended their own lives. mental health network. They even adopted the wraparound Butterfield attempts to explain the data that point to philosophy, which AWARE has embraced for years as a the fact that Montana has, since 1890, had core method of treatment. f it’s a good the highest rate of suicide in the nation, The Initiative’s work was compiled and what that might have to do with its enough reason to on the notion that there will always be a primarily rural population. One woman of mental health professionals in do it, and it will help shortage interviewed for the story, whose own rural areas. son committed suicide at 29 in Ravalli The “they will do for themselves” people, we’re going County, said: “People here are very rural. attitude associated with living on a farm to do it. — ­ Jeff They do for themselves. They won’t go or in the mountains will, for a time, at Folsom, Chief for help.” least, prevent long lines of people waiting In Montana and many other rural to get help with their depression, and any Operations Officer areas, there is a tendency for people— psychiatrist needs to work…a lot. With men, in particular—to feel great shame student loans reaching into the hundreds of in dealing even with something as treatable as depression. thousands of dollars, their time cannot be spent waiting The fear of being seen in town while walking into a mental for patients to come to them. It was with this fact in mind health clinic, or an awkward encounter at the pharmacy that the NFI team asked themselves how to attract doctors while picking up an anti-depressant, is enough incentive and/or create training and development for people who to ignore the problem, or to not talk about it with someone have grown up on a farm and will not be going to medical who can help. school? At the same time, there is a perceived problem with National attention the mental health professionals in rural areas across the The team’s conclusions, published in a 2003 report, country, not just Montana. According to numerous reports, identified its goals of reducing disparities in rural areas for articles, and even President Bush’s New Freedom Initiative mental health services. Considering the stigma attached (NFI), which was established in February 2001, the doctors to receiving them, they addressed ways to implement simply aren’t there. Missoula Independent reporter Patrick technologies that could bring the doctor to the client Duganz wrote a story on August 30 entitled “The Doctors Aren’t In,” in which he describes the ripple effect generated without having to make a large production out of it. Further, the importance of the issue to the president is from just one Missoula psychiatrist closing his practice, underscored by the fact that, even through the terrorist leaving hundreds wondering where to go for their mental attacks of September 11, 2001, the project remained health care. fully engaged and staffed in the midst of the rerouting of Duganz goes on to state that, as those in need of countless billions of dollars towards defense initiatives. psychiatric care search for a new doctor, they’re faced With the amount of attention being given to both the with the fact that the private psychiatrists in the area aren’t shortage of doctors and resources, most markedly since the taking new referrals due to their extremely large caseloads beginning of the Bush presidency, it would seem that the and the shortage of doctors. problem would be getting better. On the larger scale, it’s An interesting problem not. Many of the few psychiatrists practicing in the larger These two crises present an interesting problem. On cities of already very rural areas are completely booked, one hand, an entire population of people are unwilling, and their rates reflect that. On the other hand, most of or, given the benefit of the doubt, unable to get help with the recommendations by the New Freedom Initiative, as either their own mental health or their children’s. On the innovative and exciting as they are, remain unfunded. other hand, it seems that, even if they were willing or able, Outdating the NFI, the National Health Service Corps a steadily decreasing number of psychiatrists and other (NHSC) is an example of a federal program that has seen mental health professionals are available to provide mental some success in bringing doctors to areas that would

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normally not be professionally appealing. NHSC offers student loan repayment for doctors agreeing to work in the areas deemed to be a Health Professional Shortage Area (HPSA). As mentioned earlier, the cost of a doctorate can be within the hundreds of thousands of dollars, and the offer of that debt being permanently forgiven would seem to be too much to resist. For its acknowledgement of the problem, and its proactive suggestions in solutions, the NHSC is not entirely able to find resolution in the most rural of areas. The program requires a psychiatrist to work a minimum of 32 hours a week, a number that can be staggeringly high for an area that may provide only three or four people needing help. At the same time, traveling around the state for treatment solely to meet a patient quota is both impractical and inefficient. “They (federal government) envision a busy, city-based clinic,” says Jeff Folsom, AWARE chief of operations. “It is almost impossible for someone living in the midst of a city environment to imagine everyday life in a place where the nearest grocery store can be as far as 40 miles away.” Further, in some areas of Montana, the county may not be officially deemed a shortage area, but the ratio of doctor to patient can be as much as 1:20,000, which excludes it from the NHSC program and its incentives. AWARE has used what it needs from the suggestions of the federal government, including plans to implement conferencing network technology and its relationship with some staff psychiatrists here because of the HPSA program. “We’ve committed to building psychiatric service without relying on the federal government,” Folsom says. “We don’t want to have to rely on anyone in order to provide our services. That kind of situation can only breed inconsistency and wouldn’t be at all fair to our clients.” “Would we like the help of the government? Yes, you bet, but first, we’re going to do what’s right. Other providers have said that if the state won’t pay for it, they won’t do it.” AWARE works by carefully looking at community needs that must be filled, and, with an accurate business plan, attempts to fill that need. One AWARE staff psychiatrist in Missoula has witnessed the fallout of a provider doing the opposite. “AWARE has never tried to be everything to everybody,” the psychiatrist says. “One of the reasons that people (patients and families) get so angry with other providers is because they tell their current and potential clients that they can be, but their services don’t match the hype. They’ve gotten all this money from the Legislature, and it makes for a lot of bad blood when a client shows up to the door and is told to come back in three months because the doctors are booked to the gills.” On the larger scale, there is no telling when this crisis will end, particularly when it comes to telling a macho

culture that attending to one’s mental health is as important as attending to the physical. As to the mental health professional shortage, there will continue to be providers that get in over their heads, sign every contract available, and provide the service in the leftover time. That is a way, on paper, to deal with the crisis.

Subsidizing stability However, Folsom believes that stability can come from knowing who you are, organizational commitment, and letting people know that they are a part of a team. “We subsidize our structure because we think it’s worth it,” he says. “If we have a case management program, and there is a need for a psychiatry program, we add it, and it makes it better. If we have a group home, and we add mental supports, it makes it better.” Folsom adds that no matter how well we are doing, we are still a part of the rural community, and the problems that have hindered others in recruiting doctors could be a problem for AWARE, if not properly addressed. “We spend the money on recruitment and design a model of practice that doesn’t burn the doctor out,” he says. “By doing it in the context of a team, they’re not doing everything alone. You can’t rely on just having five psychiatrists sitting around waiting for the phone to ring while putting their lives on hold. Our case managers develop an individual crisis plan for each client. All members of the team are previously engaged in crisis plans and how they work, and that includes knowledge of the proper way to operate the 24/7 crisis hotline that helps the clients orient or reorient themselves to their individual crisis plan should one arise.” Folsom goes on to state that AWARE places a great deal of emphasis upon our doctors being given the time to develop meaningful relationships with clients. “When a new client is referred, the doctor is given up to an hour and a half for that initial interview. For follow-ups, half an hour…some places will run through 20 clients an hour.” Folsom continues, “We simply don’t believe in rolling clients through one after another, hour after hour. While it may be more fiscally viable to meet with 15-20 clients per hour, it’s not the type of service or standard that we adhere to.” So as 600 people scramble to find a new psychiatrist, providers dive into contracts that stretch them thin, the federal government envisions rural life that functions on a city’s cylinders, and a culture of social isolation slowly learns to accept the importance of mental health, AWARE is moving forward. Folsom states, “We say that if it’s a good enough reason to do it, and it will help people, we’re going to do it. That might be the reason we’re not bogged down with a psychiatry crisis.”

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Much of his time is spent visiting baler required loose product the homes around the state, to be loaded by hand into a touching base, and seeing first hydraulic compartment, the hand whether general upkeep new (horizontal) baler boasts a is where it needs to be, and 20-foot conveyor belt that runs whether any glaring problems along the floor, leading to a have arisen from the time of his larger compactor. This allows last visit. This project, though, for product to be swept directly “is something to be very proud onto the belt, and the machine of,” Francisco says, gazing into takes it from there. the space of the new building. “It The recycling operation, really shows how far we trust our which last year recycled more capacity to do serious work for than a million pounds of and by the community.” product, will now be even more For 12 years, AWARE accessible to residents of the has been operating Anaconda Anaconda-Deer Lodge area. Recycling (in collaboration What was a parking lot with Butte Recycling, also an crammed with trucks, trailers, AWARE industry) from the and recycling balers with no eastern end of the town, an area home will now be open to retail that, a few years ago, was fitted parking with a clearly marked for a predicted boom of industrial route to the new building and projects and developments its lot, with a spacious and that never quite materialized. professional recycling receiving Evidence abounds of the need for a new recycling center. DozThe expansion of the recycling area. ens of these bales of aluminum cans are produced daily by effort will mean much needed The expected efficiency of staff of Anaconda Recycling, the biggest recycling operation development in this desolate area in Southwestern Montana. Photo by Tim Pray the new building and operation of the city. will, aside from the obvious experience for our customers, not Last year, Anaconda benefits, provide a better gauge unlike any other retail store…the only Recycling purchased what is known as of improvements that the Butte difference is that the product is used.” the Jim Dandy building, a steel-framed recycling operation may require. The expansion of the facility building much smaller than the space Due to the limited space of the Jim will allow the thrift store to spread occupied prior to the move, which Dandy building, a large amount out properly and will make parking was more than triple its size. Upon of the recycling brought there was hassle-free. moving in, plans began immediately transported to Butte for processing. “No more having to maneuver for expansion. The building houses “Now that Butte will not be around trailers, trucks, and heavy the recycling operation, day/activity overwhelmed with product,” says machinery,” says Dyer. “Just park and center for adults, as well as the Hope Mike Schulte, Chief Habilitation shop.” Thrift Store. With all three projects Officer, in charge of all work services “This is a win-win situation,” operating within the same walls, space and supported living ventures by says Francisco. “For both the public is tight, and there hasn’t been room AWARE. “We can get an accurate and, equally as important, for our enough for each to do what it needs picture of exactly how they’re doing… employees and consumers, this new to do in terms of growth, comfort, or and provide them with some breathing building is safer, more comfortable, efficiency. room.” and just plain…nicer.” The thrift store receives donations While operating in the Jim and shoppers daily, and one goal Dandy building, a vertical baler was has always been to provide as close being used to compact recyclables. to a department store experience as Sometimes it took as long as six possible. hours to form a load of product. Now, “We’ve got enough product to To recycle in your community with the equipment that had been make this a legitimate retail store,” visit the Recycle Montana web stored in the parking lot, the time it says Wendy Dyer, Work Services site http://recyclemontana.org/ takes to generate a bale is reduced Coordinator in Anaconda. “This is and click on the Recycling Center to a mere 20 minutes, and it can be going to be a very pleasant shopping Locator. done more safely. Where the vertical

Recycling in your neighborhood

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Corporate Congress 2007 Breakdown A quick look at the process, potential for involvement, and timelines This year’s Corporate Congress nomination process will be refined as we continue to work to improve how all of our employees, communities and services are represented at Corporate Congress. Corporate Congress is an exciting and important strategic planning process that will take place for three days this December at Fairmont Hot Springs. All of the delegates who participate at Corporate Congress are non-supervisory / non-management staff. AWARE believes that a process that is designed to bring focus to our services and direction is best led by the folks who deliver our services day to day. As in the past, delegates will be selected to represent each and every service delivered by the organization. In addition, we have designed new “Districts,” which will provide for geographic representation. Lastly, there will be a statewide representative representing an understanding of the way AWARE functions as a whole, takes note of organization-wide trends, and can speak to that in terms of improvements that could take place. Existing delegates, who served at our last Corporate Congress, will complete their second term at this year’s Congress so that there is a balance between experienced and new delegates. We are currently looking for 12 employees to be delegates at this year’s Congress. Service Directors are currently in the process of identifying potential candidates and will be finalizing service representation by the end of October. District Representatives will be nominated through the input of appropriate district committees. A new approach, District Nomination Committees are designed to increase the opportunity for any employee who wants to participate to have greater opportunity to achieve that goal. This is a very exciting and positive opportunity to participate in a very important organizational process and to have some fun. AWARE understands that both the stronger and more motivated the pool of candidates that step forward, the better the value of the process. All employees who believe they have something to offer to help improve AWARE services should step forward and be part of Corporate Congress 2007. What do I need to do next? If you are interested in this process and would like to represent either your service or your area in general, please contact your Service Director or Administrator and let them know. Nominations for all delegate positions will be closed Oct. 16. Positions will be finalized by Nov. 1 and the Corporate Congress event held Dec. 5, 6, and 7. During the month prior to Congress, delegates will participate in preparatory activities, including information gathering and discussion with our stakeholders. DO YOU KNOW what the ten Unconditional Care Principles of AWARE are? In case you don’t, they’re listed below, and we hope you are able to think about them carefully, as they will play a central role in this year’s Corporate Congress awards ceremony.

• • • • • • • • • •

Building on our strengths is the key to 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 okay, you’re okay It takes a team Our connection with our communities is vital We strive to the highest quality of care Lighten up and laugh

Service Openings: 1) Administrative (not central office) 2) Adult Mental Health (ICBR/ACM) 3) Adult DD Services 4) CSCT 5) IFES 6) Early Head Start 7) Support Services

District Openings: 8) Billings (Consumer) 9) Galen 10) Bozeman/Livingston 11) Eastern Montana 12) Butte/Dillon

As a part of the Corporate Congress, we have a tradition of honoring employees from each service area across the state. Further, the annual Employee of the Year award

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13) Statewide Delegate


Corporate Congress awards... is an important way for our management to recognize great work through a banquet and a reception in front of your peers. In carrying that tradition forward, and further developing it, we’re merging the efforts of the Unconditional Care Commission and AWARE to acknowledge the employees that represent the very best of the work that we do at AWARE. This year’s awards are based on each of the UCC/AWARE values and principles. It is our hope and constant effort to bring these values to life in the day to day services to families. Nominations for these awards will be solicited this month. If you know of someone that lives and breathes one or more of the principles through their daily life and work, we encourage you to put together a few paragraphs explaining just how. Following is an example:\ Joe Kent, a youth case manager in Helena, has spent countless hours on the phone with his client’s teachers, working tirelessly to get him into a summer camp that would help him build upon his passion for music. Without Joe’s ability to know who to talk to and when…without his acknowledgement that “our connection with our communities is vital,” this wouldn’t have been possible, and his client would not have been spending a summer immersed in music. If you know an employee that you would like to nominate for one of the awards, write down the details and submit it to your service director.

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

We welcome... Teresa Rivenes comes to AWARE after spending time with Quality Life Concepts as both their Director of Development and Family Support Specialist. Teresa received her Masters/Doctorate in Social Work from Capella University and came Teresa Rivenes to Montana from Santa Barbara, Calif. She will be working in, and is new to the Great Falls area, where she will be spending her time developing and expanding the IFES/Children’s DD Services program. “I have to say that I do miss the ocean,” Teresa says, “but I’m genuinely excited to be here.”

Oct nov 07  
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