INKMarch/April 2009Volume 3, Number 2AWAREDay Activity Centercelebrates anniversary

Magazine reaching beyond Montana borders

By Tim Pray

It took a significant amount of patience to get the project up and running in a permanent location, but AWAREs Day Activity Center in Butte will celebrate its one-year an-niversary this April.

The center, which operates out of the former rectory of St. Josephs parish at 944 South Wyoming St. in Butte, is man-aged by Leslie Robertson, and serves eight men and women with developmental disabilities.

Though the customers degree of disability may require more assistance in certain areas of daily life, the goal of the house is to take a step back and let people do whatever they happen to be interested in doing at the moment a service model known as reactive therapy.

Reactive therapy model

Progress at the Legislature Pages 8-13

See Day Center on Page 27

AWARE begins work on jobs grant Page 3

Note to staffand friends Page 2

Bozeman man takesroad to home Page 14

ShrinkWrapwith Dr. Lourie Page 20Inside...

Apostrophe, AWAREs quarterly magazine by, about and for people with developmental disabilities, has a reach beyond Montana.

As of the first week in March, subscribers in 16 states and one Canadian province were receiving the magazine.

Subscriptions totaled 128, according to circulation manager Bryan Noonan. AWARE printed 9,000 copies of the latest issue, mailed 4,500 copies and dis-tributed thousands more at locations around Montana.

Most of the distributing is being done by Noonan and Dan McClafferty, ad director, who have been welcomed at stops all over Montana.

Apostrophe has also received ink in other publications.Great Falls Tribune writer Richard Ecke featured the quarterly in his

Spray of the Falls column on Feb. 23 under the headline, Womans story of living with fetal alcohol syndrome graces cover of magazine.

See Apostrophe Page 28

Day Activity Center Director Leslie Robertson. Photo by Tim Pray

AWAREs version of no child left behind

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 re-served. No part of this newsletter may be used or reproduced in any form or by any means without prior written permission of the publisher.

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

Lawrence P. Noonan, CEOGeri L. Wyant, CFOJeffrey Folsom, COOMike Schulte, CHO

Board of Directors John Haffey, PresidentJohn ODonnell, Vice President Al Smith Teresa Marshall Cheryl ZobenicaKeith Colbo

Editing and layout: Jim TracyStaff writers: Tim Pray Bryan Noonan

Dear Staff and Friends,

In July of 2007, there were 187 children in out-of-state facilities, deemed too difficult to serve in Montana. Its been an almost constant point of contention since that number was made public. Since that time, 171 of those children have returned to Montana or have aged out of youth services and are no longer counted towards the

total number out of state. Theres been a great deal of discussion on the topic, and even a bill written to address it. Youll get the whole story in this issue of Ink.

During a recent hearing, there was a degree of excitement on the part of the state for having brought home those 171 kids over the course of the last two years, and there were a number of different factors in the

homecoming. Whatever the reasons, were glad to have the kids home, being served in or at least closer to - their home communities and families. But what about the other 16?

The state has said that there will always be certain children who must be served in out-of-state facilities, and thats a reality in their view, but not mine. All the treatment that occurs in Texas can occur here. In fact, we can provide the service in a better and more targeted manner with people who understand and care about what makes the place we live special.

Community is defined as a group of people working towards a common goal. Depending on where you are in Montana, that definition means something entirely different and manifests itself in a number of different ways. What is most important, though, is that the emphasis is placed on working towards the goal, and not always the end result. In doing that, every member of a community is important. The slightest unique contribution to ones community or family has the power to change everything. Every connection and teachable moment is crucial. So when it is said that the fact that there are 16 children being served 1300 miles away from their support networks of home is acceptable, it flies in the face of everything weve found to be true and great about Montana.

The kids who are living in Texas right now did not need to be present at a hearing to get the clear impression that they are not welcome in their homes and communities. They did not need to be present to receive every indication that their situations are too far gone to be fixed. By viewing it as acceptable to get these kids as far away as possible, were telling them to try and get better and lay the foundation for a successful future, but to do so with no reference to all that may have been positive in their respective communities.

Through all of the obligations we have to the systems of checks and balances in the human services field; through all the forms, the plans, the meetings, and the legislation, there is the individual. It is our unit of measure, and the place we all started. We want to help an individual succeed in his or her life, and the greatest thing - what allows for that success to occur is that everything is based on what is important to a person. It is not our place to tell someone what is important in his or her life, and it is certainly not our place to take him or her away from one of the few places that presents the opportunity of success.

The individual is our unit of measure, if we had to name it. Its not a waste of time to always consider how we are helping or not helping an individual to succeed, and its not a waste of time or effort to make sure we have everything in place here at home to do so.

We will continue to consider the individuals who are not here at home to be a priority.

With best regards,

2

Larry Noonan

By Tim Pray

For people with disabilities, the barriers to gainful employment are seemingly countless: stigma, trans-portation, scheduling and education, to name a few.

With the unemployment rate hovering at near 8 per-cent, finding a job isnt easy for anyone, let alone people who have to battle with misconceptions just to get in the door or be taken seriously. But some headway may be gained through a Medicaid Infrastructure Development Grant (MIG) entitled: Montana Medicaid for Workers with DisabilitiesA Ground Level Attack on Montanas Em-ployment Barriers.

The MIG is an ongoing process, operating in three-year cycles. The last grant was written by the University of Montanas Rural Institute and included the creation of a coalition comprising stakeholders across the state, an assessment of the Medicaid infrastructure and barriers to employment for people with disabilities, the development of an action plan for the elimination of those barriers and the involvement of Montanas Native American populations throughout all its objectives and goals.

This cycle, the grant was written by AWARE staff under the supervision of Barbara Kriskovich, Montana DPHHS director of the Medicaid Infrastructure Grant as a call to action using the information gathered by the last cycles efforts. Those calls to action are:

The development and implementation of a Medicaid buy-in program for Montana. A Medicaid Buy-In allows states to expand Medicaid coverage to workers with dis-abilities whose income would normally make them ineli-gible for Medicaid.

People with disabilities risk losing their health coverage benefits if and when they get a full-time job, or the amount of their earnings pushes them to pay so much into Medic-aid that theres nothing left to live on. A buy-in program allows for people with disabilities to work and not have a fear of losing health coverage.

Senate Bill 119, sponsored by Sen. John Esp (RBig Timber), was written in order to usher in a buy-in program for the state, and has seen great success in both cham-bers of the Legislature. A hearing for the bill on March 4 included more than a dozen vocal proponents of the mea-sure including the director of the DPHHS Anna Whiting Sorrell.

Development of a statewide business leader-ship network In its infancy, the network consists of AWARE, a representative of the NorthWestern Energy Corporation, a representative of a major department store chain throughout the state and a former Disabil-

ity Navigator. These representatives will serve as liai-sons between the business, provider and bureaucratic fields and employers throughout the state who may be considering hiring people with disabilities.

Further, to bridge the gap between those seeking employment and those who are able to offer it, this network of businesses must have the ability to connect

with the popula-tions around the state. For that pur-pose of connection between the network, people who are look-ing for work, and the businesses with job vacancies, the grant has called for the DPHHS to hire a business liaison to recruit businesses and cement them into a growing net-work of opportunity.

An increased emphasis on changes in Montanas work incentives in-frastructure. The DPPHS is contracting with AWARE for the purposes of this emphasis, and that contract has begun manifesting itself with the recent hiring of two work incen-tives benefits counselors. The job duties of the counselors, Jessica Karjala and Margaret Sampsel, will be:

To provide information and counseling regard- ing insurance and public entitlements to people with disabilities, most importantly being the work incen-tives described in the Medicaid and Ticket to Work programs.

Evaluate work skills and capacities and assist clients in identifying employment-related barriers and formulating work-ready plans.

To refer clients to employment-related work- shops, schools, skill training centers, work experience assignments or other training programs.

Maintain liaison with other agencies in the field in order to coordinate work and cooperate in program-ming.

Provide technical assistance to other organiza- tions in regards to work incentives programs and protocols.

Resource-mapping is meant to enable a specific group, state, community, or corpo-ration to identify and inventory existing resources and match them to a specific purpose.

3

Buying in Medicaid Infrastructure Grant aims to reduce employment barriers for people with disabilities

Continued on next page

Provide both community and customer transit/ mobility evaluations and trainings.

An aggressive resource-mapping project. Montana DPHHS will contract with Montana State Universitys Center on Disabilities for service/resource-mapping activi-ties in order to assess existing infrastructures, in addition to analyzing how well existing systems are working or could improve, and to identify concrete policy direction for future program implantations.

These activities will assist the state in understanding the myriad of programs and supports that exist in the state. Resource-mapping is meant to enable a specific group, state, community, or corporation to identify and inventory existing resources and match them to a specific purpose. It is designed to assist Montanas communities in identifying valuable resources, ensure that customers have access to the resources they need, avoid the duplication of services and resources, enhance services, identify flexible fund-ing strategies, align youth and adult services and supports, cultivate new partnerships and relationships, and provide information across agencies.

Providing technical assistance to Department of Labor Navigators. Montanas Department of Labor re-ceived a grant from the federal government to implement a disability navigator program. The position is designed to assist people with disabilities in obtaining and retain-ing employment. Complex rules surrounding entitlement programs, along with the fear of losing financial assistance and health benefits can often discourage people with dis-abilities from working.

The disability navigator position was created to better inform those people and their families about any available work supports. Most agree that this position is an excel-lent addition to community workforce centers, however the individuals actually working on site are oftentimes over-

whelmed with information, making it difficult to perform the job duties in the most efficient manner.

Therefore, DPHHS will contract with the firm Health and Disability Advocates to provide technical assistance at job offices around the state.

Continuation of the work of the Governors Youth Transition Task Force. The group, which includes a vo-cational rehabilitation bureau chief, a Department of Labor workforce services division administrator, an administra-tor from the Department of Corrections, legal counsel for Montanas Protection and Advocacy chapter, the special education director for the Office of Public Instruction, and the director of Montanas Youth Leadership Forum. The task force has identified the major barriers to employment and education for youth with disabilities and has set out to eliminate those barriers by implementing a standard of transition for Montana.

Significant work with the Native American popu-lations of the state. The grant contracts with five res-ervations in the state to expand the knowledge of work incentives and assist Native Americans with disabilities in becoming employed. Montana will continue to partner with three reservations in particular Fort Belknap, Rocky Boy and Blackfeet to continue to provide job development opportunities. Health and Disability Advocates, the techni-cal assistance firm noted above, will also provide technical assistance to the tribes.

The overall goal of the grant has been to seek out and eliminate as many barriers to employment for people with disabilities in Montana as possible, primarily through the Medicaid Buy-In program. For Montana citizens to no longer have fear of losing health benefits, the hope is that many will seek and secure employment all over the state. Once those jobs have been secured, the efforts of the grant that focus on networks, educational transition, and trans-portation will be made much more tangible.

Jessica Karjala and Maggie Sampsel have been hired to be AWAREs work incentives benefit counselors, as specified by a contract with the Department of Public Health and Human Services Medicaid Infrastructure Grant that went into effect on Jan. 1. Read more about their duties, and the goals of the grant itself in the above story.

Karjala, from Billings, graduated from the University of Montana with de-grees in English literature and nonprofit administration. Prior to beginning her work with AWARE, she was a copywriter for an advertising agency in Billings and the owner of her own business in Colorado.

Sampsel, who lives in Missoula, graduated from Montana State University-Billings with an advanced degree in public relations, and a law degree from the University of Montana School of Law in Missoula.

Prior to working with AWARE, Sampsel spent time with Rural Employment Opportunities, Inc. as a case manager and interned at the Montana Department of Public Health and Human Services Child Support Enforcement Division.

Jessica Karjala Maggie Sampsel

4

Grant...

Pairs job duties: referral, liaison, technical assistance

5AWARE Bozeman staff will celebrate their move to spacious new quarters with an open house April 22. Details will be announced. The new offices are at 1811 W. Koch St. on the northeast corner of 19th and Koch across the street from the Westbrook Center. Left to right are: Michael ONeil (director of the Montana Home Choice Coalition), Steve Francisco (chief facilities manager), Marcy Martin (youth case manager), Shauna Baker (youth case manager), Melissa Mitchell (treatment service specialist), Leann Down (youth case manager), Jennifer Smith (administrative assistant), and Mark Sherkenney (family support specialist). Staff not shown are: Shawna Schaar (lead clinician), Mary DuVernay (service administrator), Tiffany Bartolomei (treatment service clini-cian), Lindsey Killham (treatment service specialist), Rusty Jones (treatment service technician), Kylie Izzi (TST),Marta Jackson (TST), Kristin Killham (TST), Taylor Hensen (TST), Shannon Maroney (youth case manager), Casey Wagner (adult case manager), and Renae Jones (Candlelight Initiative director and residential service specialist). Photos by Geri Wyant

Smart move

Our new building provides great meet-ing spaces for working with customers, colleagues, and community partners, says Mary DuVernay, service administra-tor for AWARE in Bozeman. Kids and parents really enjoy our larger waiting area, and staff are happy to have more private spaces to meet with families. We look forward to welcoming many people from the Bozeman area to our new workspace and continuing to expand and improve our service in the community. The new office also fea-tures web-conferencing capacity, two private conference room, a work-space for visiting guests, a large reception area, a kids playroom, two offices set-up for counseling sessions, and a small kitchen (no stove) and full bathroom (with shower) for staff use and for help-ing customers learn necessary life skills.

6Internet-based conferences provide information about how to prepare young people for adult life

By Jim Tracy

CEO Larry Noonan told more than 40 people from five states about AWARE services at a Feb. 2 semi-nar hosted by the Rural Institute.

What was remarkable about the event was that the pre-senters and participants all took part via computer or tele-phone from their own locations. Noonan made his presen-tation from the second floor conference room at AWAREs administration offices in Anaconda.

The Web-based seminar, or webinar, was the latest in a series hosted by the Montana Transition Training, Infor-mation and Resource Center, which is part of the Univer-sity of Montana-based Rural Institute.

The Center has expanded its resources and services in response to needs identified by young people with develop-mental disabilities, their families, schools, and providers. Those include the Montana Developmental Disabilities Program, Disability Rights Montana, Parents, Lets Unite for Kids, or PLUK, and the Office of Public Instruction.

Kim Brown, project coordinator and co-director of the Rural Institutes Transition Project, says the webinars pro-vide information about how to best prepare young people for adult life while they are still in school.

They also explain what adult agencies do and how to ac-cess their services and provide help in navigating the adult system, and information, ideas and technical assistance to create unique, individualized and inclusive adult lives for young people with developmental disabilities.

Lengthy waiting listIn Montana, because of lengthy waiting lists for DD

adult residential and employment services, many students with significant disabilities are not even considered for community employment, housing, or recreation because of the severity of their disability.

The general training theme of the webinar AWARE par-ticipated in was Adult DD Service Providers Who Are They and What Do They Do?

Noonan was asked to share the creative and inclusive things AWARE is doing, especially with respect to residen-tial and employment services.

He spoke about the corporations history and the Ana-conda and Butte recycling plants and Billings work servic-es and the jobs they provide. He also discussed the efforts AWARE is making to inform people about jobs and job opportunities through Apostrophe magazine.

Other presenters were Susanne Meikle, an employ-ment consultant and owner of the Bitterroot Valley-based Montana Work Solutions, and Michelle Pickell, owner and director of Job Opportunity Based Services in Missoula.

Meikle described the services her company offers us-ing community supports money, while Pickell focused on

Webinar gives AWARE five-state audience

Samples slides from AWAREs webinar presentation.

7community supports and developmental disability waiver funds.

The 90-minute session featured slides that were avail-able to people who accessed the webinar by computer. It concluded with a brief question-and-answer session. Par-ticipants included agency representatives, teachers, family support specialists and transition trainers.

To access the audio of the webinar and a pdf of the slide show, visit: http://ruralinstitute.umt.edu/transition/trainingcalend.asp.

The Transition Center has divided the webinars into two tracks: a youth track for young people with disabilities, their families and those who provide services to them,

and a customized employment track for teams that will be implementing customized employment with students and other job seekers.

Seminars still to come on the youth track are:Graduation Ideas for Rich, Full Days,

April 6; Creative Housing Options, June 1; and Self-Awareness, Self-Advocacy and Self-

Determination, Aug. 3. Employment track seminars on the schedule are:

Representational Portfolio, March 16, and Job Development and Negotiation, April 20.

Changes made in health insurance plan yearAWARE will switch its health insurance plan to a calen-

dar year at the end of December 2009.Participation in and contributions to the Medical Flex-

ible Savings Account, or flex plan, will be for a prorated period of seven months June through December 2009.

One of the major benefits to the participants is that now the deductible year and the MFSA year will run concur-rently and that should be less confusing to participants, said Geri Wyant, chief financial officer. In addition, there are a ton of accounting benefits.

Wyant noted that even though claims for the past year exceeded expectations, AWARE is not projecting an in-crease in premiums to employees for the claim period June 1 through December 31, 2009. The corporation will absorb the cost for this period, she said.

A new flex plan for calendar year 2010 will begin in January 2010, with pen enrollment in December.

At that time, plan design and premium change, if any, will be known and disclosed, Wyant said

AWARE renegotiates its coverage with Colorado-based Great-West Healthcare (www.greatwesthealthcare.com).

In survey after survey, Americans rate health insur-ance and health care as a high priority, and AWARE work-ers are no different, Wyant said. Many of the questions the payroll department receives concern insurance.

Questions frequently arise about AWAREs bi-level insurance plan, which allows employees to match their coverage to their needs.

The Price Plan meets the needs of about 56 percent of AWARE employees who have few medical risks and want the lowest possible premiums, basic catastrophic and drug coverage and good first-dollar coverage for office visits, dental, vision or other routine expenses that come up.

The Value Plan is tailored to the needs of about 44 percent of employees who are concerned with the best coverage for high medical risks and chronic medical condi-tions and want the lowest deductibles and co-insurance possible, the best drug coverage and fewer restrictions on the selection of providers.

Eligible employees may choose between the two based on how they evaluate their individual situations.

There is no underwritingyou are free to choose either the Price Plan, the base plan or buy up to the Value Plan, Wyant said. And you can change your mind each new plan year. Employees are insurance consumers free to choose.

Low-risk individuals can select a low-price option and high-risk individuals can select greater value and pay a higher premium.

Our employees can act as consumers, making value and price decisions in medical insurance just as they do with any other consumer product or service, Wyant said.

In the face of rising health insurance costs (rates climbed by 26 percent in 2008) AWARE developed the current plan rather than simply cutting benefits. A partial self-insurer, the corporation expects to contribute $1.7 million in plan-year 2008 to help cover premiums.

Enrollment has increased, and we now have 225 eli-gible employees enrolled in the insurance plan, many with dependents enrolled, Wyant said.

Still, shed like to see that number grow.If we could get more healthy bodies on the plan, it

would help contain costs and could even lower premiums, she said.

Enrolled employees receive another direct benefit since they pay their premiums with pre-tax dollars.

Wouldnt you rather be paying yourself for health insurance than paying taxes to the federal government? Wyant asked.

AWAREs insurance plan also includes a wellness ben-efit that covers the cost of an annual medical exam.

To learn more about the insurance plan, log in to the corporate Intranet web site, click PDF Manuals and then Health Insurance.

You can also email questions and concerns to Wyant any time at gfwyant@aware-inc.org.

By Jim Tracy

AWARE tracking bill progress in 2009 Legislature

By Bryan Noonan

The 61st session of the Montana Legislature is more than half over, and AWAREs hopes to get key legislation passed are still alive.

Chief Operating Officer Jeff Fol-som, registered as AWAREs lobby-ist, has testified 11 times, while CEO Larry Noonan has testified once about a measure aimed at keeping more at-risk children in Montana rather than sending them out of state for services.

Sen. Jesse Laslovichs Senate bill (SB) 399, despite opposition from the Department of Health and Human Services (DPHHS) and others, passed the Senate 50-0, and moved onto the house floor.

We were pleased to see the bill pass, Folsom said. It demonstrates that the Senate understands the unfor-tunate plight of children forced out of state to receive treatment.

Although the Senate Public Health, Welfare and Safety Committee changed the bill significantly, the goal of requiring quarterly updates on all of the out-of-state children survived. (See story on SB 399 on Page 10.)

DPHHS had requested $2.5 million to fund Kids Management Authori-ties (KMAs). Since the session began, the request has been trimmed to $2.3 million over the next two years. The Appropriations Committee will ulti-mately decide funding.

KMAs have come up in more than one bill. House bill (HB) 111, sponsored by Rep. Teresa Henry (D-Missoula) was a housekeeping measure to form a special subcommit-tee to define KMAs and describe their function. Due to the inability to define what a KMA does, the bill was tabled.

It would have provided for an ad-visory council that collaborates with

DPHHS and local advisory councils to plan and evaluate public mental health care. It also would have provided an interagency system for tracking chil-dren in need of mental health services and established membership of local advisory councils. And it would have allowed the department to establish separate advisory councils for youth and adult mental health systems.

Even though the state cannot properly define a KMA and its func-tion, the department is still asking for roughly $3 million over the next two years, Folsom noted.

With that much money going into this program, Folsom said, AWARE believes KMAs should make clear how they will deliver services to children and families, and move away from the idea of establishing full-time equivalent positions and infrastructure within the government.

Folsom said the money the depart-ment requested could go toward creat-ing 10 new KMAs across the state.

House Bill 65, introduced by Rep. Diane Sands (D-Missoula), provides details on the requested $2.3 million, while House Bill 66, also introduced by Sands, requests an additional $250,000 from the general fund to be placed in a Childrens system of care

special revenue account to use as the KMAs see fit.

Initiative-155, the Healthy Montana Kids Plan, associated with the Chil-drens Health Insurance Program, has become a hot button topic.

Seventy percent of Montana vot-ers cast ballots for the initiative last November to expand the Childrens Health Insurance Program and Med-icaid. These two government-funded insurance programs are aimed at low- and middle-income families. The state and federal governments share the costs of the programs.

Republicans on the Joint Appropria-tions Subcommittee on Health and Human Services have refused to fund the voter-approved expansion of health insurance for 30,000 Montana chil-dren. They want to delay the program for two years because of fiscal con-cerns.

Sen. Dave Lewis (R-Helena) said with the states finances worsening, Republicans dont want to launch an expensive new program even if vot-ers OKd it.

Lewis and three other Republicans on the budget panel voted against funding the Healthy Montana Kids program, resulting in a 4-4 vote that blocked the money.

That was only a first step in the lengthy budgeting process, however,

Democrats say the CHIP program is not the right place to start cutting the budget.

Money cannot be appropriated by a ballot initiative. Only the Legislature can do that.

Legislators who support the ini-tiative point out that Montanas two Democratic senators along with Re-publican Rep. Denny Rehberg voted for expanding CHIP.

A bill introduced by Rep. Pat Noonan (D-Butte) asks for more travel reimbursement for case managers to transport people to unavoidable medical appointments. House Bill

8

Some pet measures modified, but still alive

453 has been slightly modified, ask-ing the state to do a study in order to determine if there is a problem with reimbursement and how to fix it.

It wont change the issue this ses-sion, Noonan said. But it does shine light on the problem, and the study will keep the department focused on the issue.

The bill passed the House 52-48 on the third reading and is on the Senate floor.

House Bill 369, carried by Edith McClafferty (D-Butte), asks for increased funding for early childhood services. This bill is a pure appro-

priation bill and therefore will not be voted on by itself.

Folsom said AWARE hopes the bill gets proper attention and makes its way into the budget.

Michael ONeil, director of AWAREs Home Choice Coalition, has assisted in drafting a housing bill that would cap mortgage deductions to assist low-income people to buy houses of their own. AWARE is a strong supporter of this bill (LC2124) since it will allow more flexibility in AWAREs mission of helping people with disabilities buy their own homes.

Another bill that has full support

from AWARE is Senate Bill 234. The primary sponsor is Kim Gillan (D-Billings), but the bill enjoys strong support on both sides of the aisle. The measure would require insurance companies to cover the diagnosis and treatment of people under 18 with Autism Spectrum Disorder.

Currently, insurance companies are not required to cover expensive treat-ment for autism, leaving families to fend for themselves.

To follow any of these bills, visit: http://leg.mt.gov, click on Bills and Current Session.

9

AWAREs Candelight Commu-nity Living Initiative and another state program for children with autism temporarily lost their fund-ing in the House Appropriations Committee in early March.

The story of how the Legislature taketh away and giveth back is detailed in the March 10 Bozeman Chronicle.

Reporter Daniel Person de-scribes how the Candlelight home and another program came under the microscope of lawmakers on the House Appropriations Com-mittee who believed the state Department of Health and Human Services overstepped its authority by creating the programs without consent from the Legislature.

Upset by the Department of Health and Human Services ac-tion, the House Appropriations Committee, in an 11-12 vote, pulled funding from the state budget for the autism programs.

The committee of 10 Democrats and 10 Republicans later restored the funding by siphoning the money from elsewhere in the health agencys budget, Person wrote.

The Candlelight Community

Living Initiative, which opened last summer to much fanfare, can house up to four children between the ages of 10 and 16.

Gov. Brian Schweitzer attended an open house at the home, which gives low-income Montana families a place in state to take their chil-dren for 24-hour treatment.

Legislators contended that DPHHS should have received their permission before spending state money to create the group home, as well as a program to help families treat children under 5 years old diagnosed with autism.

Both programs come with ongoing costs to the state, and the health department was asking for about $900,000 from the states general fund to keep the programs going in the coming year, Person noted.

Its an excellent program. I nev-er had a problem with the autism program. But what DPHHS did was outside their authority, said Rep. Bill McChesney, D-Miles City in an committee meeting. They burdened the taxpayers with a new program that needs to be funded in the coming years.

McChesney was the lone Demo-crat to vote to pull funding from the programs.

According to Person, the con-troversy stemmed from the 2007 Legislature.

In order to have adequate fund-ing for Medicaid, the state must estimate how many families are go-ing to request help from the entitle-ment program and ask the Legis-lature for enough money to cover those predicted needs, he wrote.

He quoted DPHHS director Anna Whiting Sorrell who told leg-islators the health agency overshot in 2007 and wound up with about $30 million more than necessary.

The department returned $20 million to the state general fund but kept about $10 million to cover health service needs in the state.

One of those needs, Sorrell told the committee, was autism servic-es. The home in Bozeman allows four high-needs children to receive 24-hour care from professionals. The other program makes Medic-aid dollars available to a limited number of low-income families for early-intervention autism treatment.

Bozeman Candlelight Initiative loses, regains funding

See Candlelight on Page 13

10

By Jim Tracy

Most children who are sent out of state for psychiatric services feel unwanted, says Peter Boving-don, a Montana Legal Services lawyer assigned to handle child neglect cases.

We send them a powerful message that they always seem to get they feel thrown away, Bovingdon told a Montana Senate Public Health, Welfare and Safety Committee panel at a hearing Feb. 13.

He said he often takes calls from clients who have been sent to Texas, Idaho, Nebraska, Colo-rado, Maine, North Dakota, Utah or Georgia to places like the Woodward Academy, St. Marys Home for Boys or the Texas Oaks Psychiatric Hospital.

A scratchy little voiceIts a voice on the phone for

me, a scratchy little voice, Bov-ingdon told the senators. They are away from family and friends and support. When I talk to my clients, they always want to come back.

Bovingdon was one of a half-dozen people who testified in favor of Senate Bill 399, which would have required the state to seek in-state alternatives to plac-ing kids in out-of-state facilities.

Opposing the bill were Steve Nelsen, executive director of the Montana Childrens Initia-tive; Kimberly Gardner, a social worker at Intermountain Chil-drens Home in Helena; and Jani

Often lost in the discussion about placing at-risk children in out-of-state facilities are the kids themselves, says AWARE CEO Larry Noonan.

To illustrate the point, Noonan told the Senate Public Health, Welfare and Safety Committee at the hearing on Senate Bill 399 about a boy he talked to last fall who was told he could return to Montana from an out-of-state facility in November.

But for a number of hitches, vacations and that sort of thing, the kid didnt get back to his home until February, Noonan said. It was frustrat-ing for me to have people not concerned about trying to get this kid home for Thanksgiving and Christmas and try to get his therapy started.

Such delays by the bureaucracy to bring children home only reinforce the self-image many at-risk children have, he said.

Big people in kids livesThe kids I talk to understand this better than we do because theyve

already been convinced that except for them the world would be a perfect place, except for them everything would be wonderful, he said. That type of action from the big people in these kids lives only confirms that for them.

We can have a tendency to forget, Noonan added, just what that (out-of-state) placement can mean to that child.

He said he had lots of examples of children who had been affected in a negative way by being sent to places out of Montana.

That personal knowledge and alarm at statistics presented to an interim committee last summer, he said, prompted AWARE to propose a plan to dedicate 50 slots in its facilities for children sent out of state.

We felt we were in a position to open up 50 new beds for kids who were out of state and bring back between now and July 1 some number of children if not all 50 of them, he said.

A plan in placeHe said AWAREs board of directors agreed with the plan and was

ready to put it in place.In a letter sent last June to Bonnie Adee, chief of the Childrens Mental

Health Bureau, AWARE offered to take as many as 50 new children into its community and Galen group home system.

AWARE is prepared to do this through the development of new group homes located within the State of Montana and utilization of available placements in our current system, wrote Carter Anderson, mental health residential service director. I am holding beds open across our system in an effort to locate and place children who are currently in out-of-state placements.

The bureau didnt reply.To this day, Noonan told the committee, Ive never been responded

to by the state. Theyve never asked me a question about the plan.Why they wouldnt be interested in that plan is news to me and would

be news to my board of directors. We still dont really know what the answer is.

AWARE offers to bring 50 kids home

A voice on the phone

Bill requires details on kids sent out of state

11

McCall, lobbyist for Yellowstone Boys and Girls Ranch in Billings.

They urged the panel to allow the state to continue to rely on a state network of Kids Manage-ment Authorities to work with families of children with seri-ous emotional disturbances who would be at risk of being sent out state.

I dont have a problem with the intent and what is included in the bill, said McCall. She added that the bill raised valid issues.

We need to continue to do a better job of bringing kids home from out of state, she said. But I dont believe we need legislation to do this.

While proponents didnt get all they wanted, they won an impor-tant point, according to Jeff Fol-som, chief operating officer and AWAREs lobbyist in the 2009 Legislature.

Raising the issueThis was a success, Folsom

said. We got 98 percent of what we wanted. It was important for us to bring attention to children who we believe are unnecessar-ily placed in out-of-state facili-ties. Our hope in raising the issue of out-of-state placement is that DPHHS will be required to focus on efforts to reduce or eliminate the practice of sending children suffering mental illness away.

We also hope through this effort to bring some accountabil-ity to the process through direct reporting to the Montana legisla-ture. Not only do we bring greater trauma and send a message of rejection to these children, but we also, frankly, have no oversight authority and no idea about the

quality of the services these chil-dren receive in other states.

The bill requires the depart-ment to establish a pool of quali-fied in-state providers identified as willing and able to meet the significant needs of high-risk chil-dren with multi-agency service needs who are currently placed or may be placed out of state.

The department must also design a process in which licensed providers qualify for the pool by demonstrating their ability to provide mental health services for children using federal and state special revenue and state general fund money.

Another key part of the bill requires the state to do all that using a wraparound philosophy of care.

In its original form, SB 399, drafted by the late George Groes-beck and sponsored by Sen. Jesse Laslovich of Anaconda, would have required the state to increase, and in fact define, its ef-forts to identify an in-state alter-

native before sending any child to an out-of-state facility.

In its amended form, the mea-sure calls for quarterly reports on children with multi-agency needs receiving services out of state.

Laslovich said he expected the committee to amend the bill after DPHHS attached a fiscal note showing it would have cost the state general fund about $1 million a year over the next four years.

In its pared-down version, with an attached cost of only about $9,000 in Fiscal Year 2010, Laslovich hopes the bill will sail through the Legislature. It passed the floor of the Senate by a 50-0 vote on Feb. 24.

At the very least Im hoping it will help keep more kids in state, Laslovich said. We have to dig a little deeper. It just seems back-ward to me. If were truly con-cerned about a childs best inter-est, we need to find a way to keep the child in Montana.

Laslovich believes the report-ing requirement in SB 399 may help do that. He also hopes it will lead to a clearer accounting of the number of children who are sent out of state.

DPHHS spreadsheetsLast summer, Mary Dalton,

Medicaid services director for DPHHS, presented the Senates Law and Justice Interim Commit-tee with a series of spreadsheets that showed Medicaid had paid for 187 youths, including children under the Department of Correc-tions, to be placed in out-of-state facilities in Fiscal Year 2007 (July 1, 2006, to June 30, 2007).

Those included children in Continued on next page

At the very least Im hoping it will help keep more kids in state. We have to dig a little deeper. It just seems backward to me. If were truly concerned about a childs best in-terest, we need to find a way to keep the child in Montana. Sen. Jesse Laslovich (D-Anaconda)

12

hospitals, psychiatric residential treatment facilities and therapeu-tic group homes.

Daltons spreadsheet noted that the total number 187 was un-duplicated, meaning it did not reflect children who were receiving services in more than one category or receiving multiple services. Of the 187 individual children, 26 were placed out of state through the Montana De-partment of Corrections.

Medicaid payments for out-of-state services for the 187 children totaled $9,946,834.

Laslovichs data, taken from a DPHHS report, showed that the number of children placed in residential treatment out of state jumped from 97 in 2003-04, to 130 in 2005-06, to 197 in 2007-08. He said he was alarmed by those numbers.

As of January 2009, however, Daltons numbers showed only 25 children in out-of-state treatment receiving Medicaid payments through DPHHS. Those included 14 in psychiatric residential treat-ment facilities and 11 in therapeu-tic group homes.

A dramatic declineThose numbers reflect a dra-

matic drop in children placed out of state since 2007. In January that year, 65 children were in out-of-state psychiatric residential treatment facilities and 42 chil-dren in therapeutic group homes out of state.

Dalton told the public welfare committee that the numbers she presented last summer might have been confusing because they were numbers for an entire fiscal year.

SB 399... She said she hoped the point in time numbers she presented recently would clear up the confu-sion.

Dalton later told AWARE Ink that the steep decline in the num-ber of children placed out of state can be explained by a combina-tion of factors.

For one, we worked really hard with the help of AWARE and other providers to bring children back in state, she said.

At the same time, Acadia, one of only three psychiatric residen-tial treatment facilities (the others are Shodair Childrens Hospital in Helena and Yellowstone Boys and Girls Ranch in Billings), was released from sanctions that pro-hibited the facility from accepting new admissions, Dalton said.

The sanctions amounted to a freeze on new admissions.

They were imposed by the DPHHS Licensure Bureau when the company was known as Kids Behavioral Health before it was

acquired by Acadia. We didnt have the licensed

capacity in the state to take the number of kids needing services, Dalton said.

Other factors accounting for the decline, Dalton explained, includ-ed an overall drop in the number of children eligible for Medicaid who might have been candidates for placement out of state; the work of the Kids Management Authorities; and the work of an intra-departmental work group.

SB399 would have the state working even closer with pro-viders when it comes to making in-state service alternatives to out-of-state placement available to children with mental health needs.

A last resortThe bill says the 1993 Mon-

tana Legislature recognized that some Montana children have mental health and other needs that require services from multiple agencies and expresses a desire to provide services to these children in their homes or communities whenever possible and to use out-of-state providers only when there is no other alternative.

Current law specifically states that out-of-state placements should only be used as a last re-sort, Folsom said. Our concern has been that current efforts do not come close to leaving no stone unturned or otherwise meeting a last resort standard. Mary Dal-tons testimony before the Senate Health and Safety Committee and the large fiscal note attached to SB399, we believe, affirms our notion that a standard other than last resort is the departments cur-rent practice.

Current law specifi-cally states that out-of-state placements should only be used as a last resort. Our concern has been that current efforts do not come close to leaving no stone unturned or otherwise meeting a last resort standard. Jeff Folsom, AWARE Chief Operating Officer

13

Subsequent legislatures have strengthened last resort policy by encouraging development of an array of in-state services so that children placed out of state may return home and children in the state can remain in their homes, communities, or Montana.

In addition, the state has sought and obtained federal funds to help plan for local services that can keep children with multi-agency service needs in their homes and communities.

Despite all that, the bill says, information from DPHHS indi-cates that out-of-state placement of children continues and has increased in recent years.

As amended, the bill requires the department to develop and use an in-state pool of providers identified as willing and able to meet the significant needs of high-risk children with multi-agency service needs who are currently placed or may be placed out of state.

It says further that through use of available federal and state special revenue and state gen-eral fund money and in keeping with the states goal of using a wraparound philosophy of care, the department shall establish quarterly reporting requirements regarding high-risk children with multi-agency service needs.

The department must identify:the number of children

placed out of state;the reasons each child was

placed out of state;the costs for each child

placed out of state;the efforts the department

made to avoid out-of-state place-ments, including:

the number of in-state providers the department con-tacted about developing service alternatives for a child in or at risk of being placed in an out-of-state facility;

whether any in-state pro- viders submitted a plan for ser-vice alternatives for the child to the department; and

if a plan for service al- ternatives was submitted, the reasons the plan was not imple-mented and the out-of-state placement was determined to be necessary;

the number of children for whom plans for service alter-natives were developed, imple-mented, and resulted in the return of a child from an out-of-state placement or prevented a child from being placed out of state; and

other planning efforts to prepare for a childs return to the state.

Each quarterly report must also analyze the efforts the de-partment made to reduce out-of-state placements and establish goals and objectives for improve-ment in the following quarter.

The department has to provide the quarterly report to the Chil-dren, Families, Health, and Hu-man Services Interim Committee.

My biggest frustration was that the numbers were always changing, and not just a little bit but dramatically, Laslovich said. In statute were now mandating the department has to come with numbers.

There just needs to be a simple way to say how many kids are out

Sorrell said that legislative in-terim committees were told of the new programs.

But for some legislators that wasnt enough.

Constitutionally, the Legislature holds the government purse strings, and some legislators said they saw creation of the programs as usurp-ing that power, Person wrote.

One of those was Rep. Penny Morgan, a Billings Republican who sits on the Appropriations Commit-tee.

Im a little bit unhappy with the chain of events, she said Why do we have this committee if they can (spend money) on their own?

McChesney joined Morgan and the committees other nine Republi-cans in cutting funding for the two programs but, after a conversation with fellow Democrats, then in-troduced an amendment to restore funding at the expense of other parts of the DPHHS budget.

Candlelight...continued from Page 9

of state each quarter, he added. That doesnt seem like it would be very hard.

The media does not represent society truthfully and keeps differ-ence largely invisible, and this means it is not seen as a normal part of life. Anyone can become disabled the fact is, we will always be people first, with things we can and cant do second. I think everyone in life has their own disability something that challeng-es them whether it is visible or not. British comedian and actress Franc-esca Martinez, who recently reflected in an article in the (UK) Telegraph on her life with cerebral palsy.

14

By Jim Tracy

People who know David Schmierer describe him as steadfast, persistent, determined.

He comes by those qualities honestly, having learned from his mother, Margaret Schmierer, that you get out of life what you put into it.

She died last fall, but her words are still with him on four four-inch square plaques he keeps on a bookshelf, each inscribed with an inspirational saying:

It doesnt matter where youre from, its where youre going.

The road to success is always under construction.

If your ship doesnt come in, swim out to it.

Never, never, never give up.

The last one, Schmierer said in a recent interview in his living room, is my favorite.

That shouldnt surprise any-one.

Dave is a living example of steadfast determination in the face of adversity, said Kelly Wiseman, general manager of Community Food Co-op in Bozeman, where David works.

He has never allowed any disability to hold him back and has gone far beyond most folks expectations, becom-ing a person who owns his own house. He was fearless in the face of very scary medical procedures (major surgery in 1998) and refused to back off his goal of not just owning a house, but being a functional and contributing member of our community.

Dawson High School gradThe oldest of three children of Harold and Margaret

Schmierer, he arrived in Bozeman in September 1986, three years after graduating from Dawson County High School in Glendive.

He was moved to western Montana at the suggestion of a state agency for people with developmental disabilities and was placed in a group home operated by Reach Inc. on 15th Avenue. He lived there for nine months, then moved into an apartment on Black Avenue, where he lived with a roommate for nearly three years Over the next 10 years or

so, Schmierer, 45, lived in vari-ous other houses and apartments, always hoping some day to have a home of his own.

In 2004, that dream started to take shape after he attended a talk by AWARE Inc. Montana Home Choice Coalition Director Michael ONeil, who was at the time working on a pilot program to help people with disabilities buy homes, including through the federal Housing Choice Voucher Program, or Section 8, which provides assistance to low-income renters and home-buyers.

Section 8 helps make mort-gage payments for qualified first-time homebuyers. Schmier-er inquired about how he might participate, and ONeil encour-aged him to put his name on the Section 8 waiting list.

Homeownership classesTo qualify a person must be

a first-time homebuyer, have a household income of at least $10,300, been continuously em-

ployed for one-year (except for elderly or disabled persons), attend a homeownership counseling course and meet any other restrictions imposed by the local housing authority.

If the person is disabled or elderly, the household in-come is equal to the annual SSI amount. The employment requirement is also waived. People with disabilities and the elderly have the advantage that they can receive assistance through the full term of their loan.

I told David, Just keep working at it, ONeil said.Schmierer persisted. He filled out forms, answered

questions and followed the steps outlined by Section 8, in-cluding attending homebuyer education classes offered by the Human Resources Development Council in Bozeman.

Three years later, he had moved far enough up the list to start thinking seriously about buying a home.

In the meantime, hes saving money for a down pay-ment and hes lined up to have his savings matched, ONeil said.

Federal Home Loan Bank of Seattle Home Start Savings Program provides a match of up to $3 for every dollar a person saves up to a certain amount.

Bozeman man travels road to home

Homeowner David Schmierer of Bozeman

15

David was able to take advantage of that opportunity through his primary lender, Stockman Bank of Bozeman.

In addition to meeting home assistance requirements, Schmierer also had to contend with one of the tougher markets for homebuyers in Montana.

Bozeman is one of the hardest places to buy a home because of rising housing prices, ONeil said.

Still, when the time came, Schmierer was ready. Two years after putting in an offer, he became one of the first Section 8 homeowners in the Bozeman area.

David put himself on a strict budget for years, prepar-ing for homeownership, said Tracy Menuez, a HUD coun-selor with HRDC. Hed stop in and update us on how he was doing.

Schmierer received loan assistance through the HRDCs Road to Home and then critical final support with a loan through the AWARE Montana Home Choice Coalition DDP Homeownership Initiative.

Hes obligated to repay the loans when he sells his home, plus a share of the appreciated value of the property a one-bedroom condo he shares with his cat Delilah on Durston Road, near Bozemans bustling new business district on 19th Avenue.

The dcor reflects his range of tastes and interests: a pair of posters of jazz musicians, a collection of plates with paintings of Corvettes, framed, vintage album covers of Buddy Holly and Nat King Cole, photographs of family and friends, a television (he gets six local channels) and an XM radio receiver for music and talk radio.

I love talk news, he says. Im a talk news junkie. Thats also where I get my jazz music.

Above the door to his bedroom he has hung another important memento a metal plate with a photograph of the Community Food Co-op at 908 W. Main. The plate was his invitation to the Co-ops 23rd General Membership Meeting on the occasion of the completion of a major expan-sion in 2002.

Schmierer has been with the Co-op at almost every milestone. He was there in the early 1990s when the enterprise was run mostly by volun-teers on College Street near the Montana State University campus. In 2007, the Co-op reported total sales of more than $12 million.

When he started at the Co-op in April 1991, he was among the stores first non-management paid employees.

We knew that Dave rode a bike everywhere, and were told by the Reach representative that he was very detail oriented and would follow instructions closely, store manager Wiseman recalls.

The job fell throughSchmierer was working at Safeway in Bozeman at the

time and had lined up a job as a janitor at St. Mary Catho-lic School in Livingston, but the job fell through.

It didnt seem so at the time, but that may have been the best thing that could have happened since he landed permanently at the Co-op shortly thereafter.

He took over doing the stuff the volunteers didnt want to do washing dishes in the back and other cleaning chores.

Now he spends more time working outside. He bales cardboard for us, cleans and mops our en-

tryway and warehouse, patrols and cleans up the grounds outside the co-op, and helps with recycling and trash duties in three of our four buildings, Wiseman said.

David Schmierers preferred mode of transportation around Bozeman is a high-end Kona mountain bike. Photos by Jim Tracy

Continued on next page

16

After nearly 20 years on the job, Wise-man said Schmierer is identified with the Co-op.

Friendly attitudeDave is famous

with our membership, he said. He is known for his down-to-earth modesty, his great sense of humor, and his fine, friendly attitude.

Staffers love Dave as he is sort of a fixture around here, and one who never shirks a task and never com-plains, he added. As for me: He is as dependable as the sunrise. Also, I think he is very brave.

Schmierer also gets high marks from his supervisor, Chris Berman, operations manager at the co-op.

David is one of our most cheerful and pleasant employ-ees to work with, Berman says. He always has a smile on his face even while baling cardboard in sub-zero weather. I think we all have something to learn from Davids positive attitude.

Berman described Schmierer as a problem solver.He doesnt let a challenge stand in his way.Asked what he would tell a prospective employer if

Schmierer were to seek a recommendation for another job, Wiseman had a simple answer: You cant have him is what I would say.

Schmierer, himself, is modest about his work.

I keep the place clean, he said. I get my work done. I try to get there right smack at 10.

I like the people there, he added. Thats why Ive been there for nearly 20 years.

He rides the mile or so to work on a high-end Kona, one

of two mountain bikes he uses for transportation in and around Bozeman.

He also stays in shape by skiing, hitting the slopes as often as he can through Eagle Mount, which provides therapeutic recreation opportunities for people of all ages and disabilities.

His active social life includes membership in People First of Bozeman, where he serves as vice president and represents the local chapter in the People First Senate.

Still, the accomplishment hes most proud of is his home.

It took me nearly 20 years to get it, he said, relaxing in an easy chair in his living room.

I told David, If you prepare, opportunities come your way, ONeil said. He focused on going about what he needed to do to buy the condo and he got it. It took him a while, but he did it.

Margaret Schmierer would have appreciated that.

ing if the household meets minimum income require-ments, except in the case of elderly or disabled families.

Employment RequirementsAt least one or more adults that will own the home

must be employed at least 30 hours a week, and have been so continuously for at least one year.

Family must have completed at least one year of participation in the Section 8 rental voucher program. Families on the waiting list are not eligible.

Family must participate in Homeownership Educa- tion and Counseling.

Employment requirements do not apply to elderly or disabled families

If you are interested in the homeownership option, and meet the above requirements, please call Tracy Menuez at The Road to Home in Bozeman at 406/585-4878 (e-mail: tmenuez@hrdc9.org). Or contact Michael ONeil at the Montana Home Choice Coalition 406/449-3120 ext. 11 (montanahomechoice@aware-inc.org).

The Homeownership Voucher Program allows house-holds receiving rental assistance through a Section 8 rental voucher to apply that assistance to homeowner-ship.

Listed below are some of the basic requirements for the homeownership option. Interested households meet-ing the basic requirements should visit with local home-ownership teams to make final eligibility determinations.

Eligibility Requirements:Family must qualify as a first-time homebuyer.

Minimum Income Requirements:

for a disabled family, monthly federal Supplemental Security Income (SSI) benefit for an individual living alone multiplied by twelve

for non-disabled families, the Federal Minimum Wage multiplied by 2000 hours (currently $10,300) Public assistance may not be considered in determin-

Section 8 Homeownership Voucher Program

David Schmierers invitation to the Community Co-ops 23rd General Membership meeting was engraved on a steel plate

17

18

NEWS BRIEFSHuman services shopping mall opens

By Nicholas Ledden, Daily Inter LakeKalispell is attempting to centralize its many hu-

man service agencies by moving 15 into the long-time vacant Gateway West Mall.

Many companies are planning to be moved in by the end of the year.

The existing Gateway West Mall facility provides a unique opportunity to bring together nonprofit and county service providers to better meet the needs of clients who currently have to search for services which are scattered throughout the greater Kalispell area, said United Way Director Sherry Stevens Wulf.

Current occupants of the mall will remain, and organizers intend to re-open, and run, the food court using the revenue to benefit the non-profit agencies.

The concept is to make the Gateway Community Center truly a location where people of all income levels, backgrounds and needs can access services and participate in the work and activities of the non-profit community, Wulf said.

For more information on the Gateway Community Center, call the United Way Volunteer Center at (406) 752-7266.

Parents of disabled more stressed, illRaising a child with a disability causes more daily

stress and long-range health problems than parenting a child without disabilities, U.S. researchers say.

The report was noted in redOrbit Knowledge Net-work, an online community for people with an interest in science, space, health and technology.

According to the report, stress and health ills were greater among parents of disabled children, U.S. re-searchers found.

The study, published in the Journal of Health and Social Behavior, found parents who had children with disabilities that included attention-deficit hyperac-tivity disorder and bipolar disorder reported having at least one stressor on 50 percent of the study days compared with 40 percent among other parents.

The parents of disabled children also had a greater number of stressors and a greater number of physical health problems.

When researchers evaluated saliva samples from the parents to measure the changing patterns of a biologi-

cal marker linked to stress cortisol they found parents of children with disabilities showed patterns of chronic stress much higher than normal on days when the parents spent more time with their children.

Our findings indicate the magnitude of the addi-tional daily stress that these families face, lead study author Marsha Mailick Seltzer of the University of Wisconsin in Madison said in a statement.

Researchers used data including telephone inter-views from the Midlife in the United States study. The study looked at 82 parents average age 57 years of children with disabilities and a similar group of parents of children without disabilities.

Missoula project raises breast cancer awareness for women with disabilities

By Betsy Cohen, MissoulianWomen with disabilities are less likely to get ongo-

ing testing for breast cancer, according to researchers.Thats why a Missoula multimedia project, Every

Woman Matters: Portraits of Montana Women Living With Disabilities, has taken steps to raise awareness of this issue.

In order to encourage health care providers to break down barriers of inequality the project is planning an exhibit with photos of breast cancer survivors in Mon-tana, mostly with disabilities, and their stories.

The exhibit is planned to launch Friday, March 6, in Missoula. Once premiered, the exhibit will travel the state to various communities, health conferences and other professional events.

People with intellectual disabilitiessee better chances of going to college

U.S. News and World ReportAn increasing number of students with intellectual

disabilities are attending college, thanks to programs that are tailored to their needs.

In December 2008, the Higher Education Opportu-nity Act was established along with two multimillion-dollar federal grants to give incentives for colleges to create college-based transition programs. Experts are expecting the number of post-secondary programs to expand dramatically from its current number of 150.

Research shows that people with intellectual dis-

19

abilities that complete a post-secondary education pro-gram earn 1.7 times more per week than their peers.

For a list of existing programs go to www.Think-College.net.

Film starring man with disability tops Australian Tropfest ABC News Australia

The worlds largest celebration of short films, Trop-fest, awarded Be My Brother its top prize.

Gerard ODwyer, a man with Down syndrome, was also awarded the shows best actor award. The movie tells a story of Gerards character facing obstacles with optimism, even in the face of prejudice and misunder-standing.

The film is saying that you shouldnt have preju-dices, says Genevieve Clay, the films director, ev-erybody has something to offer. My lead actor demon-strates that.

Clay won a prize package worth $100,000, including a trip to Los Angeles to meet with film executives.

ODwyer won a $3,000 cash prize that was donated by actress Nicole Kidman.

Vaccine scare started when doctor faked and misreported dataBy Brian Deer, Sunday Times (UK)

Investigators say the study that sparked fear of au-tism being caused by vaccines was based on changed and misreported data.

Andrew Wakefield, the doctor who published the 1998 study in The Lancet said that the children de-veloped autism symptoms and inflammatory bowel disease shortly after getting MMR vaccines.

Later investigations found, that although the re-search paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medi-cal concerns had been raised before the children were vaccinated.

Vitamin B12 can prevent birth defectsBy Will Dunham, ReutersBefore becoming pregnant, women need enough

vitamin B12 in addition to folic acid to cut their risk of having a baby with a serious birth defect of the brain and spinal cord, Reuters news agency reports.

Irish women with the lowest vitamin B12 levels were five times more likely to have a baby with a neu-

ral tube defect than those with the highest levels, the researchers wrote in the journal Pediatrics.

Neural tube defects can lead to lifelong disability or death, the report said. The two most common ones are spina bifida, in which the spinal cord and back bones do not form properly, and anencephaly, a fatal condition in which the brain and skull bones do not develop normally.

The report quotes Dr. James Mills of the U.S. Na-tional Institutes of Health, one of the researchers. Mills said the study showed that vitamin B12 deficiency was a risk factor for neural tube defects independent of folic acid, another B vitamin.

MCDD releases 2009 directoryThe Montana Council on Developmental Disabili-

ties has released the 2009 edition of its popular Direc-tory.

The directory is to provide a telephone and address list of organizations and agencies that provide services and/or support to people in Montana with develop-mental disabilities. The directory is a telephone and address directory only. MCDD suggests that people contact individual organization for specific informa-tion on the services they offer. The directory is divided into sections, including national, state, and community programs and resources. A downloadable copy of the directory is available at: www.mtcdd.org

Montana Hall of Fame for Leaders with Disabilities accepting nominations

The Montana Center on Disabilities is seeking nominations for the Montana Hall of Fame for Leaders with Disabilities.

Persons nominated should meet the following crite-ria: A person with a disability who has been an agent of change within Montana is eligible for the Hall of Fame. Agents of change will have made a significant positive impact in the state or community through activities such as volunteering, mentoring, coalition building, legislative activities, fundraising, program development, or advocacy. The person need not be involved in change related to disability issues. We are seeking nominations of individuals who are leaders in any area that benefits the state or local communities.

Nominations should include a specific statement of nomination. For more information, visit: http://www.msubillings.edu/mtcd/index.htm.

Compiled by Bryan Noonan

20

Dr. Ira Lourie

Shrink wRapWhat is wraparound, and are we doing it at AWARE? These are

very interesting questions. Let me start my answer by talking

about just what wraparound is. In writ-ing this article I was going to begin by giving you the definition of wraparound that I used in my book on wraparound, which I wrote with Karl Dennis.

Karl is known as the father of wrap-around which was developed at Kaleido-scope, his agency in Chicago. However, I was surprised to find that we hadnt even attempted to define wraparound in the book.

When I think about it, the reason it was omitted had to do in part with how difficult it is to define wraparound. I once went to an entire meeting in which we tried to come up with a definition and ultimately failed.

So to define it, we need to go back to its origins at Kaleidoscope, where a number of years ago when I read their staff training manual I could not find the word wraparound. Rather, they taught several concepts starting with three basic ones.

The original and primary concept had to do with Unconditional Care, which tells us that we need to treat people under our care with the same degree of responsi-bility that we give our own children. Under the principle of unconditional care we are urged never to give up on a child. To do this, we must do what it takes to meet their needs. John VanDenBerg, another of the early pioneers in wraparound services would often state the ten principles of wraparound as:

1) Never Give Up, 2) Never Give Up, 3) Never Give Up, 4) Never Give Up, 5) Never Give Up, 6) Never Give Up, 7) Never Give Up, 8) Never Give Up, 9) Never Give Up, and 10) Never Give Up.

When a child is not doing well in our care, we must not blame him or her for those behaviors. Rather we must

What the heckis Wraparound?

ask ourselves, How did we fail to meet that childs needs, and we must revise our intervention approach so that it might be more effective.

In order to offer unconditional care one must practice several other principles:

1. To focus on childrens strengths rather than their weakness

2. To see families as a most important resource and focus on the familys strengths rather than their weaknesses

3. To be flexible thinking out of the box in the way we look for solutions to meeting peoples needs and be able to change the course of intervention when necessary

4. To be truly individualized in our ap-proach to interventionnot always focusing on which program should I use?

5. To use the full range of resources available in the community rather than just those resources that our fund-ing mechanisms support.

We have talked about these from time to time in other ShrinkWrap articles.

Over the last twenty years, these early underlying princi-ples of wraparound have been turned into a practice model for wraparound based on ten similar principles. But more importantly, people are being trained in the use of these practice models. As a result there have been quite a number of successful demonstrations on how effective wraparound is in helping kids and families do better.

Thus, wraparound has become widely disseminated as a practice, which has led to the development of some rather rigid rules as to how to do wraparound. This is strange because wraparound was created to get around all the rigid rules that made more traditional interventions so limited in the first place.

As a result of this rigidity many people now have come to think of wraparound as something that happens when you merely perform certain functions such as including families in case planning, writing some strengths in a

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treatment plan document, adding an aide to an ongo-ing program-oriented treatment plan, and/or using two or more funding streams to pay for care. They then call this wraparound, even though the basic principles of wraparound are being ignored or forgotten!

We tried a traditional wraparound approach at AWARE and it just didnt work. AWARE brought in Karl Dennis to train its staff in wraparound and it hired me to be a member of the staff. We did get to the point that many people do of being able to talk the wraparound talk, but we were not walking the wraparound walk. There were a couple of reasons that this happened.

First, we were just too big. How do you train over 700 employees to do something as difficult as wraparound. Almost all wraparound programs have a small concen-trated staff who work with a relatively small population of kids. We were trying to do this with a huge agency that covered the whole state of Montana.

Secondly, the cost of constant training and coaching necessary to do the current wraparound practice mod-els were way too high to apply to such a large agency. Thirdly, these models of wraparound required outside help in the form of interagency cooperation and sup-port that has not been available in Montana, even after the system-change models that have become Montanas KMAs.

But we at AWARE did not give up. Our CEO, Larry Noonan, demanded that we change our approach and become unconditional in our care and give a mandate to our now well known Unconditional Care Commission (UCC) to do something about it. True to the underlying concepts of wraparound, we felt that we should not focus on organizational structure or practice.

Rather it was felt that we should start where the origi-nal wraparound agency, Kaleidoscope, started 25 year before with a concept. We asked, How could we at AWARE come to accept the principle of Unconditional Care? First, we defined unconditional care, not as a the-oretical concept, but as it could be applied to AWARE. We brought in staff at all levels to discuss unconditional care concepts and what that meant to people. We then came up with ten principles that we felt could represent AWAREs unconditional care; we had no idea how those principles would translate into a practice model.

We then asked a wider range of staff to work on refin-ing those principles by making them the focus of one of our yearly Corporate Congress meetings at which staff help administration plan for the immediate future and longer term. We brought in families to help us do this.

These ten UCC principles have become the backbone of our treatment philosophy. All of our staff are indoctri-

nated with these principles from the start of their employ-ment. Our treatment planning documents were changed to reflect these principles. Our yearly corporate awards are now based on these principles. Over the span of five years, we have gotten to the point where our staff eat, drink and sleep these principles.

A very important point is that these are our principles, not those that are specifically espoused by the leaders of wraparound. If one looks carefully, one can find all of the official ten principles of wraparound in our UCC princi-ples, but our staff does not even know that what they are doing is anything like wraparound. They think they are doing AWARE. However, if you look at our treatment plans and listen to our internal case discussion, our plans are looking more and more like what one would conceive of as a wraparound plan.

Only after these UCC principles were accepted as vital by our staff did we begin to add some more traditional wraparound practice to our model. We trained our staff in the development and use of the Child and Family Team. The Child and Family team is the case-level mechanism used in wraparound programs.

It brings together the child, family members, agency personnel, and other community-based individuals who are resources for the family as a team to work together to develop a strength-based plan for helping the child and family. Important aspects of this team are that the fam-ily is seen as the most important members and the team meets as often as necessary to change the plan if it is not working.

Another vital aspect of this team is the development of crisis plans so that everyone knows what to do when expectable and unexpected problematic events happen. (I plan to write an article just on Child and Family Teams in an upcoming issue of AWARE Ink.) Are we creating Child and Family Teams as proscribed by wraparound programs? Probably not. But, we are using a Child and Family Team-like mechanism to give our workers a ve-hicle for putting into action the UCC principles they are striving to perfect. And, most importantly, it is working!

In addition, we created our OOPS, or Out of state placement staffing to help case managers and intensive family service workers hold to our UCC principles when things werent working out. While these are not true Child and Family Team meetings, they do offer support to our teams struggling with their desire never to give up.

These teams are led by our Lead Clinician, Pandi Highland, and myself. In these telephone consultations, a group of clinicians, administrators and a wraparound specialistmetalk about the case and its frustrations and come up with plans to allow kids to remain in their

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families and communities rather than being sent out of state. If you listened to one of these staffings, you would most likely think you were in a traditional Child and Family Team.

Early in March of this year, three AWARE employees, Jeff Folsom, Meghan Gallagher and myself presented a paper at a professional scientific conference at the na-tional Research and Training Center for Child Mental Health. The purpose of this paper is to show off how successful we at AWARE have been at keeping kids in Montana and their communities rather than going out of state to residential institutions. We want to demonstrate that even though we do not do formal wraparound, our non-traditional approach to creating an unconditional care environment in our agency is working as well as formal wraparound programs to prevent kids from being sent out

Shrink wRap... of state-placements and keep them in their communities with their families.

We want to demonstrate that even though we dont have a formal wraparound program we are still doing a job which is only based on wraparound principles and works just as well. We also want to demonstrate that we can create a wraparound atmosphere that will affect our entire agency of over 700 employees rather than just a small piece we would call a wraparound program. We want to demonstrate that basing services on the underly-ing principles of wraparound is more important than the use of some specific wraparound practice.

We want to demonstrate that in order to do something called wraparound one has to live the principles before one can do it. And, that is what we are doing!

Dr. Ira Lourie of Hagerstown, Md., serves as AWAREs senior medical consultant. He is the author of Everything is Normal Until Proven Otherwise.

Dressed for success

Administrative staff in

Anaconda show off their

stylish AWARE jackets. For

Christmas, full-time em-

ployees across the state

received a black-and-gray

jacket embroidered with

the corporate logo. Left

to right are Barb Wilson,

Donna Kostelecky, Anne

Wentz and Lisa Huber.

Jim Tracy photo

Book MarksBook MarksEach issue of AWARE Ink includes a collection of books, articles, documents, texts, and even movies recom-

mended by staff, covering a range of topics related to the work we do. This issue features titles suggested by Pandi Highland, MSW, LCSW, lead clinician and program officer.

Thinking In Pictures: And Other Reports from My Life with AutismExpanded Edition: Including the most recent research, therapy, and resources.Temple Grandin, 2005

This is such a wonderful text! In order to develop a better understanding of anothers behavior, it is helpful to see it through that persons eyes. This is precisely what Temple Grandin has done. In addition to her original text, the 2005 version is full of newer research, therapies and resources. Every chapter is a gold mine. At the end of each chapter are the updates. In these updates, I especially appreciated her words regarding emphasizing positive teachings, developing shared interests, learning social skills, tools for help-ing your career, the importance of mentoring, and her trouble-shooting guide for challenging behavior of those that are nonverbal. There is an incredible refer-ence section, by chapter, as well as a resource list for further reading and education.

Getting to Peace: Transforming Conflict at Home, at Work, and in the WorldWilliam Ury, 1999

When you dont believe there is much you can do to stop the fighting, you dont do much. Ury describes this book as being about how and why we may now, if we choose, learn to get along. In a typical conflict, there are two sides. Ury believes there is a third side to any conflict that consist of outsiders and the inner voice that urges us to heal old wounds, to listen and to show empathy. Beyond his theory, Ury provides us with the how of solving conflict. He defines the 10 roles we can choose from, to be an effective third side in order to contain, resolve and prevent conflict.

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March 12Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena Contact: Mary Dalton, (406) 444-4084 March 16Rural Institute Transition Project: Representational Portfolio WebinarContact: Kim Brown, (406) 243-4852

March 19Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena Contact: Mary Dalton, (406) 444-4084

March 21Understanding Developmental Disabilities 9-4 p.m.MSU Billings, Student Union Building, Beartooth RoomContact: Debra Miller, (406) 657-2312

March 23Public Health System Improvement Task Force 2-3:30 p.m.TeleconferenceContact: Sue Miller, (406) 444-3624

March 25Disability Service Public Hearing 3-4:30 p.m.Video conference in nine Montana citiesContact: Mike Hermanson, (406) 444-3833

March 26Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena, MTContact: Mary Dalton, (406) 444-4084

April 1Lead Local Public Health Officials Meeting 1:30-3 p.m.Conference CallContact: Sue Miller, (406) 444-3624

April 2Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelenaContact: Mary Dalton, (406) 444-4084

April 3Cardiovascular Health, 2009 SummitRural InstituteMissoula, MTContact: Gail Brockbank, (406) 442-4141

April 3Eagle Fest 2009BillingsContact: Eagle Mount, (406) 245-5422

COMING EVENTSApril 9Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena Contact: Mary Dalton, (406) 444-4084

April 14-162009 DPHHS Spring Public Health Conference 9-5 p.m.Crown Plaza, Billings MTAnn Hagen-Buss, (406) 444-4119 April 14-16Public Health: New Frontiers for a Healthy MontanaRural InstituteBillings, MTContact: Gail Brockbank, (406) 442-4141

April 15-17 2009 Conference on Diverse AbilitiesMissoula Contact: Nancy Marks, (406) 728-2400 ext. 1088 April 16Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelenaContact: Mary Dalton, (406) 444-4084 April 21-2327th Annual Conference of Montana Gerontology SocietyRural InstituteButte, MTContact: info@montanagerontology.com

April 23Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena, MTContact: Mary Dalton, (406) 444-4084

April 27Public Health System Improvement Task Force 10-3 p.m.TBAContact: Sue Miller, (406) 444-3624 April 30Healthy Montana Kids Workgroup 8-10 a.m.Arcade Building, 111 North Jackson StHelena, MTContact: Mary Dalton, (406) 444-4084

April 28-May 1Wraparound Process TrainingMariott Missoula Contact: Lorrie Biltoft, (406) 444-5905.

Compiled by Bryan Noonan

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By Tim Pray

Wraparound service, wraparound philosophy, wraparound systems and wraparound care. As time goes on, it has become increas-ingly difficult to be a part of the human services field childrens mental health, in particular and not hear wraparound used as an adjective for a model of mental health care.

Through a federal grant, the state of Montana has joined a national effort to embrace the wraparound movement, attracted to the positive outcomes that go hand in hand with a parallel movement towards com-

munity-based services. More than five years into the process, there continue to be varied definitions of the movement, and different interpretations, each, though, described as doing wraparound.

AWARE has approached wraparound from several perspectives and used several strategies in imple-menting it over the past decade. Working from a base of offering strong, individualized and community-based unconditional care in group home programs, and witnessing the good that it was capable of doing for people, AWARE became interested in moving to a wraparound philosophy of care as other services

AWAREs services address needs of rural communitiesWraparound

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Meagan Gallagher, former AWARE youth case manager, attended the 22nd Annual Research Conference A System of Care