Waiver Madness

Even though the month is almost over, March Madness (and the corresponding office pools) continues to occupy the minds of many. There have been a number of surprising upsets in this year’s tournament, and a recurring theme has been cropping up when the experts provide analysis of the games – teamwork has often triumphed over individual effort.

Let’s look at the example of Cornell. As pointed out in this blog, when the tournament started, Cornell had never so much as won a game in the NCAA Tournament. Their first round victory over Temple was the first tournament game win for an Ivy League school in more than 10 years. Their second round win over Wisconsin gave the Big Red the Ivy League’s first Sweet 16 berth in more than 30 years. So how were they able to succeed? Teamwork.

Cornell had four seniors in the starting lineup. Of their eight players who play more than 10 minutes per game on average, six were seniors (one was a sophomore and the other a junior). This past year, all the seniors on the team lived together in the same house. They had played together for four years. None of the Cornell players is likely to earn a huge NBA contract, but they knew each other so well and were so dedicated to a team concept that they were able to advance despite playing teams that probably had more individually talented players.

So why am I bringing this up? Well, I have already talked several times about the importance of those of us interested in resolving the short-comings of the DD system in Colorado coming together for solutions. I’ve harped on it so much it is beginning to feel like the Wilhelm Scream. (What’s that? Well, Wikipedia says the Wilhelm scream is a frequently-used film and television stock sound effect first used in 1951 for the film Distant Drums. The effect gained new popularity {its use often becoming an in-joke} after it was used in Star Wars and many other blockbuster films as well as television programs and video games. The scream is often used when someone is either falling from a great height or from an explosion. The Wilhelm scream has become a well-known cinematic sound cliché, and is claimed to have been used in over 149 films. Check out the video.)



But it is not just those of us who provide or receive services that need to work together. The funding mechanisms for service provision also need to be coordinated to provide maximum benefit for the individuals they are designed to support. Sadly, this is not even close to being the case.

For adults with developmental disabilities in Colorado, there two Medicaid Waivers that provide the majority of funding for services, the HCBS-DD “Comprehensive” Waiver and the HCBS-SLS “Supported Living Services” Waiver, and they do not complement one another. Service providers, families and guardians often spend too much time navigating the confusing landscape of getting funds for services and not nearly enough time on the much more important work of providing services.

Even worse, cost thresholds established by the State could work to deny waiver services or entrance into the waivers; thus individuals whose cost of services exceed the specified limit could be denied waiver eligibility. (Read more about this issue by clicking here to see an article by the National Association of State Directors of Developmental Disabilities Services Director of Technical Services Robin Cooper, from the March 2010 issue of Federal Perspectives).

So what happens when someone needs services but doesn’t fit into the current adult service models? I wish I had an answer. As far as I can tell, an adult who is eligible for services is entitled to residential services through an Intermediate Care Facility (ICFMR). However openings in ICFMRs are not available. As state support continues to be a struggle, and the patchwork of service options is over-worked, I am afraid we will learn what happens when someone needs a service and doesn’t fit. Similar to Cornell’s basketball team, we need to coordinate services and funding mechanisms as a team, or we risk facing a growing number of individuals who really need support but don’t have any way of getting that support.

Then again, what do I know?

Good News Friday!

At Imagine!, we are so grateful for the tremendous support we receive from the communities we serve. Today, I’d like to highlight a group that has supported our work with children who have developmental disabilities and delays for many years – the Knights of Columbus.

Last week, the Longmont Knights of Columbus made a donation to Imagine!'s Dayspring department for Early Intervention services - a check for $2331.50, funds raised from the Knights’ tremendously successful annual Tootsie Roll Drive.

In February, the Boulder Knights of Columbus Council 1183 presented a check for $1,090 to Dayspring.

In all, the generous local Councils of the Knights of Columbus in Boulder, Lafayette, Louisville, and Longmont have donated more than $35,000 to Imagine! over the past 9 years.

Many thanks to our local Knights councils!

Good News Friday!

In order to highlight the growing incidence of autism and the need for information about it, April has been designated as National Autism Awareness Month.

In December 2009, the Centers for Disease Control and Prevention reported its new national autism prevalence rate as 1 in 110 children. In Colorado, the rate is 1 in 133. This makes autism one the nation’s fastest growing medical conditions, one that is growing faster than the rates of pediatric cancer, diabetes, and AIDS combined.

There are several local events next month designed to increase awareness of autism, and I encourage you to consider attending one (or more) of the events.

On April 5, from 7 to 8:30 PM, Boulder Valley Gifted and Talented, in association with the Autism Society of Boulder County will present: Temple Grandin, PhD, speaking on Giftedness and Autism: How to Develop the Child’s Strengths. Click here for more information.

On April 22, from 6 to 8 PM, Bounce for Autism will raise money to improve the lives of all living with autism. Click here for more information.

And on April 24, starting at 10:00 AM, the Autism Speaks Walk for Autism will take place in Commerce City. Click here for more information.

What Is Inclusion?

Last week I forced you to remember the 80’s hit “Working for the Weekend,” by Loverboy.

To make up for it, I present a much more palatable 80’s hit – “My Hometown,” by Bruce Springsteen.



Of course, there is a reason I was thinking about this song. The lyrics are classic Bruce, capturing a universal mood in just a few rhymes. In this case, it is a melancholy reflection on the importance of feeling connected to something bigger than yourself - your community.

At Imagine!, we have always looked at ways big and small to allow our consumers to seamlessly integrate into their communities. Here’s an interesting example of a small effort that can make a big difference: some vans that are built with wheelchair lifts have a roof line raised higher than what you would find on an average van. This is to accommodate the person sitting in a wheelchair whose seating is now higher than the standard seats of the van. The unfortunate result of this design is that individuals in wheelchairs who ride in the van are up a little too high to look out of the van window comfortably without bending their heads down.

This means that a driver in a vehicle riding alongside the van can instantly see there is something “different” about the passenger in the van, even if they can’t exactly see what that difference is. At Imagine!, we have made a conscious choice to purchase some accessible vans with lowered floors, so a rider in a wheelchair is not instantly recognized as different. Lowered floor vans do not work for every wheelchair user, however details are important in quality services. It seems like a small thing, but it can make a tremendous difference in terms of perception.

I’m writing about this now because there have recently been a couple of very successful events in our community designed specifically for individuals with developmental disabilities. I won’t mention specific names of the events because my point here is not to disparage the supreme efforts put out by caring, dedicated people who are sincere in their desire to recognize and support people with intellectual challenges. By all accounts, the events were tremendously successful and the participants had a great time. Knowing all that, and acknowledging the powerful impact the events had on all participants, I wonder if we have more to learn. Is it possible that a design for inclusion unintentionally serves to separate the individuals from their community? The salient feature of participation is a disability. Is it possible that what is intentionally meant to show diversity, indirectly tends to result in a segregation? It is the darnedest thing. I am unresolved on the issue.

It is up to us in the community of providers for individuals with intellectual and developmental disabilities to discover how we can harness the spirit of volunteerism that was so prevalent in these events and together learn about creating a long-term approach that strives toward full inclusion as its final goal.

Then again, what do I know?

Good News Friday!

Earlier this week, I blogged about supported employment programs and the value they bring to our communities. Today, I’d like to introduce you to Letosha Patton. Her story perfectly illustrates my point.

Letosha has many challenges in her life and has required 24 hour supervision in the past. Despite these challenges, Letosha has always been determined to get a steady job.

Through courage, effort, and desire to work, Letosha managed to convince Imagine!’s C.O.R.E./Labor Source staff members to place her in a job as part of a crew at RC Special Events, an event rental company. The crew environment provided Letosha with the supports she needed to enhance her desire to be a successful employee. She quickly learned the job duties and worked so hard that the crew was given more hours, largely due to her productivity.

“Since Letosha joined a C.O.R.E./Labor Source crew in May, she has proven herself to be an outstanding, invaluable member of our team,” said Jim Faulstich, Supported Employment Coordinator with C.O.R.E./Labor Source. “Letosha cleans folding chairs, packages silverware, and performs other tasks associated with preparing for catered events. Letosha demonstrates impressive stamina and strength handling the physical requirements of this job, which includes being on her feet for the majority of up to a six hour shift. She always arrives at work in a positive mood and is willing to undertake any tasks that are assigned to her.”

Letosha’s dedication to becoming permanently employed has certainly paid off. The Director of RC Special Events specifically requested that Letosha be a permanent member of the crew. At Letosha’s request, she is now working five days a week after joining the Hungry Toad Restaurant janitorial work crew. In a brief period of time, Letosha has become one of the most valued and respected of all C.O.R.E./Labor Source employees. She is to be commended for her strong work ethic, great attitude, and warm personality.

Letosha is a great example of Imagine!’s mission in action. We provide the tools, and she provides the drive, ambition, and hard work to become an active and contributing member of her community. Congratulations, Letosha!

Everybody’s (Not) Working for the Weekend

“Work is powerful. It is the key to participation in community life.”

For those of you fortunate enough (or unfortunate enough, depending on your worldview) to be around during the 1980s, you know that there was a time when it was impossible to ignore the ubiquitous party anthem “Working for the Weekend” by a band that seemed to personify the 80s, Loverboy.



I was baffled at the time by the song’s success. Why did so many people like a song that (clearly) wasn’t very good?

Over time I have come to believe the song was successful because the sentiment was so universal. The ideas that we should have the right to work hard and that we deserve to be rewarded with a little bit of fun when the work week is done resonates with all of us.

Unfortunately, because of the way our current system of funding services for individuals with developmental disabilities is set up, we are denying a portion of our citizenry the opportunity to work for the weekend and, at the same time, contribute to their community in a meaningful way, no doubt to the extreme displeasure of Loverboy.

As you may know, a good portion of my career at Imagine! was spent working for Imagine!’s supported employment program Labor Source. The years I spent working with the Labor Source team were some of the most important in my life in terms of shaping my philosophy about services for individuals with intellectual disabilities – specifically, it convinced me that, done right, services provided can result in mutually beneficial outcomes for consumers and for the communities they live in.

Think about it. Supported employment offers people who have developmental disabilities the opportunity to develop vital job skills and become active participants in their communities.

Businesses employing consumers are able to reduce recruitment and training costs as they benefit from a diverse employee pool.

Just as important, but often overlooked, is the indisputable fact that the community at large benefits from supported employment programs. Consumers working through supported employment programs pay taxes and spend their hard earned money at local shops and restaurants. This means that the community actually gets a return on the investment they have made toward people with developmental disabilities.

Given a choice between providing services that require consumers to remain segregated, and unable to demonstrate value to their fellow citizens, or providing services that offer a genuine (and measurable) opportunity to contribute to society, it seems only logical that all interested parties would do everything in their power to enhance and support the latter type of services.

Sadly, we all know that logic isn’t always a driving force in our system of funding and delivering services to Colorado citizens who have a developmental disability. Despite the proven track record of successful outcomes from Labor Source and many other supported employment programs throughout the State, multiple onerous regulatory barriers have been placed on supported employment providers over the past 15 years that have effectively stifled any opportunity to provide these services to a substantial number of consumers.

Want to see the disheartening numbers that back that claim up? In 1997, 46.1% of consumers receiving services funded by the State of Colorado received at least some funding for supported employment services. By 2004, that number had dropped to 26.8%. The decline in the number of individuals receiving funding for supported employment services continues today. From 2008 to 2009, the number of consumers receiving supported employment services fell by 10%.

So, to recap: we’re facing an economic crisis in the State. We have far more individuals with developmental disabilities who need services than we have the resources to provide for those services. And yet, the State has created an almost impenetrable regulatory roadblock to a demonstrably effective service program that provides a tangible return on the State’s investment? I find that incomprehensible.

I have said before that I am not opposed to regulations that protect our consumers. But at a time when we need to examine every option on the table for service funding and provision, the regulations need to be written, coordinated, and enforced in such a way that they don’t hinder service programs that time and time again have been proven to be effective. Let’s let the folks we serve work for the weekend. We can even do it without subjecting them to the song.

Then again, what do I know?

Good News Friday!

I’ve said it before, but it is worth repeating. We are so fortunate at Imagine! to have so many accomplished friends in the community who actively support our mission.

Today, I’d like to congratulate two in particular who have recently been honored for their work in their own respective fields.

Imagine! Foundation Board of Directors member Julie Vlier was recently honored by the American Council of Engineering Companies of Colorado as the 2010 Outstanding Woman in Engineering. The award was created to recognize women for their professional achievements in the engineering field, and Julie, a manager in the water resources division of Tetra Tech, is most deserving of this prestigious award.

And our good friend George Karakehian, who is also a member (and past president) of the Imagine! Foundation Board, has been inducted into the 2010 Class of the Boulder County Business Hall of Fame. George, owner of Art Source International in Boulder, has been described as Mr. Downtown Boulder for his efforts to promote the downtown and Boulder. George’s tremendous efforts on behalf of Imagine! demonstrate that it would be equally appropriate to describe him as Mr. Imagine!.

Congratulations to Julie and George, and thanks for all you do for our organization and the individuals we serve!

Puzzling

Do you know what Imagine! is? According to the State of Colorado, we are many things.

Imagine! is designated as a Program Approved Service Agency by the Department of Human Services, Division for Developmental Disabilities.

Imagine! is also a contracted provider of employment services by the Department of Human Services, Division for Vocational Rehabilitation.

Imagine! is designated as a Community Centered Board for Broomfield and Boulder counties. With this designation from the Department of Human Services, we act as an Organized Health Care Delivery System and Broker of Early Intervention Services.

The Behavior Health Organization in Boulder and Broomfield counties has contracted with us to provide mental health services for adults who have both developmental disabilities and mental health disorders.

Imagine! has a child care license issued by the Department of Human Services, Division of Child Care, in order to provide after school care and a summer day camp program for kids with autism and developmental disabilities.

Imagine! is licensed as a Child Placement Agency by the Department of Human Services, Division of Child Welfare, to fill the need for foster care for kids with a developmental disability.

Imagine! operates group residential services and supports for people with developmental disabilities that are licensed by the Department of Public Health and Environment.

For State Department of Health Care Policy and Financing, Imagine! is a Single Entry Point and a Care Coordinating Agency for the Medicaid Autism Waiver.

Also for Health Care Policy and Financing, Imagine! is a Single Entry Point for the Medicaid Children’s Home and Community Based Services Waiver in order for children with disabilities to gain access to Medicaid benefits.

Why am I going to the trouble, and probably annoying you, with this alphabet soup list of licensures, designations, and contracts? Because this is what it takes in Colorado to be available to provide services to even one eligible person for their entire lifespan. Last year at Imagine!, we served 2,500 individuals with developmental disabilities and their families, and successfully navigated a myriad of regulations to serve each and every one.

Imagine yourself navigating this labyrinth - this list of departments, divisions, funding streams, ever-changing rules, regulations and billing procedures. Imagine the data systems involved and the knowledge required by the staff to successfully support an individual’s specific needs.

Imagine a thousand puzzle pieces that fit one day, and then don’t fit the next, with new pieces added to the puzzle each week. Providers in this State are asked to assemble the puzzle despite these challenges, burdened with the expectation that the puzzle will reveal a beautiful landscape of Colorado. What was a game of checkers is now a game of three dimensional chess.

It is a little like trying to solve a Rubik’s Cube while blindfolded.



And yet, just like the guy in the clip above, Colorado providers have managed to solve the puzzle again and again while still providing superior services. Surveys conducted across the State show high marks for quality and satisfaction by those receiving services. We are actually quite successful as providers of services and supports to residents of Colorado when requested (and funded).

The real challenge is serving the State itself. And that is getting more and more difficult. Solve the Rubik’s Cube blindfolded – with one hand tied behind your back.

We have reached the critical point when it is appropriate to examine this fractured disarray that makes up our system of support for citizens who have developmental disabilities and autism.

Then again, what do I know?