Wednesday, December 30, 2015

Coming Attractions 2016

It is the end of the year, and as I have done in years past on this blog, I would like to share some issues on my mind for the upcoming year, as well as make some educated guesses about what’s next for those of us in the field of serving individuals with intellectual and developmental disabilities (I/DD).

What will I/DD services look like in five years?
  • Delivery model: I see services for individuals with I/DD being swept up into other federally funded Medicaid Long Term Care Services. Right now, Colorado is moving forward with an Accountable Care Collaborative (ACC) model to expand medical home services for their adult and pediatric Medicaid population. This concerns me for several reasons, but primarily because services for people with I/DD aren’t always, or even usually, medical services, and shouldn’t be treated as such. Allow me to explain. Under the ACC model, primary care medical providers (PCMPs) contract with regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees. The goal of the ACC is to have every member linked with a primary care medical provider (PCMP) as his or her central point of care, and the PCMPs are directly responsible for ensuring timely access to primary care for ACC members. Our non-medical services are designed to provide opportunities for people with I/DD to engage fully in their communities, and therefore they occupy a unique niche in Medicaid’s funding system that doesn't fit well with the ACC model. Recent history demonstrates that when I/DD services are blended with other services in order to make appropriations easier for the State, it’s the I/DD services that suffer, followed by inevitable unintended consequences. 
  • Reimbursement model: Reading between the lines of the ACC Phase II documents, the funding mechanism for most I/DD services will probably remain a fee for service model. There seems to be little acknowledgement or memory of what a disaster this model has been. Preferably the state would consider moving the resources directly to the end-user team, and let them figure out the plan. This would be a true person-centered approach. 
  • Regulatory/legislative issues: It gives me no pleasure to say that Colorado does not appear to have the horsepower when considering unintended consequences or redundancies when creating new rules and regulations, and will struggle to keep up as the world moves at lightning speed around it. I see little evidence that this will change in the near future. 
  • Labor force shortage: Along with many others, I have been warning about the impending workforce shortage facing our field (check out this post from 2010). Well, now it is here. There are too few people able and willing to do the hard work of Direct Support Professionals for such poor pay. This is why Imagine! has been pushing for technology solutions so diligently over the past decade. We need to engage new business tools now. 
What services/service bundles will be needed or provided?
  • Regulators removed bundling in the mid-2000s. Providers are sneaking back to bundling even within the fee-for-service model. They are struggling with capacity issues and low rates and bundling services together will temporarily mitigate some of the fee-for-service issues. We’ll see if this can continue. 
What will the system look like in terms of Community Centered Boards and providers?
  • If I/DD services are crammed into the ACC, Community Centered Boards will be reinvented and redefined due to the impact of the ACC. I used to think that the concerns about Conflict Free Case Management (learn more about CFCM via video here, here, here, herehere, here, here, here, here, and here) would cause more fear in Colorado’s system, but now I think the ACC will be the ”man behind the curtain.” It is difficult to guess what the final result will look like, as the State has been completely opaque when it comes to offering information. As for providers, even though we have seen recent growth in the number of small providers, I predict we will be seeing a great deal of consolidations, mergers, or arrangements similar to franchising, moving forward. Current rates just won’t allow for smaller providers to thrive. 
What role will technology/apps play in serving individuals and families?
  • If you have read this blog at all, I think you know where I stand on this particular topic. I believe in a technology first approach. All of us use what I like to call “cognitive prosthetics” – tools like smartphones, smart homes, or even Google, that have become extensions of our being. We need to engage people we serve with those same technologies, and we need those who make the rules and regulations governing what we do to accept that this isn’t just something to look at in the future, but that it needs to be embraced immediately. 
What will new programing look like? How will it be retooled? Innovated?
  • My greatest wish is to see non-residential services evolve. Nobody’s life revolves around their residential setting, although you wouldn’t know it by looking at where the emphasis on services in our field lays. I’d like to see us get to the point where the lives of those we serve are defined by what they do when they are not asleep, and services that reflect those definitions. 
What will Person Centered training and practice look like?
  • I have never considered this anything new. I am not a fan of a phrase that is so obvious, created specifically for people with I/DD, and yet is marketed as the latest thinking - like it is an outcome. The rest of the world calls it user experience. That being said, I firmly believe that we have the tools already to deliver services that are much more focused on a user’s experience, similar to how we craft phones, tablets, vehicles, and every other activity in our lives. We don’t have a system that supports that approach, and until that changes, Person Centeredness will simply be an empty buzzword used to mask the real deficiencies in how services for folks with I/DD are delivered. 
How will personal outcome measures evolve?
  • This is probably the easiest question to answer. Outcomes should be measured by the way all of us measure outcomes: friends, lovers, family and social events; art, performance and music; life activities; travel; hobbies; fan of your favorite team; life-long learning, play; and then all the emotions, happiness, sorrow, etc. Despite my occasional cynicism, I believe we can and will get there. The biggest question is when. 
Then again, what do I know?

Tuesday, December 29, 2015

Technology Tuesday

An electronic version of Imagine!’s 2015 Annual Report is available online. An overview of our year, along with stats, stories, and successes to celebrate, are just a mouse click away. Click on the image below to check it out.!_2014-2015_Annual_Report.pdf
Can’t see the image? Click here.

Friday, December 25, 2015

Good News Friday!

Imagine!’s Annual Gift Giving Program was another huge success! 361 children and 147 adults received gifts this year thanks to the generous support of many in our community. I’ll highlight those supporters on this page in the coming weeks, but for today, please enjoy a few pictures of some of the gifts and some of the happy gift recipients, and accept the warmest of Holiday wishes to you and yours from all of us at Imagine!.

Wednesday, December 23, 2015


I recently had the pleasure seeing, up close and personal, a performance by the phenomenal guitarist Ottmar Liebert.
Can’t see the video? Click here

As I watched him, I couldn’t help thinking “this is a person who has mastered his craft.” I don’t mean that he is absolutely the best guitarist in the world (I’ll leave that debate to others), but watching him you almost sense that he is one with his guitar. He truly appears to have complete mastery over the instrument.

It can be a transcendent experience to encounter a person who has truly mastered his or her craft. Naturally, it got me to thinking: is there a person we can point to in the field of serving individuals with developmental or intellectual disabilities who can be described as having mastered that craft?

I don’t mean academics or administrators, though there are plenty of smart and talented folks who keep our field moving forward by providing the latest data and studies on what techniques or technologies may advance our knowledge and improve our outcomes. They are worthy of being celebrated, but that is not who I’m looking for today.

I’m looking for those people who simply have that innate ability to recognize the strengths of any person, irrespective of that person’s abilities or disabilities, and are able bring those strengths to the forefront. I’m looking for the doers, the ones on the front lines making an impact – the craft masters.

There are some ways that those in our field are recognized for being at the top of their game. At Imagine! we honor Employees of Distinction every year, Alliance honors a Colorado Direct Support Professional of the Year annually, and ANCOR presents an annual National Direct Support Professional of the Year Award.

Even with those recognition opportunities, I doubt right now there is one person to whom most everybody in your field could point to and say “that person has mastered the craft of serving people with intellectual disabilities.” But those awards, and evidence I see every day, indicate that many of those craft masters exist. Quite a few of them work right here at Imagine!.

The question is, are we as an organization, as a field of services, and even as a society, enlightened enough to recognize this mastery and honor it as we should? To place these craft masters on the pedestals they deserve, and to see them as people to be admired and emulated? Are we giving them the opportunity to write books, give presentations, or make videos so the rest of us can learn from their mastery? I’m not convinced we are, but I’d like us to get there.

We celebrate musicians, athletes, and performers all the time. We rightly recognize when someone has combined natural talent, hard work, and commitment to be the best at what they do. I hope you will join me in the New Year in making more effort to do the same for the dedicated men and women who anonymously work to master their craft in our field every single day. They certainly deserve it.

Then again, what do I know?

Tuesday, December 22, 2015

Technology Tuesday

Last week we shared some photos of Jessie, who receives services from Imagine!, meeting with University of Colorado College of Engineering and Applied Science students who created a wheelchair canopy to protect her from inclement weather.

Jessie’s Case Manager, LeAnne Woodward, shared some more information with us about the project, and we wanted to share that info with you. Here’s what LeAnne told us:

Two groups of CU engineering students met up with Jessie and myself back in September and said that they were starting a project and would like to design and create a mechanical wheelchair canopy that will serve as protection from the rain and snow. Jessie and I met with both teams and the students asked her what she would like the canopy to do, what color she preferred, how she would like to maneuver it, etc. They took pictures and measurements of her wheelchair and I provided photos of her back-up wheelchair at home. 

The first group presented their project to Jessie on Thursday, Dec. 11. 

Group 1: Connor Sanger, Toby Wu, Shane Nicoson, Dylan Muise 

The canopy is motorized and uses two 9-volt batteries. There is a hand lever that makes the top canopy go back and it attaches to the base of Jessie’s electric wheelchair. It is fastened to her chair with straps. It has a grey canopy. It took the students four hours per day for two weeks to complete the project. I asked them what was the best aspect of the project and they said, “The challenge of making it. Seeing the project come to life and helping others.” They said that they enjoyed problem solving. 

Group 2: Claire Bice, William Weeks, Steven Karl (not pictured), Alana Hardin (not pictured) 

This canopy is manual but it folds back and hangs down from the back of the chair when it is not in use. It is blue with a plastic window and panels on the side to protect from the weather. There is a rope attached to the center of the canopy on the inside that Jessie can pull to bring the canopy forward. It attaches to the handles of the wheelchair. 

This group said that they worked on the project for ten hours per day for three months. This included a presentation, an expo and workshops (I’m sure this goes for both groups). They said they had other designs before this one but this design functioned the best. When asked what the best part of the project was, they said, “giving it to Jessie.” Jessie picked the color for this canopy. 

Just a side note, when I met up with Jessie and the students she was absolutely beaming in excitement and said that she wanted to drive home with the canopy attached. It was a pretty cool moment for her and the students. I’m glad I was able to be a part of it. Jessie says that she likes it much better than having a flag on her wheelchair. Jessie feels lucky to get the canopy right as the winter season is starting.

Thanks LeAnne for that detailed account of the project, and thanks Conor, Toby, Shane, Dylan, Clair, William, Alana, and especially professor Melinda Piket-May, who taught the class and supported the students throughout the semester.

Friday, December 18, 2015

Good News Friday!

As the year comes to a close, I thought it would be nice to share a little review of 2015 at Imagine! (you can click on any of the images for a better view):

Learn even more about Imagine!'s year by checking out our latest Annual Report.

Tuesday, December 15, 2015

Technology Tuesday

Below are some pictures of Jessie, who receives services from Imagine!, along with students from the University of Colorado. The students gave Jessie an early Christmas present – a retractable umbrella attachment for her wheelchair.

If you know Jessie, you know she is fiercely independent, and she travels around outside in her wheelchair all the time. Colorado weather can change in an instant, and having this attachment will help keep Jessie on the move, even when the weather isn’t at its best!

The attachment was created by CU Engineering students in Professor Melinda Piket-May’s class. Learn more about the CU/Imagine! collaboration here.

Monday, December 14, 2015

Inspiration From The Slopes

We all need a little inspiration now and again.

Recently, I was inspired by a story I read about a young ski jumper named Logan. Logan’s tale originally appeared as part of the USA Nordic Sport Story Project. This project asks every ski jumper or Nordic combined skier (or fan) in the US (or world) to share a short story and photo to be posted on the USA Nordic Sport Story Project blog. Their plan is to share 31 stories - one each day from December 1 to December 31 - in hopes of raising $50,000 for funding the future of ski jumping and Nordic combined in the USA.

In a previous life, I was a ski jumper, so naturally I have been drawn to this project. But Logan’s story was especially relevant to my life and I wanted to share it with you, my blog readers. I reached out to Logan’s mom for permission to share his story, and she generously agreed. So please enjoy the story below, and I hope you find it as inspiring as I do.

Logan Mackey getting ready to launch one in Coleraine, MN

Logan Mackey is 10 years old and ski jumps with the Itasca Ski Club in Coleraine, MN. He is a friendly, generous, and sweet kid, passionate about ships, sirens and ski jumping, and loves life to the fullest. He joined ski jumping as a first grader when we were trying to find ways to help him manage his anxiety and to help advance his learning and motor skills as he had been diagnosed with a Developmental Cognitive Disability. Neither medication nor therapy had helped enough, so why not try ski jumping? 

Junior coach, Sue Kavanagh, was so supportive and engaged with Logan at that very first Learn to Ski Jump Day that he had no doubt about joining the team. As he continued to practice, his ability grew as well as his confidence and social skills. His younger brothers, age 6 and age 4, then started in the sport and Logan was able to help take on a teaching role with them, which also increased his confidence as well as his communication and his ability to lead. As he mastered the 10m hill, I thought he'd be too afraid to even go over to the 20m hill. But with the confidence given by coach Sue and 20m coach Doug Maki, Logan went down the 20m landing with barely a hesitation. He then proceeded to ski from the 20m half bar by the end of that practice and a week later, he was able to ski from the top of the 20m. I am amazed at what he has been able to accomplish! 

The benefits of this sport go beyond athletic ability and skill gained from practices and tournaments. It teaches responsibility as the kids help take care of the equipment and the hills. They learn how to support each other on and off the hills. They are surrounded by positive role models as they watch and interact with the "big" kids that jump the 40m and 70m hills. And it makes them part of something bigger as they carry on the tradition of ski jumping in Coleraine. 

 As I see him developing into a responsible, mature, happy young man, I am, and will be, forever grateful, not only to his current coaches, Sue Kavanagh and Doug Maki, but to all that have kept the sport alive in Coleraine, MN, for the last 110 years. From Ole Mangseth and John Greenway to present day Shrock's, Denney's and Rick Anderson along with many others, a lot of dedicated parents and volunteers, including those of you at Central and USA Ski Jumping, that put their time, energy and efforts into providing this amazing sport for my children as well as many others'. I sincerely appreciate everything you do. Thank you!

Friday, December 11, 2015

Good News Friday!

Thanks to you, Colorado Gives Day was a great success for Imagine!. We created a short “thank you” video below to let you know how much we appreciate your support. Enjoy!

  Can’t see the video? Click here.

Thursday, December 10, 2015

Out & About With . . . Moe's Broadway Bagel

Imagine!’s Out & About department’s fourth “Thank Goodness Its Saturday” event was dedicated to getting physical, for both parent and kid participants. The Erie Community Center was the venue for parents to enjoy a little free-time by participating in various fitness classes that the Recreation Center offers.

After working out, parents enjoyed a terrific assortment of goodies courtesy of Moe’s Broadway Bagel on 30th and Arapahoe in Boulder. I’d like to thank Moe’s for donating the delicious treats enjoyed by parents.

As for the children, they took a trip to Jump Street in Lakewood for some trampoline fun, snacks, and lunch.

Thank you again to everyone at Moe’s. We greatly appreciate the generosity and kindness of your donation!

Wednesday, December 9, 2015

All Aboard The Enterprise

In a recent post on this blog, I pointed out the sad irony of trying to provide services for individuals with intellectual and developmental disabilities in the state of Colorado: irrespective of how the economy is doing, the rates for providers always seem to get cut. Then, I questioned whether the current state leadership has the skills or capability to bring us out of the hole. Instead, we just go deeper into it.

The result is an inability to find extra funds for many of our state’s pressing needs, including services for people with intellectual and developmental disabilities (I/DD). I/DD providers can’t raise tuition, can’t blend inadequate Medicaid rates with other sources of income, and can’t increase other sources of income (such as insurance payments) while limiting Medicaid clients to a manageable loss like other areas of health care.

There may be a way to pull ourselves, at least partially, out of the hole we have dug for ourselves. In Colorado, the Hospital Provider Fee (HPF) is a major budgetary factor that is currently triggering a TABOR refund while I/DD providers are facing rate cuts. The Hospital Provider Fee generates about $750 million revenue, which counts towards the State’s TABOR revenue limit.

If the HPF were statutorily changed into an enterprise, a number of cuts proposed by the Governor could be eliminated. Colorado has almost two dozen enterprises that finance and/or administer various programs, including unemployment insurance, our higher education system, the Colorado Lottery, corrections, and special districts providing essential services such as fire protection. Changing the HPF to an enterprise would not require a vote of the citizens of Colorado.

Instead, creating this new enterprise would require the legislature to introduce a bill this coming session (which is likely), similar to HB 15-1389: Create New Hospital Provider Fee Enterprise, which was introduced last year and received too little attention too late in the session. The state legislature, the Speaker of the House of Representatives, and the President of the Senate will all need to exercise the leadership necessary to get the presumptive bill to the floor for a vote this time. Governor Hickenlooper, who currently supports the concept, could exercise the influence and leadership necessary to move Colorado out of the shadows of this perpetual cycle of budgetary crisis.

The Imagine! Board of Directors has passed a resolution, shown below (click on the image for a larger view), to support such a bill this session. Imagine! joins many other organizations across the state encouraging another look at the Hospital Provider Fee Enterprise fund.

This is not a permanent solution for the constitutional budget abuse, but it could by us a few years until our collective knowledge will allow us the necessary collaborative budget daylight we seek.

Then again, what do I know?

Click on the image for a larger view.

Tuesday, December 8, 2015

Technology Tuesday


Pictured above is Lana waiting for the bus. Lana lives in Imagine!’s Bob and Judy Charles SmartHome, and thanks to the support of Imagine!, she has been making great strides toward becoming more self-reliant. Technology has played a huge role in this move toward more self-reliance. Last week we shared a video on how a computer-based prompting system was used to increase Lana’s medication self-reliance.

Then, Imagine! took the next step. In order to start scheduling her own appointments, we devised a tool to create a mock phone menu so that Lana could practice calling in to her doctor and setting up appointments in a stress-free setting, until Lana was comfortable setting up the real appointment. And starting this week, Lana has begun using the bus to get to and from the medical appointments that she sets up by herself. Way to go, Lana!

Colorado Gives Day Is Today!

Can’t see the video? Click here

Imagine! believes in the potential of all. We believe in babies, toddlers, families, and adults at work and at play.

Colorado Gives Day is today, and it is a great opportunity to support everyone's potential through a donation to Imagine!.

The Colorado Gives Day $1 Million Incentive Fund will boost your donation, making your dollars do more to help people with intellectual and developmental disabilities. The Incentive Fund is a pool of dollars, provided by Community First Foundation and FirstBank, to boost every donation made through on Colorado Gives Day. For example, if Imagine! receives 10% of the total donations made on Colorado Gives Day, Imagine! also receives 10% of the $1 Million Incentive Fund.

Make your donation today, and thank you in advance for your support!

Friday, December 4, 2015

Good News Friday!

Today, I’d like to congratulate the 2015 Imagine! Employees of Distinction.

This year’s Employees of Distinction were selected from an impressive list of nominees because of the great work they do every day to ensure that Imagine! is able to meet its mission of providing opportunities for the individuals we serve.

As you undoubtedly know, we are so fortunate to have so many dedicated, talented, and passionate people working here at Imagine!. Even among this impressive group of employees, there are workers whose work ethic, compassion, and creativity allow them to stand out in a very gifted crowd.

They are truly Employees of Distinction, and I am honored and humbled to call them colleagues. All of our Employees of Distinction will be honored at Imagine!’s Holiday Party tonight. In advance of the ceremony, I’d like to introduce them to all of my blog readers via the short video below.

It is my pleasure to offer a hearty “way to go!” to this group of superstars!

Can’t see the video? Click here.

Thursday, December 3, 2015

Thank You, Kevin

Tuesday evening’s Imagine! Board of Directors meeting was bittersweet as we bade farewell to Kevin Nelson, who is stepping down from the board after serving for eight years. Kevin began his career working for Imagine!’s supported employment service (now called CORE/Labor Source) back in 1985. Though he eventually left that position and took a different career path, Imagine! never left his heart and when the opportunity to serve on the board arose he embraced it fully. His calm and informed leadership on the board, including a stint as Board President during a challenging time at Imagine!, was extremely beneficial and will be greatly missed.

In the picture below, current Board President Laura Koch presents Kevin with a gift of some locally distilled gin (don’t worry, we didn’t have any during the meeting!) as a small token of our great appreciation.

On a personal note, I want to say how much Kevin’s support and mentorship meant to me when I first took the position of CEO here at Imagine!. I had so much to learn, and Kevin was there to guide me every step of the way. I’m not sure I could have succeeded without him. Thank you for your service, Kevin!

PS – learn more about Kevin’s Imagine! experiences here.

Wednesday, December 2, 2015


On Friday, I will have the pleasure of introducing the 2015 Imagine! Employees of Distinction. Below is a composite picture of this year’s eight recipients.

Think you can guess who they are? Tune in to this blog Friday to find out for sure!

Tuesday, December 1, 2015

Technology Tuesday

We’ve shared before how Bob and Judy Charles SmartHome resident Lana has used an interactive medication administration tool created by Imagine! staffers to become more independent when it comes to her own medication administration. The short video below features some Imagine! staff members sharing the story, including how Lana’s success inspired her housemates!

Can’t see the video? Click here