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VOR Weekly E-Mail Update
January 27, 2006
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IN THIS ISSUE
Beyond the Beltway Reprint
January 25, 2006
Beyond the Beltway (BYB), NASDDDS' bi-weekly electronic bulletin
series,
covers state policy and program initiatives of special interest
to member
state agencies.
Edited by Kara LeBeau, M.A., State Policy Analyst
SUBSCRIBE TO NASDDDS PUBLICATIONS BY CLICKING HERE!
1. West Virginia Governor Approves Olmstead Plan and
Appropriates Funds
2. Employment Efforts Surveyed in Ohio
3. Inadequate Funding Causes New Hampshire to Slip Behind in
Services,
Report Says
4. Ohio Nonprofits Get More Bang Out of Accessible Housing Buck
5. UMass Lowell Launches Online Autism Behavioral Intervention
Programs
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1. West Virginia Governor Approves Olmstead Plan and
Appropriates Funds
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Last month, West Virginia Governor Joe Manchin signed a state
plan to
comply with the 1999 U.S. Supreme Court decision in Olmstead v.
L.C. and
E.W. that requires states to support Americans with disabilities
in the
most integrated setting appropriate to their needs. Since then,
states
accelerated efforts to move individuals out of institutions who
wanted to
leave and settled them into real homes in the community. The
signing was a
formal ceremony commemorating Governor Manchin's executive order
issued in
October to implement the Olmstead Plan. Right now, nearly 10,000
West
Virginian elders and others with disabilities live in nursing
homes; around
600 of them have developmental disabilities. About 18-20 percent
of these
nursing home residents said "yes" when asked if they'd prefer to
live in
community settings, said Tina Maher, Olmstead Coordinator for
the state's
Office of the Ombudsman for Behavioral Health.
Much credit goes to self-advocates and other stakeholders for
"keeping the
pressure up to get the West Virginia Olmstead plan completed and
signed by
the governor," said Mountain State People's Alliance staff
member Scott
Miller. (Mountain State People's Alliance is a new project
funded by the
West Virginia Developmental Disabilities Council.)
While the governor said he supports West Virginians with
disabilities, he
did not commit any funds to carry out the goals of the new
Olmstead Plan.
As soon as they heard about the official signing of the plan
slated for
December, "[b]oth the ADAPT coordinator [of West Virginia] and
myself
started contacting our list of self-advocates and family members
to start
calling the Governor's office asking that funds be attached to
the plan,
"Miller said, "so it could be implemented and not just sit on a
desk
looking pretty."
In their phone calls, self-advocates throughout the state
reminded the
governor of his verbal commitments made in previous meetings
with them to
finance community-based services and supports. "It's a matter of
being
vigilant," said self-advocate Ken Ervin, "and reminding [the
governor] of
his own words."
Shortly before the ceremony, five self-advocates including
Ervin, the state
Olmstead Coordinator Tina Maher, two Independent Living staff
and Miller,
sat down with Brian Kastick, the Governor's Director of Public
Policy and
Federal Affairs, to discuss the possibility of including
$500,000 in the
upcoming budget for Olmstead implementation. "Although he was
aware of the
request," Miller explained, The governor "had no information
about it due
to the fact that the Department of Health and Human Services had
not made
the budget request. It was our efforts that put this issue on
the
governor's radar."
About 40 people attended the official signing ceremony; three in
wheelchairs sat at the front of the room each holding a placard
that
together read, "We the people." Self-advocates wanted to make
sure "the
governor understood he was signing a document that was about
real people
and their lives in the community," Miller said. "Although we did
not get a
firm [financial] commitment at the meeting, we were left feeling
relatively
hopeful."
Then, in early January, Governor Manchin announced he was
allocating
$250,000 in his proposed 2007 fiscal year budget for the Office
of
Behavioral Health Services to implement the Olmstead Plan. The
state is
also receiving more than four million dollars through federal
systems
change grants to implement the Olmstead Plan.
The Plan. The Olmstead Advisory Council, whose members include
self-advocates, family members, providers, and state agency
representatives, prepared the state's Olmstead Plan.
"The West Virginia Olmstead Plan addresses several components of
West
Virginia's service delivery system for people with all
disabilities,
including developmental disabilities," said Frank Kirkland,
Director of the
state's Division of Developmental Disabilities.
"The plan looks at strengthening the community supports we have
and
identifying and assessing people with disabilities' desire to
reside in the
community who may now be in more restrictive settings such as
nursing homes
[or intermediate care facilities for mental retardation (ICFs/MR),]
or
those who may need community supports to prevent them from going
into more
restrictive settings. It also looks at our wait lists for
community-based
programs such as the MR/DD and AD [aged and disabled] waivers.
In total, the plan spells out 189 specific activities or tasks
that need to
be fulfilled in order to implement the Olmstead decision in West
Virginia.
Of these tasks, 52 percent (99) can be put into action without
fiscal
impact and/or regulatory change; 30 percent (56) necessitate
moderate
fiscal impact or regulatory change; and 18 percent (34) are
major
activities that would require legislative action for funding or
changes in
the laws.
These major activities and specific tasks are divided into 10
categories:
1) Informed Choice
Includes such goals as developing a resource guide and an
interactive
Website to educate individuals on making informed choices and
finding
community-based supports, resources, and providers.
2) Identification
One task in this category is to require state-operated
facilities, nursing
homes, ICFs/MR, and assisted living residences to maintain a
list of
individuals who want to return to the community.
3) Transition
Transition tasks include developing a person-centered process to
help
individuals transition into the most integrated settings in the
community.
4) Diversion
This primary goal for this category of tasks is to prevent or
divert
individuals from being institutionalized or segregated.
5) Reasonable Pace
Tasks include establishing policies so no one has to wait more
than 90 days
to receive home and community-based services once eligibility is
determined.
6) Eliminating Institutional Bias
In order to provide community-based supports and services,
institutional
bias in funding long-term supports must be eliminated. Steps to
accomplish
this include analyzing alternative uses for nursing facilities
and ICFs/MR
as well as to educate mental health commissioners about the
Olmstead
decision and alternatives to institutionalization.
7) Self-Direction
Providing individuals with choice and control over their
services and
supports underlies all self-direction tasks such as revising
policies for
licensing requirements to provide self-direction in all waiver
programs.
8) Rights Protection
Goals for rights protection include amending child custody laws
so that
parents do not have to give up custody of their children to the
state in
order for the children to receive services.
9) Quality Assurance and Quality Improvement: QA/QI activities
include
preparing an annual Olmstead Plan implementation report for the
governor
and the general public.
10) Community-Based Services, Programs, and Activities: Tasks
involved to
develop, enhance, and maintain varied community-based
self-directed
supports include amending the Nurse Practice Act, seeking funds
for
programs that support un-served or under-served individuals, and
implementing appropriate housing options in the community.
Next Steps. Now that the plan is approved, one of the first
goals to tackle
is to identify individuals in institutional settings and get
some good data
on their basic needs and which ones want to move back into the
community,
Maher said. The Olmstead Advisory Council will take on new roles
by
advising Maher about fulfilling the Olmstead Plan; making
recommendations
for long-term care institutional and community-based support
systems;
issuing position papers to identify and resolve systemic issues;
and
monitoring, revising, and updating the Olmstead Plan and related
work
plans.
FMI: To find out more about implementing the Olmstead decision
in West
Virginia, see
http://www.wvdhhr.org/bhhf/olmstead/default.htm. To learn
more about self-advocacy in West Virginia, visit the Mountain
State
People's Alliance's website at
http://www.letsgetalifewv.org and ADAPT West
Virginia's website at
http://www.labs.net/adapt/. For further questions,
contact Tina Maher at (304) 558-2159 or
tinamaher@wvdhhr.org.
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2. Employment Efforts Reviewed in Ohio
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Results from an Ohio employment survey reveal that while the
state has
undertaken initiatives to find meaningful employment for
individuals with
developmental disabilities, a tendency to rely on sheltered
workshops still
prevails. "[M]uch work remains to be done," the report said, to
enable
citizens "to leave a sheltered environment and work in their
community."
An employment committee of the Ohio Department of MR/DD Family
Advisory
Council conducted the survey in 2004 and received responses from
40 of the
88 county boards for MR/DD in the state. The survey was
conducted to learn
about employment options, best practices, and obstacles with the
intent to
share results with county boards to help them improve employment
services
for Ohioans with developmental disabilities.
Transition Planning. Survey responses to questions about
transition plans
found that a number of counties begin transition planning with
the
individual when s/he is 14 years old. Other counties used
individual
education plans, information fairs, and direct requests for
transition
planning. One county board begins transition planning by
developing a life
plan as soon as the child enters the service system. While
children in
MR/DD schools receive more information about transitioning, it's
not clear
whether they are more likely to end up in sheltered workshops or
in
community jobs. One of the larger counties helps youth finds
jobs in the
community by offering a training program or "job club," while
smaller
counties readily assist individuals looking for employment when
they
request it.
Transportation. Transportation was cited as a block to
employment - being
"the most needed component to employment, but the most difficult
to find."
At the same time, innovative solutions to transportation are
underway in
one county, for example, that is pursuing collaborations to get
transportation grants. Another county created an innovative
public
transportation service consisting of a fleet of 15-passenger
vehicles that
enables individuals to work in the community as well as
participate in
recreation and field trips.
Volunteering. Volunteer work, for the most part, was not pursued
as an
employment option in most counties. Reasons given included that
it could
not be funded and that finding volunteer opportunities was often
left up to
the individual's family and friends. Some counties considered
volunteering
an important assessment means for paid employment in the
community. And one
county reported that many of its participants were already
volunteers on
their own for causes of special interest to them.
FMI: To read the initial report, click on
http://odmrdd.state.oh.us/Dec6Survey.pdf. For other details
about survey
questions and participants, see the left-hand menu at
http://odmrdd.state.oh.us.
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3. Inadequate Funding Causes New Hampshire to Slip Behind in
Services,
Report Says
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Once recognized as a national model, the New Hampshire's MR/DD
area agency
system has slipped behind in its ability to serve children and
adults with
developmental disabilities, says a new report by the Governor's
Study
Commission on Area Agencies.
Funding in the past 10 years has not kept pace with rising
enrollments and
inflation, resulting in staffing shortages, waitlists, limited
opportunities for employment and community participation, and
lack of
resources for new initiatives such as quality improvement.
Governor John Lynch established the commission by executive
order and
charged its members to identify essential operations and
delivery systems
of New Hampshire's 12 area DD agencies and recommend ways to
operate them
more efficiently and cost- effectively without compromising
services.
The commission's findings include:
* Starting wages for direct support staff can be as low as
$7.00 an hour,
with average wages below poverty level for a family of four.
* Vacancy rates of direct support staff have exceeded 36
percent.
* The enhanced family provider system, the primary residential
service
model, and the Area Agency system as a whole, has had no general
rate
increase from at least 1995 through 2005.
* Since 1994, there has been a reduction in average costs of
community-based waiver services from $58,000 to $41,000 per
person based on
1994 dollars.
* Area Agencies' administrative costs have been reduced nearly
in half, and
the state's Bureau of Developmental Services has suffered about
a one-third
staff reduction in the past five years - affecting its ability
to oversee
programs and ensure safety and accountability.
The Area Agencies and the New Hampshire Department of Health and
Human
Services (HHS), which oversees and supervises the system, serves
10,000
children and adults with developmental disabilities.
Approximately 6,900
receive limited or periodic services, and about half of them -
mostly
adults - receive more comprehensive services under the
Medicaid-funded
community waiver programs.
The Commission offered some 35 recommendations in the report to
improve
efficiency, effectiveness, and outcomes; but the priority
recommendations
are:
1. Improve collaboration and community partnership at all
levels, including
the business community, to increase employment opportunities.
2. Support legislative action in the 2006 session to increase
direct
support staff wages and increase the enhanced family care
stipends which
have been stagnant for years.
3. Develop a human resources enhancement plan to produce
adequate numbers
of qualified administrative, professional, and supervisory
personnel.
FMI: To access the report, go to
http://drcnh.org/AAstudycomm.htm. For
further questions, contact Richard Cohen, Commission Chair, at
(603)
228-0432 ext. 15.
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4. Ohio Nonprofits Get More Bang Out of Accessible Housing Buck
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Two intertwined nonprofit organizations in Ohio devised a way to
stretch
state housing dollars and provide brand new homes and options
for Ohioans
with developmental disabilities. Delaware Creative Housing (DCH)
functions
as a housing board that provides housing and like services for
individuals
with developmental disabilities, while Creative Living Systems,
Inc. (CLS)
provides environmental modifications across the state under
three different
Medicaid waivers - Individual Options and Level One both of
which are MR/DD
waivers and the Ohio Home Care Waiver administered by the Jobs
and Family
Services for eligible consumers. Additionally, CLS has been
approved as a
housing manufacturer for the State of Ohio. Only accessible
homes are built
in their plant. The homes are then transported and set on the
owner's lot.
The two nonprofits operate under the same roof with some of the
same staff
and the same executive director.
They basically use funds allocated by the Ohio Department of
Mental
Retardation and Developmental Disabilities (OMR/DD) to purchase
existing
homes in the community. Usually dwellings are then modified to
meet the
special needs of individuals served by one of 88 county boards
throughout
the state that provide MR/DD services. OMR/DD provides up to 75
percent of
a purchase price within that allocation. The nonprofit housing
board
serving that county then either finances through a bank or the
local county
MR/DD board, the remaining 25 percent. What DCH and CLS do is
use these
funds and blend them with municipality grant monies to build new
homes that
are specially built for an individual's unique needs. They have
consistently been able to build two new accessible homes for the
price of
one preexisting home purchase allocation.
They do this by first making application to ODMR/DD to complete
a "Pilot
Project" in order to use the OMR/DD allocation for new
construction. DCH
then approaches local municipalities about supporting their
project concept
with Community Development Block Grants, and specifically the
Community
Housing Improvement Program (CHIP) that provides grants to
eligible
communities to encourage flexible, community-wide approaches to
improving
affordable housing for low- and moderate-income persons.
"We have consistently doubled the State Department of MR/DD's
housing stock
by utilizing this model," said Michael J. Corbett, Executive
Director of
DCH and CLS. "Everyone contributes a little less, everyone meets
their
objectives, everyone looks good, everyone feels good, and the
bottom line -
people with developmental disabilities get accessible,
affordable housing
that truly meets their needs."
FMI: To learn more about DCH and CLS, see
http://www.delawarecreativehousing.com.
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5. UMass Lowell Launches Online Autism Behavioral Intervention
Programs
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The Department of Psychology at the University of Massachusetts
Lowell
collaborated with the University of Massachusetts' Eunice
Kennedy Shriver
Center and the University of Massachusetts' online degree
program to create
two new online programs on behavioral intervention for
individuals with
autism.
"Early intervention is key to the successful treatment of
autism," said
UMass Lowell Psychology Professor Charlotte Mandell. "Currently,
there is a
critical shortage of skilled early intervention professionals in
the United
States. By offering these programs online, we're hoping to
extend the
knowledge and research of UMass to a much larger population."
The first new program, the Graduate Certificate in Behavioral
Intervention
in Autism, is a four-course, graduate-level certificate program
that
provides an understanding of autism and related developmental
disorders for
professionals working in psychology, education, child care,
speech and
language disorders, and mental health and human services. The
program
includes an introduction to behavioral methods and how and where
such
methods can be used and evaluated. For more information, contact
the
program coordinator, Professor Richard Siegel at (978) 934-3961
or
autismcertificate@uml.edu.
The second new program, the Online Program Leading to Board
Certification
as a Behavior Analyst, offers a sequence of five online autism
courses that
meets the Behavior Analyst Certification Board's coursework
requirement
towards national certification as a behavior analyst. For
additional
information on board certification requirements, visit
http://www.bacb.com.
For other questions regarding this program, contact Charlotte
Mandell at
(978) 934-3954 or
charlotte_mandell@uml.edu.
FMI: To learn more about the new online programs on autism, see
http://continuinged.uml.edu/online/autism.htm.
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Tamie Hopp
Executive Director
