“It’s kind of amazing. One year you’re going this way, then the next you’re in a completely different place.”
Twenty year old Jamison Cowling knows well of what he speaks. 2017 was a deeply challenging year for the Estacada resident. Jami, who experiences autism, has spent the last year and a half adjusting to life after a Traumatic Brain Injury (TBI.)
In March of 2017, he was involved in a snow-tubing accident that left him with a broken neck, broken back, fractured skull, and brain hemorrhage. The months that followed were painful and difficult, requiring around the clock care as he slowly learned to walk and communicate again. He found comfort in family support, friends, and his faith.
Says mother Beki, “When I first received the call letting us know he had been injured and was being loaded into an ambulance, my world tilted for a minute… I struggled to breathe. And then our whole family sort of went on pause for months and months while we helped Jami deal with his TBI and we advocated for all the supports he needed.”
In the early days following his discharge from the hospital, Jami slept twenty-two hours a day at times, requiring around the clock supports. His parents balanced helping Jami recover with raising his four younger siblings. “It was so hard for Jami, but he was strong,” says Beki. “A brain injury changes everything.”
He underwent extensive occupational, speech, and neurofeedback therapy and credits the exceptional supports he received from Dr. Swingen, a chiropractic functional neurologist in SW Portland, with crafting an individualized physical therapy plan that eventually got him back on his feet.
Building a Circle of Support
The life he leads today is light years away from where things were for him and his family just eighteen months ago. Soon after the accident, he enrolled as a customer of Independence Northwest support services brokerage. “Options matter,” says Beki. “The whole last year has been about creating the right Team Jami.”
Team Jami is made up of friends, family members, and paid home and community-based supports. By combining supports from his brokerage Personal Agent, medical professionals, a behavior specialist, and Personal Support Workers to help him increase his independent living skills, Jami has been able to build a firm foundation for his new life.
Success rarely comes in a straight line. As soon as he was feeling well and stable enough, Jami set his sights on employment. His initial attempt moving into the workforce wasn’t without its challenges. “I had a job and it wasn’t good for me,” he says, referring to a position he held about a year after the accident. His brain was still healing and he needed a low stress, adaptive environment. People in his circle noticed he was starting to struggle and became concerned things might be moving too swiftly. “We needed something different, something that would give me the space to think and do a good job.”
Jami’s Brokerage Personal Agent Andrea Ochsner brainstormed with the family on possible options to better support him in future job environments. She connected them with a Behavior Specialist by the name of Gabrielle Taylor, who soon joined the circle of support. Gabrielle worked with Jami to perform a functional behavior assessment, laying the groundwork for communication strategies at home and in future employment settings. “She really helped me,” he says.
Concurrently, Vocational Rehabilitation Counselor Mark Foster assisted Jami with developing an employment plan that focused on his strengths and capacities, bringing provider organization Adult Learning Systems of Oregon (ALSO) on board. ALSO helped Jami land a volunteer position with Store to Door, a nonprofit program where Jami grocery shopped on behalf of seniors and people with physical disabilities.
“Communication is everything and it furthers what Jami is able to do… (Personal Agent) Andrea has facilitated communication amazingly! She is very skilled at gathering the different members of Team Jami together, either by email or in-person meetings, and then diplomatically addresses sensitive issues in ways that put everyone at ease. When all of (us) are on the same page, then Jami wins. He gets clear, consistent, and congruent supports.”
Preparation, Connectivity, and Opportunity
In the fall of 2018, everything converged. Before he knew it, Jami was preparing for an interview with Fred Meyer.
“It shocked them I got this job so quick,” says Jami. “It was really fast.” He says the experience he gained as a volunteer at Store to Door helped pave the way for the position.
Today, Jami is working five days a week at a Fred Meyer in Clackamas County, a member of their Click List team. He reviews online grocery orders, shops the store for the items, and assists customers when they come to pick up their purchases.
“There’s a lot of variety in the job,” he says. “I have a lot less social anxiety. This weekend was Veterans Day and I thanked two veterans for their service. One served in the Vietnam War and really appreciated being thanked.”
Watching her son talk about his success, Beki beams with pride.
“When I think of all that Jami and our family has gone through in the last eighteen months, I am just so profoundly filled with gratitude that Jami is alive and breathing and walking and talking… Now we are seeing the fruits of all the efforts that everyone has made supporting our son and it is truly beautiful. We are getting our sweet Jami back and he is even better than before.”
On October 30th, 2017, Oregon Developmental Disabilities Director Lilia Teninty released the following statement regarding the Oregon Needs Assessment:
“We’ve reached some important milestones I want to share with you. The summary below reflects a great deal of work done by everyone in our service system – ODDS staff, CDDP and Brokerage staff, providers, people with I/DD and their families. Thank you for your thoughtful feedback and your efforts to help us get to this point.
The journey to create the ONA started in 2013. The Legislature told ODDS to implement a single, uniform assessment tool. It would be used for everyone we support, regardless of setting.
We engaged a stakeholder group for the project. We also hired Mission Analytics Group. Mission Analytics’ role was to ensure the ONA is a validated tool for all service settings.
The project team members have been diligent. They worked through technical challenges, revisions to the questions, and more. They conducted hundreds of assessments that were used to test the validity and reliability of the ONA. They managed two rounds of pilot testing.
We are close to rolling out the ONA. All individuals receiving I/DD services will be assessed using the ONA in 2018. We need to start the ONA assessments in January to be able to collect data needed for the Compass Project.
Based on input from advocates and partners, we asked CDDPs and Brokerages to work with us to identify staff to administer the ONA. CDDPs and Brokerages are identifying staff in their entities to perform the assessments. The ODDS assessment team will also assist with administering ONAs in rural areas of the state.
From January through June, staff will use both the ONA and the current assessment tool. In July, the ONA will be the official assessment. The ODDS assessment team will train the CDDP and Brokerage staff who will use the tool. The team will also provide technical assistance and quality assurance. They will do this to ensure the tool is administered consistently across the state.
The ONA will be administered by a staff person who is not the person’s case manager.
Benefits of separating case management from the assessment include:
Removes real or perceived conflicts of interest.
Improves objectivity and consistency.
The case manager may still take part in the assessment. The case manager will not be responsible for the results of the assessment itself. Instead, the case manager can support the person and provide information to inform responses.
Our journey to create the ONA is reaching its destination. Thank you to the many people who are making it possible.”
Kelly Quinlan has a first-hand understanding of how Oregon brokerage services help in establishing and maintaining a good quality of life for adults with intellectual disabilities. A prolific writer, with over 50 short stories and author of a self-published book of personal memoirs, Kelly is a vivacious 36-year-old woman known for her bubbly personality and unique style of dress, which includes wearing legwarmers year-round. She loves spending time with her best friend, playing board games and making movies to post on youtube. Energetic, with a great sense of humor and a variety of interests, Kelly says, “There is a lot of flavor in my life right now!“
But about 7 years ago, Kelly’s life was different. She was on a waiting list for brokerage services, and though she was connected with some social services like Section 8 Housing and Social Security Income, she did not have access to individualized supports for individuals with intellectual disabilities. “There was not a whole lot going on–working on my stories—but that was it. I was lonely without having any friends,” she recalled. When she entered brokerage services in 2008, Kelly was surprised at the variety of supports available, and pleased with how dramatically her life was enhanced. She now receives training in independent living skills, assistance with communication due to hearing impairment, support with social skills, and help with medical management. She uses two independent contractors and contracts with a day support activities provider organization for community inclusion. She describes her life as balanced and thriving, quite different from her adult life before receiving services. “If I just had funding for one thing, I don’t know what I would do. I would have to advocate and say, I need more funds for this,” Kelly says as she recounts her providers and lists her goals and support needs. “It would be hard if I didn’t get help.”
Kelly has found the design of brokerage services flexible enough to access services catered to her specific support needs. Kelly has severe food allergies, so was thrilled to find a provider who helps her shop, read food labels, find recipes, and cook. In the past, if she accidentally ate something she was allergic to, she said, “I would get really sick. And it does take me a while to get back on my feet after I am contaminated with the food that I am allergic to.” A favorite recipe she discovered with her provider is a gluten-free vegan clam chowder that “tastes like the real thing, only with coconut cream and sweet rice flour.” This brokerage service “really helps me out,” she says. Another unique service Kelly has access through the brokerage is the ability to attend the national Turner Syndrome conference each year. “I have Turner’s. I like to go to these conferences that happen every year. And the brokerage pays for that, which is really nice.” While Kelly saves money to afford a plane ticket and hotel room, her brokerage service plan covers the cost of her conference registration so that Kelly can network with hundreds of people affected by Turner syndrome and go to workshops and presentations given by healthcare providers and other professionals. Another part of her brokerage plan that Kelly states is very valuable to her is transportation services that allow her to get places she cannot access independently. The individualized services outlined in Kelly’s annual support plan are entirely unique, and as Kelly points out, different from other brokerage customers. “I live out on my own—not everyone I know lives on their own. Not everyone that I know has food allergies, not everyone I know has Turners, or the same kind of medical conditions. I don’t know anybody else that gets the same kind of services that I get,” Kelly says.
Part of Kelly’s busy schedule includes working at her uncle’s restaurant, Cheryl’s on 12th, where she spends about 15 hours per week. “I’m a dishwasher, that’s basically my title,” says Kelly, laughing. “I sometimes come out and help with washing down tables, bus tables, and sometimes I’m a hostess.” She says that she loves “working along side the people that work here…. to work with people that I’m familiar with. Most people know that I’m Eddie’s niece, so sometimes that’s when they really straighten up. And sometimes I do chuckle about that!” She prides herself on “the sense of accomplishment” that comes from helping at the restaurant. When asked what she likes most about her employment, she said, “Working. Just having a job. Being out in the community and contributing what I can do. And helping my uncle.”
Kelly is an avid user of social media. “I like posting all the stuff that I do, posting activities with On-the-Move, saying what I did at work… my family likes that I post things on Facebook so that they have a good sense of what’s going on.” She also posts personal memoirs and original creative writing on a self-publishing internet site, and makes short movies that she posts on her youtube channel. She observed that her interest in communicating her experiences through these different media increased as she has become more involved in her community, particularly through her community inclusion program. “When I started going to On-the-Move I thought, that’s interesting… this part is interesting to ME. And it’s something special that happened to me.” Having interesting, novel experiences that are independent from her family give her rich experiences that Kelly defines as key to a good quality of life.
When Kelly heard, in the spring of 2015, that there were possible cuts proposed that would negatively impact her brokerage and services, she decided to go to the state capitol to speak to her legislators directly. “It was really interesting, the building gave off the impression that I am big, large, and I mean business. I had never been there before. But inside it was more low-key and it felt like you can address your problems and someone will listen to you.” While there Kelly spoke to her representative about the importance of having people with disabilities present in the community, and how important it is to have community inclusion supports. “It’s good… being in the community with other people that are disabled. If you cut our programs, there’s not going to be any community living for people with disabilities.” She says she felt the advocacy effort was effective. “Oh, I definitely got some people’s attention. I was talking to a group of people!”
Excited to continue with advocating for individualized services and support for adults with intellectual disabilities, Kelly has already planned another trip to Salem and is joining the Board of Directors of a local Portland nonprofit. She said she would make the following recommendations to anyone just entering the brokerage system: “I would definitely tell them about On-the-Move, I would tell them that if they have any medical issues then tell your PA. If you need assistance with financials, speak up, don’t be shy, because that’s what they’re there for. When I first started, I wasn’t quite sure what to ask, or what was even available. I wasn’t quite sure if I could get help with learning how to cook, and what kinds of things would help me out when it came to community, things like that. The medical stuff is especially important,” Kelly says, referencing transportation services, adds, “and going to places that I cannot get to.” Having access to services that are uniquely individualized to her specific needs and circumstances has been life-changing for Kelly. “Yes, it’s really important!” she says.
You can read Kelly’s stories on fanfiction.net (fanfiction.net/u/37688/kellyQ) and wattpad.com (wattpad.com/user/kellyq204) and see her videos on her youtube channel (youtube.com/user/kellyq204).
This is the first of the Independence Northwest Customer Stories Project, an effort we’ve recently begun in collaboration with disability community leader Molly Mayo. We believe that hearing/reading the life stories of those who receive our services will deepen community understanding of the uniqueness of essential home and community-based brokerage services. As our system continues to wrestle with changes, we must keep the principles of self-determination front and center. There’s no better example of someone taking services and running with them than INW customer Henry Meece. You may recognize Henry from many of INW’s promotional materials. His face graces our Facebook page and several of our published documents. Henry is living quite the life and has a memorable story to tell!
Henry Meece has been a brokerage customer since 2009. He uses brokerage dollars to purchase Day Support Activities/Attendant Care, Supported Employment and Relief Care. His Personal Agent is Carie Shumway.
Henry Meece, a 25-year-old customer of Independence Northwest brokerage, can be found jam-skating at the local rink, paddling on a dragon-boat, competing in Special Olympics sports, snowshoeing, and snowboarding– when he’s not riding his skateboard to work. In March 2015, Henry was interviewed on ESPN after winning a gold medal in the 2015 X Games in the first unified dual slalom race, and in 2013 Henry’s athleticism took him to his birthplace of Korea for the Special Olympic World Games where he won a gold medal in slalom snowboarding. Henry has completed three marathons. He is proud of his athletic ability, and the interesting life that he leads. He thrives on a rigorous day-to-day schedule that he has shaped with the help of his mom, his brokerage, and his providers. He says his brokerage supports give him “something to do” and help him “stay active, make friends,” and lead an “independent life.” His mom says, “I would say of all the people we know, Henry is the most active.”
Henry was adopted by Nancy Newell and Ted Meece in 1990. His parents knew that Henry, an orphan from Korea, would probably have a disability. He began early intervention services at age 18 months and was in special education throughout school, graduating with a modified diploma when he turned 21. Although frequently in segregated classrooms, Henry experienced true inclusion in sports programs and “competed right alongside his peers” his mom states. But once school ended, without regular, structured activities, the family at first had no idea what Henry was going to do.
“Once a person is done with public school—there is nothing,” says Nancy. “It’s a very bleak outlook.” Luckily, due the advocacy of his mom and through the adult services he receives through Independence Northwest brokerage, Henry is gainfully employed and leads an active, stimulating, and productive life, which includes participation in two different community-based Day Support Activity programs. “Henry is active and integrated with these programs, but if there weren’t these programs… where is the natural inclusion?” Nancy asks. She said that policymakers should be educated about the lack of resources for adults with intellectual disabilities. “I know people that don’t live in the Portland area,” Nancy says. “These programs don’t exist in other parts of the state, there isn’t an On-the-Move, there isn’t a Creative Goals Solutions—and it’s not just Portland that has people with disabilities. It’s alarming!” And 10% of people experience a disability, she points out. She wants policymakers to understand that funding for services is vital to the life of people with disabilities after high school. “Without the funding there are no programs. Even if you could private pay, what would be out there?”
Brokerage-facilitated supports have been instrumental in matching Henry to meaningful employment. Using supported employment services, Henry has been able to gain significant experiences building an employment resume, and as a result successfully obtained two part-time jobs. He has worked at a nonprofit brew pub for three years, and at a fitness center for the past year and a half. “I like everything,” Henry says about his jobs, which total about 10 hours per week and pay minimum wage. “I want to get the money,” he says, to put into a savings account.
Nancy and Henry appreciate how brokerage supports are uniquely individualized to each person. But such open-ended options have at times made the system challenging to grasp. “It’s great to have individualized systems, but there is no uniformity,” which can make things confusing, says Nancy. “It’s a wonderful system, but how do you know about it? We’ve learned as we go along, and the information can be very difficult.” Nancy has found dealing with employment issues especially challenging, because when Henry earns an income, it affects his Social Security benefits and requires detailed documentation. “Everyone should work if they want to, and everyone should work if they can. But there are a lot of reasons not to work,” says Nancy, referring to the complex rules around earning money while receiving Social Security benefits. Before Nancy had a clear understanding of the needed documentation, which requires writing a letter to Social Security and submitting all of Henry’s pay stubs each month, she says, “I felt like a fool—the college educated mom! …You know we are doing just a bit more than waving goodbye—we’re orchestrating. We’re like an air traffic controller keeping everything in the air and trying to have everything land smoothly. So I think it is very hard to carry all this information around… and if you have one lapse,” there can be dire consequences, Nancy points out, such as the entire loss of eligibility for much-needed benefits.
Nancy and Henry describe their experience with Independence Northwest brokerage as smoothly functioning and “highly efficient. Everything behind the scenes works. The relationship between the brokerage and the providers seems to work really well. I have never had to be involved in a billing issue. Henry has never been turned away because papers weren’t signed. The relationship between the brokerage and the providers has been very strong.” Additionally, Nancy adds, “the PA [personal agent] will sit down with Henry in a way that he understands. I can be involved or Henry can get to the PA independently.” Henry has chosen to use Independent Contractors, small local agencies, and larger organizations for various services as his needs have changed throughout the years.
Nancy and Henry have begun to talk about Henry living somewhere other than his parents’ home in the near future. “These are not journeys that other people I know have taken, and the move might look different for everyone,” with options such as living in an apartment, finding a roommate, moving to a group home, or discovering other supported living opportunities.” When asked what he thought about living somewhere else, Henry said, “Good, because my girlfriend is talking about it.”
“All clients, all families are different,” says Nancy. It is clear that Henry’s unique challenges and talents could not be met with generic, non-individualized services. “It’s frustrating and complicated, yet I think it’s wonderful that all these supports are in place.”
In November and December 2014, Independence Northwest will be offering a series of forums: Brokerage 101: A Primer on Support Services. The forums are designed for people new to brokerage services – whether just recently referred (in the last year) or considering their options for in-home and community-based supports. You’ll learn where brokerages come from, what we do, and what to expect from our services. These presentations are perfect for students in transition and their families! Topics include: eligibility, funding, the K Plan, the Adult Needs Assessment, case management services, support service options, provider options, person-centered planning, supported employment, and more!
Join us to have your questions answered!
Thursday, November 13th from 5:30 – 7:00 PM
Tuesday, December 16th from 5:30 – 7:00 PM
919 NE 19th Avenue Suite 275 in Portland
RSVP by calling 503.546.2950 or emailing email@example.com. (Space is limited to 30 per session.)
The 2013-15 HCW/PSW Collective Bargaining Agreement provides for a new level of worker and compensation. Enhanced and Exceptional Workers provide services to consumers with certain assessed medical and/or behavioral needs, AND have successfully completed additional training.
The Oregon Home Care Commission will be holding the first pilot Enhanced and Exceptional Worker trainings for both HCWs and PSWs in November/December in the Portland area. If you, or someone you know, are interested in being part of the pilot, follow these steps:
1. Make sure your CPR/First Aid is up-to-date. You will need to send a copy of your certification with the application.|
2. Go to the website: ohcc-training.org. Create an account, then log in to your account. Look under “Courses” for the Readiness Assessment for your work group (HCW or PSW).
3. You are allowed to take the Readiness Assessment one time only, so some study ahead of time will be helpful. It is highly recommended that you review course manuals from the classes you have attended that are listed on the website if you have taken them.
4. Complete the Readiness Assessment. You will be able to review your answers after you finish the assessment.
5. If you pass the assessment with a score of 80% or better, you will be directed to the application. Fill this out and send to the Home Care Commission. These must be received by October 20, 2014 to be eligible for the pilot course.
If you do not pass the readiness assessment, you can use the feedback online to determine which topics to learn more about or courses to attend. The assessment will open again in 2015 the next time the course is offered.
For more information contact: Joan Medlen Personal Support Worker Training Coordinator firstname.lastname@example.org
What is DSA? DSA stands for Day Support Activities. This is a new title (with new rates) for a subset of services offered exclusively by provider organizations. DSA includes both attendant services and skills training and may be provided in either a facility or the community.
Why is this change being made? The State is aligning rates and service descriptions across both brokerage and 24/7 comprehensive services. Unfortunately, brokerages and brokerage-specific providers weren’t included in the planning for this change, which has resulted in a rocky implementation process.
What’s changing? Effective September 1st, 2014, many traditional services (like Community Inclusion and Skills Training,) when provided by provider organizations, will be collapsed into the new DSA heading. There are rate changes associated with this change. Further, these services must now be billed through Oregon’s online payment system, eXPRS.
What’s happening with Employment Services? Employment services and rates have been adjusted and amended as well. As with DSA services, billing will now go through eXPRS for services provided September 1st, 2014 forward.
Are these rates and definitions permanent? We don’t know. The state has pulled together a workgroup, set to begin meeting in late September and through October 2014. The workgroup has provider organization, county, brokerage, customer, and family representation. The group will give recommendations for everything from rates to service definitions. The first meeting is on September 29th, 2014.
Do provider agencies charge the same rate for every customer? No. Each customer has an individual rate based on his/her assigned Tier. The Tier is determined by the Adult Needs Assessment his/her Personal Agent conducts prior to ISP planning.
Can Personal Support Workers or Independent Contractors provide DSA? No. DSA is a provider organization-specific service. Similar services are provided by other provider types, but they are labeled differently and have a different set of rates.
What’s a Medicaid provider number? A Medicaid provider number is assigned to you by the State. You must have a Medicaid provider number in order to bill in eXPRS and be paid for certain services provided September 1st, 2014 forward. If you provide DSA or Employment services to brokerage customers, you need a provider number ASAP. Brokerages can no longer pay you directly for these services. Nate Deeks and Acacia McGuire Anderson are responsible for assisting provider organizations having trouble with this particular issue.
What services to brokerage customers will be billed through eXPRS? For services PROVIDED September 1st, 2014 forward, all DSA, employment and employment path related services will be billed and paid through eXPRS. This includes: Day Support Activities, Individual Supported Employment, Small Group Supported Employment, Discovery/Career Exploration, and Employment Path Services.
What are the steps a provider agency needs to take to get paid for DSA and/or employment services? The provider agency must log into eXPRS, find the specific customer for whom services was provided, locate their active Plan of Care, then bill against that Plan of Care. At the same time, the provider organization must send a copy of their customer-approved invoice and progress notes to the Personal Agent (as you always have.) From there, brokerage staff will review your invoice, go into eXPRS and give the state the thumbs up to release payment.
How do I know if my agency and customers are affected? We have been in direct contact with many provider organizations over the past month. Additionally, INW sent out mailers in the last week of September, notifying provider organizations directly of what we believe the translation will look like. However, if you have questions or believe we should make adjustments to the changes, Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.)
Will provider organizations receive new service agreements from INW? INW will not be sending new service agreements, but will send you a translation document which amends the current agreement. If you require additional documentation, please call us directly.
Do I have to submit an invoice to the brokerage anymore? Yes. You should submit your customer-approved invoices and progress notes to your Personal Agent as you always have. Nothing has changed there. Brokerages are not a pay and chaseenvironment.
Can I bill for two different services on the same invoice? Yes, you can, but you’ll need to itemize and clearly spell out the differences in services.
Are there changes to what provider organizations can/cannot bill for? One large change is that provider organizations cannot bill for miles driven while concurrently providing Day Support Activities.
Are DSA services pro-rated? No. DSA services are never pro-rated, regardless of the number of people served at one time.
Why are services in eXPRS limited to a monthly allotment when brokerage plans are written at an annual allotment? We hope this will be corrected in eXPRS very soon as it is already causing issues for providers and customers. We have a commitment from the new DD Director that annual authorizations are allowable in the system. In the meantime, the monthly limit in eXPRS creates a false restriction of services (counter to how plans were written.) If you see that the monthly restriction is too tight for a customer’s actual utilization (but keeps within the customer’s annual contracted agreement with you) give us a call and we will work towards correction in eXPRS. Thanks for your patience while this gets sorted out.
What happens if I submit “old” invoices for services provided before September 1st, 2014? Those services will not be billed through eXPRS. So, you can skip going into eXPRS and just send the bill directly to your PA. Payment will come via direct deposit or paper check from Independence Northwest.
What if I run into issues with billing? Please call Larry Deal (503.546.2950 x10) or Ron Spence (503.546.2950 x12.) We will respond to provider organization issues within 1 working day. Our aim is to work with providers to clear up issues as soon as possible.
Late Friday afternoon (05.30.2014), Interim DD Director Trisha Baxter released the following statement to the I/DD community:
“As you are aware we have many priorities that we are focusing on, all with a July 1 implementation date. We have heard from many of you that these converging priorities are causing angst, stress and strain on you, and on the system. We, as well, are discovering the complexities of handling so many moving parts all at once. As such, based upon feedback from many of you and weighing our internal priorities and commitments with SEIU, CMS and others, we have come up with the following strategy to delay portions of the work and to stage implementation in a more manageable way. Additional information will be coming out over the coming weeks about the details behind these strategies so please pay close attention to emails and other communications over the coming days.
First, July 1 is a milestone for new employment services to be offered. These services are included in the Medicaid waivers that will be submitted for approval with a July 1 effective date. These new services will still be offered as of July 1. July 1 was also a targeted date for implementation of a new rate structure for employment services for both the comprehensive and support service system. The new rate structure will be finalized next week, however, at the request of multiple providers, we will hold off on implementation of those rates, with the exception of the rates for the new services, until September 1, 2014. The new services, which include Discovery and Job Development will be paid at the new outcome based rates. All other services will continue to be paid at the current, daily rate. This additional time will allow providers of employment services an opportunity to analyze how the new rates will apply to their service arrays. Additional information about the rate transition schedule, and expectations for tracking, billing and reporting of services provided during July and August will be coming shortly.
Additionally, we have been challenged to provide training to the large number of personal support workers, CDDP and Brokerage staff, and other providers on the new plan entry and claims process within the eXPRS system. In order to allow more time for training and other associated activities, we are delaying the implementation of Plan of Care functionality to September 1, 2014 as well. We will be working with partners, including SEIU and providers, to develop an implementation plan from September 1 forward, beginning with employment services. The delayed schedule and restaging of activities is important to assure successful implementation, but it does not deter or alter the strategic or programmatic outcomes the changes are designed to achieve.
There is much work to be done over the upcoming months to ensure that individuals experiencing intellectual and developmental disabilities continue to receive services and that those providing the services are paid accordingly. We thank all of you for your continued work with us as we pull together plans for full implementation. As always, if you have questions or concerns, please feel free to contact me.” – Trisha Baxter
There are just 40 working days left between now and the end of the current fiscal year, June 30, 2014. Over the past year, that mid-summer date has been a much-publicized target for many changes in the Oregon’s developmental disabilities brokerage system. You’ve no doubt heard many times over: “this, that, or the other has to be done by July 1st”. This includes significant changes such as ensuring all 7,500 or so brokerage customers have been assessed with the new Functional Needs Assessment, ensuring that all providers are signed up in the state’s payment system, and preparing for having the state take over direct payment to all brokerage providers. In some areas of the state, customers are changing fiscal intermediaries as well. (Here at INW, this is not the case.)
There’s a lot happening. We understand that change can be confusing, frustrating and overwhelming. Sometimes all three. So here’s a cheat sheet for what you need to tend to in the next forty days.
If you’re a customer or a representative designee:
Be sure to respond to your Personal Agent’s (or a state worker’s) call to complete the new Functional Needs Assessment. It’s essential these are completed for everyone by June 30th. This allows the state to draw down increased federal funding via the new K Plan. Additionally, be ready to revise your plan to make some language changes. Your PA will help you with that.
If you have a provider, be sure that s/he has filled out a Provider Enrollment Agreement. We want to be sure they can continue to get paid after the state takes over payment (currently planned for July 1st.)
Make sure the customers you serve have scheduled a Functional Needs Assessment with their PA (or a state worker.) If they need some support during the assessment and would like you to assist, offer your help.
If you have not already, you must apply for and receive a Medicaid provider number. Sign up by filling out the Provider Enrollment Agreement form as soon as possible.
If you have already applied for a provider number, but haven’t heard back from the state, please contact them directly at DD-MH.OHCC@state.or.us
If we’ve contacted you about updating your Criminal History Check, be sure you respond quickly. All PSWs must have a CHC completed every two years. You cannot be paid without a current check on file.
Attend one of the upcoming Personal Support Worker webinars. There are currently three scheduled. The webinars will give you basic details on the state’s payment system (eXPRS) and how the way you’ll be paid is changing. Click here to learn more.
If there are changes to the deadlines or expectations (and there may be), we’ll keep you updated via additional mailing. In the meantime, keep an eye on the INW blog or our Facebook page for the latest. As always, thank you for the opportunity to serve you, your family, and this community.
Please join us for Craft Night on Tuesday May 13th, 2014 at Independence Northwest. We suggest a $3 donation, but no one will be turned away. Our office is located at 541 NE 20th Avenue Suite 103 in Portland. You may RSVP by calling 503.546.2950 or emailing Rachel at email@example.com.
Please note: if you require support to participate, please bring someone to assist you. Providers may be paid via brokerage funds to provide disability-related support.
The Oregon Support Services Association (OSSA) is pleased to announce the hiring of Kathryn Weit as our Executive Director. Kathryn is well known as an advocate and leader for services to people with intellectual and developmental disabilities. Her extensive history in our State includes participating in launching the Oregon Support Services Brokerage system, leading the Oregon Developmental Disabilities Coalition and serving as the Executive Director of the Oregon Council on Developmental Disabilities.
Her primary roles are advisory to OSSA regarding advocacy needs on major policy, budget and customer issues for support services brokerages and the broader IDD system; representation of OSSA at key DHS, legislative and other organizational meetings; recommending advocacy actions to OSSA and to function as the key communicator for the association. Additionally, she will be working in support of spotlighting client success stories with the advent of the K plan and addressing implementation concerns identified in our current advocacy position, posted here for your information. Kathryn will report to the OSSA Board of Directors, which consists of the 13 Executive Directors of the Oregon Support Services Brokerages. http://ossaweb.wordpress.com/about/
The Oregon Council on Developmental Disabilitieskicked off DD Awareness Month at the Oregon State Capitol this past Friday. At the event, they premiered a brand new video: “Expect Me to Succeed, I Will.” Take a minute or two to check out this excellent message and beautifully executed content from OCDD. Great start to the month!
Seats are filling up very fast this month! Our March 12th forum is at capacity, but there’s still space for our March 26th evening session. Save your space by calling Rachel at 503.546.2950 or emailing firstname.lastname@example.org. Lots of developments this month. We look forward to seeing you there.
Healthy Lifestyles for People with Disabilities is a holistic wellness workshop designed for people with disabilities. The workshop embodies the self-determination model, and its ultimate goal is to give participants the tools they need to evaluate their lives and identify the areas in which they would like to improve to make positive changes.
The workshop is divided into five modules including: Emotional Health, Social Health, Physical Health, Spiritual Health & Health through Meaningful Activities. Be prepared to share stories, participate in fun exercise activities, identify your dreams and learn useful tools that will help you live a happy, healthy and fun life!
When: Feb 12th, Feb 13th and Feb 14th from 8:30AM – 4:30PM
Where: East Portland Police Precinct (737 SE 106th Ave in Portland
Free lunch and snacks provided!
RSVP your space by calling Rachel at 503.546.2950 or emailing email@example.com. We look forward to seeing you there!
The talented Jenny Child (INW) and Caitlyn Child (UCP Connections) have teamed up to bring you the first co-hosted Craft Night! Join them here at Independence Northwest on Tuesday, February 11th from 4:30pm to 6:00pm. We’re located at 541 NE 20th Avenue Suite 103 in Portland, just off Glisan Street.
Be sure to RSVP to Rachel by emailing firstname.lastname@example.org or calling 503.546.2950. We look forward to seeing you there!
Our first blog post of 2014 is an important one. Late in 2013, word came from the Oregon Office of Developmental Disabilities Services that they were planning to significantly reduce Small Group Inclusion and Skills Training rates paid to provider organizations. Upon review, brokerages immediately responded explaining such a decision would put many small business completely out of business, reducing key resources for our customers statewide. In the weeks since that exchange, small provider agencies in the Portland metro area (led by On The Move Community Integration, Creative Goal Solutions and Trellis) have come together to form a grassroots coalition (known as The Coalition of Provider Organizations.) Their aim is to educate the state, legislators and the general public on their services and fight the potential reductions in rates. The group developed a comprehensive white paper on their concerns (read it here: Provider Organization Coalition Paper) and, in December of 2013, presented to and gained the support of the I/DD Coalition. As a result of their efforts, state leadership has agreed to meet with some small agencies this week as they reconsider the rates. Our understanding is that the state will need to publicly share their methodology and reasoning and has committed to entertaining stakeholder input and education throughout the process. Given the stakes, full engagement is key.
Sasha Vidales, Director of Creative Goal Solutions, one of the most sought-after agencies in the Portland area is today’s guest blogger for the Independence Northwest blog. Below, she shares what this all means from a provider organization, small-business owner and concerned community member perspective.
“Proposed Rate Cuts to Provider Organizations Threaten Innovation”
While Oregon is moving to the K-Plan, many customers are seeing increased access to funding for their services. But simultaneously, provider organizations’ hourly rates are slated to be cut by almost 18%. Perhaps most affected by these cuts are smaller, local, grass-roots organizations who have sprung up in response to the diverse needs of brokerage customers; programs like Creative Goal Solutions, which I started in 2011 to offer fully-integrating community-based services to adults with developmental disabilities. Already operating on a shoe string budget and my personal investment, the proposed rate would unquestionably force Creative Goal Solutions to close its doors within just a couple of months.
The greatest detriment would be to the individual customers served by Creative Goal Solutions, customers like Annie Rose. When Annie Rose started working with Creative Goal Solutions, she had the same goals as most twenty-somethings—to move out on her own, get a job, have new life experiences, and exert her independence. Through working with CGS, she had the opportunity to explore her greater community in a group setting. “I like Creative Goal Solutions because it gets me out of the house. I like meeting new people. I discovered new foods…I enjoy going to the park… camping was lots of fun. I like going to the library and art showings.” Soon after her start, Annie decided to move into her own apartment. CGS staff helped her establish a routine around cooking and cleaning that would increase her success as she transitioned. Knowing the importance of community connectedness, staff also helped Annie explore her immediate community on foot and on bus to find new hang-outs. She now independently works out at her local community center and has some favorite local shops and cafes, all the while staying involved in CGS’ group community inclusion. A while later, Annie also took on various volunteer jobs. With staff support, Annie Rose works alongside community members and other customers to gain job skills and give back to her community.
“I like doing Zenger Farms,” says Annie Rose, “I really like gardening and don’t do enough. Now I get to go out once a week and it’s a relief. I’m suddenly happy! I’ve noticed the weeds have gotten enormous and tough to pull out. I’m proud that I can pull them out.”Annie is just one of the over 40 customers flourishing with the support of Creative Goal Solutions’ unique service model. When I started Creative Goal Solutions, I was excited to use innovative strategies to develop meaningful, community-integrating experiences for our customers. I envisioned services that would empower each customer to become involved citizens and create meaningful visibility for themselves. Over the past two and a half years, I’ve assembled a team of highly creative, motivated and skilled employees to put this vision into action. Now, we boast a diverse array of programs to accomplish that vision.What I didn’t realize upon CGS’ inception, was the tremendous value of the group-model. Customers learn so much from each other and there is often a lot of camaraderie, connectedness and natural support developed. At the same time, the model differs drastically from facility-based models in that customers are making daily, “real-life” contact with their communities through recreation and volunteering. Many customers and parents, including Laurie Burk, have noticed the difference.
“[The facility-based program he attended prior to CGS]… provided little or no outside community activities. There was nothing special about the program. I likened it to a daycare center. Since attending CGS, he has shown much improvement. We believe this to be directly related to attending outings to places that “regular” people go. I don’t think many people who are not affected by developmental disabilities understand the secluded life of a young person with disabilities and what they face day in and day out… Just because he has a disability doesn’t mean he doesn’t have worth.”Our Volunteer Program connects and teaches customers at six different community organizations, including The Rebuilding Center, SCRAP, Hoyt Arboretum, Impact NW, the Bike Farm, and Zenger Farms. All of these sites give our customers job-like experience where they can gain skills and confidence working right alongside community volunteers. The program has been tremendously impactful in our customers’ social well-being and sense of worth and individual contribution.
Nightlife Group at local pub
We also provide fully-integrating recreation experiences. The programming is diverse, offering many activities not commonly accessible to people with developmental disabilities. We fill the monthly calendar with customer-preferred activities, such as bowling and libraries and unique experiences, such as attending the Feast of Guadalupe concert, Leech Botanical Gardens, and a tour of the Human Society. We also offer a Nightlife Group. Through this, many customers have their first experiences going to activities like stand-up comedy, salsa dancing and pub trivia. Additionally, our camping trips afford customers the opportunity to be away from home with a group of friends and foster budding friendships through exploring nature.
At Creative Goal Solutions, we continually challenge what others think possible. Those with seemingly significant barriers are equally engaged through our program. Oxana Betska, a mother of one such customer wrote, “[Though he is] nonverbal, he is very social. He wants to be around people, go places, learn new things… [at CGS] he is taught how to behave around other people, how to treat them properly. We can definitely see the progress he has made paying attention to the instructions he was given, evaluating the situation which can be new for him, becoming more independent and mature. The program has helped my son gain self-esteem. Through the program our son volunteers at the retirement center. He has a wonderful time there!”
Volunteering at Bike Farm
Writes Matthew Burk, customer and self-advocate, “I like the format where we meet at the office and board mass transit and go to different places like Fazio Farm, The Old Church for a lunch time concert, the Rose Garden up near the zoo, the zoo, and the game room down at PSU among other cool places. My favorite part of the program is that being a boy from SE Portland I get to see the other parts of the city that I never knew existed. If cuts were to be made I’m not sure what I would do. Without CGS I would go back to being a couch potato and having no routine.”
Despite our customer’s successes, we’ve experienced significant barriers when it comes to a functional and sustainable business model, having to fit a square peg in the proverbial round hole. Our program model of fully-integrating group experiences does not fit well in the current provider rate structure. Most traditional services are provided with one staff per one customer or take place in a facility. Our services don’t fit either of those models and our way of providing services comes with substantial added costs as well as barriers to be able to bill for the full rate. Despite these barriers, we’ve persevered. We’re proud to be one of the handful of truly unique, local, grass-roots organizations with truly unique services to offer.
Rock wall climbing
It’s hard to imagine the local impact of all of these customers losing the visibility and community presence that we’ve worked so hard to promote. Observing our customers’ growth in confidence and self-efficacy over the past two years has been one of the most impactful experiences of my life. Equally important, I’ve seen our community’s response to our customers. I believe that through our work, we’ve begun to shift how people understand disability. They are witnessing all that people with developmental disabilities are capable of contributing, and, with time, learning how essential they are to the fabric of our community.
We’ve accomplished a lot in just over two years. I have many more ideas that I’m actively implementing: a self-employment program, a healthy lifestyles group, and leveraging our culturally-competent, 50% Spanish-speaking staff to better engage Latino customers. Yet, my intense passion and enthusiasm is met with a very real possibility of closure. I’m working hard to push back against the proposed cuts. I’ve co-formed a coalition of small provider organizations, including On-the-Move Community Integration and Trellis to express our alarm and the potential impact of cuts. We’re meeting with decision-makers at the State level as well as other affected provider organizations. I am also counting on the support of families, professionals, self-advocates, community members and the decision-makers at DHS to halt rate cuts and make the growth and development of our innovative program, and others like it, to flourish… for the betterment of our customers and the betterment of our communities.
Sasha Vidales has worked in community services for 14 years in mental health, policy research, training development, case management, quality assurance and other capacities. She has a BA in Psychology and an MBA in Organizational Behavior and is trained as an Autism Specialist and Social Sexual Consultant. Sasha founded Creative Goal Solutions in 2011 because of her belief in and commitment to strong communities. She knows that strengthening communities requires meaningful and full integration for all people. If you are interested in learning more or joining the coalition, contact Sasha at email@example.com.
There continue to be hold-ups on the State’s move to take over payment to providers of brokerage services.
Representatives from the Office of Developmental Disabilities Services promise there’s continued work on a solid plan, but as of right now they have produced no clear plans or feasible timelines. What we do know is this:
Payment will not be coming through the State effective January 1st, 2014
We will continue to provide your payment until an appropriate plan is developed and agreed upon.
Given the amount of work left to do during implementation, our best guess is a transition several months into the new year at this point.
If you haven’t sent in your Provider Enrollment Agreement, do so now. This is an essential action on your part, regardless of changing timelines.
If you have turned in your PEAA and have received no response back from the State, contact them directly at DD-MH.OHCC@state.or.us. (We initially thought we would be able to send out emails for those who had provider numbers, but the information we have received from the State isn’t in a format that allows us to do so given our limited resources.) Please email the State for assistance on this matter.
Many of you have received requests for W4s, I9s, and Direct Deposit forms. (Oddly, this request also went to Independent Contractors, a designation of providers who do not utilize W4s or I9s in their business practice.) Stranger still, we understand that you’re being told to submit items to brokerages. We have already processed these forms during your initial qualification and we cannot process them a second time. Please send your W9s, I9s, Direct Deposit forms directly to the State at:
Mail: DHS – ITBSU
ATTN: eXPRS User Enrollment
500 Summer Street NE E-12
Salem, OR 97301
Finally, provider organizations who need a provider number should be hearing from the State shortly. We are aware of a transmittal being developed and have heard it should be out within the next week or so.
Unfortunately, the State has not provided a phone number to field your questions. If that changes, we will update you and share the resource. We will continue to update you as we have more clear information. Thank you for your continued patience during this process. Rest assured that your payment will continue to come through us in the interim while these bureaucratic and procedural tangles are dealt with.
Independence Northwest continues its community outreach on big changes to brokerage and I/DD services in Oregon. Since August, we’ve held many highly successful community forums presenting to over 300 community members – and we’ve got two more scheduled for the month of December!
Join us if you’d like to learn more about the K Plan, the upcoming needs assessment requirement, new options for case management, plans for a new universal ISP, changes to provider payment and rates and much more.
Remember to RSVP by calling our front desk 503.546.2950. You may also email us at firstname.lastname@example.org. Space is limited, so reserve your space at one of our evening or day sessions today!
Big thanks to all the families, customers, providers and community members who have joined us in the past few weeks. Your questions, comments, concern and input continue to make a difference in the restructure of the I/DD system!
Where: Hollywood Senior Center, 1820 NE 40th in Portland
When: Third Wednesdays of each month Nov – June from 4 – 7PM
Interested in learning and practicing how to prepare a variety of delicious and healthy dishes without a range or too much knife work? Come learn with us!
$5 per session – all fees go toward covering the cost of ingredients
Accessible for all – We’ll use techniques and utensils well suited to adults with disabilities, seniors and those with limited space or appliances.
Cook up community! – Be part of a welcoming, positive social environment with neighbors of all ages and backgrounds
Please note: There’s a preliminary organizing meeting from 4 – 5PM on November 6th!
This group is led by Eleanor Bailey, an adult experiencing Down Syndrome and an advocate for people with disabilities. The group is also supported by Kitchen Commons, the Hollywood Senior Center and students in the Wholistic Nutritional Program at the Wellspring School for Healing Arts.
Please bring your own personal support if needed. If your support person will be enjoying the meal as well, please have him or her contribute $5 to cover the cost of ingredients as well.
RSVP before each session – reserve a spot by calling the Hollywood Senior Center at 503.288.8303!
Yesterday was not only the first day of autumn – it was also the 1st Annual Cuts for a Cause Benefit for Independence Northwest.Heritage Barbershop, a local Portland business, sponsored the event offering free haircuts and styles to brokerage customers and their caregivers. Despite the blustery weather, we had a great turnout and the event raised $600 for the Independence Northwest Emergency Fund! The Emergency Fund helps people with intellectual/developmental disabilities in times of need.
We owe a huge debt of gratitude to Heritage Barbershop’s owner, Brian Porteous, for this event. What a guy. Brian pulled together a fantastic raffle including donated goods and gift certificates from local businesses including:
Huge thanks to these businesses for donating to this cause. We appreciate your support! For those who couldn’t stick around until 4PM for the raffle drawing, we’ll be notifying winners by phone shortly.
Additionally, we’d like to extend gratitude to the barbers Jen Mattson and Tariq B for volunteering their professional services to our customers and their caregivers. They did a fantastic job and gave some very fine cuts yesterday. And big thanks to Lorissa Prestwood Porteous, provider De Linda French Davis, INW Operations Director Ron Spence, and INW Board President Bill Beckett for helping the event run so smoothly!
This was truly a community event and we look forward to the 2nd Annual Cuts for a Cause event next summer!
We’re proud to announce what we hope will become an annual tradition: Cuts For a Cause, an event on Sunday, September 22nd, that will offer free haircuts to our customers and their caregivers and will raise money for our emergency fund, a small pool of money we keep to help out our customers in times of extreme need. We will be partnering for this event with Heritage Barbershop, a newly-opened business that has generously offered the time and talent of its barbers to make this event possible.
Heritage proprietor Brian Porteous is no stranger to giving haircuts to people with disabilities. He spoke to me recently during a haircut of my own about his experiences early in his barbering career in California. “There was a group who came in every couple of months and I learned really quickly that just like everyone else, people with disabilities are all different from one another,” he told me. “Next to giving a good cut, a barber’s most important skill is communicating with the person in the chair, and that’s all about treating every person as an individual.”
Space is limited and must be scheduled ahead of time. Please call Rachel at our office (503.546.2950) to schedule an appointment. If the free haircut slots fill up we’d still love it if you’d stop by and say hello. We’ll have free popcorn and will be having drawings for prizes every 30 minutes or so. And of course we’ll be accepting donations from those of you are able to give a few dollars to what we think is an important cause. We can’t thank Heritage Barbershop enough for their support and generosity and look forward to a long partnership with Brian and his barbershop.
Announcing an upcoming self-advocate and parent meeting with Patrice Botsford, State Director for Oregon’s Office of Developmental Disabilities. Many changes are ahead that will affect services for people with intellectual and developmental disabilities. Washington County brokerage SDRI is hosting an evening discussion on August 22nd from 6 – 8pm. Join them to discuss the changes and have your questions answered! The meeting will take place at Edwards Center: 4375 SW Edwards Place in Aloha.
Be sure to RSVP to Dan Peccia at 503.292.7142 x11 or email@example.com.
Thanks to Dan, SDRI and Edwards Center for pulling this important evening together.