Oct nov 07

Photo by Sheila Horsley

See Grant Home on page 4

See Recycling on page 18

By Timothy PrayA million pounds of recycling are

getting a new 12,000-square-foot home in Anaconda next to its previous home, the much smaller “Jim Dandy” building.

The move, which opens up the former to renovations of the Hope Thrift Store and AWARE’s Day Activity Center program, means easier recycling for people living in Anaconda.

Steve Francisco, AWARE’s Corporate Facilities Manager, who is in charge of the project, climbs out of his truck at eight in the morning at the construction site.

“Wasn’t it just summer two weeks ago?” he asks.

He walks up to the 12,000 square foot steel building and begins his rounds with the myriad of contractors who have already shown up on site, ensuring that the work being done is all according to plan and on schedule.

“There are always small fires to put out. That’s the nature of contracting,” Francisco says. “This project, though, has gone exceptionally well, and everyone involved has done their best to ensure that we stay on budget and on time. That’s all you can ask for when you’re undertaking a project of

AWAREINKOctober/November 2007

Volume 1, Number 2

Danny Bowen poses in the fork lift at Anaconda Recy-cling. Photo by Tim Pray

Former nursing home residentsenjoying family life in Glendive

By Jim Tracy Families come in all sizes and shapes.No one understands that better than

Maureen Wildin and her housemates at the Grant Home in Glendive.

Maureen used to live with 31 other people behind a high security fence in the Montana

Mental Health Nursing Center in Lewistown, a state institution with more than 100 residents. Today she and her housemates have private bedrooms in a tastefully decorated four-bedroom home on a tree-lined street in a quiet neighborhood on the southeast edge of Glendive.

‘My forever home’

Recycling plant expands

this magnitude.”Most of Francisco’s days are filled with

facility management on a much smaller, but no less important, scale, overseeing every single one of AWARE’s homes, working with each community’s maintenance coordinators.

Inside...Notes from the tour — Page 2

Quality Assurance update — Page 5

Shrink wRap with Dr. Ira Lourie— Page 6

Automated Incident reporting — Page 8

AWARE IFESavailable statewide— Page 9

CEO named Behavioral HealthChampion — Page 10

Book Marks — Page 11

‘Windshield time’in Eastern Montana — Page 12

Employee Handbook review— Page 14

Psychiatry crisis?

2

Hundreds of pieces of chicken, countless hamburgers and hotdogs, pounds of potato salad, enough soda to fill a pool, thousands of angry bees, and a chipmunk.

That about sums up my experience in August visiting AWARE offices around Montana. I criss-crossed the state attending picnics from Franklin Park in Missoula to Makoshika State Park just outside of Glendive, putting 2,565 miles on my truck, a lot of “windshield time,” as case manager Eileen Dey in Miles City calls it. Makoshika means “land of the bad spirits” in Lakota. Glendivers describe themselves as “good people surrounded by bad lands.” But I’ve found that even Montana’s bad lands beat the good lands in most other states.

I followed a loose framework, knowing that each community would add something different to the discussion and agenda.

With the state as large as it is, it would have been foolish to expect that everything be the same in every community. That’s part of what made this so enjoyable…not only getting the chance to connect with the people who work so hard, but connecting with them on their home turf, with all the subtle differences that exist from place to place…it was a great and informative trip.

Attendance was good. The purpose of the tour was to speak to a few of the new things that are occurring organization-wide, a few things that are returning, such as Corporate Congress, and to speak generally about an

emphasis on communication.The “communication element” was threaded into

everything that came up during the discussions, as the tour itself was based on trying to improve communication. More specifically, though, here are some notes from the tour:

AWARE has brought on three new board members, bringing the number serving on the board to six. There is still an effort underway to fill two more slots, and when filled, the board will improve upon its already tireless work and be running on all cylinders. Board members, all volunteers, come from all walks of life and have agreed to take time away from their personal ventures to collaborate on ways to help AWARE continue as a leader in the services it provides.

“AWARE Ink,” this newsletter, is another new development in improved communication. We have published newsletters before, and most versions of it have been put on the back burner. Tim Pray and Jim Tracy, both relatively new to the AWARE staff and introduced at the picnics, have come on board to work on various projects relating to both the public and staff, and one of those projects is to relaunch the newsletter and see that it remains a constant.

Tracy has a background in newspapers, having been a reporter for the Montana Standard (Butte), publisher and printer at the Philipsburg Mail, and, most recently, editor

Notes from the tourGreat Falls staff gather at Black Eagle Park in August to hear a report on AWARE from CEO Larry Noonan. Photo by Jim Tracy

3

of the Anaconda Leader. Pray moved to Montana from Los Angeles one year ago, and has a background in television and film, both producing and overseeing publicity for projects he worked on.

Tim and Jim were brought on to wrap their arms around AWARE’s growth statewide. With so much happening, new positions were needed, ones that would relay new information to staff, friends of the organization, government bodies, and partners. Along with the newsletter, they are working on revamping the AWARE website and handling media inquiries, special projects, and community outreach.

A major reason for the tour was to kick off this year’s Corporate Congress. The Board of Directors, now strong as ever, will issue its goals and directives at the time of printing, which signifies the official start to the Corporate Congress process, most importantly giving us a theme to work with for the year.

Corporate Congress is a tool that genuinely sets us apart from other providers…other organizations as a whole, as a matter of fact. What form it takes is entirely up to us. More specifically, it’s up to the delegates involved to make arguments, ask questions, and provide enthusiasm

that will shape the ways that AWARE works with communities. Ninety-nine percent of the suggestions that delegates have given to me and to the management team over the years have, in one form or another, been implemented into AWARE policies and procedures. Our training program, HELP, is a product of such input from Corporate Congress.

Coverage of this year’s event should be excellent, due to both Tracy’s and Pray’s backgrounds, and the entire staff of AWARE can expect to be filled in on exactly what happens day to day. The hope is that those who are shy or not interested in participating this year will get a better view of how Corporate Congress operates and will garner some newly rekindled interest in the event.

State and contractual news was discussed as well. First, AWARE will now be providing targeted case management in Missoula, Billings, and Columbus due to the hard work of Jaci Noonan, who wrote the proposal to the Department of Public Health and Human Services. Jaci’s time, which was, until the beginning of August, primarily dedicated to Eastern Montana, will now be spent entirely across the state.

AWARE is also the first statewide provider of Intensive Family Education and Support for children’s DD services. Considering the number of other providers, it’s a big deal. It’s also important to note that this adds a level of complexity to our services. When we serve a child, we can, if the individual so desires, make a seamless transition into our adult services. It can be a good thing for the consumer, and, of course, it can strengthen our professional credibility.

The Montana Home Choice Coalition, a partner agency of AWARE that helps families and individuals with disabilities secure home loans and coaches them through the entire process of purchasing a home, has secured an additional $200,000 in funding from the state. This money is available to all agencies like the

Coalition, but year after year, it has been Michael O’Neil, director of the project, who seeks to secure the dollars.

The “picnics” involved a lot of speaking, more than some people preferred. For instance, a gentleman from the Little Belt Home in Great Falls who had to wait an hour for lunch, observed—when he got a chance to get a word in—that “a speech is like a wheel—the bigger the wheel, the longer the spoke.” It’s hard to pass up an opening like that, so I stopped talking and we had lunch.

A debate topic that emerged from the tour was what’s better—chicken from the supermarket deli or grilled burgers and hotdogs? We had burgers and hotdogs in Miles City, Glendive, and Kalispell and chicken in Billings, Great Falls, and Missoula. I can tell you that the chicken from the Missoula Broadway Street Safeway, hands-down, was the best. In Butte and Anaconda, which as everyone knows is different from the rest of the state, they served sandwiches.

I’d like to start doing these trips more often. As the organization continues to grow, it becomes increasingly important to keep in touch on a face-to-face basis, although remembering everyone’s name will be virtually impossible. I always tell people that, if they see me at the mall or at a restaurant or something, please say hi…I always enjoy seeing AWARE folks in random spots around the state.

When I started working at AWARE in 1987, I never could have imagined it would take me a month to get around to the different communities and meet all the people who are doing all this amazing work. It was a great trip.

I hope all is well with everyone,

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

Board of Directors

John O’Donnell, President, Allan Smith, Vice President Teresa Marshall Cheryl ZobenicaKeith ColboJohn Haffey

Written and Edited by Tim Pray and Jim Tracy

AWARE Ink is published bi-monthly by AWARE, Inc., a 501(c)3 non-profit organization at 205 E. Park Ave., Anaconda, MT 59711. Copyright ©2007, AWARE, Inc. All rights reserved. No part of this newsletter may be used or reproduced in any form or by any means without prior written permission of the publisher.

4

Grant Home...Before they even

moved in, Maureen and her housemates were deeply involved in making decisions about their new home through focus group design meetings.

They made it clear, for instance, that they wanted to share their home with only three other housemates, avoiding the stress of living in the typical eight-bed adult group home.

They wanted bathrooms with spacious baths and showers that allow staff to help them with their daily hygiene and bathing routines if necessary. They wanted full accessibility so that medical or mobility impairments no longer required that they be in a hospital or nursing home setting. They wanted private space combined with shared space, including a patio where they could sit outdoors.

But more than anything else, they wanted their own bedrooms since many adult group homes and adult foster care programs where they had lived before required them to share a bedroom.

The Supportive Living duplex design they agreed on meets all their needs. It incorporates private rooms and shared living space, innovative accessibility features throughout, outdoor sitting areas and landscaping—overall a place where Maureen and her housemates feel secure.

“They tell us they feel safe here, and that has had a lot to do with our success,” said Natalé Adorni, program manager at the home.

“You watch them grow,” Adorni added. “You invest in them. You witness them being able to have a quality of life they would not have had without this experience. Every day we let them do a little bit more”

Maureen and her housemates were able to move into their new home in 2005 thanks to a partnership of city, state, and federal governments, the Department of Housing and Urban

Development, Fannie Mae, AWARE, and the Montana Home Choice Coalition, a statewide collaboration led by AWARE that creates better housing choices for people with disabilities.

HUD HOME Investment Partnership Program funding administered by the Montana Department of Commerce was key to making the project affordable. A $276,776 grant allowed the partners to design and build a home truly tailored to the needs and wishes of the residents.

The City of Glendive donated the project land. In return, the community gained eight new residents and the services AWARE provides to them. In addition to providing a quality, affordable, and safe home for people with severe disabilities, the duplex made a significant economic contribution to the area.

Residents, ages 47 to 65, receive support 24 hours a day, seven days a week. The total direct job creation associated with the program was 14 full-time jobs with total estimated salaries and benefits of $400,000 a year.

The total annual estimated economic contribution to the Glendive

area economy is nearly $500,000. The construction of the duplex added an additional short-term impact with local contractors and suppliers.

Fannie Mae provided project financing through local lender, Action Mortgage, using the Fannie Mae Community Living Loan for the first time in Montana. The Community Living Loan provides

advantageous residential rate financing for small, community-based homes for adults and children with disabilities who cannot live independently.

AWARE contributed significant financial and organizational resources to build the home.

The Montana Home Choice Coalition directed development of the project. AWARE coordinates this statewide coalition of Montana citizens, advocates, providers, federal, state, tribal, and local agencies, the housing finance community, Realtors, and the home-building industry, all working together to create better community housing choices for all people with disabilities. The Coalition works on housing issues across the housing and disability spectrum. Developing new community living options for people with disabilities in institutions is among its priorities.

In accordance with Americans with Disabilities Act and 1999 U.S. Supreme Court Olmstead decision, AWARE and the Coalition pulled together the partners to successfully transition residents of the Nursing Care Center to community living. This is part of an overall effort by AWARE and the Coalition to close a wing at the Nursing Center and open up 22 community living opportunities for its former residents.

All of the residents—adults with serious disabling mental illness with long histories of institutionalization

Grant Home in Glendive complements a new Senior Center across the street in Glen-dive. Photo by Codi Newton

They tell us they feel safe here, and that has

a lot to do with our success. — Natalé Adorni, Grant Home

5

Program officer Pandi Highland, a licensed clinical social worker based in Butte, has been traveling the state after helping revise charts and clinical material to assure that AWARE continues to deliver the highest quality services.

By Pandi Highland

To date, I’ve traveled the state from Miles City to Helena, Kalispell to Butte, from Dillon to Bozeman, from Great Falls to

Anaconda, and from Deer Lodge to Missoula. There is one city left! I will travel to Livingston in October to audit Support Services and to provide training regarding the new forms.

This is just the beginning! This service-wide quality assurance audit is part of a continuing effort to deliver quality service, and we are building a system to utilize in the future. Each service is responsible to schedule quality assurance audits, and I will provide assistance as needed to complete the audits. This is our first step in formalizing the process.

At the same time, quality assurance is just one aspect of how we are assuring that we are following our values of strength-based, family-driven services.

The quality assurance audits have been a joy! I’ve had the opportunity to visit multiple AWARE offices across the state and meet the fantastic teams who provide our comprehensive and coordinated services! As part of this process, I’ve been able to train staff regarding the new forms for Strength-Based Service Plans, Outcomes, and Assessment Tools, teaching new skills, celebrating successes, and supporting our teams’ practice.

New forms developed for Strength-Based Service Plans, Outcomes, and Assessment Tools have been implemented with positive results from staff and families. We sincerely believe that building upon strengths is the key to success! By using the new forms, which focus on identifying individual and family strengths, we are helping families create responsive, dynamic, and flexible approaches to accomplish individual goals!

Quality Assurance helps AWARE deliver the highest quality of care available! This is a challenging opportunity, but each of the communities and the individual staff that I’ve worked with during the last 90 days embody the value of providing high quality care and are up for the challenge.

Building AWARE’s quality assurance systemand frequent hospitalization—now have the chance to live successfully in a community while at the same time having their health and safety needs met with individualized on-site intensive supportive services.

AWARE provides these services through the Montana Department of Public Health & Human Services and the federal Medicaid program.

Adorni explained that the Grant Home uses strength-based strategies, emphasizing what residents have rather than what they do not have, what they can do rather than what they cannot do and what that have been successful at rather than past failures.

“When you go to strength-based, you really need to rely on the community,” Adorni said. “The community is an external caregiver to our clients.”

Glendive has filled that role nicely, she said.

The city was chosen as the site for the home for four main reasons: preference of future residents for a home in Eastern Montana; Glendive’s welcoming attitude toward people with disabilities; a trained, experienced direct-care workforce; and the city’s active participation in the project.

The site where the partners chose to build is across the street from a new, HUD-funded Senior Center. City officials felt that the duplex would complement the Senior Center and improve the neighborhood at the same time. The lot where the home sits was previously the site of an abandoned house the city had demolished in an otherwise well-kept neighborhood.

Now after two years of success in community living (all other original duplex residents have been successful as well), Maureen loves to tell visitors about how much she loves where she lives now. She calls it “my forever home.”

“We have pushed that families come in all sizes,” Adorni said. “And we are family here.”

Michael O’Neil, Director of the Home Choice Coalition, contributed to this story.

Pandi Highland

6

Shrink wRapIn the last issue of

AWARE Ink this column focused on AWARE’s

Unconditional Care Commission (UCC). In that article I told how AWARE’s management had made a recommitment to unconditional care and how the UCC had been created to define what Unconditional Care at AWARE actually means. A lot has happened since that original article was written over a year ago and that is what I’ll be talking about in this article.

The UCC was an exciting and dynamic process that included a wide range of AWARE employees on the Commission itself, input from groups providing children’s case management, therapeutic family care, group homes, and finally a focus on the UCC values at Corporate Congress last fall.

Since that time, AWARE has moved ahead toward full implementation of the UCC values, especially in our child and adolescent services. All of our case managers and therapeutic family care staff have been trained in planning services for children and adolescents by using Child and Family Teams. Using this approach, a family becomes partnered with AWARE staff and other providers and agency workers involved with their case, to collaboratively create an intervention plan what will best help the child or adolescent involved. The AWARE staff member (a case manager or a TSS) works with the family to help them elucidate their needs, to figure out with then what has and hasn’t worked in the past, and to then develop intervention strategies to help alleviate the problems. Some of you might

say, “This is what we have always done!,” or “This is what the KMA (Kids Management Authority) is doing!” But, there are some major differences that make this Child and Family Team process special, producing unique and more pertinent responses that work better than what has been tried in the past with this same family. (For an explanation of KMA, please see Page 15.)

The first difference is the concept of service planning being strength based. Again, you might say, “We’ve always been strength

based! How is this different?” What makes this different is that this time we are not only going to make a list of strengths that the individual has, we are going to use those strengths in coming up with solutions for their problems. For example, when we identify that being a good fisherman is a strength that a particular individual has, we will find a way in which his or her interest and expertise in fishing is used in helping to get past that person’s needs and problems.

A closely related second difference is that the Child and Family Team will not only focus on the strengths of the individual who is in our services, but also the strengths of his or her family. Often we can find ways in which these strengths can be used to overcome not only the individual in our services’ problems, but also family problems that might be complicating the problems of their family member or hindering solutions.

Both the using of strength-based approach and Child and Family Teams is being accomplished by the use of new assessment and treatment planning processes developed within AWARE

Dr. Ira Lourie

7

under the leadership of Pandi Highland from Butte. Our new assessment process is focused first on strengths and only later on needs. And this assessment doesn’t just list a few strengths that people have identified off the top of their heads. Rather, it goes through all aspects of people’s lives to systematically discover strengths where they might otherwise be overlooked. Then it is the team’s job to use those strengths to meet the needs that have presented themselves. If we add these family strength-based interventions along with our more traditional program related resources, we ultimately end up with a more powerful and useful intervention plan within which the family has a prominent role in the solution to individual and family problems.

The third major difference in our new Child and Family Team approach is that of Family Voice and Family Choice. Over the last 20 years we have progressed more and more as a field in being more family friendly. This has meant that we do a better job of encouraging individuals and their family members to be aware of and participants in the treatment planning process. But more recently, there has be a shift from this approach, in which we have struggled to make families more included in the decision-making that professionals direct, to being first family centered or focused, in which families have a greater role in the treatment planning to where we are today with Family Voice, Family Choice. This is based on the strength-based approach in which the family’s strengths are recognized and utilized. In recognizing family strengths, we come to the understanding that a family’s ideas about what needs to be done and what might help are important and have a great deal of validity. Yes, professional opinion about what needs to be done has a very important place, but if the professionally driven ideas don’t have acceptance by the family, they probably won’t work. Often I ask families of children, “What has worked in the past, and what hasn’t worked?” They always have an answer. And when they are asked further, why aren’t we doing the things that have worked, the answer is that the current professionals in the case have their own way of dealing with problems

and haven’t even asked about the past. The job we have in helping individuals and their families is a very complicated and difficult one. When we do it without considering the wisdom of the individual and the family we are blocking out a major resource and trying to do the job alone both with blinders on and an arm tied behind our back. Things work best when we have true professional and family collaboration.

A fourth difference is between the AWARE Child and Family Team and the state’s KMA process. Yes, the KMA does bring many of the same people to the table. But, it is less personal and more formal with decisions often being made out of the context of the child and family strengths. The KMA has regular members who gather together, listen to a presentation about a child and his or her family and make recommendations. On the other hand, the Child and Family Team is made up of family members and individuals who are working closely with the family, some who are agency representatives and some who are folks from the community, including family friends. Unlike the KMA, which is a static one-step process, the AWARE Child and Family Team is a dynamic ongoing process that works with family members over time, constantly revising the treatment plan as needed. Our AWARE Child and Family Team approach is based on the national model of providing “wraparound services” as the vehicle for providing true interagency supported care.

Making our services more strength based, family driven and team oriented will improve our services. AWARE’s Unconditional Care Values bring us closer to providing services in this family and strength-inclusive ways. When we are fully successful in making these values the basis of our service delivery we will reach the goal of delivering the best and most appropriate services that we can, along with the individuals we serve and their families.

Dr. Ira Lourie serves as Medical Director to AWARE, Inc. He is the author of “Everything is Normal Until Proven Otherwise.” He resides in Hagerstown, Maryland.

8

Automated system speeds up reporting of incidentsBy Jim Tracy

Donna Kelly remembers the days when reporting

incidents required hours on the telephone taking notes.

Like other AWARE staff charged with investigating and resolving incidents reported at group homes, work areas and adult day centers, Kelly had to communicate on paper and send correspondence through the mail, waiting days sometimes to get a response.

Today communication about incidents travels at cyber-speed thanks to an automated reporting system developed by AWARE information technology specialist Nick Rub in Billings.

“He’s got it set up so that if two people sign off on a report it gets sent off automatically to the state and to the consumer’s case manager,” said Kelly, supervisor of supported living services. “It’s really good because it gets out immediately to the people who need it.”

Staff used to wait until the mail brought them reports written on paper.

“Now I come in in the morning, turn on my e-mail and if there was an incident report during the night, it’s already there internally for me to see,” Kelly said.

The automated system also makes it easier for staff to discuss incidents.

Friday meetingsKelly sits on several AWARE

incident management committees that gather every Friday morning by conference call. Meetings are kept to about an hour and a half.

Members of the committee, which handles incidents involving adults affected by developmental disabilities or mental illness, are Chief Habilitation Officer Mike Schulte in Anaconda; Program Director Julie Thilmony in Billings; Training Director Tim Hahn in Galen; Case

Manager Gloria Glaser in Miles City; Service Administrator Barbara Mueske in Butte; adult mental health Group Home Manager Tommy Walker, also in Butte; and Kelly.

Another separate committee handles incidents involving youth receiving mental health services.

The committees establish what happened and what measures are needed to prevent further occurrences. They also review all internal investigations surrounding critical incidents.

In some cases, outside agencies become involved, such as law enforcement when a crime has been alleged. Providers have 15 working days to complete the investigation.

The automated incident report form includes details such as the names of the parties involved, dates and times, type of group home, a written account of the incident, names of witnesses, type and location of injury if there was one, injury causes, and comments by supervisors and committee members.

State regulationsIn the case of people affected by

developmental disabilities and mental illness, Montana requires providers to report deaths, emergency room visits, allegations of abuse, neglect or exploitation, medication errors, police involvement, injuries, missing persons, property damage, restraint, and suicide threats and attempts.

Providers must submit both “reportable” and critical incidents, each requiring separate procedures.

When an incident occurs, the supervising staff member typically logs into the network and answers questions on an automated form, Rub explained.

Some questions are simple check boxes while others feature drop down menus.

“Once you start, it’s very easy to get through,” Rub said. “Once you hit ‘submit,’ all the parties who need to know have been sent an email with the report.”

Depending on whether an incident is tagged as critical or not, supervisors of the facility where the incident happened review the report and add comments and suggestions.

The reports are sent automatically to the consumer’s case manager and to a quality improvement specialist, or QIS, at the state. The QIS oversees contracts with provider agencies like AWARE that serve persons affected by developmental disabilities and mental illness. The QIS’s job is to monitor and review programs.

Usually incidents are resolved by changing practices or providing training or counseling, said Mike Schulte, who chairs the weekly incident management team sessions.

A key advantage of the system, he said, is that it helps keep staff throughout AWARE’s service areas informed.

“If a staff member at a group home comes on in the afternoon and there has been an incident in the morning, they’ll know about it,” he said.

It also takes advantage of staff experience.

“With this system, committee members can enter their own comments about an incident,” Schulte said. “That’s very helpful because they have a wealth of knowledge and

Continued on page 11

Now I come in in

the morning, turn

on my e-mail, and if there

was an incident during the

night, it’s already there

internally for me to see. —

Donna Kelly

9

By Jim TracyPeople across Montana can now access Intensive

Family Education and Support services through AWARE.“We are now a recognized provider everywhere in the

state,” said Mike Kelly, IFES service director who is also in charge of therapeutic family care, community support and outpatient therapy services.

“After nearly five years of effort, we are the first and to date only service provider to be authorized to provide IFES in all five regions of Montana instead of only the two regions where we formerly were allowed to operate.”

Kelly explained that IFES services are intended for families with children—from infants through age 21—who have extraordinary needs and a developmental disability.

“Intensive Services is a Medicaid Waiver program that provides case management and an array of other support services,” he said. “The service is aimed at families whose children have uncommon medical or behavioral needs as well as a developmental disability.”

IFES can curtail out-of-home placement for children now living with their natural families or allow children living in more restrictive environments, such as group homes, to return to their natural families or to be placed with foster families.

“The program is required to have a strong case management component,” Kelly said.

Keeping families informedAWARE’s four family support specialists (or case

managers) assure that eligible families know about and use appropriate services.

Such services include respite care, minor modifications to a home, physical therapy, occupational therapy, speech therapy, adaptive equipment, and habilitation aide services.

Each family’s needs are considered when developing an “Individualized Family Service Plan” and personalized cost plan, Kelly said.

“It’s very similar to the therapeutic family care services we offer,” he said. “With the right training and support, we can provide an excellent service.”

Kelly gave this hypothetical example of a person who might benefit from IFES: a child with autism who is “medically fragile and has frequent mood swings, someone who needs one-on-one supervision, someone who is self-abusive, someone the school system has identified as too much work, too much trouble, too disruptive and unsafe to himself and unsafe or others.”

Parents of such children often become frustrated and need respite, or relief from the day-to-day pressures of care-taking, he said. IFES can help cover respite care.

“Almost everyone uses respite. For many families it’s a Godsend,” Kelly said.

The service can also provide coaching in parenting in addition to medical care.

AWARE Support Specialists already certified in IFES are Deb McGrath in Livingston, Renae Jones in Bozeman, and Mary Graham Rasco in Kalispell. Kelly is also working on certification for Emily Pray, also in Kalispell, and Jenne Peterson in Butte.

The specialists have 14 people on their caseload of eligible consumers, but that list should grow with the expansion of AWARE’s IFES certification in all five regions. Across the state some 323 consumers are receiving the service, with a long waiting list of people who have applied.

With AWARE now a statewide provider, families needing IFES everywhere in Montana have at least two provider choices.

“They really are in the driver’s seat when it comes to choice,” Kelly said, noting that consumers can “port,” or carry, their eligibility with them within a region and from region to region.

Choosing AWARE for the service, he suggested, makes sense.

“We have dedicated, trained staff who have a tremendous amount of resources available to them to assist families,” he said. “We have medical expertise. We have people with mental health backgrounds. We have people with developmental disability experience. We can put a team together like no other provider in the state by virtue of who we are.”

“We have a huge array of services,” he added. “And if we don’t have a resource, we have enough connections to get that resource. The consumer really is our priority. We look at what is working and how we can further support that by using what works with kids and their families to make sure their needs are met. We turn those needs into strengths.

“People talk about teams, but I really think AWARE takes it very seriously.”

Family Support Service consumers can now chooseAWARE in all five Montana DPHHS-DD regions

We have a huge array of

services. And if we don’t have a resource, we have enough connections to get that resource. — Mike Kelly, IFES Director

10

AWARE CEO Larry Noonan has been named one of the year’s Behavioral Health Champions by Behavioral Healthcare magazine.

He will be featured as part of the cover story in the November issue.The Cleveland, Ohio-based monthly describes itself as “the practical resource on technology,

reimbursement, and treatment trends for managers and clinicians in the mental health and substance abuse fields.”

In the cover story of the August issue, titled “Opportunity born from tragedy,” writer Ronald A. Allison argues that the Virginia Tech tragedy should motivate changes in Virginia’s mental healthcare system

According to Allison, executive director of the Cumberland Mountain Community Services Board in Cedar Bluff, Va., and a member of the Commission on Mental Health Law Reform in Virginia, the Virginia Tech tragedy has placed the nation’s mental healthcare system under the microscope “with Virginia’s public system being examined under high magnification.”

After the shootings, the American public was justifiably upset, he writes.“People who normally don’t think about mental healthcare wondered, ‘How can something

like this happen in rural America?’ ‘Could someone have stopped this from happening?’ ‘Is the mental healthcare system broken?’”

Allison says responsibility for the tragedy is unfairly being placed “squarely on Virginia’s public mental healthcare system.”

“The general public’s reaction is understandable, but from a realistic point of view, this condemnation is totally unjustified,” he says. “After all, the public mental healthcare system lacks adequate funding and the necessary resources to be able to prevent incidences like the Virginia Tech tragedy.”

You can read the entire article at www.behavioral.net.

National publication names Noonan ‘Behavioral Health Champion’

Larry Noonan

PROUD OF THEIR EXPANSION, the Anaconda Recycling Center crew poses in front of an aluminum can baler that was used at the 2002 Winter Olympics in Salt Lake City. Front row (left to right), are: Lisa Vidrine, Judy Armbruster, Terri Rodden, Aimee Roberson; back row: Norman Tholstrom, Denny Bowen, Jerry Micheletti, Wally New Robe, Dean Rollins, Danny Bowen, Dan Schlangen, Hank Semenow, Dan Ramsey, Linda Weer, Jay Arensmeyer, John Micheletti, Russ Carstens, and Dave Venturelli. Photo by Jim Tracy

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It wasn’t until she tried electroconvulsive therapy, or ECT, that she could reclaim her life. This book became available in paperback on Sept. 6.

The Boy Who Couldn’t Stop WashingBy Judith L. Rapoport, M.D.Having a family member myself who is diagnosed

with obsessive-compulsive disorder fuels my hunger for information about the mysteries surrounding this irrational disorder. Dr. Judith Rapoport shares the extraordinary experiences of her patients to give their first -hand accounts of living with a disorder where people spend six hours a day washing their hands and still cannot believe they will ever be clean. New breakthroughs in the diagnosis are discussed in the book.

His Bright LightBy Danielle SteelI am not a Danielle Steel fan and, in fact, I don’t

believe I have ever read one of her books before this one. His Bright Light is a personal story of Danielle Steel’s son’s life. It is an account from a parent’s perspective of raising a child with bipolar disorder. She chronicles his life and the progression of the disorder and its effect on her and the entire family. She describes her interaction with and reaction to professionals with whom she worked to treat her son. It is a depiction of a devastating illness and a harrowing portrait of a masked killer called bipolar disorder.

Book MarksEach issue of AWARE Ink includes a collection of

books recommended by staff, covering a range of topics related to the work we do. This issue features titles suggested by Barbara w who has worked for AWARE as a service administrator in Adult Mental Health Services for the past 2½ years. She has worked with people with mental illness for the past 30 years. Barbara holds a bachelor of arts degree in English, a master’s degree in counseling and a nursing degree.

Saving MillieBy Tina KotuskiThis heart-wrenching account of a daughter’s reactions

to and life with her mentally ill mother gives powerful insights into what children experience when they have a mentally ill parent. It is a difficult book to put down once you begin the read.

ShockBy Kitty Dukakis and Larry TyeI recommend this book to all professionals, not only to

inform themselves about the history of and current states of ECT, or electroconvulsive therapy, but also so they can recommend it to patients. Any patient considering ECT would do well to read Dukakis’ and Tye’s take on this intervention. Kitty Dukakis has battled disabling depression for more than 20 years. Coupled with drug and alcohol addiction that both hid and fueled her suffering, Kitty’s despair was overwhelming. She tried every medication and treatment available. None worked for long.

Book Marks

can use their experience in assessing a situation and suggesting ways to resolve it.”

The system also makes it easy to spot factors that may be contributing to recurring incidents—time of day or location, for example.

For training director Tim Hahn that automated trend analysis is a big plus. Before the new system came on line he had to sort through reams of paper reports to analyze incidents and try to identify trends.

“This is much easier and faster,” he said.

According to Rub, the automated reporting system is unique to the industry. “We’re the only company that has this system in place,” he said.

Incident reporting... Other providers use a program developed by the state.

Rub, a 2003 graduate in computer and information technology from the University of Cincinnati, spent about a month writing the first draft of the program.

First he broke down the paper incident reporting forms provided by the state.

“Basically what I did was to take what I know about what computers can do for people and applied that to the paper form. First I wrote the program in English, then I wrote it programmatically using data diagrams to see if everything was going to flow.”

“Everything has to link together,” he said. “I had to write a lot of different things to make this work.”

Even now he’s making fine adjustments so that supervisors will be able to change information about staff and consumers.

While the program is more convenient, Rub said its real value is that it frees up staff time for other jobs.

“Doing manual tasks usually requires hours of paperwork,” he said.

“With the automated system, not only is it faster, but you have more face-to-face time with your clients. You get to do other things that are even more important sometimes.”

AWARE staff who use the program agree.

“We love what Nick did,” Kelly said. “It’s really working well for us.”

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By Jim Tracy

Some days AWARE case manager Eileen Dey sets out at 5 a.m. from her cozy office in Miles City to

visit clients on unmarked back roads 150 miles away.It’s not out of the ordinary for Dey to log 300 miles

or more on a day trip in her 2004 Chevy Suburban and to return home long after dark.

“Generally I take off very early in the morning,” Dey told AWARE Ink. “It’s common to be gone for 12 to 14 hours, especially on days when I visit clients on the Crow and Northern Cheyenne reservations.”

Dey and her counterparts in Miles City, Glendive and Westby – Keith Polesky, Gloria Glaser, Patrick Roe and LeAnn Westgard – travel circuits across a 10-county area in Eastern Montana that is bigger than the state of South Carolina.

They regularly visit outposts that aren’t even listed on the state highway map. Dey’s stops include small towns like Lame Deer, Wyola and Busby, but also places with only a handful of people and no services – places like Jim Town and Muddy Cluster and Teepee Town.

Case manager Gloria Glaser’s twice-a-month circuit takes her to small towns, smaller towns, and wide spots in the road. She has clients in Wibaux, Baker, Richey, Circle, Terry and Fallon and stops in the country “that are in between those places.”

Directions to those in-between places are sometimes sketchy.

“To visit one of my rural places between Wibaux and Baker I was told to turn by the feed lot, take a left by the supper club, go five miles and take a right by the roping arena,” she said.

Long hours on the road (“windshield time,” Dey calls it) gives the traveling case managers an appreciation of the vastness and beauty of Eastern Montana.

Among the breathtaking sights on the eastern flatlands are the

towering storm fronts that fill the sky in late afternoon, creating a backdrop like a giant projector screen for lightning and rainbows.

Summer thunder clouds may be a sight to behold, but it’s best not to get caught gazing at an Eastern Montana winter storm.

AWARE’s circuit riders have learned to take winter storm warnings seriously—if they know about them ahead of time, that is.

“A couple of times I’ve been caught in horrible blizzards,” Dey said.

White-knuckle driveOn one occasion, she spent a several white-knuckle

hours in her Suburban crawling back to Miles City on Interstate 94 after it had been officially closed because of a snow storm.

“I made it home on a wing and a prayer,” she said. “The biggest trouble out here is you never know what

the weather will be like,” said Keith Polesky of Miles City, who has been plying eastern Montana roads as an AWARE case manager for nearly 16 years.

One of his weekly trips takes him 200 miles north to Glasgow and back with stops in between.

“You may see four vehicles in a 200-mile stretch of the highway in the middle of the week. You may … and I repeat may … see four vehicles,” he said. “You usually see one car an hour—a car about every 75 miles.”

So don’t count on a lot of help if you get stranded.

Road work

Case managers brave blizzards, ‘windshield time’ to serve consumers

Sun rays burst from a cloud bank east of Miles City on a summer afternoon.Photo by Jim Tracy

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“If it starts to blow, there are no hills or trees to stop the wind,” Polesky said.

He recalled a storm he ran into on the way back from Glasgow last spring.

“It crept up on me. I was driving, and everything was fine. There was a little snow blowing. All of sudden I topped a hill and it was a white-out. It was like driving into a different world.”

With snow pelting his windshield, he pulled over at a farm house about 50 miles outside of Miles City.

“I just pulled into a driveway,” he said. “I couldn’t even see the road.”

An elderly couple took him in until the storm cleared enough to continue.

He had to stop again farther down the road at the home of a friend. The storm finally let up three hours later.

“It took me eight hours to get home from Glasgow that day,” he said. “It should have taken three hours.”

LeAnn Westgard has had lots of blood-pressure-raising experiences driving on snowy roads in the northeastern corner of the state.

For a storm story, though, it’s tough to top her yarn about the time she spent four days in Plentywood waiting for the road to open so she could return home.

An AWARE case manager for 14 years in Westby on the North Dakota border, Westgard regularly drives 180 miles from there to Glasgow at least three times a month, often staying overnight to complete her rounds. She has 45 people on her list of consumers, about half of them in Plentywood.

“I just like to spend the time with the consumers,” she said. “I’ve known many of those people for 14 years. For a lot of them, we are their families. You’re basically what they have.”

Thirty belowShe’s had a few close winter calls, like the time in

2000 when she and a fellow case manager broke down on Highway 2 between Glendive and Sidney. It was about 9 at night and the temperature had plummeted to 30 below. Traffic was a trickle and most of the vehicles that passed them didn’t stop.

“Thank goodness someone finally did and gave us a

ride or we would have sat out there and froze,” Westgard said.

But that was nothing compared to the storm that stranded her in Plentywood for four days in 1996.

She was returning home after visiting consumers and heard a warning on the radio.

“It said the weather was going to get bad, so I took off out of town,” she said.

Highway 5 climbs from the valley where Plentywood is to a high plateau where Westby is

located, just 26 miles away. In good weather, the trip takes about a half hour.

“By the time I got to the top of the hill, I could barely see,” Westgard said. “If you can’t see in Plentywood, you know Westby is going to be way worse.”

She had driven only about a mile out of town, so she turned around, drove back to Plentywood and got a room at a motel.

“I was stuck over there for four days,” she said. “Everybody was stuck there. The stores weren’t even open because those who got out of town, including many of the business owners, couldn’t get back in.”

For three days she attempted to return home on various back roads with her brother-in-law, who works for the telephone company and was driving a one ton pick-up.

“Every day we would try a different road to see if we could get back,” she said. “We ended up coming home on the fourth day on a seldom-used back country road that a farmer had plowed.”

White crossesEven when the weather is good in Eastern Montana,

roads often are not. Hilly, curvy Highway 313 between Saint Xavier, which dead-ends at the Yellowtail Dam, and Fort Smith, is littered with white crosses—reminders of deadly accidents.

There are lots of other scary roads on and off the reservations. Among those, Dey includes Blue Creek Road, Lynch Road, Cow Creek Road and Highway 212.

But there are scenic byways that more than make up for those, she said, like “the Little Horn Road, between Wyola and Lodge Grass.”

“It’s an incredibly beautiful drive,” Dey said. “Every time I go down that road I’m filled with awe.”

Walls of snow line Montana Highway 5 between Plentywood and Westby in the far northeastern corner of the state. Photo courtesy of LeAnn Westgard

Continued on page 14

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She’s also been awestruck by wildlife that share the roads.

One day she was driving from Miles City to Muddy Cluster on the Crow Reservation. Her young passenger kept saying “Deer! Deer! Deer!”

“All of a sudden there was the biggest, handsomest whitetail buck I’d ever seen standing in the middle of the road staring at us,” Dey said.

On his road trips, Polesky has seen “a lot of deer, elk, antelope, even bobcats.”

“I’ve seen pretty much about anything you can imagine, but I haven’t seen a bear yet,” he said.

His most memorable wildlife experience occurred in the winter on Interstate 94 north of Miles City.

“A herd of antelope was crossing the highway,” he said. “They followed the leader in almost single file over the fence. I had to wait for a long time for them to cross the highway. There must have been 150 antelope stuck between two fences on the interstate. It was pretty wild.”

Case manager Patrick Roe doesn’t have as many wild tales to tell but give him time. He has been with AWARE for a year, making trips from his office in Glendive to visit consumers in Sidney, Culbertson and Bainville, a round trip of a couple hundred miles.

Roe said he routinely dodges turkeys and pheasants in the AWARE minivan.

For Roe and the other case managers, the job makes the long trips worthwhile.

“I like working with the people,” said Roe. “It’s the best part of it.”

“They depend on you to be their family, to be their outside link to the world, to access services and assistance and to advocate for them,” said Polesky. “A lot of our clients don’t have family involvement. It’s our job to insure they have the best quality of life possible. It takes a lot of work to make sure their quality of life is enhanced.”

For some of the people they serve, case managers are their lifeline.

“There are some that I am their only support system,” Glaser said. “Some have no family or no close family. They look at me as their link to the outside world.”

Glaser numbers among her successes a woman who bought her own home with AWARE’s help.

Bad wiring, leaky roof“She was living in substandard conditions in a mobile

home,” she said. “The steps were dangerous, especially for a person with physical challenges. It had bad wiring, poor heating, and the roof leaked. It was just kind of falling apart.”

Today the woman has her own home and keeps it up with the help of AWARE and her neighbors and natural supports in Glendive.

Dey counts among victories just being accepted by consumers and their families on the Crow Reservation.

“Now they hug me and have even offered me sweet grass braids (a prairie grass used as incense),” she said. “It’s taken almost a whole two years for them to let me in.”

Jaci Noonan, DD case management director, worked as a case manager in Glendive for eight years, serving clients in small towns in Dawson and Richland counties.

Here’s how she summed up her trips while supervising the rest of the counties providing coverage: “Bad weather, blizzards, other harsh weather, critters in our path including pigs, wild turkeys, cow herds, skunks and the other animals our state has to offer, the miles between, vague directions to travel on gravel roads, broken windshields, being snowed-in, eating way too much gas station food, different cultures, no cell phone reception, late nights, should I go on?”

But the blessings, she said, far outweigh the hardships: “Getting to know the clients and their families, the ability to work with a variety of service providers and community and state resources, the incredible scenery we view with each trip, the books on tape and singing to myself, getting to see others on our team, getting to know other cultures and history, and hearing and assisting with the success stories of the folks we are honored to serve.”

Employee Handbook review underwayHere’s your chance to review AWARE’s

employee policies and procedures, make comments and suggest changes.

The Human Resources Department has been revising the Employee Handbook for the past year. The handbook is designed to acquaint staff with AWARE and provide information about working conditions, employee benefits and policies affecting employment.

It covers such items as equal employment opportunity, open door policy, orientation, benefits, time keeping and payroll, work conditions and hours, leaves of absence, and employee conduct and employee discipline.

Please take a few moments to review the draft revisions, located on AWARE’s Employee Web Site, and forward any questions about the policies in the handbook or suggestions for policy changes to your immediate supervisor or to the Human Resources Department.

Or send your questions and suggestions to “Ask AWARE” at ask@aware-inc.org and we’ll pass them on.

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By Jim Tracy

Imagine sitting in a car while being bombarded by baseballs and golf balls.

Tim Hahn and Scott Yebba went through just such an experience two summers ago while driving from Miles City to Billings.

Hahn, AWARE training director, remembers the day well. It was June 12, 2006. He and training coordinator Yebba were returning in late afternoon to Anaconda.

“We saw this huge, ominous-looking black cloud coming from the southeast,” Hahn said,

Almost simultaneously, an alert blared over the radio warning them of a severe thunderstorm “with grapefruit-sized hail,” Hahn said

“There’s no way there could be hail that big,” he remembers joking to Yebba, who was driving. “It was the first time I’d ever been in a car and actually heard a weather warning.”

Within minutes, the warning became reality. A storm they’ll never forget forced them to pull over on Interstate 94 near Hathaway, about 25 miles west of Miles City.

“We saw the cloud, but there was no where to go,” Hahn said.

“We were in no man’s land,” said Yebba. “The next exit was like 15 miles down the road and we had passed a rest area 10 miles back.”

For 20 minutes they sat while hail stones the size of golf balls and baseballs pelted the front and driver side of their car, a 2005 Ford Taurus that is by now familiar to AWARE drivers because of the dents left by the hail.

“It shattered the windshield,” Hahn said. “Shards of glass were coming inside the car.

“We stuck our briefcases up against he windshield to avoid being showered by the broken glass.”

Hahn also remembers hearing the storm.

“The sound as the hail was hitting the car was intense – very scary,” he said.

“It sounded like shotgun blasts inside that car,” said Yebba.

“We were laughing, too,” he added. “You get to the point where you just start laughing.”

Hahn said other vehicles, including a truck and semi that had pulled over behind them, sustained “significant damage.”

News reports at the time said the storm damaged crops and buildings throughout southeastern Montana. After the hail let up, Hahn and Yebba limped back to Miles City. The next day they drove to Billings, driving slowly while peering through the broken windshield.

A repair shop there replaced the windshield, but deep dents remain – a conversation starter for anyone who drives the dimpled silver Taurus, also known as AI 55.

Hail! Hail!

AWARE trainers recall hellish storm

We were in no man’s land. The

next exit was, like, 15 miles

down the road, and we had just passed a

rest area 10 miles back. — Scott Yebba,

Training Coordinator

The KMA, or Kids Management Authority, is the infrastructure that supports a comprehensive and statewide system of care. The KMA has two primary functions: development of a continuum of care within their respective communities, and case planning and coordination for individual youth with serious emotional disturbances and their families. This system of care is child-focused and family driven. It also provides wraparound services to youth and their families within their communities. Characteristics of the system include:

A service design and delivery based upon the strengths of the youth, family, and community; �An awareness of familial, cultural, racial, and ethnic differences; �A focus on prevention/early intervention; �An orientation toward outcome/results; and �A funding mechanism that blends available resources � .

The SOC Committee (Children’s System of Care Planning Committee, born out of Senate Bill 94), together with community KMAs, identifies training needs, service gaps, funding, and other barriers to service delivery. Together, they implement responses to identified needs.

What is a KMA? From “An Introduction to Montana’s Kids Management Authorities,” by the DPHHS Children’s

Mental Health Bureau

health services.The President’s New Freedom Initiative, one of many

attempts at diagnosing and treating the problem of rural health shortages, was made up of a bold, aggressive team of mental health experts who identified what they considered to be the major barriers to an efficient and helpful rural mental health network. They even adopted the wraparound philosophy, which AWARE has embraced for years as a

core method of treatment. The Initiative’s work was compiled

on the notion that there will always be a shortage of mental health professionals in rural areas.

The “they will do for themselves” attitude associated with living on a farm or in the mountains will, for a time, at least, prevent long lines of people waiting to get help with their depression, and any psychiatrist needs to work…a lot. With student loans reaching into the hundreds of

thousands of dollars, their time cannot be spent waiting for patients to come to them. It was with this fact in mind that the NFI team asked themselves how to attract doctors and/or create training and development for people who have grown up on a farm and will not be going to medical school?

National attentionThe team’s conclusions, published in a 2003 report,

identified its goals of reducing disparities in rural areas for mental health services. Considering the stigma attached to receiving them, they addressed ways to implement technologies that could bring the doctor to the client without having to make a large production out of it. Further, the importance of the issue to the president is underscored by the fact that, even through the terrorist attacks of September 11, 2001, the project remained fully engaged and staffed in the midst of the rerouting of countless billions of dollars towards defense initiatives.

With the amount of attention being given to both the shortage of doctors and resources, most markedly since the beginning of the Bush presidency, it would seem that the problem would be getting better. On the larger scale, it’s not. Many of the few psychiatrists practicing in the larger cities of already very rural areas are completely booked, and their rates reflect that. On the other hand, most of the recommendations by the New Freedom Initiative, as innovative and exciting as they are, remain unfunded.

Outdating the NFI, the National Health Service Corps (NHSC) is an example of a federal program that has seen some success in bringing doctors to areas that would

If it’s a good enough reason to

do it, and it will help people, we’re going to do it. — Jeff Folsom, Chief Operations Officer

‘A Good Enough Reason to Do It’Down and out in Montana’s mental health crisis, and what AWARE is doing about it

By Tim Pray“Social Isolation, Guns, and a ‘Culture of Suicide”

is an article written by New York Times reporter Fox Butterfield in 2005. It tells the stories of three people: an adolescent, a middle aged man, and an elderly man. They all have two things in common. They all lived in rural Montana, and they all ended their own lives.

Butterfield attempts to explain the data that point to the fact that Montana has, since 1890, had the highest rate of suicide in the nation, and what that might have to do with its primarily rural population. One woman interviewed for the story, whose own son committed suicide at 29 in Ravalli County, said: “People here are very rural. They do for themselves. They won’t go for help.”

In Montana and many other rural areas, there is a tendency for people—men, in particular—to feel great shame in dealing even with something as treatable as depression. The fear of being seen in town while walking into a mental health clinic, or an awkward encounter at the pharmacy while picking up an anti-depressant, is enough incentive to ignore the problem, or to not talk about it with someone who can help.

At the same time, there is a perceived problem with the mental health professionals in rural areas across the country, not just Montana. According to numerous reports, articles, and even President Bush’s New Freedom Initiative (NFI), which was established in February 2001, the doctors simply aren’t there. Missoula Independent reporter Patrick Duganz wrote a story on August 30 entitled “The Doctors Aren’t In,” in which he describes the ripple effect generated from just one Missoula psychiatrist closing his practice, leaving hundreds wondering where to go for their mental health care.

Duganz goes on to state that, as those in need of psychiatric care search for a new doctor, they’re faced with the fact that the private psychiatrists in the area aren’t taking new referrals due to their extremely large caseloads and the shortage of doctors.

An interesting problemThese two crises present an interesting problem. On

one hand, an entire population of people are unwilling, or, given the benefit of the doubt, unable to get help with either their own mental health or their children’s. On the other hand, it seems that, even if they were willing or able, a steadily decreasing number of psychiatrists and other mental health professionals are available to provide mental

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normally not be professionally appealing. NHSC offers student loan repayment for doctors agreeing to work in the areas deemed to be a Health Professional Shortage Area (HPSA). As mentioned earlier, the cost of a doctorate can be within the hundreds of thousands of dollars, and the offer of that debt being permanently forgiven would seem to be too much to resist.

For its acknowledgement of the problem, and its proactive suggestions in solutions, the NHSC is not entirely able to find resolution in the most rural of areas. The program requires a psychiatrist to work a minimum of 32 hours a week, a number that can be staggeringly high for an area that may provide only three or four people needing help. At the same time, traveling around the state for treatment solely to meet a patient quota is both impractical and inefficient. “They (federal government) envision a busy, city-based clinic,” says Jeff Folsom, AWARE chief of operations. “It is almost impossible for someone living in the midst of a city environment to imagine everyday life in a place where the nearest grocery store can be as far as 40 miles away.” Further, in some areas of Montana, the county may not be officially deemed a shortage area, but the ratio of doctor to patient can be as much as 1:20,000, which excludes it from the NHSC program and its incentives.

AWARE has used what it needs from the suggestions of the federal government, including plans to implement conferencing network technology and its relationship with some staff psychiatrists here because of the HPSA program.

“We’ve committed to building psychiatric service without relying on the federal government,” Folsom says. “We don’t want to have to rely on anyone in order to provide our services. That kind of situation can only breed inconsistency and wouldn’t be at all fair to our clients.”

“Would we like the help of the government? Yes, you bet, but first, we’re going to do what’s right. Other providers have said that if the state won’t pay for it, they won’t do it.”

AWARE works by carefully looking at community needs that must be filled, and, with an accurate business plan, attempts to fill that need. One AWARE staff psychiatrist in Missoula has witnessed the fallout of a provider doing the opposite.

“AWARE has never tried to be everything to everybody,” the psychiatrist says. “One of the reasons that people (patients and families) get so angry with other providers is because they tell their current and potential clients that they can be, but their services don’t match the hype. They’ve gotten all this money from the Legislature, and it makes for a lot of bad blood when a client shows up to the door and is told to come back in three months because the doctors are booked to the gills.”

On the larger scale, there is no telling when this crisis will end, particularly when it comes to telling a macho

culture that attending to one’s mental health is as important as attending to the physical. As to the mental health professional shortage, there will continue to be providers that get in over their heads, sign every contract available, and provide the service in the leftover time. That is a way, on paper, to deal with the crisis.

Subsidizing stabilityHowever, Folsom believes that stability can come from

knowing who you are, organizational commitment, and letting people know that they are a part of a team.

“We subsidize our structure because we think it’s worth it,” he says. “If we have a case management program, and there is a need for a psychiatry program, we add it, and it makes it better. If we have a group home, and we add mental supports, it makes it better.”

Folsom adds that no matter how well we are doing, we are still a part of the rural community, and the problems that have hindered others in recruiting doctors could be a problem for AWARE, if not properly addressed.

“We spend the money on recruitment and design a model of practice that doesn’t burn the doctor out,” he says. “By doing it in the context of a team, they’re not doing everything alone. You can’t rely on just having five psychiatrists sitting around waiting for the phone to ring while putting their lives on hold. Our case managers develop an individual crisis plan for each client. All members of the team are previously engaged in crisis plans and how they work, and that includes knowledge of the proper way to operate the 24/7 crisis hotline that helps the clients orient or reorient themselves to their individual crisis plan should one arise.”

Folsom goes on to state that AWARE places a great deal of emphasis upon our doctors being given the time to develop meaningful relationships with clients. “When a new client is referred, the doctor is given up to an hour and a half for that initial interview. For follow-ups, half an hour…some places will run through 20 clients an hour.” Folsom continues, “We simply don’t believe in rolling clients through one after another, hour after hour. While it may be more fiscally viable to meet with 15-20 clients per hour, it’s not the type of service or standard that we adhere to.”

So as 600 people scramble to find a new psychiatrist, providers dive into contracts that stretch them thin, the federal government envisions rural life that functions on a city’s cylinders, and a culture of social isolation slowly learns to accept the importance of mental health, AWARE is moving forward.

Folsom states, “We say that if it’s a good enough reason to do it, and it will help people, we’re going to do it. That might be the reason we’re not bogged down with a psychiatry crisis.”

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Recycling in your neighborhoodTo recycle in your community

visit the Recycle Montana web site http://recyclemontana.org/ and click on the Recycling Center Locator.

Evidence abounds of the need for a new recycling center. Doz-ens of these bales of aluminum cans are produced daily by staff of Anaconda Recycling, the biggest recycling operation in Southwestern Montana. Photo by Tim Pray

Much of his time is spent visiting the homes around the state, touching base, and seeing first hand whether general upkeep is where it needs to be, and whether any glaring problems have arisen from the time of his last visit. This project, though, “is something to be very proud of,” Francisco says, gazing into the space of the new building. “It really shows how far we trust our capacity to do serious work for and by the community.”

For 12 years, AWARE has been operating Anaconda Recycling (in collaboration with Butte Recycling, also an AWARE industry) from the eastern end of the town, an area that, a few years ago, was fitted for a predicted boom of industrial projects and developments that never quite materialized. The expansion of the recycling effort will mean much needed development in this desolate area of the city.

Last year, Anaconda Recycling purchased what is known as the Jim Dandy building, a steel-framed building much smaller than the space occupied prior to the move, which was more than triple its size. Upon moving in, plans began immediately for expansion. The building houses the recycling operation, day/activity center for adults, as well as the Hope Thrift Store. With all three projects operating within the same walls, space is tight, and there hasn’t been room enough for each to do what it needs to do in terms of growth, comfort, or efficiency.

The thrift store receives donations and shoppers daily, and one goal has always been to provide as close to a department store experience as possible.

“We’ve got enough product to make this a legitimate retail store,” says Wendy Dyer, Work Services Coordinator in Anaconda. “This is going to be a very pleasant shopping

experience for our customers, not unlike any other retail store…the only difference is that the product is used.”

The expansion of the facility will allow the thrift store to spread out properly and will make parking hassle-free.

“No more having to maneuver around trailers, trucks, and heavy machinery,” says Dyer. “Just park and shop.”

“This is a win-win situation,” says Francisco. “For both the public and, equally as important, for our employees and consumers, this new building is safer, more comfortable, and just plain…nicer.”

While operating in the Jim Dandy building, a vertical baler was being used to compact recyclables. Sometimes it took as long as six hours to form a load of product. Now, with the equipment that had been stored in the parking lot, the time it takes to generate a bale is reduced to a mere 20 minutes, and it can be done more safely. Where the vertical

baler required loose product to be loaded by hand into a hydraulic compartment, the new (horizontal) baler boasts a 20-foot conveyor belt that runs along the floor, leading to a larger compactor. This allows for product to be swept directly onto the belt, and the machine takes it from there.

The recycling operation, which last year recycled more than a million pounds of product, will now be even more accessible to residents of the Anaconda-Deer Lodge area.

What was a parking lot crammed with trucks, trailers, and recycling balers with no home will now be open to retail parking with a clearly marked route to the new building and its lot, with a spacious and professional recycling receiving area.

The expected efficiency of the new building and operation will, aside from the obvious benefits, provide a better gauge

of improvements that the Butte recycling operation may require. Due to the limited space of the Jim Dandy building, a large amount of the recycling brought there was transported to Butte for processing.

“Now that Butte will not be overwhelmed with product,” says Mike Schulte, Chief Habilitation Officer, in charge of all work services and supported living ventures by AWARE. “We can get an accurate picture of exactly how they’re doing…and provide them with some breathing room.”

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This year’s Corporate Congress nomination process will be refined as we continue to work to improve how all of our employees, communities and services are represented at Corporate Congress. Corporate Congress is an exciting and important strategic planning process that will take place for three days this December at Fairmont Hot Springs. All of the delegates who participate at Corporate Congress are non-supervisory / non-management staff. AWARE believes that a process that is designed to bring focus to our services and direction is best led by the folks who deliver our services day to day.

As in the past, delegates will be selected to represent each and every service delivered by the organization. In addition, we have designed new “Districts,” which will provide for geographic representation. Lastly, there will be a statewide representative representing an understanding of the way AWARE functions as a whole, takes note of organization-wide trends, and can speak to that in terms of improvements that could take place. Existing delegates, who served at our last Corporate Congress, will complete their second term at this year’s Congress so that there is a balance between experienced and new delegates.

We are currently looking for 12 employees to be delegates at this year’s Congress. Service Directors are currently in the process of identifying potential candidates and will be finalizing service representation by the end of October. District Representatives will be nominated through the input of appropriate district committees. A new approach, District Nomination Committees are designed to increase the opportunity for any employee who wants to participate to have greater opportunity to achieve that goal.

This is a very exciting and positive opportunity to participate in a very important organizational process and to have some fun. AWARE understands that both the stronger and more motivated the pool of candidates that step forward, the better the value of the process. All employees who believe they have something to offer to help improve AWARE services should step forward and be part of Corporate Congress 2007.

What do I need to do next? If you are interested in this process and would like to represent either your service or your area in general, please contact your Service Director or Administrator and let them know.

Nominations for all delegate positions will be closed Oct. 16. Positions will be finalized by Nov. 1 and the Corporate Congress event held Dec. 5, 6, and 7. During the month prior to Congress, delegates will participate in preparatory activities, including information gathering and discussion with our stakeholders.

Corporate Congress 2007 BreakdownA quick look at the process, potential for involvement, and timelines

DO YOU KNOW what the ten Unconditional Care Principles of AWARE are? In case you don’t, they’re listed below, and we hope you are able to think about them carefully, as they will play a central role in this year’s Corporate Congress awards ceremony.

Building on our strengths is the key to success• We take on and stick with the hardest challenges• We are agents of change• Everything is normal until proven otherwise• Families are the most important resource• I’m okay, you’re okay• It takes a team• Our connection with our communities is vital• We strive to the highest quality of care• Lighten up and laugh •

As a part of the Corporate Congress, we have a tradition of honoring employees from each service area across the state. Further, the annual Employee of the Year award

Continued on page 20

1) Administrative (not central office)

2) Adult Mental Health (ICBR/ACM)

3) Adult DD Services

4) CSCT

5) IFES

6) Early Head Start

7) Support Services

8) Billings (Consumer)

9) Galen

10) Bozeman/Livingston

11) Eastern Montana

12) Butte/Dillon

13) Statewide Delegate

Service Openings:

District Openings:

Teresa Rivenes

AWARE, Incorporated205 East Park AvenueAnaconda, Montana 59711

1-800-432-6145www.aware-inc.org

is an important way for our management to recognize great work through a banquet and a reception in front of your peers.

In carrying that tradition forward, and further developing it, we’re merging the efforts of the Unconditional Care Commission and AWARE to acknowledge the employees that represent the very best of the work that we do at AWARE. This year’s awards are based on each of the UCC/AWARE values and principles. It is our hope and constant effort to bring these values to life in the day to day services to families.

Nominations for these awards will be solicited this month. If you know of someone that lives and breathes one or more of the principles through their daily life and work, we encourage you to put together a few paragraphs explaining just how. Following is an example:\

Joe Kent, a youth case manager in Helena, has spent countless hours on the phone with his client’s teachers, working tirelessly to get him into a summer camp that would help him build upon his passion for music. Without Joe’s ability to know who to talk to and when…without his acknowledgement that “our connection with our communities is vital,” this wouldn’t have been possible, and his client would not have been spending a summer immersed in music.

If you know an employee that you would like to nominate for one of the awards, write down the details and submit it to your service director.

Corporate Congress awards...

We welcome...Teresa Rivenes comes

to AWARE after spending time with Quality Life Concepts as both their Director of Development and Family Support Specialist.

Teresa received her Masters/Doctorate in Social Work from Capella University and came to Montana from Santa Barbara, Calif.

She will be working in, and is new to the Great Falls area, where she will be spending her time developing and expanding the IFES/Children’s DD Services program.

“I have to say that I do miss the ocean,” Teresa says, “but I’m genuinely excited to be here.”