OSSA’s Vision for the Future of Disability Services in Oregon

Sometimes, in the midst of change, it is hard to see the way forward.  Oregon’s system of services to people with intellectual and developmental disabilities once felt like it had a clear identity as a national leader for progressive, community-based service.  We closed down institutions.  We gave control to the people using the services.  We showed that giving people self-determination can not only be right, it can also be cost-effective, good business.  Somewhere, in the crush of change and hurtling, forward momentum, we have lost the clarity of that identity.

Oregon the beautiful, through and through.

Oregon the beautiful, through and through.

Now is the time to work to reclaim that pioneering spirit at the heart of our state.  Make no mistake, it will take work–no one else in the nation is using the K Plan in the same way that Oregon has.  We’re out on the grand stage, we’re under the watchful eye of the national Centers for Medicare and Medicaid Services, and we need to make this work.

It is in the spirit of collaboration, excellence, and service that we offer our Vision for the Future.  As is stated in our Opening Thoughts on page 2, this is “intended to be a starting point for discussion,” not a perfect, finished product.  We start with the vision and we fill in the rest, together.ossacoverforfacebook

Take a look, let your gears turn, and share your thoughts with us.

Thank you!

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Who is OSSA?

Dear Personal Agents, Brokerage office staff, Lead Personal Agents, Operations Managers, Fiscal Managers, accounting staff, Provider Coordinators, Resource Managers, and every other Brokerage staff member,

At the start of February 2015, you hired me to serve as your Executive Director. Did you know that? The Oregon Support Services Association represents the 13 Brokerages around the state of Oregon. OSSA’s board of directors is comprised of the 13 Executive Directors of each Brokerage. But OSSA is so much more than that—our membership includes each and every person employed by a Brokerage to do the work of Support Services for individuals with intellectual and developmental disabilities. So to you all I say, thank you for taking a chance on me, and let me tell you a little bit about the person you hired, and the work I’m going to do.

Katie Rose enjoying a cup of coffee

Can’t get enough good coffee.

A life-long Oregonian, I started in the field of I/DD services fresh out of college, working in direct care at United Cerebral Palsy Association of Oregon and SW Washington. Since that time I’ve served at Mentor Oregon as a Personal Agent, Lead Personal Agent, and Brokerage Director, for a total of 12 years in the field.

Serving in these capacities, I’ve developed a strong theory of leadership: leadership exists in service to the people doing the work. We accomplish that by clearing the way for the actual work to get done, with easy to understand guidance, increased efficiency, and a sharp focus on our customers. True leadership isn’t afraid of feedback or differing views, and it remains open to new facts, and developing realities.

Personal Agents, that means you’re at the top of my pyramid, because you’re answering the needs of individuals in service directly. Office support staff, PA supervisors, other managers—you’re next, as you directly support the work that Personal Agents perform for customers. Brokerage Directors, you support the whole team, and I work directly for you. My charge as OSSA Executive Director is to be a strong and unwavering voice for our collective needs, concerns, passions, and goals.

To close this post, I’d like to share with you some of OSSA’s priorities over the next two years. In a release coming later this week, OSSA is incredibly excited to share with you Our Vision for the Future of Disability Services in Oregon, created by your Directors at last September’s OSSA retreat. The document is well worth your time. It outlines an ambitious, energizing plan for rebuilding a stellar service system to Oregonians with intellectual and developmental disabilities. As a preview, some of OSSA’s key priorities include:

  • Honoring the strengths of Oregon’s case management workforce by returning to a system of specialized case management, where people who choose in-home supports are assisted by Brokerage staff, and people who choose licensed/certified settings are assisted by CDDP staff
  • Re-infusing the system with the principles of self-determination at every point possible, by returning budgetary control to customers, educating customer employers on employment responsibilities, engaging customers in provider choice, and encouraging responsible fiscal management of public funds at every level.
  • Restoring true choice to individuals entering and in service by removing the caps on current Brokerage contracts
Image of Katie's office door while serving as Brokerage Director

My door while serving as Brokerage Director at Mentor Oregon was plastered with the wonderful Rosie the Riveter, sporting my likeness.

I hope this is as exciting to you as it is to me.  The last two years of rapid change in Oregon have left me feeling battered, without direction, reactive, and operating in a permanent crisis mode. It seems like the old service system was demolished without a clear idea of what should be built to take its place. No one does their best work without a clear vision for what they want to accomplish.

We cannot afford to wait for someone else to tell us which way to point the ship, we must define success for ourselves, and head in that direction.  I intend to meet the challenges and opportunities laid out in our vision head-on, with partnership, advocacy, and strength.  Join me, members of OSSA–there is a lot of work for us to do.

Sincerely,

Katie Rose

Oregon I/DD Advocates Testify to Senate Committee on eXPRS State Payment System Implementation Concerns

Senator Sara Gelser, Chair of Senate Committee On Human Services and Early Childhood

Senator Sara Gelser, Chair of Senate Committee On Human Services and Early Childhood

On Tuesday, Oregon Support Services Association’s Executive Director Katie Rose testified to a Senate committee regarding the state’s roll out and implementation of its payment system, eXPRS.

Additional testimony was provided by Margaret Theisen (CEO of the state’s largest brokerage Full Access), Chris Burnett (Executive Director of Oregon Rehabilitation Association,) Gary Zenzen and Chris Schwartz (from provider organization Partnerships in Community Living,) Lilia Teninty (Director of Oregon’s Intellectual and Developmental Disabilities Program,) and Don Erickson (Chief Operating Officer for Oregon’s Aging, Disability, and Developmental and Intellectual Disabilities Programs.)

The five advocates testified to the Senate Committee on Human Services and Early Childhood: Senator Sara Gelser, Senator Michael Dembrow, Senator Laurie Monnes Anderson, Senator Alan Olsen, and Senator Jeff Kruse.

If you’d like to learn more about the issues surrounding the implementation of eXPRS in brokerage and county services statewide, click here to watch a full video of the testimony.

If you’d like to read testimonies from some of the participants, follow the links below.

Katie Rose Testimony 02.10.2015 eXPRS
Margaret Theisen Testimony 02.01.2015 eXPRS
Chris Burnett Testimony 02.01.2015 eXPRS

Brokerage Association Announces Leadership Changes in 2015

In the spirit of the new year, the Oregon Support Services Association announces two changes in leadership. 

Larry Deal, Executive Director of Independence Northwest brokerage, has assumed the role of OSSA President. He follows in the footsteps of Margaret Theisen, whose tenure spanned the birth of the brokerage association and four incredible years of unprecedented growth and change.   We are deeply indebted and grateful to Margaret for her influential and principled leadership. Margaret passed the torch to Larry after the association’s Board of Directors meeting in December.  Larry brings with him 13 years experience in Oregon’s Support Services system, and a deep talent for innovation, communication, and partnership. Dan Peccia of Self Determination Resources Inc. and Bill Uhlman of Eastern Oregon Support Services Brokerage will continue in their roles as Vice President and Secretary/Treasurer respectively.

Additionally, the association will begin a transition from its first Executive Director. For the past year, OSSA has been led by the incomparable Kathryn Weit. Her advocacy, passion, and leadership has greatly furthered the mission of OSSA by promoting, assuring, and protecting the integrity of Support Services for adults with intellectual and developmental disabilities statewide. We’re excited to announce that beginning in February 2015, Katie Rose will assume the Executive Director role full-time. Katie will be leaving her position of six years as the Director for the Mentor Oregon Brokerage presently serving individuals in the greater Portland area. As OSSA Executive Director, she will report to the OSSA Board of Directors, which consists of the 13 directors of the Oregon Support Services Brokerages.

Katie can be reached at katierose@oregonsupportservices.org beginning February 1, 2015. Stay tuned for additional contact details.

If you’d like to learn more about the association, please visit us at www.oregonsupportservices.org.

eXPRS Trainings for Personal Support Workers Scheduled in Portland Metro and Mid-Valley Areas

In January 2015, the Oregon Department of Human Services is putting on a series of trainings on their electronic billing system eXPRS. The trainings are specifically geared toward Personal Support Workers. You may attend a training at any of the sites below, whether you serve individuals at the particular brokerage or county. Be sure to RSVP by emailing ODDS.training@state.or.us.

Please note: RSVP-ing in the comments section below does not guarantee you a space at one of the trainings. Please email ODDS.training@state.or.us to reserve your spot. Thanks!

PSWTrainingsJan2014

PSW TrainingsMidValley

Today: Brokerage Association Director, State DD Director and Provider Organization Director Talk I/DD System Changes on OPB’s Think Out Loud

Tune in today at noon on Oregon Public Broadcasting- OPB‘s Think Out Loud. Listen in as brokerage association Executive Director Kathryn Weit, ODDS Director Lilia Teninty and provider organization director Shanya Luther discuss changes to Oregon’s intellectual and developmental disability services.

From OPB: Oregon’s system for delivering home and community-based services to seniors and people with disabilities is in the process of being completely overhauled. The state has said that the new system will increase the amount of funding provided by Medicaid for disability-related services and give individuals more choices in how and where services are provided. Parts of the system are already in place, and parts are still in the process of being rolled out.

This overhaul is a component of the Affordable Care Act, and Oregon is one of the first states in the country to implement it. 

GUESTS:

An Update on Systems Vision and Direction from Brokerage Association President Margaret Theisen

Staff.margaret-120x150
On Monday, November 10, 2014, Kathryn Weit, OSSA Executive Director and I participated in a vision and values discussion organized by the Office of Developmental Disabilities Services and the Oregon Council on Developmental Disabilities. Later in the day I stopped on the way home for groceries and when asked how my day was by the clerk, I said my day was excellent.  I can’t recall the last time I said that about work!  I surprised myself with that comment.

We spent an entire day discussing and refining the language for the values and vision statements that will be used to guide the system that provides services to people with Intellectual / Developmental Disabilities. The people attending the meeting represented all parts of the DD system, including State staff, and all were highly engaged, respectful and positive. It was the first meeting with a constituent group in my recent memory that was not dominated by complaints, whining, and finger pointing.

We don’t have final outcomes on vision or values statements, but within a week we will have the vision statement and we will have values work after that.  I feel very inspired by the day, and I am eager to see the final vision product by the work group.  When that is done later this week, final definition of the values statements we worked on will go forward.  I am on that work group with 6 people including Lilia Teninty, the State DD Director. Finalized, these statements will be shared widely and used to guide future decision making.

Next steps include scheduled discussions on Medicaid and the K Plan with Robin Cooper, an expert on these issues from The National Association of State Directors of Developmental Disabilities Services in Washington DC. Once we increase our knowledge base with, and understanding of Medicaid and K, Lilia plans to pull together groups to address specific topical areas beginning with case management.

I think Lilia is very much on track and as always, Bill Lynch’s facilitation was important and focused.  While our work didn’t address many of the day-to-day issues we are struggling with, I feel more confidence in our direction than I have in over two years!  I think Monday was a great start to a different/better future!

Margaret Theisen, OSSA President

State Delays eXPRS Implementation and Employment Rate Changes to Fall 2014

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

State Looks to Reduced Rates for Supported Employment and Day Program Providers; Community Responds

On May 9, 2014, during a monthly meeting with brokerage directors, ODDS staff shared potential rate decreases to providers of Supported Employment and Day Habilitation (ATE programs). The proposed reduction would occur across the comprehensive and brokerage systems and go live as early as July 1st, 2014. 

Last week, the Oregon Support Services Association, the Oregon I/DD Coalition, the Oregon Rehabilitation Association and the Oregon Council on Developmental Disabilities each submitted letters to state leadership asking the state to reconsider any rate reductions. We all await responses and will update you once we have additional information on the direction the state decides to take on this important subject. 

As always, the brokerage association will continue to advocate for appropriate payment to providers of these essential services – particularly during a time of need for increased provider capacity and better employment outcomes for Oregonians with intellectual and developmental disabilities.

Stay tuned.

– The OSSA Communications Team
OSSA Executive Director Kathryn Weit
Margaret Theisen
Larry Deal
Katie Rose

 

An Interview with Brokerage Association Leader Kathryn Weit (Part One)

By Larry Deal
Executive Director, Independence Northwest
Communications Director, Oregon Support Services Association

I recently sat down with newly-appointed Oregon Support Services Association Executive Director Kathryn Weit to discuss her history, her thoughts on the brokerage system, the implementation of the K Plan, and where she sees brokerage services headed.

Kathryn has been a hugely influential player in services for people with intellectual and developmental disabilities both in the northwest and nationally. She played an integral role in the development of brokerage services in Oregon and brokerages statewide could not be more pleased that she’s signed on to lead us into Oregon’s next phase of services. Sometimes the best way to figure out where you’re going is to remember how you got where you are. Our conversation started there.

Larry: What did services look like in Oregon twenty years ago?

Kathryn: Looking back fifteen years plus, prior to the filing of the Staley lawsuit and the creation of the brokerage system, Oregon was in the process of downsizing an institution and we had very, very long wait lists.

Larry: Wait lists for community-based-services?

Kathryn: For everything. I use the term wait list loosely because it really never was a wait list. It was a crisis list. If you went into crisis, you got services. There were very few services for adults except group homes. Any family of a child under 18 who needed any kind of support had to go through the Child Welfare system. And they had to say they were on the verge of having to place their family member out of home, usually into foster care. It had to be that serious before there was a possibility of getting in-home supports. The stories you’d hear families tell about trying to survive without any support and then having to say this. It was devastating.

Larry: And your son, Colin – you were in this situation with him, right?

Kathryn: When my son was sixteen, we had a major crisis in the family and we had to go the crisis route. We had to go to Child Welfare and we had to tell people why we couldn’t handle our situation any longer by ourselves.  It was one of the hardest things I have ever done in my life.

Larry: And when you say services – what are we talking about here? What did these services look like?

Kathryn: Early on the services through Child Welfare were designed to support families with respite, in home support, and things like behavior support. Later the Developmental Disabilities Program created some very small, grant funded, family support programs for families with children under 18. It was later expanded to include families of adults. Services were extremely limited. For example in Multnomah County there were only fifty families who had access to supports. (Ed: for comparison, there are thousands in services in Multnomah County today.) It was very limited, but it gave advocates a model to draw from. First, someone needing supports got a “guide” (much like a Personal Agent) to help find and engage with community resources. And second, you got a little bit of funding. But for the first time it was funding that was family-controlled. The satisfaction level in that program was incredibly high. People thought it was amazing. And when the state asked, people told them that their “guide” was the most important thing. These pilot programs helped shape some of the understanding of policymakers.

Larry: The structure sounds very much like the structure and services offered by brokerages today.

Kathryn: Yes. Then later, before the Staley lawsuit was filed, the state applied for and received a Robert Wood Johnson Foundation grant. The idea was to look at what was becoming a national agenda in terms of self-determination and to apply some of those principles to adult services. They set up a small model brokerage (Self-Determination Resources Inc.) and this really pushed systems change.

Larry:
At the time, over 5,000 people were waiting for services, which led to Staley v. Kitzhaber.

Kathryn: If you consider both adults and children who were eligible but not receiving services, yes. Yes, the lawsuit was based on the fact that there were people who were eligible for services but denied them. The State chose to negotiate a settlement of the lawsuit.

Larry: After the lawsuit was settled, the state set out to develop services for everyone on the wait list. How did the brokerage model emerge?

Kathryn: Oregon chose very specifically to say: “This is Oregon, we have economic ups and downs, we are not a rich state, we cannot afford to provide 24 hour, seven days a week residential services to everybody on our wait list.” Many people don’t need that level of service. We learned that people are good decision makers about what they need in their lives when given support and guidance that’s meaningful to them. A crucial element was that families and individuals with disabilities needed to be in the leadership role. Through much discussion, stakeholders arrived at the conclusion that small, decentralized nonprofit and community-based programs would provide a solid foundation for choice-driven services.

Larry: And then we fast forward thirteen years. Oregon chooses to pursue higher federal funding through the Community First Choice Option (the K Plan.) What are your thoughts on this change?

Kathryn: I think that for years we have argued that we needed more resources in the DD system. We all know that there are people with significant support needs who aren’t receiving the level of supports that they actually require and need. We knew that the existing Support Services funding was not adequate for many people. I think the K is an incredible opportunity for Oregon to bring more resources into the state. The challenge is in the implementation.

Larry: Do you think the state expects us to deliver services differently now as a result of the K Plan’s implementation?

Kathryn: Well, additional resources are wonderful but we need to remain focused on the goals, the vision that people with disabilities, with appropriate supports, can create a full life, rich in friends and meaningful community connections, employment and significant relationships.  It is what we want for all our children. There’s no reason we have to lose those values, though I believe they are significantly endangered. The K has forced change in what I believe are the fundamentals: self-determination, choice and control. We have moved to a system that is deficits-based. That being said, I think there are ways- could have been ways – that didn’t undermine these cardinal values. Brokerages are committed to keeping the conversation about these values alive. It hasn’t been popular because it isn’t easy. I think we all recognize that any kind of system change is difficult and that the implementation process is the hardest part. That being said I am struck by the lack of planning that has ignored the hydraulics of a lifespan service system, the failure to listen to the lessons learned in the past, and the failure to listen to operational wisdom of stakeholders. The result has caused long-held priorities to be turned inside out. We will continue to  push for involvement in these conversations, before decisions are made.  It is important to have our core values drive decision-making instead of being after-thoughts that are an inconvenience to the process.

Larry: You mentioned a deficits-based approach. This brings to mind the Functional Needs Assessment or Adult Needs Assessment, which is a tool we now use when people enter brokerage services. The tool measures a person’s support needs and determines what services they’re eligible for. When you think about having a needs assessment completed – well, that’s something many states require. This isn’t a new idea, it’s not out of left field. But what you’re saying is that it’s not the tool that is the concern, it’s the approach.

Kathryn: It’s the implementation that’s the problem. Most states have some kind of assessment like this – a functional needs assessment. I think the key is in how the process gets framed. I recently went through an assessment with my son. I think the person who did it is wonderful and I understand that time is short. But I would have liked to hear “What would he like to be doing? What would he like his life looking like?” It would help focus on the idea that these supports are being offered for a purpose. There is great power in starting an assessment by talking to someone about who they are and what they hope to be. It’s not just powerful for people with disabilities. It informs the way we all think and behave.

Larry: I think brokerages are focusing on goal development first and finding a way to fit the needs assessment in as naturally as possible. It’s a shift and we’re still learning how to make all the pieces fit. One of the bigger concerns right now is that the tool being used is temporary, just a placeholder. This is an untested experience and, as it stands right now, Oregon plans to change the assessment tool we’re currently using and replace it with a different tool by January of next year.

Kathryn: What we must not lose sight of is that this may be just a pilot project in some people’s eyes, but for the people going through this assessment having their support plans radically changed, there is nothing “pilot” about it. This is about their lives. It’s about getting the resources they need and are being told they’re entitled to under the new funding model. I think it’s a really important message that people making these decisions need to understand. This is not a pilot. These are people’s lives. Clearly, the introduction of any new assessment tool and process must be thoroughly planned and implemented in a way that does not disrupt the lives of customers and families or cause chaos in the system. January 2015 is too soon. The dust will have not settled from this last effort.

Stay tuned for Part 2 of our talk with Kathryn. She discusses the brokerage response to the K plan, the concern over monthly versus annual budgeting for customer plans, and thoughts on appropriate long-term strategies to assure a sustainable future for services for Oregonians with intellectual and developmental disabilities.