Services
Sub-Group Members: Alice Conway, Deb Parker Wolfenden, Margaret Forbes, Chandra Murphy, Dixie Leavitt, Helen Bailey. This sub-group was facilitated by Donna Lerman, and staffed by Eileen Griffin.

Transition Services. The sub-group discussed the draft objective and the tasks associated with it. To make their case that the State needs to do better at budgeting for kids transitioning to adult services, the sub-group suggested the following data:

• the number of kids of transition age in restrictive settings;
• the number of kids of transition age in residential care settings, etc.;
• the number of kids on waiting lists across departments (personal care attendants, day habilitation, waiver, etc.);
• the number of kids covered under Katie Beckett;
• the number of kids in special education with a transition plan;
• 504 kids;

Direct funding. The sub-group agreed to change "voucher" to "certificate" since "voucher" conveys negative meaning to some people. The sub-group identified the following ideas for making their case that restricted funding is a problem:

• are hospital readmission rates related to restricted funding?
• the number of individuals who bump from setting to setting or service to services based on how their needs are classified, rather then letting the person make choices about how to spend the money. (Need gradations in services tied to classifications.) If you give money to the individual, less of a revolving door.
• promoting self-determination (explore social role valorization/Wolfenberg);
• consumer driven model (TWWIIA);

For tasks under this objective the sub-group identified the following:

• need to determine eligibility criteria and process, and number of people likely to be affected.
• research models from other states (i.e., Minnesota)
• need to allow people to determine their own needs, while incorporating some kind of "surrogate" decision makers when people are not in a position to determine their needs.
• need to examine role of support person in interacting with a provider.
• need to explore ways to make people feel empowered to make choices with their money ("It’s not my money. It’s the State’s")

Advocacy, self-advocacy, self-monitoring. For the third objective, the sub-group proposed the following language and ideas:

• To develop a plan to ensure that a person with a disability has the ability to advocate for self and have access to support services, to assist in advocacy when appropriate.
• People participate more actively in quality assurance to determine the need for advocacy.
• Speak up for quality services;
• Speak up at work.
• Making advocacy organizations and advocacy more user friendly,

The sub-group discussed the "medical model" saying that many providers tell people what they need. People are afraid of speaking for their needs; afraid of losing services. But people know better for themselves what they need. Can they get their needs met better if they speak up?

For tasks, the sub-group identified the following:

• design advocacy models that make it possible for people to participate who don’t usually have the opportunity, the means, the time to do so.
• develop "user friendly" guide to educate people about their rights.
• develop way to identify resources need to assist in advocacy regimen (transportation, day care)

Workforce
Sub-Group members: Lora Perry and Cynthia Sudheimer. Stuart Bratesman staffed this sub-group.

The sub-group agreed to limit its focus to workforce needs for direct care staff.

The following ideas were discussed:

• Workforce needs are not merely a question of numbers, but also quality of staff, training, and preparation. Current wage levels and training opportunities often attract persons who are poorly educated, poorly motivated, and who come to regard motel room-cleaning or fast food work as a move up to a better occupation.
• The basic concept of a direct care job to serve consumers with challenging needs should be fundamentally re-invented to make pay, educational requirements, and skill-level comparable to a grade school teacher or social worker.
• While "personal care and home health aides" is the seventh fastest growing occupation in the U.S., the biggest challenge is turnover and retention. For every person hired each year to fill a newly created direct-care job, eight more are hired to replace people who quit. The sub-group asked staff to research turnover rates in other occupations to set a reasonable target goal for direct-care staff turnover.
• The sub-group wants to learn what university-level direct-care related training and educational opportunities are currently offered in Maine and to gauge interest in expanding or creating new programs.
• The sub-group want to explore whether George Soros or Ted Turner would be willing to underwrite a ten-figure donation to establish a permanent endowment fund to subsidize direct care wages in Maine.

Coordination
Sub-Group members: Chris Zukas-Lessard, Stephanie Crystal, Christine Bartlett, John Baillargeon, Susan Wygal, Nat Hussey.

Single entry point. This sub-group discussed the following:

• a simple form (as cover/computer intake) taking in name, address, date of birth, and with the ability to complete the application process for other services and identify other service needs (computerized online application, identification of needs, eligibility for services, etc.)
• Children’s Cabinet pilot; integrated case management (Christine Bartlett to find out more)
• Service eligibility criteria; service description for all state programs
• Structure for staff; training, communication, etc. across agencies and within agencies so all working with the same information;
• staged implementation, work out to private agencies.

Funding. How does the money follow the consumer? What does that mean?

• transition to another service system?
• vouchers?
• pooled funding for "wrap around" services?
• assignment of funds for consumer to use for services?

Balance accountability and flexibility for the individual.

Service matrix/inventory. The discussion about the service matrix and the inventory of services led to the following comments:

• The matrix is too general. Breakdown to actual service level; computerized cascade of screens breaking down by elderly/adults/children, then by service category (a particular service might appear in multiple categories) and then break out each individual service, service providers.
• State agency websites should have inventory of services that can be linked in a consistent format; connect with group of state agency webmasters.
• BCFS licensing: interactive website; service providers, who they are, what they are, vacancies.
• BDS and the Hospital Association have "bulletin boards" to facilitate crisis work. Accessed through crisis services.
• Need to collect data on the number of people receiving services (and on waiting lists?); helpful for grant applications. For BDS: community support (adults and children), the waiver, ICF-MR; for DHS: waivers, nursing facilities, psychiatric facilities, private duty nurse/personal care services, consumer-directed personal care services, home based care.

5. Housing, Transportation and Employment
It was agreed that Barbara Donavan would be invited to attend the next Work Group meeting.

6. Real Choices Grant Application
The sub-group working on the Real Choices Systems Change grant application met on April 24 to develop and expand on the ideas identified by the Work Group at the last meeting. The next step will be to review a more detailed description of the ideas to determine how to prioritize.

7. Other Business
It was suggested that "Announcements" be added to the end of each meeting agenda.

8. Next Meeting
Agenda items for the May 23 meeting include: sub-group activities, timeline for developing and drafting the plan; housing transportation & employment. The May meeting is scheduled for Wednesday, May 23rd from 1:00-to-4:00pm at the Cohen Center. Helen Bailey is the chair of this meeting.