COUNCIL OF THE SOUTHERN MOUNTAINS
Title XIX Waiver Program
Jeanna Cook, Director of Clinical Services
304-862-3144, extension 238
Jeanna Cook, Licensed Social Worker
Director of Clinical Services
The Council of the Southern Mountains has obtained approval to serve the needs of developmentally disabled consumers through a locally operated human service agency. The needs of consumers with developmental disabilities must now be met in the most cost effective manner by local providers familiar with the intrinsic needs of area residents. Community based services must be enhanced to serve eligible individuals and their families and avoid the inefficient expenditure of resources on expensive facilities and overhead. Community based services will be implemented by the Council that places consumers first in decision making and futures planning for self-realization of life goals. This proposal meets the State Health/Mental Health Plan.
The Council of the Southern Mountains is a community action agency established in 1964 to help low-income individuals and families achieve economic, social and psychological self-sufficiency. The Council is a 501 c (3) nonprofit corporation governed by a volunteer Board of Directors. The agency serves people in the southern part of West Virginia with emphasis on McDowell County, an economically distressed area experiencing high unemployment and social disparities.
The proposed catchment area is located in the coalfields of southern West Virginia. The economic conditions of the 1980s resulted in the loss of jobs in the primary employment area of coal mining. Due to the economic downturn, families suffered as poverty levels increased dramatically. Since 1980, 60 percent of the population has left the County, leaving approximately 25,000 people. Mercer County has a population of 60,000 with Wyoming in the 26,000 range.
Purpose
The Council of the Southern Mountains, referred to subsequently as CSM, must provide leadership in seeking increased levels of service for individuals with behavioral health needs. These individuals need skills and training that would lead to full participation within their communities through development of their abilities. Individuals with developmental disabilities require specialized interventions to be utilized for treatment, training, social interaction, meaningful employment and pursuit of their own life goals.
This CSM application focuses on creating an alternative for community based services to provide eligible consumers educational and occupational skills development interventions. The process will assist targeted individuals in obtaining vocational training, job readiness skills and social competencies that will facilitate employment.
Statement of Need
According to Mission of Faith statistics about McDowell County, found at www.missionoffaith.com/mcdowell_county.htm, the following challenges exist in the County:
• McDowell is the sixth poorest area in America
• It has the fifth highest child poverty rate
• It has the sixth worst health status in America
• Unemployment persistently doubles the state rate and more than triples the national rate
• The median family income is half the national average
• It has one of the lowest levels of educational achievement in the nation
• It has the highest illiteracy rates among adults in West Virginia
• Of its high school graduates, only 44 percent attend college
• At 3.4 percent, it has one of the lowest levels of college graduates in the workforce in the nation
• Most of the land and natural resources, 85 percent, are owned by absentee landowners
According to the U.S. Bureau of Labor Statistics, McDowell County had a recent 11.2 percent unemployment rate. This figure is twice the state rate and does not account for the hundreds of individuals that have given up and no longer seek employment because they lack the necessary skills, both vocationally and socially, to achieve and maintain a job, especially individuals with a behavioral health diagnosis of mental retardation.
According to the State of West Virginia BEP labor force statistics for 2003, the annual average unemployment rate for McDowell County was 13.1 percent with 910 individuals identified from a total labor force of 6, 930. Also, in regard to underemployment, as previously defined, U.S. Census Bureau statistics reveal that the per capita income of County residents, based on latest figures of 1999, was $10,174 as compared to the State average of $16,477. Median household income, again using the same source, was $16,931 as compared to $29,696 for the entire State.
Further, the average age of County residents is 40.5 years, one of the oldest in the State, which also contributes to the need for services providers for behavioral health interventions. This fact is important due to the levels of interventions needed in this age group and identifies the lack of skills in modern technology and long term job losses with resultant functional deficits of the local population. Additionally, persons living in the County below poverty levels is 37.7 percent, compared to 17.9 percent for the State, indicating further that underemployment along with unemployment is dramatic in the area. These are also statistics from the U.S. Census Bureau.
Another factor contributing to high unemployment and verifying the need for this application is the number of people in the County with a diagnosed disability, age 5 and over. U.S. Census Bureau reports this number to be 10,180 individuals. With the 2000 population being 26,568 this amounts to 38 percent of the County residents. Utilizing 2003 population estimates, the percentage exceeds 40 percent. Nationally, unemployment rates for people with disabilities approaches 85 percent and higher.
These figures dramatically support the need for innovative interventions to overcome the cycle of despair in McDowell County. Proposals such as this by CSM for locally operated program options should be approved to provide help to those in need; help to those with limited hope; help to those that seek solutions to their respective life situations.
Project Goals and Objectives
Goal 1: CSM will design and implement a comprehensive, fully integrated system that appropriately balances the roles, responsibilities and accountability of all service providers, consumers and their chosen
representatives, and fosters true “local partnering and ownership” for community based interventions.
Objective 1: Within 90 days of approval, staff will initiate coordination and implementation of the behavioral health services.
Objective 2: Within 90 days of approval, a Behavioral Health Advisory Council will be established composed of no less than 6 members with a disability or a family member of a person with a disability. An effective treatment environment will be established as documented by written protocol. This Committee will report to the Executive Director and in turn to the Board of Directors to ensure inclusive, consumer/family driven services are consistently provided. Treatment will be designed to promote and/or retain integration of individuals in the community.
Outcomes: Individuals presenting with targeted needs will be served within the community. Approved services and settings will promote independence and maximum functioning of individual receiving services. By-laws will be developed and subsequently approved by the Advisory Council. Staff will complete all documentation on a timely basis as required by the funding source and internally.
Goal 2: CSM will provide local collaborations, public and private, at all levels and among all stakeholders that builds system capacity, optimizes resources and sustains measurable high performance throughout the system.
Objective: CSM staff will establish community based alternatives to address the needs of target individuals within this area.
Outcome: CSM will fulfill the precepts of this application to serve people
with identified needs in a coordinated cost effective manner through an integrated continuum of care. This continuum will compliment and not duplicate services to accomplish economical interventions.
Goal 3: CSM will focus on community based and outpatient services and not restrictive, expensive inpatient or residential services. Provide community education and awareness of the plight of this proposal’s target population and how community based interventions can overcome their obstacles to effective interventions. To assure every consumer, family member (if appropriate) and stakeholder are aware of and have universal access and choice to the full continuum of available programs and services. Accessibility of services should accommodate integration into the community and limit disruption of normal daily living activities.
Objective 1: Upon approval of this application, project staff will develop presentations for civic groups, provider agencies, potential consumers and their families, potential employers and local media on the concepts
Council of the Southern Mountains
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of community based behavioral health interventions and treatment modalities.
Objective 2: Within 3 months of funding, project staff will have awareness articles
published in local print media; appear on radio and television community awareness programs presenting the concepts of community based treatment interventions and give at presentations to designated groups and/or agencies through a speakers bureau format.
Outcomes: Increased public awareness of the efficacy of community based behavioral health interventions and referrals to the services being identified as originating from these awareness presentations. This information will be obtained at the consumers’ intakes.
Goal 4: CSM will advance an individual/family driven community based system-wide waiver consumer focused, quality service that is continuously improved.
Objective: Upon initiation of services for targeted individuals, a Personal Futures Profile will be developed that includes:
1. intensive case management services
2. their personal career choices and desires
3. timelines for referrals to other agencies, trainings, job
readiness skill acquisition activities and job placement
4. Individual Development Accounts-money management,
savings accounts, etc.
5. Transportation plans
6. establish a family and community support system
7. services will be located within 30-40 minutes of the individuals served, with all sites accessible for people with disabilities.
Outcome: Consumers will also be given access to participation in IPP planning and implementation, informed consent to treatment information, and access to an advocate as recognition of their individual rights.
Goal 5: The CSM behavioral health program will provide an array of
approved services that will meet the needs of individuals based on their stated needs and life goals.
Objective: The CSM will serve individuals with documented MR/DD
disabilities by:
1. Linking to agencies for career development services,
including CSM.
2. Completing all referral information and personal
life plans as stated by consumers and family members (if appropriate).
3. Providing all intervention methods and treatment modalities as outlined in this application
within the community at accessible sites and locations,
when necessary.
4. Ensuring access to services that fulfill life goals for
individuals with verifiable disabilities with the best
treatment modality being recognized as employment or
meaningful training for subsequent employment based
on age appropriate interventions. Therefore, all eligible
individuals will receive job mentoring services and
training with subsequent job placement activities, as
appropriate.
5. Ensuring that referrals, for crisis intervention services is made in timely manner to the local collaborating Mental Health Agency.
Goal 6: To reduce the number of under-served and un-served consumers in
this catchment area.
Objective: Serve 5% of the eligible population in the catchment area. (Based
on the national prevalence rate, approximately 2000 individuals
would be eligible in this catchment area for services.)
Outcome: Serve at least 5% (100) of the underserved or unserved of these consumers within 1 year.
Program Design and Behavioral Health/Fiscal Plan
The CSM behavioral health program will offer a comprehensive scope of medically necessary medical and mental health services to diagnose and treat eligible members. Covered and authorized services will be provided within the scope of the behavioral health license and in compliance with all federal and state mandates. Implementation of this proposal will be initiated through staff educating service providers, families and targeted consumers of the program strategies, methods and activities. The concept of community based, non-Center based services will be communicated to all involved in order to assure an agenda of inclusion for the individuals
identified for this project. Presently, there is only one local agency providing services within this county.
The community based model concept will ensure functional assessments are completed that show individuals’ strengths that can be built upon and match people to services and referrals they are truly motivated to seek, maintain and excel. The staff assists the individuals in remediation functional impairments and developing self actualization skills. In addition, staff, through this model are available to provide on-going follow up services to the consumers, families, other providers and subsequent employers to facilitate overall consumer development.
The CSM community based model concept is one that focuses on people and helps them overcome their personal barriers to achieving self-sufficiency. The staff will, as determined on an individual basis, link consumers to specific trainings, independent living skills, job assessment services through local Work4WV outlets, obtain job readiness skills such as job seeking techniques, application completion, obtaining appropriate dress for job interviews and subsequent employment, employer contacts to provide specific interventions to prevent consumer loss of placements and follow up services to assist with job retention. These follow up services facilitate consumer development, problem resolution and long term life goals enhancement. They will also assist potential employers with on-site job specific training for the new consumer employees through the Job Coach Model. This model provides another advantage of this application by helping alleviate the barriers targeted individuals face, that of providing a helping hand many need to accomplish their life goals. The agency already utilizes services through our Retired Seniors Volunteer Program and this could enhance assistive living training services in a cost effective manner. Our foster grandparents currently serve 239 special needs children within the county.
Barriers to effective services for targeted individuals which this application would address center on the lack of coordination between service providers. Many times the reasons targeted people are not efficiently and effectively served are limited hands-on assistance, lack of facilitation with potential providers, transportation and accessibility in rural areas. This application seeks to become the bridge over these barriers and provide service interventions that overcome these obstacles. Coalition building and communication are key factors this agency will be responsible for in behavioral health service provision. Letters of Understanding will be sought from DHHR, Division of Rehabilitation Services, Works4WV, Southern Highlands CMHC, hospitals and doctors’ offices.
In the statement of need section above, the statistics on disabilities in McDowell County and this area was provided to demonstrate how profound the barriers are for full opportunities for all residents. As a result of the limited understanding of mental health issues and disabilities, an educational approach will be taken by the agency to better inform targeted consumers with disabilities and their families of how services are implemented. Linkages will be made with service providers and others to address the specific needs of people with disabilities in this endeavor. Also, the agency will initiate Individual Personal Futures Plans for targeted consumers. Individuals will have their training and career desires and wishes documented with plans formulated that set agreed upon dates for expected achievement of their personalized plans. These plans will document the timelines for activities of daily living skills, career assessments, training, job readiness skill acquisition and job placement, and home based services through intensive case management. These plans could even provide for volunteer placements to orient individuals to work environments, this would be based on personal choices and resources, to
transition them into the competitive market. Also, as the result of limited facilities to provide intensive crisis services, the approval of this application could help prevent a crisis escalating to the point of inpatient treatment, by providing access to services within reach, not in the next county or state. These strategies will serve to help overcome the barriers to full inclusion.
These Personal Futures Plans would also include plans for consumer transportation to interventions, pre-employment services and subsequent employment for individuals within the Job Coach component of services. In rural settings, transportation stands out as a major barrier for consumers in all aspects of life enhancement. There is limited public transportation in this County and every effort will be made to ensure targeted individuals know how to obtain even this service. Friends, families and co-workers are all potential transportation providers and the program will work out transportation for consumers before services begin to ensure placement success. Individual plans may also be developed with consumers to start training in how to save and even assisting consumers in establishing savings accounts to address their transportation needs and future life choices.
The staff within this proposed service will be responsible for coordinating services and communicating the goals of the program to consumers in the area. The educational process will show the advantages of a community based program with local staff knowledgeable of regional specific needs. The outcomes of providing well trained staff for consumers and families with on-going follow up assistance is the most cost effective means of service implementation. The staff serve as an overall advocate for the consumers and provides “hands on” assistance when needed through facilitation, training and education. In addition, consumers will have access to services within a 30-40 minute radius, through qualified staff be available at the five outreach sites.
The agency proposes to serve McDowell, Mercer and Wyoming Counties initially as this is our core area. The agency presently serves McDowell County, one part of this proposed catchment area, through five Head Start Centers with a family first service provision standard. Family Service Coordinators under a licensed Social Worker develops empowerment and inclusion for consumers’ families. The agency also serves eight southern West Virginia counties through our Foster Grandparent Program and Retired Senior Volunteer Program (RSVP). The agency operates emergency food pantries, job training programs and low-income weatherization services to help people reduce the expenditure of their limited resources on energy. All of these components reflect the human service component of the agency which fosters assistance for people in need through program advisory committees, parent policy councils and consumer involvement in agency service administration. The Behavioral Health component would follow within the agency mission of “Bringing Opportunities Within Reach” for all our citizens. Consumer and family input would be ensured as the development of a Behavioral Health Advisory Council, composed of consumers and family members would be initiated at the very beginning of services.
Administrative Ability
The CSM is a community action agency in existence since 1965. The organization has successfully operated scores of grant awards and human services programs. The agency is governed by a 15 member volunteer Board of Directors who represent a broad cross section of area citizens. The agency presently has an annual budget of $3.1 million and has managed
budgets over $6 million dollars per annum. The agency is audited annually and complies with all governmental and funding source reporting requirements.
Qualified staff will bill approximately $48,000 per year in waiver services. After expenses, a margin of $5,000 will be obtained that will result in program support. All billing requirements will be met as mandated with internal assurances performed to ensure accuracy and appropriateness.
The CSM will self-monitor all funding guideline compliance measures and adhere with all annual audit results to ensure acceptable fiscal and managerial procedures are completed. All CSM Internal Auditing Procedures will be executed. Additionally, the E.D. shall, on a monthly basis conduct a review and appraisal of overall programmatic operations to ensure progress is being made toward the achievement of stated goals and outcomes. Program participants shall complete an evaluation tool or satisfaction survey instrument to ascertain program effectiveness.
Program Evaluation
Weekly staff meetings will be conducted with supervisory staff with minutes maintained documenting issues discussed with action plans developed. Project staff will compile all reports into quarterly evaluations with an annual report the final product. This report will evaluate in depth all project goals, objectives and funding source requirements.
Monthly case management reports on each consumer showing progress toward goals and objectives of their Personal Futures Plans.
Finally, a crucial component of the evaluation process is the consumer and other stakeholders’ evaluation and input into program processes and updates. Satisfaction surveys will be completed by all stakeholders, monthly for consumers and quarterly by all others. A report will be generated by staff for each segment with analysis of project results and recommendations to ameliorate identified problems. Satisfaction survey results will be included in the final annual report.
Conclusion
The CSM is seeking a license to serve individuals with disabilities that will bring “opportunities within their reach.” A community based model is proposed to serve individuals and their families in their natural environments, i.e., living, working and social locations of their choice. The CSM respectfully requests approval of this application in order to provide choices for consumers and their care providers (if appropriate) through a human services agency with an established system of intervention and knowledge of our regional needs. This is the mission of our agency and this proposal will help our fellow citizens achieve the dignity of meaningful life experiences through self actualization and equal opportunities.