PAULA MCELWEE:  Remember I use 
"guys" generically, I am from

the Midwest but when I go to 
the south they are offended.

Well, there are a few 
people in the south who

have been offended when I say 
that, so I have to explain my

culture, so if we all 
can come back together.

What I found in that last 
session that Maureen did

was aren't all of the pieces 
starting to come together?

Didn't you feel like, 
oh yeah, now this is what 
the whole thing looks like.

We have been looking 
at different pieces.

Here is the whole.

We have a couple of different 
things we want to do in this

session that are not on your 
agenda that will replace what

is on your agenda 
for the next hour.

And what we want to do first 
is you can ask Maureen any

questions that you have and we 
can follow up on those and go

into depth a little bit more on 
the things she presented that

show you that statewide system, 
the statewide collaboration.

Exciting, wasn't it?

For those who don't already 
have a statewide collaboration.

Yay.

Let's look at what it takes to make 
quality happen as a way of life

among the CILs in your 
area and I bet she has 
some answers for you.

So let's do a little 
question and answer first.

Think about your questions.

If you wrote them down on 
a pad of paper and we didn't 
pick them up.

Sorry.

We got busy with figuring out 
how we would do this so we will

pick them up for later but feel 
free to ask questions you 
didn't get a chance to ask.

We have one right back here.

AUDIENCE MEMBER: Ideas for 
bringing it down for a center?

I think we would have a 
difficult time brining it

across the state 
where I am at.

MAUREEN RYAN:  And actually 
I think this session can be for 
both of us, too.

It will take two of us.

So, yes, I do realize that 
there are states where possibly

there is only one or two 
centers, and so building the

statewide coalition may be 
hard because there is two.

I don't know, 
two can work, too.

Sometimes two can be 
easier than California that has 
38 or something like that?

Not quite that many.

It is hard for me to go there 
because I really find so much

value in the state that I 
almost rather focus on why

you can't work from the 
state but I will try to answer 
your question, Randy.

You know, trying to be as good 
as you can be inside your own

center, for the internal 
network that we talked about,

and then every center still has 
their own external network that

we talked about with other 
players in your community and

whether you like them or not, 
they are a part of your

community and you 
need to get along.

You need to do the same thing 
that we talked about doing

statewide with your, just 
within your center if you 
can't go statewide.

You will just have to make 
those decisions within your

own group and, you know, 
looking at it probably with

some initial discussion with 
management first to see if you

have management buy in, and 
then talking with if you

have a management team, 
you have been writing a scope 
each time and the board and

bringing everybody in 
to the whole scoop.

Hopefully your strategic 
plan is around this.

Every center should have 
a three-year plan or an

annual plan and a longer plan 
or however you want to make 
that, be part of that.

I don't know how this 
wouldn't be part of that.

To me you have a strategic plan 
and off your strategic plan is

an annual plan which would 
include a fiscal plan,

which would include your 
resource development.

You would have your 
programmatic plan,

you would have 
your advocacy plan.

All of those components could 
be individually looked at for

quality denominators and 
quality definitions if you

want to think about trying 
to break it out that way.

You can still look at it as 
an infrastructure government

management, quality management 
kind of define quality and then

also look at it from a 
programmatic service way if you 
want to define it that way.

However you want to break it 
down inside your center and

define quality and then bring 
people into the loop and then

make them think about the 
external players they have

to work with and 
do the same thing.

PAULA MCELWEE: Some of the 
very same areas can be measured

at the individual level 
because that's what 
happened here, right.

As a state they decided 
what the measures were

but each center had to 
measure their own before

they could collaborate 
and put it together.

So each state measured
the things that caused their

center to be a great 
investment in their state.

You can do that same thing.

You can look at the same 
components that cause you

to be able to say, 
we are making a difference 
in the community.

We are making a difference in 
individual lives and we are a

great investment for our state, 
whatever you pick, but those

being great examples from what 
Maureen presented this morning.

Other questions or comments?

MAUREEN RYAN:  Did that work, 
Randy?

Back here.

AUDIENCE MEMBER: Yes, 
Erin from Minnesota.

You talked a little bit about 
doing, getting feedback from

consumers in surveys from 
different periods and I think

it was mentioned two 
legs at time of intake.

Did the whole network in
Wisconsin agree these

are the barriers listed 
that we are going to

be asking people that 
they are facing?

MAUREEN RYAN:  Yes.

AUDIENCE MEMBER: And 
they are all going to be 
using the same format?

RYAN:  Correct.

And we review the format 
every year to see if 
there are any tweaks.

We started it about 
five years ago.

It has probably been through, 
like three revisions.

Some of the areas have
been pretty similar.

When we say things like 
"housing," it's a pretty

broad topic, so one of the 
issues we had when we got that

back was, well, what about 
housing, so we had a little

difficulty trying to find how
broad the category would be

versus how narrow and we could 
focus in on the issue,

and so that was, that's 
a struggle that we still

work on because other, 
if we really broke

everything down, there would 
be a million things on the

checklist and it would be 
unmanageable so we try to

break it into categories but 
then it can't get so broad

that, transportation, well, 
what about transportation.

That's too broad.

So we try to do something in 
the middle and that's where

we do our tweaks and revisions 
as we learn but everybody uses 
the same form statewide.

AUDIENCE MEMBER: So 
just to follow that, 
I know you mentioned at

the time of intake and 
continuing it throughout

the year and not doing 
it once a year.

Is there a certain format 
that everybody is agreeing 
they are following?

They are doing it a certain 
point or every so often or when

people are accomplishing 
goals or doing new plans,

AUDIENCE MEMBER: I would 
like to answer that.

I want to differentiate 
this survey from our
general service survey.

This is a statewide advocacy 
needs survey versus our

service survey, and so the 
one we do for advocacy 
that Maureen is talking about,

that is the one format we 
use statewide and it is

online with survey monkey 
and the paper format is

actually the same questions

and each center  has a 
staff person enters that

information into survey monkey 
at a different link and then for our

services, that varies center 
to center on how we do the 
service satisfaction survey, so.

AUDIENCE MEMBER: So advocacy 
needs survey is done once with each

person done at the time of 
intake, usually?

AUDIENCE MEMBER: Yes, it's 
optional but we encourage 
that need and we do it at

time of intake because sometimes as 
everybody knows, people die,

leave, whatever and so 
we don't always capture it.

They have moved on, things like that, 
so when we go through about the agencies

and IL and those things, we can 
talk about advocacy needs and explain

that there and then when we do 
like a booth or fair or expo, we will

sometimes have a survey out or 
link out or something like that 
to capture that information.

PAULA MCELWEE: Think about how 
much that conversation can

inform the process of working 
with that individual on what

their real needs are, 
not just on the reason they 
came in your door, right.

You can see those 
bigger pictures.

MAUREEN RYAN: It's also 
really led to our grassroots 
that we are trying to develop.

We are always working on 
building our grassroots

network, so when we find people 
who are addressing barriers, 
instead of just identifying

their barrier, are you 
interested in working on that?

Come join our 
grassroots network.

That's a door that opens to be 
able to talk about that.

We have to have a 
grassroots network.

AUDIENCE MEMBER: I am 
John with ARCIL  Austin.

One of the first things with 
your coalition, the state 
coalition, you hashed out

how you report and count 
various services.

Texas has failed at that.

We have drastically different 
numbers coming from different

centers to the point where if 
you look at a list that the

state V.R. agency compiles, 
you get no sense of 
credibility at all.

You can't have one center 
doing more I&R than all 
of the others put together.

It just isn't happening, 
so but the state is not

forcing people to follow any 
real guidelines on how you

count consumers or services 
and neither is RSA and we are

floundering on that and we have 
no credibility to explain.

We can make the same claim.

You know, we are a great 
investment, we save money 
and they say how much?

And we say Doh.

PAULA MCELWEE:  Exactly.

MAUREEN RYAN: If you 
don't have good 
data to back that up.

And we got called on it.

Absolutely.

Before we had good data, 
we got called on,

we were saying, 
something about our employment 
services, and we had community

rehab programs saying, 
no way you are doing that 
much in employment.

So we had to be able to back 
that up and I think one of your

points, I don't know who draws 
up the geographic maps or what

states have for the coverage, 
but a lot of times it doesn't

make any sense and you may have 
a state that has half the state

and then four other centers 
that have the rest.

And you will have sometimes 
that imbalance with a center

that has a really large portion 
of the state with geography and

money and they are probably 
in a balance there but you can

explain that, then, 
because of that.

But if you're all somewhat 
equal, there shouldn't be

outliers like that because then 
it skews all of them down.

AUDIENCE MEMBER: It does.

We not only got caught on it, 
we lost money on it because

the legislature was pretty much 
ready to fund new centers and

bring us, others of us, up 
to a normal funding level.

Then they started questioning, 
what are they actually reporting,

how does this match, 
how does this make any sense,

what's the return on 
the investment.

We really can't answer that well.

MAUREEN RYAN:  So you 
have a state association in Texas?

Do you get together and talk 
about taking that on yourselves?

AUDIENCE MEMBER: They've 
been talking about it 
since day one.

Peggy can talk about that

MAUREEN RYAN:  I don't mean 
to put anybody on the spot.

AUDIENCE MEMBER: Yes.

That's been a topic 
of discussion.

If you imagine two cats, 
you put them in a cardboard

box and set their tails on 
fire, that kind of discussion.

No!

[Laughter].

Not Peggy.

PAULA MCELWEE:  There's a 
microphone back there, for you.

AUDIENCE MEMBER: No, it's not true.

I think you said it very well, 
and I was very happy to 
hear that you were

saying about the center 
directors, we center directors

are very passionate, 
and we're very strong.

And that's why we're directors.

So when you put us all 
together, we all have 
our opinions.

So, yes, it may appear that 
we're scratching eyes out,

but we're also going to the 
bar and enjoying ourselves.

With one another.
Whatever.

But anyway, I think through 
that discussion, there is

a bond, and I really feel that, 
as a director, that peer

support that we get when we 
meet, we discuss and we cuss,

but there's nobody else that 
we can go to to understand, 
they get it.

We may not agree, 
but we get it.

So that, in itself... so, 
I beg to correct you, 
John, but it's not that bad.

The other thing, though, 
is that we do find that this is 
something that's needed.

MAUREEN RYAN:  You do what?

AUDIENCE MEMBER: We do 
feel having that 
consistency to be able to.

It is a very hard thing to 
wrap our arms around.

Because we do collect data.

It's not collecting data that's 
the problem, we all collect 
data, it's how we count that.

And that is where we have 
challenges, because every

center is community based, 
and it is challenging.

PAULA MCELWEE:  You know 
if you could even come up 
with one thing, start there.

You don't have to start 
with a complete roll-out.

I think Maureen described very 
well, that it wasn't always smooth

sailing in the beginning, they 
had to meet and meet and meet.

Come up with the one thing
that you most want to say 
to the rest of the public

and how can you collect your 
information to say that.

It's so powerful, then you'll 
want to collaborate on others.

AUDIENCE MEMBER: I think 
we've gotten to that point.

We have come, we've had a lot 
of discussion on how to do 
this, but we have come and

said, wait, if we don't do 
this, someone else will do 
this for us, so we have said

let's start with how 
we count our I&R's.

That's a big step for us.

We're going to start 
with looking at that.

Our SILC has been challenged, 
tasked with our vocational

rehab to collect, but there 
lies, you know, we have

two, that's their charge, 
so how our vocational rehab

looks at data is different than 
what a center looks at data.

So that will be an interesting 
process, too, seeing what the

outcome of that looks like 
and how we, as centers, can 
incorporate that or tweak it.

So it's a process.

MAUREEN RYAN:  Okay.

A couple things on that.

I would really suggest that 
part of your statewide 
coalitions, for those of you

that are working on statewide 
associations and you've heard 
of that, which I strongly

suggest if you can, please 
bring in your assistant

directors or your 
program folks.

That really helped, 
let's say, adjust the 
ego level in our room.

[Laughter].

And also focus more on that 
kind of dialogue about let's 
bring it into the consumer,

you know, walk Joe in 
the door of a center for 
independent living.

What happens with Joe
all the way through.

Take it to that level and take, 
take the discussion off

yourselves and 
onto the consumer.

And before you start 
counting data,

make sure your definitions 
are in sync because,

otherwise, you're going 
to have to back up.

And, you know, start there.

Because what someone is calling 
an I&R might not be what

someone else is, so don't 
bother to even getting to the

subject of how to count 
them until you are in 
sync with what it is.

But I really like the idea 
about starting with one thing.

That's a great idea.

PAULA MCELWEE:  You've 
got to start somewhere.

One other thought just,
we need to remind ourselves

frequently, we're used to being 
advocates, we're used to being

testy wherever we have to be 
testy, and we forget that we 
are not the enemy.

We have to find ways, right, to 
bring that emotion and channel

it in the right direction 
because we're probably pretty

good at it, and we don't want 
to be destroying the potential

power of this group of 
people by our fighting 
among ourselves.

So I've seen a lot of places, 
in California it's real popular

thing to have a list of 
rules to meet by, and to go

through them together at the 
beginning of the meeting,

to remind you to respect each 
other and listen to each other.

So I saw a hand 
back here somewhere.

No?
I imagined it.

Maybe back here?

Questions or comments?

Anybody else?

MAUREEN RYAN:  I wanted 
to bring up another thing.

I'm sorry.
I have a little tickle.

One of the things I think 
that's really important to

look at when you're talking 
about quality is to not work

in silos within your center, and if 
you've got some staff working,

for example, on a special 
project, something other than

core services, transportation 
services someone mentioned, and

they come in that door to the 
center, Joe comes into the

door, let's always try to 
think about that because Joe 
can come in many doors.

If he comes in through 
the transportation door,

does someone actually offer him 
the opportunity to talk about 
what else the center offers?

I mean, that doesn't have 
to be shoved down his throat,

that doesn't have to take up a 
lot of his immediate time,

he walks in the door we're 
not talking pounce on Joe,

but I think we're doing our 
fellow brothers and sisters

with disabilities a disservice 
if we don't at least bring that

up and continually bring that 
up in a very respectful way 
throughout that process.

But we want to make sure if 
you're getting the experience 
with transportation,

that that's not all you get, 
and that staff internally are 
doing intrareferrals as well

and that you're all on the 
same page with this whole 
consistency and this level

of quality, because we see 
that operating, core servers 
sometimes work together well,

sometimes they call those 
direct service staff and

they may be unified and they 
may have their own staff

meetings and their own 
sets of definitions and

how to collect data, but then 
you have this other staff in centers

who are doing things like work 
incentives or transportation

and employment, and they're 
not even connected with each other

inside IL, inside one center, 
so just connect, connect, 
connect, connect.

That's really important 
to think about.

And what also goes along with 
that is, sometimes centers,

particularly it seems to 
be in a large city, may have,

for example, an office of 
deaf and hard of hearing

down the road, and someone 
comes in the center, Joe comes 
in the center, and Joe is deaf.

And they don't have anybody 
that's at that front desk that

knows how to deal with that, 
we call them the ambassador 
of first impression.

First experience with IL, 
walk in the door, the counter

is too high for somebody in a 
chair, you don't have anybody

that signs, and you are trying 
to go back and forth.

That first impression is really 
important and it might be

easier for centers to just say, 
oh, center for, office of deaf

and hard of hearing 
is down the road.

Again, that robs a person of 
what they might be able to

experience in an independent 
living center, which is

different, different than 
what's going to happen down

the office of deaf 
and hard of hearing.

Doesn't mean they might not 
need both, but don't think

there's anything 
that replaces that.

So please try to watch how 
appropriate your referrals are 
outside of your center, too.

That's really important.

AUDIENCE MEMBER: Staying 
on the showing value 
and the return on investment

question, 704 report 
used to have,

MAUREEN RYAN:  That's 
just RSA coming in.

Watch what you say.

AUDIENCE MEMBER: RSA is 
a bunch of really nice people.

And they do wonderful work.

They really should not be 
killing me or anything.

Okay, is this too close or,

PAULA MCELWEE: He 
is working with you.
A little closer.

AUDIENCE MEMBER: Okay.

We still have a number of 
people transitioned out of 
institutions.

We can make a credible argument 
that it saves the state money and it

used to have number of people 
prevented from going into institutions.

It no longer does that.

The state, our state in the 
budget, explanations and so

forth, they still 
make that claim.

They don't define 
what that means.

Nobody defines what that means.

There is no standard for what 
you are actually noting that

someone is at risk and what it 
takes to claim that you have

prevented someone from 
going into an institution.

So does anybody have any good 
guidelines about how that can 
be monitored or accounted?

PAULA MCELWEE:  One piece 
of that is if they are 
eligible for HCBS,

someone has determined that
they otherwise would be served

by an institution, so if the 
funding is HCBS, it means it is

a waiver to institutional care.

So it is an easy number to come

up with, right, anybody 
that has the HCBS service,

because they have been, 
they have been judged to 
be eligible for HCBS.

AUDIENCE MEMBER: Yes, 
the federal stuff that 
I found, it says if you have

a need for ongoing services 
like that, and you have at 
least three IADL needs,

I think is the terminology they 
use, but that is not an easy thing

to verify at an intake, 
of course a lot of people go,

it would be nice if we have 
a lot of people that were 
receiving waiver services.

We have as many people 
on waiver services that,

on waiting lists for waiting 
lists for waiver services 
and it hasn't been

determined so it would take 
a pretty significant evaluation 
to accurately determine that.

MAUREEN RYAN:  We 
used to use the 
meeting nursing home

level of care and we
would know that but the

prevention piece was 
really difficult.

Let me back up to getting 
people out of nursing homes

and trying to demonstrate how 
much money that shows.

Center usually have a role in that 
but we also got called on the carpet

that you aren't the only ones 
who helped getting people out

of nursing homes so you can't 
claim dollar for dollar in 
savings per person.

That's how challenging 
it can get.

So we used, we went with the 
national study and we apply how

much it saved by the person 
that we were helping relocate

into the community and that 
we provided assistance for 
that transition.

We aren't going to start 
breaking down for this person,

we provided 68% of the 
transition, while this 
person was 10%.

But we also are not saying 
dollar for dollar we saved 
you this much.

We are part of the process that 
helped to transition this person,

this many people equals 
this much savings.

PAULA MCELWEE:  We have 
a question back up here.

AUDIENCE MEMBER:  In
North Dakota we talked about

definition and what we 
came up with is that

institutionalization 
has to be imminent,

some entity has to be 
planning the placement,

whether it's a doctor, nurse, 
family, but it is being planned,

and that's the only ones, only
individuals that we count.

We don't use waivered service 
because almost everyone with

a significant disability 
is on waivered services, ,

and we didn't think 
it a good measure,

especially for centers that 
have a large fee for service

program related 
to waivered services.

MAUREEN RYAN: You are
referring to how you are 
addressing prevention right?

AUDIENCE MEMBER: Yes.

PAULA MCELWEE:  I think 
the important thinking is that

you agree on the definition
and it is defined.

Because if you agree on the

definition and it's defined, 
then you can measure it.

Until you agree on the 
definition and define it,

you will have this potluck 
of whether or not the measures 
are meaningful.

So that's the important thing.

You can look at the process 
here and you can copy things

and ask for copies of 
definitions from other people

but it's really only going 
to be meaningful when you 
do it at home.

MAUREEN RYAN:  So when 
you get questions, 
you can back that up.

PAULA MCELWEE:  You can't pick 
it up from somewhere else.

You defined it and are 
measuring it and you are 
doing it hopefully together.

I think any time you can do it 
together, it's that much more

power for the movement and for 
the people in your state.

Other questions or comments?

MAUREEN RYAN:  I want 
to mention one other quick

thing, a return on investment, 
we talked a little bit about

that for staff and 
staff turnover.

Also comes up a lot of 
times with centers on resource

development and one of the 
things I think someone

mentioned earlier today, 
you can put $11,000 in on

a golf outing or a wheelchair 
washer or whatever you want to 
do and get back $2,000.

And sometimes that may be okay 
with what you did and what you

got out of that was some 
community messaging and good

information about your center 
and if you make that decision

and you want to continue that, 
you can probably do that a few

times but that's 
a lot of inputs.

That's $9,000 you aren't 
getting back, so it isn't 
always meaning that it's wrong.

You don't always have to make 
money on everything you do.

But somewhere along the line, 
you are going to have make some

money so looking at the return 
investment and making a 
conscious decision, we know

going into this we probably 
aren't going to make any money

but we are really communicating 
with the community on this one

so it's worth it this time to 
do this, or maybe a couple of

times but we can't 
keep that up.

So those are some, people 
will throw out that return on

investment or ROI and it can 
mean a lot of things in IL and

apply to a lot of different 
areas so I just wanted

to clarify because we 
talked about one thing

in the ROI and it 
could cross a lot of lines.

PAULA MCELWEE:  Any other 
questions or comments?

Let's look through real quickly 
and see if any of these things 
bring up additional ideas.

So I am looking 
for a specific slide.

In the core services numbers, 
you saw the centers are all 
keeping these numbers.

How many received information 
and referral, how many received

IL skills, peer support, individual
advocacy, community and systems

advocacy, these numbers sound 
familiar because you are also putting

the same numbers right 
on your 704 report.

How many of you have a database 
program of some sort you use 
to accomplish that?

More than half.

If you don't, we do want to 
suggest that you look at some 
way to do that.

We have a link on the wiki page 
of the 8 that we are familiar

with that provide that specific 
service, and you might find 
that useful to know.

We have representative from 
one of them with us today.

So, and she's waving back in 
the back corner, so she may at 
some point want to, you might

want to talk to her about what 
that looks like for your center 
if you don't already have a

database or you can look at the 
other examples, but much of the

information that you get, 
you get from that database.

Now, how does that happen?  
Okay.

I meet somebody at the center, 
and when I meet that person

after that meeting, I enter the 
information into the computer

that, who that person is, 
whether or not they have a plan 
or waived the plan, what their

goals are, and what we are 
going to be working on with

them and then that information 
carries forward until we close

that record when those goals 
are met or we can no longer 
reach the person.

And sometimes that person stays 
with you through a series of

goals, so, remember, the red 
house, the example that Maureen 
gave, they want to move into a

red house but there are things 
they need to do before the red 
house that is five years down the line.

You may have a series 
of goals related to it.

All of these pieces are 
measurable pieces if you 
are doing it right.

You can write a goal that you 
can't measure its done, or it isn't 
complete enough to say when

it's finished, so if the goal 
is housing, is that a goal?

No.

It's a service area, right.

Housing is not in 
itself a goal.

Finding a specific kind of 
housing in a specific

neighborhood in a specific 
price range with or without

roommates, that would form 
the nature of the goal of 
the first task.

Those details around what 
housing would be would be 
the actual goal.

So as you look at these, 
these measures are not related 
to goals set, goals met.

These are numbers of people and 
that's one of the things that 
you measure but then when you

get into the actual goals set, 
goals met, it gets a little 
more complicated.

Anyway, I don't know if anybody 
has any questions about data

collection systems or not, 
but a couple of other pieces 
about that.

Sometimes a new person will 
come into a center and they 
will think if they got bad

information that the answer 
is to just start over with a

different database 
provider and that takes a lot

of work and a lot of 
redoing and you lose

things and I have seen centers 
that change every two years.

Because I've got this one and 
it never does what they want

and so they go to the 
next one and it never does 
what they want.

You may need to get some 
assistance to make sure you

are doing it correctly with the 
one you've got, either from the

manufacturer, from technical 
assistance, from another 
person who uses it.

Go back and reread the 
documentation that you've 
got with the program.

Whatever you need to do, 
but make sure that you are 
using it well, because they

are not cheap systems and 
if you have this history of

changing because you don't get 
good data, I would back up and

ask myself, what are we doing 
wrong, because most of these

are used effectively somewhere 
in the country, so anyway,

that will be another hint, 
you can't just toss them every 
time you are dissatisfied.

MAUREEN RYAN:  We also 
have a couple of large centers

in Wisconsin and they actually 
have IT people on staff,

and then we have very 
small centers that don't, 
so we share a lot.

We do a lot of sharing of 
resources and technical 
assistance.

And it really helped us to sit 
down with an IT person and tell

them what we were trying to get 
and then they talk computer

talk to the MIS people because 
it is different languages,

so we found that really helpful 
to have computer people talk to

computer people and then have 
program people talk to

somebody on their staff, and 
then particularly if you are

going in into a 
program as a state.

You can usually work out, work 
up, sometimes you can work out

some deals with some of the 
companies about, if everybody

is transitioning over to build 
in X number of technical

assistance hours and ongoing 
technical assistance hours.

Don't be afraid to negotiate 
that but it is really a lot

easier if you are using 
the same management 
information systems

because people can learn tricks 
about how to get reports out in 
the same way.

PAULA MCELWEE:  Exactly.

If you have in your group, a user
of the same system that you use

is really savvy, I bet all of 
you have done this kind of

technical assistance 
with your phone.

You have somebody in your life 
who understands your phone 
better than you do.

Maybe not.

Maybe you are the expert in 
your circle of friends and

family but somebody is the 
expert in the circles of family

and friends of the little 
nuances of how the phone works.

Why is the batteryalways running 
down on my iPhone?

Well don't you know you are running 
all those programs memory resident.

I didn't know that.

Yes, you can turn them 
off this way.

Until you know that, nobody 
tells you that, right, but you

can have in your own circle, 
that group of people who have

that kind of expertise that a 
user has around using it,

in addition to the expertise 
you get from the company around 
how it's built and what kind of

reports you can get 
out of it and so forth.

So always be willing to 
ask those other tech savvy

people, we are pretty good 
at that as a society today.

I think it serves us 
well for the most part.

Any other questions or comments 
about any of this?

AUDIENCE MEMBER: Coming 
up with the 70% for 
staff documented time,

do you take out the 
administrative days,

vacation, sick leave, 
all of that sort of thing 
before you take,

MAUREEN RYAN: Time off.

Administrative, are 
they in a staff meeting?

Staff meeting time 
can be built in.

AUDIENCE MEMBER: Okay.

PAULA MCELWEE: We 
have one over here. 
You are good.

AUDIENCE MEMBER:  Testing

When working with consumers in 
developing goals, do you put a

time frame on the independent 
living plan when you are making 
goals with that consumer?

Are you supposed to put a time 
frame to achieve these goals?

MAUREEN RYAN:  Yes.

And who's responsible 
for which parts.

AUDIENCE MEMBER: Okay.

All right.

MAUREEN RYAN:  Then best 
scenario would be to review 
them no longer than quarterly.

Can that be done for every 
goal on every consumer by 
every staff person?

Probably won't happen, 
but set those goals and

expectations and make that 
clear with your staff.

Start somewhere so it's clear 
to all your staff what's

expected, so they have 
that constant reviewing.

Otherwise, it gets 
old and stale.

And there's really good tricks 
in management information

systems to tag what's due, when.

So it will pop up as 
reminders for staff.

AUDIENCE MEMBER: Seems 
like that would make it

more manageable in trying to 
get proper outcome.

PAULA MCElwee:  You need to 
measure at every level.

If you just think about what you do.

You need to measure 
your process.

When people come to the door,
how are people greeted,

what are they provided with, 
you need to measure their plan,

what goals have they set and 
how can they know when they've

completed them, how can 
you help nail down a 
measurement for that.

You need to translate that into 
what you're doing in your own  
stragic planning.

Probably individual objectives 
for staff makes good sense 
as part of that.

What are the components 
of a goal?

It's defined, if there's 
any question about the

definition, it's written down, 
seems like a basic,

but you 
need to make sure 
it's written down.

It has a target date.

I'll write these on 
the board in a minute.

It has a target date.

It has a person responsible.

And you have a way to know 
whether or not it's been met.

And you revisit that on some 
schedule basis.

Now, the regulations actually 
only require that you revisit

the independent living plan of 
an individual served annually.

Well, that's not sufficient to 
really be a part of whatever is

happening in 
independence 
in their life.

So we recommend them 
much more frequent than

that, and some 
centers do it monthly.

They touch base at 
the end of every month.

They look back through their 
lists and they say, you know,

I haven't heard from Joe for 
a while, and he was working

on X, Y, Z, and that might be 
something you want to do.

Richard has a 
comment back here.

RICHARD PETTY:  I'm not 
sure we've said this, 
but just as a reminder on the

ILRU website, the tutorials 
section, rapid course section,

you'll find a tutorial on 
consumer service records,

a tutorial on goal setting, and 
a tutorial on the initial 
interview, with a consumer.

So those may be helpful, too.

PAULA MCElwee:  They're 
excellent training.

They're really good for you to 
put in that plan, training plan

for staff, so that as new staff 
comes on they understand your

philosophy of that from a more 
global perspective, and then

you can help them to know your 
individual forms and policies

and procedures that you do at 
your center, but certainly,

we want to equip people to be a 
part of this team that occurs 
when someone comes in the door.

Now, Maureen said, I forget 
exactly how you said it.

MAUREEN RYAN:  Ambassador of 
first impression.

PAULA MCELWEE:  Ambassador of 
first impression.

What does that ambassador of 
first impression accomplish?

They assist that person in 
seeing this is a community

they've joined, 
if they want to.

Right?

This is a community of people 
with disabilities that are

together, changing what's 
going on around them on a 
regular basis.

And so if they can understand 
that when they come in the

door, that is an important 
thing to partner with their 
goals and objectives.

If they don't understand that 
when they come in the door,

what were the things that you 
were saying a little bit

yesterday about how people 
sometimes expect just for us

to hand them whatever, food, 
bus pass, you know, whatever,

housing list, whatever 
it is that we have.

That's what, that's what 
we think is a center.

And that's what they believe 
is a center, because that's all

they see when they 
come in the door.

So unless they see that 
community and unless they're

given an opportunity to 
understand that they are being

welcomed as part of that 
community, they may take 
their bus pass and go.

And we really want 
to be more than that.

Right?  
We want to be more.

Question in comment?

AUDIENCE MEMBER: I have 
a quick question on slide 30.

You have listed the number of 
people with disabilities that

have been assisted in 
reducing or eliminating 
their public benefits.

I was wondering how you 
came up with that number.

MAUREEN RYAN:  The second 
bullet?

AUDIENCE MEMBER:  Yes.

MAUREEN RYAN:  As I mentioned 
before, the work incentive,

we have work incentive 
benefits specialists in each 
independent living center, and

they do reports per center on 
that exact kind of statistic.

And that comes from a couple 
different work incentive

programs, so they have 
to look at those programs 
and put that number together.

Half the problem of good 
data is to try to figure out 
how to get it.

And sometimes your management 
information system may be able

to do it, but you don't know 
that in the beginning, and/or

you're not entering it in 
a way that can be pulled 
up and queried.

So we started backwards and we 
said, this is a statistic we 
want to find out and capture.

And, again, we had the 
program people talk with

the IT people to figure out what with 
our management information

system would have 
to occur to be able to 
pull that out for us.

And that dialogue worked.

I want to point out that top 
statistic, we included that

statistic one year because we 
thought about all the people

with disabilities that we 
hire within our centers.

We're actually a large employer 
of people with disabilities in

centers for independent living, 
and we don't even think about

that from that perspective 
sometimes.

And as long as we're measuring 
and talking about getting the

benefit of getting people off 
benefits, has that really 
happened for our own staff?

I mean there still is, there 
still are some centers that,

they'll have a lot of staff 
on benefits, and we would like

to see that, that 
working the other way.

And we know there's a lot of 
disincentives out there about

that, but we wanted to 
take a look at that.

We're thinking about pulling 
this out of the report because

it really doesn't, it isn't a, 
wow, flash statistic,

though we got 14 of them, 
but a lot of them weren't on

benefits, or was at different 
times in our lives.

Things happen, you know.

It was just for different 
reasons, but we're kind of

thinking about pulling that 
statistic because it doesn't 
really look good.

So we learn from 
what we do, too.

PAULA MCELWEE:  But it does 
tell you're paying attention 
how important that of the.

MAUREEN RYAN:  We were 
paying attention and we 
tried to count it.

PAULA MCELWEE:  Yeah.

AUDIENCE MEMBER: On the 
return investment, have 
you ever presented where

the centers in the state have 
brought in additional funding

from other, to show legislators 
this is, you know, because of

these centers within our 
community, we've been able

to bring additional 
funding, which,

MAUREEN RYAN:  Right.

Our statistic, I think, 
was 3.8 million of IL funds,

resulted in $54,000,000 
of revenue.

So if you doubled the 3.4, 
look what we could do.

And look how great 
our outcomes are.

That's a great 
investment piece.

AUDIENCE MEMBER: Do 
you use that for the 
legislators or decision makers 
within your community?

How do you use that figure?

MAUREEN RYAN:  Legislators 
definitely because we're 
looking for statewide funding.

Other private funders we've 
utilized that with also.

I would say funders 
were wide open.

We are a good investment 
for public and private dollars.

PAULA MCELWEE:  You know, 
when you're collecting

the information, you will 
find uses for it that you 
might not think of at the

time you decide to collect the
information so you may very

well be writing a grant six 
months after you've given this

report to the legislature 
and think, oh, that fits the
question they have here.

I'm going to answer 
that question as well.

You can use the information 
a number of different ways.

AUDIENCE MEMBER: It's 
weird because you can make 
an argument it's a good thing

if people are less dependent 
on public benefits.

You can also make an argument 
it's a good thing if you

actually help them access 
public benefits.

If people, if you help 
people gain eligibility for

Social Security benefits, 
you may top, you know, $12,000

per person per year federal 
money coming into your state 
that is spent in your state.

MAUREEN RYAN:  Right 
here at home, right?

AUDIENCE MEMBER: Have 
you guys noted that before?

MAUREEN RYAN:  I think that 
depends on the climate of your

legislators, and we have to 
change that frequently, this book,

I'm holding up a spiral that 
says Wisconsin Coalition of

Independent Living Centers, 
ILCs are a great investment.

We change this book depending 
on who's in office when we

need to, and bringing in 
federal dollars is attractive

to some legislators, to some 
legislators it isn't.

Some legislators want to think 
everybody has got to pull

themselves up by 
their boot straps.

Some are great about accessing 
benefits, so this is a fluid

piece, and we, again, target 
our message for what works.

And we're not above or, 
we're not above doing that.

AUDIENCE MEMBER: Politicians 
in Texas like to 
think poor people, bad,

that's the level of 
understanding they have.

PAULA MCELWEE:  We know 
that the interesting thing 
about that issue, specifically,

of getting on and off of Social 
Security and into employment is

that there are centers who have 
decided not to do benefits

counseling because they feel 
like that's not helping people 
to have a sustainable life.

Now, in California, you try 
and live on Social Security,

you know, when your house is,
you know, housing costs are

four times or more greater than 
they are in a lot of the rest

of the country, so some of 
the centers have said, I'm not 
doing anybody any good.

Besides, they can find a 
lawyer to do that piece 
for them; right?

I'm not doing anybody any good 
helping them get onto benefits, 
I need to help them get jobs.

So you'll see a varied 
look at that benefits 
issue among centers.

It's one of those areas where 
you need to talk it over and

see what you agree with as 
a center or between centers

because you can take either 
approach, I think.

AUDIENCE MEMBER: Well, 
going back to the at risk 
of going into an institution,

that's one thing that happens 
to people if they have

disabilities and they don't get 
some form of financial support,

they're going to end up in an 
institution somewhere.

The other place you've got to 
look at is people coming out

of hospitals because the 
hospital, the nursing

facilities in Texas recruit 
from hospitals, somebody

has had an operation, 
doesn't have a home because 
they've been in the hospital

and may have lost their home 
and everything, so they go

directly into a nursing 
facility, where if, and I think 
you can talk about that,

if we can get them right at the 
time they're in the hospital, 
then you're a deterrent.

PAULA MCELWEE:  If you 
can get at the time of charge

planning somehow, then you 
can be part of that and that's 
an important thing.

Another place people end 
up if they have no source 
of income is homeless.

We have a number of people 
who are homeless who 
are our brothers and

sisters with disabilities 
and it's another area 
of significant

AUDIENCE MEMBER: Most 
of ours are homeless that

we are working with, 
that's why we're trying

to get them to Social Security 
or something so they can 
get some form of housing.

MAUREEN RYAN:  I think 
that's a good point about being

careful what our message is 
about assisting people to 
access the benefits

they need to live, versus 
helping, assisting those who

can get as independent as, we 
have to be careful about that.

It's a really good 
point you brought up.

PAULA MCELWEE:  It's a mix, 
hard one to balance.

Any other questions or comments 
around this information.

What did you think?

Can you see some of these as 
measures you could use?

I feel like, I was all 
excited as she was going 
through her presentation.

I was thinking, these are 
usable measures.

We can grab a hold of this one.

We can use this one.

And so while we're not going 
to give you a specific plan,

you can take some of these 
samples and think about what 
would work well for you.

Right?

So let's talk about, for a 
minute, how will you implement

this back home, or how will you 
go about the process of

figuring out your measures and 
applying them so you can share

that information, maybe state 
wide, maybe just with your

centers' stakeholders, 
but what are your plans?

What are you going to do next?

We'd like you to take a few 
minutes and do that at your 
tables.

So take a few minutes and 
actually begin to talk together

about what's the next step 
for making measures of quality 
happen at home.

What do I need to do next?

And we're going to give you 
just about ten minutes for 
that, and then we're, I think 
ten minutes.

What time have I got?  Okay.

We're going to do about ten 
minutes for that, then come 
back and share.

So about ten minutes 
to take a look at that.

Thanks.

[Group discussion.]

PAULA MCELWEE:  Let's 
come back together.

What are you going to 
do when you go home?

Anybody have something 
exciting in their plans as 
a result of the training.

What is going to happen 
when you get home?

I know you were not 
done yet, but we have 
to move this along.

So what are you going 
to do when you get home?

Anybody?
If not, we have more 
we can talk about.

AUDIENCE MEMBER: There 
is a couple of things 
that were pretty much in

agreement that we would all 
like to do, is start with the RSA

checklist, the site visit and 
start examining and do a

GAP analysis on what we are 
doing, what we've got, what we 
don't have.

Being able to establish some 
employee staff performance

professional goals as well as 
personal development to make

sure we've got the best 
possible skill sets within

the organization and then start 
to envision how do you take

what we are currently working 
on and turn it from this to

excellent and define what the 
metrics are for excellent and 
then building it from there?

PAULA MCELWEE:  A roadmap.

There you go.

Anybody else?

AUDIENCE MEMBER:  It would 
be connecting the dots to make 
sure that the satisfaction is

overall not just for 
the consumers but 
the community and

making sure that success is 
for satisfaction overall.

PAULA MCELWEE:  Good.

We have one over here.

AUDIENCE MEMBER: And we 
have been talking about 
how this would be good for us

to clarify some things that we 
are already doing and maybe

go back and fine tune 
a couple of things but 
really just confirmation that

there are a few things that we 
are doing that seem to be what

we should be doing but to 
expand on them a little bit,

but one thing we definitely 
need to do a little better in

our center is to do a little 
more work around goal 
setting and documenting.

There is a lot of good work 
going on that just isn't being

documented by the staff 
and by the consumers.

That's one thing I try to tell 
my staff all the time in the

staff meetings and things is if 
you don't document, nobody

knows it happens, so document, 
document, document, document,

and that way another staffer 
can come up and pick up the

file and go forward and know 
recently what happened, what is

expected to happen next 
but we know that's always

probably one 
thing that is lacking.

PAULA MCELWEE: That 
is so important though.

Let me follow up with 
one comment on that.

There was a goal up here, 
what is it, around 75% of

direct service time or 
something like that, 
for the direct service staff.

I did a consult with a center 
and they were not using,

to give them credit, 
they were not using their

database for time keeping 
for staff but they were having

a lot of trouble seeing where 
things were kind of falling

through the cracks, so I had 
them run a report by staff

person of who they served 
in the last complete month,

how many hours they had 
provided those services,

how many of those people had 
written goals, how many knew

intakes by staff person and 
I handed them out to the staff

people at the meeting and we 
went through the content of

that report and they saw 
their own numbers, 
and I tell you something.

There was a big change in 
behavior just by seeing that

they only had 12 hours of 
direct service time last month.

MAUREEN RYAN: Yes, Paula, 
I was going to say that 
that's something I have done

for quite a while with our 
staff and the last couple months

I haven't done it because I have 
been busy with other things and

I actually had a staff person 
say the other day,

I really missed getting 
the reports from you.

Can you start doing those again.

They are individualized, they 
go to the one staff person.

It is not comparative to any 
other staff but it is that one

staff person and what their 
last month looked like?

PAULA MCELWEE:  We all have 
good intentions, right.

We can self-correct if we can 
see what is actually being

recorded about what 
we are doing.

I think you had a comment.

AUDIENCE MEMBER: Yes, 
this is Jack from ARCIL.

We are going to analyze the 
information, look at it with

what we already got in place 
because we got a lot of this

stuff in place and see if there 
is anything new and I found one

thing that I did like, 
was the code of ethics.

I mean, we have in our policy 
professionalism and pleasant

and smiling but I don't think 
we ever came up with a code 
of ethics for the staff.

I don't know if I can sell it.

PAULA MCELWEE:  How can 
you not sell ethics?

If you ask me, will you 
agree to a code of ethics, 
how can I say no?

AUDIENCE MEMBER: Well, 
it's like, you know, 
what, it's like, well,

we have our, we have a lot of 
pride at our center and people

have their own ethics and 
their own way of dealing with it.

PAULA MCELWEE: But we 
all should be willing then 
to say we are ethical people.

AUDIENCE MEMBER: But I like that.

MAUREEN RYAN:  We have done 
some training on ethics and if

nothing else, it really is 
fabulous dialogue.

People get to address 
situations that they don't

get to talk about on their 
day-to-day work about ethics

and, you know, it doesn't 
have to get real formalized 
and real rigid.

We don't want to go down 
that road but ethics is 
a huge thing.

The dialogue, they loved it.

You thought it would take an 
hour and they could have gone

on and on and on and we ended 
up doing a DVD/CD that

anybody could use it any 
time so it's available if 
you want a copy.

PAULA MCELWEE:  A good 
resource we might provide.

I think there is a 
question over here.

AUDIENCE MEMBER: Erin 
from Minnesota.

I think a lot of things 
that I was going to 
say have been said

already and I think just to 
bring all these things

together because sometimes
we get so wrapped up and forget

to go back to some of the 
basics and make sure all 
those things are in place.

I think it is important to look 
at the training for staff,

specifically staff that might 
be more in administrative roles

or billing or definitely 
reception staff.

Maybe they don't get as much 
training on IL philosophy and

consumer control as, 
and focusing, you know,

if they are focusing on the 
technical skills for their job

but they are so much more than 
that every day and answering

every phone call and getting 
people to the right place and

giving them that basic 
introduction and what their

understanding of what a center 
for independent living is and

that's a huge impact on what 
the consumers are getting,

when they first step 
in the door and make 
that first contact.

I think looking at it from all 
levels, making sure this

consistent information is 
getting to board members to 
leadership to direct service

staff to peer support staff or 
volunteers and to consumers 
because there are so many

things like this is really only 
relevant for management to 
worry about or only the

executive director needs to 
know if it is in the 704 report.

But it affects everybody's
ability to do the job and

for it to be a good, 
smooth system there

needs to be more 
communication and 
awareness on every level.

PAULA MCELWEE:  We are 
better at keeping track of

information if we understand 
the purpose of that information.

So by its very nature, 
your database, 
the MIS system

is going to be more 
accurate and complete

if people know 
why they are doing it.

So that will be helpful.

We had one here.
Michelle.

AUDIENCE MEMBER: I think 
this goes back and touches 
base on the 704 and

what is being reported and it's 
capturing the good data.

That kind of stuck with me 
through the training because we

do a whole lot of work but if 
it's not written down you did not

really do it, so I think it's 
just making sure the foundation

is laid for us as a new CIL.

Making sure the 
correct data is being

captured so, therefore, 
we can go above and 
beyond with the

compliance, want to
make sure we were

complying and two, 
to go above that, we need

to make sure we are doing it 
correctly and just constant, 
you know, open communication.

Yes.

MAUREEN RYAN:  And capturing 
your data is really about

giving yourselves credit for 
all of the good stuff you are

doing because we fall into 
funders, formats, with as

minimal data as we have to 
collect and they don't tell

the good story about all 
of the great stuff we do.

Second table here 
in the middle.

AUDIENCE MEMBER: What 
I do every morning, not 
every morning but twice a week,

I meet with the staff and find 
out where they are at,

what problems they are having
and how we can solve the issues

to continue and I also make a
point of finding something they

did that week and validating 
to give them support.

PAULA MCELWEE:  I like that.

MAUREEN RYAN:  I want 
you for my boss.

PAULA MCELWEE:  I like 
that a lot.

Other comments or questions 
around this topic?

One thing, oh, we have 
one over here.

Yes.

AUDIENCE MEMBER: Patrick
from the Poughkeepsie 
center in New York.

Like today, my staff, I work 
with them once a month for 8 
hours and it is called peer

review and for the peer 
review for that day, we have 
case logs that we go over.

We have someone come in 
and train and then we support

each other and before that, 
like once a year, we have

a retreat with the board of 
directors and we point out what

we want to accomplish for the 
next five years and the monthly 
meeting with my staff,

we continually try to attack 
each of those goals.

PAULA MCELWEE:  To close 
the loop, do you report 
back to the board?

AUDIENCE MEMBER: Monthly.

PAULA MCELWEE:  Every month.

So you see that loop, yes, 
you have your planning and

training, your planning and 
training that takes place

with staff and you talk about 
their progress and then you

report that back to the 
board and then you continue, 
right, in a cycle?

AUDIENCE MEMBER: Yes, 
and from the consumer 
perspective, I develop a welcome

letter, every time a consumer 
comes in, they receive a

welcome letter, personally from 
me, welcome letter to outline

our mission, our values, 
our goals and what is an
independent living plan,

what is confidential, and 
everything that we have,

our bylaws and our procedure.

The consumer themselves
have a synopsis of what they 
are expecting to receive from us.

It works sometimes 
and doesn't sometimes.

They are warned,

PAULA MCELWEE:  But when you 
have something like that that

you have decided is important, 
if you measure it, you will

know whether it's happening 
or not and you can cause it to

happen and that's something 
that is important about this

whole process, is that you 
identify what matters and 
then you assure it happens

and measure, is it continuing, 
and that cycle gives

you the guarantee that you 
are doing what you said 
you are going to do.

When you told them what they 
should expect, it also means

if they wanted something, 
they will come back to you and

say, you told me I was 
going to get this, right, 
so where is it?

And then you will know.

AUDIENCE MEMBER: And 
when we, when they 
complain, I say to them, 
you developed it.

I gave you a piece of paper and 
you gave me 20, 20 ideas and

now you have to own it, 
basically, my staff is my

consumers and I tell them that 
and they laugh, but, really,

as directors, I have to care for 
my staff, as much as they 
care for the consumers.

PAULA MCELWEE: That 
is a good philosophy.

AUDIENCE MEMBER: Because 
they need to feel that.

The same service you give 
to your consumers I give 
to you and vice versa.

PAULA MCELWEE: I hope 
that you heard from us 
and from the examples that

have been given that this is
not just a single layer within your

organization but it 
permeates everything 
you do if you do it correctly.

It permeates all of the people 
that are a part of your center 
and permeates all of the layers

of services and actions 
that you do within your center, 
so ...

Other comments or 
questions on this?

We want to touch base on 
one little thing, not a little thing.

It is a big thing.

And that is the issue of 
base funding for centers.

Does anybody have any 
conversation about 
this back home?

California does, I know.

So, yeah.

West Virginia.

This is a tough one, because 
when things first started,

you know, my first center, 
my first grant was $295,000, 
Title VII in 1979.

Well, it was 18 counties, right.

But it was a big grant.
Right.

There is a center in Kansas 
where I was, there is a center

in Kansas that gets 20,000 
Part B dollars now today.

So where is the equity in that?

How does that make any sense?

So this is a topic that also is 
part of how we measure things,

right, is around that issue of 
do we have sufficient resources 
to make things happen.

And I think I would like you 
to jump in on part of that.

MAUREEN RYAN:  Sure.

I think, you know, money is 
probably the biggest divider,

and I think we were fortunate 
enough or just stubborn enough

to keep at it in Wisconsin and 
really worked on statewide

equity very early, early, 
early, early on.

And we kept at that and 
we wrote our SPIL very 
specifically.

This started before there was 
even a SPIL to achieve, before

there was a SILC to achieve 
statewide equity.

We realize that it was important 
and we also realized that it was

important that there was not 
a differentiation between

state funded centers and 
federally funded centers.

If you run into that, the 
statewide centers, we would

hope that you can at least have 
the same quality level and

requirements for compliance 
within your state funding 
that you do federally.

Otherwise, you've got two sets 
of standards and requirements

in your state, and that 
makes it really difficult for

compliance and 
working together.

So I think it's important to 
try to get state and federal

funding for every 
center in the nation, 
but that's not realistic.

There are states that don't do 
any state funding, and then

however you decide what your 
equity is needs to first start 
with your base funding level.

I think we started out with a 
$250,000 base funding level.

We are now at 580,000, 
base funding in Wisconsin, 
that's our level of base 
funding.

I just want to put a quick 
mention out there.

APRIL is doing a national 
survey on this, sending out to

all the centers, and asking 
them what it would require to

be at a level that they 
describe when they send out the

survey, what this would cost 
you in your area, and initial

results are coming in around 
the $565,000 level.

So just to think about that 
when you go back to your states

and you've got centers that 
are starting up still today 
at $90,000.

That is a plan for failure, 
and if we don't stop that

ourselves, we're going to 
be in bigger and bigger 
trouble every day.

So I really ask you to take 
this question seriously and

this issue seriously and 
start some dialogue in your

state around the 
equity in centers.

And obviously you should 
be doing that as part of 
your SPIL, but to get

down to a different level than 
just what's required in SPIL,

and granted, that's a tough 
subject to talk about, 
sharing of money in your state.

There's nothing harder to 
address, but it's a crucial

issue when you allow these 
centers for $90,000 to start.

That just doesn't work.

So please take this seriously.

PAULA MCELWEE:  Anne has a 
comment.

ANNE WEEKS: Yeah.

I'd just like to 
make another comment.

It's not always just a 
matter of equity in the state,

it's equity in the country, 
back in the days of competitive

grant awards, West Virginia was 
lucky enough to get almost

a million dollars in the state 
and in the four centers,

and according to the now 
formula that we use and RSA

and the wisdom of doing 
everything based on population,

West Virginia has not 
had an increase in 7C 
money since 1987.

So we're struggling, when I'm 
listening to people talk about,

you know, I've got this 
program manager and this

program manager, this person 
doing this and this person

doing this, we're struggling to 
keep one person in each center

that is working with 7C staff, 
because we don't have any money.

I think there has been a lot 
of conversation about that

and that's part of what the 
reauthorization has been

working on, trying to come up 
with a solution for that,

and I would like to encourage 
people because there are a lot

of new people coming into 
centers who were not part of

that conversation years ago 
when it started, is to think

about equity among 
the states as well.

MAUREEN RYAN:  Great point, 
Anne.

PAULA MCELWEE:  When you 
look at all we believe we 
should be doing,

it is very difficult to do that 
on a shoe string, 
if not impossible.

And some of the centers that I 
work with, when they've had

a review, they end up on a 
reimbursement voucher basis.

Did you know that?

You go under conditions.

So they cannot draw down their 
money until they have sent all

the receipts in and gotten them 
approved and get approval back,

which can sometimes 
be a six-week process.

And they have no line of 
credit, they're small,

and how do they
pay their payroll?

How do they keep 
their center going?

Because they can only 
work on reimbursement, 
and they have no cash flow.

So we have created, 
not that they haven't 
had a contribution

related to their compliance in 
the past, but we've created a

situation where it's very 
difficult for them to be able 
to continue to move forward.

We've really had a hardship.