Aging & Disability Resource Centers: Rethinking Relationships Across Aging & Disability Networks 2007 ASA/NCOA Conference March 8, 2007

Session Outline ADRC history and overview ADRC history and overview Making the Case for Collaboration Making the Case for Collaboration From theory to action-your minds at work From theory to action-your minds at work Experiences from the field—two state case studies Experiences from the field—two state case studies

Impart knowledge about the significance the ADRC program plays in the delivery of long term services and supports Impart knowledge about the significance the ADRC program plays in the delivery of long term services and supports Engage participants in an intellectual discussion about collaboration across aging & disability networks and the significant role it plays in this initiative Engage participants in an intellectual discussion about collaboration across aging & disability networks and the significant role it plays in this initiative Learn about the experiences of new and “seasoned” states as they build important collaborations to affect systems change Learn about the experiences of new and “seasoned” states as they build important collaborations to affect systems change Session Goals

To have Aging and Disability Resource Centers in every community serving as highly visible and trusted places where people of all incomes and ages can turn for information on the full range of long term support options and a single point of entry for access to public long term support programs and benefits. CMS and AoA Vision

Administration on Aging Centers For Medicare & Medicaid Services Aging and Disability Resource Center Program FY 2004 ADRC Awardees FY 2003 ADRC Awardees FY 2005 ADRC Awardees AlabamaIdaho Ohio Arizona Kansas Tennessee Colorado Kentucky Texas DC MichiganVermont Guam MississippiVirginia Hawaii NevadaWashington Wyoming AlaskaIndiana ArkansasIowa CaliforniaNew Mexico FloridaNorth Carolina GeorgiaNorthern Marianas IllinoisWisconsin Louisiana New Hampshire Maine New Jersey Maryland Pennsylvania Massachusetts Rhode Island Minnesota South Carolina Montana West Virginia MA

Timing is not everything – but almost Events – Leading to ADRC

1990- Americans w/ Disability Act (Congress) Americans w/ Disability Act (Congress) Olmstead Decision (Supreme Court) Olmstead Decision (Supreme Court) New Freedom Initiative (President) New Freedom Initiative (President) Real Choice Systems Change Grants (Congress to Real Choice Systems Change Grants (Congress to CMS) CMS) Aging & Disability Resource Centers- (Historic Aging & Disability Resource Centers- (Historic AoA-CMS Partnership) AoA-CMS Partnership)

Systems Change Vision

Awareness & Information Awareness & Information –Public Education –Information on Options Assistance Assistance –Options Counseling –Benefits Counseling –Employment Options Counseling –Referral –Crisis Intervention –Planning for Future Needs Access Access –Eligibility Screening –Private Pay Services –Comprehensive Assessment –Programmatic Eligibility Determination –Medicaid Financial Eligibility Determination –One-Stop Access to all public programs CONSUMER ACCESS ASSISTANCE AWARENESS & INFORMATION ADRC Required Functions

“All are integrated or so closely coordinated to appear seamless to the consumer.” How Functions Work As A Whole

Partnership with the Medicaid Agency and Disability and Aging Networks Partnership with the Medicaid Agency and Disability and Aging Networks –State and Local Advisory Committee Representation –Signed Streamline Access Plan Establishing collaborative working relationships Establishing collaborative working relationships –Consumer participation: target populations –Service providers –Advocacy groups –Other Grantees: Real Choice Systems Change Value of Partnership Benefits consumer Value of Partnership Benefits consumer –Helps streamline services across agencies –Enhances trust and reduces frustration and confusion –Build program visibility and broadens outreach Federal Partnering Requirements

Federal Partnership Federal Partnership –AoA, CMS, ACF/ADD, NCD, HHS Office on Disabilities, NIDRR, NICL –Cooperative agreements; interagency agreements State Partnership State Partnership –State agencies impacted by ADRC goals and mission Signed letters of support signifying collaboration Signed letters of support signifying collaboration Signed Streamlined Access Work Plan Signed Streamlined Access Work Plan –State level advisory board Work groups/teams Work groups/teams Local/Community Partnership Local/Community Partnership –Pilot sites, target population advocacy groups, local level advisory board, community organizations –MOUs/MOAs & work groups/teams ADRC Partnering

ADRC Collaborative Results

Partnerships Cut Across Many Types of Organizations

grantees, n=24 grantees Other Transportation Services Task Force or Advisory Group Social Services Social Security Administration SHIP LTC Providers Medicaid Housing Services Employment Disability Services Adult Protective Services Aging Services Advocacy or Consumer Group 211 Grantees Partnering With Different Organizations

Activities State Level Partners (n=211 in 24 states) Pilot Site Level Partners (n=288 in 51 pilot sites) Formal Protocols/MOUs29%28% Co-location of Staff at Local Level 13%16% Information Sharing42%44% Joint Training19%25% Joint Sponsorship of Programs18%23% Elements and Activities of Partnership

A Case For Collaboration ADRC

ADRC Challenges ADRC Opportunities ADRC Challenges ADRC Opportunities “No one’s going to run my Demystifies the turf issue: The ADRC project is program!”not about duplication. It’s about agencies collaborating to delivery the best consumer provision. “What’s in it for me?” ADRC can help free up staff and resources to focus on other core functions and priorities “We don’t do it that way!”Culture Shift: Stepping outside of a silo and collaborating provides an agency the opportunity to improve service provision “We don’t have funds for MIS.”Provides resources for multiple partners to update and/or have access to an I & R system “They don’t have experienceCross training; allows professionals to step outside serving our population.”of their silos and understand the system holistically as well as another providers’ point of views Case Building for Collaboration

In the Department of Human Resources, the Division of Aging Services and the Division of Mental Health submitted a joint budget request for state fiscal year 2007 to integrate ADRC coordination between the developmental disabilities service delivery system and the aging network. They were awarded $700,000. Georgia

Nine-Step Model of Conflict Resolution in Partnership and Collaboration 1.Listen with respect 2.Look at the situation from the other person’s perspective 3.Let the other person hear an explanation of your perspective 4.Recognize similarities and differences 5.Acknowledge any cultural differences (remember culture goes beyond race and ethnicity, it includes disabilities, age, geography, income, social affiliation, etc... ) 6.Find common ground 7.Recommend action/be creative 8.Determine what adaptations each person is willing to make to find a satisfactory alternative 9.Negotiate an agreement Energizer *The National Multi-cultural Institute 2004

ADRC State Collaborative Case Studies

2003 ADRC grantee and 2005 expansion grantee “No Wrong Door” decentralized model Partnership between Independent Living Centers (ILCs) and Aging Service Access Points (ASAPs) Initial pilot site in the Merrimack Valley to the Greater North Shore region Third year expansion to the Greater North Shore region Massachusetts—Aging & Disability Resource Consortium

Enhance individual choice and support informed decision-making through the provision of comprehensive information and assistance about long-term support options Provide seamless access to services for elders and persons with disabilities of all ages Improve collaboration between ILCs and ASAPs Decrease gaps in current services through joint advocacy and problem solving Key Project Objectives

Built upon the existing infrastructure of ASAPs and ILCs-many of the required functions are already performed in some capacity Establishes formalized partnerships between ASAPs and ILCs to serve individuals based upon functional need versus age categories Streamlines existing functions across the two organizations to better serve consumers The Massachusetts Model-Design

Consumers, providers and support persons can contact either ASAPs or ILCs and receive the same comprehensive information and access to long term supports Community organizations are aware of ADRCs and can refer consumers, or contact ADRCs directly, for information about and access to long term supports “No Wrong Door” versus “Single Entry Point”

Support for project by executive leadership at State and local levels EQUAL partnerships Recognition that there are more similarities than differences Agencies retain own autonomy, yet strengthen community presence through collaboration Support of regional variation and ownership over model Key Factors to Success

Cross-training of ASAP and ILC staff to enhance service delivery Coordination and streamlining of key functions within existing organizations “No Wrong Door” approach versus “Single Entry Point” Involvement of consumers and community stakeholders as advisors Key Aspects of the Massachusetts Model

  It’s the right thing to do!   Increased access by consumer to broader array of options for living independently   Opportunity to advocate together on legislation and policies that enhance the ability of individuals to live independently in the community   Major federal initiative Why Collaborate?

  Compatible vision and mission   Both serve populations who need functional assistance   Access to different arrays of services   Both local non-profits with local consumer-controlled boards   Various funding bases   ASAPs: Older Americans Act, EOEA, Medicaid, other state/local   ILCs: Title VII of Workforce Investment Act, State IL, other state/local Recognition of Similarities

  Use of core client-centered databases and management information systems   Commitment to serve individuals in the settings and manner of their choice   Commitment to divert and/or transition individuals out of institutions to home and community-based supports Similarities (Continued)

Be flexible Be flexible Support regional variation Support regional variation Engage community agencies as partners Engage community agencies as partners Johnny Appleseed approach—sow the seeds locally Johnny Appleseed approach—sow the seeds locally Cross-state agency leadership commitment and support Cross-state agency leadership commitment and support Strong communication strategy Strong communication strategy Key for ADRC Success First Steps: State Agencies

 Begin ASAP / ILC dialogue early  Involve senior leadership  Identify “champions”  Leave ASAP / ILC “hats” at the door  Begin cross training and information sharing Key for ADRC Success First Steps: Community Agencies

 Enter Memorandums of Understanding  Facilitate “seamless” interagency communication  Reach out to other organizations for their involvement in ADRC  Invite consumer participation  Create advisory group(s) Key for ADRC Success Second Steps

2005 grantee 2005 grantee Building a decentralized model Building a decentralized model Two pilot regions Two pilot regions Key partners: Key partners: –AAAs –Vermont Center for Independent Living –Brain Injury Association of Vermont –Developmental service providers –VT 211 Program Vermont Aging & Disability Resource Connection

Formation of Statewide Planning Council-key stakeholders involved in decision-making Formation of Statewide Planning Council-key stakeholders involved in decision-making Formation of two Local Implementation Teams—regional variation and support for local leader buy-in and development Formation of two Local Implementation Teams—regional variation and support for local leader buy-in and development Consumer leadership—orientation and active engagement at all levels Consumer leadership—orientation and active engagement at all levels Vermont Model: Key Components

Building upon existing infrastructure of key organizations that serve the four target populations Building upon existing infrastructure of key organizations that serve the four target populations Using call module and resource database software to enhance sharing of key resource information across partnering agencies Using call module and resource database software to enhance sharing of key resource information across partnering agencies Building comprehensive cross-training curriculum based on several components: Building comprehensive cross-training curriculum based on several components: –Philosophies and cultures serving different populations –Nuts and bolts—how do individuals with different functional needs access services—what are the eligibility processes and what services are available? –How can we collaborate to better serve our common clients? Establish formalized MOUs among regional partners and between regional ADRC and State agencies clearly outlining expectations and relationships Establish formalized MOUs among regional partners and between regional ADRC and State agencies clearly outlining expectations and relationships Vermont Model Design

Small state, most folks know each other Small state, most folks know each other Everyone wants a piece of the action—hard to “phase in” Everyone wants a piece of the action—hard to “phase in” The “what about me’s” in the model design The “what about me’s” in the model design Building trust across agencies that have never worked together in the past Building trust across agencies that have never worked together in the past Comfort with sharing resources Comfort with sharing resources Vermont Model: Building Collaborative Partnerships

Communication and active engagement from the executive leadership to front line staff is critical Communication and active engagement from the executive leadership to front line staff is critical An honest and transparent process will take you far An honest and transparent process will take you far Be open to change and shifting in design if it doesn’t meet local expectations Be open to change and shifting in design if it doesn’t meet local expectations Be flexible with workplan targets—it doesn’t all flow the way you thought it would when you wrote the proposal! Be flexible with workplan targets—it doesn’t all flow the way you thought it would when you wrote the proposal! Listen to your key stakeholders—they know their stuff Listen to your key stakeholders—they know their stuff What We Are Learning

Dina Elani Senior Policy Advisory, CMS Leslie Swann Aging Services Program Specialist, AoA Heather Johnson-Lamarche ADRC Project Director, MA and VT For More Information:

Aging & Disability Resource Center Technical Assistance Exchange