Healthy an Ready to Work

Tom Gloss: Okay. I think we’re going to go ahead and get started. We may have a few people join us as they finish their regional lunch meetings and make their way to the beach room. Do you hear me okay in the back? Great. I’d like to welcome you to this session on Healthy and Ready to Work, and a specific presentation from the folks from our Wisconsin project, we’re glad to have them here and we’d like to welcome each of you for being with us today. My name is Tom Gloss and I am the Federal Project Officer for the Healthy and Ready to Work initiative and I’ve been working with this program since the--let’s see, I came to MCHB in November of 1997, actually Healthy and Ready to Work started as an initiative a few years before that with a planning opportunity for some projects across the country. There were about nine projects that started out looking at health and transition issues for children and youth with special healthcare needs. Those projects ended in 2001 and we have five projects running now, plus Kentucky, which was on a different funding cycle, so a total of six projects going. And those projects now are looking at a specific charge of how we create a Healthy and Ready to Work youth transition program within a state Title V Children With Special Healthcare Needs Program. And our focus today is to share with you a few things that Wisconsin’s project has done and how they can help enhance a Title V program. Of course we’ve covered a lot of ground, the water, if you will, in the past five or six years. Lots of things have changed and when Healthy and Ready to Work started back in the mid ‘90s we were in the midst of a welfare reform, and there was a whole movement in the country in terms of helping people who wanted to work, who were able to work, to work, and not receive a government check. And at the same time the Supplemental Security Income, the SSI roles, for people with disabilities, were on an upward track. There were more and more young people coming on the SSI roles and social securities actuaries projected that a child who started receiving SSI benefits based on a disability, would continue to collect those benefits for about 30 years. It’s like a person’s working life, a career, but collecting an SSI check, not working, not being out in their community, and we viewed that as a negative thing and so it kind of fit in with if you’re helping people off other programs, other federal government programs, into the world of work. It seemed to make a good fit, a good connection with helping people with disabilities, and especially young people who had special healthcare needs and disabilities move into that world of work. I, for one, was a proponent that it made more sense to help a young person file those lifetime achievements and milestones of anyone else to move on through education and employment, than to take an old person like me, a 50-year old, a 55-year old, who has a disability, and trying to get that person, “rehabbed” and back to work. Let’s put some investment into the young people and help them on that path to achieve their goals and achieve work outcomes. We have--I’m not going to take a lot of time because I want the presenters to have the most time in this session, but what I do want to tell you is that we have--on your desk there is an evaluation form for this session and I ask that you fill it out as we go and make sure you drop it off at the end. We also have for you a copy of the handout of the power point presentations, and then we have a resource that was prepared our Healthy and Ready to Work national center and we have Patty Hacket and Cynthia Glimpse here in the front from our national center. And the national center serves a role of kind of coordinating, monitoring, helping disseminate information that the individual projects have been working on and they create some of their own materials too. So this handout from the national center actually takes the six performance measures that were just approved that deal with children with special healthcare needs and the transition is the last one of those six. But it breaks down some of the tools and concepts that have come out of our Healthy and Ready to Work initiative and puts them in context of those six performance measures. So hopefully that will be a big help to you as you’re looking at the performance measures and how you’re going to deal with those, and that you will share this information with your cohorts back in the general session and they’ll all want to get a copy of this and the website, www.hrtw.org, is on here and that’s where they can get more of those. Also I want to bring to your attention that we have worked through the American Academy of Pediatrics and this actually came out a year ago in December in the Pediatrics December 2002 and it’s a consensus statement that was developed by the American Academy of Pediatrics with the American Academy of Family Physicians and the--I always get it messed up, it’s a long name, but I think it’s the American Society of Internal Medicine--their opinion as three major medical organizations, medical representative organizations, their opinions and viewpoints on transition and that transition is something that should be planned for and prepared for. And this has been distributed and this is available also at the website through a link and it’s a good thing to work with physicians and for families to know about that they can talk with their doctor about. Okay. With that said I’m going to just briefly introduce our panelists and let them give a full introduction to you of who they are, their background. But first we’ll be hearing from Susan Uttech, who is the Family Section Chief of the Wisconsin Title V program. We’re happy to have Susan with us. And then we’ll hear from Tina Sanders, who’s a young adult in Wisconsin and been involved with the Healthy and Ready to Work project there, followed by Amy Whitehead, who’s the Program Manager for the Wisconsin Healthy and Ready to Work project at the Waisman Center. So, Susan, I’ll turn it over to you.

Susan Uttech: We have to slide things here a little bit carefully, so--welcome. I’m glad you’re here. Again, my name is Susan Uttech, I’m with the Wisconsin Division of Public Health and I’m the Family Health Section Chief, in which we have the Title V program for Maternal and Child Health and children with special healthcare needs. And really what I’m trying to do is just really kind of set the stage of what we do regarding the Children With Special Healthcare Needs Program and how closely we work with actually the transition grant that Tina and Amy will be talking about. So I can go right to the slide with--right, okay. In 1999, what we did is we decided to have five regional children with special healthcare needs centers established. It was done through a competitive process and it was very new for us, a new initiative, but we felt that that was the way to build infrastructure and systems building for this population. When we did the competitive process we ended up with having successfully funded three hospital based centers, the University, which is where the Waisman Center is and then one local public health department. And so you can see the northern region is the family resource connection, St. Mary’s hospital in Rheinlander, the northeastern region is with Children’s Hospital of Wisconsin at St. Vincent’s hospital. Southeastern region is Milwaukee Children’s Hospital. Southern, of course, is the Waisman Center with the University of Wisconsin, Madison, and then last is the Chippewa County Public Health Department, who is responsible then for the western region regarding the center for children with special healthcare needs. Come on in. Feel free to just get comfortable. So we have a really diverse setup and we’ve learned a lot from that. The things that work and the things that don’t work and how we want to proceed. One of the things that we have done--you can go to the next slide--is there were three main things that we want to accomplish as part of establishing these centers in 1999 and we really stay with those purposes today, too. The centers are a source for providing information, referral, and follow-up services to children and families and really have done a wonderful job of making themselves known in their region as well as connecting with healthcare providers and others as establishing that system of care for children with special healthcare needs. And we also promote a parent to parent support network and have tried to establish at least one county parent liaison in each county so that we have an established network of parents, and we have more work to do there, but, you know, this was all kind of our beginning. And then establish a network of community providers for local service coordination, which is primarily our local public health departments, but our centers work very closely with the local public health departments for that. In addition now, in this next year of 2004, we’ve tried to take the six performance outcomes for children with special healthcare needs and shape the activities of the centers, the five regional centers, around those six performance outcomes. One of which--we all know what number six is, it deals with transitions. And so we’re really working on the centers in dealing with the transition issue as a whole, which really worked very nicely with what was happening with the Healthy and Ready to Work grant and how the centers--the five centers statewide--could help move the grant forward. So the coordination and collaboration was almost intuitive because I think the missions on parts of these are very similar. So it’s very exciting, it’s a natural fit and I think out of that we’ve seen some already gains in thinking about transition across the state, avoiding some duplication and so Amy and Tina will talk about that, and I’m here to answer any questions you might have regarding the state program.

Amy Whitehead: Okay, great. Thank you Susan. You want me to put this down? Sit down, okay. Okay. I’ll try to sit down. All right. I want to first acknowledge MCHB and thank them for the opportunity for the Wisconsin Healthy and Ready to Work project. We just have gained so much from this project and we will share that with you today. But we so much appreciate that opportunity and I want to acknowledge Patty Hacket, she’s given us so much support as a national resource over the years and also acknowledge Susan Uttech in our state Children With Special Healthcare Needs Program, which designated us as an applicant and made all of this possible. So with that said, I’d like to introduce myself. I’ve worked at the Waisman Center for the last 14 years, which is a university center for excellence and developmental disabilities at the university. And I got into this field because of my son Charlie--this is Charlie, he’s now 20--and I started out in early intervention when Charlie was little and I’ve just followed--my career path has followed his life. And so I just want to--I’m very passionate about this topic of transition on a number of levels. I wanted to share that. What I’d like to do, and what we will do in this presentation is give you a background of Wisconsin Healthy and Ready to Work and really describe the model that we have developed, as you know, it’s a four-year model demonstration project, we’re about halfway through it. so I’d like to describe the model and then really provide all of you an opportunity to reflect on what’s happening in your own state and give you a chance to think about how you’re currently addressing transition and if there are also some ways that you might think further about enhancing transition activities in your home state. Okay. So when we first thought of applying for the Healthy and Ready to Work grant, what we really looked at is how would we integrate transition activities into our current Children With Special Healthcare Needs Program. And we came from the view that in Wisconsin there wasn’t a lot happening around adolescent transition. Susan showed you the map, it’s a large state, there were pockets of activity, but really there wasn’t uniform work being done in this area, so we really saw a gap not only in the state, but also within our center for excellence at the university. No one was addressing transition, we have a very strong birth to three effort. We have a lot going on with adult services, but no one was addressing the youth. And you all have copies of the handout that Patty brought around, the performance measures, and the sixth one, I’m sure you’re all familiar with, is that all youth with special healthcare needs will receive the services necessary to make appropriate transitions to all aspects of adult life, including adult healthcare, work, and independence. So when we first thought about developing a model, we researched the literature and we tried to get our hands on everything we could around transition. We talked to a number of people, we talked to the people who had previous Healthy and Ready to Work phase one grants and we tried to collect all the information we could on adolescent transition for youth. And from that we pulled out several key elements that were consistent across all of our research that really tie into transition and we created a model using these key elements. So these are the elements that we identified, person centered, family centered, medical, home, community, commitment, skills and knowledge, statewide linkages, and continuous evaluation. We learned that these kept coming up as primary elements of transition and if you look at other people’s work they might be called different things, but in general as I go through these you’ll recognize them as the common themes. And then what we did, as part of our preparation for Healthy and Ready to Work, is we assessed these elements in terms of what was happening within Wisconsin, around these. We looked at are these things happening, if so, who’s involved in and what’s the breadth and depth of involvement and where are things happening and how can we build on those? And because Wisconsin is such a large state, what we found is there might be a really great activity going on in Milwaukee county, but no one in the western part of the state would know about it because it’s such a large state and people often don’t have money to disseminate or do outreach. There was some things happening, but no one knew what each other was doing. We also looked at what was our Children With Special Healthcare Needs Program doing in relation to this and what is the mission of our Children With Special Healthcare Needs Program and we saw there was a really good fit there. We also looked at our partner programs to see who was doing what. For example, the parent training and information center, the PTI is doing some work--was doing some work around transition as it relates to the Individuals with Disabilities Education Act and what should be on the IEP and that sort of thing, but they weren’t really touching on the health piece. So we looked at what was going on, what was missing, whose job is it to do the education piece, whose job is it to do the community piece and so on. And what we came up with is a taxonomy, or a model, for adolescent transition, and it’s based on these elements. And I like this quote from John Muir because it says, “When we try to pick out anything by itself, we find it hitched to everything else in the universe.” And this is so true of adolescent transition, that it’s so connected. So when I describe the model in the next period of time, I will isolate each of those elements, but I want you to keep in mind that they’re all interrelated and we’re really looking at people as whole people, not as separate parts. Okay. So now I’d like to describe each element and to look at how we’re working with that element within our Wisconsin Healthy and Ready to Work project and then give you a chance to reflect on what’s happening in your state and hopefully what you’ll come out of after the end of this presentation is some ideas about how, in your own state, you might replicate parts of this model, or at least it might give you some ideas to build on the activities that you’re already doing. So the first element is the person centered, family centered element and MCH and Children With Special Healthcare Needs Program has a long history with being very committed to family centered care. The past Surgeon General, Everett Coop, articulated the principles of family centered care and that’s been just crucial to the whole movement in moving forward for people with special healthcare needs. The adult arena has done a lot with promoting self determination and person centered approaches and the whole self directed services piece. So we saw an opportunity with this project to really marry those two elements and come together--bring together the person centered piece and the family centered piece, and I’d like to say that hasn’t been without tension. There’s a certain amount of tension around that because as the youth get older there’s a push to have them be more independent from their parents, but we have the parents who have been strong advocates all along the way and may not be wanting to push their kids to independence or whatever. One of the examples that we’ve seen is we heard from our youth--we were planning a training for some youth and we had a lot of discussions with youth about what should this training look like, and in the end the youth really thought it should be no parents allowed. So we organized the training and it came out that several parents were very upset about this “no parents allowed.” And we still had the training with just the youth, because that’s what they told us they really wanted and it was in a very safe environment and we worked through it. But there have been things like that that have come up that have shown us there’s a certain amount of tension between these two approaches, but we are trying very hard to blend them. I like this quote, “If people don’t have their own vision, all they do is sign up for someone else’s, the result is compliance, not commitment.” So we’re really working on involving the youth. One of the ways that we do this is working with individuals themselves and we’ve been very involved in a person centered planning approach called the PATH, in fact, the star in the upper corner of the slide is part of the PATH process, because in a path--are any of you familiar with the futures planning process, PATH? You know, it’s a group of people sitting around someone’s living room and really helping the youth with the special healthcare need to identify the North Star, and that’s the star, where do I want to go? You know, I want to be a singer in the band. Okay, how are we going to help you to get to that point? What are we going to do in the next three months? What are we going to do in the next six months? What are we going to do in the next year? And who’s going to help you to get to that point? And so it’s very much focused on the individual, but the family’s there helping to brainstorm and assist the youth in thinking through what he or she would like to do. We’ve had PATH trainings where family members have participated in the trainings and children with special healthcare needs staff. So as a result we have our regional center staff ready to replicate the trainings and carry on after Healthy and Ready to Work is gone. We also have family members facilitating the PATH process for other family members and we hope that that will sort of bridge the person centered, family centered approach. One of the ways that we’ve stayed very involved in thinking about the person and the family centered approach is to involve a lot of youth and young adults in our project, and we’re privileged today to have Tina Sanders here with us. Tina’s been very involved in our young adult advisory committee and she’s been involved in other aspects of Healthy and Ready to Work, so she’s going to tell you a little bit about herself and her involvement. Tina?

Tina Sanders: Well, first of all I would like to thank Healthy and Ready to Work and Tom Gloss for asking me to come and talk to you guys. And as Amy said, I’m going to introduce myself. I am a 25-year old student at MATC, which stands for Madison Area Technical College. I live in a small town of 1,000 people and I also have two sisters, one is a twin and one is an older sister, and my interests include science, ocean life, history, and just basically learning anything and all that I can. Why did I get involved in Healthy and Ready to Work? To make a difference in the future in the disabled community, not only to make a difference but so I can learn when I wanted--when I get my teaching degree, so I can teach them how to make a difference in their own lives. And one reason I want to teach and help people with disabilities is to help them avoid some unpleasant high school experiences that I have had. One that has really stuck in my head was when I was in high school. I was on a fieldtrip with five students and a teacher and there wasn’t enough people to take a school bus, and so what we decided to do was take the teacher’s car. And so we got done with the presentation, or the fieldtrip, actually, and what ended up happening was everybody was starting to get hungry because it was around suppertime and so everybody stopped at McDonald’s, I think it was. I don’t quite remember where we stopped, but instead of the teacher taking me out of the car, she left me in the car while everybody stayed in McDonald’s, having their supper and so I ended up having a cold meal. And then I got home and I told my mom and dad about this, and when confronting her they said--well, what she said was the reason I did not take Tina out of the car was because I was too tired to take her wheelchair out of the trunk, and I personally do not think people have the right to treat people like that, and that is one of the reasons that I got involved with Healthy and Ready to Work and want to become a teacher. Why do I think it’s important for younger adults to be involved with Healthy and Ready to Work? Well because they bring an important perspective to members of the disabled community and also what might seem important to someone that is not disabled or is an older disabled person might--it might not be important to a young disabled person. Their opinions give organizations insight and knowledge of what is really needed to make life better for the disabled community, for example, SSI. When getting something from SSI, I read it, I feel like I am reading some kind of lawyer language and then also, trying to get a job while on SSI is--I find it to be really hard because my experience is they’re, like, well, you can get a job, but you can only work so many hours without it affecting your SSI and when you’re on SSI it’s really hard to, you know, actually get out on your own because it’s a very limited income and so it’s just like, it’s not really worth getting a job and being on SSI. And so if younger adults are involved, it will help to get their concerns to organizations that can help and maybe some of their concerns can be addressed, and this is why I think it is important for younger adults to be involved in Healthy and Ready to Work.

Amy Whitehead: Great. Thanks Tina. What we’d like you to do now is just turn to the person at your table and just take a minute to talk about how your state program is already involved in the person centered approaches, or whatever project you work on and what’s in place already or what needs to be in place to make this happen, and then we’ll share. So just take a minute and think about that and talk to the person next to you. Okay. If you could wrap it up, I know it’s not a lot of time. Could we have a couple people who would share what’s going on in their states? Will someone raise their hand? Do we have a volunteer to share something in this area? Yes?

Unidentified Speaker: The only thing I know of systematically of what’s happening in my state, Rhode Island, is the on the IEPs, you know, have a component of transition, we reflected on the IEP and when that starts, I think at, like, ninth grade and tenth grade, you know, and we’ll follow through with it. And I was just saying that lots of the efforts that are happening there are hit or miss, you know? It’s not a systematic approach.

Amy Whitehead: Great. Okay. So the IEP, that’s something to build on, that there is something there and how could we build on that. Anything else? Yes?

Kathleen Fisher: I’m Kathleen Fisher, we’re here from Arizona, and in Arizona we have a variety of programs, but in particular, with my office, the office of children with special healthcare needs, which is in the department, our department of health services. We have several programs, but one thing in particular has been a large program called children’s rehabilitative services and it serves 0 to 21. and there are now some well defined guidelines for transitions that are actually in the contrast and we have used that or paid use on my staff that actually do a lot of the training with these contractors that provide (inaudible) out in the communities.

Amy Whitehead: Okay. Great. Another idea. Good. All right. Thank you.

Tom Gloss: Could you just repeat and summarize that so he’s got--because she didn’t have her microphone?

Amy Whitehead: Okay.

Tom Gloss: Just summarize what she just said.

Amy Whitehead: Well, in your--I might not, it was very detailed. You’re using youth to train and it’s currently through your Maternal Child Health Program, is that right?

Kathleen Fisher: Yes.

Amy Whitehead: Okay. As all of you are very much familiar with the medical home, the outcome we’re looking for is to assure that all youth with special healthcare needs have medical homes responsive to their needs. And I think all of you are familiar with this and what we’ve learned in Wisconsin that we value the importance of going beyond the clinic visit with the youth and the physician, the medical personnel and looking at a much broader array of issues relevant to health. Transition is a process, not an event. The actual process should be gradual, occurring in harmony with adolescent and family development, while there’s not one current model, whenever it occurs, communication among pediatric and adult providers, parents and youth, is critical. To address this element in Wisconsin with our Healthy and Ready to Work project, we early on brought on a medical consultant, Dr. Bill Schwab, and this has been very helpful for us to have someone on staff who understands the concepts of medical home from a physician point of view. And Dr. Schwab has been helpful in really helping us to understand what the challenges are with medical home and what are some of the strategies to try to implement change. One of the examples I’ll give is that as we’ve gone around the state with this Healthy and Ready to Work project, we’ve always asked people, is there any kind of information you would like that would be helpful for you? And one of the surprises to us is that we are asked over and again to provide information about guardianship and alternatives to guardianship. So we are doing a training this spring north of Madison, and a physician called us up, a local Madison physician, and said, “I really want all my residents to go to this guardianship training, but it’s too far away and the date doesn’t work. Could I work with you to have a guardianship training for my residents?” So we were thrilled and we worked with this physician to setup a training in Madison at a time that worked for everybody for these medical residents and other health professionals. And our medical consultant, Dr. Schwab, and a lawyer, who’s an expert on guardianship, did the two-hour session together and really educated physicians about the importance of their role in educating youth and families about decision making authority. What we found in going around our state, and I’m not sure how it is in your state, but that people are not necessarily getting the information they need around this and we have kids who are young adults living at home and the parent’s don’t have anything in place legally in terms of decision making authority. And it’s one thing if they’ve decided not to put anything in place, but we’ve found that people just haven’t addressed it. And we have promoted the idea to medical doctors, that they can play a key role in educating families and youth about this, especially now with HIPA and hospitals are becoming more and more conscious of following all the regulations, so when you go to admissions if your child is over 18, they’re probably going to want to see some paperwork on guardianship or power of attorney or whatever, if that’s necessary. So we’ve been working with the medical community through our medical consultant to try to increase the knowledge about the importance of decision making with the youth and families. That’s just one example. We are working with our medical home learning collaborative and on Friday I was in northern Wisconsin and gave a presentation on how medical practices can really support youth. And you know what? In a lot of ways their role is very much like our role at Children With Special Healthcare Needs Program in terms of being facilitative and making those connections between different parties and really informing, providing information to the youth and families, and then the empowerment piece of promoting youth independence and independent decision making and self determination. So I think there’s a lot that we can do in there that doesn’t necessarily cost a lot of money, it’s more having the staff time and expertise to meet with medical professionals and share with them some ideas about how they can play a facilitative role in this process. We also are working on a curriculum that trains youth to be more involved in self directed care. With all of these, what we’re really looking at are four things. The first is that youth, that all people--that you should know your own condition and the treatment that you’re getting for that condition, if you’re on certain medications, the names of those medications, and then second, to be able to tell that somebody else, and third, to increase the amount of direct contact with the medical personnel, depending on your special healthcare needs, so that you’re talking directly with the medical personnel as much as possible. And then, lastly, that move from pediatric to adult healthcare really being an important one and something that should start very early. Okay. So we’re going to give you two minutes and if you want to turn to your neighbor and talk about what you’re doing in your state to promote the medical home around transition for youth and what’s already in place, what’s working, or what seems to be challenging about this. Okay. Okay. I know this is quick, but we want to cover a lot of ground here. Could we have a couple volunteers to share what you’re doing in your state and I’ll try to paraphrase it. Yeah?

Unidentified Speaker: I’m from Rockville, Maryland, and we’ve developed what we think is the most important component, number six, which is medical home.

Amy Whitehead: And how have you developed the medical home?

Unidentified Speaker: Okay, well we certainly think in the medical home program in MCHP that (inaudible) activity to take (inaudible) place all through the lifetime.

Amy Whitehead: Yeah.

Unidentified Speaker: Of a child with special needs so it’s a natural fit.

Amy Whitehead: Great. Okay. That’s a really good point. So they’re looking at the developmental nature of transition, how right from the beginning of life there’s some things you can do to prepare that individual for the eventual transition during the adolescence. Okay. Anyone else like to share? Yeah?

Brian: Brian from Ohio. I just want to share a problem that we’ve discussed. A real challenge that we find in Ohio, and then Hawaii shares this problem, is that transition from pediatric care to adult care and from pediatric to family practice. And we’re still very much challenged (inaudible) it’s a huge challenge for us.

Amy Whitehead: Yeah. The challenge of moving from pediatric to adult healthcare seems to be huge. I know, actually, today as we speak, John Rice is meeting with Children’s hospital in Milwaukee in Wisconsin to address that and that hospital has looked at how to do that. And it’s a process and by clinic, like the HIV clinic is doing a lot, the peds clinic is doing a lot to pair with the adult HIV clinic and it’s those one to one relationships and meetings and discussions and it’s a process, and we’re seeing it happen clinic by clinic in Wisconsin. But I appreciate your comment, it’s a struggle. Yes?

Unidentified Speaker: (Inaudible) from Massachusetts and we are working through our medical home (inaudible) and having our state paid care coordinators in practices, but we’ve also been using some of our CC funds in our office on helping disability to identify in champion practices have successfully transitioned youth. And we are doing interviews with them to see what are their practices, you know, what are the things that they’re identifying as helping them to be successful in transitioning youth. And we’re doing that in collaboration with our constituents for children with special healthcare needs, but also really looking at our position, which is across the lifespan and we have initiatives across the lifespan. So we’re just trying to piece little pieces of the community together to really look at this really tough issue and I think that looking at healthcare transition is one of the hardest cases because there are so many other issues that families are dealing with that their healthcare has been stable for a long time and so they’re not really, you know, they’re looking at moving out of the school system, they’re looking at that community (inaudible) and some of the other major life issues, that healthcare, you know, you just want to leave that alone right now, because you finally got that in order. So that’s one of the things that we’re looking at and we’ve found that there aren’t--there’s some adult practices that do it very well, but they’re far and few between and then there are pediatric practices that really don’t want to let go of the kids, and then there are the families who don’t want to let go of the pediatric practices. So it’s a multiplicity issue.

Amy Whitehead: Yeah, it’s that John Muir quote again, you can’t separate out just one thing. Everything’s hitched together. I think though--just, did everyone hear in Massachusetts, the idea of diversifying your funding, your Children With Special Healthcare Needs Program might not have all the funds necessary for this, so looking at other funding sources, Massachusetts looking at CDC and other sources and also finding some really exemplary practices and examples and then disseminating that and holding those up as champions or examples for others to follow. Thanks for those comments. Okay. The next element is the asset based community development element. Actually this term was coined by John Kretzman and John McKnight at Northwestern, and they have a whole institute on community development and have done a lot of work in this area, and they’re really looking at the non-traditional partners. They’re not looking as much at service delivery systems; they’re looking at those local grass roots activities. This quote is from one of their books, it’s “Communities growing in power naturally or intentionally identify the capacity of their members. However, the most powerful communities are those that can identify the gifts of those peoples at the margins and pull them into community life.” This is really a strengths-based model. This model is built on the assumption that communities are loaded with strengths. That there are people in those communities who have strengths and organizations and they may be visible or they may be hidden, but they’re there. It’s built on the assumption that people intrinsically want to give and intrinsically want to make a difference in the world while they’re here on earth. So the idea is that there are people out their waiting to give, and it’s tapping into that and capturing it that can make a difference with this population. I’m going to give you a couple examples from my own son, Charlie. One is when he was 16 on his IEP it said he would get a job. So he and his teacher went down to the union, to the employment office and he’s there filling out some forms with the teacher and a man walked up to him and said, “Oh, are you looking for a job?” And it was like, “Yes.” And he said, “Well, I’m--I’m looking for someone to work in the catering office at the union and would you be interested in doing clerical work?” Now, the Memorial Union is like the coolest place for a high school student, because it’s where all the college kids go, so the idea of working on campus was really exciting to Charlie, and it happened, it’s like a connection was made. I’d like to give you another example of a connection, again, from my son’s example where he in his Norstar, he wants to be an artist. He has taken a lot of art classes, has all these paintings, and they’re sitting in a portfolio. And, I’ve been saying, “Charlie, you know, the next step is you’ve got to start packaging your art and selling it. You can’t just keep painting, painting, painting, you’ve got to do something with it. You know, if you want to be an artist, you’ve got to sell your art.” And we’ve sort of hit a dead end with that. So the nurse, the school nurse at his high school, has been very involved along, wonderful person, and she was sitting at lunch at West High with the math teacher and she mentioned about Charlie’s art. And the math teacher on the side is actually a professional photographer and he sells his photographs and he shows his photos in art fairs and that sort of thing, and he said, “I’d love to help Charlie frame his artwork.” So another connection’s been made. And now Charlie and Mr. Lang and I are working on getting Charlie’s pictures framed, and it’s a community connection, there’s not money being exchanged or anything like that. It’s just that two people talked and a connection formed and it led to something happening. So these are examples of what we’re looking for with the asset based community development model or element. And part of it is going into local communities and saying, “What’s already there? What can we build on?” And mapping that out somewhat, looking at the connections that are already in place and the partnerships, things that are already happening, especially around shared values with maybe faith communities being a good example. And where are people feeling a sense of belonging? So, how can the Children With Special Healthcare Needs Program be involved at such a grassroots activity? And this is how we’ve been doing this. And it’s just, I have to say, a really exciting part of this model and I think it’s very doable for any state. The first thing is working with our children with special healthcare needs staff in the regions, because we have a large state, we can’t possibly know the personality of all the different parts of the state, but the regional centers help us identify the communities where there already is a certain amount of activity, already there’s some sparks of excitement and interest, and they’re movers and shakers. So we go into those communities and we try to help facilitate some of these community connections. I’ll give you one example, in Iowa County, which is just west of Madison, we did the PATH process with several youth, that was the first step. And then, from the PATH process, we learned that these youth actually were feeling a strong sense of social isolation. And so part of the PATH in futures planning was how can we get you more involved in some kind of community activity or social activity? And from that, another thing that came out is the parents were feeling like it wasn’t safe for their children to be alone out in the community and a lot of them had their kids in a sheltered workshop and were really, you know, very leery of their kids going out and doing things. They were very much protecting their kids, which is understandable, but what we ended up doing in response to that is we worked with a consultant, Deidre Haffner, to do a six-part training called “Safety in the Community.” And Deidre has done this training for a long time. It’s two hours for six weeks, every week it’s two hours. And she worked with youth on everything from what do you do if you’re home alone, you lock the door, to self defense to taking care of your own personal space and what’s safe touch and sexuality and those sorts of things, and she worked with them through the fall semester last year, and at the last session they said, we don’t want this to end. They said, "Could we do a part two?” Well, Deidre’s never done a part two. She always just does this part one. So we said, well, let’s give Deidre a semester to sort of plan part two and then next fall we’ll do part two. So we went away for a while and in the summer we came back to that group and we said, okay, we’re now getting ready to do part two in the fall, and it turns out that in between, when we left them in December and July, that they had been connecting on their own and they formed this social group and they’ve gone to baseball games together and they’ve gone out socially, to the mall, they’ve done all these things as a group of about eight kids, in different configurations. And so what we learned from that is that they, actually, what they got out of the safety course, in addition to the lessons, are the social piece. So from there we’re starting to work with them to map what’s in your community. And you can’t see this very well, but it’s one of those business maps of Iowa County, and we’re looking at what exists in your county that would match your interests? So let’s say you’re really interested in food, well, there’s a community SHARE program where people get together and they purchase food together and they distribute it. There’s a, you know, an adopt a highway group, and if you’re interested in working with a group to clean up the highways and all this. So we’re trying to connect now the youth with their interests so they can branch out from their safety group of their friends and also then start connecting with other local organizations that are not necessarily affiliated with anything to do with disabilities or special healthcare needs, but are local organizations that are the heart and soul of America. So we’re really excited about that. And I think, you know, for Children With Special Healthcare Needs Programs, is our role can be facilitative. We can think about how do we facilitate these connections to make things happen. So we have another chance for you again to--why don’t we just have a couple people share what you’re doing within your state, or your organization to promote this idea of local community development? Okay. Yeah?

Unidentified Speaker: In Oklahoma we have one of our contractors is Sooner Success, and specifically they have a model in one of a five-county region where they’re doing exactly this.

Amy Whitehead: Great.

Unidentified Speaker: Their goal eventually is to cover as much of the state as possible with these local community (inaudible).

Amy Whitehead: Excellent. So Oklahoma has this sort of model in place and your goal is to cover the whole state. Is it through the Children With Special Healthcare Needs Program?

Unidentified Speaker: Part of it.

Amy Whitehead: Part of it, okay.

Unidentified Speaker: (Inaudible) funds just a portion of it, not all of it.

Amy Whitehead: Excellent. Okay. So that’s a really good example. I think it’s hard when you think of a large state, and Oklahoma’s fairly large too and then you think of how do you cover the whole state? That’s been a challenge for us, I know.

Unidentified Speaker: Well, and of course, one of things, as you know, usually in the urban communities, you have a lot of resources, but in the rural areas, you don’t, so that’s why we’re kind of starting out in the rural areas, and, you know, we’ll hopefully bring it, you know, down into the urban also.

Amy Whitehead: Great. Thanks for sharing that example. Okay. Any other examples? Yes?

Unidentified Speaker: In Arizona we have a section in our office of children with special healthcare needs office, we have a section of community development and one of the things that we have is again, we have (inaudible) financially supported parents that are out in these rural communities across the state and we kind of work with them and help facilitate to get them to provide some leadership training and then they have grants with us, or not grants, but contracts with us and they work within their communities to connect to providers in their community, the school system, just anybody that would be involved with children with special healthcare needs and they have these parent led community teams that just accomplish a variety of things (inaudible) community wants to accomplish it.

Amy Whitehead: Excellent. So Arizona is doing a lot of this through your Children With Special Healthcare Needs Program with the model that parents are leading these activities. That’s great. So you--when you--you know, after this session, you can all connect with one another to see if you want to follow up and get more information about one of these states. Okay. The next element that we identified for our model was skill development, and that’s based on the original desired outcome, to assure that youth with special healthcare needs participate as decision makers and partners. I think this element is fairly self explanatory. You know, there’s so much to learn. We can always learn more. There’s a huge need for information in a variety of formats in terms of trainings and web-based information and written materials and video and direct phone contact. So there’s a lot that needs to happen. In our particular state, in Wisconsin, as Susan mentioned, our children with special healthcare needs regional centers are set up to provide information and assistance, so this is a nice add on. It fits really perfectly with our particular state. I’d like to just highlight a couple of the skill development opportunities that we’ve worked on here and that’s providing training for youth in different formats. The gathering of youth was the one I mentioned earlier where the youth didn’t want parents allowed in the training. That is held within the context of a two-day families conference that we have had for a number of years in Wisconsin. It’s a wonderful event. It’s a family’s conference and the Healthy and Ready to Work dollars allowed us to add an element to that, a youth track where the youth could then have separate training designed especially for them, but they were still with their families at the family’s conference. Additionally, we helped to support a transition camp, which was held at the University of Wisconsin in Whitewater. For those of you who don’t know, Whitewater is our--we have a large state university system and Whitewater’s our campus that’s been designated as the most accessible campus for people with disabilities and a lot of resources have gone into making that campus accessible. So we held the camp on that campus this summer for a week. And it was an out of home, you know, away from home experience for youth, in high school, to think about their future and think about moving on, transition, it was wonderful because there they were, on a college campus, they got that experience of living in a dorm while they were learning these skills. So we’ve tried to provide the learning opportunities in a variety of formats so that it’s available to everyone. And like Arizona, we’ve done some parent leadership training and then of course we’re doing a lot with the referral and follow-up over the phone for people. So this one is something I think that maybe has been easier for us as a state because our Children With Special Healthcare Needs Program already does a lot of the skill development work. Okay. You want to--could we just get a couple comments from people and what you’re doing in your state relevant to skill development for youth or parents or providers, medical people? Yeah?

Unidentified Speaker: I’m (inaudible), I’m from Alabama, and one of the things that we had, it’s not just with children with special healthcare needs, but we’re a part of it, it’s a youth leadership forum, which I think originally started in California and came through our (inaudible) people with disabilities and we’ve funded that through funds (inaudible) workforce (inaudible) and it’s on a college campus, the kids, anywhere from 15--they’re all kids in high school, and we did take some kids that are out of college, I mean, out of high school, that are still at home and not working. And it’s an on campus experience at Troy State University, it’s one week, it’s a lot of skill building, leadership skill building, look at occupational and then forming opportunities of whether they want to go to college or not. We try to connect them with the local career centers and just see how they could work and try to get them connected back in their home communities and also talk about empowerment, being part of decision making, trying to get them to be part of their IEP decision making when they get back to school and those kinds of things. And then what we do in the CSSU program is some of those youths who are graduates of that, we have a youth advisory committee of seven young people who we actually bring in, we (inaudible) they can come in on a regular basis and work with our adolescent coordinator, give us feedback on how we can do better in our program and how we can help them connect with all these (inaudible) so we’re working on those kinds of things. We’re also trying to take the 2010 express, I know that’s a bad term, but that concept and take it further into a 2010 action plan, and of course one of those goals is, is that transition (inaudible) and we’re also trying to build that into our state plan of (inaudible). So one of the things that we’re trying to do is (inaudible) issues and (inaudible) state level, come up with a state plan, and take it down to the local level. And one of our goals is to build in for every new person that’s fixing to transition out of our program that’s at 21 for us, that we will develop a transition plan that incorporates all (inaudible) also trying to look at doing it with a person centered approach.

Amy Whitehead: Yeah. Great. So Alabama, you’re doing a lot with the youth leadership forum and with the young adult advisory committee and integrating the transition into those activities. Yeah. That’s great. Okay. Fantastic. Any other examples? Okay. Okay. The next element we identified was that of statewide linkages. And this is a quote, “The qualitative difference between collaborating and cooperating is the willingness of organizations, or individuals, to enhance each other’s capacity for mutual benefit and a common purpose. In this definition, collaborating is a relationship in which organization wants to help its partners become better at what they do.” Okay. When we began Healthy and Ready to Work two years ago in Wisconsin, there wasn’t any sort of interagency group addressing adolescent transition. There wasn’t a statewide group. So one of the things that we developed with Healthy and Ready to Work is a consortium that meets quarterly and it’s composed of about--actually, we have about 70 members, 40 or 50 come regularly, people from all different agencies, local community people, young adults, youth, consumers, and we all come together quarterly to share information about what’s happening in transition that you know about either through your personal work or through your professional work. And for a first time it feels like we as a state have a really good handle on what’s happening around adolescent transition in our state because as I mentioned, in the very beginning of this presentation, prior to this, people didn’t know what one another were doing and there were some great things out there, but no one knew about them. So this has just been a wonderful forum for information exchange. In fact, in our October meeting, which is tomorrow, there was a conflict for a couple people with another meeting, and they begged us to rearrange the date because they really wanted to come to the consortium meeting. So to me that says people are really valuing this, we’re getting consistent attendance, we’re having people come to us and ask, could I also join the consortium and it’s not, you know, anybody really can come who’s interested. It’s allowed us to identify the strengths and also the gaps and when there’s a gap we try to figure out how we can address the gap. It’s allowed us to align some initiatives that are really similar. We have a lot going on in Wisconsin right now and it’s allowed us to align some of those initiatives, so it’s been very positive. The young adult advisory group meets alone, but they also are part of this consortium. Just one quick example of an outcome from the consortium, there are actually many, many joint grant writing people working in partnership who didn’t before. I think this is something, and I’d just like to say, for the role of the--the future role of the Children With Special Healthcare Needs Program, it’s really a facilitative role. It’s, you know, we do buy lunch. We buy lunch and we make name tags and that kind of thing, but it’s really bringing people together, so it’s not something that costs a lot of money, and it’s quarterly, we try to bring people together at the table and get people talking to one another. At the very beginning there was a little bit of--at breaks--someone would do a little bit of, you know, DVR bashing or Department of Public Instruction bashing, but we’ve gotten over that and people don’t do that anymore, we’re trying to bring these issues to the table, and it’s just been really positive. I’ll give you one example is that our state bureau of disabilities is working on a functional screen for children. And this is going to streamline the eligibility process so there’ll be a functional screen and then your eligibility for a number of programs will be determined as you enter the system. And we’ve worked with them in conjunction with our Social Security Administration in Wisconsin because Social Security is very interested in streamlining the process for kids getting into SSI, especially at age 18 for the kids who are--we know that they have lifelong disabilities, they’re right now on the Katy Beckett program, which is a doorway into Medicaid for kids whose parent’s income is too high to qualify for SSI so they have to have complex medical needs and then they get Medicaid, basically. So at 18 usually those kids would automatically qualify for SSI, but currently they still have to go through the whole application process and there are a lot of hoops. So we’re working with the Bureau of Disabilities and the University School of Nursing and the Social Security Administration to look at how to use that functional screen to streamline the process of moving kids from childhood services into adult services. So if you qualify for certain things as a child, we can predict that you’ll probably qualify for certain things as an adult and that we can hopefully streamline that so when you hit age 18 there are not all these big bumps in the road and you all of a sudden have to fill out 10 new applications for things, but that we know you’re going in a certain direction in terms of eligibility for programs and we can streamline that. Just as an aside, because any time I talk about getting kids on SSI I can feel Tom’s vibe over there and I want to say that in Wisconsin, for kids with complex medical needs you would stay in school until 21 and there’s that window between 1 and 21 when kids are going to need Medicaid and they’re not working, they’re in school, so we need to make sure that they continue their Medicaid coverage. But we are right on with Tom, you know, we want kids to get as much as they can off of SSI. Okay. So, just again, this consortium has helped us to strengthen our partnerships in a number of ways. We’re feeling the economy and the crunch for dollars, so we’ve been able to partner with some different initiatives to stretch the dollar and this outcome of being in the know has been really important to people, and we’re looking at how we can continue this after Healthy and Ready to Work ends. The youth and young adult piece has been incredibly important, I don’t need to say to all of you, I know you know the reality check piece, the experience and the perspective of youth has been invaluable. I mean, we can sit around in our staff and come up with a great idea and we present it to our youth consultant, and they’re just like, no, that would never work and then we have to go back and rethink it, so we are involving youth all along the way and then the nice part about that is we get a better product, but the youth also get a leadership piece that through that process there’s an empowerment piece that’s very powerful that we’ve seen with a lot of our youth. And now I’m going to turn it over to Tina and she’s going to talk a little bit about how she’s been involved in these statewide linkages.

Tina Sanders: Okay. One of the statewide linkages I have been involved in is statewide consortium on transition which is, like Amy said, a whole bunch of people getting together from different organizations and talking about the issues that are important. And another I have been involved in is the transition camp at the University of Wisconsin, Whitewater, and basically what that was is about 35 kids got to go to--went to Whitewater and they were learning how to basically better advocate for themselves, and what my role basically was, there was to be a counselor. And the last thing that I’ve been involved in is youth transition advisory group and what that is, is a whole bunch of, like seven or so, kids, or young adults, get together and we talk about how we think that things can better be approved so that either we can understand or how we can get these programs, like for example, SSI. You know, some people might not understand, how do you get SSI? How do I get on SSI? And what transition advisory group does--is we talk about how we think it would be better for the people that run the SSI department, you know, we say, “Well this is how we think it would be better, this is how we think that the young adults would be able to understand and how to get onto SSI.” Okay. And Circles of Life conference. I was also a volunteer there actually and from what I was involved in, it was a pretty good experience, like the UW Whitewater camp, it was basically teaching kids how to advocate for themselves in all aspects and teaching them how to, you know, be able to just go up to someone and say, hey, I don’t know how to do this, or can you help me do that, and that’s what circles of life, when I was there volunteering my time that’s what I got out of circles of life conference. And what did it take for me to participate in Healthy and Ready to Work? The encouragement of the Healthy and Ready to Work group at the Waisman Center and all their pictures are up there, everyone that’s involved, and Jenny Wagner, she’s a friend of mine. Martha Mock, Deborah, Amy, and Beth Sweden. I have done presentations and they’ve all said how well of a good job I’ve done and also part of the Healthy and Ready to Work person that’s not in here, but is involved in it, is my mother and she has helped me and encouraged me by telling me what people from Healthy and Ready to Work have said about me that they haven’t told me directly. And what did it take for me to participate in Healthy and Ready to Work is the transportation for my family while working on getting my driving permit and license. And a quote that I think that is really powerful is, “Everybody thinks of changing humanity and nobody thinks of changing himself.” And the reason I think that this is a powerful quote is because it really talks about what Healthy and Ready to Work is all about and if you really think about it, people would rather change humanity instead of thinking about better ways of changing themselves.

Amy Whitehead: Great. Thank you Tina. What we’d like to do is just take a minute, you can turn to your neighbor and think about how your state Children With Special Healthcare Needs Program has been involved in these statewide linkages, or are there some things that need to be in place to make those linkages happen or what are some challenges to making those happen. Yes?

Unidentified Speaker: Can I ask one question first?

Amy Whitehead: Yes.

Unidentified Speaker: Your statewide consortium, is it just a state agency, or does it include private care organizations and business organizations and private practices?

Amy Whitehead: That’s a good question. Did everyone hear the question? Does the consortium broaden itself beyond state agency types into the private sector? That is the goal. We feel that the strongest part of the consortium right now has been key stakeholders who may have transition as part of their mission, or they want to have transition as part of their mission. We have reached out to the business community and to the more informal, non-traditional representatives. We definitely have the consumers and the youth and the parents there. To be honest, it has been more of a challenge to get the business people involved, but it’s definitely on our radar screen, we’d like to see that happening. We’re trying to figure out how to best do that. We do have one consultant we’ve worked with who’s in the business community and she’s someone who sort of goes between the two worlds because she’s employed a lot of people with disabilities over the years and then she was involved in making a video about how to support individuals with disabilities in the workplace. So she’s someone we’re working with and courting, if you will, to try to get more business people involved, but that is something that we are not--I can’t say that we’ve achieved that goal at this point. I hope after the four years that we have achieved that. The other group we’re really looking at is getting more people from faith communities and some of the more local organizations coming consistently. And what we’re trying to do at this point to address that is invite people around a particular topic so each consortium meeting has a topic and then make sure that the person we’re inviting, who might be a little more distant at first from the group, that that person would have a role, like they do a presentation about their experience in employing people or from the health perspective. So we are working on that, but we have not reached that. Good question. Okay. You want to take just a minute and--why don’t we just share as a large group. Do you have--have other people been working on statewide consortiums of some sort or another? Or there have been things in place in your state? Yes?

Unidentified Speaker: In Massachusetts our consortium for children with special healthcare needs has really been a real central factor in our success. And one of the areas that we’ve really made great strides in the last year is bringing health plans into the consortium, the major health plans in Massachusetts all send a representative to the consortium and they are sitting on various subcommittees, you know, being transition or medical home or the medical necessity (inaudible) subcommittee and various other ones and that has really--it’s really been beneficial in Massachusetts as we struggle with how we identify children with special healthcare needs and in the state and in the practices and we’re re-looking at our directions manual for families to get them out and the health communities are going to agree to pay for it, the manuals and we haven’t figured out the strategies for dissemination yet, but that’s been a real strength the consortium in our state has really brought together consumers and state agencies and other organizations and it’s just really a very dynamic and involved group.

Amy Whitehead: That’s tremendous, Massachusetts is involving health plans in their consortium and it’s a well-established consortium. I remember hearing a presentation on it last year in June at the meeting, the children with special healthcare needs meeting. So that’s a great model and we’ll have to talk and get more information about strategies. Yes?

Unidentified Speaker: Kind of just to add to that, (inaudible) next week that consortium’s going to be meeting actually getting--doing (inaudible) presentations of some national data that we’ve been collecting around cost of (inaudible) children with special healthcare needs so, you know, it’s a good example of how things happen at the state level and things happening at the (inaudible) level and how (inaudible).

Amy Whitehead: Great. All right. Good. well, we’ll look forward to hearing from Massachusetts more in the future too and hear what you’re doing. Okay. The last element is continuous evaluation. Not everything that can be counted counts and not everything that counts can be counted. And we are--in Wisconsin we are collecting data in all sorts of ways. We have people keeping journals about the community work. We do session evaluations after trainings. We’re interviewing people. We try to respond to evaluation data as we get it to keep refining the model so that we’re responsive to what we learn and hear. I mean we are in the process now that we’re halfway through Healthy and Ready to Work to think about how we can describe the model and really wanting from you, to know what you need as state programs. Actually I’m going to pass out a form and in the last 15 minutes or so, if you could, just think about some things that would be helpful to you and your state around looking at adolescent transition and how to integrate it into your Children With Special Healthcare Needs Program, we’d appreciate any information that you have because we’re getting ready to think about how to disseminate this information and we want it to be useful to other states as well. Just back. The other thing that we’re doing is we’ve worked closely with Susan and the state Children With Special Healthcare Needs Program to look at how we collect data and the data has a brand new data system called Sphere and it’s really wonderful, it’s all web based and we’ve worked with the state to make sure that the transition questions that are on there are in keeping with what we’ve learned. So I think that’s another example of how to work with the state Children With Special Healthcare Needs Program around this to make sure you’re collecting the data that you would like to collect. Okay. I think given time, we’re just going to move on. Just to review, I also have another handout I’d like to give you that has--it’s actually one from the national center (inaudible) and this handout is “Promoting Transition, 15 Things Title V Programs Can Do.” So I tried to share with you today, and Tina, and Susan, and Tom, we’ve all tried to share with you the model from Wisconsin and the way that identified elements and how we’ve gone about addressing those elements and assessing them and thinking about the role of the Children With Special Healthcare Needs Program in that and then these 15 things your Title V programs can do is another way of looking at that and you’ll notice when you read through it there’s a lot of overlap in how we today describe these six elements and how these 15 items are articulating on that sheet. And we’re really I think saying the same thing, that there’s some core activities that can be addressed in order to improve adolescent transition. Okay. Any other comments or questions or thoughts? Yes?

Unidentified Speaker: At what age do the kids start participating in the advisory committee and what’s your youngest?

Amy Whitehead: We’ve had one youth started at age 11, when we began the project and he was our youngest participant, and then it’s from 11 to I’m trying to think how old, maybe our oldest one is about 19 right now or 20. we, you know, just a comment about that, they keep getting older, so, you know, we are constantly looking at bringing new kids on and what’s come out of that group, I didn’t mention this, is the youth now want to be led by the youth. Originally we had Julie Sipshon from the national CASA project leading the group, but the youth said we want to lead ourselves, so they’re in the process of having a youth leader facilitate the meetings and plan the meetings, which is really exciting. We still need to get their input into our project, but it’s really nice that they’ve sort of taken control of how those meetings will be run. But we do try to get an age range with the kids and we try to make sure there’re different kinds of special healthcare needs, so we have everything from a young woman who has kind of significant, really, life threatening allergies and asthma to kids who use augmentative communication devices and are nonverbal. So we’ve tried to have representation from a variety of conditions so that it’s really broad. Okay. Any other comments or thoughts? Okay. I wanted to mention, the National Healthy and Ready to Work initiative, through MCHB and Patty and Cynthia are here today and they’re great resources, do you guys want to hold up your hands? Did we lose Patty? So if you have questions, their website is wonderful, they have lots of resources and I encourage you to go on that website and it will have links to all different sorts of things, so that’s really fantastic. And again, just in closing, I want to again thank MCHB for this opportunity today and for the Healthy and Ready to Work project and I’m going to turn it over to Tom to close.

Tom Gloss: Thank you Amy and to Tina and to Susan. I’m grateful for your participation in this session. Wisconsin is one of five phase two Healthy and Ready to Work projects that’s currently running. The others are in Arizona, Iowa, Maine, and Mississippi and the Kentucky project just ended. So material about all of those projects is available on the hrtw.org website, encourage you to check that out. For the future what we’re looking for is these were demonstration grants. We will not be doing more demonstration grants in this area. We’re moving towards implementation. So those of you from states that didn’t get a demonstration grant, we’re hoping that you will take these tested models that came out of the grants and put together your unique programs in your states. What we expect to have is some sort of technical assistance, so I can’t talk about dollar amounts or whatever, but if you’re starting to put together something, some program and you think you could use some technical assistance money, give us a call. And we’re trying to work on those things and we’re starting small, but as these projects end, that’s what I expect will happen, is we will move towards smaller amounts spread out to more people to actually technically get your program in your state going. Not to test models, we have tested models, and you should be able to pick something if not the entire model or methodology that Wisconsin tested, something from Wisconsin, and something from Kentucky and something from Arizona, and put together your own program that meets the needs of your state. So obviously, as they’ve said here, first you need some sort of needs assessment. You need to know what’s going on in your state and where the gaps are. That comes from talking to the youth and the families, they’re the ones who can tell you what’s working, what’s not working with transition. So that’s the first step. The other, you know, Amy’s outlined for you what they went through and if you take what she said, her presentation in context with that first handout I gave you from the National Center, that has the six core elements as they relate to transition. Transition is one of the six, but we can’t do transition without the other five. So they’ve taken all six core elements and put in concepts of transition and if you go through there and with Amy’s presentation you ought to be able to get some semblance of how does this fit in our state? How does this work in our state? What’s not working? And I would strongly suggest if you don’t already, have a parent and youth advisory, and whether you have them together at first or just right from the beginning separate them out, you hear there’s a learning curve and a growth that goes on, and eventually the youth want to be their own leaders and their own thinkers and talkers. And as you get to work with them, and Tony Wall from Maine always says, you know, she was really nervous about starting that process with the kids, she was really afraid of it, but once she got in there and started dealing with the kids, she learned how helpful they are, how the youth really know what they need and what they want. They’re great spokespeople for themselves. You can take them up to your legislators, you can take them and--or let them take you and do their presentations and talk about what they need and what’s working, what’s not working, and as she says, they keep her young. And she’s found more in common in fact that they like the same kind of music and they have lots of things in common, so it’s not such a scary proposition. Tina doesn’t look scary, now, does she? Did she scare you? No. No. And we appreciate all the growth that everyone’s going through and the willingness of the states to take on this initiative, the time has come, the youth are looking for their futures and that’s what we’re about is helping them make that successful leap to their futures. So if you have any questions or thoughts or concerns, please, please, please contact us. And also, please do your yellow evaluation sheet for this session. I know this is the best session of this entire conference and you will reflect it on your evaluation form. Can you join me in giving a round of applause for our panel members please? Thank you so much, you can drop your evaluation sheets off here and the next session starts at 3:45.