Category Archives: Continuum of Care

It’s a beautiful day in the neighborhood!

 

Therapy Garden at Fircrest

 

 

Today was a wonderful day in the neighborhood.  I have been volunteering frequently in the community gardens at my son’s supported community.  As I spend more and more time on campus I see more and more how strong and supportive the community is.

Today I had 5 residents from 3 different houses helping fill the watering cans from the rain barrels that have been collecting rain water, planting peas, parsley, carrots, and watering the strawberry plants that we planted last week in the new strawberry field.  In addition to this we all sampled several varieties of the tasty greens that we are growing – the favorite is the Ruby Streaks Mustard Greens and the Tatsoi – an Asian green that is crisp and mild.

We then cleaned spruced up some gardens which have a huge dill plant and then weeded around the raspberry plants which are rejuvenating.  Next on the list was to water the blueberry grove which also has lots of onions and garlic growing around the perimeter.  It’s great that some of the residents have really taken on ownership of these gardens and the watering!

While I was there today I know that residents from two households were going to go to movies – different movies at different theaters and some others were going to go out for dinner.  Many were out walking and enjoying the weather and it always amazes me that everyone knows everyone else and they watch out for each other.

I also witnessed a support team call  - in this community there is always the opportunity at any moment for a crisis to erupt given the high intensity and support needs of most of the residents here.  When a support team call goes out there is extra staff that respond from various houses to the house in need to add extra support to manage whatever crisis has or is occurring.   When there is this type of support in a community it alleviates the need to call 911 for police to respond because the staff are familiar with the residents and are trained to manage the types of behaviors which typically cause a crisis.

It is shameful that many people, included those who call themselves advocates for people with developmental disabilities, push to close these supportive communities.  One reason they do this is because they are clueless as to the benefits of a supportive community for those who need this level of care.  They call these communities ”institutions” because they have not visited recently and have a pre-conceived ideas in their head that if these residents were dispersed, away from their friends and supports, they would be much better off!  They use incomplete information to say that the supportive communities are too expensive.

It’s such a shame that those who push to close these supportive communities refuse to visit and refuse to look at complete and accurate data regarding the cost, supports and services – comprehensive and cost effective and SAFE!

I do know that I enjoy spending time at my son’s community.  It truly is a “neighborhood” where everyone knows your name!

 

 

 

 

 

 

 

 

 

Entitlement?

We hear over and over that the Intermediate Care Facility for those with Intellectual Disabilities (ICF/ID) is an entitlement – but what does this mean in real life?

One would think that if something is an entitlement that it would be there for you when you needed those services   Not so with the ICF/ID and in the state of Washington, the ICF/ID is not available to you if you are 21 or under.

Recently I had a conversation with an executive director of an adult family home which is licensed for adults with developmental disabilities.  In talking about the experience that our family  went through in order to have our son admitted to the ICF/ID for lifesaving care,  this person was horrified.

She had heard that the ICF/ID was an entitlement and was very confused by our story.  She had no idea of the struggles and crises that most families and individuals have survived in order to be lucky enough to utilize this “entitlement.”  She then stated that she needed to hear these stories because she had believed that the ICF/ID was an entitlement not realizing that it is really far from that in real life stories.

Listen to the stories of families who are the survivors.  Of the many, many families that I have had contact with and of the stories I have heard, not one has had the ICF/ID offered to them as an entitlement.

In fact, after a long meeting with my son’s case-manager and the Children’s manager for the Division of Developmental Disabilities to discuss discharge planning from one of his many prolonged hospitalizations, I overheard the DDD manager say “Don’t offer them anything!” as I left the meeting.

What they did offer was for us to call 911 for his next crisis since the Regional Service Network Administrator had indicated that he would not approve another admission for our son since “he was not improving with treatment.” Doesn’t that mean that he needs more help and maybe ought to be able to take advantage of his “entitlement?” DDD didn’t think so.

Obviously with respect to the ICF/ID, the definition of “entitlement” is different and does not mean a guarantee of access to benefits based on established rights. It seems to mean fight until you are almost dead, endure abuse, be jailed, or many other horrible scenarios before you may be “entitled” to access appropriate care in the ICF/ID.

People need to know the stories of our survivors.  Please share yours.

 

Let Your Voice Be Heard

The National Council on Disability (NCD) is an independent federal agency charged with advising the President, Congress, and other federal agencies regarding policies, programs, practices, and procedures that affect people with disabilities.
NCD’s quarterly meetings are open to the public. People and organizations that represent the interests of people with disabilities are encouraged to attend these meetings, in person or by phone. The next NCD meeting is April 22 – 23, 2013 in Washington, D.C. The focus of this meeting will be NCD’s future “Policy Roadmap.” Families living in the D.C. area are encouraged to attend in person or you can join the meeting by phone (download the agenda, with location and phone details, here).

 

Next Phone & In-Person Public Comment Opportunities

April 22 – 23, 2013 during the NCD Quarterly Meeting

NCD will host two open public comment periods at its upcoming quarterly meeting on April 22-23, and we’d love for you to share your insights with us about emerging issues or other concerns on which you believe NCD should focus its attention.

For the two open public comment periods, statements will be received on any topic on a first-come, first-serve basis by phone and in-person. The first 30-minute open session is Monday April 22, from 4:45 P.M. until 5:15 P.M. ET and the second open session is Tuesday April 23, from 11:45 A.M. until 12:00, noon ET.

On Tuesday, April 23, NCD will hold an additional public comment period from 9:30 – 10:00 A.M. ET, reserved for in-person comments only regarding recommendations for NCD’s engagement on the UN Convention on the Rights of Persons with Disabilities (CRPD).

If you are interested in giving public comment, you will be asked to provide your name and organizational affiliation, if applicable, and to limit your comments to three minutes so we can hear from as many people as possible (for this reason, it’s advisable to write out what you intend to say).

NCD’s quarterly meeting is open to the public, and interested parties may join in-person or by phone in a listening-only capacity (with the exception of the public comment periods) using the following call-in number: 1-888-727-7630; passcode 5450168. If asked, the call host’s name is Stacey Brown or Jeff Rosen.

You may also provide public comment at any time by sending your comments in writing to Lawrence Carter-Long, Public Affairs Specialist, at LCarterLong@ncd.gov, using the subject line of “Public Comment.”

 

NCD April 2013 Meeting Agenda

 

Pilot Program Promising

Comprehensive, coordinated and cost-effective care – this is not impossible!

Children’s Comprehensive Care Clinic is a pilot program in Texas which is showing promise.  In Washington, we could expand on this by utilizing the campus communities at the Residential Habilitation Centers to become “Comprehensive Care Clinics” for our citizens with developmental disabilities.  The report, Medical Care Task Force Jan 2002,  outlines a process to establish comprehensive, coordinated and cost-effective care.

When looking at cost of care for residents in the supportive communities or dispersed communities, some of the major costs that are not included in the dispersed community costs are medical, psychological, and therapeutic costs.  Removing these costs from the cost analysis does not mean they are free – it means they are not available or accessible or not provided.  Of the many, many studies that have been done this issue of not including medical costs is a problem.  What is interesting though is that the studies that have been conducted in the UK are more accurate – different funding and different agendas.  The UK studies have consistently found that dispersed community services are more expensive than institutional services.

Another interesting issue is “quality of care” and “quality of life”.  The Arc and other DD Advocates do not look at issues that are outside the personal outcome measures, such as choice and community involvement.  They are missing a huge part of “quality of care” issues by their narrow focus and do not realize that “quality of care” influences “quality of life”.

Quality of care (health and safety outcomes) can be measured objectively where as “quality of life” is more subjective.  We meed to include measurements of quality of care into our assessments and cost analysis.  Below are some examples of areas needing evaluation.

a..  access to comprehensive health care services (primary, psychiatric and dental care as well as ancillary services, including care coordination)
b.  rates and status of abuse/neglect reports and investigations (including victimization in the community)
c.  mortality review
d.  access and utilization of behavioral services and
e.  similar direct measures.

When people who require complex care from a variety of professional services receive all their care in a “medical home” model, such as the ICF/ID, dispersing these people  will make access to healthcare, therapies, nursing, recreation and more unavailable. It is well documented that people with ID have higher rates of chronic medical and psychiatric illness than the general population.   It is also well documented that people with ID have an increased incidence of medical illnesses and have need for comprehensive, coordinated medical services. (Kaye McGivney, 2008)  For the best care it is critical to maintain the same providers over time and to avoid disruption of services. (Kaye McGivney, 2008) No longer will services be accessible or able to be shared.    This means that either the cost of care will greatly increase or that the person will not receive care.

Research also shows that those with DD, when admitted to the hospital, stay longer than those without a developmental disability.  People with DD are also less likely to be discharged to their pre-hospitalization living arrangement due to the fact that the needed supports were not accessible.  This fact highlights the importance of having specialized residential centers (ICF/IDs) to help alleviate the cost of care, crisis care and hospitalizations.  Having such centers increases stability is cost effective and provides stability to the citizens.  (Haier Saied, 2003)

Developmental Disabilities are not only experienced by the person but by the family.  We need to look at not only individual quality of life but the families’ experience and quality of life too. (Colvin, 2006) It is critical to the health and safety of our most vulnerable citizens and  a responsibility of our communities and government to realize that we need supportive communities such as the ICF/ID to best care for some of our citizens in the most cost effective, stable, reliable and safe method.

To do otherwise, is negligent.

Works Cited

Colvin, A. D. (2006). Variables Influencing Family Members’ Decisions Regarding Continued Placement of Family Members with Mental Disabilties in One State Operated Institution.

Haider Saeed, H. O.-J. (2003). Length of Stay for Psychiatric Inpatient Services: A Comparison of Admissions of People with and without Developmental Disabilities. The Journal of Behavioral Health Services & Research, 30(4), 406-417.

Kaye McGinty, R. W. (2008). Patient and Family Advocacy: Working with Individuals with Comorbid Mental Illness and Developmental Disabilities and their Families. Psychiatric Quarterly, 193-203.

 

Public funds used to discriminate – The Arc of King County

There has been a long-standing issue with regards to advocacy by The Arc of King County.  The Arc of King County has a contract with King County Department of Community and Human Services, Developmental Disabilities Division, which provides thousands of public dollars, both county and Washington State funds, to The Arc of King County to fulfill advocacy, outreach and support to people with developmental disabilities and their families.

The Arc of King County discriminates against people and their families who may need the full continuum of care support needs provided in our state operated residential habilitation centers.  These supportive communities provide an intense level of support in the most cost effective and safe way to some of our states most vulnerable citizens.  The Arc of King County does not support any form of congregate care and therefore uses their personal and corporate biases in violating the contract they hold with King County.  In essence, they are using our public funds to mislead and misinform people.

It is perfectly fine for The Arc of King County to not support congregate care but they need to be upfront and honest with that bias and allow others to share information and education regarding these supports.  Censorship is regularly used by The Arc of King County to prevent families from sharing information regarding the needs of people who may desire the community supports at the residential habilitation center.

The Arc of King County denies access to Facebook pages, Websites and public blogs to people who may support a full continuum of care.  This is violates the contract they hold with King County.

Please write to your King County Councilmember informing them of these violations and inappropriate use of our county funds.

The Arc of King County Contract with King County 2012

The Arc and King County Contract with highlighted boxes

The Arc of King County and Social Media

king county funds to The Arc of King County

 

 

 

Washington State Discriminates against youth with DD

 

 

 

Our state has passed legislation into law which discriminates against our youth with developmental disabilities who have high

support needs – look at the facts – 42.3 % of the documented cases reviewed for RHC admission were of people 21 and under.

 

Developmental Disabilities Admissions Review Team Data from September 25, 2011 

admissions Review Report

 

 

11 of the 26 documented people who applied for RHC admission between September 2011 and September 2012 were age 21 or under.

 

That is 42.3% of the documented population.  This is clearly different than the story we hear from The Arc and DDD. 

Our young population is in need of these support services and our state is denying them these supports. 

 

 

(This does not include those who requested admission and were denied by their case manager.  This is the first step and if the person insists and specifically requests to have their person reviewed through the admissions review team, then it gets to this point.  We have no measures to know how many, in reality, are denied admission to the RHC and we do not know what the follow up of those people who were told “no” by the case manager is or what became of them.)

Below is an excerpt from a letter that I wrote to the DD Service System Task force on September 5, 2012.  I have outlined some of the issues regarding this discrimination.  The 18 year old in this letter is awaiting an appeals hearing with DDD.  They denied him admission but he is allowed to continue his short term stay until the appeal trial.  He is doing well with the needed supports at Fircrest.

Letter to Washington State Developmental Disabilities Service System Task Force

September 5, 2012

 

 

Age of Clients

I am greatly disturbed by SSB5459 which passed into State Law discrimination against our youth who may need the level of support services only provided in the RHCs.  I can find no mention of limiting support services by age in either the US DD Act or the 1999 US Supreme Court Decision Olmstead which would support such discrimination.

In regards to the Federal Home and Community Based Service Waivers, these are set up to allow for choice to not live in an institution and to promote community care.  The states may have choices to limit waivers to certain groups or populations but I do not see information from CMS which allows a state to deny those under 21 the supports services needed in the ICF/ID or that the ICF/ID has a federal age requirement for admission.  (See attached document regarding ICF/ID services) When there are no community alternatives for one under 21 who may need these support services and the person is denied long term admission to the RHC, where is this person supposed to go?  The issue is not if these services are available, they are – the issue is denying these services to those under 21 only due to the fact of this person’s age.

Former Secretary of the Department of Social and Health Services, Susan Dreyfus, responded to my question regarding this issue with “they still have a choice – they can send their child out of state.”  Why, when we have the appropriate services right here in our state would we choose to send our children to other states to receive the same service?

Below are some excerpts from the HCBS Waiver applications and contracts which refer to choice.  These individuals have been assessed to have the level of care support needs of the RHC but are not given the choice to utilize those services.

Currently, I am working with a family who has an 18 year old boy at Fircrest.  They family has requested that he receive long term placement at Fircrest given his intense support care needs and having no safe alternative in a community setting for him.  He had been on the CIIBS waiver until his recent short term admission for crisis care at Fircrest. The family has looked at over 8 community placements and with each setting there would be significant problems regarding safety for this individual. These issues range from close proximity to busy streets (this boy has a history of elopement and is very fast and strong) to high staffing turnover (up to rates of 49% in community residential homes) which would significantly put this young man at risk given the fact that he is non-verbal, aggressive, has PICA, does not sleep through the night and has to be moving constantly.

Since being on a short term stay at Fircrest, this boy has improved with his sleep patterns and behavior and has met the short term goals.  The reason he has met these goals is because he has the support staff that he needs to be successful at Fircrest.  This issue of support needs is often misunderstood.  This does not mean that now this boy is “cured” and he can return to his old environment and he will maintain the skills that he has accomplished at Fircrest.  This means that in order to be successful, he needs to have these supports in place.  Without these supports his life is at risk.

I would really like to emphasize this fact of support needs.  These individuals are not individuals who will learn a skill then go on their way.  These are individuals who will need to have these supports throughout their lives.  It is the level of supports which are stable and sustainable that enables these individuals to be successful and contributing members of our community.  Removing these supports puts their lives at risk.

Please take into consideration these issues when looking at the DD System of supports and the role of the RHC in that system.  I believe that the RHC is a critical part of the continuum of care service model which is a model that can best serve ALL citizens with developmental and intellectual disabilities.

Please see the link below for more information on this issue.

 

Washington State Discriminates against youth

 

Rhetoric and Hearsay are not Facts

One often hears the same “facts” over and over and then wonder why things do not improve or change.  The reason is because they are not the facts – only hearsay, wishful thinking and rhetoric.

People do not want the facts – as Senator Adam Kline states “when one is uncomfortable with the facts, one ignores them.”  This is often the case with Senator Kline when facts are provided to him.  Senator Kline is not the only one who ignores facts – there are other advocates who state they see no benefit in looking at the facts – the facts that do not agree with their wishful thinking.

Maybe the only way to get the facts to the public and the legislature is to encourage our Senators and Representatives to request Washington State Institute of Public Policy (WSIPP)  to research the issues.  The Institute’s mission is to carry out practical, non-partisan research—at legislative direction—on issues of importance to Washington State.

I have contacted WSIPP regarding the report

CHILDREN AND ADULTS WITH DEVELOPMENTAL DISABILITIES:
SERVICES IN WASHINGTON, RESEARCH EVIDENCE

with new information and issues concerning our citizens with developmental disabilities.  The lead author of that report wrote “

“You raise some very interesting points, particularly regarding cost-shifting and other impacts of services for individuals with developmental disabilities on the individuals’ families and communities. If we were to receive another research assignment in this area, we would use your suggestions to shape our work plan.”

The first thing I would ask is that WSIPP look at the report

Assessment Findings for Persons with Developmental Disabilities Served
in Residential Habilitation Centers
and Community Settings

which is regularly referred to regarding issues of support needs and acuity of people with DD.

That data clearly indicated that those in the RHC had significantly higher support needs overall than those who lived in the other two community settings.  Yet, the data did not support the hypothesis which DDD desired and therefore, the author chose to combine the two populations which were to be compared into one population.  The final conclusions and key findings only referred to two types of residences: 1. ) RHC and community residential settings and 2.) other community-based settings.  This manipulation of results greatly affected the interpretation of some excellent data and has been used inappropriately.

This chart has the actual data and the 3 populations depicted.  It is clear from this graph and also the report “An extremely large percentage of clients living in RHCs have high acuity levels (and therefore elevated or urgent need) for protective supervision (95.3 percent) and interpersonal support (86.3 percent), and almost three fourths have high acuity levels for activities of daily living (73.6 percent).” These are the areas which are the highest predictors of out-of-home placement needs.

interpersonal and protective supervisoin chart

“Clients in RHCs and community residential programs were more likely than those in other community-based settings to be categorized as “high acuity” based on their DDD acuity scale scores in terms of activities of daily living, interpersonal support and protective supervision needs. RHC clients were also more likely to have high acuity scores on medical, mobility and behavioral measures than those supported in the community”

real data for RDA

“Support needs are higher in most general life tasks, such as daily and community living activities, for DDD clients served in RHCs and community residential settings than for those supported in other community-based settings.” (italics by this author which indicate the combination of two populations which were to be compared)

manipulated data

One last graph to indicate the inaccurate information on costs – looking at this it makes sense why we have continued crisis and lack of care and services.

cost discrepancy

It’s time to take the big step and face those “uncomfortable” facts.  These are the facts that will help change things around and improve services.  It’s time for people to be informed!

For bibliography and references see the Legislative page of this blog

Alarming? Really?

 

 

Prevent abuse of people with developmental disabilities was the Op-Ed piece in The Seattle Times yesterday written by Sue Elliott, executive director of The Arc of Washington State and Ed Holen, executive director of Washington State Developmental Disabilities Council.  The issues brought forth are not new and I’m wondering why these agencies have not been continually advocating for safe and appropriate care, oversight and investigations all along?  It was clearly evident from the Op-Ed piece Supporting our most vulnerable citizens published in 1999 by these same two authors that these issues were of great concern.  What happened in the past 13 years between these two essays to improve the situation?  Apparently nothing – so what are these agencies advocating for and what is their purpose?

My belief is that these agencies have been led down a misguided path – rather than looking at the person who they are supposedly advocating for they have been advocating for those who gain financially from social experimentations of rapid deinstitutionalization without evidence based studies that this is the best option for some of our most vulnerable citizens.  There seems to be a rule that the data which DSHS and DDD share with these agencies is golden even though it may not make sense.  But because the data supports the agenda of these agencies which are backed by their supporters who will gain financially from this misguided advocacy,   it is used as fact and this is what our policy makers are given to use for legislative purposes.

In my attempts to ask these advocates and other decision makers in our state about the questionable conclusions I have been told may several of the executive directors of Arc chapters in our state that they do not question the information which DDD gives them, they do not ask questions about the sources, they assume the data is correct.

Recently, when I asked to meet with the statewide coordinator of the parent coalitions run by The Arc of King County,  he wrote he had seen my questions and data but did not want to address them.

All I can think is that these people just put their head in the sand and do not want to face reality.  They need to look at the questions asked and answer them, look at the glaring discrepancies and address them – they need to be accountable for their actions and inaction in their advocacy and not blame the legislature.  They are the ones giving the legislature the information and if they give the legislature garbage they will get garbage.

My concern is that many vulnerable people are being hurt by these who claim they care.

 

 

Social Circles, Segregation and Disabilities

The social life of a person with intellectual disabilities is often studied and looked at only from one variable—that of interacting with  others who have or do not have  an intellectual disabilities.  From this model, the  social life is often seen as segregated and isolated with few contacts other than family or paid providers.  There have been some recent postings on various sites about people with disabilities and friends (My Child’s Dream to Have Friends , 51 People) and it made me think more about social circles and who is in them.

This is the reality of the situation when a person needs the assistance of another person to interact with others, to take turns in a game, need verbal or physical cues to manage life skills, to  go out to events or attend groups, go to the store , go to the doctor or any other outing which entails leaving the home and no amount of social engineering will change this.

Rather than focusing on the one variable of disability and looking at all contacts as having a disability or not, try looking at social contacts from various angles—what type of people does one interact with?

When looking at social circles from this perspective I think that one may find that the person with intellectual disabilities is much more integrated with a variety of people from various cultures and walks of life than those of us without disabilities.

How many adult women have equal men and women friends?  How many adults have daily contact with people from many different countries and cultures?  How many adults have daily contact with people from all walks of life—from highly paid professionals (doctors and health care providers) to some of the lowest paid workers in our community  – the  caregivers who  work so hard caring for our loved ones? How many have daily contact with people of all ages from college students to the elderly?

I know that my son  learns about many countries and cultures—he knows and experiences various foods from different countries and knows they may have a different religions.    He notices differences and asks about them but he does not make judgments and discriminate—he accepts things as they are.

All people are equal in his eyes—gay people, straight people, poor people, rich people, Black people, Asian People, White people, people who “talk funny” (have an accent because English is their second language) handicapped people in wheelchairs or needing walkers,  people with multiple tattoos and piercings (people who may look scary to me),  yet my son accepts all people equally.  He does not discriminate.

Yes, my son does notice differences and comments on them—sometimes this is difficult in public because in our culture this is taboo.  He is just observant and wants to know about people.    He has opened my world to meeting people from all over the world who I never would have met except for the fact that he asks everyone “What country are you from?”  If I stayed in my own little world and social circle and didn’t travel with him I would have missed out on these opportunities.

Yes, my son does live in a supportive community with others who have intellectual disabilities but his life is far from segregated—it’s completely the opposite and if one examined their own social circle from variables other than if one is disabled or not, we would see very different connections and realize that those who we may think are the most isolated and segregated are actually quite the opposite.

 

 

Cultivating Dreams

The Power of a Mom’s Love  is an Op-Ed piece in The New York Times about a mom who has been tireless in her efforts to provide for her son.  She has started a program called “Cultivating Dreams” which will offer people with special needs a community of their own.  This will be much like an “assisted living” community for the elderly.  The community residents will live freely but also work in the community – in a bakery, in the garden  or other jobs which suit the residents.

I love this idea but I’m concerned about it too.  Concerned because we already have many  supportive communities (state operated) which are being shut down, one by one, across this nation, with the Department of Justice and “so-called” advocates such as The Arc and all it’s subsidiaries  saying these supportive communities are isolating, segregated and expensive.  None of these adjectives describe the supportive community which my son lives in but the “so-called” advocates do not listen to the families of the people who call these communities their homes.

Historically, it has been the changing philosophies of professionals and state agencies which have influenced  decisions on how best to serve individuals with disabilities.  Despite reports by professionals, program planners and “advocate” groups which embrace the  increasingly accepted goal of deinstitutionalization, the families and caregivers of the individuals involved have different opinions.  Yet despite the move towards self-advocacy, the parents and caregivers of this population are not heard.

The person who can not speak up for themselves as a self advocate needs people who know them well to help advocate for them.  These family members and caregivers are ignored though – which means the population which can not speak or advocate for themselves is ignored.  Who listens to the people who know this population best, who care for them, who know  best how to support them?  Apparently no one does and this population is left at the mercy of professionals, program planners and “so-called advocates” – to make decisions.  This is WRONG!

One can see an example of this in a recent assessment (2010) done by the Division of Developmental Disabilities of all residents in the Intermediate Care Facility for those with Intellectual Disabilities (ICF/ID) in Washington State.  This assessment was the same assessment which was done for all DDD clients on the Home and Community Based Service waivers.  The findings were utilized in determining the closure of one of the communities  surveyed.  Evidently, the choices of the families involved did not matter.

 

Resident's choice

In addition to the assessment above, every year the family/guardian needs to sign a consent and is asked specifically about desires to move.  It is clearly indicated that residence is strictly voluntary and the guardian could chose at any time to remove the resident from the ICF/ID which would not jeopardize the resident for eligibility with services from DDD.

From this, it is very clear that these families are choosing this supportive community – maybe it would be wise to listen to them and find out why they prefer it.  Maybe the professionals, program planners, and advocates would learn something.

So, getting back to “Cultivating Dreams” – I’m very glad to see this concept heralded as a good choice for our children.  I hope the dream is realized.