Editor's note: This is one of four stories on Boone County Family Resources. The other installments include a look at the agency's growth and need for expansion and how the agency has helped Max Lewis and Isaac Pasley.
COLUMBIA — Susan Thompson knows firsthand how the families of people with disabilities benefit from community support. Thompson, a case manager for Boone County Family Resources, grew up with a mother who is blind.
"It kind of gives you a different vision in life — pardon the pun," she said. "So I've had the heart to help these individuals be understood for most of my life."
Thompson said she believes it's important to advocate for people with disabilities — and, more important, to teach them how to advocate for themselves.
"That's a lot of what we do," she said of the agency's mission. "Our goal is to help them become more independent."
Thompson is one of more than 25 case managers at the agency who help clients craft and stay on track with individualized support plans. Each manager has an average caseload of about 48 clients, associate director Robyn Kaufman said.
The plans they create reflect the diversity of needs among clients of all ages and all manner of developmental disability.
"There's a plethora of services … based on the need," Thompson said.
Boone County Family Resources connects its clients to community services that help them live at home or with family. Those might include transportation, recreation, personal attendants and even crisis services.
It also helps infants, toddlers and their families through First Steps, its early intervention program, and provides job training for adolescents and adults through Life and Work Connections.
It cares for still more clients — about four dozen — in facilities the agency operates for people who need daily support to live in their community. These facilities differ from group homes, which often feature shared living spaces, in that they are what Kaufman called "apartment settings that are integrated into the community."
From July 2010 through June 2011, Boone County Family Resources served 1,392 clients — 75 more than the year before, according to its 2011 annual report.
That growth in clientele has been steady since the agency was established in 1976. That's when voters approved a 5-cent property tax levy to help fund the agency, which was then called Boone County Group Homes. The following year, eight clients were housed and cared for in a group home.
In 1993, Boone County voters elected to boost that property tax levy to 12 cents.
For the fiscal year ending June 30, the county property tax brought in more than $2.5 million, representing about 24 percent of the agency's total revenue for the period, according to a 2011 independent financial audit prepared by Williams Keepers. Most of the rest of its money comes from Medicaid and the Missouri Department of Mental Health.
Nearly 84 percent of its spending is directed toward client services.
Now, the 35-year-old agency has an annual budget of about $10.75 million and holds nearly $5 million in capital assets.
If the goal of Boone County Family Resources is independence for clients, its method is connectivity. Its partnerships allow numerous organizations to coordinate and streamline client services. Collaboration also keeps costs down.
These connections include working in tandem with the county. A specialized case manager from the agency keeps hours at the Boone County Family Court's Juvenile Division to help connect eligible juvenile offenders with agency services such as behavior therapy.
The agency also maintains rent-free office space at Oak Tower, a Columbia Housing Authority high rise. The agency's personnel there helps expedite referrals between those agencies before costly complications arise.
Boone County Family Resources' 2011 annual report quantifies its network as 202 agencies, therapists and other professionals that it utilizes for 44 different client services.
“We also have collaborations and nonpaid referral relationships with numerous organizations,” said Les Wagner, who was the first executive director of Boone County Family Resources and has served for more than 34 years. “It’s really the ‘roll call’ of helping organizations in Columbia.”
Referrals come from schools, physicians, therapists, state agencies and community members. Another partner is the Columbia Elks Lodge Local 594, which sponsors an annual picnic for Boone County Family Resources' clients. Friends of Boone County Family Resources, a nonprofit group of about 10 volunteers, throws an annual party for the agency’s clients and runs a program that redistributes wheelchairs, walkers and therapy equipment to clients who need it.
The technology exchange started as a planning committee, on which Boone County Family Resources held a seat. It grew into an online database of equipment available from a number of sources at any given time.
When someone needs a manual wheelchair or an item to help them with daily living such as a shower chair or commode, for example, the database helps connect the client to the equipment when he or she lacks insurance, Medicare or other resources. The technology exchange helped client Max Lewis, a resident of Paquin Tower and a board member for Boone County Family Resources, get his mouth-activated phone after he broke his arm and shoulder last year.
Kaufman said that kind of community innovation and support is invaluable.
“We are fortunate,” Kaufman said, “to live in a caring community with multiple service agencies and organizations who are both committed to helping their respective clientele as well as open to collaboration and creative problem-solving with others.”
The evolution of local services
Over the years, much has changed about the delivery and scope of social services in Missouri.
What used to be coordinated by the state is now more likely to be managed locally. Where segregation and institutionalization used to be the norm for people with developmental disabilities, the goals are now keeping people at home and integrating them into the community.
Boone County Family Services serves 95 percent of its clients through community-based support that allows people to remain in their own homes or live with family instead of being placed in a residential facility.
“It’s much more normal for them and gives them a sense of place and belonging in the community,” Wagner said. “And it’s much less expensive to the taxpayers.”
Indeed, budgets motivated some of the ongoing shift from state-managed to locally coordinated social services.
Boone County Family Resources was one of Missouri’s first county-based “SB40 boards.” The label refers to Senate Bill 40, the 1969 state legislation that authorized such agencies.
By providing county funding for developmental disability services, Missouri is able to draw more federal dollars than likely would be available to match state funds alone.
The arrangement ensures that counties are reimbursed for services provided to Medicaid-eligible consumers. That maximizes local dollars to make more resources available, according to the 2004 annual report of the Missouri Association of County Developmental Disability Services.
Jake Jacobs has served as the association’s president for the past year. He is executive director of Developmental Disability Services of Jackson County, the Kansas City area’s counterpart to Boone County Family Resources.
“It’s nothing we lobbied for or promoted,” Jacobs said about the shift toward local coordination of services.
The county-based SB40 board structure enabled counties to step into a new role when the need arose. Following national trends toward integration and deinstitutionalization, that time became ripe in the past decade.
“We didn’t have any kind of agenda to control all services locally. But when Gov. (Matt) Blunt ... stopped the hiring of all new state employees,” Jacobs said, caseloads soared at the Missouri Department of Mental Health.
Turning to county agencies for case management was part of the solution.
Boone County Family Resources started developing programs to train clients in practical living skills in 1981. And 10 years later, it became the first SB40 board to offer county-based case management. Now more than 70 county boards provide local case management.
Wagner thinks it works well. “County boards historically are more efficient, spend more time in service to clients and have a higher level of satisfaction among persons served,” he said.
Wagner pointed out that “SB40 boards range from urban boards that are nationally accredited and have sophisticated accounting and information systems to smaller boards.”
Their funding can come from county taxes, grants, state dollars and/or federal Medicaid, depending on the county. The majority of revenue for Boone County Family Resources comes from federal Medicaid dollars and from the state Department of Mental Health, which contracts Boone County Family Resources as an administrative agent in Boone County.
"People (with developmental disabilities) go to the state to determine eligibility for services, and the state determines and approves what services those people get," Jacobs said. County boards then often assist in providing those state-approved services, he said.
As of late December, 17 people from Boone County were on the state’s waiting list for benefits affording them the type of community-based, in-home support that Boone County Family Resources provides. Three more people were waiting for residential placement, said Bob Bax, spokesman for the Missouri Department of Mental Health.
Statewide, those figures balloon to about 4,400 and 260, respectively, Bax said.
“The Department of Mental Health doesn't have unlimited funding for out-of-home residential placements, which is the most expensive,” Wagner said. “That’s why it’s important to have less expensive community-based support alternatives that support people living in more normal settings."
Boone County Northern District Commissioner Skip Elkin serves on the Boone County Family Resources Board of Directors. The County Commission appoints the agency’s board members, and the commissioners take turns serving as liaison to the board.
“I think it’s a great organization,” Elkin said. “It serves a lot of people in our community that would probably be institutionalized if not for the agency and its services.”
Leadership among Missouri’s SB 40 boards
In 1989, the Boone County Family Resources board signed an intergovernmental agreement with the Missouri Department of Mental Health to pilot the Family & Community Living Support program, which six years later would become the first such program in the country to become nationally accredited.
In 1990, Family Resources was part of the first Early Childhood Advisory Council, a collaborative network of agencies designed to improve and streamline services for infants and toddlers at risk of disabilities.
The council's activities include "child find" programs to identify young children who might be eligible for the First Steps program, Kaufman said.
In 2011, Boone County Family Resources enrolled a total of 246 children in First Steps. "The agency continues to exceed the state's child count goal for Boone County each quarter," Kaufman said.
"Early intervention pays off. Children may need fewer support services down the road, and some children exit the program because they have developed age-appropriate skills," she said.
Wagner said innovation comes with a purpose.
"We don't pilot the programs just to pilot them," he said. "We find ways to meet the needs of individuals, and sometimes that means creating something new, and sometimes that turns into something that can help other people, too."