Patrick Cadigan: 0:02

So when you think Post Secondary Transition, we want you to think of these key words, individual, unique, exploratory. And what do we mean by that? Well, transition for one person can be completely different for the next person. It's an individualized experience. There is a lot of information out there, there's a lot to consider. So it will be a unique experience, trying to do all of it at once can really feel consuming. As you explore the options that are available to you, using your child's school experiences will help with all the necessary research. You are using available resources at your disposal. That could be a special educator, a general education teacher or school administration, outside agencies, or if it's even supported in your school system, it could be a transition coordinator. But right now, we're here to have a conversation. So welcome. This is the Post Secondary Transition podcast. We try to cover the ins and outs, and everything in between of the transition process for families of students with disabilities. I am one of the hosts. My name is Patrick Cadigan. I am a special education teacher in the public school system. I do have a co host, and who would that be?

Meghan Smallwood: 1:26

I am Meghan Smallwood, and I'm a public school transition coordinator.

Patrick Cadigan: 1:31

One topic of discussion that comes up frequently in our transition community is self directed services. It's been mentioned more than a handful of times. So both Meghan and I thought that it would be a good idea to have a broad, but deeper conversation, opening up the idea to families who may be thinking about this path. We also thought that it would be a good idea to invite Jamie Brodnax, along for the conversation for longtime listeners will remember that Jamie is a Coordinator of Community Service. And we needed her assistance to help us understand what self-direction looks like from her side of the pond. So let's join our regularly scheduled conversation already in progress. No, get out.

Meghan Smallwood: 2:23

It's a big topic.

Jamie Brodnax: 2:24

Always.

Patrick Cadigan: 2:26

All right. So if we're going to be if we're going to be talking about self-direction, I'm gonna give a shout out to our website at www.postsecondarytransition.com. With our own official definition, self directed is a service delivery model for individuals and their support circle who wish to exercise, more choice, control and authority over their supports. It allows greater control over services and staffing, the ability to be creative in use of funding, and the ability to completely individual individually individualize days, it promotes personal choice, and control over the delivery of services and budget. Now, once again, we have Ms. Brodnax, who is here to help us in this conversation. So, Jamie, you're a Coordinator of Community Service, if you had to define service to self-direction. Sorry, if you had to define self-direction for families, what would you say to them?

Jamie Brodnax: 3:27

Honestly, it wouldn't be too far off from the definition that you just provided. The way that I really describe self-direction is by saying that it is a much more individualized way of receiving your DDA services. And it really puts the control back into the hands of the person that is receiving services because like you just said, it allows them to create a plan that is specific to their needs, their preferences, how they would like their day to go. And really down to the details, scheduling service hours staff with those staff do really there's there's an endless amount of ways that self-direction can be individualized to the person.

Meghan Smallwood: 4:10

Can I just ask so how many, as a coordinator, how many, like do you have on your caseload Jamie?

Jamie Brodnax: 4:16

Specific to self-direction or in total

Meghan Smallwood: 4:18

In total and then how many are actually doing self-direction. I'm just curious, like the breakdown.

Jamie Brodnax: 4:23

So right now I have about 34 people on my caseload, but that fluctuates. I've had probably as low as 31 and as high as almost 50 at one point. And self-direction wise it started that I only had two people and now I would say probably five that are active and five more that are transitioning.

Meghan Smallwood: 4:47

Oh wow. So there's definitely an increase.

Jamie Brodnax: 4:49

Oh, for sure that it's the direction that people are moving.

Meghan Smallwood: 4:53

Yeah, that's what I've been trying to explain more and more to parents that are exiting because I know the initial thought you know When they hear about self direction, they're like, well, it's just gonna be me. I can't do that. That's a lot, I already have a full time job.

Jamie Brodnax: 5:08

So, I definitely spend time reassuring, you know, individuals and their families, that yes, there is more responsibility. But that responsibility is not as overwhelming as it once was. There are so many different tools now that we use to support the families and making these decisions. And there's, as long as you have a good support team, and everybody does their role, it's not that much more challenging than using traditional services.

Meghan Smallwood: 5:37

Is it true that once you like, get that initial startup, like that's the it's a lot front loaded work. Like once it's set up...

Jamie Brodnax: 5:45

Absolutely.

Meghan Smallwood: 5:46

...its not, as you know, scary, I guess, long term wise, it's just little tweaking here and there.

Jamie Brodnax: 5:51

Exactly. Once you make those big decisions, and you start putting the plan together, and all of those pieces really fall in place, you'll see that you know, moving forward, like I said, there are some responsibilities that you're going to have to address as things go, but the bulk is taken care of right there in the beginning.

Patrick Cadigan: 6:10

And then one of the questions that I was thinking about, because I know that this is something that the three of us have talked about offline, is there still like a challenge around hiring, like finding staff for families who choose self-direction?

Jamie Brodnax: 6:22

I think that there's a challenge in hiring staff for all service models right now. People in traditional services are having just as many difficulties as having, you know, their day programs or the providers that they use for their different services and providing staff? So yes, but I wouldn't say that it's more challenging in either service, the really, the only difference is between whose responsibility that falls on. So obviously, in traditional, the hiring falls on the provider, but the individual is still impacted when that provider can't find staff, though in self-direction, yes, that responsibility will fall on the individual and their team. But at the end of the day, it's still the individual that's impacted.

Meghan Smallwood: 7:06

Could it actually be better, because with the self-direction model, you have more flexibility to change how much you want to pay them, as opposed to the traditional that has that set rate.

Jamie Brodnax: 7:17

And that's really one of the selling points of self directed is being able to offer, you know, what we call a living wage, having someone be able to survive off of this job, and also offering them benefits that make them want to keep working. That's not something that all providers are able to do.

Meghan Smallwood: 7:36

Yeah, you see such a big turnover with a lot of the traditional day programs, when we go to visit, you know, even with the higher ups like the admissions director, I know, some of the places we go, it's a different person, every time we're trying to schedule a tour. So I feel like that can be very telling.

Jamie Brodnax: 7:51

And especially for some individuals who it matters to them to have the same staff or to have, you know, know what to expect when they're receiving their services. If every time they're having to put in the effort to get used to a new person, learn how this person does things that can impact their day.

Meghan Smallwood: 8:11

That's important to families, too.

Patrick Cadigan: 8:13

Well, and I'm just thinking about, you know, working with students with autism, and how some of them have challenges with transitioning. So yeah, like this, this introduction of, you know, this constantly revolving door of new people could be could present challenges.

Jamie Brodnax: 8:29

Another big selling point for self-direction is the ability to use your family and friends, you know, the people who know you best and know how to support your needs, and have them be able to be paid to provide that support; it's huge.

Meghan Smallwood: 8:44

I have a couple families that upon exit, they did self directed the model. And they said, well, we already had these people working with our child or young adult prior to you know, them graduating and they're willing to continue. So now we'll just move into this model where they're being paid.You know, it's just already they had established people that knew their child and, you know, wanted to continue, they have that relationship, so it made it a lot easier.

Patrick Cadigan: 9:09

Well, speaking of being paid, this is something that we have talked about the three of us have talked about to varying degrees, and I was wondering if you could talk about, on our Facebook groups, there has been a lot of discussion around this. There have been challenges with the payment system, something changed, and there's a lot of frustration for families. What is it, what are they talking about?

Jamie Brodnax: 9:36

Specifically, what they're talking about is challenges with the FMS or now called the FMCS.

Patrick Cadigan: 9:43

All right, so acronym vomit alert, what is FMS?

Jamie Brodnax: 9:47

Sorry.

Meghan Smallwood: 9:48

FMCS.

Patrick Cadigan: 9:49

FMCS.

Jamie Brodnax: 9:50

Yes. It is FMCS now. I have to remind myself

Meghan Smallwood: 9:54

So the parents not responsible for sitting daily, but it stands for the Fiscal Management and Counseling Service and the way see that I kind of put that to the families is that is like your payroll department. They are the people who are going to make sure that everybody's checks are right, their taxes are right. All your forms are in your trainings are up to date, all those important things that help you stay within compliance, as far as you know, basically running your little business. there writing up the paychecks and getting all the tax forms made.

Jamie Brodnax: 10:28

Absolutely not.

Patrick Cadigan: 10:30

But then then that's also not something that they can do without like they have to have it.

Jamie Brodnax: 10:35

It is mandatory. I think it's pretty well known but maybe not last year, there was a big shift in the FMS agencies that DDA um held contracts with. We ended services with one agency brought on two new ones. So then it became the options were the ARC of Central Chesapeake, GT Independence. And honestly, I forgot the third one, but that third one is no longer providing services in Maryland. So now we just have those two options, which is the ARC of Central Chesapeake and GT Independence. So there's been a lot of back and forth because people signed up to work with one FMS, and then were given very short notice to switch. Then on top of that, you know, as the FMS agencies are handling all these new incoming enrollments, they're struggling to keep up with the people that they already had. And it's just caused a lot of delays. And unfortunately, some missed payments. Through that switch, everything also became online. So before where families were used to completing paper, timesheets, and doing a lot more back and forth communication with their support broker and the FMS, now they're using apps and using the computer, which for some is a really great change, for others has been really challenging, and that's causing even more barriers. And just making sure that you know, everything is submitted on time and correct. And that the FMS is then able to issue those paychecks and reimbursements on time.

Meghan Smallwood: 12:08

So with the change in in FMCS, it sounds like for those who were already established from self-direction, it was a bigger, I don't want to say blow to everything, but like it was a lot harder than those who are just starting out, because they didn't know any different.

Jamie Brodnax: 12:24

Exactly, yeah. So if you're brand new, you're coming in, everything is already electronic. you're downloading the apps, the website is up and running. But for the families who have been doing it a different way for years, some of that was a big learning curve.

Patrick Cadigan: 12:38

Are they being offered supports to kind of help like guide them through that or...

Jamie Brodnax: 12:44

Yep, so...

Patrick Cadigan: 12:45

OK.

Jamie Brodnax: 12:45

...there was optional training, that you could reach out to the FMS and request.

Patrick Cadigan: 12:50

Ok,cool.

Jamie Brodnax: 12:51

Both FMS also have videos on YouTube and other websites that you can access that will walk you through,

Patrick Cadigan: 12:59

Oh, YouTube, boy, I'm sure that families who struggle with computers are gonna love YouTube. Yeah, let's dive into that universe.

Jamie Brodnax: 13:08

You can also reach out to your coordinator and your support brokers for help and learning those as well.

Patrick Cadigan: 13:14

So opening up the conversation to a broader set of topics; as a Coordinator of Community Service, what how would you define the benefits of self-direction?

Jamie Brodnax: 13:25

I think the main benefit is that individualized plan, the individual is given the power to really break down their day, moment to moment to determine what they want to do, what service they want to receive, who they want to support them in that moment, how they're, you know, paying this person, what sort of benefits that they're giving them, how much time they're spending into the community, just, you know, the control really is the main benefit. Because when you're using a traditional provider, you do have to give up some of that.

Patrick Cadigan: 14:04

So in this area of control, one of the things that you had mentioned earlier is it it sounds like families can hire friends or other family and like, I got, why would they do that?

Jamie Brodnax: 14:18

There's a lot of different reasons. You know, just being familiar and comfortable is I think a big one who knows you better than your parents or your friends that you spend time with that you know, understand you understand your needs. And also you know, you have a good solid relationship with already and a lot of times these people are already doing this work, just not being paid for it. You know, moms, dads, siblings, grandparents, your your village so to speak, they're already doing the work so why not be able to pay them for everything that they already do?

Meghan Smallwood: 14:55

Yeah, and it helps to have that list of people so you've got the plan A, the plan B, the plan C, because we all know things happen, and you need to have backup.

Patrick Cadigan: 15:04

I'm gonna be the cynic. And I'm gonna throw it out there.

Meghan Smallwood: 15:07

No.

Patrick Cadigan: 15:09

Oh, whatever. I'm always being teased, and I don't do anything to deserve it. But what about, fraud? As soon as you brought up that people are hiring their friends and family, my first thought went to fraud, like, is that something that you think that we're going to need to worry about?

Jamie Brodnax: 15:26

I think anytime money is involved, you have to consider that as a possibility, there are always going to be people who try to take advantage or manipulate things in some way. But with, you know, the oversight provided by DDA, the team members that are put in place such as the FMS, the support broker, the coordinator, everyone is really working together to check each other, make sure that all of the math is correct, make sure the services are happening as planned. So I think that there, you know, there's always the possibility, but if everyone again, does what their job is telling them to do, it should be a very small possibility.

Patrick Cadigan: 16:05

I hate to say it, I was probably putting you on the spot. But I seem to remember, and I don't know if it was you that I had the conversation with, or if it was someone else, but there, once COVID kind of started to become less of a, I shouldn't even say less of a thing, but just kind of started to slide more into the background, didn't they discover quite a bit of fraud was actually going on?

Jamie Brodnax: 16:32

Yeah, there was a lot of things that were just not prioritized during COVID. As far as regulations were concerned, just, there wasn't the manpower, there wasn't the ability to see people in person, there were just a lot of things that we couldn't do as effectively as we can now that we're back in person, so there was a lot of things that weren't happening necessarily straight with, you know, our expectations. But to my knowledge, all of those things are being worked out.

Meghan Smallwood: 17:05

Is it true, I don't remember where I heard this somewhere along the lines, like I know, you can hire family, you can hire friend, or you can hire family. But is it that you also have to have an employee who is not family as part of their self directed staff or can it solely be family?

Jamie Brodnax: 17:22

I can solely be family.

Meghan Smallwood: 17:24

Okay. I thought I for some reason someone had mentioned that once because I didn't know if that was even like an issue, I guess for fraud because I have a family who, you know, they have a large extended family and they have a plan to use family members because they know the young adult very well and they feel comfortable. And culturally, they like to keep it together, you know that way. And I didn't know if that was okay.

Jamie Brodnax: 17:48

So, if an individual does elect to have only family members, their support broker will be a non-family person.

Meghan Smallwood: 17:57

Gotcha. Okay. That makes sense.

Patrick Cadigan: 18:01

So another thing that we were talking about offline earlier, and I wanted to ask you about again, was this day to day administrator service. Can you explain, this is something that's new to both Meghan and I. Can you explain it?

Jamie Brodnax: 18:18

Yeah, yeah, absolutely. So the day to day administrators service is a new service that I believe DDA just started offering on July 1, it is not funded through a specific DDA service, but instead is funded through the unallocated funds left over in a person's budget after you know, all of their employee wages, and taxes and things like that have been, you know, accounted for. So if the individual has enough money left over to fund this service, it can be provided up to 40 hours per week at a varying wage, you know, DDA provides guidelines to determine the wages that you pay in different services. And the day to day administrator, I really look at it as you know, so to speak, like the mom and dad kind of role that it this person is going to be the person that is doing household management tasks. They are scheduling appointments, they are creating with the assistance of the individual creating the individual's daily schedule, their employee schedule, they may be doing financial services for the individual managing their benefits, anything should really just help kind of keep the household and that person services running smoothly. And, you know, like I said, things that mom and dad pretty much already do without getting paid for.

Meghan Smallwood: 19:48

So, who, where would they find someone to do this administrative service?

Jamie Brodnax: 19:55

So it can be really anyone. There are there are no limitation Jins as long as you know, just the same as any other self directed employee, they, they need to be able to pass an in person CPR, first aid training. And they need to be able to pass that national background check that the FMS provides, it could be their parent, it could be just any staff person that they, you know, choose, there's a lot of flexibility, just like with every other service, it can go anywhere from one hour a week, to 40 hours a week. You can offer benefits in this position, you can offer varying wages, it's, it's really up to the individual to decide how they want to utilize that service.

Meghan Smallwood: 20:41

And it's something they could change, like if they started, like front loaded with a lot of hours. And then as time went on, you know, a parent felt like, well, I can handle this a little more myself, they could decrease the hours for somebody, right?

Jamie Brodnax: 20:52

Yeah, absolutely.

Patrick Cadigan: 20:54

So again, it seems like it's just going back to that notion of individualized control, giving a greater level of control to the families.

Meghan Smallwood: 21:01

Right. I did have a provider question, though. And I'm not sure how much you know about this. But like, so many families are like that, you know, when they think, Okay, I'm going to do self directed. But I want a vendor want to vendor with an agency. And I feel like in our county specifically, that's tricky, because not all the very agencies want a vendor. But I constantly hear from like coordinators who work in other counties like that there's a lot more options out there. But I know something might have changed with the way they were paid to make it easier that they could vendor, but they're just choosing not to do you know anything about that.

Jamie Brodnax: 21:36

It's a little bit of all of that. One is that we just, it is hard to find providers who are willing to be vendors for self-direction. And then the providers who do often will only accept a certain number of self directed people. And then on top of that, it's hard to work a vendor into a budget, especially if a person is trying to use say, for example, a day provider who for those 40 hours per week, that is going to eat up a lot of money out of the budget, because the provider rates are higher than what is being paid typically to staff. So you're losing a lot more money when you're going the provider route. And you're not able to determine how much you know the staff make. So you could be paying out a huge portion of your budget and your staff is still getting next to nothing. Because that provider can charge whatever they want as long as it's within DDA guidelines.

Meghan Smallwood: 22:35

Good to know. And isn't it like, you know, a lot of times they could you know, if you want to go only for two or three days out of the week, like the vendor prefers to have someone who's there five days a week, like for staffing purposes, it makes more sense on their end. But there are other options aside from like a day program that you could use your self directed funding for, right?

Jamie Brodnax: 22:56

Yeah, yeah, for sure. So there are so many different community activities, social groups, and then even providers who are specific to wanting to work with people who are self directed and cater programs that fit those self directed schedules. There are providers who offer just, you know, drop ins. So there's there's a lot of different options that don't require you going to a provider every single day, and spending that 40 hours a week there.

Patrick Cadigan: 23:27

So one other question that I have, and I think we might have touched on this earlier, but I did kind of want to come back to it to get a little bit more information. Nursing support is; can that be, can that be blanketed under self-direction?

Jamie Brodnax: 23:41

Oh, yeah, absolutely. nursing support is determined based off of a person's health assessment score. So any person who receives a three or higher on their health assessment is required to have nursing support services added to their plan, traditional or self directed. The one thing I guess that families don't love about nursing support is that it cannot be a family member that provides it, it has to be a outside person, who is also a DDA registered nurse.

Patrick Cadigan: 24:17

So I would imagine that, then that would kind of lead us back into challenges with finding people who, you know, who provide that service. Would that be accurate?

Jamie Brodnax: 24:30

Yes, and no. So there, you know, we, as coordinators receive lists of both support brokers and nurses who are interested in providing those services to people in self-direction. I think the biggest challenge is just finding nurses who are taking on new individuals and then ensuring that they can work with the individual schedule, and that the family and the nurse you know, are able to develop a good working relationship

Meghan Smallwood: 25:00

I just know, for a lot of my students who have, you know, nursing complexities, it self-direction has been a great option for them just because of the routine in general, you know, they are not required to get up and get on a van at 8am or earlier than 8am Really, and, you know, stay at a place all day, if they can handle it because of fatigue, or their medical needs, and also those who actually have a nurse that accompany with them, there's so many providers that, for liability reasons, do not want a private duty nurse attending, that's not one of their staff members. So there's just a lot of complications I know, in general. So that's why self-direction has been a good option for them.

Jamie Brodnax: 25:44

The ability to customize is really what self-direction is all about. And like you said, Megan, for people who do have a higher health need, you know, being able to say, I had a rough night, I'm gonna stay home today and my staff can stay here with me, parents are not left with the responsibility of trying to find you know, taking off work or finding someone to stay home because their family member feels too ill to go into a day program.

Meghan Smallwood: 26:12

Right.

Jamie Brodnax: 26:13

You know, you're you're really able to receive the services that you need, where you're at. And, you know, that's a big benefit.

Meghan Smallwood: 26:20

Yeah, and I know providers, you know, if you're missing too many days, attendance becomes an issue for them. So you don't have to worry about that. Because no one's keeping in check on, you know, are they going out. Are they reporting every day they're doing what works best for them, and after meaningful day.

Patrick Cadigan: 26:41

So we're gonna pause the conversation there. But needless to say, there is a lot more to be said. So please plan to join us in our next conversation with Jamie as we shift focus a bit and we're going to talk about the more traditional agency model, and how that can differ from self directed services. But before we let you go, we wanted to share out another Well, that's helpful resource. Now this time, we're going to send you over to the Autism Speaks website, more specifically, their informational page around applied behavior analysis, or ABA. Applied Behavior Analysis is a therapy that is based on the science of learning and behavior. Now this page gives you an easy to understand overview of what ABA is, and can be a good jumping off point for parents who are starting to explore options that might benefit them. Just to give you an idea. This page talks about how ABA therapy works. It goes into discussion or gives you information around positive reinforcement, the ABCs of behavior analysis antecedent behavior consequence, what an ABA program involves planning and ongoing assessment and lots of other information along with even more links. So again, this is a good jumping off point for parents who are just getting started in this world. You can surf over to www.autismspeaks.org/appliedbehavioranalysis or more easily, you can follow the link in our show notes. Speaking of shownotes, you can follow the information from this conversation, and all of our other conversation in the show notes that we provide. Please like, follow and share out the podcast. You can also visit our YouTube channel where we've posted videos of all of our conversations, including doing some of the legwork for you. We've curated videos on topics that revolve around transition, like playlists that cover guardianship, alternatives to guardianship ABLE accounts. One of our newer ones is all of the Transition101 podcasts that we've done, we've put those all together for you in a playlist and there's going to be more to come. So be sure to subscribe there as well.

Meghan Smallwood: 29:12

Yes, definitely.

Patrick Cadigan: 29:14

And finally, you're gonna have to go check out our website. It has a whole lot of information and a whole lot of links around the transition process. You can find our contact information there. So please go visit www.postsecondarytransition.com. All right, Ms. Meghan. I think that we are good for this week. I think you can sign us off.

Meghan Smallwood: 29:34

All right. Bye.