DOCUMENT RESUME

ED 250 897 EC 171 135

AUTHOR Hitzing, Wade; Kozlowski, Ronald E.TITLE Future of Institutional Services in Ohio: Do We Need

to Plan for Institutional Services? Position PaperNo. 1.

INSTITUTION Ohio State Univ., Columbus. Herschel W. NisongerCenter.

SPONS AGENCY Ohio State Dept. of Mental Health and MentalRetardation, Columbus. Div. of Mental Retardation andDevelopmental Disabilities.

PUB DATE Feb 84NOTE 35p.; Funding was also provided by the Ohio

Developmental Disabilities Planning Council. Preparedby The Institutional Services SubcommitteeDeinstitutionalization Task Force. For relateddocuments, see EC 171 134-139.

PUB TYPE Viewpoints (120)

EDRS PRICE MF01/PCO2 Plus Postage.DESCRIPTORS *Community Programs; *Deinstitutionalization (of

Disabled); *Developmental Disabilities;*Institutional Role; Planning; *Program Development;Services

IDENTIFIERS *Ohio

ABSTRACTThe first of five papers written by the Ohio

Developmental Disabilities Planning Council's DeinstitutionalizationTask Force Project, this document focuses on the role ofinstitutional services. Following a brief summary of planninginciples (least restrictive alternative, right to services,

nt..,emalization, equal justice, respect for human dignity, anddevelopmental orientation), the document reviews planning processesand strategies. Each of 10 potential system barriers (prior fiscalinvestment, employee rights, parent concerns, public attitudes,community resources, funding resources, legal concerns,coordination/management, individual rights, and community programcapacity) is addressed in terms of consequences, solution strategies,and conclusions. Recommendations include increased funding to expandlocal services, cost-sharing between state and local community, andincreased planning efforts geared to developing integratedcommunity-based services. (CL)

***********************************************************************Reproductions supplied by EDRS are the best that can be made

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COO

OLLI

POSITION PAPER NO. 1

The Future ofInstitutional Services

in Ohio:

Do We Need to Plan forInstitutional Services?

I

U.S. DEPARTMVIT OF EDUCATIONNATIONAL INSTITUTE OF EDUCATION

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

"This document has been reproduced as

received from the person or organizationoriginating it

I Minor changes have been made to improvereproduction quality

Points of view or opinions stated In this documnt do not necessarily represent official NIEposition or policy.

111111__

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

Ronald E. Kozlowski

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

Prepared by The Institutional Services SubcommitteeDeinstltutionalization Task Force

2

Total copies printed: 900Unit cost: $ 1.1422Publication date; 2/84(Includes paper costs)

3

POSITION PAPER NO. 1

The Future ofInstitutional Services

in Ohio:

Do We Need to Plan forInstitutional Services?

Prepared byThe Institutional Services Subcommittee

Deinstitutionalization Task Force

Wade Hitzing, Subcommittee ChairpersonRonald E. Kozlowski, Project Coordinator

The contents of this paper reflect official policy and positionsof the Ohio Developmental Disabilities Planning Council.

December, 1983

4

"LONG RANGE PLANNING DOES NOT DEALWITH FUTURE DECISIONS, BUT WITii THEFUTURE OF PRESENT DECISIONS."

Peter Drucker

This paper reflects the official position and policy of the Ohio DevelopmentalDisabilities Planning Council. The development of this paper was supportedby funds made available through a grant from the Ohio Department of MentalRetardation and Developmental Disabilities, authorized under P.L. 95-602 tofurther the attainment of the goals and objectives of the Ohio DevelopmentalDisabilities Planning Council.

The contents of this paper do not necessarily reflect the position or policyof the Ohio Department of Mental Retardation and Developmental Disabilities,and no official endorsement of the above agency should be inferred.

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CONTENTS

Preface

Acknowledgments vii

Ohio at a Crossroads

Basic Planning Principles

Least Restrictive AlternativeRight to ServicesNormalization PrincipleEqual JusticeRespect for Human DignityDevelopmental AssumptionEffectiveness and Economy

1

2

Planning Process 6

Potential System Barriers 8

Prior Fiscal InvestmentEmployee RightsParent ConcernsPublic AttitudesCommunity ResourcesFunding ResourcesLegal ConcernsCoordination/ManagementIndividual RightsCommunity Program Capacity

General Conclusions

Community Institutions

Phase Out of Dual System

Recommendations

References

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23

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Deinstitutionalization Task Force inside back cover

Institutional Services Subcommittee

6

inside back cover

i i i

PREFACE

Changes in the philosophy of services and a growing concern for therights of persons with developmental disabilities have led to a nationaldeinstitutionalization movement. Thus, the service system for Ohio's citizenswith developmental disabilities is in a period of transition as the state movesfrom an institution-based to a community-based service delivery model. Althoughthe deinstitutionalization movement has increased the move toward community-based services, numerous constraints continue to challenge this effort. Withthe transition in progress, the development of long- and short-term servicedevelopment plans is critical to the evolution of a cohesive system that uniformlyprovides appropriate and adequate services. Identification of the nature andshape of the desired service system, the recognition of existing and potentialconstraints, and the development of an effective planning process must occurto assure that quality services are available now and in the future.

It is within this context that the Ohio Developmental Disabilities PlanningCouncil created the Deinstitutionalization Task Force Project. The purpose ofthe project was to establish and provide staff support to a DeinstitutionalizationTask Force, which was formally constituted in March 1981. The Task Force,composed of representatives from various agencies and consumer groups (seeinside back cover), was charged with the responsibility to identify major issuesrelated to deinstitutionalization and to develop recommendations for increasingthe availability of appropriate services to persons with developmentaldisabilities.

Given its charge, the Task Force had two major options in terms of whereto focus its attention: (1) on the nature or structure of the service system or(2) on the service process. Because of the scope and complexity of the issuesrelated to deinstitutionalization, the Task Force decided to focus on the natureor structure of the service system. This approach was chosen because (1) anappropriate structure is a necessary condition for the development of quality,appropriate services and (2) many process guidelines and safeguards are alreadypresent in rules and regulations. By focusing on the structure of the servicesystem, the Task Force could then develop a plan containing: (1) a broadoutline of the proposed service system and (2) a broad outline of proposedplanning strategies.

The Task Force considered this option as most consistent with theDevelopmental Disabilities Planning Council's advocacy function, in that thedevelopment of a broad outline of the proposed service system facilitatessystemic change. Long-range service goals define how things "ought to be"and can be used to guide short-term transition planning.

The Task Force initially sought to identify the various legal andphilosophical principles in the field of developmental disabilities and to definewith a high degree of clarity the actual issues surrounding deinstitutionalization.These deliberations were based on experiences in Ohio and augmented by theexperiences of some of the more active state programs outside of Ohio. Thebasic concepts that emerged were used then to guide the planning process.

Preface

This led to the second step, which was to apply these concepts to aservice system for persons with developmental disabilities. The Task Forceselected the following broad areas in which to concentrate its efforts: (1)the role of institutional services (2) residential services (3) adult services (4)informal and formal supports, and (5) administrative structure and finance. Toprovide broad-based professional and consumer input in addressing these generaltopical areas, a subcommittee structure was established. The followingsubcommittees were constituted by the Task Force:

o Institutional Services Subcommitteeo Community Services Subcommitteeo Prevention of Institutionalization Subcommitteeo Finance Subcommittee

This structure essentially provided a two-tier review process. Eachsubcommittee was charged with the initial development of a position paper ona selected topic. The Community Services Subcommittee was charged withinitial development of position papers on two topics. The papers were thenall submitted to the Task Force for review and/or modification, and subsequentlyadopted as official position papers of the Task Force. The five position papersprovide statements of program philosophies and service strategies that can beused to develop quality services for persons with developmental disabilities.Each position paper contains a series of broad recommendations that the TaskForce believes should be used in developing specific implementation plans.

The Task Force believes that the position papers describe a realisticdirection for Ohio's service system and should be used as roadmaps for developingquality services for persons with developmental disabilities.

Papers in the series include:

Position Paper No. 1: THE FUTURE OF INSTITUTIONAL SERVICESIN OHIO:Do We Need to Plan for Institutional Services?

Position Paper No. 2:

Position Paper No. 3:

Position Paper No. 4:

Position Paper No. 5:

Nisonger CenterThe Ohio State University

vi

RESIDENTIAL SERVICES IN OHIO: The Needto Shift from a Facility-Based to a Home-Centered Service System

FUTURE DIRECTIONS IN ADULT SERVICES

PROMOTING QUALITY COMMUNITY LIVINGTHROUGH FORMAL SUPPORT SERVICESAND INFORMAL SUPPORTS

FUTURE DIRECTIONS IN ADMINISTRATIVESTRUCTURE AND ITINANCE: PREREQUISITESFOR COMMUNITY-BASED SERVICE.

Ronald E. KozlowskiProject Cooedinator

ACKNOWLEDGMENTS

The Deinstitutionalization Task Force Project was originally established througha letter of agreement between the Ohio Developmental Disabilities PlanningCouncil, The Department of Mental Retardation and Developmental Disabilities,and the Ohio State University Research Foundation (Nisonger Center) to identifyissues and develop recommendations relative to deinstitutionalization in Ohio.The products of the Task Force are the result of a collaborative effort byvarious individuals, representing a variety of organizations and.agencies, whoparticipated on the Task Force or its subcommittees, or otherwise providedassistance in developing the various position papers. Forty-two individuals,representing thirty-three organizations and agencies, contributed to thedevelopment of the five papers. Appreciation is extended to those individuals,who graciously gave their time, patience, and expertise.

A special mention is made of the sincere efforts that were put forth byDr. Jerry Adams, who conceived the project and devoted tremendous personalenergies toward making project activities viable. Succeeding Dr. Adams,Dr. Denis Stoddard also devoted much personal energy in supporting the project.Dr. William Gilbert and Dr. Henry Leland (Co-chairpersons) guided the TaskForce through its deliberations and saw to it that the Task Force completedits tasks. Appreciation is also expressed to the Ohio Developmental DisabilitiesPlanning Council for recognizing the significance of this project and providingfunding for its activities, and adopting the position papers produced by theTask Force as official policy and position statements of the Council.

vii

Ohio at a Crossroad;

DEINSTITUTIONALIZATION has been defined in variousways. The term has been used to describe: (1) movementof residents out of state institutions; (2) development ofcommunity-based programs; (3) prevention of institutionalplacements; and (4) institutional reform. Sometimes, it hasbeen defined as a process and, at other times, as a goal orobjective.

Ohio has played a part In the national deinstitutional-OHIO ization movement. The average number of developmentally

AT A CROSSROADS disabled persons living in institutions in Ohio decreased from10,017 in 1967 to 4,500 in 1982, a decrease of 5,517 or 55%.However between 1968 and 1982, the number of state-operatedresidential institutions increased from 7 to 13; as of June1982, 5 of Ohio's state-operated residential facilities hadpopulations over 300 each.

Concurrent with the decline in the number ofinstitutional residents has been an effort to upgrade thequality of services provided by state institutions. In part,the Medicaid Program (Title XIX) has provided both fiscalincentives and higher program standards for institutionalservices. The state has sought to meet institutionalIntermediate Care Facility-Mental Retardation (ICF/MR)standards to capture federal funds, thus sharing financialcosts with the federal government. Although the institutionalpopulation has been declining, the necessity for upgradinginstitutions to meet Medicaid standards has resulted in anaccelerated flow of state dollars into Ohio's institutions.

The deinstitutionalization movement in Ohio has resultedin rapid growth of community-based services. For example,enrollment in County Boards of Mental Retardation andDevelopmental Disabilities programs increased fromapproximately 9,675 in 1967 to 23,098 in 1982, an increaseof more than 139% (Ohio Department of Mental Retardationand Developmental Disabilities, 1982). The number ofcommunity beds licensed by the Department of MentalRetardation/Developmental Disabilities increased from 700 in1971 to more than 6,656 in 1982. As of December 1982,there were 814 licensed community residential facilities inOhio.

Although the deinstitutionalization movement hasincreased the growth in community-based services, numerousconstraints continue to challenge this trend. During thistransition period, the development of long- and

r:

nd short-termservice development plans is critical to the evolutioncohesive system to provide appropriate and adequate servicesuniformly. The identification of the nature and shape of thedesired service system, the recognition of existing and

1

Planning Principles

potential constraints, and the developm,Int of an effectiveplanning process must occur to assure that quality serviceswill be available now and in the future.

a,In Before considering the role of institutional services, itBASIC is important to clearly delineate some basic planning prin-

PLANNING PRINCIPLES ciples. The specification of these principles, or planningassumptions, will provide a listing of positive criteria to assessboth short- and long-term planning decisions.

LEAST RESTRICTIVE ALTERNATIVE

The principle of least restrictive environment requiresthat the living environment be the most age and culturallyappropriate for meeting a person's needs for supervision andtraining, without imposing unnecessary modifications or denialof personal rights. A further consideration is that theselection of a particular living situation must be based onthe person's needs and wishesnot just on the optionscurrently available in the service system.

There is a relatively simple test for dealing with theissue of determining least restrictive alternative. In tryingto decide whether a specific living situation fits the criterionof least restrictive alternative, one must ask whether thereare examples of persons with similar needs being appropriatelyserved in other, less restrictive, settings. This type of testwas critical to the landmark Pennhurst Case (Laski, 1980).The basic strategy of the plaintiffs was to show that, foreach resident living in Pennhurst (a restrictive setting), therewas a person with similar needs who was being appropriatelyserved in a less restrictive setting. After being presentedwith many such examples, the judge concluded that aninstitutional environment was not necessary to meet theresident's needs in that each Pennhurst resident had a"functional twin" living in an appropriate, less restrictive,community-based setting.

It is important to point out that application of theprinciple of least restrictive alternative does not mean thatOhio will be able to provide all persons with age and culturallyappropriate, typien1 residential settings. However, applicationof this principle does require that placement of a person insettings other than these be proven as necessary to meetingthe person's needs. In other words, the basic planningassumption should be that all individuals will live in small,well-integrated, positively valued settings. Any deviationfrom this strategy, toward more restrictive settings, can onlybe undertaken after proof that the person's needs cannot bemet in less restrictive alternatives.

2

Planning Principles

RIGHT TO SERVICES

The assumption of a right to services concerns the rightof a person to services or treatment that promote growthtoward increased independence and competence.

While a person may benefit train institutional programs,it is questionable whether such programs provide an adequatetreatment or service environment. Given that the ultimategoal for all persons is for them to live as much as possible ina complex, heterogeneous, community-based setting, theadequacy of any institutional setting must be questioned. HOWdoes the congregation of large numbers of persons withdevelopmental disabilities in physically aiid socially segregatedsettings contribute positively towards enhanced independenceand competence?

NORMALIZATION PRINCIPLE

Over the past 5 to 10 years, many institutions haveattempted to "normalize" their services and settings. Beyondcosmetic changes, more serious attempts, such as cottagedevelopment, have been made. (It is important to note thatanother important factor in cottage development was theattempt to qualify for Medicaid funds.) While it would bedifficult to deny that a 16-bed cottage is an improvementover a 60-bed institutional ward, such cottages clearly donot provide a reasonably typical, positively valued residentialsetting. Appropriate application of the principle ofnormalization should result in the development of residentialservices that ensure a person's presence and participation in

the community. Groups of cottages located on the groundsof a state institution are not consistent with this approach.

EQUAL JUSTICE

Adherence to the concept of equal justice requires thatpersons with developmental disabilities be provided servicesand supports that will allow equal opportunity for growth anddevelopment. Each person with developmental disabilities, asdo other members of society, has a right to receive servicesfrom publicly supported programs. The arguments used withrespect to Right to Services are relevant here also. In avariety of places across the United States, persons with severehandicaps are being served in quality, integrated communitysettings (Apolloni, Cappuccilli, & Cooke, 1980; PCMR, 1978).The principle of equal justice requires that Ohio's long-rangeplans be based on the assumption that all persons canparticipate in community life.

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4

Planning Pi inciples

RESPECT FOR HUMAN DIGNITY

While a respect for human dignity may seem to be moreabstract than the other planning principles, it is still extremelyimportant. Human dignity is closely related to a person'sability to make choices, select and maintain possessions, tobe treated with respect, to live in surroundings that fosterindividuality and allow for privacy, to p:rticipate in thedevelopment of their own service plan, and to receive servicesand supports tailored to their own unique needs. Most personshave characteristics and competencies valued by others. Theycan usually advocate for themselves and can, therefore, gainat least a minimum of dignity and respect.

Except in very limited ways, persons with severehandicaps cannot gain the same degree of dignity and respectby their own actions. It is, therefore, extremely importantthat they be treated with respect and served in settings thatare as positively valued as possible.

DEVELOPMENTAL ASSUMPTION

Traditionally, mental retardation and other forms ofdevelopmental disabilities have been looked upon as "healthproblems", and services have been structured on a medicalmodel. Many needs, such as communication, personal skills,homemaking, and social skills, were attributed to the person'sdevelopmental disability and viewed as being a sickness orphysical problem, remediated or met by medical settings andapproaches, medical processes, and medicines. Persons withdisabilities were perceived as having limited potential. Inpart, institutional services have been based on the medicalmodel.

However, since knowledge about developmentaldisabilities has expanded, it has become clear that adevelopmental disability is not primarily a health problem. Adisability is not the same as an illness nor, very often isthere a cure. Developmental disabilities are conditions,stemming from physiological or psychological handicaps thatsignificantly curb or affect a person's development. Ifdevelopmental disabilities are a developmental problem, thenthey must be approached as such. Human beings, by theirnature, grow, change, and develop; persons with developmentaldisabilities are not exceptions. The only difference is thatpersons with developmental disabilities need specialized,sometimes long-term, help to develop as fully as possible.

The developmental assumption is considered, by mostauthorities, to be a desirable approach to serving personswith developmental disabilities and serves as a basis for validservice development and delivery. The developmentalassumption is based on two principles.

13

Planning Principles

o Life as Change: Human beings are in a constant stateof change from the time of conception until death. (Theassumption that persons with developmental disabilitiesare often physicially and psychologically fixed orunchanging is, in effect, to deny their humanity; allpersons, regardless of the type or degree of handicap,have the potential for positive growth.)

o Modifiable Development: The rate of development isinfluenced by interactions of many internal and externalfactors, including inherited characteristics, health, andthe external environmental setting (The rate, direction,and ultimate level of development can be influencedthrough teaching, and by utilizing and controlling certainphysical, psychological, and social aspects of theenvironment.)

A primary goal of programs for persons with specialneeds should be to increase the adaptive behavior and generalcompetencies of the individual by modifying the rate anddirection of behavioral change. Persons with developmentaldisabilities should be approached from the standpoint of beingcapable of growth, learning, and development. They shouldbe considered in a state of constant change that can besignificantly influenced by conditions imposed within theenvironmental setting. Persons with developmental disabilitieshave normal developmental stages of infancy, childhood,adolescence, and adulthood. Within each stage, differentneeds are emphasized. Although these stages may be delayedin varying degrees, persons with special developmental needsshould not be subjected to socially imposed perceptions thatlimit growth.

The primary implication, of the developmental assumptionis that programs be oriented toward the individual, and thatprogram goals be dynamic and individually defined.Residential programs should be designed to be as growth-enhancing and supportive of learning as possible. Institutionalsettings, which tend to congregate large numbers of personswith special needs and segregate them from normal communityactivities, are not consistent with the developmentalassumption.

EFFECTIVENESS AND ECONOMY

The issue of effectiveness has already been dealt with,at least in part, in the discussion of the DevelopmentalAssumption. It is paradoxical that one of the most frequentlycited reasons for institutionalization, that it provideseffective service and treatment, is not supported by research?endings (McCarver do Craig, 1974; Pilewski do Heal, 1980).The only real justification for using an institution, as atraining center, is to prepare persons to live in an institutional

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Planning Process

setting. Recent research shows that it is very important,especially for persons labeled as severely and profoundlydisabled, to participate in training programs that are as similaras possible to normal community settings (Martin, Rusch,Heal, 1982). This is especially important for persons withmental retardation because of their difficulty in generalizingfrom the original learning environment to other settings.

It is ironic that the other reason for the developmentof state institutions, economy of service delivery, is notsupported by cost data. A number of studies have shownthat quality, community-based programs can be provided atno more, and in some cases less, cost than institutional care(Boggs, 1981; Lakin, et.al., 1982; Touche-Ross, 1980).

However, there is an important complication to theeconomy analysis. Cost incentives and disino.entives must beanalyzed separately for each of the major "actors" in thedeinstitutionalization movement. Research has shown thatthe financial burden of maintaining individuals in state-operated facilities falls predominantly to the state and federalgovernment, while the financing of community residentialprograms shifts more to local government resources in tandemwith increased contributions from residents/families and otherlocal sources (W ieck 3c Bruininks, 1980).

Another important cost consideration is the maintenanceof a dual residential system, consisting of both state-operatedand community programs. The dual system results in separate,and uncoordinated planning and budgeting for residentialservices; overuse of costly institutional services; anddiminished possibility of utilizing scarce resources to developquality residential programs.

Although cost considerations are important, it is moreimportant not to lose sight of humanitarian considerations inproviding community-based residential programs.

The Institutional Services Subcommittee, in analyzingPLANNING the need to plan for institutional services in Ohio, firstPROCESS attempted to specify and analyze the long-term goal of

institutional services. The intent was to develop a standardagainst which individual needs, as well as system constraints,could be assessed. Rather than considering a variety ofpossible goals, the subcommittee decided to analyze only themost desirable or ideal goal. Definition of the concept of"desirable or ideal" was guided by the previously describedplanning principles (normalization, least restrictivealternative, etc.). Simply stated, the subcommittee's desirableor ideal long-term goal for institutional services was that"All persons with developmental disabilities will have their

Planning Process

needs met in small, well-integrated, community-basedsettings."

With this long-term goal as a standard, the subcommitteedeveloped a working assumption to guide its planning process:"Ohio can begin to plan for a community-based service system,for all its citizens with developmental disabilities, that doesnot include institutional residential services."

It should be noted that while the primary focus of thesubcommittee was on an analysis of Ohio's developmentalcenters, to a lesser degree it also discussed community-basedinstitutional services such as nursing homes and largecongregate facilities. The subcommittee did not set a specificbed size as a definition of an "institutional residentialprogram." However, for purposes of analysis, residentialprograms that congregate more than six to eight individualswere considered institutional. Therefore, another way tostate the working assumption Is:

"OHIO CAN BEGIN TO PLAN FOR A SERVICESYSTEM, FOR ALL ITS CITIZENS WITHDEVELOPMENTAL DISABILITIES, THAT HASRESIDENTIAL ALTERNATIVES ACCOMMODAT-ING NO MORE THAN SIX TO EIGHT PERSONS,UNLESS JUSTIFICATION IS PROVIDED THATLARGER SETTINGS ARE REQUIRED TO MEETTHE PERSON'S SERVICE NEEDS."

The first major issue addressed was whether or not therewere any individual needs that could be met only ininstitutional settings (individuals could not be served in small,integrated, community-based settings). The consensus wasthat even the most profoundly handicapped, medically fragileperson could be served outside of an institutionif sufficientcommunity services and supports were provided. This positionrepresents a significant change from earlier analyses, whichoften resulted in statements such as:

"Because of Mary's profound level of mentalretardation, she must live in an institution."

"Because of Jim's high seizure rate, he will requireintensive institutional services."

Historically, individual characteristicsneeds, deficits, etc.- have been used to justify the continuation of institutionalservices.

However, concluding that there are no individual needsthat require institutional services does not automaticallyresult in a call for an end to institutional services. Althoughthere are no individual-based needs that require continuedinstitutional services, perhaps there are system issues that

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System Barriers

function as major barriers to an eventual phasing out of allinstitutional services. There may be other system factors,such as cost-effectiveness, personnel, resources, etc., thatrequire continuation of some institutional services. Adoptionof the planning assumption does, however, clearly require thatif we ultimately plan for long-term continuation of someinstitutional services, we do so not because it is the onlyway to meet the person's service needs, but because Ohiocannot provide sufficient supports and services for all personswith developmental disabilities to live in community-basedsettings. This does not make such a planning decision rightor wrong, it simply makes it clear why it was made.

The planning strategy used by the subcommittee indeveloping the positions ou'lined in this paper is shown infigure 1.

Each of the following system constraints was selectedPOTENTIAL for one or more reasons: (1) it represented a barrier toward

SYSTEM BARRIERS developing a plan for phasing out institutional services, suchas lack of funds or personnel resources; (2) it represented apotential problem that could develop if the plan was adopted,and institutional services were gradually phased out. Examplesof the latter problem include negative fiscal impact on localcommunities, and loss of state jobs. The possible consequencesof each barrier or potential problem are presented, along withpotential solution strategies.

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PRIOR FISCAL INVESTMENT

Ohio has an enormous fiscal investment in institutionalservices, especially in terms of property, buildings, and bondindebtedness. In addition, the presence of state facilitieshas an enormous impact on local economies, particularly inrural areas.

Consequences

If alternative uses are not found for buildings andproperty, the phasing out of institutional services could beperceived as a "waste" of resources. This could result insignificant public protest and political repercussions. Ifinstitutional services are phased out prior to the final "pay-off" of the bond indebtedness, the state will have the expenseof buildings without any way to generate the resources topay for them.

Solution Strategies

There is no overall strategy that can be used to dealwith all prior fiscal investments; an urban institution might

PlanningObjective

WorkingAssumption

System BarriersFigure 1

PLANNING STRATEGY

Describe ultimate functioning rolefor institutional programs

First, consider most desirable option- -no institutional services, services pro-

vided by small community-based programs

Can this working assumption be adopted?

Analysis of major barriers

Individual variables

Given sufficient resourcesand services, individual

needs can be met outside ofinstitutions

1

[--This conclusion supportsadoption of the working

assumption

System variables

Analysis ofpotential barriers

If barriers cannot beresolved, working

assumption is rejected andother options for institu-

tional services must be considered

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If barriers can beresolved, working

assumption is acceptedand planning can

begin.....=69

System Barriers

easily be sold or renovated for another purpose, but feweroptions exist for rural institutions. Given the broad rangeof demographic variables, each local community will have todevelop specific plans to deal with this issue. Generalsuggestions discussed by the subcommittee included:

o Changing the present bonding structure to allow moreflexibility

o Using facilities for other public purposes, to offset someof the indebtedness

o Selling, leasing, or giving away properties

o Using developmental center facilities as communityregional centers (diagnostic centers, workshops, ruralmedical centers, etc.), but not for long-term residentialplacements

Conclusion

Given the gradual nature with which institutionalservices would be phased out, prior fiscal investment is notan immediate problem. Gradual phasing out will also allowtime for local communitiues to develop facility-specific plans.This is not a major barrier that precludes adoption of theworking assumption.

EMPLOYEE RIGHTS

A large number of individuals are employed in state-operated developmental centers. In addition, many otherpeople are employed in community-based institutions, such asnursing homes. Phasing out of institutional services will resultin a loss of these jobs.

Consequences

The loss, or simply threat of loss, of institutional jobs,and the resulting impact on local communities, especially inrural areas, could result in lobbying and subsequent politicalaction. This type of protest could, at least temporarily,disrupt the movement toward deinstitutionalization. It willbe very difficult to protect the rights of institutionalemployees while, at the same time, ensuring that persons withdevelopmental disabilities do not remain institutionalizedsimply to maintain job positions.

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System Barriers

Solution Strategies

Gradual phasing out of institutional services will allowfor natural job attrition, which will greatly reduce the numberof people who might be "forced" to leave their jobs.Retraining and relocation programs will also allow manyemployees to transfer to job positions created in localcommunities. It is also possible that local jobs could bemaintained in those facilities sold or converted to other uses.Other possible solutions include:

o Providing temporary financial parity betweeninstitutional and community-based jobs

o Developing funding transition programs, whereby thestate shares at least initially in funding for newcommunity job positions.

o Transferring state civil service employees to local civilservice systems

o Providing job placement programs

This is, potentially, one of the more explosive barriers. Thetransition to a community-based system will benefit personswith developmental disabilities, but it will, at the same time,have a negative impact on those rural communities that havecome to rely on institutional funding.

Conclusion

Employee rights is not a major barrier that will precludeadoption of the working assumption. However, it may becomea major barrier if the state does not initiate efforts to addressthis issue equitably.

PARENT CONCERNS

Initially, some parents/guardians of persons withdevelopmental disabilities are concerned t.':

o Institutions may be the safest place fr their son ordaughter.

o Community programs may not endure; ,hey can't trustthat such programs will be able to provide life-longservices.

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System Barriers

Consequences

As with institutional employees, parent groups mightbecome more politically active and work to stop thedeinstitutionalization process.

Solution Strategies

A variety of strategies could be used to allay parentalconcerns. The most effective way to meet parental concernsis the development of a comprehensive, adequately funded,life-long, community-based service system. Historically, wehave seen "The State" as the final, if not primary, residentialservice provider. We have also equated residential serviceswith institutional living. Over time, parents will come torely in the same way on their local system and realize thatadequate residential services can be provided in thecommunity. Other strategies include:

o Developing a stable, adequate funding base forcommunity-based services

o Clearly communicating that the move to community-based services does not mean that the state isrelinquishing its responsibility to ensure adequate servicedelivery

o Maximizing parent involvement in planning, placement,and long-range follow-up processes

o Providing an on-going, comprehensive, and permanentmechanism for case management and, if necessary,guardianship

The preceding solutions are proposed in an attempt toincrease parents' acceptance of community-based services.However, the state should also clearly communicate that thereis no legal or value-based reason to provide a more restrictivesetting than is necessary to meet a person's needs. No onehas a right to institutional services, if their needs can bemet in less restrictive settings.

Conclusion

Parent concerns is not a major, long-term barrier. Asquality community programs continue to be developed and agood track record of stable funding is evidenced, parentconcerns will diminish. However, this is a major politicalissue for now and the immediate future.

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System Barriers

PUBLIC ATTITUDES

Historically, institutional services have been perceivedas necessary by society at large. In addition, there has beensome lack of acceptance of community-based alternatives.

Consequences

Negative public reaction to deinstitutionalization couldresult in restrictive zoning laws, defeat of local levies forfunding of community programs, etc.

Solution Strategies

The short history of the deinstitutionalization movementshows that public attitudes can be changed in a positivedirection. Possible strategies include:

o Developing smaller (more easily accepted) programs

o Increasing local involvement and local control ofprograms, and planning

o Increasing acceptance of permissive zoning codes

Conclusions

Public attitudes is not a major, long-term barrier. Asquality community programs continue to be developed, publicacceptance of such programs will increase. Increasing localinvolvement and control in planning and operating serviceprograms will assist In overcoming negative public attitudes.

COMMUNITY RESOURCES

The shift to a community-based service delivery systemrequires a dramatic increase in the number of trainedpersonnel in local MR/DD programs and in generic serviceagencies. Personnel resources become increasingly moreimportant as more severely, handicapped persons return totheir home communities. At a minimum, each person mustbe assured of receiving no less service (both quantity andquality) in community programs than they received previously.Historically, Ohio has not been able to rely on the availabilityof adequate generic service resources. Nursing homes andother large, institutional-type community programs haveusually been self-contained programs, and made minimal useof community resources. Smaller, more integrated programswill rely much more heavily on the availability of genericservices (medical, dental, psychological, etc.).

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22

14

System Barriers

Consequences

If adequate community resources are not available, twoproblems could occur: (1) some persons will continue to beplaced in institutions, or remain institutionalized, becausecommunity programs to meet their needs "are not available"and; (2) some persons might be placed in community programsthat would not be adequate to meet their needs.

The first problem will result in a slowdown in thedeinstitutionalization process. The second problem, which ismore likely to occur, will result in a violation of persons'right to adequate and appropriate services.

Solution Strategies

At least four major strategies are needed to deal withthe problems described above:

o Attention should be focused on the development ofadequate community services.

o The state should ensure that adequate standards andmonitoring mechanisms, including consumer evaluation,are developed to ensure quality service provisions.

o A consortium of state agencies should be formed toinfluence colleges, universities, and other genericagencies in their development of appropriate pre- andin-service training programs (mobile training teamsshould be developed to provide both training to genericproviders and direct service to clients until adequatecommunity resources are developed).

o Some counties, especially those in rural areas, need todevelop the ability to provide financial incentives toattract competent personnel, or to establish multi-countyprograms.

Other strategies suggested include:

o Initiating a state billing system for providing "upfront"funds to pay Medicaid providers

o Revising rules and regulations so that daily maintenance,habilitation, and rehabilitation services can be providedby a wider range of trained and experienced staff

o Establishing a system of family supports to assist familiesin obtaining needed services

Development of adequate and comprehensive communityresources is a long-term process, but it should be possible to

23

System Barriers

synchronize this development with the gradual phasing out ofinstitutional services.

Conclusion

Community resources is not a major barrier to adoptionof the working assumption. However, if as institutionalservices are phased out, adequate services are not availablein the community, progress will stop. Availability ofcommunity resources is not a barrier to planning and initialimplementation but, unless intensive efforts are made, it couldvery well function as a major, long-term barrier.

FUNDING RESOURCES

The phasing out of institutional services, especially ofdevelopmental centers, has a profound impact on how thestate's financial resources are allocated. A lack of fundsfor community programs has frequently been cited as a barrierto deinstitutionalization. Equally important is the issue ofcost-effectiveness of service provision. Given the history ofcommunity services, it is extremely important that, in additionto being adequate, the funding base must be seen aspermanent.

Consequences

It will probably not be possible to make the transitionto a community-based system without some initial increase incosts, which is an inherent problem in a "dual" service system.Also, it will not be possible to develop a comprehensive systemof community resources without transferring funds from theinstitutional systel

Solution Strategies

As is the case with most of the other potential barriers,the funding issue requires both short- and long-term solutionstrategies. Some short-term strategies include:

o Increasing the use of Medicaid funding for community-based services to help eliminate one of the disincentivesto deinstitutionalization

o Increasing joint funding/programming to distribute costmore equitably between state and local human serviceagencies

o Making changes in rules and regulations pertaining toPurchase of Service so that adequate, flexible funding

15

System Barriers

is available to meet the needs of persons with severedisabilit. ;s

o Using Department rules, regulations, and the Certificateof Need review process to establish standards forcommunity-operated nonprofit, and private for-profitfacilities

o Reducing funding and capital formation disincentives forresidential development by nonprofit groups, whichmitigate against developing smaller facilities

Major long-term strategy(ies) must deal with the issue ofmaintaining state responsibility for seeing that adequateservices are provided while, at the same time, developing afunding formula that provides an appropriate balance offederP.1, state, and local funding. If counties perceive thephasing out of institutional programs to be a means for thestate to escape from its current financial obligations, theplan will fail.

Conclusion

Based on the limited amount of cost-effectiveness datanow available, it seems clear that quality communityalternatives can be developed that are not more expensivethan comparable institutional services. There is no reason,based on available cost data, to prevent adopting the workingassumption and beginning the planning process. Costs mustof course be monitored and will obviously result in revisionsto the plan, but this is no reason not to begin.

LEGAL CONCERNS

The Ohio Revised Code (ORC) outlines the serviceresponsibilities of the Department of Mental Retardation andDevelopmental Disabilities. Currently, it is not clear what,if any, legislative changes will be necessary to phase outinstitutional services gradually.

Consequences

A lack of legislative authority could hinder, at leastinitially, the deinstitutionalization process.

16

Systew Barriers

Solution Strategies

Analyze ORC and, if necessary, make changes that allowfor:

o A mechanism to assure provision of service, even if thestate is no longer a direct provider of service

o Maintenance of a pinpoint of responsibility at the statelevel

Conclusion

Legal concerns do not have the same substantive impactas do the other issues. If the other issues can be resolved,this problem will surely not be a major one. However, realor "supposed" legislative mandates might be used by opponentsto slow o deinstitutionalization process.

COORDINATION/MANAGEMENT

The phasing out of institutional services requires aredefinition of the responsibilities and management functionsof state and county programs. An effective administrativestructure is necessary for maintaining a comprehensivecommunity-based service delivery system.

Consequences

The potential consequences of problems in coordinationand management are difficult +o describe. It is fairly easyto determine whether sufficient funds are available andwhether adequate numbers of trained personnel are available.It is much more difficult to judge whether a service systemis adequately managed and well-coordinated. However, it isnot difficult to see the negative effects of a poorlycoordinated service system. Lack of a coordinated systemresults in:

o Gaps in the service system

o Inflexible use of funds and personnel resources

o Fragmented service plans

o Inadequate monitoring of service provision

o Inappropriate duplication of effort

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18

System Barriers

A "non-system" approach results in either a major barrierto continued community development or a large decreasein the quality of service provided.

Solution Strategies

Redefining the responsibilities and management functionsof state and county programs probably will be the mostdifficult one to overcome. Systemic problems require systemicsolutions. It is far too simplistic to direct administrators to"develop a well-coordinated service system". Development ofsuch a system requires major changes in:

o Regulatory authority

o Funding sources

o Flexibility in utilizing funds

o Decision-making responsibility

o Case management responsibilities

o Pinpoints of service responsibility

Additional strategies include:

o Using existing technology (specifically computers) moreeffectively to assist in planning and monitoring

o Using the Individual Habilitation Plan OHM as the basicdocument for planning and evaluation

o Developing more effective means for advocates toinfluence the system

o Building normalization criteria and legal rights intostandards, regulations, and monitoring systems

o Developing mechanisms to coordinate fragmented servicedelivery at the local level (county/multi-county)

o Establishing mechanisms to improve the interfacebetween community residential facilities and CountyBoards of MR/DD

o Strengthening the role of the Department of MR/DD inmonitoring community programs

o Coordinating planning at the local level to guide futuresystem development

27

System Barriers

o Strengthening the role of the Department of MR/DD inhelping coordinate planning at the local level

Conclusion

The current lack of an effective administrative structureserves as a barrier to continued community development anda major barrier to the gradual phasing out of all institutionalservices. This barrier does not require rejection of theworking assumption, but does have to be the first ma orvariable considered in the planning process.

INDIVIDUAL RIGHTS

Persons currently residing in institutions, or those whomay be in need of some form of "long-term care", have certainrights and needs. Plans for phasing out institutional servicesmust ensure the protection of a person's rights as well asensure that the person's needs are being met.

Consequences

If parents, the public, and professionals were to perceivethat individual needs were being sacrificed in the name ofinstitutional depopulation, there would be a powerful politicalbacklash. This backlash is At t'ady apparent in the manydocumented cases of "comnrittit'l dumping programs".

Solution Strategies

As was stated earlier in the Parents' Rights section,no one has a right to live in an institution if his or her needscan be met in a less restrictive setting.

Some persons may wish to remain in institutions. Onemust ask if such persons have ever experienced moreintegrated residential alternatives. Given that the phasingout of institutional services will be gradual, it will be possibleto temporarily respect the wishes of most, if not all, of theseindividuals. However, once the institutional population getsbelow the level of economic feasibility, the remainingresidents must be moved.

Conclusio

Given the gradual phase out of institutional programs,and the number of persons who have lived in institutions fora long time and would likely wish to continue to do so,

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20

Community Institutions

consideration of individual rights is not an immediate barrierto accepting the working assumption.

COMMUNITY PROGRAM CAPACITY

The problem of community program capacity is notactually separable from those of funding, personnel resources,and system coordination. Given that these problems are tobe dealt with effectively, program capacity will not be anissue. However, it is important to note that the completephasing out of institutional services, both developmentalcenters and community-based institutions, requires asignificant increase in the capacity of community programs.Many of the persons who have already left developmentalcenters have returned to live independently, in the communitywith their families, in room and board homes, or in nursinghomes and other community institutions. Most of the severelydisabled residents remaining in institutions will not return totheir families and, therefore, the plan calls for thedevelopment of a large number of small, community-basedliving options.

No major problems preclude Ohio from adopting theGENERAL working assumption and beginning to plan for a community-

CONCLUSIONS based service system, without institutional services.

Many problems could ultimately cause such a plan tofail or require modification. However, this does not meanthat Ohio cannot begin the planning process.

A growing controversy in most states centers aroundCOMMUNITY the present and future role of smaller institutional programs

INSTITUTIONS located in the local community. Examples of such programsare nursing homes (ICF), nursing homes for persons withmental retardation (ICF/MR), and specialized care facilities.

Many states have such programs as the major means ofdepopulating their large institutions. For example, in the1970's, Wisconsin had more people institutionalized in nursinghomes than in state-operated developmental centers. In FY1979-80, more than half of all the moves out of institutionsin Florida were to large community-based ICF/MR programs.Ohio has also witnessed a rapid growth in the number oflarge community institutions. For example, in January 1983,there were 81 ICF/MR facilities with a total 2,715 beds. Ofthese, 2,473 were in facilities of 16 beds or more.Approximately 91% of the individuals living in an Ohiocommunity ICF/MR program were living in facilities with 16or more beds.

29

Community Institutions

Four serious objections have been raised to a"transinstitutionalization" strategy:

o In some community-based institutions, conditions are atleast as dehumanizing as in large state-operated centers.

o Some persons have been placed in community-basedinstitutions (such as nursing homes), which are notdesigned to meet the needs of persons withdevelopmental disabilities.

o Given that there are more integrative alternativespossible, placement in a community institution, even onelocated in the person's home community, is unnecessaryand inappropriate.

o The development of large community institutions merelytransfers the problems associated with congregate carefrom the state to the local community.

Most of the issues raised under the section on PlanningPrinciples are applicable here; only the differences will bedescribed.

Least Restrictive Environment: Clearly community-based institutions will be smaller and probably closer tothe person's home than the present state-operatedinstitutional facilities. However, smaller four- to six-bed ICF/MRs (as operated in Michigan and a number ofother states) represent a less restrictive option.

Right to Services: It is difficult to defend communityinstitutions as the best learning and service environment.

Normalization Principle: Community institutions clearlyfacilitate physical integration. However, they havelittle, if any, impact on the person's social integrationin the community.

Equal Justice: Can we allow funding priorities todetermine whether some persons are transinstitu-tionalized to community institutions while persons withsimilar needs are served in smaller, less restrictivesettings?

Respect for Human Dignity: Community institutions suchas nursing homes or large specialized care facilities,are not positively valued by society. The "best" nursinghome in Ohio does not have young, nondisabled personson its waiting list. Placing disabled persons incommunity institutions further stigmatizes them; if thisis necessary to meet their needs, then it must be done.If less stigmatizing, more positively valued alternativesare possible, they must be used.

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30

Dual System

Developmental Assumption: Community institutions, likeall institutional settings, tend to congregate personswith special needs and segregate them from normalcommunity activites, which is not consistent with thedevelopmental assumption.

Effectiveness and Economy: One advantage to theinstitutional strategy has always been described aseconomy of scale. Some persons contend that the mosteconomical way to serve persons with severe handicapsis in relatively large numbers (30-100 persons). Yet,this advantage has never been supported by cost data.In fact, a number of states have developed an alternativeapproachusing small group homes. The cost data fromthese programs show that quality, appropriate servicescan be provided at a cost equal to or less than commun.yinstitution costs.

As delineated in Position Paper No. 2 on residentialservices, community institutions do not play a role in long-term plans for residential services. Therefore, it will be aserious mistake to continue the development of communityinstitutions. Tremendous sums of money would be necessaryto establish a sufficient number of community Institutionalfacilitiesfunds which will have to be diverted from thedevelopment of smaller, more integrated home-centeralternatives. The continued development of large communityinstitutions will merely perpetuate the problems associatedwith Ohio's institutions by transferring those problems to thecommunity. Although community institutions may be newerand better equipped than older state-operated facilities, it isimportant to remember that the goal is to promote the physicaland social integration of persons with developmentaldisabilities. Small, more integrated home-centeredalternatives provide a more likely environment to achievethat goal. To facilitate the movement to a service systemwithout institutional services, the state needs to begin nowto develop plans for the eventual phase out of communityinstitutions.

During the past several years, significant progress hasPHASE OUT been made to improve the availability of community-based

OF DUAL SYSTEM programs in Ohio. The growth of the state's Purchase ofService program, the passage of Amended Substitute SenateBill 160, (ASSB 160), which expanded the role andresponsibility of County Boards of MR/DD, and increasedfunding for community programs, are indicative of the state'seffort to improve service availability at the local level. Whilethis progress has been significant, the current dual servicesystem of separate community and institutional programs raisesorganizational barriers to the continued development of

effective service:, These barriers result in:

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Recommendations

o Separate and poorly coordinated programming/budgetingof institutional and community-based services

o Over-use of costly institutional services for manypersons with developmental disabilities whose needsmight be met more appropriately in a community setting

o Unclear roles for the Department of MR/DD, CountyBoards of MR/DD, and state-operated institutions in:(1) service delivery (2) fiscal control (3) systemmanagement and accountability, and (4) clientresponsibility.

The Deinstitutionalization Task Force believes that a"single- focus system" should be developed, which would assurecontinuity in services and flexibility in the range of servicesavailable to meet the needs of persons with developmentaldisabilities. This continuity and flexibility can only beaccomplished, in the long run, when responsibility for allclient services is located at the county or multi-county level.Therefore, it is proposed that a single, unified system ofservices be established that coordinates the resourcespresently available and locates client responsibility in thecommunity, regardless of where or how the service is provided.Although the Task Force's long-term plan calls for the phasingout of state and community institutions, this process cannotbe achieved immediately. A significant time period will benecessary for planning and developing implementationstrategies to address the barriers delineated in this report.However, movement toward a unified service system shouldbegin ,low, to eliminate the negative consequences of thepresent dual service system. A first step in that process iselimination of the dual client responsibility that presentlyexists. The following recommendations are proposed:

o The Department of MR/DD should delegate respons-RECOMM ENDATIONS ibility for the provision and planning of services to

County Boards of MR/DD.

o Comprehensive planning by County Boards of MR/DDshould include plans for the delivery of services tocounty residents, persons placed under the Purchase ofService program, and county residents currently residingin state developmental centers.

o Current state developmental centers, as long as theyexist, should be viewed as a community resource to beaccessed when the service they are equipped to provideis not presently available in the county.

o The Department of MR/DD budgeting process should bechanged to allocate state resources to County Boards

3223

Recommendations

of MR/DD for the purchasing of services from statedevelopmental centers for each county's clients.

o Increased funding should be provided to further expandlocal services to meet the needs of those personscurrently residing in state facilities who could benefitfrom community services.

o Persons who are seeking admission, or who are referredto a state developmental center should first be evaluatedby the County Board of MR/DD to determine if theirneeds can be met more appropriately in a communitysetting.

o A cost-sharing mechanism should be developed andphased in over a four-year period, that equitablydistributes the cost between the state and Hu_ localcommunity for nonreimbursable costs (e.g., non-ICF/MR)of maintaining a person in a state facility.

o Department of MR/DD planning efforts should be morestrongly geared to moving the state toward developingintegrated community-based services.

o These proposed changes should take place as a jointlynegotiated shifting of-responsibilities and accountability,which should occur over a period of four years (1984-1988),

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REFERENCES

Apolloni, T., Cappuccilli, J. & Cooke, T. (1980). Achievements in residential servicesfor persons with disabilities. University Park Press.

Boggs, E.M. (June 5, 1981). Testimony on the Medicaid program and mentally retardedpeople. The Subcommittee on Health and the Environment of the Committee onEnergy and Commerce, U.S. House of Representatives. Washington D.C.

Lakin, K.C., Bruininks, R.H., Doth, D., & Hauber, F. (September 1982). Sourcebook onlong term care for developmentally disabled people. (Center for Residential andCommunity Services Project Report #17). Minneapolis, MN: University ofMinnesota.

Laski, F. (1980). Right to services in the community: Implications of the Pennhurstcase. In R.J. Flynn & K.E. Nitsch (Eds.), Normalization, social integration andcommunity services. Baltimore: University Park Press.

Martin, J.E., Rusch, F.R., & Heal, L.W. (1982). Teaching community survival skillsto mentally retarded adults: A review and analysis. The Journal of SpecialEducation, 16 (3).

McCarver, R.B. & Craig, E.M. (1974). Placement of the retarded in the community:Prognosis and outcome. In N.R. Ellis (Ed.), International review of research inmental retardation, 7. New York: Academic Press.

Ohio Department of Mental Retardation and Developmental Disabilities. (December1982). Annual financial and statistical report. Fiscal year 1982. Columbus, Ohio.A uthor.

PCMR. (1978). Mental retardation: The leading edge. Report to the President1978. Washington: U.S. Government Printing Office.

Pilewski, M.E. & Heal, L.W. (1980). Empirical support for deinstitutionalization. InA. Novak 6( L. Heal (Eds.), Integration of DD individuals into the community.Baltimore: Paul H. Brooks.

Touche-Ross. (1980). Report on costs of community-based and institutional servicesin Nebraska. Unpublished manuscript.

Meek, C.A. & Bruininks, R.N. (1980). The cost of public and community residentialcare for the mentally retarded people in the United States (Project Report No.9, Developmental Disabilities Project on Residential Services and CommunityAdjustment). Minneapolis, MN: University of Minnesota, Department ofPsychoeducational Studies.

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DEINSTITUTIONALIZATION TASK FORCE MEMBERS

Henry Leland, Co-chairpersonChief of PsychologyNisonger CenterThe Ohio State University1580 Cannon DriveColumbus, Ohio 43210

William Gilbert, Co-chairpersonAdministrator, Psychological ServicesOhio Department of Rehabilitation

and CorrectionsSuite 4121050 Freeway DriveColumbus, Ohio 43229

Dorothy ReynoldsExecutive Vice PresidentFranklin County Mental Health Board447 East Broad StreetColumbus, Ohio 43215

Kate HallerLegal Counsel to the DirectorOhio Department of Mental Health30 East Broad StreetColUmbus, Ohio 43215

Roger GovePsychiatrist235 Old Village RoadColumbus, Ohio 43228

Nick WasylikOhio Association for Retarded Citizens751 Northwest BoulevardColumbus, Ohio 43212

Wade HitzingExecutive DirectorOhio Society for Autistic Citizens751 Northwest BoulevardColumbus, Ohio 43212

Anita BartonOhio Private Residental Association36 West Gay StreetColumbus, Ohio 43215

Denis StoddardExecutive DirectorOhio DD Planning Council30 East Broad StreetColumbus, Ohlo 43215

Bruce MohleyChief, Office of PlanningOhio Department of MR/DD30 East Broad StreetColumbus, Ohio 43215

Alvin HadleyDirector, Division for Services to

Families and ChildrenFranklin County Children Services1951 Gantz RoadGrove City, Ohio 43123

Cheryl PhippsAssistant SuperintendentFranklin County Board of MR/DD2879 Johnstown RoadColumbus, Ohio 43219

INSTITUTIONAL SERVICES SUBCOMMITTEEDEINSTITUTIONALIZATION TASK FORCE

Wade Hitzing, ChairpersonOhio Society for Autistic Citizens751 Northwest BoulevardColumbus, Ohio 43212

Ray AndersonOhio Department of MR/DD30 East Broad StreetColumbus, Ohio 43215

Robert MillerOhio Association for Retarded Citizens751 Northwest BoulevardColumbus, Ohio 43212

Grant ShoubAttorney1116 South High Street, Suite KColumbus, Ohio 43206

Betty LynchOhio Civil Service Employees

Association1960 West Broad StreetColumbus, Ohio 43223

Roger GovePsychiatrist235 Old Village RoadColumbus, Ohio 43228

William GilbertOhio Department of Rehabilitation

and Corrections, Suite 4121050 Freeway DriveColumbus, Ohio 43229

William GibsonOhio Private Residential Association30 West Gay StreetColumbus, Ohio 43215

Ron HoleyOhio Department of MR/DDMt. Vernon Developmental CenterSanatorium RoadP.O. Box 762Mt. Vernon,Ohio 43050

Agency affiliations are provided for informational purposes only, and do not necessarily implythat the respective organizations or agencies have endorsed the contents of this paper.

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