You are eligible for public mental health services. Now what? You can choose how to have your services delivered. In addition to its more traditional services like day programs or group homes, Network180 offers three different types of self-direction (SD) arrangements. Each one provides you a different level of control over and responsibility for those services. In all self-direction arrangements, services cannot be provided in a segregated setting, but must be delivered in your home and/or your community. 

• Provider with Choice – In a provider with choice arrangement, you choose one of the agencies in the Network180 network of care to deliver the services you are eligible for. Your supports coordinator or case manager can tell you who these agencies are. The agency that will employ your staff. You

negotiate with the agency about how, when, where and by whom your services will be delivered. You may want to meet or interview a staff person before he or she works with you. You may want the staff to follow some “house rules” like not smoking in your house or not borrowing your phone. You may want your services delivered in the morning or the evening. You may want to set up a way to deal with a staff person you do not like. Your agreement with the agency is put in writing and signed by you and the agency.

You will have an individual services budget (ISB). Every month you review the documentation the agency’s employees are required to keep and verify that payment should be made to the agency. You will receive a monthly report from the agency showing how many units of service you have used, how many you have left and how much your services cost.

• Purchase of Services – In a purchase of services agreement, you choose an agency that is not part of the Network180 network of care to provide the services you are eligible for. Your agreement to use a purchase of services arrangement is put in writing and outlines the responsibilities of both you and Network180. The agency you choose is the employer of your staff, but you have control over how, when, where and by whom services are provided. You sign a contract with the agency that outlines your role and the agency’s role. You may want to include specifics about house rules, how to deal with staff you don’t like, when you want services delivered and other important details, just like in a provider with choice arrangement.

       You will have an individual services budget and Network180 will provide a fiscal intermediary (FI) to help you manage it. Every month you review the documentation the employees are required to keep and verify services were provided according to your individualized services plan and that payment should be made to the agency. Once the fiscal intermediary knows you have authorized payment and the agency has provided an invoice, the agency is paid for providing the services to you. The fiscal intermediary will provide you with a monthly report showing how many units of services you have used, how many you have left and how much your services cost.

• Employer of Record – In an employer of record arrangement, you are the employer. Your agreement to be an employer of record is put in writing and outlines the responsibilities of both you and Network180. This arrangement gives you the most responsibility and control over your services and who provides them.  You recruit, interview, hire, schedule, evaluate and manage the employees who deliver the services you are eligible for. You determine when, how, where and by whom your services are provided. Your employees must meet certain criteria, go through back ground checks, attend training and sign employment agreements and Medicaid Provider agreements.

       You will have an individual service budget. A fiscal intermediary helps you by being an “employer agent.” This means the FI can help you manage your budget and will do things like process payroll and deposit taxes. The fiscal intermediary also works with you on a schedule and pay rates for your employees that allow you to stay within the parameters of your budget.

Every month you review the documentation the employees are required to keep, including Medicaid documentation and time cards. You verify services were provided according to your plan of services and that payment should be made to the employee. The fiscal intermediary will provide you with a monthly report showing how many units of services you have used, how many you have left and how much your services cost.

Other Things to Remember about Self-Direction Arrangements.…

Using a self-direction arrangement is your choice. If you decide you no longer want to use a SD arrangement, you will still be eligible for services. Your services will be provided in a different way.

If you decide you do not like the type of SD arrangement you start with, you can try a different type of SD arrangement. 

Using a SD arrangement does not free you, agencies or employees from having to comply with state and federal laws and regulations such as Medicaid and labor laws. Your supports coordinator or case manager will help you to understand and fulfill your responsibilities under these laws and regulations.

Family matters for Linda and Joel Bentzen, mother and son.

Twenty-nine year old Joel Bentzen offers a batch of cookies he just made, grinning slightly as he passes the container over the kitchen table at his Kentwood residence. Although Joel has lived with autism since he was at least three, it is obvious he cannot contain his pride. Nor can his mother, Linda Bentzen.

"We don't know how he does it, but he makes cookies from scratch," she says. "Back when he was ten or eleven, he started making brownies and then cookies. I would measure out the ingredients and he would stir it, put it on the pan and bake it. One time I got busy and didn't have the ingredients ready for him, so he made cookies without me. Even if I didn't have it set up ahead, he made cookies anyway and they always turned out!"

Joel and his mother don't take these experiences lightly and believe they offer unique opportunities for Joel to learn and grow. 

"Everything he does increases his understanding of how the world works and what is going on," she says.

Many individuals, like Joel, who has a developmental disability, benefit from some type of support. Fortunately, Joel has also received the unconditional support of his family.

"You need to change your expectations when you realize your child has special needs," says Linda. “We wanted him to do all that he was capable of doing."

Linda and her husband, Bill, kept Joel in school until he was 25, feeling that in school he would learn what he could and have a wide variety of experiences which would help develop work skills that would eventually benefit him later in life.

"When he got done with school, it was obvious he was going to need someone to keep him supervised," says Linda. "He can't really handle money. He can't make a phone call independently. There are lots of survival skills he doesn't have."

Despite these barriers, Linda hoped that Joel would do something where he was truly contributing. At first, he worked at a supervised assembly line job with other individuals that have a developmental disability. Although Joel enjoyed the work, it was not an active, social environment. It became very repetitive.

"For some people, doing the same thing day in and day out is fine. Sometimes it brings a sense of security. But for Joel, I don't think so," says Linda. "He got 'creative' in assembling the equipment and they said what he needed to do was skill building."

Eventually Linda met a speech pathologist and told her of Joel's story and the various activities he participates in at home. Joel has different chores written out on cards with visual aids to assist him. On the cards are items such as: do laundry, change bed, walk on treadmill, vacuum, dust, empty and load dishwasher. This impressed the speech pathologist. Because of her background in education, she came up with an idea that may possibly become Joel. 

"I've always appreciated special-education teachers," says Linda. "They are just excellent people. That field draws wonderful people of high-quality."

The speech pathologist happened to work at a school and thought the school's custodian could use some help. She would check on this and let Linda know.  

"A few weeks later," explains Linda, "we were meeting with the principal, the custodian, and the speech pathologist and talking about the possibility of Joel going there to work," says Linda.

The custodian was willing to take Joel on. The school was a large building and quite old. There was certainly plenty of work to be done.

Joel's supports coordinator designed an independent employment format based on self-directed employment. Although Linda admits it was a mound of paperwork, Joel would benefit from having a job coach who would work closely with the custodian. The job coach would keep track of what tasks Joel should be completing daily and the goals would be reviewed annually. It even worked out that Joel's brother was able to be the job coach. 

At the time, there were things Linda was not sure about. Although she was confident Joel could learn, she was concerned that complex tasks may be too much for him. The custodian, however, was quite confident in Joel's potential. Fortunately the custodian's intuition was correct. Joel has learned to wipe tables, sweep and mop floors, and empty trash. 

"Last summer he even painted the restrooms of the school," explains Linda. "The custodian asked, 'Do you think he would want to do some painting? He can start with the floor.' "

Joel completed his painting task and learned the satisfaction of a job well done. 

"None of this would have been available to him if the custodian and school administration had not been willing to let Joel try,” says Linda. “This work gives him the opportunity to use skills he already had and to develop new ones, like being on time and checking his work.”

When Joel arrives at the school, he has a clipboard that contains a checklist of tasks for him to complete. He uses visual instructions, hoping it will eventually phase out the need for a job coach. 

"I like it," says Joel about working at the school. "I like that school." 

At the beginning and end of Joel's workday, he signs in or out. By doing this, the school secretary always knows when he is in the building. Linda appreciates this attention. It's a safe environment for him. 

Joel has a good relationship with the school staff. He proudly wears a name tag given to him that indicates “assistant custodian.” People know he belongs there and is a part of the school. He is treated the same as any staff member. When the school had its annual staff dinner, Joel was invited to attend. Later, he shows off an expensive pen set that was given to him as a Christmas gift.

"The school principal once said the school values diversity," says Linda. "He felt that in a way, Joel represents diversity." 

Linda, although noticeably grateful that the school has given Joel work, acknowledges the challenges for families with children that have special needs and admits that at first, she wasn’t very familiar with the system of care, how it is funded, and the different providers available to individuals like Joel. It is often to the benefit of families and caregivers to become familiar with these details.

"I didn't know what network180 was, versus what Hope Network was, versus Thresholds," she admits. "I think the system is full of well-meaning people, but I do think if the support coordinator hadn't found a way for this to work, what would we have done?" she says.  

Regardless, Linda is now at a stage of contentment for her son and hopes Joel's work situation continues. 

"I'm grateful that he is as capable as he is and that he is as happy as he is," she says. “He is purposeful. He has a reason to get up, and work he is happy to do. This is what we hoped for! I am very happy. Joel could do this the rest of his life."