"LESSONS LEARNED ON SUSTAINABILITY" WEBINAR

~ NOVEMBER 29, 2011 ~

LIZ PERSAUD: Good afternoon, everyone. This is

Liz with the Pass It On Center. It's so wonderful to see

all of you on here today.

I'm looking at the clock, and it looks to be about

that time. We've got 2 o'clock eastern. So if it works

for all of you, we'll actually go ahead and get started.

We have an absolutely wonderful webinar today that

Joy Kniskern and Trish Redmon with the Pass It On Center

are going to be talking to you about.

It's actually Lessons Learned from the Original AT

Reuse Demonstration Project. And this webinar is going to

be focused on sustainability.

They've done some great research, some checking in

with the original demonstration grants, and just wanted to

share some information that they've learned with talking to

these programs across the country and how they can share

their lessons learned and tips and successes on

sustainability with all of you here.

Before we jump into the content of the webinar,

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throughout the process of the webinar, too, to make sure

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not many delays.

Trish, if you'll move on to the next slide, please.

Wanted to share with y'all that we offer credits

for all of our webinars. We're really happy to do this.

And we know that many of you are taking advantage of it.

We really appreciate that.

We do offer CEUs for all of our webinars. And to

be able to access your CEUs, if you just visit the AAC

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send me an e-mail -- it's liz@passitoncenter.org -- with

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than happy to send you a verification form.

This particular webinar today is actually offering

1.5 CRCs. So it's really a great way to catch some of your

credits if you need to.

At the end of today's webinar, we definitely need

your help. And what we need is for y'all to fill out a

little survey about our webinar today. This really, really

helps us to turn those results in and be able to offer more

credits to you. This is one of the ways that we're able to

offer those credits.

It also helps us to create our webinar schedule for

next year and just know what it is that y'all need. We

definitely are listening to you, appreciate the time that

you take out of your busy days. We all know that time is

very precious and appreciate all of you jumping on the

webinar with us and your feedback for it as well too.

The other thing that I would like to ask for each

of you is, if you could, in the public-chat area, just type

in your name and your organization. This actually helps me

to populate the attendance list, which again helps with

credits.

So again, if you could just type in your name and

the organization that you're with into the public-chat

area, again, that helps me to keep attendance and keep

track of who's joining us at any given time.

I want to let you know that the webinar is being

recorded. Kimberly Griffin is our transcriptionist, and

she is on here today. And I also want to say happy

birthday to Kimberly. It's her birthday today.

But she's recording the webinar today. And in

about three to four weeks we'll have the written

transcription and the audio transcription up.

We actually will have the PowerPoint up before the

end of the week as well too. So we appreciate Kimberly

jumping on and doing that.

Now, before I pass it to our main speakers, Trish

Redmon and Joy Kniskern with the Pass It On Center, I want

to just pass the microphone over to Caroline Van Howe with

ATIA.

Caroline, we really appreciate you jumping on the

webinar and helping us out today and being here today. We

had a wonderful time at ATIA, very successful conference in

Chicago. We're looking forward to Orlando at the end of

January.

So Caroline?

CAROLINE VAN HOWE: Thanks, Liz. And welcome,

everybody.

Yes. Just wanted to say thanks for the support.

And of course part of -- ATIA is part of the national task

force team for the AT Reuse Project with the Pass It On

Center. So we're always interested to see how everyone's

doing.

Just wanted to share with you the conference is

taking place in Orlando. The next conference for ATIA is

taking place in Orlando, Florida. And depending on where

you're based, that might be a very attractive place to go

in January.

It's January 26th through the 28th, 2012. And as

in previous years, a substantial number of AT reuse

sessions will be taking place as part of the AT reuse

strand at ATIA Orlando.

I think there's also some special sessions that the

Pass It On Center team are also providing around AT reuse

that I'll let them tell more about with you.

There is a special Pass It On Center discount code

that I will put in the public-chat area. Just wanted to

let you know. And thanks for the opportunity.

LIZ PERSAUD: Thank you, Caroline.

And, yes, I do want to mention that the Pass It On

Center will have an AT reuse strand at ATIA Orlando, and we

will also have a booth.

Our strand is about seven sessions. Each of the

sessions are integrated into the larger strand and brings

an aspect of AT reuse into ATIA and the session as a whole.

So we really appreciate your attention to that.

And if y'all want to attend, Caroline will put that

discount code in there for Pass It On Center. We certainly

look forward to you being there.

So with that being said, I'm going to pass it now

to Trish Redmon with the Pass It On Center.

TRISH REDMON: Thank you, Liz. I want to make sure

everyone can hear me before I start. Any issues hearing

me? Okay.

Today we're going to do the first of two webinars

on lessons learned from the 12 demonstration projects. And

today I've noted that this is lessons learned or lessons to

be learned. If we haven't learned them, now's a good time

to pick up on them.

In 2006, as part of the Rehabilitation Act, the

U.S. Department of Education made grants to 12 AT programs

for reuse projects as three-year demonstration projects.

Now, all of these were centered around reuse, but

each project had one or more specific goals and activities

that might have made it of a different nature. For

example, one was centered completely on computer

refurbishing and reuse, and another was focused entirely on

agricultural workers.

So the grants had a variety of purposes and

objectives, and that made them even more interesting for

their diversity.

They also funded one national technical assistance

center, which is the Pass It On Center. And today we're

going to talk about what we've learned from those projects,

both from the reports they filed as they tracked their

project through the three years, their final reports, and

all of the many things they shared with all of us in the

programs and at the Pass It On Center as those three years

and the two subsequent years progressed.

So this is an accumulation of that knowledge passed

on through reporting, through national conferences,

participation in the ATIA reuse strands, and then our

webinars.

First of all, let's just take a look at who those

were. We had the Delaware AT Initiative, DC Shares from

the District of Columbia, STAR Network from Georgia.

And STAR Network was a combination of existing

programs, Friends of Disabled Adults and Children and

ReBoot as a core to build a statewide network and then a

regional network.

Idaho had a project called AT4ALL. In Kansas we

had Expanding Reuse from AT for Kansans, which had about a

dozen objectives and a very sweeping breadth of activities

and objectives. Mississippi's Project START was another.

Paraquad, an independent nonprofit in St. Louis,

had AT Reuse For Independent Living. New Mexico had an AT

Reutilization Model. And in Oklahoma we had AMBUCS, the

Share4Life computer project. In Texas we had Project MEND

in San Antonio. Virginia had VATnet. And Wisconsin had

the Agricultural AT Reuse Project managed by Wisconsin

Easter Seals.

And these are some of the lessons we've learned

from those projects.

Today we're focusing on sustainability, which is,

at its most basic, just to survive as long as you're needed

or as long as you want to.

And if you can imagine a world when we don't have a

need for safe, appropriate, and affordable AT, then we

won't need a reuse program. But until we have that perfect

world when everyone has all the health care, insurance, and

access that they need, and there are no delays, then we'll

still need AT reuse.

Our objectives today are to look at the key factors

in program sustainability, to learn successful strategies

that addressed the challenges to sustainability for

programs, and to assess consequences when we don't plan

early enough or adequately for sustainability, and then to

reiterate some of those lessons for strategic planning.

Some of the key factors that we've examined for

sustainability are, first of all, ensuring that all our

practices are safe, effective, and appropriate.

Another is that all programs need strong leadership

and management and management that understands the business

case for AT reuse. This is one of the key lessons we

learned from the demonstration projects, that we should be

applying some of the lessons of business to our programs,

whether they're non-profit, governmental, or otherwise.

We also learned that we must engage our

stakeholders to serve customers and to build community

support.

And a key issue for all of us is diversifying the

sources of funding to promote our financial stability. As

we do that, we need to expand our capacity to serve

customers and to demonstrate the value of the reuse

program.

And finally we want to look a little bit at

resilience. And resilience in being prepared to shift

priorities or adopt new models of operations as the things

that we were planning are impacted by external factors.

All of these things are enormous challenges to

survival and growth.

And Joy is going to talk now about planning for

sustainability.

JOY KNISKERN: Thank you, Trish.

And I really appreciate all of your comments and am

very happy to see all of you here today.

A plan for sustainability really is -- "A goal

without a plan is just a wish," by Antoine de St. Exupery.

And with the 12 grantees, I think many of you who

are with us today certainly know that we've started so many

presentations with also the statement from Stephen Covey,

"To begin with the end in mind."

And so with that, it's just very important to

understand what your goal is; to develop a plan around that

goal; and to break it down, as we're going to do today,

into these several different areas.

Our first responsibility -- and this is one of the

things we really emphasized in the very beginning -- was to

ensure safe, effective, and appropriate assistive

technology reutilization.

And with the demonstration projects, what we found

is that so many of the projects were interested in how you

look at different kinds of ways to assure safe, effective,

and appropriate reuse.

And they've shared their expertise in the reuse

conferences, all of the webinars, all of the ATIA

conference sessions. And many of the demonstration

programs have hosted visits to educate others, people who

have come to their program to learn about what they're

doing, and also where they have shared with others in

different ways what they've done.

With others they've helped with Pass It On Center

to develop the indicators of quality for AT reuse. And if

you were to look at our website, you would see that we have

a whole section of quality indicators for AT reuse.

Those indicators were not developed in any kind of

vacuum. We had several very serious, in-depth focus groups

spanning several days where program directors, people who

are involved in reuse at the grassroots level, really came

in -- Cathy Valdez, folks from Paraquad and also from FODAC

and many others -- to really give informed expertise as to:

What are those qualities for AT reuse? How can we develop

these indicators of quality to reach our goal of insuring

safe, effective, and appropriate AT reuse?

And all of the grantees donated many types of

models; examples; policies; procedures; forms that they've

used; marketing strategies; marketing audiences to get

gently reused equipment; presentations; and forms that are

in the Pass It On Center knowledge base, which now holds

about 750 objects.

If you go there, you'll see that there's just many,

many types of information that you need. And I would say,

even with that, we welcome your ideas and questions in

areas that we need to expand in that knowledge base.

Before I go on, I also want to mention that we've

worked with so many different states across the country who

have replicated some of the practices that the 12 grantees

have shown us, and we've seen a lot of cross-sharing among

many states and territories. And that's really what we've

wanted to see happen.

When we look at safe reuse, really that's a focus

on sanitizing practices and device tracking. How can we

assure that devices are sanitized according to manufacturer

specifications? And how can we track those devices so

that, if there's a recall at either the FDA level or the

manufacturer's level, that the people who are the end users

really know that there is an issue that needs to be handled

with respect to recalls?

Sanitization policies and procedures --

If you can go back, Trish, a little bit there, a

few more comments.

Policies and procedures, tile rooms (Paraquad and

FODAC), automated cleaning devices, and worker training.

This is an example of a HUBSCRUB, and there's

several different types of manufacturers that will produce

a type of device that you can clean nonelectric items very,

very quickly.

What we also saw at Paraquad, when we went there in

one of the first two years of the Pass It On Center grant,

was that they actually had a steam room that was quite

efficient where you could put multiple nonelectric devices

in there.

And, in fact, FODAC liked it so much that, when

they were able to raise the money through county funding,

they replicated that. And that's something that we see

happening across the country.

Virginia picked up on using the HUBSCRUB. They

bought about five HUBSCRUBs for use across the state with

their distributed model of AT reuse.

Tracking devices for warning and recalls. We

already talked about that.

Okay. You can advance the slide now.

When we look at appropriate devices and selecting

the right devices, it's very important to have some method

where the consumer can be matched to the right device and

also training in proper use.

And in terms of matching, I think Trish is going to

be addressing that a little bit later on.

In terms of training for proper use, this is a

picture from Paraquad out in Missouri. And they actually

have a whole room where people who received mobility

devices can go through training with professionals from

Washington University, occupational therapy specialists

there, to understand how to use equipment.

And the functional design of reuse centers at

Paraquad, FODAC, and Project MEND is something that people

who are starting programs or who want to expand their

programs may want to look at how they've done a functional

design that works for moving equipment through quickly,

matching, and so on and engaging those AT professionals for

matching.

FREE and Paraquad both are working with

universities where specialists there can come in and work

with individuals. There are different models for doing

that, but those are two that we really, really like.

Survival and sustainability does require planning.

You want to look at your financial resources for the

program. You want to look at your human resources and

inventory of lightly used equipment.

Those are three categories of need that we've heard

voiced from many programs, is what can we do to diversify

our sources of program funding, and what can we do to plan

for that?

We've recommended developing a three-year,

long-range financial plan. And I would say that we know

that the majority of the programs that we've worked with in

the demonstration grants have done just that. They've

looked at how they can plan for growth and operations.

You kind of have to ask yourself, if you have a

program, and there are other people who are coming to your

door, and you can't satisfy their requests for reused

equipment, are you going to turn them away?

And similarly, if you have donors of gently used

equipment, and you don't have adequate space to house the

equipment, are you going to turn them away?

What we've seen is a trend where programs do tend,

if they're well operated, to expand and grow their

operations and use that financial plan, that three-year

plan, to really strategically look at how they're going to

do that.

In human resources, same thing. You need to plan

for succession of management and key roles. You need to

look at how you're going to develop your employees and your

volunteers, how you're going to train them, and how you're

going to develop those plans for succession planning.

We've seen at least one example with one of the

demonstration programs where leadership and the whole

program was based with volunteers. And in that particular

model, one person, the leader of the organization, had all

the knowledge, all the skills, all the know-how.

And as the program moved through their development

with the grant that they received from RSA, the program

just imploded. And we'll talk about that in a little bit.

We've always said we need to learn from our

successes as well as those challenges where things didn't

work out exactly as we planned.

You also need to look at your inventory of lightly

used equipment. How are you going to get the kind of

equipment that you can use for placing with individuals who

are your customers?

And so we'll advance to the next slide.

Global change is upon us. I think every day we're

hearing and listen with great concern about governments in

Europe where they're becoming bankrupt.

We know that in Birmingham and also Harrisburg,

Pennsylvania, there are major concerns about city

governments becoming bankrupt in some areas of the country.

And so many governments have created support models

that are unsustainable and face citizen expectations of

expanded services with limited resources.

And we know that we're living in a society right

now that tends to be, unfortunately, litigious with an

entitlement mentality.

Fear of litigation for many is a barrier to

full-scale adoption of safe and appropriate reuse as a

cost-cutting alternative.

We've worked with a number of programs across the

country. I think there have been about 17 programs overall

that have requested assistance, for example, in looking at

Medicaid as one potential third-party funder of reuse

programs. And other programs have looked at vocational

rehabilitation and reuse with the VR program. And those

are just two examples.

And our suggestion is that we move forward and look

very carefully at our relationships with third-party

funders. And certainly we don't want to look at

third-party funders as any kind of cash cow as a way to

sustain your program.

And as we promote AT reuse to meet the needs of

increasing economic pressure, what we've asked ourselves

is: Would this limit consumer choice? Would it curtail

the supply of lightly used devices available for reuse?

If say Medicaid or other agencies were to jump into

reuse as a way to cut costs, would that limit the

consumers' choice of devices that would be available to

them? And similarly, if they did that, what would that do

again to the supply of devices that all of our reuse

programs really count on?

Those are things that we look at very, very

carefully. And as we move into our presentation later on,

we'll be talking about diversifying your sources of income

and really looking at the many different ways that you can

do that.

Strong leadership is also an important aspect of

sustainability. You've got to have a stable program

infrastructure to survive. You've got to have that

succession plan, as we talked about, for your key leaders,

your CEO, your president, and the key roles within your

organization, whether your organization is dedicated to

reuse -- and FODAC is an example of that -- or a program

like Paraquad that is a program within an umbrella

organization, a center for independent living.

In either case you really have to work on how

you're going to do that and really work, and work very

hard, at cross-training all your staff in key roles so

that, if one person has to step out -- it's like the old

goose story. You've got the lead goose that goes to the

back, drops to the back, so other people can take the helm.

All volunteer operations are risky. I just touched

on AMBUCS in Oklahoma. This is Share4Life computers, and

it was a computer-refurbishing program.

This program started years ago, and it was 100

percent volunteer operated. Before they got their grant,

they were actually in a building without running water, and

they didn't have any heat. But they had this amazing group

of volunteers.

And so AMBUCS applied for a grant. They were

awarded a grant. And they were able to get a lovely

building that they had leased. They were able to hire some

part-time paid staff to help support the operation and to

support what they thought would be a flourishing of this

program.

Unfortunately, part of what happened is the

knowledge in that program was all vested in the person who

was the volunteer director. And when the partially paid

staff came on board, many of the volunteers who had given a

number of years towards supporting that organization felt

like they weren't needed anymore.

And so this is a really good example of how those

points of transition in your organization, when you're

moving from say a very small, volunteer-operated

organization, or where you're going to bring on paid staff

to take the place of where volunteers helped you in the

past, that that's a transition point to pay very close

attention to and to make sure that you build the supports

and the infrastructure to weather those changes.

And so we'll move on to looking at some real stars

in the demonstration grant world. And we know that there

are many fine leaders with reuse programs across the

country that we've met throughout these years.

And some of the ones that really stand out to us in

terms of the sharing that they've done and how they've

learned and shared with all the states and territories are

Chris Brand, Joanne Willis with the STAR Network; Sara Sack

with Kansas; Sonja Schaible with the FREE Foundation; and

Barclay Shepard, who's with VATS organization, the AT

program in Virginia; Ron Seiler with the AT program in

Virginia; and Sarah Johnnes, who was with the reuse

program; Cathy Valdez in Texas; Carla Walker and Lindsey

Bean with Paraquad, and that's in a CIL, a center for

independent living; and Dorothy Young in Mississippi.

With all of these projects these people made

major -- and continue to make major contributions to our

program. When you go to our website, you'll see many of

the items that they've supplied to us over the years, and

we continue to follow as they grow and expand their

programs.

And then Trish is going to talk about our

stakeholders and how you engage your stakeholders.

TRISH REDMON: Engaging the stakeholders is a major

part of making your program a part of the community, of

building a brand that everyone recognizes as a major

resource.

And again, we're continuing our theme of planning,

that "Plans are only good intentions unless they

immediately degenerate into hard work."

And then Warren Buffet says, "All hard work brings

profit" -- that might be questionable sometimes -- but he

says, "mere talk leads only to poverty." We can probably

agree with that, that there's no profit in just talking

about the problem.

So let's talk about who our stakeholders are.

First of all, they're the people who need us: the

uninsured, the underinsured, and individuals waiting for

AT. Those are the prospective customers for reuse.

There are those professionals who encounter

customers with an unmet need for AT and refer them to reuse

programs. There are the agencies and organizations who

serve people with functional needs. We have health care

providers who refer people, who work with people who need

assistive technology.

Then we have those people who have unused assistive

technology and may have no idea that so many other people

are in need of that device. We have manufacturers and

suppliers of AT who sometimes themselves provide used

devices or model devices.

Or in some cases in our communities, I happen to

know there are DME providers who provide free devices when

they encounter people who simply have no insurance and no

funds to pay for necessary AT.

And then we have our boards of directors and our

advisory councils and even our private insurance companies.

So almost everyone in our community is a

stakeholder in some sense -- the caregivers and the family

members of people who need AT. So all of us are

stakeholders in having strong reuse programs.

We've learned from our programs that there are many

ways to build community support. But most of all we need

to collaborate with all the agencies and organizations that

serve the same populations for similar needs.

And that's the theme you'll find running through

our entire "lessons learned" today, that successful

programs collaborate and partner with all the stakeholders.

We need to work with community organizations to

create awareness of the reuse program. Whether those

community organizations serve people who use AT or serve

other constituencies, they have the ability to pass on

word-of-mouth information about the reuse program, to refer

people, to gain supporters, and even the possibility of

financial support for your program.

So one key to building community support is to

become a recognized contributor to your community.

If you are a nonprofit, you need to develop a

strong board. And Cathy Valdez has helped us with one

example of rebuilding a board.

Cathy encountered this shortly after she took over

Project MEND in San Antonio, that there was a lot of change

in her board in a transition and the lifecycle of the

organization. And so she's had some experience in what it

takes to rebuild a board.

And first of all, we want a strong board because

strong boards can give us information and expertise in

areas that we don't have within the organization. Very few

of our programs can afford a large paid staff.

And so, especially if you're a standalone

nonprofit, you can't afford to hire an expert in human

resources or finance and accounting or an attorney. You

just can't have all those professional resources on staff.

So board members with access to resources in their

own corporations or organizations are very valuable. Board

members usually bring financial support.

Perhaps in addition to their own limited financial

support, they usually have significant contacts in the

community to bring that financial support with connections

to potential donors or funders.

And so from Cathy we learned about her experience

in developing a board. First of all, she developed generic

descriptions for board members and officer roles. Just as

in your organization you write job descriptions, she wrote

descriptions for board members and outlined the

expectations and responsibilities for those board members.

And then she proceeded to recruit from the

leadership training programs in the San Antonio community,

specifically United Way and the Chamber of Commerce.

And nearly all major cities have these leadership

training programs, and they're usually called Leadership

San Antonio or something similar.

And some colleges have nonprofit leadership or

management programs. So those are sources of possible new

board members, in addition to your own board members who

might suggest others who can fill your unmet needs.

I thought it was amusing that Cathy described to us

an event that she compared to speed dating where a class of

leadership training individuals were graduated, and they

were all put in a room, and people from nonprofit

organizations were allowed to come in and do speed

interviews for potential board members.

We want to build relationships in the health care

community. If you can tap into the medical services of the

largest health care providers in the area, you can build

some really wonderful relationships. Now, that is not a

simple task, and none of us would say that it is.

As Sonja Schaible said to me, it requires a lot of

weaving. And she means weaving relationships, a lot of

networking. It takes a lot of time to build awareness of

what you're doing in the reuse program and how it benefits

them.

It is very important though. For example, in

hospitals -- and I think we touch on this somewhere else --

some of you may be aware that reimbursements in hospitals

are not uniform. That is, every hospital doesn't get paid

the same amount from a third-party provider for the same

procedure or service. They get paid based on their

outcomes.

And so there's an incentive to have better

outcomes. If they send someone home from the hospital

without the AT they need, then their outcomes are not going

to be as good. So they have a real incentive to give

access to devices to improve outcomes as quickly as

possible.

The FREE Foundation and VATnet in Virginia have

space donated at three different health care facilities to

actually house outreach centers in VATnet.

Project MEND works closely with the county, the

city, and the university medical center in San Antonio,

which is where the University of Texas Medical School is.

And FODAC here in the Atlanta area actually works,

in some sense, the other way. They provide large numbers

of wheelchairs, for example, to Atlanta's largest public

hospital.

So creating that relationship can work both ways.

You might get devices from the hospital, but you also are

more likely to be asked to help their patients who cannot

afford the AT.

We want to partner with programs that train AT

professionals. Joy mentioned this earlier. This is a real

key.

Paraquad, as she mentioned, has a relationship with

Washington University and its occupational therapy program.

In fact, we should mention that Lindsey Bean

Kampwerth, a doctoral graduate from Wash U who's been

working with Paraquad and the Pass It On Center for the

last four years, was recently promoted to manager of the

reuse program at Paraquad.

The FREE Foundation has partnerships with five

colleges and universities that have physical therapy,

occupational therapy or physical therapy assistant

programs.

And so they have students who come in and intern in

their programs, who learn about assistive technology and

assistive technology reuse, and assist with the assessments

and the fitting.

That gives them the opportunity for on-site

training and sanitization and repair because they might

have to do that in a minor way in the course of their

future professional work.

It gives them experience matching AT and working

with patients and devices. And it gives them awareness of

AT resources and makes them an advocate for our programs in

the future.

Joy, I'm going to let you talk about diversifying

sources of income.

JOY KNISKERN: All right. And I'm hoping that,

with some sound adjustment, you can hear me a little bit

better.

Is this better than it was before? Okay.

In diversifying sources of income, "Never depend on

a single source of income." And another quote from Warren

Buffet that we like, "It's no use carrying an umbrella if

your shoes are leaking."

You've got to have all the legs of your stool in

place to really bring your program to the point at which

you can truly sustain it.

Some of the grantees really talked with us a lot

about how much credibility getting a grant, a federal

grant, from Rehabilitation Services Administration meant to

them in terms of growing their program.

They used it to really leverage sources of support

from both private foundations and from public entities as

well.

And, you know, in today's tough economic climate,

it's really important to show funders, whether they're

foundations or public entities, that you really have that

support. And the more people who are on your train, the

stronger your train will be, and the farther it will

travel. It's just one of those things that's extremely

important.

And in finding other sources of funding then, they

leverage those sources of funding as well to bring in

additional levels of support. And we're going to go into

some of the sources of support in just a minute.

But first what we're going to look at is how do you

balance those sources of support and those sources of

income.

And this is an example that was shared about a year

ago from Chris Brand, who is the executive director with

Friends of Disabled Adults and Children. And basically he

and others have suggested you want to look at a three-way

split.

Government. He was pulling in about 32.6 percent

of his income from both the county government; he receives

a little bit of money from the state AT program; and he

receives some funding from the demonstration grant, what we

call the STAR Network here in Georgia.

He also earned 33 percent income -- and we're going

to take a look at that a little bit later on -- from

churches.

And also from their thrift store they receive now

about 19.2 percent of their income. And I will tell you

that, when they started the thrift store back in the early

'90s, when it first opened up that first year, they

generated about $11,000 in income. That picture has

changed for them, and we'll talk about that later.

In terms of fees for services, 12.8 percent of

their income comes from fees. And fees include things like

charges for batteries, reupholstering wheelchairs that come

in.

A charge for -- or a donation from a person who

will look at how they can support the program.

Contributions. They received about 2.2 percent of their

income from churches in the area, 6.8 percent from

corporations.

They have a very active foundation development

activity now. 12.4 percent of their income comes from

foundations in the Metro Atlanta area and from individuals.

Individuals coming into their stores and also into

their facilities are always asked if they would like to

make a contribution. And it's also on their newsletter and

so on. And then organizations as well.

In addition to that, they've done -- and we'll talk

about this a little bit later on -- an event every year

that has become very successful.

And we're going to take a look now at Virginia's

five-legged stool. This was developed by Barclay Shepard,

and he talked about a diversity of grants and government

sources that they would use to develop their program.

Carolyn Phillips and I had the great pleasure to go

to Virginia and work with some of their key organizations

and looking at how would they develop a sustainability plan

and who would be involved and so on.

And so Barclay took this information. And working

with Sonja Schaible with the FREE Foundation and others

there, they developed a three-year plan.

And in that three-year plan, they looked at what

grants they could secure, what kind of stimulus funding

they could get, state funding, looked at working at

third-party payor organizations and also legislative

funding.

And they generated quite a bit of funds. They

received from the Brain and Spinal Injury Trust Commission

I believe something like $414,000.

And normally those funds would be used just for

those who had sustained spinal and brain injuries in the

state. But they allowed, as how so many of the people they

serve have those injuries, and they could reach a broader

group to serve as well.

And then they received some stimulus funds. They

do receive some state AT money. And they're working

collaboratively with the VA and Medicaid.

That did not pan out for them to be a source of

income. But rather what they did develop -- and Sara Sack

was involved in working with them and their Medicaid agency

in looking at how they could collaborate.

And what they came up with was we can collaborate

most effectively by trying out what it would be like if we

had a sticker program whereby any equipment that's

purchased through Medicaid funds or VA funds would be

stickered with a toll-free number, and that was done in a

very contained area in Roanoke, Virginia. And so they're

still looking at what will develop there.

Okay. We'll move to the next slide.

Even small partners add financial stability.

Smaller partners can provide things like storage space;

share professional expertise, either legal or financial;

share space or services: office, copier, utilities.

We know that Touch the Future, Inc. that operates

the ReBoot program for many years, they had a partnership

with an organization called The Common Good. And they

refurbished cell phones.

They don't have that relationship right now because

that group I believe outgrew the facility that was there.

But there are many examples where people have shared space

and shared those services together.

Paying for specific expenses, repair and

refurbishing. If you look at a couple of models, they've

been based where the state AT program or another entity

receives funding, and then they pay venders to actually do

the refurbishing.

And in other cases there are collaborative

arrangements where vendors will assist in looking at

whether a piece of equipment is something that can indeed

be refurbished or whether or not it's completed its useful

life.

Providing services. Pickup, delivery, and

assessment. That gives a great example. Their

collaboration with the FREE Foundation and Goodwill

Industries in Virginia has been very much a win-win

situation.

It just so happened that a couple of the partners

were co-located. And so that, as Goodwill Industries did

their runs to pickup all kinds of items that they

refurbish, Goodwill turned over all the durable medical

equipment items to the FREE Foundation in order for them to

go ahead and refurbish those kinds of equipment. And

that's worked out very, very well.

In terms of providing storage space, there are

examples where you can look at partnering with

organizations that can do that for you and provide it at no

cost.

We're going to take a closer look now at some of

the fee-for-service revenue.

One of the things that Trish did is she polled all

the demonstration programs to look at what kind of fees for

services are they currently using, and how do you deal with

that customer who comes in the door and who says, "You

know, I just -- there's absolutely no way that I could

afford to pay for one dollar of this equipment."

And so these are some of the ways we've broken

these down.

Processing and application fees, $20 to $65.

There's a range there. Wheelchair repair services --

that's something that both FODAC and Paraquad do -- $25

plus parts, $50 was another program, $15 for each 15-minute

increment.

And if those of you have questions about --

And I'm sorry you still hear the hum. I promise

I'm not humming in the background too. But I did try to

adjust my sound here.

We can also supply information to you about the

specifics of organizations that have supplied those

particular kinds of fees.

In terms of service delivery, some programs charge

$25 to $75, depending on the distance and whether a truck

is in the area.

Wheelchair battery sales discounted at 35 or 40

percent below retail. So one of our programs has gotten

some really good deals on batteries, and they do need to

charge because the cost of batteries has gone up generally

because of the cost of lead that is in them, but the

discounted rate makes it more affordable.

Donation and recycling fees. $10 per item are

suggested fee by the device.

Another program -- and this is the STAR Network.

And we don't know of anybody else that's doing this. We

found that it's been a very successful model in both

Georgia and South Carolina, which is a part of the STAR

Network, which was our demonstration grant in Georgia.

From the very beginning, part of our long-range

plan was to establish a network membership fee. So for

example, if there's a center for independent living in one

part of the state, we said, from the STAR Network

standpoint, that they would provide technical assistance

and training; transportation resources to deliver

equipment, to pick it up; assistance in learning how to

clean a wheelchair, when to know whether something needs to

go back to the central refurbishing facility, which is

FODAC, and that's located in Atlanta; or if it's something

say in Macon, which is about an hour and a half from

Atlanta, is a device that could be cleaned and serviced

right there without having to come back to Atlanta.

So the network membership concept is something

that, perhaps in a larger state, might work in a way to

expand either an existing program or to launch one across

the state.

And then South Carolina pays a $2,500 out-of-state

fee. And that's because the STAR Network has to travel a

good bit farther.

And what is done is the STAR Network shares a

transportation and distribution calendar every month so

people can be ready with donated items at the centers for

independent living; for pickup, those things that need to

be picked up; and also for receiving the orders that

they've placed with a major reuse facility, which is FODAC

and ReBoot.

ReBoot does refurbished computers. And then FODAC

does durable medical equipment.

And also some program charges a fee based on just

the refurbished equipment itself. It's based on the type

of device and its value after refurbishing.

So those are some categories of fee-for-service

revenue. There are many different things that people could

consider to do to raise revenue that way.

Another way that you can develop revenue or income

is to collaborate with local hospitals and health care

systems.

Project MEND out of San Antonio, Texas. And Cathy

Valdez is with us today.

Glad you could join us. If there's anything you

want to add, please feel free to raise your hand or jump in

the chat area.

They develop agreements with city and county to

provide services to the city and county for individuals who

needed refurbished equipment.

And they also have a wonderful relationship with

the county hospital system and university health systems to

get very, very gently used donated equipment.

And then Friends of Disabled Adults and Children

provides DME, durable medical equipment, to public

hospitals.

We found that Grady Hospital in Atlanta was in need

of about 200 different manual wheelchairs every month,

because it's a hospital in the core of our city here in

Atlanta, and they work with many people who are Medicaid

beneficiaries.

And they found that many people just didn't have a

way to leave the hospital without a wheelchair. And

indeed, some of the wheelchairs were just being stolen.

And so at first there was a relationship with FODAC

where they would provide that equipment to the hospital,

every month about 200 different manual wheelchairs. And

they were -- the last time I talked with Chris Brand, they

were working to develop a fee-based arrangement to make

that exchange. And the hospital, in turn, was locking down

its security so that the equipment wouldn't leave the

premises.

Assigning responsibility for ongoing pursuit of

revenue. That is another strategy. And you can work with

your board for doing this.

You can definitely -- with a nonprofit

organization, having worked with many nonprofits over the

years, with many nonprofits there's an explicit

understanding coming in that, if you're a member of the

board, we expect for you to contribute financially or to

contribute expertise as a part of your responsibility on

the board. And that is just one of those expectations.

To use the outcomes to demonstrate value for

investment of public dollars at local and state level. And

both the Virginia program and FODAC have done a tremendous

job in studying outcomes to show the return on the

investment of their programs.

And how did they do that? They actually assigned

responsibility to individuals to really collect the data

and to run the numbers using return-on-investment models.

And if you go to our website, you will see some of

the satisfaction surveys that were used to -- and some of

the surveys that were used with consumers to look at the

value from the consumer's eyes as to what reused equipment

helped them to stay out of nursing homes, stay out of

having to go for emergency visits at hospitals, and become

more independent.

You can also assign responsibility to pursue grants

to explore new forums of assistive technology, reuse or new

populations, to serve individuals.

And you can also look at fundraising as an

institutionalized activity or ongoing role. So program

leaders active in community affairs, marketing managers,

development managers.

Both FODAC and Project MEND have grown to the point

where they were able to identify and recruit development

managers to pursue both public and private grants and

corporate donors and to work on fundraising events.

I don't know that Project MEND is doing fundraising

events right now, but FODAC definitely is. They have

several different events every year.

All right. And then in working with Medicaid, we

touched on that before. Kansas has developed a model where

Medicaid pays the Kansas program to literally track

inventory of Medicaid beneficiaries, the equipment that is

assigned to Medicaid beneficiaries.

And the funding that they receive from Medicaid is

used to cover the cost of refurbishing DME by working with

vendors in the community.

And any items that are not needed right away are

recovered for reuse and assigned within 90 days to other

programs within the community. So after 90 days, if the

gently used equipment that is recovered is not used, then

it goes to partners like the MS Society and so on.

And Sara has also worked with us in developing

Medicaid relationships with programs working with Medicaid

in about 18 different states.

And again, as I said, we're looking at that as a

potentially slippery slope. And in order to do that, you

need to be sure to contact Sara at the Pass It On Center if

that is a relationship where your program is being

contacted by Medicaid so that we can kind of guide you

through that process.

Idaho has developed a billable Medicaid service --

this is one of the programs that Sara has worked with --

for reuse that allows for up to 75 percent of the cost of

new equipment.

And then Paraquad actually does equipment repair.

They repair wheelchairs, and they will bill Medicaid for

Medicaid-eligible services there.

So there are a couple different ways that you can

work with Medicaid. Or you can look at a low-risk way,

like VATS has done, Virginia Assistive Technology Program,

and simply look at a stickering program.

All right. We want to also look at optimizing use

of human resources as a way to expand the capacity of your

program. Here are a couple of models for using volunteers.

Project MEND has used seniors who are paid through

an AARP work program. And then AMBUCS in Oklahoma used

unpaid volunteers from the local AMBUCS chapter. And also

I think FODAC uses community service volunteers. And we've

also seen programs that use interns with college programs

who will come in and work in specific areas of concern.

What's important with that: to optimize those

human resources, to make sure you have a training program,

you have mentors in your program to work with that

individual.

When somebody comes in and they want to volunteer,

you don't want to assign them to a task that is not well

specced out so they will know what to do and that they've

got that supervision of one paid staffed person or some

individual to work with them.

One of the things that we suggest you do is assign

a value to the volunteer hours. So in other words,

volunteer can be a cost or a benefit to your program. What

is the value of that volunteer to your program?

You want to look at how that volunteer is going to

be used. If you have a volunteer, for example, who is

going to be entering your data, then that is something that

would work if the person knows how to do it, and that's not

going to be a cost to you. If they don't do the data

properly, then that's going to be something that's going to

be very expensive to go back and to redo.

And if you want to find out what volunteers are

worth in your state, you can look at this really helpful

website and find out what the volunteer time is worth.

You can also use calculations in your

return-on-investment formulas. And we'll be working with

you on that in future webinars.

You want to establish a relationship with local

corporate and foundation donors. Here are some examples

from several programs and the corporate donors that they

identified in their community.

Paraquad has worked with Anheuser-Busch, Emerson

Electric, AT&T, Newman's Own, Graybar Foundation, and

Macy's. Project MEND has worked with the Gordon Hartman

Family Foundation, WellMed Charitable Foundation, the

Kronkosky Charitable Foundation, Alcoa, Orsinger

Foundation.

What you want to be sure of is that these corporate

partners -- that not only their employees know about your

program and what you're doing but also work with these

donors so that their patrons, the patrons of Macy's, --

their employees and their patrons know about what they're

doing.

That will tend to provide you with a greater

resource for donated goods and the potential that they will

refer people who need your services as well.

You want to establish relationships, really good

relationships, within the community as well.

Project MEND has been a shining example of really

working within their community to develop those kind of

relationships.

And I know they did a lot of work with United Way.

I think Trish touched on how they worked with the power

lunches or the power dating kind of scenario where Project

MEND and other groups went in, and some of the new people

on the board with United Way and other groups had an

opportunity to come in and quickly spend time with Project

MEND, and they received all Project MEND's information.

And so you want to do that.

The local foundation in San Antonio helped build

the new office building for Project MEND. And there's

Cathy right in the middle as that new building goes up.

And then FODAC has done an extraordinary job

working with stimulus funds through the county government.

In fact, they received substantial funding. And I wish you

could see the new building. For any of you who've been

here to Georgia and had an opportunity to go to FODAC a

couple of years ago several different times when we did AT

reuse conferences, it would look like an entirely different

building at this point.

There's a drive-through entrance where anybody

coming in doesn't have to worry about getting wet. And

that includes MARTA buses and some of the paratransit

services as well.

And then they have a whole beautiful entrance area,

an area that is dedicated to all of the refurbishing

activities, another area dedicated to where people learn to

use equipment, where assignments are made.

And it's really wonderful to see many of the

demonstration projects growing in this way: Project MEND,

Paraquad and many others.

In terms of serving unique populations, let's take

a look at what that's -- I think I touched on this earlier,

that VATS received about $414,000 from the Commonwealth

Neurotrauma Initiative. And actually they were able to use

these funds to serve anybody who came -- comes to the FREE

Foundation to receive equipment.

And in Virginia, if you can imagine this, VATS

provides central coordinating organization. VATS is the AT

reuse program there.

And then the FREE Foundation and the centers for

independent living around the state really provide a

comprehensive, coordinated system where they're working

with Goodwill Industries for that transportation back and

forth.

VATS also has had an extraordinarily wonderful

relationship with some of the community hospital

foundations, and they receive equipment from them, and they

have also received funding from the hospitals as well --

the hospital foundations.

And the veterans project, Project MEND, has worked

with veterans from Texas. And as a matter of fact, they

received a significant award recently, the Community Hero

award, for their work with veterans and the wounded

warriors and the VA outpatient clinics and so on.

And so, if you want more information about that,

please be sure to talk with Cathy Valdez.

We have received requests from different programs

through the years as to how can we work with our veterans?

And this is a relationship that takes a while to really

work through different levels of responsibility in your

local area.

Both Project MEND and also the program in Puerto

Rico has developed some very good, excellent relationships

with their veterans groups.

You want to also think about being entrepreneurial.

And we talked earlier about how FODAC developed this thrift

shop years ago in the early '90s. And I mentioned at that

time that, the first year they opened their doors, the

thrift shop, they netted about $11,000. And that was

pretty good.

But one year recently they netted, guess what,

$184,000 in one year. And with ARRA funds, the stimulus

funds they received, they expanded and improved that thrift

shop.

It's a place where, any time we have meetings

there, I got to tell you, people are interested in reuse,

but they'll take that time to go by the thrift shop.

They also provide services to other organizations,

if you have the capacity, for repairs and software for

program management and sanitization.

An example from the STAR Network is Walton Options

from Independent Living. And they bought a couple of

HUBSCRUBs.

And one of them they actually put into a portable

trailer that is wheelchair accessible. They can take that

to locations, and for a service they can provide cleaning

for nonelectric wheelchairs.

So they've gone to nursing homes. They've gone to

other facilities. They've provided services when there are

events like their annual conference on assistive technology

in South Carolina.

The HUBSCRUB has traveled there and provided that

service to patrons of the conference. And that's really

something to look at.

In terms of renting DME for temporary use, one of

the ideas that we had thought would be a good

entrepreneurial activity to pursue, if you live in a major

city, is looking at temporary use of wheelchairs for hotel

guests and renting them out and developing relationships

with hotels so they don't have to have space for

wheelchairs there. Just make yourself known; provide the

transportation to and from when a guest arrives.

All right. And then also for short-term use for

those who really don't want to buy equipment. Somebody who

wants to try out a piece of equipment for a while, they

don't want to buy it, but they're willing to pay for that.

Sponsor fundraising events. We touched on that.

FODAC has done an annual run, walk, and roll at Stone

Mountain. I've participated in that myself, and so have

our staff.

They charge $50 a person. And for that they get an

event T-shirt, and they get an all-attractions pass to the

park. So $20 gets you into the event, but $50 gets you all

those goodies.

And they've done this for 12 years. The very first

year they did it, they did it just around their facility,

and it was a one-mile race. Now it's like five miles. And

you can walk it; you can run it. It's one of those things

that brings in some good income for them.

They also do an annual breakfast with Santa. And

that's another event that they've done every single year.

Create an annual event that increases public

awareness of the program and raises money for operations.

Years ago I worked with Goodwill Industries. And

one of the events that they did every year that was

successful was to have a ghostless ball. And at a

ghostless ball, you work with your board and all their

contacts, and it's one of those things that kind of funny,

but it brought in some good revenue.

Instead of having a ball that costs a lot of money

to do and having a ball where people spend money on buying

fancy clothes, do a ghostless ball. And they actually sent

out invitations that says "Come to our ghostless ball.

You're actually not invited," and so on, so on.

In terms of expanding the capacity, Trish is going

to jump into that and talk about aspects of expanding

capacity and some of the lessons learned there.

Trish, take it away.

TRISH REDMON: Beware your expansion, and do this

carefully.

A couple weeks ago I had a meeting with Joy, and

she told me that she had discovered, during a presentation

at Georgia Tech, that we were in the business of reverse

supply chain logistics.

One of the guests had come up and said, "Wow, AT

reuse is really a cutting-edge thing, given all the demands

for resources in the world, and you're really there. This

is a very important thing."

I know a little bit about supply chain logistics

since I have a graduate degree in business, but I didn't

know much about reverse supply chain logistics.

So I read a little about it. And it is important.

It's about knowing how to recover a product for a variety

of reasons. Whether there are recalls or replacements or

repairs or for parts or to, as most people commonly say,

recycle. We might say repurpose it.

It turns out that this is a major, major issue for

corporations in a worldwide economy; and that, if they can

master the art of efficiently recovering devices through

the network, they can save up to 10 percent of their costs.

So maybe we could consult with some of those people about

doing that.

But we have programs that are doing this

effectively. And you can see that we have labels. We've

mentioned that Kansas labels all Medicaid purchases as

property of the State of Kansas. And when you no longer

need it, you return it, and it has the 800 number.

You can see Virginia's label: "If you would like

to donate this item to the reuse network, call toll free,"

and they have an 800 number.

Recently Nebraska adopted this strategy and created

some really neat labels that say "No longer need this item?

Someone else does."

And so this is one good way to recover equipment,

is to get people to cooperate with you in stickering new AT

devices for reuse.

Sara Sack, a couple of years ago, talked about

considering the source of new AT and durable medical

equipment and examined who pays for it the first time,

because that might provoke some thoughts about how you

develop a strategy to recover the devices for reuse.

And so she found that Medicaid and Medicare are the

largest payors, and they account for basically 60 percent

of all durable medical equipment purchases, followed by

private insurers and then VA and VR.

And so you might think, How do I work with those

third-party payors to recover the unused equipment?

And a lot of effort has been devoted to doing some

of those things but probably an opportunity area for all of

us to work more at recovering lightly used equipment.

Partnerships are a key way to expand capacity. We

work with established organizations that serve people, and

we can serve more people that way.

DC Shares was a program that partnered with the

Washington area wheelchair society to repair wheelchairs

and with the Washington PC users group and the Mac users

group, which is called Apple Pie, to refurbish computers.

And so through those partnerships, they significantly

expanded their capacity to serve the community.

STAR Network expands the service area in a formal

way by having interested existing organizations affiliate

with outreach centers. And so we have AT resource centers

and independent living centers and even the Columbus

Library as affiliate outreach centers of STAR Network.

In Virginia we've already mentioned that Goodwill

Industries donates all the DME they receive and donations

to the FREE Foundation, and the equipment goes into VATnet.

So those partnerships are expanding capacity by bringing

used technology into the system.

We want to develop strategies that increase the

numbers of devices. We talked about tracking them. But

then there's also the issue of hot collection drives.

One of the things we learned were some completely

new strategies from Kansas. They learned that they could

collect significant amounts of equipment if they partnered

with Red Cross when Red Cross did blood drives, and that

worked for them.

And then they later said, Well, you don't need to

spend all day doing these equipment drives. These can be

really focused events. You can advertise them ahead of

time. You can tell people, We're going to accept equipment

donations at this location, and we're only going to accept

donations for 2 or 3 hours, and then it's over.

And you can have those events take place in

multiple locations at the same time so that you take

advantage of any free advertising or print promotion that

you may have garnered.

And so in one day perhaps you have a donation event

that takes place in five cities, and you have a truck go

collect all of that.

The other thing we learned about expanding

capacity, too, from Kansas is that we don't want to accept

everything; that we need to develop standards for the

equipment that we accept.

And in the case of Kansas, they've targeted lightly

used, high-value equipment so that they've been very

successful in collecting very expensive, lightly used

durable medical equipment.

And as Joy mentioned, they don't keep the items in

inventory forever. They keep them 90 days in the central

inventory, and then they send them to their partners for

their loan closets and to be used locally.

Mississippi has partnered with community

organizations and with churches as a strategy not only to

expand their capacity to garner more devices but to reach

their rural communities.

Most of our AT Act programs exist by networking

resources throughout their states. There are few, if any,

who have the resources to do everything on their own. So

they achieve this by networking.

And this is certainly true of reuse programs. And

the hub-and-spoke model is widely used, but it has a lot of

variation on what the centralized activity is.

Joy mentioned that in STAR Network we have

centralized refurbishing for durable medical equipment at

FODAC and for computers at ReBoot.

But in other hub-and-spoke network and service

models, that centralized activity might simply be inventory

management, the way Kansas tracks the Medicaid inventory.

It might be administration of a network. It might be the

fiscal coordination of it. Or it might be the repair and

refurbishing.

And we have seen this model used over and over.

And the question simply becomes: How many partners can you

bring into the network to fulfill different roles and to

expand your capacity to serve people who need AT?

We mentioned the regional model with the outreach

centers. Joy explained that, that they pay a one-time fee

to join as affiliates, and then we have centralized

refurbishing.

Those outreach centers and affiliates can then

request equipment for the customers that need it and have

it delivered to them from a central inventory that's held

at FODAC or at ReBoot.

We have a lot of virtual networks in the country.

And Kansas was one that Joy already reviewed how they

contract the refurbishing with DME vendors, and they don't

hold the equipment, but they manage the inventory.

The Virginia Reuse Network with the FREE Foundation

and the Department of Rehabilitation Services is a virtual

network, but they have locations throughout the state.

Most of your programs have done that successfully

in order to expand their capacity. In Idaho they partnered

with the Department of Education and with some centers for

independent living to provide your transition services.

So, Joy, let's talk a little bit about resilience.

JOY KNISKERN: If you've got all the other pieces

of your stool in place, resilience is one of those

characteristics, one of those things that can help bring

you through the tough times.

And it's the capability to anticipate risk, limit

impact, and bounce back rapidly through survival,

adaptability, evolution, and growth in the face of

turbulent change.

And I think in two words I would say you need to

ask the question, "What if?"

You need to ask the question: What if I lost my

right-hand man or woman who does the repair and maintenance

with my equipment? What if I lost that one funding source?

What is going to hold your organization together?

Those are the things that you need to ask in order

to survive the tough times. And so we're going to give a

couple of examples of two of our demonstration programs.

And there were only 12 demonstration programs

altogether. So the fact that two of them are fabulous

examples of resilience in the face of some major obstacles.

In Idaho they learned that the greatest needs were

for laptops for secondary transition students and updated

computers for rural special education classrooms.

That was not something that was in their original

proposal. And then they focused their resources to really

partner with other organizations to respond to those needs.

And as a result, they built stronger relationships

with several groups, the VR program and the Department of

Education, to get a source of ongoing funding to refurbish

laptops and computers for individuals.

In the case of Kansas, a part of their

demonstration proposal was that they were going to collect

and refurbish and place PDAs and other handheld devices.

And as they began to step into that, they realized

that technology, the whole change and evolution of the

technology field, made that quite not such a good plan.

Essentially there were far too many devices to make

it feasible. And so they shifted the direction of their

program into more of the program that they developed in

working with Medicaid partners and developing expertise

along those lines.

In terms of recommendations -- and these are ideas

that you can take away to really strengthen your program or

develop one if you don't have one -- think about holding a

meeting of stakeholders to really talk about what can be

done to enhance the sustainability of your program.

And this could be either local, state or regional

summits. I believe that we've done probably close to 17

summits across the country in various states and even in

one of the territories in Puerto Rico.

And what we've learned from that is, by working

with the state AT program or even another entity that works

with the state AT program, bringing folks together to

really talk about what's currently happening in the state

reuse, where are the gaps, what are the needs, who are the

stakeholders, who will contribute -- that we can develop

basically the beginning parts of a plan in a period over

several days and then continue to work on it over a period

of about a year.

And if you don't have a sustainability plan, write

one. What lessons can you incorporate?

And we've shared many lessons today from many

different programs. What can you learn from that? What

are the takeaways that make sense to you?

If you do have a sustainability plan, one of the

things that we would like to recommend is take a moment,

convene a group of the people who are your stakeholders

together, review it, and update it.

Did you get some good ideas from this webinar

today? If you pull a group of people together to look at

your sustainability plan, what ideas today can you take

back to them?

And so with that, we want to let you know that, in

December, December 13th at 2:00 p.m., we're going to be

talking more about the lessons learned or to learn from the

demonstration programs and specific outcomes.

We'd like to invite you at this point to ask any

questions or to share any comments about what you'd like to

hear more about.

And with that, I'll release the mic. And again,

we're thrilled that you all were able to come here today.

All right. And Liz is going to share some comments

with us.

All right. We really invite you to take a moment,

go to SurveyMonkey, and please provide your brief

evaluation of today's webinar. We welcome your comments.

We would love to hear from you as to the sorts of

things that you learned today that helped you that you can

take away or other ideas that you'd like for us to focus

more on the next time around.

Thank you so much, and take care.