"LESSONS LEARNED FROM THE AT REUSE

DEMONSTRATION PROJECTS: OUTCOMES" Webinar

~ December 13, 2011 ~

LIZ PERSAUD: Hello, everyone. This is Liz with

the Pass It On Center.

According to my clock, it is 2 o'clock, 2:01

eastern time here in Atlanta. So we're going to actually

go ahead and get started.

We do know that your time is precious and valuable,

especially as we all have hectic schedules as we're

wrapping up the year, doing lots of reports, getting lots

of projects to a comfortable point in time as we take time

off for the holidays and welcome in the new year.

So we want to get started on time. And we'll be

here with y'all until about 3:30 p.m. eastern.

So thank you so much for joining us today. It's

great to see everyone on here. Thanks again for taking

time out of your busy schedule.

I did receive many e-mails today, yesterday and

last week from many folks all over the country saying about

how important this webinar was, but unfortunately they

weren't going to be able to join us. So they're looking

forward to catching up with us and also catching the

archive in a few weeks on the Pass It On Center website.

So again, welcome to everyone.

We're really excited about bringing you the webinar

today. This is the second part basically in a two-part

series that looks at the original reuse demonstration

projects grants that were originally funded by RSA and

really looking at the lessons learned.

Back in November we did lessons learned from the AT

reuse demonstration projects on sustainability. We had

great feedback, great attendance. And we're going to be

getting that up on the Pass It On Center website shortly.

So today's webinar focuses on outcomes from many of

those projects and just sharing that information with all

of y'all so you can utilize that; gain from their success

stories, from their helpful solutions as you enhance your

program and do your work when it comes to AT reuse.

So hopefully everyone can see the opening slide.

It has the title, "Lessons Learned From the AT Reuse

Demonstration Projects: Outcomes."

If you are having difficulty seeing the slide, over

on the left-hand side there are two green arrows that

circle each other, kind of like a recycling symbol. And

that's the refresh symbol. So you can certainly click on

that, and that will refresh your screen and hopefully bring

the picture in a better format for you.

There are a few photos that we have on this

beginning slide. Trish Redmon, a consultant with the Pass

It On Center, is absolutely invaluable, and she had pulled

together this PowerPoint as we were all giving her

information.

And she's got some wonderful pictures up here that

I wanted to just take a few moments and just quickly

explain to all of you. But they're examples of just the

great work that programs are doing all over the country.

On the left-hand side we have two individuals

actually petting a small calf, a baby cow. And these folks

are actually out from Wisconsin out in Easter Seals. And

they do a lot of work with farmers. Just a great variety

of different programs across the country. So that's what

they're doing over there on the left.

The photo in the middle is of some folks packing up

equipment into the back of a truck. And those are

computers. And these are the folks from Oklahoma with the

Computers For Kids program. And this is a donation drive,

and they've got a ton of equipment and just getting all

that equipment into the truck.

And then over on the right-hand side we've got two

gentlemen shaking hands with great smiles on their faces.

And this is from Mississippi. And the gentleman on the

left is someone who actually received some reused AT, and

there he is with his supervisor at work.

So we just wanted to share those photos with you so

you can get a glimpse of just what's happening all over the

country.

Down at the bottom of the opening slide, it says

download useful information from the knowledge base. So

we've got a lot of great content that Trish packaged

together that's in the knowledge base. And that's

passitoncenter.org/content. And she also posted that in

the public-chat area.

But we've got supporting documents, forms and data

collection instruments that will hopefully benefit all of

y'all as you're going through the webinar and definitely

afterward as well.

And so we'll go to the next slide.

We've also done a few housekeeping tips. Just

wanted to point that out to y'all as we're waiting for the

slide to come up.

If you are interested in communication with us at

any time throughout the webinar, you can do that through

microphone and through chat.

If you're utilizing a microphone, what you want to

do is just hold down the "Control" key. And when you're

finished speaking, you're going to release the "Control"

key. So hold down the "Control" key, be sure to ask a

question, any comments, just interacting with us. And then

when you're finished speaking, you definitely want to let

go of the "Control" key, and that allows us to finish

talking and allows other folks to contribute as well.

And over on the right-hand side under the

public-chat area, some of y'all have seen us saying hello,

getting some sound checks done, some different folks saying

hi to us.

So that's our public-chat area. Feel free to type

in there. Again, any questions, any comments that you

have, that's another great way to communicate with us.

We'll all definitely be looking over there throughout the

webinar, being sure to capture your questions and anything

that you have to say.

If you have the need for any adjusting of

accessibility options, you can do so over on the left-hand

side under on the "Options" menu.

There's an accessibility link that you can click

on, and it takes you through various options that you can

do to configure your screen to best suit your needs.

I do want to let you know that we archive all of

the Pass It On Center webinars. Kimberly Griffin, who is

from REACH, and she's our transcriptionist, she's on here

today.

Hello, Kimberly. And it's great to see you.

She's actually recording this webinar, and we will

have the audio and transcript as well as the PowerPoint up

on the Pass It On Center webinar in about three to

four weeks.

So this slide says that we offer credits. We

definitely do. We offer CEUs and CRCs. If you're

interested in getting CEUs from today's webinar, you can do

so by visiting the AAC Institute's website. They're the

ones that we collaborate with to bring you CEUs.

That website is aacinstitute.org. If you click on

their website, you can go to the section that says "CEUs."

You should hopefully see today's webinar posted. And then

you just follow the instruction to get your form and your

information for CEUs.

We also offer CRCs for today's webinar. We are

offering 1.5 CRCs. So some of you have already e-mailed me

behind the scenes that you need your CRC verification form.

If you need that, just please feel free to send me

an e-mail with your name, organization, city, state, and

e-mail address. And I'll definitely get that out to you

after the webinar.

And so we'll jump to the next slide, please.

Just want to let y'all know that we have an

evaluation. And if you guys could just take a few moments

to fill out the evaluation at the end of the webinar. We

promise this does not take a long time at all, but what it

does is just help us to offer these credits.

We do listen to all of your feedback. In fact,

we've got a meeting set up in just a few days where our

team is going to get together, take a look at all the

previous webinar evaluations, and look at the schedule for

next year and what y'all are saying that you need and what

you want to hear for the upcoming year as far as webinar

topics.

So definitely anything that you're interested in,

please include that on the webinar evaluation because we do

take that into consideration as we're planning for upcoming

webinars.

I also wanted to ask everyone a favor. In the

public-chat area, if you could just type in your name and

the organization that you're with. What that does is,

again, it helps us to create an attendee list, which helps

us to continue providing credits.

Some of you have already done that. We really

appreciate it. But especially for the ones that have

signed on with just an acronym, it helps us to give some

identifying information.

So if everyone can just type in your name and tell

us what organization that you're with, that definitely

helps us to continue offering credits. So we really

appreciate that.

We wanted just to give some brief information about

ATIA Orlando. We just wrapped up successfully ATIA in

Chicago. And we will be in Orlando in 2012.

Wanted to remind everyone to definitely go ahead

and register for ATIA. It's January 26th through 28th at

the Caribe Royale Resort in Orlando. And you can receive a

discount from the Pass It On Center. And you'll need to do

that by December 19th to utilize all those savings.

But here's some brief information about how it

works. You're basically going to go to the ATIA.org

website, click on "Register." You can also download a

registration form.

That's our code for the Pass It On Center. It's

PANZ3, P-A-N-Z-3. All the instructions are on there.

You're going to enter that on page 3. And then you'll

receive a $25 discount off of your registration. So we

definitely wanted to share that with all of you so you can

utilize that. And hopefully we'll see many of you out in

Orlando.

As we're getting prepared for ATIA, we are working

on our reuse strand. We have seven sessions that we were

very successful with in Chicago. So we're very happy to be

bringing you that again in Orlando.

So we quickly just put up the titles of these

presentations here. These are going to be delivered from

the Pass It On Center staff and many of our team

consultants from all over the country.

So Amy Goldman with the Pennsylvania program. Sara

Sack with the Kansas program. As well as Joy Kniskern;

Carolyn Phillips; myself, Liz; Trish Redmon; Lindsey Bean

Kampwerth out at Paraquad.

So we're really excited to be bringing you this

information here. So those are the titles of our

presentations for the AT reuse strand.

We're going to also have a booth. So take note

that we're in the exhibit hall, booth No. 1122. We'll be

there. So definitely stop by and visit us.

And we'll go to the next slide, Trish.

And again, just some more about the webinars.

Since we are going to be in ATIA, we will not have a

webinar in January, but we'll resume in February of 2012.

And as usual, we plan to have our webinars the last

Tuesday of each month for an hour and a half,

2 o'clock p.m. to 3:30 p.m. eastern. If there are any

changes, just watch out for the announcements, and we'll

get all that information out to you.

We'll also be creating our list of the schedule for

the next year, and we'll be sending that out with an

announcement to y'all very shortly as well.

So as we jump into the content of today's webinar,

we wanted to share with y'all some recommended reading.

This is a book by Mario Morino called "Leap of Reason:

Managing to Outcomes in an Era of Scarcity."

Folks are saying this is definitely a must-read for

nonprofit leaders. We have taken a few of the excerpts

from the executive summary just to share some of the points

in this book, and we used that throughout the presentation.

So we wanted to share this with you.

This book is published by Venture Philanthropy

Partners. And it's available free at leapofreason.org. So

we wanted again just to share this resource with you. We

recommend reading it. We'll be using it throughout the

webinar today. And it is available free to all of you.

And we'll go to the next slide, Trish.

So with that being said, I wanted to introduce our

speakers today. I'm sure many of you are familiar with

them, but we've got Joy Kniskern with the Pass It On

Center; Lindsey Bean-Kampwerth who is the manager of the AT

reuse program over at Paraquad, and she's also a consultant

and does great work with us here at the Pass It On Center;

and then also to Trish Redmon, a consultant with the Pass

It On Center, invaluable work and very instrumental in

pulling this webinar together today.

So thank you all for your time. Hope you enjoy the

content today. And I'm going to pass this over to Joy to

continue with her part. So thanks, everyone.

And here you go, Joy.

JOY KNISKERN: Thank you, Liz.

And also thanks to Lindsey and Trish and to all of

the 12 demonstration grantees who have helped to share

information in building this webinar. And thanks to all of

you for joining us today.

Today we're going to be talking about program

experiences with respect to the outcomes they've achieved.

And we want to look at the importance of gathering data on

outcomes from AT reuse programs.

With data we can make compelling data as to -- and

really it helps us to manage our programs more effectively

so that we can offer efficient programs.

We want to identify some of the methods of

measuring outcomes and what different programs have done in

approaching this issue. And we also want to look at using

outcomes to drive program decision-making.

We know that outcomes will really help us when

we're looking at whether or not we need to make one choice

or make another choice when it comes to everything from who

we're serving to what kind of devices we're really going to

refurbish and make available to our customers.

And then we also want to take a look at the

implications of outcome measurement to leveraged fundings.

And we'll be looking at how different programs have

approached this and the different funding sources that

they've pursued as they've looked at their outcomes.

And what we're going to be doing today is really

focusing on the outcomes and all of the objectives with

respect to the 12 demonstration projects that were funded

three years through Rehabilitation Services Administration.

And also, as I think many of you know, RSA also

funded one national technical assistance center. And we

feel very fortunate and honored to have had the opportunity

to work with the Pass It On Center over the past five

years, and we're moving into a sixth year of work with all

the demonstration grantees as well as with all states and

territories.

And really what we want to look at is some of the

outcomes and work with these 12 projects today. And I'm

just going to run through this list quickly:

Delaware, the Delaware Assistive Technology

Initiative; District of Columbia developed a wonderful

project called DC Shares; the Georgia STAR Network, pleased

to be a part of this whole process; Idaho developed the AT

Reuse Project; Kansas has been involved in expanding reuse

and assistive technology for Kansans; and then the

Mississippi Project START.

And then we're going to advance to the next slide.

And in addition to that, the Center For Independent

Living -- I think it's the oldest Center For Independent

Living in the country -- is Paraquad. And they are working

with an AT reuse model for independent living that serves

Missouri and Illinois.

In New Mexico, the New Mexico AT program received a

grant to work on their demonstration AT reuse model.

Oklahoma submitted a proposal for a grant called

AMBUCS' Share4Life Komputers, and that's the ASK program;

then in Texas, Project MEND is a 501(c)(3) nonprofit that

was involved in reuse, and they also received a grant.

Virginia Assistive Technology Network. It's the

VATS program. They received a grant to develop the

Virginia reuse network.

And then Wisconsin was an AgrAbility program, and

they received a grant to develop the agricultural AT

equipment reuse exchange called the AATER now.

And so those were our 12 programs.

Okay. Let's take a closer look at DC Shares. And

I hope you all can see the data here. They basically

looked at quantitative measures as a form of outcome,

quantitative outcome measurement.

And this capacity measurement shows a dramatic

increase in AT that was available for reuse during this

grant period.

And if you look across this grid here, you see,

from 2007 to 2010, they went into a no-cost extension.

They served a total of 2,838 individuals. And then if you

look at the total number of devices, that's much larger, on

the far right-hand column. It's 4,263 devices.

So what we know about that, from looking at that

program and many others, is that, oftentimes when people

come in to look at reuse, they're going to want one or more

devices.

And so you'll always see, I think in most programs,

that the number of devices exceeds the number of people who

are requesting them.

The value of these devices was a little under

$2 million. And that's looking at the manufacturer's sales

price minus 20 percent, or 20 percent less than the

manufacturer's retail sales price, and what that individual

would have had to pay if they had paid out of pocket.

Now, what we know, from looking at various

programs, not just the 12 demonstration grantees but

programs across the country, is that many of the people who

show up on the steps of reuse programs are those who are

underinsured or uninsured, meaning they really don't have

very good alternatives to look at devices that they might

need.

And so with this particular model, the whole idea

was to expand reuse of durable medical equipment -- they

were already doing some of that -- and computers in

collaboration with other local nonprofits.

One of the challenges they faced was transportation

in an urban area with all the traffic. And so for those of

you who are representing rural states, know that our highly

densely populated urban areas equally share in some of

those challenges; they're just a little bit different.

All right. We'll advance to the next slide now,

Trish.

Delaware is developing an AT reuse initiative that

is in collaboration with both Goodwill Industries and with

Medicaid.

Now, they had gotten a very late start. One of our

colleagues, Carolyn Phillips, our project director -- and I

see she's on the line here -- she was very involved in

Delaware in the very early phases when they first got their

grant to do a summit where all the stakeholders came

together: people representing disability organizations,

Medicaid, all of the potential AT reutilizers, the AT

program -- to look at what the needs were in that state.

We're following the development of this program.

We're very excited to see what they derive. We don't have

a lot more information right now to share with you, but

we'll be doing that later.

The Georgia STAR Network, basically the focus of

this grant in Georgia was to build upon the existing AT

reuse programs already in place. ReBoot with Touch the

Future, Inc. does refurbishing of computers. And then

Friends of Disabled Adults and Children, which is FODAC --

you see the acronym on the left-hand column -- they have

been in the business of doing refurbished durable medical

equipment since 1986.

And so with that, we also had a very strong network

of our assistive technology resource centers affiliated

with the AT program in the state. And they, in turn, had

different satellite groups that they were working with,

often disability organizations situated throughout the

state.

And so the whole point of this was to really

coalesce this entire puzzle of pieces -- pieces of this

puzzle on the table so that we could increase the building

infrastructure that could really sustain itself after the

grant funding was to disappear.

And so centralized refurbishing of durable medical

equipment and computers are done both at FODAC and Touch

the Future, Inc., ReBoot. And then the distribution

channels are with all of the statewide assistive technology

resource centers. There are other centers that have

donation sites.

And so we'll move to the next slide there.

Basically, in looking at outcomes, there's a lot

more that we measured than is just shown on this slide.

But in -- across the four years -- and that includes the

extension project years -- there were 13 really solid

partnerships established with groups across the state

serving as equipment depots and collection sites and

distribution sites.

There were 228 visits made to collaborate and

provide training so that, if refurbishing could take place

at the local level, then people would know how to handle

that.

The miles that were traveled over this four-year

period was over 27,000 miles. The devices collected were

over 5,000. And the computer and related devices collected

exceeded 2,000.

Now, the unique thing about this particular

model -- we're not familiar with any other state that is

doing this -- it has worked very well in our state where,

if somebody wants to participate as a part of the STAR

Network, they would pay a one-time fee of $1,000. And that

covers the cost of the training, the cost of making sure

people know how to use the database so we can track these

outcomes, and really so that people can do local area

refurbishing of simple items.

And then annually each of the partners pays another

$1,500. And so you're probably asking, Well, what does

that buy them?

There's a one-month -- every month there's a

transportation network from the central locations, and the

truck will go around to different sites. Everybody knows

ahead of time where these sites are. And there's

collections that take place as well as the potential of

distributing equipment that people need at the local level.

And so out-of-state fees, we've worked in the past

with South Carolina and have certainly opened doors to

looking at how we could collaborate with other states. And

those would be greater because of the transportation area

or the distance in miles to cover to get there.

And so we're going to move on to the next slide.

And with that, FODAC and the STAR Network really

started out of an individual's basement in 1986. And

basically it was supported through one local church.

Oftentimes -- and I think after the last webinar we

received input on one evaluation, How did these programs

start?

Well, in the case of FODAC, there was no money;

there was no support. The person was providing personal

storage out of their basement.

And the same could be true with ReBoot. I think

our AT program had about $5,000 to launch ReBoot back in

the late '90s. And Carolyn Phillips was very involved in

that.

And basically we built collaborations. And both of

the entities found that there was an increasing demand for

these kinds of devices; there was a champion who stepped up

to the plate and then was effective in bringing other

participants around them to really marshall really a strong

array of resources over time.

So now FODAC is a large nonprofit. It has served

the larger Atlanta Metro area, Georgia, neighboring states.

And it really has responded to international disasters,

such as Haiti, by providing additional funding through

local governments. And organizations have allowed for

their major expansion and renovation.

They got a lot of stimulus funds at FODAC. And

their new facility is 54,000 square feet and upgraded with

a clean room, which is a tiled room for sanitization and

refurbishing. So it's really been great to see that grow.

Another state that has really done a tremendous job

in growing their program through this tiny RSA

demonstration grant was Idaho. And they started with a

model in their proposal where refurbishing and reassignment

of devices was going to be done through centers for

independent living and resources sort of scattered about

the state.

And Pass It On came in and worked with the then

director at Idaho and looking, with all the stakeholders,

as to, Is this going to be a model that will work for them?

What eventually evolved is that these organizations

became networked more effectively around the state and

around reuse. And they've established a very billable

Medicaid service for AT reuse. They have a service that is

more centralized in the refurbishing that they're doing

with the refurbishing across the state. And they are now

providing a program to supply computers to students in

post-secondary schools.

All of this has really increased their referrals

and the volume of their equipment that's available for

reuse. And we're following that very, very closely. And

we'll have updates throughout the years -- throughout this

next year and hopefully the year afterwards.

Kansas has been such a model for all of us in the

country in how they've really pitched their program and are

working with Medicaid. This came about through a

legislator who saw that there was equipment that was being

abandoned along the side of the highway and saw that

frequently enough to make some phone calls, contacted Sara

Sack and said, "You know, it looks to me like there's waste

with equipment that's been provided. What can we do to

make a change?"

And so their collaboration with Medicaid is

twofold. They are stickering their devices that are

purchased through Medicaid funds that, when a person

doesn't need it anymore, they can funnel it to the reuse

program where it's refurbished and reassigned.

And they're also offering an inventory tracking

system for Medicaid so that, when somebody is assigned a

Medicaid supplier of durable medical equipment, the Kansas

program actually has this information, and they can check

to be sure that the person is receiving indeed what they

were supposed to receive.

And then, in turn, they use the funding that

they're getting to offer the inventory program to basically

provide refurbishing through vendors in the state. And

through this they've networked with existing loan closets

and reuse organizations across the state.

What's really interesting about their approach is

that they don't have a lot of storage capacity, and they're

working with partners across the state. And so, after 90

days that piece of equipment that's been turned in to them

for refurbishing with a vendor, that it's only stored for

no more than 90 days. And after that, it's distributed to

other networks such as the MS Society and so on.

One thing that's very important to realize is, if

any state is thinking about working with Medicaid, to

please contact us because it's one of those things that's

very important to be very careful in pursuing. It is not a

cash cow. And also, it is extremely important to realize

that we recommend a consumer-centric approach, meaning that

the person with the disability should be involved in making

that decision as to whether or not they might used reused

equipment or something that's new.

In many cases it's a stopgap until a permanent

piece of equipment can be obtained through the regular

Medicaid channels.

And so, if you look at the three years here, they

show -- and there are many types of data that Kansas does

collect.

But in terms of the savings and the value of the

equipment to the consumer, if they'd had to buy it new, was

almost $2.5 million, and that was for a total of 1,996

devices.

Okay. Let's move right ahead.

Although we have a lot of slides to cover, we do

want to make this very interactive. So at any time while

we're speaking, if those of you on the call, on the webinar

have a question, please either raise your hand or use the

chat, and we'll read your question, and we'll respond to

that.

More lessons learned from Kansas. One of the

questions we often receive is, "How do you receive good

equipment? What do you need to do to collect equipment

that is really good?"

And Kansas is really focused on doing a couple of

different strategies. One is to have multiple location

drives for a very short period of time. Like pick a

Saturday across the state, and do 13 drives working with

all the partners.

And they've had a lot of success with that. It

certainly takes a lot of planning but effective in getting

good, gently used items in.

They also found that, if they partnered with the

Red Cross when the Red Cross is doing blood drives, that

this was a great way to get equipment.

Essentially they would put up a booth and talk

about their Assistive Technology for Kansans AT program,

and they would inform them about what they're doing with AT

reuse. And people would call them afterwards with very

good equipment to donate.

Being specific about desired donations. And in

Kansas they look toward high-value, lightly used and

bariatric equipment. They are very specific about their

focus.

They have also done a lot of different topics that

are listed in the Pass It On website and how to plan major

events, how to create public awareness for reuse. You can

look at the Topeka donation drive by going to the

youtube.com/passitoncenter and get a little press release

there that was done in Topeka.

They also have a very sophisticated inventory

program that they are very willing to share with other

programs. So if you're interested in that, be sure to

contact either us or Sara Sack, and she will work with you.

All right. We'll move on.

Mississippi Re-Tech. There we go. We've got the

whole slide now.

Mississippi focused on education and awareness of

AT for underserved areas of the state. And with that they

served 1,130 customers who acquired DME and received

training. And there were 3,450 residents who received

training on AT through partnerships with private

organizations and hospitals across the state.

They did a huge public awareness campaign with

lovely PSAs that reached over 17,000 residents in the

state. And then they also developed AT distribution

centers with Methodist churches, health departments, the

Muscular Dystrophy Association/AbilityWorks sites.

And they really wanted to reach the large,

underserved rural populations in Mississippi and wanted to

work very closely with those community organizations.

What's nice about the model they've established is,

there was such a focus on this collaboration with other

organizations, that they've developed a nice synergy in the

state that is sustaining itself.

New Mexico. New Mexico we will be reporting on in

more detail later on. Their goal was to build a

sustainable AT reuse project through partnership with the

New Mexico TA project, the AT Act program, basically; and a

community nonprofit called Adelante that already provides

the repair and refurbishing of the services.

And they are primarily serving an urban area in

that state. This is for DME and computer reuse.

And then Paraquad. Touched on that a little bit

earlier. And Lindsey Bean will be joining us later in the

webinar to talk a little bit more about a specific approach

they developed to measure outcomes in terms of use of the

equipment, which is very helpful.

They developed AT sanitization videos, clinical

assessment video to share with their independent living

center partners. They developed repair training module and

video for public sharing. They also define outcomes for

measuring methodology and completed a retrospective study.

And that's what Lindsey is going to really talk with you

about.

They shared best practices through conferences,

webinars, knowledge base. And basically, as I mentioned

before, Paraquad is a major IL center in St. Louis, and it

serves Missouri and Illinois. And they are focused on the

outcomes research.

Okay. And then AMBUCS' Share4Life Komputers in

Oklahoma. This is a project that really started eight

years prior to receiving their grant in 2007. They were

able, through the grant, to move to a larger facility with

heat and water, but the building was sold, and the project

was unable to locate space.

And this is the program that we talked about last

week, if you were on the webinar, where a lot of the

knowledge and the charisma was with the director of that

program who was very, very capable and did a wonderful job

during the time before the grant and during the grant.

They distributed nearly 2,000 pieces of equipment,

still with largely a volunteer staff. But there were some

paid staff positions created. And for various reasons the

project closed in May of 2010.

Again, one of the lessons learned there was that

the -- sort of the leadership for the program needs to be

something that is distributed across everybody who is

working with the program.

So if the person who is in the lead for whatever

reason cannot continue or needs assistance, that there will

be other people and a very strong board to create that lift

for continuing the program.

And then Project MEND in Texas. Project MEND was a

reuse program in Texas when they got the grant. And their

proposal was to expand durable medical reuse services.

Theirs is a major collaboration with local area hospitals

and the county to receive good equipment from the

hospitals.

They have a very good service where they match the

equipment using trained professionals, certified

professionals.

They have been a major contributor to the Pass It

On Center and to best practices by sharing their

procedures, working on the quality indicators for AT reuse

on our website.

And they've really served as a model for nonprofit

sustainability: partnerships; diversified funding; and,

highlight, underscored, board development.

One of the things that Cathy Valdez has done, as a

tremendous leader of that organization, has developed a

very well-defined board roles and responsibilities where

everybody gets involved, everybody contributes. And it's

helped her program to make amazing strides.

If you look at the number of clients they served in

2007, 723. They've more than doubled the number of people

that they've served in a three-year period.

And the data speaks for itself. They've served

now, in the grant-year period, 3,676 people total. DME

items that they have distributed to these individuals,

9,106, with a value of those devices of over $2 million.

Virginia's reuse program, the FREE Foundation, is a

collaborative organization. It's a 501(c)(3) nonprofit.

And the AT Act program and all the network

affiliates, which included centers for independent living,

serve individuals with disabilities and persons with spinal

cord injuries or traumatic brain injuries as well as

veterans and voc rehab clients.

And they also have a wonderful partnership with

Goodwill where Goodwill donates all the collected AT to the

reuse network, and then it's refurbished and distributed

out.

Woodrow Wilson Rehab Center has been a key partner.

And where they come into play is helping with assessments,

to make sure the matching is done well, along with one of

the universities in the local area.

FREE was one of the first programs to collect

outcomes data to leverage funding for AT reuse. And we're

going to take a look at that in a minute.

Also, if you go to the Pass It On Center, you'll

see a video that we filmed online. It's at

youtube.com/passitoncenter.

Now let's look at their data. What's interesting

about this data is you see in the first three years they

really more than doubled the number of people that they

were serving. Everybody in the network across the state,

which included CILs and so on, were engaged. And the value

of the services more than doubled during that time also.

2010 looks like an anomaly. It's really a no-cost

extension for a partial year of data. Also, during that

time, on the positive side, they received a major grant,

the VATS program did, from the Brain and Spinal Injury

Trust Fund to continue to sustain the program.

But services needed to be focused on working with

those primarily with brain and spinal cord injuries. In

addition to that, one of the centers for independent living

backed out of services with the program. And so you see

that their data actually decreased during that fourth year.

What is happening now, after talking with Sonja and

with Barclay, is that those numbers are again increasing

because they've done such a good job in finding funding

resources and really filling some of the gaps that occurred

when the Center For Independent Living stopped being a part

of that network.

And Sonja's on with us today.

So, Sonja, anything that you'd like to comment on

there? We certainly welcome your comments.

All right. And we're going to jump on to the next

slide.

And then also in Wisconsin -- and I think many of

you are familiar with all of the national AgrAbility

projects. So it was really great to have that opportunity

to work with some of the AgrAbility programs.

And the one in Easter Seals out of Wisconsin, they

had found that they were basically supporting about 450

items per year. Farm workers were getting different kinds

of devices through Easter Seals each year in that state.

And what they didn't have was a want ad so that

they could really find an effective way of posting items

that were available and also gathering the needs data of

people out there.

And so this whole program was all about developing

a website for farmers with disabilities to exchange their

AT used in farming.

Through this project they analyzed about 335 cases.

And they surveyed these farmers to look at, Is this a

feasible thing to do?

And they developed a Craigslist-type website that

promotes this type of exchange of serviceable agricultural

assistive technology. And it also provides a venue for

high-value reuse items.

And if you look at the website at the base of the

slide, that's where you can get to that website. That

would be a good idea to replicate in states where you have

AgrAbility programs.

And we'd be interested in hearing about that. If

you find in your state that you do have something like

this, we'd love to see those AgrAbility programs fill out

information on the Pass It On Center where -- it's our

"find reused AT" program locator with a map of the United

States.

And we'll move on.

And in terms of measuring outcomes, "Only a

fortunate few nonprofits have a reliable way to know

whether they're doing meaningful, measurable good for those

they serve." And that's a quote from the "Leap of Reason."

And with that, I'm going to turn the program over

to Lindsey. And she's going to talk a little bit about why

measure outcomes and some of the information from the

Paraquad experience.

LINDSEY BEAN KAMPWERTH: Hi, everyone. I hope you

can hear me well. I tested this a couple times. So I hope

everything is good.

Hello from St. Louis. It's raining here, which is

better than snow, but...

So why measure outcomes? So you can capture a lot

of information from your raw data, which is more, you know,

your numbers of devices distributed or donated to you.

That's more of an output.

But really our goal should be to measure some

achievements or more of outcomes. So you know that maybe a

hundred people got a device from you, but you don't know

the impact that device has had on their lives.

And for most of the organization, that's why we're

here, is to help people and have an impact on their lives.

So the outcomes are really to see if we're

achieving the desired results of our programs; aid in

program evaluation, because program evaluation will always

impact our program, and then from that we'll evaluate it

again, and it's a continuing circle that you can just keep

doing, keep doing and get your program -- you know, it's

never ending; and then demonstrate the effective use of the

resources provided to us.

Thanks, Trish.

So measuring customer outcomes. So did the

customer actually get what they needed? So actually seeing

if you could fulfill the requests that were needed.

I know here at Paraquad sometimes, since our

inventory is based on donation, we can't always fill every

request. So keeping track of that.

Did they get the needed devices in a reasonable

time? So defining the timeliness and tracking the time

from the request to the actual match.

Were they satisfied with their services? So the

number of customers satisfied with the services. Each time

we have a reuse appointment, they're getting a satisfaction

survey to fill out.

And last one, did the equipment increase

independence, participation in work, school or community?

And if you guys have any other outcomes that you

measure, please go ahead and throw them out there in the

public-chat area. There's lots of things that can be

measured. So these are just a couple that were thrown out

here.

So quantitative measures are measures used as

numerical data under standardized conditions. So they're

your numbers. A lot of that data that Joy was looking at,

numbers and everything, percentages, is your quantitative

data.

So sometimes this is the volume tracking, your

donations, your devices assigned, value of donated devices,

those type of things.

Tracking of needs met. So your applications and

requests fulfilled.

And your calculation of avoided costs. So lost

work time avoided, maybe those health care expenses,

environmental impact.

Some of you guys are telling me my sound is going

in and out. And I haven't moved a thing. So I'm trying to

talk a little louder. Okay. Looks better. Okay. Great.

So the last point on that quantitative measures is

our use of business tools, so that return-on-investment

analysis. The cost benefit that we're getting from

redistributing a piece of reuse equipment, something

(inaudible) to measure.

If you want to go to the -- thanks, Trish.

So tracking the volumes. So you can track the

number of usable devices donated; the value of the donated

items, so that's part of your return on investment; the

number of devices reassigned; those individuals served,

because we know sometimes people are getting more than one

device; and the value of the reassigned AT.

And a really, really most helpful tool would be a

good inventory system.

So Kansas has a great one that they're willing to

share. They do a great job of tracking the client

information, the equipment information, and then the

contacts to match it up.

We use a database called Brightree, but this also

helps us with our repair center that we have. So ours has

a little bit more capabilities than just a regular reuse

program would need to do out repair program.

So go to the next slide.

So outcomes assessment. Your impact on the

beneficiaries of AT reuse. So some of the objectives

requires a qualitative measurement, like that satisfaction

can be on a Likert scale, you know, ranking on a 1 to 5

scale; or the individual impact of reused AT. So sometimes

that's more your qualitative data, hearing stories of why

it has helped them.

Some of the outcome data may be combined with the

numerical data and the qualitative data. So compare those

together, and that makes a really strong argument for what

you're doing and showing how your program is helping.

So the outcomes research. Here's some examples of

the collection instruments that can be found in our

knowledge base. The knowledge base is great.

So Paraquad specifically, we created our survey

with some academically designed instruments so that they

were already tested for validity, reliability and things

like that.

The CORE is more of a demographic part of the

survey.

PARTS/G is about participation general. So it asks

a lot of questions about what people are actually doing in

their everyday life. So it talks about moving around in

your home to moving around outside your home, leisure

activities, taking care of your household. It has quite a

few domains.

The SPARC, which is asking kind of like where

typically you go and how many times a week, a day, a month,

a year you go. We use pieces of that.

The FREE Foundation designed a monthly survey of

outcomes to assess the impact of AT. So there's some

different ways that you can do it.

And then the program survey of customer

satisfaction. There's the QUEST, the Quebec user

satisfaction -- I'm forgetting the T -- but that's a

great -- assistive technology. That's a great survey that

measures the satisfaction with the actual device and then

with the actual procedures that they got it. So it

discussed follow-up. And it's again the Likert scale.

And then finally the complex rehab survey in

Georgia that Joy was speaking on, confirmed barriers to

acquiring assistive technology, which I'm sure that we

know.

The QUEST survey I believe was the Quebec User

Satisfaction Assistive Technology.

Trish, I might have flip flopped a couple, if you

were going to type it in the public chat.

So surveys of customer satisfaction. Idaho surveys

users of the AT4ALL to evaluate and improve web exchange

sites. It's also the Pass It On Center knowledge base, the

user services, them measuring customer satisfaction.

We do an annual survey of participant satisfaction

with users of the repair and reuse services. So like I

said, we actually will always give them a survey every time

they come in here.

For reuse it's a lot of times we're seeing them

only the one time. For repair it's sometimes multiple

times. So we want to know about their satisfaction each

time they're using our service.

You can go to the next one, Trish.

So when I was a student at Washington University, I

worked with this program with Carla Walker and Kerri

Morgan. And so we wanted to see what was happening with

the assistive technology that was distributed.

The program had been going on about three years,

and there weren't any formal follow-ups or anything like

that that they were doing.

So we wanted to know if they were using the AT and

in what activities; if they were not using it, why they

weren't using it; if it was reducing falls; and then their

satisfaction with the device and the program.

So like I said, here's the surveys that we used,

and there it is. The Quebec User Evaluation of

Satisfaction With Assistive Technology; the CORE; and the

PARTS/G.

So the PARTS/G really went on to that "what

activities they were using it." The QUEST was the

satisfaction. And the CORE was just that general

demographic information to see who we were serving.

We created three different survey versions. One

was based on mobility devices. One was shower chairs and

transfer tub benches. And then the other was the toilet

seat, commode.

And we created them three separate like that

because really we didn't know how much the leaving your

home or moving around your home impacted by a commode. But

there was some other parts of the PARTS/G that actually

that was relatively in regard to toileting.

And then we mailed those surveys at the time to 338

different customers.

So if you go to the next slide.

We got more mailed back than we thought we were

going to, and we found out a lot of information. For the

most part, a lot of people were still using their

equipment, which was great. And for the most part, if they

weren't using it, they only needed it for temporary use at

some point not any major reasons of it breaking or

something like that.

So we converted that survey into tools to do the

ongoing outcome research that we do. So we wanted to

improve the device-fitting practices during the initial

evaluation. We identified some of those reasons for device

abandonment. We wanted to address the follow-up of

services needed and then address the impact of the device

on the person's participation in activities in their home

and community.

Again, this is what people want to know. The data

needs to show that the people are using it to kind of get

the funding aspect to it and more support in our

communities.

Customers are asked to participate, at the end of

the device-matching appointment, in the first kind of

pre-survey. We turn it into a pre/post. And then

follow-up is in 30 days after.

So it's basically the exact same survey, but we

want to see the change pre/post with getting them the

appropriate device that they need.

And then the participants can receive $10 when the

post-survey is completed. So that's, for the most part,

how everything is going.

We have kind of revamped the survey a couple more

times since then, just kind of shortening it is the biggest

issue. As most of you know, time is important to people.

But everything else should be on the knowledge

base. And if you guys ever have any questions, feel free

to e-mail me or throw some questions up in the public chat

right now.

I think I'm turning it back over to Trish, I think,

or Joy.

JOY KNISKERN: Thank you, Lindsey. That was very

helpful in looking at the tools and instruments and

strategies of what you've done with respect to measuring

those outcomes.

And again, we're looking at the approach as not

necessarily all the data that was gleaned from some of

these surveys. We have done that in the past. We can

certainly do that again.

One of the things that I wanted to slip back to is

there were a couple of comments here. I want to make sure

that we've addressed all of them.

And from WATAP, both Sam and Alan have asked "Can

we comment on whether these 12 programs have continued past

2010? I'm curious to know if the programs are continuing

to operate beyond the demonstration grant money."

And the answer to that is yes, with the exception

of the program in Oklahoma. And in the programs where

we've seen the most engagement in looking at collaborators

and how we can all work together and creative ways to

leverage funding together, those are the ones that seem to

have really built on this really -- maybe an existing

foundation and really jump started what they were doing in

a much bigger way.

And so, yes, with the exception of one program,

they are all continuing. And if there's anything else I

can provide with that, I'd be happy to do that.

So we're going to jump right into the next slide.

And it has to do with identifying avoided costs.

One way to look at outcomes is what did the availability of

an AT device avoid? And there are a number of ways you can

look at that.

One way is to look at the health care costs of what

would have happened if the person didn't get a device:

prevention of falls, reduction of visits to the emergency

room, prevention or reduction of the stay time in

skilled-nursing facilities.

And you will see, when we get into a little bit

more information about what the FREE Foundation has done,

that they actually used other information and references to

put numbers to these figures based on a survey of

participants in their program.

Lost income due to missed work. If somebody is

missing work because they don't have a device that they

need, how is that affecting them on the job?

And what other costs of the device did reuse result

in? One of the things that many programs are now gathering

is the landfill costs for disposal. And that's an

important thing as we look at increasing emphasis, in this

country and certainly in many other countries, on reducing

landfill costs and reducing what's in our landfills. And

also not only reducing what's in the landfill but

repurposing things that otherwise would just be wasted.

And we'll move on to the next slide.

We're going to take a closer look now at the FREE

Foundation. And they had noted that in Virginia about

20 percent of Virginians were uninsured persons who had no

access to health care or the AT that they needed; and that,

of the insured persons, many of them were unable to get

equipment or get it in a timely manner.

In some cases these are people who are insured, but

there's this gap of time between the time that the approval

comes through and what they need. So what's going to

happen to those people when they don't have what they need

on a short-term basis?

And then they looked at the consequences of that --

if you're unable to recover fully from the disability

because you didn't have the device. Was the person going

to have more falls? Did they think that they would have

repeated hospital stays or doctors' visits or emergency

room visits or stays in skilled-nursing facilities and

assisted-living facilities? And again, like we talked

about, what about the lost wages of patients as well as

caregivers?

And so they began to frame this in terms of --

could you pop back on that last slide. I didn't quite

finish there. If you could go back.

And then they looked at the measurable costs. In

other words, they actually gathered data from resources --

and this is on our website at the Pass It On Center -- the

cost of a typical office visit, the average daily cost of a

hospital stay, the average cost of an E.R. visit, the cost

of a typical stay in a skilled-nursing facility for

recovery, and then the financial impact of job loss.

So this is a very, very exciting survey that the

FREE Foundation did.

And we'll move on to the next slide where we're

going to talk about their methodologies and how they went

about collecting the data.

They looked at what were their objectives. They

wanted to show the equipment donators the therapeutic and

financial impact. In other words, how is this helping

people, and how is it saving them money?

And they wanted to show financial supporters the

impact of funding. So if somebody is going to give you

money from say a foundation, what impact is it going to

have on the people that are your target population?

And then they also wanted to test and monitor their

service delivery model. Are they really effective in what

they're doing? Is this working? Are they improving that

person's quality of life in terms of prevention of things

that were creating a lot of problems for people like falls?

So they surveyed about 120, 130 people, AT

recipients, and this was post-services, to determine if

they had become more independent, if they had had fewer

falls, if they reduced the number of medical visits and

services, and had they been able to remain at home.

And what they found was very exciting information.

They looked at -- and we can advance to the next slide.

For every 100 people served, 26 hospital stays were

avoided. And then they calculated in Virginia the average

stay at the time for hospital stay was $1,149, for a

savings of a little under $150,000.

There were 29 emergency room visits that were

avoided. 29 times the cost of that visit, which was

$1,896, for a total of a little under $55,000 in savings.

They saved 11 moves to skilled-nursing facilities

that were avoided. And they calculated, for an average of

50 days, which is what the literature showed them, and at a

cost of $10,150. This was done several years ago. I'm

sure that is higher now. And look at how much it saved

them: $111,650.

And then 11 moves to assisted-living facilities

were avoided. Again, 11 average stays of 50 days and a

savings of a little under $54,000. That's pretty

compelling information. If I were with a foundation that

supported those kinds of causes, I would certainly look

toward funding them.

So let's move ahead to some research that we did in

Georgia. And Lindsey touched on this. Laura Cohen, who's

known to many of us nationally, and one of our staff at the

time, Rhonda Perling, did a survey of about 49 individuals

who were being served at Friends of Disabled Adults and

Children. And this was in 2010.

And basically the research question was for us, if

safe, appropriate AT reuse could be the first choice when

readily available to Medicaid beneficiaries, could it free

funding desperately needed for complex rehab?

Our independent living counsel director had

approached us and said, "We've got a real problem here in

the state where complex rehab is being underfunded by

Medicaid."

And essentially they weren't paying for -- Medicaid

wasn't paying for a lot of the accessories that are so

important to make certain types of complex rehab, meaning

sophisticated electronic systems, work for individuals.

And the thought was, if we could use, refurbish,

and distribute gently used items that are lower cost, would

that free up funding for Medicaid to invest more in the

higher and more complex items. Very different model from

the one in Kansas.

And so basically we felt like we needed to start at

the very beginning and take a closer look at indeed why are

people coming to reuse programs in the first place.

And with this, basically the findings support what

we found with AT Act programs before, and that is that

systems are too complex to navigate. In some cases people

had insurance; they had Medicare; they had Medicaid, but

they'd just gotten fed up with the wait. And sometimes

they had to wait too long to get it. There was that

stopgap provision of reused equipment.

Many had inadequate insurance coverage. In other

words, they just couldn't afford the co-pays.

And then some individuals were just not aware of

what insurance was available to them. They couldn't say

whether they were on Medicaid or Medicare or what their

other benefits would be.

The lesson learned is we believe that there's a

need for funding navigators for AT specifically and that AT

reuse programs could certainly play a part in maybe working

with other people in the community who could support that

kind of intake questionnaire process with people applying

to the programs.

And then that way, if somebody can be redirected to

private insurance or Medicaid or Medicare, then you've got

a way to do that and saving your reused items for those who

truly would otherwise go without.

And we'll move right ahead.

And I'm going to turn it over to Trish now. She's

done an excellent job in working with Dr. Sack on looking

at the business analysis of return on investment.

Take it away, Trish.

TRISH REDMON: Thank you, Joy.

We want to credit Sara and the Kansas program for

being the first to really emphasize the need to apply

standard accepted business practices to AT reuse programs.

And those are very important.

And the book that we're recommending, "Leap of

Reason," emphasizes that, to get funding in the future,

that it's going to be very important to demonstrate what's

possible and that it's important to help nonprofits and

funders alike understand the value proposition.

And that's what this is about. Using

understandable business analysis for those foundations and

those corporations and those major philanthropists who

think in those terms to understand the return on investment

for AT reuse.

So as we've said, Kansas led the way in

recommending that programs adopt return-on-investment

analysis. And at its most basic, you calculate the value

of the equipment. If you're a business, you would say,

What's the value of the goods I produced, and what did it

cost me to produce them?

And so, in an AT reuse program, we would say,

What's the net value of the reused equipment? And that is

the value that we've assigned to the equipment minus the

program expenses, all of the program expenses it took to

acquire them, and then derive that return percentage by

dividing that by the cost of the program expenses.

So we wind up with a percentage or with a number of

dollars returned for each dollar invested. And this is the

standard return-on-investment analysis.

Now, Sara Sack has been very kind in applying that

and even in doing presentations on refining models and

showing how important it is to focus on high-value items.

And so here's an example of return on investment

for the program. And on her basic model, the value of the

equipment was $960,000 minus the $271,487 invested in

getting that, which gives us the $668,517. And then,

again, we're going to divide that by the program expenses.

And so, using that analysis, Kansas was returning

$2.46 for each dollar invested. And Sara said one of their

local legislators had said he would be very happy to see a

dollar returned for every dollar invested. So they were

doing quite well.

We've seen other programs look at some of the

things we talked about. We collect the value of the

reusable devices, but how do we get to a bigger measurement

of the real return on AT reuse?

Virginia dealt with the value of avoided health

care costs. Kansas and Georgia and several other programs

actually measure and report the environmental impact

savings; that is, what's the value of equipment kept out of

a landfill? How much money did we save the local

government providing that landfill?

And then Joy mentioned a few minutes ago that

Virginia dealt with the economic value of work. What is it

worth to avoid having someone lose their job; or miss work

for a number of days, weeks, or months; or in some cases

have a caregiver, have to forfeit their job to take care of

someone.

And so, in thinking about that, we said, if we

really sum all of those values together, we have a much

greater calculation of the approximate value of investment

in AT reuse.

And we call this approximate because this model

doesn't value completely in a quantitative way what it

means to someone to be able to return to school, to return

to work, to participate in their family fully, to

participate in the community. We haven't assigned values

to that.

But this is an approximate value, in the terms that

people can understand, of what is the total value of the

investment AT reuse.

So if we sum those things together, subtract our

program expenses, and divide by program expenses again,

what would the return look like?

And again, we're grateful to Sara Sack who was kind

enough to recompute those things. But let's touch on in a

minute -- one more minute on what those are: The value of

the reusable AT -- Joy mentioned that; the donated devices;

the value of the prevention for the health care costs.

And we can collect survey data to compile these

values. And I've noted for you that the survey used by

Virginia and the FREE Foundation is in our knowledge base.

And what I did to make it simpler is to collect all

of these things into one document for you. So if you take

a look at the knowledge base today, you'll see a

compilation with all of the surveys mentioned lumped into

about an 11-page document for you.

And then we look at environmental impact. What's

the weight? Some people use some standard tables for

simplicity and ease of calculation of what's the average

weight of a computer or a wheelchair or a walker or

whatever that's diverted from a landfill. And then you can

find what the cost of landfill disposal is in your area.

And then the economic value for -- and the FREE

Foundation used federal poverty guidelines. You could

determine an average day's lost work avoided. You might

use minimum wage in your state. These are very

conservative measures. So we're not overstating the

impact.

And then Sara recalculated the return on investment

from Kansas with a couple more values because she used an

ultraconservative measure, since she had not surveyed

Kansas, and said, "Okay. Instead of the percentage that

Virginia found, suppose only 1 percent of those customers

served avoided going into assisted living?" One thing. So

she took an ultraconservative measure and said, okay, that

would be an added impact.

And she had the data on the landfill savings and

the amount kept out of landfill, the 37-plus tons, and the

cost of landfill disposal, $38.80 per ton. And even

without adding in lost wages, what happens to the return on

investment? It changes her $2.46 to $3.11 for every dollar

invested, or it kicks it up 26.4 percent.

So if we think about what does this mean in

persuading funders that investment in AT reuse is a really

sound investment for a great return, then that's attractive

to almost anyone in those terms.

So this is what we learned about leveraging

outcomes.

And another point from "Leap of Reason," they said,

We will be required to do this, not just have more

performance data; we'll have to have more decision-making

rigor, and there's going to be a spillover effect for

private funders.

Which is to say that all the government agencies,

all of the corporate foundations, all of the nonprofits

that give us money, all of the granting agencies are going

to take a stronger look at what's happening with their

money.

And so FREE Foundation in Virginia reuse network

used those calculations of avoided health care costs to

lobby for funding for their reuse program with their

legislature. They literally collected the data, and they

created little one-page flyers.

And if you go back to our March webinar on Making

the Business Case for AT Reuse, you'll see some of those

things.

But the point is that you can use these models to

build your own instruments to collect data from your

customer. And you can use the calculations that are

appropriate to your area to develop a financial impact

analysis to show prospective funders.

So if you take a look in the knowledge base for the

questionnaire and go back to our webinar archives, you can

find those resources.

One methodology based on FREE is you can collect

all the data in an original way, and that's the greatest

degree of specificity and accuracy and will probably have

the greatest impact.

If you really go through the list that's in the

ancillary package, you collect the data to match the

calculations that FREE Foundation did, you are using the

data in your state or your area, then you'll have a very

specific calculation to show a prospective funder.

And if you look at the survey instrument, you'll

know what to collect.

Or before you do that, if you'd like to look at

your data now and see what kind of impact would it have on

my return-on-investment calculation, then you can use

Virginia's results, as Dr. Sack did in her second

calculation, make a conservative assumption to estimate the

impact in your service area, and that will give you a rough

look at how much is this going to change the

return-on-investment calculation.

So I'm going to turn this back to Joy to talk about

the broader impact of what's happening with measuring

outcomes in AT reuse.

JOY KNISKERN: Thank you, Trish.

And I think that we want to take a look at how you

can develop models for outcome-driven collaboration with a

focus on long-term outcomes that would bring with it

inexorable pull toward multiorganization collaborations

capable of delivering a comprehensive set of services.

Now, what we've said previously in many different

webinars is that, the extent to which you're really working

with a broad range of people -- disability advocate

organizations, AT reuse organization, VR programs,

third-party entities -- working together to create this

wonderful energy around AT reuse to find ways to stretch

your dollars and to really provide a consistent and safe

and appropriate consumer-focused approach to really reusing

equipment.

So with that, we're going to move on to the next

slide.

And the changed landscape. Since these grants were

given in 2006, I think the need for affordable AT has

really increased. If you look just at one piece of data,

the rising employment that resulted in a loss of insurance

coverage and therefore access to AT for millions of

Americans, you can see that the number of people who are

unemployed moved from a little under 4 percent to a little

under 10 percent of Americans.

And of course we do know in different states that's

not always the case. Everybody should move to North

Dakota. And Scott Weissman is on the phone. I'm sure

they'd welcome us there because their unemployment rate is

practically nil, I believe. But in any event, that's just

one of the pieces of the changing landscape.

We have also certainly experienced decreasing

dollars. Medicaid programs in these states are so

stretched, and the needs continue to increase.

And so all of that has placed more pressure on the

AT reuse programs to provide an appropriate, safe

consumer-centric approach to providing equipment, either on

a short-term basis or on a more permanent basis, if indeed

it's somebody who's not insured.

And we'll move on to the next slide.

The bottom line is that we've seen that the success

of these programs is heavily dependent on the partnerships,

the collaboration, and the relations formed to optimize the

use of resources.

And it goes without saying that we're also talking

about diversifying funding to support the program. You

should have a mix of public and private funding, and to

continually have people who keep on the radar scope, how

they can use this data to approach new funding sources.

If we collect specific outcome data, we can use

this business analysis to show how effective an investment

in AT reuse can be to leverage funds to sustain these

programs that serve those in need.

And again, we underscore the fact that AT reuse is

only one part of the picture. It in no way diminishes or

takes away the need for first-line new equipment that

people need in specific cases. It's just a part of the

whole service delivery continuum.

And so with that, in looking at the outcomes, you

heard Trish talk about this wonderful instrument that she

really kind of came up with looking at all the great work

that Sara Sack has done and the FREE Foundation and looking

at how can we put it all together?

And what we want to toss out to you today -- and

we'll be getting information out to all the states and

territories -- we'd like to do a mini competition awarding

some grant funds. And we'll be working with our team to

come up with what this will look like. It wouldn't be

until probably sometime in January or February -- where

programs out there that have existing reuse programs in

place would look at the CAVIAR as an approach to collecting

data on people that you have served.

And what we want to do is define some parameters

around that. Like maybe it would be people served within

the last three months of your program. And then look at

that from all the programs and put that into a bigger

picture that gives a more in depth use at AT reuse.

And so we'd like to welcome you to think about

that. We'd love for you to share in this. We'd love to be

able to share your data and then the collective data.

So if you are interested, please e-mail me, and we

will put your name on the list, and we will certainly be in

touch with you later -- or earlier next year.

And with that, I'd like to suggest that you please

evaluate us. And we have a few minutes open for questions

and answers -- actually, only three.

But we do certainly like for you to evaluate us and

let us know what you think.

We're very interested in hearing from you about

whether or not this was helpful in expanding your

understanding as to how outcomes can help your program and

specific strategies and tools that are already there that

in some cases have been vetted like through different

programs. Like Paraquad, they're using instruments that

have already been tested for reliability.

We'd really like for you to evaluate us. And in

that evaluation, you can share information about the kinds

of things that you really want to learn more about.

Last time in the evaluations we received, one

responder suggested that we need more information about how

to obtain gently used good equipment.

And so we'll be putting our heads together and

culling information from all the programs and rolling that

out in the new year.

So with that, let me just get off the mic and see

if there are any questions or comments. There was a

comment up there. I don't want to miss it.

Sonja has said -- let's see. "Thank you Sonja

Schaible and the FREE Foundation for pointing us in this

important direction."

And Trish also commented that "We promised a bar

chart, and this is it. Evaluate us at SurveyMonkey.com."

And so with that, I'll just get off the mic. And

hopefully this has helped you today.

Okay. This will be our last webinar of the year,

wrapping up 2011. And we really wish you all a very merry

holidays and hope that you will jump on our webinars

starting next year.

Sonja has said "You're welcome. Always glad to

help," in response to Trish's question.

So enjoy your holidays coming up. And we look

forward to seeing you in the new year. Take care.