A Few Thoughts on 36 Years Spent in the East Tennessee Community
Mental Retardation Service System
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NOTE – 2007 is the 30th anniversary of TennCo (as it is now known). In honor of this occasion my friend Kyle Hauth (realizing my advanced age, but attempting to appeal to my ego by talking up my VAST experience) asked me if I would write an article relating some of my memories of the early years of the mental retardation system in East Tennessee. Those of you who know Mr. Hauth realize it is difficult to tell him no.
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After graduating from the School of Social Work at the University of Tennessee in the early 70’s I worked in the field of public housing and then as Director of a program for juvenile offenders operated by the YMCA in Chattanooga. The “glamour” of this job soon wore thin (despite the fact that I was making more money than I had ever made at $12,000.00 per year) as I quickly realized the responsibility and liability involved and decided to move back to Knoxville where I still had a strong base of friends and business contacts.

This was before the days of computers so I had a friend in Knoxville mail me copies of the “Employment” ads from the Knoxville paper each Sunday. One ad was for a Community Organizational Specialist with the Department of Mental Health and Mental Retardation. I knew a bit about the mental retardation system having had a disabled sister who attended the public schools and then Orange Grove Center prior to passing away of Leukemia in her late teens. I called the number that was listed and talked to a lady named Gene Williams who set up an interview with me the following week at Orange Grove. When I arrived for the interview I met Ms. Williams and a coworker, John Hinkle, who asked me a few questions and then told me they had reviewed my resume and that if I were interested in the job it was mine. I thought to myself at the time that this was too easy and there must be something they were not telling me?

On April 15, 1974 I went to work for what was then called the East Tennessee Office of Community Services and begin what was to become an adventure that has now lasted 33 years and counting. At that time there were five employees working in a small storefront office and only a handful of contracted community agencies scattered across the 34 counties of East Tennessee as compared to today when there are 169 East Tennessee Regional Office employees in four locations and 177 contracted agencies and individual providers.

In 1974 Greene Valley Developmental Center was viewed as the “Hub of the Service Delivery System” for mentally retarded individuals in East Tennessee with a population of over 2,500 (as compared to 274 today). Gaining admission was not that difficult, but few people left. In those days professionals often encouraged families to seek admission to the “institution” rather than trying to care for their disabled relative in their home. Day services for adults were scarce in the community and the few residential resources that existed catered mainly to individuals leaving their family home for the first time rather than coming out of Greene Valley. The main residential resources in East Tennessee were a few group homes operated by Orange Grove Center (with a number of the available “slots” being available only on a “private pay” basis) and a large dormitory operated by the Sunshine Center (now the Sertoma Center) that had recently opened in an aging building which had formally been a residence hall for the School for the Deaf in Knoxville.

The main challenge of my new job was to work with community groups throughout East Tennessee to develop resources, especially for those individuals who needed to leave Greene Valley to return to their home communities. I learned very quickly that I had two things in my favor in relation to meeting this challenge:

1. State funding was readily available for new services since very little was being spent for this purpose in the community at the time. The amount of funding for each new provider was small, but since almost no state funds had been available previously community groups and parents were generally happy with whatever amount could be generated and found many creative ways to stretch and supplement what DMH/MR could provide.

2. I had three excellent mentors to turn to for guidance and direction in our Regional Director, Gene Williams, Assistant Superintendent for Residential Services at Greene Valley, Ms. Margie Nelle Cardwell and Mr. Allen Bullard who had recently left Orange Grove Center to work in our Central Office. Over the years Ms. Williams and Ms. Cardwell proved to be my main teachers and role models and did more to shape me personally and professionally than anyone I have ever known. Mr. Bullard traveled the state to assist all three regions with the development of resources and was always available by telephone or in person for needed support, be it emotional or professional.

My second day on the job was the beginning of my introduction to the community service delivery system at the time. One of my coworkers took me to Jellico, Tennessee which is a very isolated rural community on top of a mountain on the Kentucky border. We arrived at lunch time and stopped at a local fast food restaurant where we met two men who were to become life-long friends; Ron Stephens and Bob Stallard. Bob was an Outreach Social Worker for our office who worked with individuals and families in a five county area and Ron was a new graduate of the local college who had recently came to work as the Director of Pine Mountain Center which provided day services to disabled individuals in the county. Bob later worked for me as the Administrator in our office for 20 years before retiring and Ron went on to receive a PhD from Ohio State in Special Education and now lives in San Antonio, Texas. After lunch we visited the center which was located in an aging former school building which the school system had abandoned and the county had donated rent-free to the Board of Directors. The facility was typical of many of the other early ones where such agencies were located as most started out in former school buildings, the basements of churches and other such facilities where they paid either no or very little rent. Every penny of state and local funds available to such agencies as this one was required to pay staff and provide services day to day.

During this initial visit, I noted several other trends which were common to most such community agencies in the mid-70’s. All of the staff, including the agency Director, were either fresh out of school and/or new to the field with very little formal training and were learning on the job daily. The agency had few staff, but the ones they did have worked long hours and worked very hard. The two “instructors” for this particular agency left early each morning to drive lengthy van routes picking up individuals throughout the county and then after their days work at the center they would transport the individuals home before their own day ended. For this they were paid a minimum monthly salary, generally with no benefits, and yet they obviously cared a great deal for the individuals they worked with and seemed happy to have the job. Overtime and compensatory time were terms that one never heard in those days.

I quickly learned that recruiting potential vendors of services was not an issue. Since there were few community agencies in East Tennessee, there were always more community groups expressing interest than there was funding for new services at any one time. The method used for initiating and funding community services at that time would be completely foreign in today’s world. There was little consistency or individualization in relation to how services were funded in these early days. Each agency had an annual contract with DMH/MR for a set amount of money for the entire Fiscal Year to serve a “minimum number of individuals” and payments were made in 12 equal monthly installments barring any contract Amendments to change the total amount of funding provided. For day services, for example, there was not a standard reimbursement amount per person, but instead such rates were negotiated with Boards of Directors individually on a per agency rather than a per person basis. If a community group in Rhea County was interested in starting a local agency to provide day services and our office was told a set amount of state funding was available, we would negotiate a contract stating the agency would provide day services for a minimum number of individuals at any one time for that amount of funding. There was no funding distinction based on the individual needs of the people being served and when calculated on a per client basis, there was often a considerable dollar difference in what various agencies were being paid for basically providing the same service.

All of the above issues aside, however, communities tended to “take care of their own” and often “over enrolled” providing services to several more individuals than their contract required by raising other funds to supplement the minimal amount received from DMH/MR. Since very little initial training was required or available, agencies often made very liberal use of volunteer labor as well as donated vehicles, materials, building space, etc. It was not uncommon when an agency first opened to see them operating in a local church with the understanding that all equipment and materials would be stored on Friday afternoon since the space would be used for services on Sunday.

Due as much to funding restrictions as to philosophy, the first community residential services in East Tennessee were all provided in group home settings; usually for 8 to 12 individuals. The size of such homes was never an issue, however, for relatives who had either not had any residential option outside their own home in the past or had a son or daughter living in a large “cottage” situation at Greene Valley with many other individuals, often miles from their home communities. Staff for such homes generally consisted of a set of two individuals, many times a husband and wife, known as “house parents” or house managers with relief staff on the weekends. At times when such relief staff was not available, it was not uncommon for the regular staff to continue working through the weekend. Usually the children of such staff also lived in the home relating to the individual “residents” as they would to a big brother or sister. Many such homes had both men and women residing in close proximity, but this never seemed to be an issue as the residents of such homes truly functioned as a “family”. In such homes, what was sacrificed in relation to individualization of services was often made up for with the consistency of the long-term relationships that developed between both the individual residents and between the individual residents and staff. In many cases, there was not a great deal of “turn over” of residents or staff over time which allowed the development of close relationships. This is a far cry from the shift staffing pattern common to most supported living homes today where turn-over is often the norm rather than the exception.

As with the first facilities used for day services, some of the ones used for group homes at that time were definitely physically and structurally “questionable” as I think back on them today. There was no Licensure Office in those days and few standards relating to health and safety requirements existed. Due to available funding, agencies were often forced to be creative in locating inexpensive (shall we say cheap) facilities for this purpose at times. This was one of the motivations that led DMH/MR staff to seek assistance from HUD (Housing and Urban Development) in setting up a program where local agencies could access funding through long-term mortgage contracts for the construction of affordable and structurally sound homes. Many such homes still exist across East Tennessee today, though often with a reduced number of residents.

Part of my funding negotiations with Boards of Directors in relation to new residential programs was to assure that a percentage of all admissions would be individuals who were ready to leave Greene Valley. This was generally not a problem as most such groups were aware of families in their community who had relatives living at Greene Valley. At the same time, since there were almost no community residential resources there were many extremely capable individuals who should and could have returned to their home community years before had this been an option, but since it was not many had been institutionalized for a good deal of their lives.

The usual decision making process for populating a new group home would be for me to work with local agency representatives and staff at Greene Valley to set up a time when we could visit and meet individuals who might be interested in admission. We would generally talk with a number of residents and Greene Valley staff who worked with them during these visits and the agency staff would then let me know after a few days which individuals they were interested in for admission (quite a difference from today when individuals and their families decide which agency they are interested in for the provision of services). Often, Greene Valley staff had a very difficult time convincing such individual’s relatives to allow their family member this opportunity to return to the community. They saw the institution as a long-term resource, but were not so sure about the stability of these new community agencies. One positive thing about such transitions was they usually involved several individuals who knew one another well from years together at Greene Valley moving at the same time which meant being able to share their common fears about the transition as well as their adjustment to their new environment. A negative factor was having to leave many friends (both fellow residents and staff) behind. This was eased somewhat by making arrangements for Greene Valley staff to visit former residents at their new home at times as well as arranging times when former residents could return to campus to visit their friends.

For someone like myself who was very involved in working with community agency staff in funding, setting up and locating residents for such early homes and who visited them often, there were few things that shocked or surprised me after awhile. On one such visit a resident told me a story of how someone was taking a shower on the second floor of the home, dropped a bar of soap outside the shower and it slid through a hole in the floor and hit him on the head as he sat watching television below. On another such visit I encountered a situation where upstairs bedrooms required an evacuation route in the event of a fire. I asked the staff about this as I saw no fire escape and they pulled a box out from under a resident’s bed which contained a chain ladder which could be attached to the window ledge once the glass was raised. The local Fire Marshall had approved this arrangement despite the fact that few, if any, of the residents living upstairs could have possibly climbed out the window, much less down the very flexible ladder given their ambulation skills and eye/hand coordination.

In the early days of our system, an agency’s survival necessitated a close working relationship between everyone involved including Boards of Directors, staff, residents, parents, funding sources and, yes, even Regional Office staff. Communication and cooperation was never an issue in those days and I soon got to know hundreds of individuals on a first name basis across East Tennessee. One of the real joys of my job at that time was the relationships I established with individuals and their relatives due to my involvement with helping folks transition from Greene Valley or their own home to residential facilities in the community. It was not at all unusual to have family members call my home at night or on weekends with questions about their relatives care or simply to get reassurance that they were doing the right thing for them. I often transported individuals and their family members long distances to visit and/or “interview for a vacancy” at a group home which allowed ample time to become well acquainted. As you might imagine, however, there were times during such trips when an individual or family member would tell me something that I would just as soon have not heard. As I said earlier, however, such opportunities often led to the establishment of life long friendships that I value more and more with the passage of time.

As agencies developed in communities across East Tennessee, there was soon a need for some type of organization that would allow staff to meet one another and have the opportunity to discuss common issues and goals. Before there was a state Director’s Association, there was first an East Tennessee Director’s Association which came together initially with the assistance and encouragement of Regional Office staff. Since there were not that many agencies at the time and many of the ones that did exist were located in rural areas, the Regional Director initially organized and set up the meetings including coming up with agendas and inviting (strongly encouraging) agency Directors to attend. Staff training was not readily available in those days, and an off-shoot of the Director’s Meetings was an annual three-day training conference in Crossville at Fairfield Glade which DMH/MR set up and funded for the first few years. Many agencies would close so direct care staff could attend and all Regional Office staff was invited. These initial conferences proved to not only provide opportunities for learning and exchanging of knowledge among agency staff, but also wonderful opportunities for bonding and establishing contacts with staff at the Regional Office as well as other agencies who had similar experiences, interests and, yes, frustrations. After the first few such conferences, word spread and agency staff from other regions of the state begin to attend which broadened the opportunities for establishing contacts even more. From these humble beginnings a State Director’s Association developed which eventually evolved into the strong lobbying organization with their own paid Director and Legal Counsel now known as TennCo. The original small training conferences for East Tennessee agency and regional office staff have now developed into a large annual conference in Nashville which provides training resources for hundreds of agency staff from across the state.

Looking back at these early years of our Service Delivery System there is little resemblance to what it looks like or how it functions today and I find myself amazed at the changes and development over time. From its humble beginnings with services initiated by local community groups with very limited financial assistance, our system today can be characterized as “big business” with some agencies being part of multi-state operations with their corporate offices located far from Tennessee. Almost all DMRS funded Provider agencies have an annual budget in the millions of dollars and where agencies were originally paid a few hundred dollars per month for the provision of day and residential services they are now paid a few hundred dollars per day for these two services in most cases. Of course, as the types of services available and reimbursement rates have increased, the amount of oversight, documentation requirements and accountability has also increased thus the continuing increase in the size of the DMRS Regional and Central Office staff.

Whether the quality of individual care for the people now receiving services has increased commensurate with the additional money being spent I’ll leave to someone much smarter than me to determine. I will tell you, however, that like many “old timers” I often find myself missing the “good old days” when our system was much less complicated and competitive and I knew most of the individuals we funded and the people who worked with them by name.