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Envision Newsletter

Envision Summer Newsletter 2014

Hi Everyone

Just sharing for everyone’s reading pleasure – or not.  We are celebrating our 50th year during this fiscal year, 7/14 – 6/15.  Final decisions about events are not yet ready to be shared, but looking at an activity that will encompass all 4017 square miles of Weld County, Colorado.  Envision is the Community Centered Board, responsible for intake and case management for all individuals with intellectual and developmental disabilities in Weld County.

By |2016-11-03T10:15:11+00:00September 4th, 2014|Categories: Linda Medina's Posts|Tags: |Comments Off on Envision Newsletter

Good Golly it is Difficult to Remember….

…to come up with ideas to write in this blog!  I calendar the need to write, but then when my calendar pings at me, I find myself at a loss for what to record for posterity, or any other reason.  So today, what is on my mind?  Besides Allison’s email that reminded me that I have not written a blog for awhile?  Lots and lots of things – I/DD determination changes in Colorado (ok, that was in August 2013, but I have an appeals hearing Thursday, so it is on my mind), billing Targeted Case Management units – yes, Therap helps, but cannot make them remember to record all of their activities!  Um … Supports Intensity Scale, Quality Improvement Strategy, and Incident Report Trend Analysis.  Oh, wait … that last item would be great to blog about, and ask the rest of you all what types of IR Trend Analysis you use and how you use the reports available in Therap to help support trend analysis!  So, do you and what do you use?  I have absolutely no use for the reports that tell me how often a GER is viewed (is that helpful for anyone out there?  If so, please enlighten me), but find difficulty generating reports with other information that I would like to have.  Still trying to figure out how to get everything I need out of Therap without needing to supplement with other data.  Once I could do that, I could make a pitch for using Therap GERs exclusively without having to record the information in yet another database just to get other reports (yes, we do still use another database, sadly)!  Feedback would be most welcome.  Maybe I will write more on this topic in another blog, taking the time to first gather my thoughts.

What else is on my mind?  How about The Walking Dead?  Yes, yes, I am a fan nerd.  LOVE IT!  The character development and storyline is so much more than the undead – they are just background, really.   So GLAD it is back on again for another 8 weeks, before heartbreak again strikes.  The only difficulty is that I lie in bed Sunday nights thinking about how the Zombie Apocalypse would affect me and everyone I know.  Probably should record it and save it to watch on Friday night; but who can stand to wait that long??  Hmmm… no electricity, so no electronic record keeping in Therap.  Would any of us take time to assist the people we serve today to try to survive, or would it be a free-for-all, everyone for themselves kind of thing?   It would be a rough situation, so likely only the strongest and luckiest (unluckiest?) would survive, even briefly.  I think I would like to survive – but only if I could hang with a Daryl and Michonne; I would likely be the Hershel character, or so I would like to think (would love to be Michonne, but have to be a realist…).  So what does The Walking Dead or Zombie Apocalypse have to do with Developmental Disabilities services or Therap?  I have no idea.  However, I will ponder that thought and look for a correlation before continuing this post thread, if I ever do.  Meanwhile, in a grisly way, it kinda fits with the season … Happy Valentines’ Day! I’d chews you! ;)

By |2016-11-03T10:15:18+00:00February 11th, 2014|Categories: Linda Medina's Posts|Tags: , , , , |4 Comments

Halloween!

One of my favorite times of the year – but sadly, I have not come up with any creative costume ideas this year! Since I am out of time, unless I am struck my a bolt of inspiration yet today, I will likely put some blue color in my hair, temporary tattoos on my face, find something odd in my closet (yes, I do have some odd clothing), and dress up tomorrow as either an aging teenage wannabee (oh to be young again! but retain the knowledge and experience of my years …) or an indeterminant alien. We will see what occurs. I have a meeting to attend tomorrow in Denver where there will be State employees, so will likely attend by phone. Not that I would be embarrassed, but do not want to be a potential distraction from the business of the meeting! Yeah, I’ll just stay here in Evans for the day. That way I can be sure to be home in time for Trick or Treating kids!

Flood recovery in Colorado is still underway. Still a lot of people hurting and working on recovery, but a lot already re-settled as well. The destruction was amazing to see, but even more amazing is the speed in which roads were re-constructed (even though mostly temporary fixes) and re-opened. Each time I drive on the one road closest to where I live that cut Greeley off to the east, I see different things each time that attest to the power of flooding rains and rushing waters. Wow.

Therap, Therap, Therap! I have not tried anything new for awhile, and we are not currently looking to add additional modules to what we are now doing, so I am spending far less time in Therap than previously. However, I am playing more with reports, trying to find data that we need in a manner that will be most useful and easy to locate. So today I downloaded multiple reports from multiple places in Therap, deleted columns, sorted, added formulas, added colors, and other fun stuff. I was able to create 3 different reports that will each give me a part of what I was trying to find, but none that give me all that I want. Hmmm. I have saved and sent them off to others here, to be certain that what I created is indeed what everyone else wants, and if confirmed, will see if I can either find in Therap or have Therap create for me a report that combines all desired information, or start playing to see if I can combine the information in the reports through use of pivot tables. I do not have a lot of experience with pivot tables, so it will be an interesting effort. However, I do know how to read instructions, and can usually figure out what it is I want to do if it can be done! And I think I understand that we can combine information from one or more tables as long as there is some common data in each report, right? We will see how that goes. Hopefully it is not too frightening an endeavor.

If you enjoy the day, have a frightening Halloween!

By |2016-11-03T10:15:20+00:00October 30th, 2013|Categories: Linda Medina's Posts|Tags: |Comments Off on Halloween!

Colorado Floods

It was not 40 days and 40 nights, but at times it did begin to feel that way, especially for people who felt the full impact of the floods, and especially given our normal semi-arid climate. The rain began in our area (Greeley/Evans, CO) on Monday, September 9th, and did not quit until early Monday morning, September 16th (yesterday). More than 20 inches of rain fell in mountain communities, many of which are so incredibly damaged with no road access and certainly without fresh water. Rescues happened – and are still happening – by zipline and by helicopter. Weather reporters indicate that Weld County received (only) between 4 and 5 inches of rain, but being downriver, we have received those 20 + inches as well. Many communities in Envision’s catchment area, all of Weld County, are significantly impacted. We continue to try to contact all of our clients, families and staff to assure they are ok and to see what we can do to help. Envision is located in the city of Evans, which has a compromised sewer system due to the floods (the water treatment plant is under water), and we are under a “no-flush’ rule – an inconvenience at best given the devastation for many that has resulted in total loss of homes and belongings, and I believe 8 lives at last count. That is expected to rise, but we pray it rises by very little, as more people are found and communications are re-established. Many, many Colorado communities are impacted by the flooding, including mountain communities of Estes Park, Lyons, front range communities of Ft. Collins, Longmont, and Boulder, in addition to the northeastern plains communities in Weld County and those beyond who just began to receive the flooding waters over the weekend and will continue to do so throughout this week as the water continues it’s path of destruction. Water that will now just sit until it slowly trickles on downstream or evaporates over time. Meanwhile, the clean up has begun. We are beginning to collect funds from all employees and board members who are willing and able to contribute to help anyone with a need. My family has been very fortunate, as our home was 3 – 4 blocks from the flooding to the south and to the east, and about 10 blocks from the closest flooding to the north. My extended family – children and grandchildren, siblings – living out in smaller towns across eastern Colorado were also spared any flood damage, for which we are eternally grateful, and we can deal with the imposed travel restrictions due to damaged or no longer existing roads or inability to flush for a few days, which is annoying and sometimes frustrating, but it is nothing compared to what others are facing. Please keep all Coloradoans impacted by floods in your thoughts and prayers, and contribute through charitable organizations if you are interested and able. We have a long road ahead, but we will get there!

By |2016-11-03T10:15:21+00:00September 17th, 2013|Categories: Linda Medina's Posts|Tags: , |2 Comments

Long Overdue …

Danica

Yes, it has been awhile. We continue to use Therap daily. We are gearing up for tracking training in Therap, and almost have it ready to go. As an oversight agency – a Community Centered Board providing case management and contracting services for individuals through a number of agencies, some of whom are using Therap and some who are not – we were exploring the possibility of having everyone enter GERs into Therap, regardless of whether or not they use Therap. It would certainly help when looking at trends, saving a great deal of time over our current method of trend reporting. I have gone so far as creating a GER entry super role, and played with it, but there are some significant barriers.

We have both a service agency Therap account, through which our internal provider agency completes all of their documentation and through which we route all billing, and we have an oversight account, through which case managers can view activity involving clients served by providers using Therap. If we began requiring all providers to enter Therap GERs, I believe they would have to enter them into our oversight account to enable us to pull data across all agencies. The difficulty is that I believe we would then need to import all of the IDFs for those clients in our oversight account, creating alot of extra work. I need to explore further if it would be feasible to enter outside agencies’ GERs into our provider account without them then interfering with the internal agency GER reports. As I write this, I think it would be possible; we have IDFs entered anyway, so as long as they are assigned to the correct program, it should work. Once I figure that out, it will likely be more challenging to talk service providers into entering them online rather than creating and sending paper copies. If anyone else has done such a thing and has suggestions, I would welcome them.

Some personal updates: In July, my position changed. I stepped down from Case Management Director after 14 years, and am now doing Compliance and Quality Monitoring. I am also continuing to be our agency administrator for Therap and two State data systems, a Supports Intensity Scale Trainer and Interviewer, and I serve on various work groups as they crop up. Also in July, my big, sweet, 6.5 year old black lab mix, Jack, passed away from a mast cell cancer that grew above his heart. That was so very difficult. We had little warning.

I am nearly a hypochondriac when it comes to my pets, and Jack had been to the vet frequently during the year, beyond annual shots updates. He had bloodwork in April and in May to look at the effectiveness of a supplement I was giving him. Later in June, I noticed Jack acting lethargic, panting more and eating less. As we were experiencing extremely hot weather, I figured that was the cause, but took him in to be checked out anyway on a Friday. As I had not noticed any vomiting or diarrhea when I was with him – he spent stretches outside with our other dog – the vet barely looked at him, commenting that his respiration seemed fine and he was looking good. That weekend, I followed him around every time he was outside, collecting samples. I took him back again Monday, providing the samples and again telling them he was lethargic, not eating at all, but still drinking plenty of water. The vet checked the samples, proclaimed him to have an overgrowth of a bacteria in his colon, and prescribed an antibiotic. Again, the vet did not touch him and commented on how great he looked. On Friday, I was back again – he was still not eating, I was having to force-feed him the antibiotics, he was now drinking less, and his breathing seemed even worse to me. The vet stated that since his bloodwork looked so good, she just did not know what to tell me. I argued with her that she had not taken any bloodwork since looking at the effectiveness of the supplement early in June. She insisted that bloodwork had been drawn the previous week. I had to insist that she look again because she was mistaken.

When she returned to acknowledge her mistake, she approached it as if she would have to talk me into allowing the test with the costs involved. I told her I had been asking her to run a full panel, and that was what I expected that day. When she returned with the results, she noted that there were concerns and sent me immediately to the Pet Specialty/Emergency clinic 30 miles away. Of course I went. After a late night there, and a full day the next day, costing over $1600, I learned my Jack had cancer. They recommended further diagnostics to pinpoint the specific type of cancer – a mass above his heart, which was either mast-cell, requiring cracking his chest open and extensive recovery time if it had not metastasized and they were able to get it all, or lymphoma, requiring 6 months of chemotherapy, which may extend his life a year – and I needed to make a decision about treatment. Having experienced a CCL tear, surgery, and therapy/recovery just over a year earlier, I knew I could not put Jack through that again, and opted to take comfort measures, only. They told me we would have a few weeks with him.

We took him home Saturday evening, notified our kids and grandkids who also loved Jack enormously and who came to see him Sunday, and he passed away waiting by the front door for me to come home from work on Monday. So much for a few weeks. Needless to say, after 16 years of using the same veterinary clinic, I will not return. I had an especially difficult July, trying to figure out why I did not notice that he was ill much earlier. On the other hand, our other dog, who pretty much always followed Jack around, going out when he did and just being a very playful, fun-loving dog, also went through a period of mourning, during which she also had to teach us her communication system. She would not alert us to her needs as Jack always had, and never had to because Jack took care of “speaking” for both of them. So we have had a period of re-bonding and re-training, and discovering what a bright, unique dog Sophie is. The photo is of Jack with our granddaughter, Danica, on his last full day with us. He was always lovely with kids.

Linda

By |2016-11-03T10:15:31+00:00March 4th, 2013|Categories: Linda Medina's Posts|Tags: , , |3 Comments

South Texas for SUMMER Vacation?

Yes, I was there for just over a week! HOT, HUMID – but everyone said that we were lucky to be there Memorial Day week, as the previous week was even worse. We celebrated my mother-in-law’s 83rd birthday with her, with more than 50 other family members. My husband is the oldest of 11 kids, so just a tiny little family. ;-) We were in the previously tiny town of Carrizo Springs – now growing by leaps and bounds because of oil, creating crazy traffic! It was great to see everyone. We also drove over to Roma to see other family, then went on to South Padre Island. Our granddaughter (who went with us for the first time – we usually take at least one grandkid along, but even though she is the oldest, has never been able to go) was dying to see the ocean for the first time in her life, so we drove over to South Padre, since we were so close. Yes, I know, it is the Gulf, not, technically, the ocean, but for us landlubbers, it is close enough! She actually got to see a dolphin, so that made her day! We all loved the sand and water. I was hoping for cooling breezes off the water, but no such luck. It was just as hot and humid as the rest of South Texas! I hate to say, but my favorite part – paying just $3.11/gal for gas at Port Isabel just before crossing the bridge to the island! Yes, I am a bit of a cheapskate!

Just discovered that I never got back to this draft – was planning to add a photo, but never got back to it. So here it is, a month later. Colorado has had weather as hot as south Texas that I whined about, but without the humidity. And with the fires we have had throughout June, we could have used that humidity! Some fires are being contained, but others continue to pop up, so hoping for a weather change to RAIN soon! At least the High Park fire, that they expected would not be contained until fall when we get snow, is now 100 % contained – well ahead of schedule, thanks at least in part to tiny bits of rain on a couple of days. Fires have been burning in the mountains, into towns and cities (Boulder, Colorado Springs), and out on the eastern plains. Our area had one fire that did not make headlines, and was fortunately quickly contained, but it burned a bit of acreage in rural Weld County. Fortunately for our community, mostly all we have had to contend with is smoke and allergy-like respiratory symptoms.

Now to focus and prepare for my first Therap webinar presentation and Therap conference presentation. Anybody know any good ice breaking jokes?

By |2012-07-02T16:29:46+00:00July 2nd, 2012|Categories: Linda Medina's Posts|Comments Off on South Texas for SUMMER Vacation?

Tracking Caps with Service Authorizations

Colorado expects to impose caps on the number of targeted case management (TCM) units that can be billed per client served, limiting us to 240 x 15 minute units per fiscal year, starting with a limit of 60 units for April – June 2012. Although the proposal is still in draft, and April is now history, we are anticipating that it will become reality, and have been updating our TCM service authorizations to include those limitations. I created 3 month service authorizations to limit usage to 60 units, which I will edit if the caps do not become retroactive to April 1. Case managers will still be able to enter all of the real units used, but the service authorizations will prevent us from overbilling. We do have issues to address to deal with meeting the needs of some of our clients who have frequent contact with case managers. I pulled a billing report for the first three months of the year, and found a handful of individuals who had used well over 100 units just in those three months! We are brainstorming ways to help clients find alternative means of addressing their needs, not using their case manager as their one source of assistance or safety net, or whatever. It will be a challenge to avoid providing costly free services.

By |2016-11-03T10:15:42+00:00May 10th, 2012|Categories: Linda Medina's Posts|Tags: |Comments Off on Tracking Caps with Service Authorizations

Password Security and Oversight Account

I just realized today that I missed posting ANYTHING last month!  Whoops! Of course, it is far easier to remember your password if you post regularly…

We have just finished crafting the final version of our new Electronic Data Management policy, related to all things Therap. As a result, we will be implementing new, more secure and more regularly changed passwords. Yes, I am prepared to be thoroughly detested by all staff here shortly, as people REALLY complain about having to change their passwords and having to try to remember something new. Not only do we have to log in to our computers and Therap, many staff work with a variety of software systems required by state agencies, and have as many as 7 other log-ins and passwords, all of which have different re-set dates. I tried to be clever and just reset four when the first had to be reset, to use the same password multiple times. Unfortunately, my trick to help me remember without writing it down actually backfired and resulted in me forgetting the password needed to access all four systems!!

We started building a Therap oversight account a few months back – we are a case management agency contracting with a number of service provider agencies and independent contractors to provide services to our clients. We have five service agencies in some stage of beginning to move to Therap, but so far only two are far enough along that we are able to access any information via the oversight account. There have been a few changes to the account since it was first initiated, and when I finally had time to spend in there, had to play around awhile to find what I needed. Now, once the client is connected, it is nice to see what information can be pulled via reports or even to look at what is going on outside of our agency, without having to wait to receive a paper copy or physically going to a program location to conduct monitoring. I am hoping the oversight account continues to grow and develop capacity, and intend to continue making suggestions as I work my way through it.

My eyes are getting tired and my neck is getting stiff – I need a lower screen so I can stop leaning my head back to peer through my bifocals at the screen! Or just use my laptop, perhaps. Either way, I need to stop typing and go request some accommodations. And try to think of something more exciting to write about before next time! Linda

By |2016-11-03T10:15:43+00:00April 4th, 2012|Categories: Linda Medina's Posts|Tags: |Comments Off on Password Security and Oversight Account

MAR

Happy Valentine’s Day!

I have been working with our provider agency nurse to get medications entered, so that ALL MARs will be entered in Therap (for that agency) by March 1st.  Yes, I truly wish it was less tedious, but just to see how well staff are responding and recording makes it all worth it  ;-/.  As I work through the 1000+ drugs we are entering (currently at 822), I keep looking for shortcuts and ways to speed it along.  I am liking the copy form feature!  However, it is critical to assure you check each field to assure it is updated if needed.  One suggestion we would like to share – although many have probably discovered it already – is that it helps to leave a blank line between dosage times for meds given more than once a day.  When they are one after the other on the MAR, it is easy for staff to accidentally complete two blanks instead of just the one.  Just thought I’d share!

Update on our agency fundraising house raffle:  We had our first early bird drawing yesterday, giving away $2500 to a local woman who had purchased two tickets.  We called her via speakerphone to give her the good news.  Man, was she excited!  Not only did she win the first early bird drawing, but she is still in the running to win the remaining early bird drawings, the multi-ticket drawing, and the grand prize!  I hope that different people win each prize, but wouldn’t it be amazing to win more than once?!?!  If you are that person, of course…  It is not too late to get your tickets, to help support a great cause.  Purchase by 2/28, and you will be entered into two more early bird drawings, with the multiple ticket and grand prize drawing on 5/31.  www.envisionhomeraffle.org.

‘Til next month – or until I get a wild hair to share –

Linda

By |2016-11-03T10:15:45+00:00February 14th, 2012|Categories: Linda Medina's Posts|Tags: , , , |Comments Off on MAR

Colorado Medicaid Billing

Just wanted to share the news that, according to our finance director, our December billing submitted in January with the 5010 Medicaid changes was very successful, thanks (we believe) to Therap! Some other providers in Colorado not using Therap did report some difficulties. Kudos Therap! In these days of squeaky tight budgets, smooth billing is critical!

Hope you are all having as much success with the billing in spite of 5010 updates. Emoticon showing smiley face

By |2016-11-03T10:15:49+00:00January 27th, 2012|Categories: Linda Medina's Posts|Tags: , |1 Comment