Unlocking Financial Security: The Impact of Maryland ABLE on Disability Benefits

Written by

By: Renée Dain, SVP, Strategic Partnerships and External Affairs

Imagine a world where saving money doesn’t mean losing essential benefits. That’s the reality Maryland ABLE creates for its residents with disabilities and their families. This innovative savings program, established under federal law, addresses a crucial gap: the financial vulnerability of individuals depending on government support, such as Medicaid and Supplemental Security Income (SSI). By allowing people to save without affecting their eligibility for these programs, Maryland ABLE not only preserves necessary benefits but also promotes financial independence and improved quality of life. It’s a testament to the power of thoughtful legislation and community advocacy in creating more inclusive opportunities. Let’s dive into the story behind Maryland ABLE’s inception and its impact on those it serves with Kelly Nelson, Outreach and Communications Manager at Maryland ABLE.

What is Maryland ABLE?
Maryland ABLE is a savings program, that makes it possible for people with disabilities and their families to save and invest money without losing the federal and state benefits they need, like Supplemental Security Income (SSI) and Medicaid. The money in an ABLE account must be used for “qualified disability expenses.” These are things that help the person with a disability support or improve their health, independence, or quality of life. Not only can the person with a disability put money in their account, but so can family, friends, and others. Marylanders who put money in a Maryland ABLE account lower their state taxable income. There are other tax benefits, and account fees are low.

How did Maryland ABLE get started?
For decades, people with disabilities were stuck in a cycle of poverty as they were unable to save for the future or save for the additional costs of living with their disability. People with disabilities, their families, advocacy groups, and service provider agencies joined together way to advocate for a way to save money without losing SSI, Medicaid, and other benefits. People depend on these government benefits for income, health care, and other needs. In 2014 Congress passed a law in 2014 called the Stephen Beck, Jr., Achieving a Better Life Experience Act. It is called the “ABLE Act” for short. This law made it possible for states to create ABLE programs to help people with disabilities build more financial independence. Maryland took advantage of this opportunity and started to create the Maryland ABLE program in 2016. By late 2017, the program was up and running and people started opening Maryland ABLE accounts.

What are some of the benefits of having a Maryland ABLE account?

  • Easy to open an account. You only need $25 for your first deposit.
  • Easy to put money into your account. The minimum deposit after opening your account is only $5.
  • Family and friends can deposit money to your account. This can help you meet your goals.
  • Easy to get money out of your account.
  • Use the money in your account for a lot of different types of things related to your health, independence, and quality of life.
  • Deposit up to $18,000 each year; more if you work.
  • Save while still being able to keep federal and state benefits like Medicaid; SSI; waiver services; and food, energy, or housing assistance (like Section 8).
  • Save up to $100,000 before your SSI benefits are affected.
  • Make deposits until your balance reaches $500,000.
  • Pay no tax on the money your account earns or on the money you withdraw to pay for qualified disability expenses (QDEs).
  • People who live in Maryland and put money into your account, including you, get a tax benefit.

Learn more about Maryland ABLE from Kelly Nelson, Outreach and Communications Manager by viewing a recent Community Enrichment Webinar HERE.

The Maryland ABLE website at www.marylandable.org serves as an excellent source of information, offering a comprehensive set of Frequently Asked Questions (FAQs).

The Users Guide to Maryland ABLE published by the Maryland Developmental Disabilities Council has been a helpful tool for self-advocates and families as it explains the ABLE program in an easy to digest format. Please note that the Guide was published in 2021 so it does not reflect the standard annual contribution limit of $18,000, which became effective on 1.1.24 or a description of the new fixed income investment option and the allocation method for contributions for savings/investment.

The ABLE Today website is a good resource for learning about the 48 ABLE programs nationwide, archived presentations on a variety of ABLE related topics and other helpful resources.

Transitioning Youth: What to Know as You Grow

Written by

By: Renee Dain, Sr. VP, Strategic Partnerships and External Affairs

Transition is defined as “the process or a period of changing from one state or condition to another.” When you think about your life’s trajectory, it’s incredible to reflect on the vast array of transitions you have experienced in all domains: physical, emotional, social, and cognitive. As adults, we know that transitions are inevitable, through our experiences such as moving into a new home or starting a new job, and small transitions, such as a change in daily routine. While the transition may be difficult, we learn to adapt and manage feelings of stress, anxiety, and nervousness.

For adolescents, the transition to adulthood is perhaps one of the most challenging times in a young person’s life. Leaving the routine of high school to the unpredictable transition to adult life can be even more daunting for a student living with disabilities and/or a complex medical need. This is because they are leaving secure supports that are mandated by law and moving into a system where services are less certain. While one child may transition smoothly, another may have difficulties, which can be impacted by their temperament, life experiences, and resiliency. Keeping child development in mind helps us understand children’s emotions and behaviors as they face transition.

We recently sat down with Alyssa Stoffel, Team Manager, Rare and Expensive Case Management (REM) Program and Sheryl Nickel, Clinical Care Coordinator, Model Waiver Program to learn more about the transition process.

At what age do young people typically begin the transition into adulthood?

Transitioning Youth (TY) is a term used for children ages 14 to 21 who are preparing to leave the school system, either through a certificate or diploma track in high school. Students with disabilities should begin the transition planning process no later than age 16. At The Coordinating Center we recommend supporting students and families with the transition process as early as 14, which is especially important in preparing for the transition to adult healthcare. Within the school system, for students participating in the Individualized Education Program (IEP), transition planning is a part of the IEP process. The transition planning process is designed to help students with disabilities prepare for life after high school, ensuring they have the skills and support needed to achieve their goals in areas such as higher education, vocational training, employment, adult services, independent living, or community participation.

For students living with an intellectual or developmental disability, the Maryland DDA has a special category of eligibility and priority for services through the Governor’s Transitioning Youth Initiative for people 21 through 22 years of age. This makes it possible for the DDA, working with the Division of Rehabilitative Services (DORS), to fund employment services and other day services for eligible students leaving school who otherwise may have gone on the DDA Waiting List. A student is eligible from their 21st birthday until their 22nd birthday to apply for DDA services. If their date of graduation is after the student’s 21st birthday, they are eligible for one year after the date of graduation to apply.

What role can care managers (e.g., care coordinators and supports planners) play in supporting transitioning youth and their families?

One of the best ways adults can support adolescents with the transition process is to start early. Parents, caregivers, teachers and care managers can play an important role in supporting young children through transition. Adults can ensure that children feel protected and nurtured, transforming transitions into learning opportunities that bolster development across all areas of a child’s life.

Care managers at The Coordinating Center are trained to support adolescents and families through the transition process. For youth living with complex medical needs and/or disabilities we can support and/or facilitate the transition to adult healthcare. We recognize how daunting this can be, as the population we serve require specialized and coordinated care. Establishing new relationships with providers who may not have the same level of expertise or understanding of their specific conditions can lead to feelings of anxiety and insecurity. There’s also the challenge of self-advocacy and healthcare management, which needs to be taught early.

There are many other aspects of the transition to adulthood that Care Managers can help facilitate. We can support students with the transition to post-secondary life (e.g., education or training, employment, and, when appropriate, independent living skills) through advocating for transition planning and services during the Individualized Education Program (IEP) process. We can also support students with intellectual and/or developmental disabilities access transition youth services through the Maryland Department of Developmental Disabilities (DDA).

What are some helpful tools for adolescents and families?

There are a lot of great resources out there. One of the tools we encourage families to review is The Coordinating Center’s Milestone Checklist, which starts through birth through the transition to adulthood. Click HERE to access the checklist.

For families looking for resources related to healthcare transition, we recommend the following Got Transition tools:

Students with intellectual and developmental disabilities should consider services through the Maryland Developmental Disabilities Administration. At The Coordinating Center, we are a provider for Coordination of Community Services, a DDA program. Click HERE to learn more.

View the webinar presented by Alyssa Stoffel and Sheryl Nickel on April 16, 2024 HERE.

Alyssa Stoffel, MS, RN, CPN, CCM, Team Manager – Contract Support, REM has nearly 20 years of experience in the human services field in various roles focused on ensuring meaningful community life for individuals with complex medical needs and disabilities and has been with The Coordinating Center for just under nine years.

Sheryl Nickel, BSN, RN, CPN, CCM, Clinical Care Coordinator, Model Waiver has 16 years of experience in the human services field and has been with The Coordinating Center for just under seven years.

The Rare and Expensive Case Management (REM) Program is Maryland’s, case managed, fee for service alternative to HealthChoice Managed Care Organization (MCO) participation. The REM Program is for individuals receiving Maryland Medical Assistance with a qualifying diagnosis that is rare in occurrence and expensive to treat. The purpose of the program is to provide community-based care coordination services for people with specialized health care needs, providing access to high quality, medically appropriate health care services in a cost-effective setting outside of a managed care organization.

Model Waiver is a Maryland Medicaid program, which allows medically fragile individuals, before the age of 22 years to live at home. Without this benefit, these individuals would be hospitalized, as their medical needs require hospital or nursing facility level of care. Under the Waiver, the parents’ income and assets are waived during the financial eligibility process even though the child continues to live in the community with their parent(s).

Finding a Voice Through Self-Advocacy

Written by

By: Cindy Ngo, MSW, Supports Planner; and Megan Bazzett, MS, CPRP, CFRP, CFP Director

Advocacy can take many forms including individual advocacy where a person or group represents the interests of a few or even systemic advocacy where groups faced with a common issue can affect change on a broader scale (for example, working toward a change in policy or legislation). Self-advocacy is the ability for a person or their representative to communicate their interests and then make decisions on the next steps to meet those needs. So why is it important that our participants know how to self-advocate, and how do we, as Supports Planners and Service Coordinators, support and enhance this skill? 

We recently sat down with Megan Bazzett, Director, Community First Programs at The Coordinating Center to learn more about self-advocacy. 

What are the benefits of self-advocacy?
When a person self-advocates or has someone advocate on their behalf, it gives them a voice and an opportunity to be heard. Our participants are experts in their own interests, so it is important that they have a platform to communicate these interests. Advocacy can support the protection of human rights, act as a catalyst for change, and have a positive impact on others with similar needs. 

What are a few strategies to getting started with self-advocacy?
In terms of self-advocacy, participants should educate themselves on the related topics. They should complete their own research and learn what has been done already to address their needs and discover if there are any existing advocacy efforts to accomplish their goals. When engaging in individual advocacy, it is important to remain educated and connect with support networks whether that be peers facing the same issues or support groups and advocacy groups. If engaging in systemic advocacy, people may want to go further and advocate at a broader scale by affecting policy or legislation. 

What role can coordinators and supports planners play in supporting individuals and families with self-advocacy?
As Service Coordinators and Supports Planners, we often advocate on behalf of others to different entities to ensure our participant’s service needs are being met. We can also support our participants by ensuring they have as much information about their current situation as possible and connecting them to related resources. We should also encourage participants to practice self-advocacy in their day-to-day life, whether that be during medical appointments, so that they can get treatment that works for them, or during collaborative meetings with their Service Coordinator/Supports Planner, to ensure their service needs are being met. It is important for us to keep our participants informed, educated, and connected to resources so that they effectively support themselves. 

Join Megan Bazzett on March 19, 2024, at Noon, for a special webinar on Finding a Voice Through Self-Advocacy. Click HERE to register to attend. This webinar is part of The Coordinating Center’s new Community Enrichment Series – engaging workshops supporting individuals and families to achieve their aspirations for a meaningful life! 

Megan Bazzett has 24 years of experience in the human services field and has been with The Coordinating Center for just under two years. As Director, Community First Programs at The Coordinating Center, Megan is responsible for oversight of the Supports Planning services provided to approximately 3,000 Maryland residents. Supports Planning services help eligible older adults and individuals living with disabilities to access home and community-based services. While eligibility requirements vary by program, the range of service and support options include personal assistance services, nurse monitoring, assistive technology, home modifications, home delivered meals, and more. 

 

Navigating Advance Directives, Guardianship, and Power of Attorney for a Secure Future

Written by

By: Renée Dain, SVP, Strategic Partnerships and External Affairs
Nicole Dozier, LCSW-C, Social Work Consultant for Community First Programs 

Advance Directives, Guardianship, and Power of Attorney are legal tools that individuals can use to plan for their future, particularly in situations where a person may be unable to make decisions for themselves due to illness, incapacity, or other circumstances. Clearly outlining one’s wishes and designating decision-makers can help prevent family disagreements during challenging times. Having legally binding documents in place can provide a clear roadmap for how decisions should be made, reducing potential conflicts. 

We recently sat down with Nicole Dozier, LCSW-C, Social Work Consultant for Community First Programs at The Coordinating Center to learn more about these legal documents and planning for your future.  

What is the difference between an Advanced Directive and a Power of Attorney? I am not an attorney or legal expert, but in my role as Social Work Consultant for Community First Programs at The Coordinating Center, I have seen firsthand the importance of planning for your future. An Advance Directive primarily deals with healthcare decisions. It allows individuals to express their medical treatment preferences and appoint someone (a healthcare proxy or agent) to make healthcare decisions on their behalf if they become incapacitated and are unable to communicate their wishes. A Power of Attorney (POA) grants someone the authority to act on behalf of another person in specified legal or financial matters. The person granting the authority is known as the “principal,” and the person receiving the authority is the “agent” or “attorney-in-fact.” 

Both documents, an Advance Directive and a POA, should be set up when you are of sound mind and able to make decisions, as they are activated only when you are incapacitated and are unable to handle your affairs. 

What is Guardianship, and in what cases is it necessary?
Guardianship is a legal process where a court appoints a guardian to make personal and/or financial decisions for an individual (the ward) who is deemed legally incapacitated and unable to make decisions for themselves. Guardianship proceedings are initiated through a court petition and involve a legal determination of the individual’s incapacity. Guardianship may be necessary if a loved one is experiencing severe cognitive impairment, traumatic brain injury, mental health conditions that impede one’s ability to make reasonable decisions, or another urgent situation that impacts the person’s ability to make decisions, which may be temporary or permanent. 

Why is planning for your future important?
Planning in advance can help ensure that your wishes are honored and that your affairs are managed in a manner consistent with your values and preferences. Knowing that one’s wishes will be respected, and that trusted individuals are empowered to make decisions on their behalf, can provide a sense of peace and security. It also relieves loved ones of the burden of making difficult decisions without clear guidance. 

Join Nicole Dozier on February 20, 2024, at Noon, for a special webinar on Advance Directives, Guardianship and Power of Attorney. During the webinar we will explore everyday scenarios that will enhance your understanding of the advantages of having these documents prepared in advance. Click HERE to register to attend. This webinar is part of The Coordinating Center’s new Community Enrichment Series – engaging workshops supporting individuals and families to achieve their aspirations for a meaningful life! 

 Nicole Dozier, LCSW-C has 17 years of experience in Medical Social Work and has been with The Coordinating Center for almost six years. As Social Work Consultant, Nicole is responsible for providing clinical expertise to staff providing services to individuals in the Community First Programs.   

Thriving Beyond Diagnosis: The Art of Chronic Disease Management

Written by

By: Renee Dain, SVP, Strategic Partnerships and External Affairs
Joyce Falkenhan, DNP, RN, B-C, CNRN, Consultant for Community First Programs 
Anne Conway, RN, BSN, MS, CCM, Director of Health Plan and Hospital Services 

Chronic Disease Management (CDM) is the comprehensive and ongoing medical care, treatment, and attention required for health conditions that persist for one year or more. These conditions often limit activities of daily living and necessitate continuous medical intervention, including treatment regimens and medication. Additionally, individuals with chronic diseases may face an increased risk of developing other long-term health issues.  

Care coordination plays a pivotal role in CDM by ensuring that healthcare services are well-organized, efficient, and tailored to the specific needs of individuals with chronic conditions. Care coordinators can bring together various healthcare providers, specialists, and support services to work collaboratively. This integration ensures that different aspects of a patient’s care, from medication management to lifestyle interventions, are aligned and cohesive. It’s also vital that the individual is involved in their own care. Effective care coordinators empower individuals with chronic diseases by providing them with information, education, and resources to actively participate in decision-making regarding their health. This can enhance adherence to treatment plans and improve overall outcomes. 

We recently sat down with Joyce Falkenhan, DNP, RN, B-C, CNRN, RN Consultant for Community First Programs at The Coordinating Center and Anne Conway, RN, BSN, MS, CCM, Director of Health Plan and Hospital Services to learn more about CDM.  

What are the risk factors associated with CDM?
Risk factors for chronic diseases can be divided into nonmodifiable and modifiable categories. Nonmodifiable risk factors, inherent and unchangeable, include age, with the risk of many chronic diseases increasing over time; race, where certain ethnicities may exhibit a higher predisposition to specific chronic conditions; gender, as some chronic diseases affect men and women differently; and family history, where genetic factors and family health history contribute to an individual’s susceptibility to certain chronic conditions. On the other hand, modifiable risk factors can be influenced through lifestyle choices. These include smoking, a significant risk factor for various chronic diseases such as cardiovascular diseases and certain cancers; excessive alcohol consumption, which can contribute to liver diseases and other health issues; being overweight or obese, crucial in preventing and managing conditions like diabetes, heart disease, and musculoskeletal disorders; physical inactivity, linked to the development and progression of several chronic diseases; and poor dietary choices, high in saturated fats, sugars, and low in essential nutrients, which can increase the risk of chronic conditions, including diabetes and cardiovascular diseases. Understanding and addressing these risk factors are integral to effective chronic disease management, allowing for targeted interventions and lifestyle modifications to mitigate risks and improve overall health outcomes. 

What are some prevalent chronic diseases that require long-term management?
Numerous prevalent chronic diseases demand sustained attention and long-term management due to their persistent nature. Examples of such conditions include diabetes, where both Type 1 and Type 2 necessitate continuous monitoring and control of blood sugar levels through medications, dietary adjustments, and lifestyle modifications. Hypertension, or high blood pressure, often requires prolonged medical intervention and lifestyle changes to regulate blood pressure and diminish the risk of cardiovascular complications. Cardiovascular diseases, encompassing conditions like coronary artery disease, heart failure, and chronic heart ailments, typically demand ongoing management through a combination of medications, lifestyle adjustments, and, in certain instances, surgical interventions. This consistent and comprehensive approach to chronic disease management is crucial for enhancing patients’ well-being and preventing complications associated with these enduring health conditions. 

Why is Chronic Disease Management Important?
Taking care of chronic diseases is really important because it helps people living with long-term health issues live better lives. It involves giving regular medical attention, keeping an eye on things, and acting quickly when needed. This helps control symptoms, avoid problems, and make overall health better. Besides helping individuals, it also makes the healthcare system work better by preventing lots of hospital visits and emergencies. This helps save resources and money. Chronic disease management also deals with how different health problems can be connected, stopping more issues from happening. It’s about putting the person at the center of their care, so they can learn, make changes in their life, and get support. This doesn’t just lead to better health; it also gives people a feeling of control and well-being. So, taking care of chronic diseases is like a smart plan that helps everyone – the person and the whole healthcare system. 

 Join Joyce Falkenhan and Anne Conway on January 16, 2024, at Noon, for a special webinar on Chronic Disease Management. Click HERE to register to attend. This webinar is part of The Coordinating Center’s new Community Enrichment Series – engaging workshops supporting individuals and families to achieve their aspirations for a meaningful life! 

 Joyce Falkenhan, DNP, RN, B-C, CNRN, has 45 years of experience in health care and has been with The Coordinating Center for two years. As RN Consultant for Community First Programs at The Coordinating Center, Joyce is responsible for providing consultation, health and community care expertise and direction, as well as education and mentoring for members of the CFP team. She provides input into client-specific care and home care coordination to enable individuals with complex health care needs to safely live in the community. 

 Anne Conway, RN, BSN, MS, CCM, has 20 years of experience in health care and has been with The Coordinating Center for three years. As Director of Health Plan and Hospital Services at The Coordinating Center, Anne is responsible for the oversight, and management of care management and care coordination service programs for health plans and hospitals.   

“We Are Stronger Together”

Written by

By: Renée Dain, SVP, Strategic Partnerships and External Affairs and Dianne Edwards-Barnes, Diversity, Equity, Inclusion and Belonging Coordinator

We started off the year celebrating the 40th anniversary of The Coordinating Center with the launch of our “We Are Stronger Together” Blog series. We chose this tagline because we truly believe at The Coordinating Center that building a culture that is diverse, equitable, and inclusive drives innovation, productivity, results, customer satisfaction and ultimately, a sense of belonging for our coworkers and the people we are privileged to serve each day. So how exactly are we all these things? It starts with our commitment to Diversity, Equity, Inclusion and Belonging (DEI&B).

At The Coordinating Center we aim to dismantle inequalities within our policies, systems, programs and services by embracing Diversity, Equity, Inclusion and Belonging (DEI&B) and leading with respect, acceptance and compassion. It’s what makes us exceptional in achieving our mission and drives us to deliver culturally competent and effective care coordination services. We believe we are stronger together.

  • We are passionate about embedding DEI&B into everything we do for our coworkers, community and the people we are privileged to serve;
  • We respect all individuals irrespective of gender, race, ethnicity, national origin, religion, age, sexual orientation, gender identity, education, ability, and any other characteristics that make a person unique;
  • We value individual identities and unique perspectives by creating safe spaces that invite courageous dialogue and embrace authenticity;
  • We recognize that equity must take centerstage by creating a culture that promotes understanding that people have different needs and wants;
  • We acknowledge unconscious bias; and,
  • We take an active stance against racism and social injustice. Being non-racist and impartial is not enough.

We recently sat down with Dianne Edwards-Barnes, Diversity, Equity, Inclusion and Belonging Coordinator, to learn more.

Tell us a little bit about yourself and your position at The Coordinating Center?
I’ve been actively involved in fostering diversity, equity, inclusion, and belonging (DEI&B) at The Coordinating Center for quite some time. In 2020, while I was serving as a Supports Planner, I served as the co-chair of the coworker-led DEI&B Committee. In 2021, I furthered my commitment by earning a Certificate in Diversity and Inclusion from Cornell University. This program equipped me with strategies to enhance engagement, counteract unconscious bias, and create a more supportive and engaging work environment. In 2022, I was honored to be appointed as The Coordinating Center’s first DEI&B Coordinator.

As the DEI&B Coordinator at The Coordinating Center, I collaborate with colleagues across all organizational levels to cultivate a culture of community and inclusion. My role involves identifying opportunities for advancement and providing support by serving as a central point of reference for all things DEI&B related.

I have over 17 years in training and professional development and 13 years of experience in social and human services, including seven and a half years as a Supports Planner. Beyond The Coordinating Center, I’ve been actively engaged in volunteer work with organizations such as the Arthritis Research Foundation, March of Dimes, United Way, American Cancer Society, and the AIDS foundation. Additionally, my wife and I were former Crisis-Care Foster Parents, providing a home for over 75 at-risk children.

We often hear about DEI efforts, but less about belonging. Why is belonging critical to DEI?
Inclusion involves creating a space where diverse individuals feel welcome and valued. Belonging takes it a step further by ensuring that individuals not only feel included but also truly accepted and able to bring their authentic selves to the table. Bringing one’s authentic self to the workplace means being genuine and true to one’s identity. It involves being honest about who you are, your values, and your beliefs, without fear of judgment or repercussions. It also means that individuals feel free to express their individuality without conforming to stereotypes or societal expectations. This includes embracing and celebrating differences in personality, style, and cultural backgrounds. Coworkers should feel empowered to communicate openly about their experiences, perspectives, and challenges. This openness contributes to a culture of transparency and trust within the organization. We recently polled our coworkers about their DEI&B experiences at The Center and we learned that 81% strongly agree/agree that they can be their authentic selves at The Center (14% were neutral).

What efforts to date have been implemented to advance DEI&B at The Coordinating Center?
We uphold a strict zero-tolerance policy against bullying, harassment, and discrimination. Our commitment to accountability is reflected in our grievance policy and process, which guarantees a fair and impartial system for addressing concerns without prejudice.

To ensure equal access to services, we provide reasonable accommodations in both the workplace and for our clients. We deeply respect the religious beliefs and practices of all colleagues, making appropriate accommodations for their observances. As a testament to our dedication to historical significance and inclusivity, we established Juneteenth as a paid holiday ahead of the federal government. This decision acknowledges the momentous occasion of June 19, 1865, marking the complete emancipation of slaves and symbolizing the first true day of freedom for all Americans.

We pursue cultural competency throughout our organization by creating substantive learning opportunities and formal transparent policies. We require and provide training for all coworkers on DEI&B inclusive of unconscious bias. This year we launched our monthly Diversity Dialogue Series, with a wide range of topics such as – Unconscious Bias, Generational Diversity in the Workplace, Hispanic Heritage Appreciation and Indigenous Peoples and the Modern-Day Effects of Colonization. All coworkers were required to attend at least one and 32% chose to attend more than one. We’ve also updated our policies to integrate gender-neutral and anti-ableist language in policies and practice.

Our primary objective is to address workplace inequality by actively seeking diverse talent and fostering a culturally varied pipeline for coworker and board leadership. We approach the hiring, promotion, and evaluation processes with intentionality and awareness of personal bias. In 2022 we were recognized for being among the Top 100 companies with inclusive benefits, by Mogul. (Click here to learn more about our inclusive benefits)

Breaking Stereotypes and Unraveling the Threads of Homelessness and Hunger

Written by

By: Renée Dain, SVP, Strategic Partnerships 

National Hunger and Homelessness Awareness Week, occurring annually one week before Thanksgiving (November 13 to 21 this year), sheds light on the challenges faced by the less fortunate in society, especially during the holiday season and harsh winters. This significant event, organized by the National Coalition for the Homeless, inspires Americans to get involved in social causes by making donations, signing up for volunteer programs, and participating in awareness initiatives and rallies. The week serves as a platform to address the root causes of homelessness and advocates for change by holding lawmakers and councilmen accountable.  

Many individuals or families experiencing homelessness face unjust stereotypes and discrimination, often being wrongly perceived as criminals. They are unfairly treated by both laws and city planning and often face unkindness from other residents. National Hunger and Homelessness Awareness Week aims to dispel these misconceptions by educating people about the reasons behind homelessness and encouraging compassionate support. For many Americans living paycheck-to-paycheck, a sudden illness, injury, or job loss can lead to poverty, hunger, and/or homelessness. According to the Census, in 2021, nearly 38 million Americans live below the poverty line, and one in seven children is affected by poverty. USA Facts reports more than half a million Americans are homeless. Thankfully, various organizations step in, offering essential services such as food, shelter, and medical assistance. During this week, it’s essential to celebrate by backing local organizations that assist individuals in finding jobs, permanent housing, and access to medical facilities, fostering a more empathetic and supportive community. 

In this blog post, we will explore with Priscilla Lissik, Director, Homeless Support Services, the stereotypes, causes and solutions to unraveling the threads of homelessness and hunger. 

What are some additional stereotypes and prejudices faced by homeless individuals and how can we combat them?
Individuals or families experiencing homelessness frequently confront a barrage of stereotypes and prejudices, perpetuating misconceptions that they are lazy, dangerous, or solely responsible for their situation. These prejudices hinder empathy and often result in social exclusion, making it even harder for them to reintegrate into society. To combat these stereotypes, it is essential to raise awareness about the diverse reasons behind homelessness, emphasizing the systemic factors like lack of affordable housing, mental health issues, and unemployment. Education and media campaigns can challenge these stereotypes by highlighting individual stories, showcasing the resilience and strength of homeless people who are working towards improving their lives. Encouraging personal interactions and fostering understanding within communities can also break down barriers, fostering empathy and support networks. Ultimately, combating stereotypes requires a collective effort to change societal attitudes and promote inclusivity, ensuring that homeless individuals are seen as individuals with unique stories and potential, rather than being defined by their housing status. 

What are the main causes of homelessness, and how can they be addressed?
Homelessness is a multifaceted problem stemming from various factors such as the lack of affordable housing, unemployment, mental health issues, substance abuse, domestic violence, discharge from institutions, natural disasters, economic crises, inadequate support for veterans, and systemic problems like racism and discrimination. To address these challenges, comprehensive solutions are crucial. This includes increasing the availability of affordable housing through subsidies and public housing programs, improving access to job training and mental health services, implementing substance abuse prevention and treatment programs, enhancing discharge planning for individuals leaving institutions, establishing disaster response plans, providing targeted support for veterans, addressing systemic issues through policy changes and education, and strengthening social safety net programs. Collaboration among government agencies, nonprofit organizations, and the community, alongside adequate funding and a focus on both immediate assistance and long-term strategies, is essential to making significant progress in reducing homelessness. 

What is the impact of mental health issues and substance abuse on homelessness?
The impact of mental health issues and substance abuse on homelessness is profound and interconnected. Individuals grappling with mental health disorders often face challenges in maintaining stable employment and relationships, making it difficult to sustain housing. Moreover, untreated mental health conditions can lead to self-medication through substance abuse, exacerbating the problem. Substance abuse further hampers one’s ability to hold a job, maintain housing, and build a support network, often resulting in a cycle of homelessness. Additionally, the lack of access to mental health services and addiction treatment programs in many communities leaves these vulnerable individuals without the necessary support to address their conditions, perpetuating their homelessness. Addressing mental health issues and substance abuse is thus pivotal in any effort to combat homelessness, requiring comprehensive programs that offer treatment, counseling, and social support to break this destructive cycle. 

What are the root causes of hunger in our society?
The root causes of hunger in our society are indeed intricate, involving multifaceted issues such as poverty, limited access to education, employment opportunities, and healthcare. A critical aspect amplifying this crisis is the existence of food deserts, where impoverished communities lack convenient access to affordable, nutritious food. In these areas, residents are forced to rely on unhealthy, processed options available at convenience stores, perpetuating cycles of poor nutrition and related health problems. The combination of economic disparity, educational limitations, and food deserts intensifies the struggle faced by individuals and families, particularly in marginalized communities. To create a hunger-free society, it is essential not only to address poverty and promote social and economic equity but also to establish initiatives that eradicate food deserts, ensuring everyone has access to fresh and healthy food options, regardless of their socioeconomic status. Integrating these efforts is crucial to breaking the grip of hunger and fostering a more equitable society for all. 

What is Housing First and how is care coordination essential?
Housing First is a proven approach to addressing homelessness that prioritizes providing stable and permanent housing to individuals experiencing homelessness, without requiring them to address other issues such as mental health or substance abuse problems first. The core principle of Housing First is that having a stable place to live is fundamental to addressing other challenges. Once individuals are housed, they are better positioned to access the necessary support services, such as mental health counseling, substance abuse treatment, job training, and healthcare. This approach focuses on the immediate need for housing and then provides ongoing, individualized support to help individuals reintegrate into society successfully. 

At The Coordinating Center we believe in this model and are presently supporting Montgomery County residents experiencing housing insecurity through a Housing First approach. Our Homeless Support Services Coordinators play a vital role in the Housing First model. They collaborate and coordinate with various service providers, such as social workers, healthcare professionals, counselors, and housing agencies, to ensure that individuals transitioning from homelessness to housing receive comprehensive and integrated support. Care coordination ensures that individuals have access to the services they need, such as mental health treatment, substance abuse counseling, employment assistance, and medical care. It also helps in managing the complex needs of individuals, ensuring they are connected to the right resources, and providing ongoing assistance to prevent them from returning to homelessness.  

Our Coordinators provide good tenant training, which focuses on educating tenants about their rights and responsibilities, promoting positive and respectful behavior and ensuring they have the necessary skills to maintain their housing stability (e.g., learning about the terms and conditions of their lease agreements, receive training on financial literacy, household management and social skills). 

Tell us a little bit about yourself and your position at The Coordinating Center? 
As Program Director for the Homeless Support Services Division, I am responsible for program development and execution of our services for people experiencing housing insecurity. I oversee the Housing Initiative Program (HIP), a Housing First program in Montgomery County that provides immediate access to permanent supported housing directly from a shelter setting and the new Street to Home Program, which is a partnership with Bethesda Cares and Mary’s Center. I have been with The Coordinating Center for 18 years and serve on the Systems Coordination Committee which is part of the Interagency Commission on Homelessness. In addition, I am active in the Maryland Dental Action Coalition, the state’s leading non-governmental oral health policy and advocacy organization, which working to improve the health of all Marylanders through increased oral health promotion, disease prevention, education, advocacy and access to oral health care.    

In Conclusion
By coordinating care effectively, individuals can address the root causes of their homelessness and work towards stable, independent living. Care coordination is essential to the long-term success of Housing First programs, as it provides the necessary wraparound services to help individuals rebuild their lives and maintain their housing stability.  

Advancing Access and Equity

Written by

By: Renée Dain, SVP, Strategic Partnerships and Sherell Townes, Program Director, Coordination of Community Services for DDA

October this year holds special significance, as it commemorates the 50th anniversary of the Rehabilitation Act of 1973 and National Disability Employment Awareness Month (NDEAM), which aims to raise awareness about disability employment issues and promote the inclusion of individuals with disabilities in the workforce. The Rehabilitation Act of 1973 was the first federal legislation to address access and equity for people with disabilities. which served as the foundation for the subsequent enactment of the Americans with Disabilities Act of 1990. The history of NDEAM traces back to 1945, when it started as a week and focused only on people with physical disabilities. Later, it expanded to a full month, and its name and scope evolved to acknowledge the importance of increasing the workforce inclusion of people with all nature of disabilities. 

In observance of NDEAM and in tribute to the 50th anniversary of the Rehabilitation Act, the U.S. Department of Labor’s Office of Disability Employment Policy has chosen the theme “Advancing Access and Equity: Then, Now, and Next” to both champion NDEAM and honor this important milestone. This annual observance is a vital opportunity to recognize the value and potential of individuals with disabilities in the workforce. It’s a time to celebrate their achievements and renew our commitment to fostering inclusive workplaces. In this blog post, we will explore with Sherell Townes, Director of the Coordination of Community Services Program, the significance of NDEAM and how Coordinators of Community Services play a pivotal role in supporting disability employment.  

What are some of the obstacles that individuals with disabilities face with accessing employment?
Although there are resources to support individuals in their pursuit of employment, individuals living with disabilities often encounter formidable obstacles preventing them from achieving their desired opportunities. Oftentimes, opportunities are turned down due to the inhospitable nature of the workplace environment. This can include inaccessible office buildings, restrooms, or workstations, making it difficult or impossible for people with mobility impairments to navigate the workspace. Businesses may not be equipped with assistive devices and technologies that would aid in the person’s ability to be effective in their position.  

Beyond the physical realm, there exists a social dimension to the problem, which can be challenging to address due to employers’ inadequate or lax enforcement of policies regarding inclusivity. Discrimination and biases can create social barriers for individuals with disabilities. Employers may have preconceived notions about their capabilities or be unwilling to provide necessary support and accommodations. Some policies and regulations inadvertently create employment barriers for disabled individuals. For example, disability benefits can dissuade some from seeking employment out of fear of losing those benefits. Additionally, current policies often fail to account for individuals requiring highly specialized work accommodations. 

For individuals with communication disabilities, such as speech or hearing impairments, there may be challenges in effectively conveying information during job interviews or while performing job tasks. Not all workplaces are equipped with Braille materials or tools, such as Braille signage, documents, or equipment with Braille labels. This lack of accessibility can create significant barriers for individuals who rely on Braille for reading and communication. 

Overcoming these obstacles requires a concerted effort from employers, policymakers, and society to promote inclusivity, awareness, and accessibility in the workplace. Legal protections, reasonable accommodations, and initiatives that support diversity and inclusion can all contribute to improving the employment prospects for individuals with disabilities. 

What are the benefits of promoting disability inclusion in the workplace?
The benefits of strong inclusion policies and practices in the workplace create a culture that is supportive and welcoming to all differences. It minimizes stigmas and draws awareness to biases that would otherwise make it difficult for individuals, such as those with visible and non-visible disabilities, to flourish. There are millions of individuals with disabilities who desire to be fully integrated in the workforce and by promoting disability inclusion policies and practices, individuals will have equal opportunities for employment, advancement and will be compensated fairly. Efficient inclusion practices provide individuals with greater job satisfaction as they can fully immerse themselves in the work culture.  Policies would therefore be structured in a way that accommodates those who require a greater level of support to be successful in their position. This would directly impact retention as individuals would be better able to keep up with the ongoing requirements, training, and their increasing responsibilities.   

How do Coordinators of Community Services support disability employment? 
Coordinators of Community Services support the philosophy of Employment First, a concept that is driven by the Maryland Developmental Disabilities Administration (DDA) to facilitate the full inclusion of people with the most significant disabilities in the workplace and community. Under the Employment First approach, community-based, integrated employment is the first option for employment services for youth and adults with significant disabilities. The guiding principle of Employment First is that all individuals who want to work can work and contribute to their community when given the opportunity, training, and support that build upon their unique talents, skills, and abilities.  

Coordinators of Community Services (CCS) utilize person-centered planning tools such as Charting the Life Course and the Supports and Services Planning Tool, to assist individuals, and those that support them, develop a vision for their life, set goals and identify needed supports and services, including employment. The results from these tools become the framework for the development of the individual’s Person-Centered Plan (PCP). For identified services/goals, the CCS navigates resources that match the individual’s needs. Once the connection is made between the provider and the client, the CCS provides ongoing emotional support, monitoring of services and continued assessment of the individual’s needs, wants and desires.   

When employment is identified as a goal, the CCS connects the individual to employment providers funded by the DDA and helps facilitate access to other providers, such as the Maryland State Department of Education – Division of Rehabilitation Services (DORS). The mission of DORS is to provide leadership and support in promoting the employment, economic self-sufficiency, and independence of individuals with disabilities. DORS provides personalized support and employment services to eligible job seekers with disabilities. 

What are some resources (organizations, programs, tools) that can help individuals with disabilities find employment?
DDA partners with over 200 providers/vendors that help with finding employment for individuals with disabilities. These providers are accessible by clicking HERE for Maryland’s Provider Search. 

The Maryland State Department of Education – Division of Rehabilitation Services (DORS) helps people with physical, emotional, intellectual, developmental, sensory and learning disabilities go to work and keep their jobs by providing services such as career assessment and counseling, assistive technology, job training, higher education and job placement. To locate the closest DORS office, CLICK HERE. You can also learn more to see if DORS is right for you by clicking HERE. 

The Maryland Department of Disabilities has comprised a job seeker fact sheet library, which answers common questions and concerns about employment and disability. Click HERE to access the library. 

What is the Employed Individuals with Disabilities Program (EID)?
Access to healthcare and health insurance is critical for many individuals with disabilities. The cost of healthcare and concerns about losing coverage can be significant barriers to seeking and maintaining employment. The Employed Individuals with Disabilities Program (EID) Program, administered by the Maryland Department of Health (MDH), provides Medical Assistance (also called Medicaid) to working Marylanders with disabilities who meet a few conditions. For the most up to date information however on the Employed Individuals with Disabilities Program (EID) click HERE.  

Tell us a little bit about yourself and your position at The Coordinating Center?  
As Program Director for the CCS Program, I am responsible for program development and execution, quality oversight, training, and compliance. I work closely with the DDA in Central, Eastern, and Southern Maryland and the DDA’s regional office, to ensure the individuals we serve, and their families have access to critical resources and Medicaid Waiver services that encourage self-sufficiency, health and safety and real community participation. I have been with The Coordinating Center for 10 years and bring extensive experience in behavioral health and home and community-based services. I’ve served as a Crisis Counselor, Mental Health Counselor, Care Manager and Supports Planner, helping people with behavioral and mental health conditions, complex medical needs and those with intellectual and developmental disabilities achieve their aspirations for a meaningful life. 

Conclusion
National Disability Employment Awareness Month (NDEAM) serves as a reminder of the progress we’ve made in promoting disability inclusion in the workforce and the work that still lies ahead. Coordinators of Community Services are instrumental in this journey, providing essential guidance and support to individuals with disabilities as they pursue meaningful employment. 

Sickle Cell Matters 2023

Written by

September is National Sickle Cell Awareness Month, designated by Congress to help focus attention on the need for research and treatment of sickle cell disease. We recently sat down with Karen Twigg, Vice President, Population Health, Community Health at The Coordinating Center and Dr. Jason Fixler, attending physician in the Pediatric Hematology/Oncology Program at the Herman and Walter Samuelson Children’s Hospital at Sinai, a part of the LifeBridge Health System, to learn more about sickle cell disease.

What is Sickle Cell Disease?
Advocacy for people with complex medical needs and disabilities is at the core of The Coordinating Center’s mission. It is inherently important for us to increase community awareness of diseases and disorders that are often not given media attention. This is especially true in September, which is Sickle Cell Disease (SCD) month, as it gives us an opportunity to shine a light on a disease that is often pushed into the shadows. According to the National Health Institute (NIH), SCD affects more than 100,000 people in the United States and 20 million people worldwide… and most of those with SCD are of African-descent.

SCD is a group of red blood cell disorders affecting hemoglobin, the protein in your body that carries oxygen to your cells, which can cause symptoms ranging from fatigue to severe pain. People suffering from SCD are born with the disorder (inherited) but usually do not show symptoms until they are about nine to twelve months old. Individuals with SCD have red blood cells that are rigid and sickle-shaped, like a crescent moon, rather than being flexible and disc-shaped, like a full moon. A round shape allows red blood cells to move easily through blood vessels, while a sickle shape causes the red blood cells to stick to each other causing clumping that can block the blood flow through the body. Read more>>

What treatments are available for SCD?
The standard treatments for SCD include medications that prevent red blood cell sickling, pain crises, and other severe complications. For a disease that affects so many people, there are relatively few disease-specific medications available to treat or prevent SCD’s impact on the body. However, there are diagnostic tests that can be used to help with the management of SCD. As previously noted, SCD can impact blood flow to the body’s organs – including the brain. Transcranial doppler (TCD) ultrasound is one example of an important diagnostic test that can be used to avoid one of the most severe complications of SCD. TCD is used to predict the risk of stroke in children and adolescents with SCD. This simple, 15-minute, non-invasive test, which measures the speed of an individual’s blood flow in their brain, can preserve a child’s quality of living – or save their life.

Although there have been many recent breakthroughs in medications and cures for sickle cell disease, this has all happened in the past 10-20 years. Historically, research into the development of new treatments for this disease has been grossly underfunded, as other diseases have caught the media’s attention and led to their being the focus of funding and fundraising. Some of the newer therapies to treat SCD include gene editing and the use of a chemotherapy medication (agent), Hydroxyurea. This agent has been the most successful addition to the battle against SCD and has been used for over 30 years. Although there have been newer medications recently introduced to treat SCD, they have had limited ability to change the course of the disease.

Interview with Dr. Jason Fixler:
According to Dr. Jason Fixler, attending physician in the Pediatric Hematology/Oncology Program at the Herman and Walter Samuelson Children’s Hospital at Sinai, gene editing is the most exciting innovation to affect SCD. He explained the process of gene editing:

“We take out the patients’ stem cells and then either insert the normal hemoglobin beta gene or make the cells produce more hemoglobin F (fetal hemoglobin). Both result in eliminating sickling and the complications of sickle cell disease such as pain, stroke, and acute chest syndrome, which is sickling in the lungs that can result in respiratory distress or even death.” This mode of treatment is still in the experimental stage.

One of the most significant challenges that an individual with SCD and their family may face is the management of a sickle crisis. Developing a crisis management plan with a medical provider knowledgeable about SCD is essential to proactively managing a sickle cell crisis – especially a pain crisis. Communication of the crisis management plan to hospitals and emergency room staff can help people with SCD avoid the mislabeling of a pain crisis as an addictive or behavioral health issue. As a pediatric hematologist for over twenty years, Dr. Fixler has had many opportunities to teach residents about the numerous challenges revolving around the management of SCD. He shared that “many residents and medical personal have the most issues surrounding acute pain crisis and narcotic use.” Dr. Fixler used a patient story to describe and explain these issues.

“A 12-year-old male with SCD was admitted to my floor for the treatment of pain crisis. He had severe pain in his back and legs which was not controlled with oral pain medications at home. He was placed on a patient controlled analgesia pump (PCA) that gave him morphine as needed and Toradol (intravenous medication similar to ibuprofen) to control his pain during his hospitalization. On day three of his hospital stay my residents approached me because they felt he was faking his pain and was ‘drug seeking’. When I asked why they felt this way, their response was he is playing his video games and having fun so therefore he cannot be in that much pain and should be discharged home. I turned this into a teaching moment that those residents will always remember.”

Dr. Fixler went on to say “I brought the residents into the patient’s room and began asking the patient several questions revolving around his pain:

  • Dr. Fixler: Where is your pain?
    Patient: Back and legs still.
  • Dr. Fixler: Has it improved over the past day?
    Patient: Yes
  • Dr. Fixler: Are the narcotics helping the pain?
    Patient: Yes
  • Dr. Fixler: What else, besides the narcotics, helps with the pain?
    Patient: Taking my mind off the pain.
  • Dr. Fixler: Can you explain what you mean?
    Patient: Well, when I talk to my friends and family I am not thinking about the pain and I feel better. Also, when I watch a good movie, I lose track of the pain while I am watching it.
  • Dr. Fixler: What else besides talking on the phone and watching TV helps your pain?
    Patient: I love playing video games at home with my friends. When I am in the hospital, I can still play with them which is really cool. Sometimes I am having so much fun I may even laugh.
  • Dr. Fixler: So, while you are laughing and playing video games is your pain gone?
    Patient: No, I just get sidetracked and it feels better. It is still there, but kind of in the background. I hate hitting the pain button because the medications make me feel weird and sleepy. The video games take my mind off the pain and I notice I hit the pain button less often.”

Dr. Fixler led the residents out of the patient’s room and went to another room to discuss this interaction. He stated that this was their “AHA! moment when they realized that, just because someone is having fun playing video games or on the phone laughing, it doesn’t mean their sickle cell pain is gone.” People suffering with SCD are using these activities to help decrease their focus on their pain and to possibly help decrease the amount of pain medication they need. Dr. Fixler went on to say that “we shouldn’t punish our patients for trying out activities that may help them manage their pain” – we should listen and support them, not make assumptions and judgements.

In Conclusion:
So, as we recognize sickle cell disease (SCD) in the month of September, we hope that the information in this blog provides many people with their AHA! moment about the struggles and challenges people suffering from SCD face on a daily basis. Dr. Fixler’s hope is that more attention will be paid to the funding of research and the development of new treatments and cures. We are optimistic that, with increased awareness and knowledge… and media attention, SCD can step out of the shadows and have its moment in the spotlight.

Nurturing and Empowering Families through Care Coordination

Written by

By: Renée Dain, SVP, Strategic Partnerships and External Affairs

At The Coordinating Center, we understand the importance of comprehensive care and support for individuals and families. This month, as we celebrate the convergence of National Immunization Awareness Month, Children’s Vision and Learning Awareness, and National Back to School Month, we’d like to highlight how our dedicated Care Coordinators can play a vital role in ensuring you and your loved one’s well-being. In this blog post we will explore how our Care Coordinators can provide valuable assistance and support to promote your family’s health and wellness. Let’s dive in and discover the benefits of having a caring ally by your side.

  • National Immunization Awareness Month highlights the importance of vaccinations in preventing and controlling infectious diseases. Vaccines are crucial for safeguarding children’s health and preventing the spread of dangerous illnesses. Care Coordinators work closely with healthcare professionals to ensure that you and your family are up to date with immunizations, helping to protect you from vaccine-preventable diseases while promoting overall community health. Click HERE for the American Academy of Pediatrics Child and Adolescent Immunization Schedule by Age and HERE for the Centers for Disease Control and Prevention’s Adult Immunization Schedule by Age.
  • Children’s Vision and Learning Awareness Month focuses on the crucial connection between vision and learning. Clear and accurate vision is fundamental for children’s academic progress and overall development. Unfortunately, vision problems often go unnoticed, hindering a child’s ability to learn and comprehend. Care Coordinators can assist in coordinating comprehensive eye examinations, ensuring that any vision issues are identified early on. By promoting regular eye examinations, recognizing the signs of vision problems, and creating eye-friendly environments, we can support children in achieving their full potential.
  • National Back to School Month signifies the exciting time when students, parents, and educators prepare for a new academic year. It’s a time for fresh beginnings, setting goals, and embracing the joy of learning. This month-long celebration encourages families and communities to support students as they embark on their educational journey. Care Coordinators can provide valuable support to make the transition back to school seamless and successful. They can help families navigate the educational system, attend IEP meetings, and access resources to support specific needs. They are there to listen, offer guidance, and empower you to advocate for your child’s academic and emotional well-being.

Benefits of Having a Care Coordinator at The Coordinating Center include:

  • Personalized Support: Our Care Coordinators work closely with you to understand your unique needs, providing personalized support tailored to your preferences.
  • Expert Guidance: Our Care Coordinators possess extensive knowledge and expertise in navigating healthcare, education, and community systems. They can provide valuable guidance and connect you with relevant resources.
  • Holistic Approach: Our Care Coordinators take a holistic approach, recognizing the interconnectedness of physical health, vision, and education. They can help address the multiple dimensions of well-being.
  • Advocacy and Empowerment: Our Care Coordinators are dedicated advocates, ensuring that you have the information, resources, and support to make informed decisions and advocate for your own or your child’s needs.

Conclusion:
As we celebrate National Immunization Awareness Month, Children’s Vision and Learning Awareness, and National Back to School Month, our Care Coordinators stand ready to provide essential support, guidance, and advocacy for you and your family. Whether it’s promoting immunizations, nurturing clear vision, or facilitating a smooth back-to-school transition, our Care Coordinators are committed to your overall well-being. Reach out to us and discover the difference a caring ally can make during these important awareness campaigns. Together, we can ensure your health, happiness, and success.