Bending the Arc of Disability History Toward Rights, Freedom, Social Justice, and Belonging

So, we have come a long way since 1800s and the opening of that first institution in Massachusetts, but we're not done. Past is the past, we must know it, we must respect it, and we must appreciate the hard work and effort by our predecessors in toiling to make the changes that we have reviewed so far, and there are more coming.

None of this was given to us on a silver platter, and no offense to anybody's religion, the rules of law are not carved in stone like the 10 Commandments. They can be taken away, or amended, or modified at any time by the Congress, by the Court, or any other official bodies if the whim, or the value, or the cultural shift goes backwards.

As I said, we must have eternal vigilance to respect where we have been, where we are, what else we're doing, and what else we must do to get to that full understanding of the civil rights under the Americans with Disabilities Act of equal opportunity, community integration and participation, economic productivity, and independent living. That has to be blazed in red, and if I, again, were in charge as soon as a kiddo was diagnosed, put it right in there in bold red, that's the life plan, no different than any other kid. And that's what parents need to hear instead of don't do this or don't do that or your kid never will or whatever.

So, let's take a look now and see where are we with values with some of the national organizations. So, we'll start with The Arc. Look at that, full inclusion and participation. All right, persons with intellectual development in the community throughout their lifetime. Seems to be in alignment, so that's good.

United Cerebral Palsy, to advance independence, productivity, and full citizenship of people. Life without limits, that seems pretty open.

Autism Society, vision, meaningful participation and self-determination in all aspects of life. Advocating for inclusion, participation, and self-determination. Some of these words in their mission and vision you'll notice come from federal law. That's wonderful, that kind of plagiarism we like. We like that kind of copycatting.

So, it goes on. This is the Alliance for Full Participation, a self-advocacy group in New England. We want dignity and respect for all. We want full participation. Simple, all right?

I recently did a conference for Williams Syndrome Association, a relatively small population, but I share with you because I did some research before I went there.

We believe that, this is in their declaration, everyone benefits when individuals with Williams Syndrome are meaningfully included in educational, work, and community setting. Should receive all necessary supports and services, participate fully in family lives, community, society as a whole. How beautiful.

High expectations should be the norm. Okay, decide how they best learn, work, and enjoy. Inclusion is not one-size-fits-all, will look different for each family. I love it.

Creates a sense of belonging in society, meaningful relationships, and opportunities to achieve dreams. Belonging in society. They must have been reading some of Dr. Carter's literature 'cause he's now taken integration, inclusion, and moved it to the next step and said the real issue is belonging. Are you a true valued member? Not just socially there, not people say hello to you.

And another point of reference that you all can look up is from the Collaboration to Promote Self-Determination. Once again, an organization created by Madeleine Will on Values & Principles for Policy Framework. It's a simple one-pager, and maybe I can make it available and will be linked.

These core values are at the core of what we believe. Equality, choice, presumption of competence, remember Einstein, community, home, work, dignity of risk, and equity. And the dignity of risk gets in bold letters. That is an important component of the world going forward. Not stupid risk, not dumbness, not letting somebody who has a tendency to elope to just walk out of the house and walk down the street. No, but how about we figure out a mitigating strategy?

And a young lady that I was court-appointed guardian ad litem for a number of years ago had a lot of issues. The real issue was, unfortunately, she almost died in a group home by grabbing somebody's meds that had been left on the kitchen table. So, she lived, her mom sued, and the state had to find an appropriate setting, so we created this one in a home, but she tended to wander.

So, I said to the state, "What the heck? How about we we'll lock the front door, we'll make sure that's protected, but not to totally prevent her from fresh air, how about we put a chain-link fence in the backyard 'cause several of the other houses in the neighborhood had one. She didn't appear to be a climber or have any interest in climbing, but that way she could go walk in the backyard and maybe even if she got a dog."

And they said, "What?"

Well, if she wants a dog, why can't she have a dog if it's gonna be her own house? And lo and behold, chain-linked fence, dog. And eventually, she learned the neighborhood and was able to go out the front door too. But that's part of the dignity of risk, we can't totally insulate people from the world because then we wanna know why they have no assertiveness and they have no initiative 'cause we do everything to them, with them, or for them. It won't work.

So, mitigated risk, helpful risk, support are critical if we're going to advance the real dignity of the lives of people.

So, here we're back to the ADA, and again, look at the vote, look at the vote, 91-6, 377-28. And having been around when this passed, I can tell you most of the people who voted no because you have to get underneath the vote, we make assumptions, weren't against people with disabilities, these were people who believed this was the state's business and not the federal governments. I have to respect that. I can disagree, but it wasn't, "Oh, those whatevers, they don't deserve civil rights." No, they believe that the state should be making this call. But as you can see, it was a ground swell.

All right, equality of opportunity, full participation, independent living, economic self-sufficiency. Clear as a bell for everybody, and that's what we have.

But now again, I wanna share with you findings of why Congress helped pass this. Unfair and unnecessary discrimination and prejudice denies people opportunity. And look at this one, I bolded it out, but the quote is for real, costs the United States billions of dollars on unnecessary expenses resulting from dependency and non-productivity. Ladies and gentlemen, that's Congress.

Again, that's not an ideologue, that's not Dr. Tramér with his economic studies, although they probably read them or heard them in testimony, they understood that by denying civil rights and equal opportunity to people with disabilities, we are hurting the American economy. We're promoting dependency, we're promoting stigma of helpless, useless, whatever terms people want to use.

We have to move past it. And take a look at these numbers. And we're past it now, annual expenditures for SSI, SSDI, Medicaid, and Medicare passed $1 trillion a couple of years ago. Even in Washington DC, a trillion is a lot of money. Even billions are, but a trillion dollars for what? Non-productivity, non-participation, okay? And now, what's compounding it particularly is we're all living longer, including people with intellectual and developmental disabilities.

Okay, when I first started in this field when I was in kindergarten, most folks would die at 30, 35. Particularly people experiencing Down Syndrome, Cerebral Palsy, pneumonia, upper respiratory. That was considered typical. Okay, not today. And I've given you the citations here. Okay, these folks are gonna be the same age as most of us. In the old days, parents in the old Arc movement, "Boy, I just hope my kid dies one day before I do." Odds on that happening today are slim to none. More than likely depending when you had that child, they're gonna outlive you by 10, 20, 25, or 30 years.

So, that puts even more pressure on the public funding, which is why waiting lists continue to grow and grow because basically what we've got is people just totally dependent on a group home, a day program, case manager, transportation, medical, blah, blah, blah, blah, blah, blah, blah. And to give you an example, one state that I did some work in several years ago, I won't name it, but it's a high price state.

The average cost of somebody on the DD Waiver, $90,000 per year. Let's assume that person came in at 25 and lived to be 75. 50 years unadjusted for inflation, that's $4.5 million that that state went on the hook for for that person the day they entered the system, and the next day for the next one and the next one and the next one and the next one.

Is it any wonder states say, "We can't do anymore. These people are living longer and they're consuming a lot of money. What would happen if we reduced that $90,000 to even $50,000 a year after five years of heavy investment in self-sufficiency, employment, assistive technology?" Wow, you think it might have a dent on the wait list, average costs? We've got to start thinking this way or there will never be enough money, even if the tooth fairy decides to put another trillion dollars in the Federal Reserve, which it's not gonna happen.

So, we've gotta begin to look at this and we have to also understand the ADA. Again, this is in the regulation, very different from least restrictive environment in special ed.

A public entity, and this is federal, state, or local, shall, that's a must, that's not an option, a may, could, would like to, administer services, programs, and activities, the most integrated setting appropriate to the needs of qualified individuals with disabilities.

Well, guess what? We have enough examples and enough research that the most integrated setting for everybody 99.9% of the time is the same communities in which you and I live, the same places or kinds of places we work, the same social, rec, and leisure places we go, the same restaurants and movies if they can afford them, and all of that. And that's the most integrated setting. You don't have to work your way through the continuum.

The presumption is with support you can do just fine there and you have a right to be there and there has to be real cause to justify why you're not in the most integrated setting. And we'll see that pretty soon in the litigation called Olmstead, okay? This went to the Supreme Court in 1999, Lois Curtis and Elaine Wilson, the two plaintiffs, the only reason Olmstead's name is there is because he lost the case and the state of Georgia did at the Federal Court level, so it went to the Supreme Court. And again, the advocates were pretty anxious about how this might turn out. But fortunately, it turned out well.

The Court said with Justice Ginsburg writing for the majority, the ADA is a fundamental civil rights statute. So, now we have the Court affirming what Congress did. This is a civil rights law. It's not just nice words on a piece of paper. This is a guarantee that people with disabilities have protected rights in this country, no different from any other citizen, and less removed by due process of law.

Discrimination includes segregation, isolation, and institutionalization, that's what this case was about. And thank you Sue Jamieson, the woman in the mauve-pink dress, who was the attorney. And there you see Lois Curtis. Unfortunately, Elaine has passed away. But the brief history, if you don't know it, these two women had dual diagnosis, intellectual disability and psychiatric. So, they kept getting bounced around the inpatient psych hospital, the state psych place, the state DD place, back and forth, and whatever, and never were given the opportunity for most integrated setting. And their lives were pretty messy.

So, Sue got a hold of the case and she brought it and lost, and they agreed to take it to the Supreme Court. And lo and behold, they were victorious. Both women moved to a home 'cause they were friends where they lived together till Lois passed, I'm sorry, till Elaine passed. And what they found out is Lois, this person with dual diagnosis, mentally ill and disabled, blah, blah, blah, was a gifted artist. And here you see her in the White House presenting a portrait to the President of the United States. She is continuing to thrive, she has an art gallery, she sells her stuff online. She was destined to be locked up and probably would've died on the back ward of an institution overdosed with medication.

So, the Supreme Court affirmed she and Elaine had a right to the most integrated setting called the real community. So, there it is again.

It's interesting that the Department of Justice had to write rules and explanations of what we mean by most integrated setting. Interact with non-disabled persons fullest extent possible. Yeah, and what's a segregated setting? Congregate settings, populated extensively or primarily with individuals with disabilities. Oh, really? Sounds like institutions, sounds like lots of big group homes, sounds like day programs, and a lot of stuff that still goes on today. But that's the definition, and we'll keep plodding.

Then, from that case we got another one and there was one in between I didn't have time to show it in Rhode Island, but this one was brought by eight self-advocates in Oregon. Remember, I showed you Oregon has numbers going up in employment and it's because of this litigation. Eight self-advocates, eight of them were in a sheltered workshop. They wanted to get real jobs and the state said, "Sorry, our employment slots are full. You'll have to wait until we can serve you." Nice, huh? I wanna go to work, but sorry, we don't have any slots for you so you'll have to wait.

So, they filed a lawsuit and with the help of the protection and advocacy in Oregon, but it didn't get very far so they then brought in the United States Department of Justice. And this is a direct quote from the letter from the US Department of Justice, and I want you to just see the language that they used, "Oregon discriminates against individuals with IDD by unnecessarily segregating them in sheltered workshops and placing them at risk of such segregation in violation of Title II of the ADA and Section 504." And within they brought 504 in is they encroached the ADA with 504 into the public school system 'cause the ADA doesn't really have authority over public schools, but 504 does, and so they were able to get at that with this lawsuit. And it continues, "Sheltered workshop segregated facility, little no contact, well below minimum wage," and it continues, and they just kept going and going.

So, it took several years to settle. I was honored to be an expert witness for the Department of Justice on this, spent a day with lawyers grilling me. And what helps sometimes, and some of my colleagues will tell you the same thing, is when the lawyers representing the state of Oregon who was outside lawyers don't know the field and they give you a softball when you're having a deposition, they can't ask the Judge to say out of order because they've asked the question. So, they raised the question of the continuum. The transcript is loaded with my debunking the continuum and other things. I mean, I was grilled for eight hours. Don't be an expert witness for the Department of Justice so the pay is sub minimum wage, I think I got a $50 stipend, but well worth it, well worth it.

But again, this case took a long time to settle and there was a seven-year Agreement and they moved the system pretty well forward with numbers, not just macro, it'd be nice to do this, it'd be nice to do, they had to meet quotas or they would be in violation of the Settlement Agreement, so they did it and they got it done. And they've just finished the seven-year run and they have met all their targets, including deferring a large chunk of kids from special ed into employment rather than into sheltered work and day services.

And then, I love this quote, came a little later from Patti Killingsworth recently retired as the head of TennCare in Tennessee, long-term services and supports. And she testified before Congress, and Patti just retired. She was a mom, her daughter passed away several years ago, but she was leading the effort in Tennessee for a number of years.

Look at this beautiful quote, "Access to employment is the most vital civil right because it opens doors to all the other civil and citizenship rights that most Americans take for granted. We can't leave it unfinished. We cannot afford morally or financially to ignore it."

This is coming from a state bureaucracy leader who is passionate about Employment First and developed the first Employment and Community First Choices Waiver in this country in 2016, which is continuing to expand and grow strong. But that's a powerful statement.

And I wanna make one more comment here about our friends at Medicaid in terms of their understanding this. I've shared with you some of the guidelines from Medicaid. Well, a number of years ago at a national conference on HCBS Waivers, there was a section on what would be calling paying for performance rates rather than fee for service for customized employment. And I was in the audience and I had done some of the work on it with other people, but Ralph Lawler, the head of the waiver branch for the Feds, was moderating this and he did this whole thing with slides about we pay for this, we pay for that, we don't pay you by the hour. And again, I wish I had a camera.

At the end, they open it up to questions and this person stands up, gets a microphone, "So, Mr. Lawler, I'm a provider. What you're telling me is if the person doesn't end up getting the job, we don't get paid?" He said, "Yes, that's what I'm saying." She said, "But that's not fair." At that point, and like I say I wish I had the camera, Ralph Lawler takes the podium mic off the stand, walks out there, didn't quite get in her face but close, and he said, "It's clear you don't understand customized employment with fidelity." Now this is the head of the Waiver Bureau, not somebody from Virginia Commonwealth, or University of Oregon, or Mike Callahan, or whatever, this is the Fed saying, "If you did the discovery right, if you did the plan right, if you did the job development right, that person didn't fail, you failed the person. Stop making people with disabilities the victim."

I really wish I had been able to record that. He wasn't prompted, he was passionate about don't keep milking us for money when you haven't done your job the way you need to do it. I thought you wanted to crawl under the chair. And he wasn't really, I mean he was talking to the audience as a whole, but he knows it works, and his language was, don't blame the person, they're not the victim. You messed up, you need to own it and take accountability.

So, that's another strong piece. When people tell me, "Oh, the Feds won't approve this or what," let me tell you, CMS in Baltimore is not the enemy on any of the best practice stuff that we want to do, I promise you. Here's a quote from John, a self-advocate, again, we've said it before, "Employment First means people of all abilities need to have a purpose in life. A meaning, okay? Give the opportunity and strive to get a job and be part of your community." So, that's the self-advocate, again, in perfect alignment with everything that we have been saying.

So, what do employers have to say? This was a study done several years ago, paid for by several groups. But what I like about this, no offense to our university friends, it was done by an HR firm called the Institute for Corporate Productivity, no knowledge of disability. They were given 230 employers, small, medium, large, across the country to go interview and what were their experience in hiring people specifically with ID/DD, "They comprise an underutilized population." This is their report of potential employees to be a positive influence on coworkers and customers. Oh my goodness.

And the bottom line, okay, "Gained dependable, motivated employees, deserve observable business benefits, helping create inclusive cultures, broaden the talent pool in the workplace." Okay, and then there's their four main findings, good fit, exceeds expectations. So, their cultural belief system by willingness to hire with competent support staff till they faded was, "Wow, these people can really do good work." They got good support. That's another key piece of this work.

The support person, be it a job coach, employment facilitator doesn't say, "Okay, I'm out of here." You've gotta be available at all times to maintain credibility with the employer. And now we've learned with virtual, you can do it with a phone call, you can do it with a camera, phone, or whatever. You don't have to get in the car and drive 20 minutes to the work site, but it needs to be maintained. And about a year and a half ago, Dr. Paul Wehman from VCU did a major webinar in Kentucky, and I happened to catch it, on where are we in employment.

And the one thing that Paul said, and it sticks with me, "We've gotten good at a lot of this, the piece we're still not real good at is understanding the employer and real collaboration with the employer and the business owner." So, that's still work that we need to do even in the best of our employment practices, but there are some agencies that are magnificent at that. So, that's a good thing. And then they find out, and here's the actual table. And work quality and productivity may have been down a little bit, but they were so pleased with all the other stuff, including killing the myths, "Oh, they're gonna have more sick days, they're gonna become injured more, your claims are gonna go up."

All that is mythology, it is not true. And they were able to document that wasn't what happened at all. And it was a benefit, even though productivity may have been just a tad low and they were happy they did it and they're happy to continue to do it. And then, now we've got since 2014, finally some rules on Section 503 from 1973 that all federal contractors have to have a 7% utilization goal. There's no penalty, but all the numbers are on the Department of Labor website.

When I go meet with Voc Rehab agencies or Department of Labor folks at the state level workforce or providers, I say, "So, have you checked to see who are the federal contractors?" "What are you talking about?" "Oh, come on. These are people with big federal contracts, they pay good salaries, they don't just have engineers who need Master's Degrees, they have entry level, they have mid-level, they have support, all that kind of stuff." "Oh, we didn't think about that." They have to have a target of 7%. Their numbers are posted, there's no penalty. Go to the website, see who's in your state, who's employing, who's not? The ones who are, go cultivate them. The ones who aren't, get those who are to go talk to them with you and open those doors to employment.

So, this is a whole new arena and it's only eight years old, but whatever. And now, I want to bring you to the most recent convergence that boggles my mind of bipartisanship. July 28th of this year, that's not even three months ago, Disability Policies in the 21st Century: Building Opportunities for Work and Inclusion was published as a report by the House Energy & Commerce Committee Republicans, and their leader is Cathy McMorris Rodgers. Some people watching this will know, Cathy McMorris Rodgers is from Washington State and she is the mom of a daughter with disabilities. Oh my God, it happens on the Republican side and the Democratic side. She has also been well cultivated by Madeline Will over the years and people from the National Down Syndrome Society to get to this place, and she's done other things.

But I gave you the exact quotes from the Executive Summary because I want you to see how it aligns with where we are today, "More can be done to remove barriers that keep people with disabilities from living up to their full potential and contributing to their communities." There are three, and she's named them three priority areas. Okay, look at this first one, "Ensuring access to long-term services and supports, that's the Home and Community-based Services and Supports Waiver in Medicaid by eliminating wait list for such in Medicaid and making coverage options more affordable for those not covered by Medicaid."

So, what they're talking about is changing eligibility for Medicaid, maybe not for healthcare, but for the long-term services and supports 'cause you might get health insurance from your employer, but where are you gonna get those supports? Well, if you're a person with a physical disability, you're gonna get your personal assistant or your direct support professional, your job coach, or whatever. It's coming again from the Republican side of the aisle, and I don't wanna play those games, but most people would say, "They said what, spend more money, eliminate the waiting list?" Yeah, it just came out.

All right, look at this one. And again, I didn't write it, I had nothing to do with it, "Making communities daily life more accessible, access to assistive technologies." Thank you, Representative McMorris Rodgers. "And enforcing accommodations requirements in ADA and Section 504 in healthcare settings." She is aware what happened during the pandemic, and I don't know how many of you are, how many people with disabilities were denied access to intensive care units, were on lists of non-acceptable for ventilators if they needed one because they had Down Syndrome, because they had Cerebral Palsy, because they had a developmental disability.

These were in policy guidances at hospitals and, in some cases, in state agencies. Fortunately, our legal advocates filed briefs quickly and the Office of Civil Rights intervened, but blatant discrimination was going on in this country because somebody's life to put on a ventilator because they had Down Syndrome wasn't as valuable as somebody who didn't.

What kind of civil right protection is that? Who's deciding on your quality of life? Who's deciding? But again, culture, stigma, stereotype, limited expectation. That triangle, without the triangle, perception, preconceived. No, your life's not that big a deal. This 40-year-old who's got a Master's Degree coming up in the corporate world, he's more valuable than you are, says who? We don't play that game in this country, I hope.

All right, then, "Moving the workforce toward integrated employment, eliminating subminimum wage and providing supports and funding opportunities in the workplace." Folks, that's pretty cool in my opinion. And whether it came from the Democrats, or the Republicans, or bipartisan, this is the Committee, Energy and Commerce, that controls Medicaid and Medicare, just so you know, in the House of Representatives, this is power. This is important. It may not go any place in this session, but hopefully, it will go in the 117th.

And look what she writes further 'cause she's the lead author, "The policies coming out of Washington today threaten the ability of many Americans, including those with disabilities, to reach their potential. Instead of encouraging and supporting people with disabilities to live as independently as they are able. Many of these policies make it more difficult to work or just easier to not work at all due to the failures of a system that encourages poverty in exchange for access to key services and supports." And she's referring to SSI and Medicaid.

And the last time I looked at the data, hang on, SSI beneficiaries between 16 and 64, the working age, less than 5% report any earned income. The vast majority are living in poverty. And if you're not aware, the largest group of Americans living in poverty every year for the last 20 are people with disabilities every year.

And the number has hardly dropped, whereas the numbers in other categories have gone down. So, in a sense, we can look at all these wonderful laws, all this money, but for me, as I said, return on investment, outcomes, we're not there yet, and we have a lot to do.

But as she ends up here in this last one, okay, she's read the research too, "Work and engagement has strong associations with positive health outcomes." Maybe she saw the University of Iowa data. "In part, these associations are driven by income, increase in quality of life, job security, but having a job, attending school, and other forms of community engagement also are associated with positive physical and mental health outcomes." Amen, Hallelujah. We need to get everybody in every state legislature and every member of Congress to know those are the research facts. This is not hyperbole, this isn't wishful thinking, it's real.

And just a few days later comes out this report from the Biden Administration. So, I don't think these were done together, but for me, it is the glowing piece of this session because now we have bipartisans, basically the Republican members in the House on this Committee and the Democratic Administration basically saying the same thing, A Framework for Community Engagement: A Pathway to Competitive Integrated Employment. And this came out five days later. I don't think they were in tandem with one another. And if they were, more power to them, I'd love it.

Alright, this is from the Office of Special Ed and Rehab Services, the Office of Disability Employment Policy, the Administration on Community Living, and HHS, and Substance Abuse Mental Health Services Administration. This is all the big players. And here's their opening statements, "Employment, paid work, leads to economic opportunity, equity, and independence." Sound familiar? Okay, nothing here is not compatible with what we just saw from the House Republicans on Energy and Commerce. "Ability to enjoy benefits of employment through careers," notice, "And jobs available to all, competitive earnings, integration," and they explain it to be sure, "Integrate interaction with coworkers and others without disabilities." Very much like in the WAIO, a definition of competitive integrated employment, they would cite that, of course.

"Opportunity for advancement," okay, "Competitive integrated employment, okay, "Economic security, health insurance, paid leave." All right, "Their skills and talents contribute fully to the economy." This is gorgeous and very consistent with what we just saw from the House. "But too often, unemployed, underemployed, low wages because society views their potential with low expectations."

And Allan would say with no expectations because you're just a slug. "Community engagement to expand skills and experience." They define it, "Secure high quality, satisfying careers and jobs. A joint federal vision for community engagement to facilitate community integration for individuals, including youth with disabilities." Again, this has to start in school, and so they come up with some principles here. Okay, "Interest, personal interest," so it's individual, "Keep individuals on the path to employment and engagement in the community provides opportunities." So, this is what they're saying has to happen starting early, "Build relationships and social networks."

Yeah, we all started doing that in school and we had clubs and associations and people we hung out with and people we didn't, and people we like. Yeah, that can happen too. "Sharpen workplace and social skills." Not gonna learn those in a classroom, sorry, ain't gonna happen. "Learn work skills." Yeah, how about summer work? How about volunteering? All right, and then, "Expand the opportunities for employment. Community engagement should be individualized." Remember before, transition is not a program, it's an individual plan. Interactive and supported. This is elegant.

So, this is the Biden administration in perfect alignment with all our prior laws and the Republican members of the Energy and Commerce Committee also in alignment and even going a little further about some changes we need to make in SSI and Medicaid. And then, this last piece just happened a month, not even a month ago. The Department of Education Rehabilitative Services Administration awarded five year grants to 14 states for what they're calling, and I don't if you call this S-W-T-C-I-E, SWTCIE, we love acronyms, Subminimum Wage to Competitive Integrated Employment Demonstration Projects.

And here's a quote from the Secretary of Education, Secretary Cardona, "Our Real Pay for Real Jobs initiative is about building a more equitable, inclusive workforce that thrives on the talents of Americans of all abilities." All right, "Innovative efforts, build on them, secure better paying job, build economic security, and lead more fulfilling independent lives."

And we will see here are the states that are getting a ton of money for five years. They had to apply. These are the state folk rehab or workforce agencies in tandem who are getting, as I say, I don't know why Ohio's was less, but basically almost $14 million over five years. That's $2.8 million a year. That should build a lot of infrastructure, that should do a lot of best practice training with competency and certification of fidelity. And for those of you in these states, please monitor that this money is not wasted, that it is targeted, that it is used well, and that the providers and the state agencies are accountable for outcomes, for real measures of systems change and economic productivity of the individuals. And that's really a lovely place for us to be as we think about the future.

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