By Kathleen Wilson

A residential center designed to fill a major gap in the care of people with mental illness opened last week in Ventura.

The new Anka-Ventura Crisis Residential Treatment Center is a licensed short-term social rehabilitation facility designed for people who are not so acutely ill that they need to be confined to a psychiatric hospital but who require more intensive care than they can get in an outpatient setting.

Some clients will use the county’s first such center to ease their recovery after leaving a hospital, others to avoid it in the first place.

“I would bounce back quicker if I went to a crisis unit rather than the hospital,” said Diana Hernandez, 45, of Ventura, who has been diagnosed with bipolar disorder. “I would rather be in a place where people aren’t that much of a danger to self or others, so I could focus on wellness.”

The project had gone begging for lack of a site since 2005, when advocates put it at the top of the list for proceeds from a state tax on millionaires. Price, building size and concerns that neighbors would fight placing the center in a residential area stymied the opening.

Last year, county officials decided to solve the problem by converting a 15-bed psychiatric facility known as Hillmont House at the Ventura County Medical Center campus into the residential crisis center.

“This will help people be in a community-based setting and it makes sense to have it on a hospital campus with access to services people might need in a short-term setting,” said Roberta Chambers, vice president of development for Anka Behavioral Health Inc., a nonprofit behavioral health services organization based in Concord.

While clients can remain at the Anka-Ventura CRT for up to 30 days, Chambers said the majority will participate in a seven- to 10-day program.

The new 15-bed center is designed for adults, ages 18 to 60. They must have a mental illness, be willing to participate in a voluntary program, take prescribed medications, and be willing to abstain from drugs and alcohol during their stays. A doctor also must certify that they are in stable medical health. The center is not a walk-in facility.

Ratan Bhavnani, executive director of NAMI Ventura County, an affiliate of the National Alliance on Mental Illness, said his grassroots organization — which is dedicated to giving a voice to the mentally ill and their families — has been waiting eagerly for such a center to open.

“Over a year ago, we encouraged the Ventura County Behavioral Health to really go for a crisis residential center,” said Bhavnani. “We were instrumental in helping to clarify their thinking.

“Hospital isn’t always the place to be for financial reasons or in terms of recovery. We are hoping this short-term crisis center will provide much-needed support and also save funds for other folks who need help.”

Meloney Roy, director of the Ventura County Behavioral Health Department, said she had hoped to open the center in January, but that turned out to be an optimistic timeline.

Roy said it’s taken this long to get all the pieces together, including building renovation, licensing approvals and patient transfers.

The Hillmont House clients who require long-term treatment have been transferred to Casa de Esperanza, a senior care facility on Lewis Road outside Camarillo.

“We had to move people out of the facility at Lewis Road. Then we had to prepare the building and then we had to move folks from Hillmont out to Lewis Road,” Roy said. “It was just a domino effect.”

The final community care licensing approval came through in the past two weeks to allow the center to open, said Chambers.

The staff includes a psychiatrist, two psychologists, licensed vocational nurses, case managers and peer counselors who are in recovery from mental illness.

Patients’ insurers, whether private or Medi-Cal, will be billed and uninsured clients will pay on a sliding fee scale.

For Diana Hernandez, the new center will, she hopes, offer her a way to better manage crisis episodes in a supportive environment.

“It’s a trauma going through the whole hospital process,” she said. “I’ve come to a place in recovery where I know when I can do self-care and I know when I need help. It’s going to be a tool when I can go to crisis unit instead of hospital.”

— Star correspondent Rachel McGrath contributed to this report

It is a hot day in Rome as Arthur Johnson navigates his bicycle across Shorter Avenue toward his home.

 For months, Johnson has been walking everywhere he needs to go, but on this particular August day he is riding on a new set of wheels with a shy smile to show he is pleased.

“It’s a nice thing,” he said.

Johnson was given the bicycle by Justin Hight, owner of Easy Money Pawn on Shorter Avenue, after Hight heard Johnson’s story.

Johnson is a consumer at Anka Behavioral Health, a California-based counseling service awarded a state contract on April 1 to provide services as the state moved patients out of Northwest Georgia Regional Hospital, which is expected to close Sept. 30.

For years Johnson has struggled with bipolar disorder and schizophrenia. But he says each day at Anka he feels a little more like himself.

“They adjusted my medication, and it’s better,” Johnson said.

For about a month he has been going to counseling at Anka on Redmond Circle twice a week, walking eight miles in the heat for treatment.

That was until his counselor, Marshall Lynch, told Hight about Johnson. “We’ve been lucky in this business, successful. So I wanted to give back,” Hight said.

Lynch said he couldn’t think of anyone more deserving than the shy, quiet Johnson who never misses an appointment. He said Johnson is an example of a person who is living in recovery from a mental disorder and is very dedicated to getting a little bit better each day.

“It doesn’t matter if it’s hot or raining, he’s there,” he said.

Like many of the clients seen at Anka, Lynch says the 34-year-old Johnson had been in and out of hospital settings before finding a community-based service.

“We call ourselves a hospital without walls,” Lynch said. “The hospital concept has been a failure. Many patients leave and then comeback with the same problem.”

Lynch said with Anka the patients are learning to live their lives in the outside world while getting the treatment they need.

The program has helped many consumers find housing and they can be a mobile unit that will come to the patient in a moment of crisis.

“We see them out in the community and we can provide them with support,” Lynch said.

Johnson says he plans on sticking with Anka’s program. “I feel better,” he said right before hopping on his bicycle and riding away.

See the full article @ http://romenews-tribune.com/view/full_story/14975872/article-Bike-helps-man-go-to-treatment?instance=home_news

INTRODUCTION

Data of institutional placements estimates that 62,496 people with intellectual disabilities in the United States live in institutional settings, defined as congregate living settings for 16 or more people (Research and Training Center on Community Living RTC, 2007).  This number remains high despite Olmstead v. L.C. in 1999 in which the Supreme Court upheld that people could not be institutionalized against their will if able to live in the community (National Council on Disability NCD, 2003).  While this litigation and its upholding by the Supreme Court established the rights of individuals to receive services in the most integrated setting, it did not have provisions to enforce the ruling at a state level.

Since 1999, there has been a varied response to the Olmstead ruling amongst states.  There have been at least 167 Olmstead or Olmstead-related state lawsuits since Olmstead v. L.C. ruling (Center for Personal Assistance Services PAS, 2011).  These suits establish the legal responsibility of each state to enforce the principles set forth in the Olmstead ruling.  RTC (2007) reports the following state-specific progress on deinstitutionalization:

• At least eight states do not operate institutions to serve people with intellectual disabilities.  These states are Alaska, Hawaii, Maine, New Hampshire, New Mexico, Rhode Island, Vermont, and West Virginia. 
• Six states, however, still have institutional populations over 2,000.  These states are California, Illinois, New Jersey, New York, Ohio, and Texas. 
• The other 36 states have achieved varying levels of deinstitutionalization. 

From the above data, it is clear that institutional settings are not required to serve people with intellectual disabilities, even with complex service needs.  This is evidenced by multiple states serving their entire population of people with intellectual disabilities in smaller, community based settings.

COST EFFECTIVENESS

Cost comparison data between institutional and community services is unclear as to which is more cost effective.  This is likely a result of the combination of funding streams that support institutional and community services and the diversity of community based service costs.  Institutions generally access both state and federal funds to provide services, therefore lowering costs to the state.  Community settings, however, only include matching federal funds if a Home and Community Based Services (HCBS) waiver program is in place.  Additionally, the cost of institutional placement fluctuates based on census and need. Examples include the cost per person at a developmental center in California increasing during a planned closure as the census declined faster than the operating costs (Department of Developmental Services, 2008).  Community costs are also difficult to define.  This is attributed to the heterogeneity of the community population and the diversity of community services and costs.  For example, intensive behavioral supports in a residential facility with 24-hour staffing is more expensive than a person receiving up to 12-hour in home and family supports. 

In states where the HCBS waiver is maximized, it is likely that there would be substantial costs savings in transitioning people from institutions to community based settings.  This is maximized if there is an integrated system of care with explicit cost containment measures.

VALUES GOVERNING DEINSTITUTIONALIZATION

The value of inclusion, with a philosophical basis in normalization, has become a guiding process in the services provided to people with intellectual disabilities.  Nirje (1969) defines the normalization principle as “making available to the mentally retarded patterns and conditions of everyday life which are as close as possible to the norms and patterns of the mainstream of society”.  Renzaglia, Karvonen, Drasgow, and Stoxen (2003) define inclusion as
• a lifestyle in which people are active participants in their own lives
• are empowered to have control and make choices
• with the sociopolitical power to enact and sustain their choices

Renzgaglia et al. (2003) list universal design, person centered planning, positive behavior supports, and self advocacy as central to the implementation of inclusion.  They also recognize that inclusion differs from other service delivery models in that people are able to move into less restrictive settings before developing all of the skills that may be required.

It is from the idea of inclusion that the concept of dignity of risk arose.  Dignity of risk is the idea that people can not truly be independent and have the right to make choices without the possibility of failure (NCD, 2003).  It is with the dignity of risk that services began to change from protection of people with intellectual disabilities to helping people achieve the lives of their choosing.  This included providing supports based on individual needs.  The Research and Training Center on Community Living (2004) also reinforces the idea that this process requires necessary community supports. 

While inclusion has become a value that most intellectual disability advocates embrace, it has not yet been fully realized within service provision.  This has prevented disability advocates from thoroughly exploring the outcomes of community based services.  The absence of a comprehensive evaluation leaves people with intellectual disabilities and service providers without the resources or knowledge to explore and address both the successes and difficulties that arise in community based settings. 

Living in the community with the dignity of risk exposes people with intellectual disabilities to the same ills that affect society at large. Christian and Poling (1997) recognized that people with intellectual disabilities are no longer protected from unhealthy living arrangements when in the community.  As a result, problems like untreated psychiatric conditions, substance abuse and/or forensic involvement may arise for people with intellectual disabilities. These issues require specialized supports beyond the typical service strategies.

SERVICE STRATEGIES AND COMPONENTS

The most current paradigm for serving people with intellectual disabilities is the person centered planning (PCP) model.  The PCP model typically consists of interdisciplinary team (ID) meetings with supports chosen based on an individual’s preferences and needs.  Typical members of an ID team include the person served, service coordinator or broker, any involved family, behaviorist and/or psychiatrist (as necessary), and the current service providers.  If a person has other involved professionals like an occupational or physical therapist, they may also be involved.

For people who have “typical” needs related to their intellectual disability, this model is generally accepted as fairly effective with most needs being met.  When a person has “atypical needs” like co-occurring psychiatry, substance use, or forensic involvement, this model appears less effective.  For someone whose needs are more complex and atypical, the standard approach is not adequate. 

Specifically, the characteristics of this group meet the following general statements:

• Borderline intellectual functioning to mild mental retardation
• May have an increased awareness of being different
• Tends to have a more common presentation of psychiatric symptoms
• Has many of the adaptive skills necessary to manage living independently or could learn them with minimal training
• Lacks the maturity, judgment, and impulse control to manage independence safely
• May be more impacted by social and emotional difficulties as opposed to functional impairments or life skills deficits
• May be more likely to experience serious problems as a result of impulsivity and lack of judgment
• May be more vulnerable to peer pressure, coercion, and being taken advantage of
• May be more likely to become involved sexually, with drugs and/or alcohol, and the criminal justice system

In order to meet the needs of the group described above, specialized services and supports are required to prevent and address institutionalization.

Assessment: A typical assessment for someone with an intellectual disability generally includes assessments required to establish the disability and assess which types of services are necessary.  This may include IQ testing, adaptive functioning and skills, medical, and a functional analysis if problematic behaviors are present.  The person’s preferences and needs are also regularly included.

For the group described above, a qualitatively different type of assessment is indicated which would include social and emotional functioning, experience and impact of trauma, mental health assessment, substance abuse screening, and communication.  Additionally, a functional analysis must consider additional factors that influence behavior to include psychiatric symptoms, social pressures, emotionality, sexuality and relationship, etc.  While a typical functional assessment would be completed by a behaviorist, the additional domains exceed the scope of practice for a behaviorist unless they are also a licensed mental health clinician competent in integrating these factors. 

Clinical Services: Typical clinical services for people in community based settings include medical, neurological, psychiatric, and behavioral supports.  Occupational, speech, and physical therapy may also be indicated.  In order to address more complex issues as they arise, the model of service should shift to include group and individual services with a focus on social and emotional skills, judgment and decision making, and impulse control.

Crisis: As these individuals are generally not well served in typical psychiatric settings, it is imperative that each community cultivate crisis services to address either behavioral or psychiatric crises as they arise.  In the absence of a safety net of crisis response, people are more at risk of the crisis escalating and leading to institutional placement.  Additionally, family and other support people may be more likely to support community placement if they had confidence that the community would offer the same level of emergency support as an institutional setting.

Behavioral Supports: The typical paradigm of positive behavioral supports currently has a focus on antecedent management, specifically in adapting an environment if a person experiences difficulty, and skill acquisition.  This prevents a person from experiencing natural consequences of their decisions and removes any sense of personal responsibility.  There also appears to be a lack of training to equip someone to manage the complex situations that occur with increased independence and a general hesitance to allow people to fail.  With the population described above, there must be a balance between personal accountability and individualized needs and a balance between the safety net and dignity of risk.  This requires that we provide supports so that people can manage more complex situations safely and allow people to accept as much personal responsibility as is developmentally appropriate.

Ecological Factors: Additionally, poverty, sexuality, substance use and abuse, and stigma must be integrated into the assessment and planning process.  These topics must be handled with sensitivity and normalized into the general consciousness of provider groups and the community of persons with intellectual disabilities.

SUMMARY

It is both cost effective and in alignment with the generally accepted values of community integration to continue with de-institutionalization.  This requires that states maximize HCBS waivers in a way that creates solutions for all people with intellectual disabilities.

While the person centered planning process is meant to combat a “one size fits all” approach, it is one paradigm from which to provide services and is not appropriate for the population described previously. 

As a result, each community must expand the paradigm to include additional service strategies including a qualitatively different assessment process, crisis services, and an expansion of clinical services to include more than positive behavioral supports.

Additionally, there must be a commitment to allow people to experience some level of consequence for their behavior while providing training and supports to prepare them for more complex situations.

Ultimately, this is a problem that has evolved from work previously done.  Without the advocacy and commitment to community integration, people would not have access to this level of independence or exposure to these challenges.  With this freedom comes responsibility.  As a provider community, we must adjust our paradigm of service delivery to equip people with intellectual disabilities to manage the complexity of independent living safely and responsibly.

WORKS CITED

Center for Personal Assistance Services (n.d.).  Retrieved January 14, 2011, from
 http://www.pascenter.org/olmstead/olmsteadcases.php

Christian L., & Poling, A.  (1997).  Drug abuse in persons with mental retardation: A review.  American
Journal on Mental Retardation, 102, 126-136.

Department of Developmental Services (n.d.).  Retrieved August 28, 2008 from
http://www.dds.ca.gov/factsStats/docs/factbook_8th.pdf

National Council on Disability (2003, September 29).  Executive Summary.  In
 Olmstead: reclaiming institutionalized lives [Abridged Version]  (pp 1-8).  Washington, D.C.:
Author.

Nirje, B.  (1970).  The normalization principle: Implications and comments.  Journal of
 Mental Subnormality 16(31), 62-70.

Renzgalia, A., Karvonen, M., Drasgow, E. Stoxen, C. C.  (2003).  Promoting a lifetime of
 inclusion.  Focus on Autism and Other Developmental Disabilities, 18(3).

Research and Training Center on Community Living, (2004).  Community For All Tool
 Kit.  Retrieved February, 24, 2006, from http://thechp.syr.edu/toolkit/

Research and Training Center on Community Living, (2008, August). Executive Summary.  In Residential services for people with developmental disabilities: Status and trends through 2007. (pp iii-ix).  Minneapolis: Prouty, R.W., Alba, K., and Lakin, K.C (Eds.).

Note about the author: Roberta Chambers joined Anka Behavioral Health, Inc in 2005. As the Vice President of Development, Dr. Chambers facilitates Anka’s growth and expansion working with an interdisciplinary team to design new and innovative programs to meet customer and consumer needs while containing costs. Prior to joining Anka BHI, Dr. Chambers was the Clinical and Training Director at the California Autism Foundation. She received her Bachelor of Arts in Liberal Studies and Psychology from San Francisco State University and her doctorate in Clinical Psychology from John F. Kennedy University. Dr. Chambers has presented at the YAI International Conference on People with Disabilities (2007) and at the National Association of Dually Diagnosed (2009) on the Next Generation of Dual Diagnosis: a Functional Assessment of Drug and Alcohol Use in People with Intellectual Disabilities.  This paper, “Unlocking the Institutions, Innovations for People with Intellectual Disabilities and Co-Occurring Psychiatric, Substance Use, and/or Forensic Involvement,” has also been accepted for presentation at the Pacific Rim International Conference on Disability in April 2011.

HUD requires participation in a bi-annual point in time (PIT) count for all Continuum of Care (CoCs) regions across the nation.  This count determines the amount of funding that local communities receive.  The PIT count takes place all on the same day and involves the efforts of shelter staff, program staff, hospital staff, volunteers from the community, and outreach workers.

Anka Behavioral Health, Inc. participates in every count utilizing their skills and knowledge base in order to ensure that those living in encampments, that are not visible to the untrained eye, get counted.  Anka’s participation is not only welcomed but appreciated by the Cities and County in their outreach efforts.  The outreach teams use an organized approach to the PIT count with teams placed in each part of the County.  Team members also participate by training community volunteers in safety issues.  Project HOPE also assists the county in partitioning the mapped areas so that community volunteers focus on areas that are known to have homeless communities.

For every count so far, the highest numbers come from Project HOPE.  The total number of individuals counted this year was 1031, slightly less than the 1075 from the year 2009.  Although the count this year decreased, the team noticed in their daily efforts, an increase in homeless families and newly homeless due to the economic downturn.  We also expect to see a rise in veterans due to the disproportionate rate of homelessness amongst veteran’s who do their service in wartime.

OFFERING A FULL SPECTRUM OF CARE
Anka Behavioral Health employs over 900 employees spread out over 35 location in California and owns more than 500 beds. The flagship service of the corporation is Crisis Residential programs, which is offered on a short-term basis at multiple facilities. A broad spectrum of in-patient and outpatient Mental Health Services are offered including long-term care and psychiatric counseling for individuals and groups. Similar services are offered for people who are Developmentally Disabled, with the addition of specialized in home support care. Anka also provides a therapeutic environment for the treatment of Drug, Alcohol and Eating Disorders.

Specialized Forensic Services designed for people who are disabled and are involved in the criminal justice system, are provided for the State Government of California. “The are the very people who should not be inside a prison.” explains Michael Barrington, M.A., M.Ed., Ph.D., President and CEO of Anka. “They need treatment and out intent is to normalize them as best we can and get them back into their regular community.” Combined, all of Anka’s services add up to approximately 10,000 patients being served each year.

OUTWARD GROWTH, INWARD FOCUS
With a Ph.D. in Organizational Management and three additional Masters degrees, it’s easy to see why Barrington is qualified to the lead Anka. He was hired as CEO thirteen years ago to change the course of the organization. “They were a bleeding heart business, services were dictated by how people felt and I was hired to reform the company. Now I see our organization as a business with a heart. We use a very strict business model but we have a heart and we have been enjoying a 12-15% growth annually for the past seven years,” explains Barrington. “This year we will exceed that, and next year we will exceed it again because of new business we are already working on. This is very encouraging.” Barrington adds that this continued expansion feeds directly into the corporation’s mission statement “to provide more services to more needy people.” “Organically we are growing tremendously in the State and that will continue, but externally we are also growing because of the acquisitions and mergers we are working on.” He credits Anka’s highly energized staff and management team for the rapid growth. This team consists primarily of Ph.Ds and about half are only in their thirties, and having vice presidents and executives that are both highly trained, highly skilled and young, has led to a very dynamic leadership group at Anka.

“We consider ourselves a Walt Disney-type organization, because of our creativity,” explains Barrington. He says unlike hospitals that need to market their services which are fixed or static to the surrounding community, Anka has the ability to work on reverse. “We have a really simple formula that has really given us our market edge. If you want to buy our services there are three questions I will ask you: ‘What do you want? Where do you want it? And when do you want it?’ And I’ll make the price right for you. We have a formula that allows us to go anywhere in the United States and we do, and we can deliver a program to you in 180 days, including the facility.” Although the organization is keen on expansion, that doesn’t mean that less attention is given to investments in the infrastructure. The corporation retains its own real estate broker as a full-time employee and about 50% of the facilities are owned by the organization. “We’ve also very highly invested in IT, with developing electronic health records and the security needed, and in California there is also the whole issue of electronic signatures which is very controversial.”

CREATIVE SOLUTIONS FOR SATISFACTION
Although today the group enjoys a team of quality staff, until recently, it was a major challenge hiring them. “Before there was a frenzy at the feeding trough for qualified personnel which pushed salary caps very high. We developed a partial solution but it has changed with the economic crisis because there are so many qualified people out of work.” This soft employment market, however, will not last. To address recruitment in the long-term, several years ago Barrington developed an in-house education program. “For the right people we pay for their education right up to Ph.D. level, so we are grooming them to stay with us in the future and to be leaders.” The culture of the organization has also played an important role in employee retention. Anka address this issue by forming a cultural committee that focuses on nurturing the group’s mission, vision and values. The committee has across the board employee representation. They select themselves and they tell the executive leadership team what they want. A representative from the cultural commitee also has input on everything from the corporation’s logo to the kind and frequency of company celebrations. “When we hire, we hire for attitude we assume they have the skills, but we need people who share our values.”

When a new employee does come on board, the team welcomes each new employee with a company shirt, flowers and a small ceremony. Barrington says that little acknowledgments like this awards programs and various holiday celebrations that the cultural committee also organizes, help to solidify the team spirit and enhance employee satisfaction. Two major awards hearken back to the Disney-inspiration. They are the annual Mickey and Minnie Mouse awards that are given to the most creative staff in each region. “We studied the programs and we feel it’s significantly reduced our turnover rates by about 8%.” The efforts towards satisfaction extend into their quality initiatives. Because Anka provides services to multiple and varied customers in a very competitive market place, there is a constant demand for improved quality products. But in this company, such challenges are welcomed and used as an inspiration for continued improvement and the development of cutting edge delivery services. Barrington implemented the ASTRA system, which enables the gourp to monitor facilities, right down to the most distant location, with a direct link to the corporate office. The ASTRA instrument allows for weekly internal audits at every site.

“Our own QI team goes out on a rotation basis measuring quality by looking at customer service and quantifiable outcomes. This is something we are consistently working on, but particularly when you are in a growth mode. How do you grow aggressively and the environment, the culture that you have established?” Anka’s leadership team continually addresses this question, so the company can enjoy both growth and consistency. “We are to the Behavioral Health industry what the Silicon Valley is to the world of computers and technology. We are creative, innovative and dynamic and we attract people that are very excited to be working with us. Our products are the best in the market place.”

His uncle was a missionary, a member of the order Les Peres du Saint-Esprit – known in English as the Spiritans, or the Congregation of the Holy Ghost. The order, founded in France in 1703 to serve the poor, works in developing countries. When Barrington was a young boy, his uncle would bring by his friends – fellow missionaries returning from nations such as Haiti, Kenya, Madagascar, Mauritius, Nigeria, Sierra Leone, and Tanzania. “All exotic places to an impressionable young boy,” Barrington says. “At seven, eight years old, I was enthralled with these guys.” Another career was never an option for him. He went to boarding school in the north of England and to college in France, and if he ever toyed with the idea of any other profession, he was nudged by an uncle, or an aunt, or a parent to remind him that the seminary was where he was headed. “From the cradle, I was the one,” he says. “I was marked.”

At the age of 26, he became a priest and began his life of service. His grandmother said it, and it was so.

Decades later, Barrington is resting at a gate in the San Salvador airport, his black Spanish leather boots propped on the window frame, his legs crossed. It’s 2:30 in the afternoon, and his eyes are shut as he listens to one of the 17 CDs of the latest Dan Brown audio book. It’s a rare quiet moment during his latest assignment.

He’s wearing a polo shirt with the name of his club – the Rotary Club of Concord, Calif., USA – stitched on it, and a Paul Harris Fellow pin. On his wrist is a dual time-zone watch that he always wears when he travels, one face set to the time at his current location and the other set to home. On his finger is a Claddagh ring, a family heirloom passed down to the eldest son.

He’s been assessing the El Salvador portion of a complex Rotary Foundation Health, Hunger and Humanity (3-H) Grant project as a member of the Foundation’s Cadre of Technical Advisers – a group of Rotarian volunteers with technical expertise who help the Trustees review, monitor, and evaluate humanitarian grant projects. This grant, involving clubs in Bolivia, the Dominican Republic, El Salvador, Panama, and the United States, will help establish a network of hospitals and clinics that provide burn treatment in Latin America. Barrington has spent the last few days traveling through the bush to visit burn clinics and meeting with Rotarians involved in the project. Today he’s en route to Panama for the next leg of his mission. 

From conception to completion, 3-H projects undergo five evaluations, several of which are on site, to evaluate feasibility, Rotarian involvement, implementation, and impact, and to ensure the grant’s compliance with the Foundation’s conditions. (Cadre members also review efforts funded by Matching Grants larger than US$50,000, and will be reviewing grant projects carried out under the Future Vision Plan, though as of press time the details had not yet been determined.) “We as trustees rely very much on the professional expertise of these people,” says Foundation Trustee and cadre chair David D. Morgan. “They are in a better position than anyone else, having been on the site and interviewing the sponsors and beneficiaries, to tell us about any particular project.”

Barrington’s report to the Trustees – more than 10 pages – is due within two weeks of his return. He has nearly finished a draft based on the on-site interviews, hours of phone conversations, and in-depth reviews of paperwork he’s already conducted. “I have to write a story that has a beginning, a middle, and an end, put in photos, so it makes sense to them,” he says. “They’re going to make decisions based on my report.”

The flight starts boarding, and once in his seat, he pulls out a 3-inch white binder stuffed with documents. “This is my bible when I travel,” he says. Inside are printouts of every piece of information he’s gathered about the project, starting with the initial e-mail with assignment details from Rotary International staff in Evanston, Ill., USA. Often that e-mail comes only a few weeks before the site visit, and in that time, he scrambles to pull together as many details as he can about the effort and the culture of the country he’s visiting.

“I love being an entreprenuer, refining systems, designing systems. That’s what I do for Rotary.” -Michael Barrington

Though Barrington speaks Spanish, French, Portuguese, and three African languages, all the Rotarians he meets once the plane lands in Panama speak English. Panama City is much like Miami – an international port city with skyscrapers and upscale shopping malls that, like the rest of the country, uses U.S. dollars for currency. But the business culture in Panama is much different from that in the United States, Barrington says. Americans like it when people cut to the chase, but in Panama, being so direct is an insult. On the first night, during dinner with then-grant manager Michael Cosaraquis at a restaurant overlooking the harbor, the president of Panama casually walking by, Barrington weaves in questions about the project’s burn prevention outreach efforts between talk of golf and family. “You really have to study each country, study what the Rotarians are doing, figure out how you are going to approach this,” he says. “This is all part of the preparation.”

Because of his natural ability to pick up languages and adapt to other cultures, as a priest he was often transferred by his superiors, never in one spot for too long. On his first assignment, he arrived in Nigeria at the beginning of the civil war. After six months of teaching at a junior seminary, he was transferred to the most isolated parish in the diocese. He spent the rest of the three-year war there, deep in the bush on the edge of the fighting, sick with malaria several times. When the war was over, he was moved to another part of the country to work on reconstruction projects with relief groups such as Oxfam, the World Health Organization, and Caritas, and was responsible for developing hospitals, schools, low-cost shelters, and small businesses. “This is why I know so much about this project,” he says of the effort he’s evaluating. “A burn center is just another clinic.”

His bishop called him in one day and asked him to open a new parish in an isolated village, 45 miles across the jungle from the nearest priest. He lived alone in a mud hut for two years, cooked on three stones, bathed in a river. He gave his own blood to save the life of a pregnant woman. He asked the village elders what they needed and then helped them make it happen, whether it was a school or a clinic. In his honor, they decided to name the parish St. Michael’s.

“There’s so much you want to do,” Barrington says. “You see the tremendous suffering of people. An example: There was a huge area that was 6,000 square miles of territory, zero health care. Zero. People get sick, they die. You see this every single day wherever you go – people sick, people dying, the poverty of people, people living at a subsistence level. It tears at you. You want to do something to help – you just don’t have the resources. You watch people die. I buried a lot of people. Children. I buried lots of them. I’m tearing up even telling this. I know we change the world one life at a time. But when you’re there and see this stark poverty all around you, you want to change it, and you don’t have the resources to do it.”

All told, he spent 7 of his 10 years in Africa living on his own. In that time, he began struggling theologically, pondering what the church was about. And he vowed he would never live alone again. “It felt like I was wearing a suit that didn’t quite fit,” he says. “I knew I was very lonely. I knew I wanted a companion.”

Still, Barrington was convinced that it would kill his father if he left the priesthood – “He was more Catholic than the Pope,” he says – so he hung in there, taking a sabbatical that involved living in a Trappist monastery in Northern Ireland and then as a hermit. The longer he stayed in the priesthood, the more he got promoted, eventually training future missionary priests in Puerto Rico and establishing fieldwork placements in Brazil, French Guiana, and Mexico. When his father died, what he needed to do became clear. At the age of 40, he left.

Still, humanitarian work continues to be part of his life. While in Panama City, Barrington tours the Apaniquem burn center with Ricardo Barría, past president of the Rotary Club of Panamá Nordeste, and Cosaraquis. The Panamá Nordeste club founded and now oversees the center, which is the only one of its kind in the country. Patients spend hours traveling by bus for their weekly appointments.

Cosaraquis pulls a box of compression bandages off a cart. In other countries, clinics buy rolls of compression material, then hire and train somebody to take burn victims’ measurements and sew the finished bandages. In Bolivia, a clinic was brought to a standstill when it ran into a problem with materials. By using pre-made bandages, which are available in a variety of sizes and can be shipped overnight, Cosaraquis is able to eliminate the sewing step.

“It’s cheaper that way? Did you write that in the report?” Barrington asks. “This is the kind of info we should share through Rotary, because it can be done anywhere, and it can eliminate problems. I think it’s just great.”

The Rotarians who work on grant projects are volunteers, not professional grant administrators. As a cadre member, Barrington has a deep understanding of all the fine print that goes along with Foundation grants, spelling out their terms and conditions. That makes his role as a technical adviser twofold: He’s here not only as a support to the Trustees, ensuring that donations to The Rotary Foundation are spent responsibly, but also as a Rotarian with expertise in Foundation grants, helping Rotarians make their projects stronger. He shares with Cosaraquis information about a group called Physicians for Peace, which is providing burn treatment training to doctors in the Dominican Republic, among other developing countries. The staff from the clinic in Panama used to travel to Shriners Hospital in Galveston, Texas, USA, for training but lost that resource when the hospital was wiped out by Hurricane Ike. (It has since reopened.)

“Right now, this is my vehicle where I can live out my gospel message. Sevice Above Self — to me, Rotary was coming home.”

“You have to be an ambassador. That’s the best word. We’re all in this together,” Barrington says of his role. And because he’s a Rotarian himself, he’s able to talk shop, including grant projects going on in his own club, where he’s a past president and the chair of the international service and Foundation committees. “I always say, if you have questions, let me know. If I don’t have the answer, I know how to get it.”

“He knows what he’s talking about,” says Alexei Oduber, the current grant manager in Panama and a past president of the Panamá Nordeste club. “He understands the project management part. You sort of feel like you’re talking to an elder – a person you would talk to like an uncle who knows about the business, and you want to do a new business venture. He’s more of a trusted partner than an auditor.”

While Barrington is in Panama, the club arranges for him to speak with project beneficiaries – in this case, a three-year-old boy and his mother, who were both burned when a gas tank fell and exploded while they were cooking. The boy has had 18 surgeries already; he just got back from a hospital in the United States and carries a frog umbrella to protect himself from the sun while he’s outside.

“She had a wonderful spirit,” Barrington says of the boy’s mother when he emerges from their small concrete home. “She kept thanking God they were alive, and loved the treatment at Apaniquem.”

He spends the rest of his time in Panama going over paperwork at the Panamá Nordeste club headquarters, reviewing the financial accounting and the 3-H grant overall. “It’s somebody who’s going to be looking at our project to help the project, and therefore us,” Oduber says of receiving a visit from a cadre member. “As it has been so far with Michael, if you find a professional delivering criticism, it’s in the best interest of the project, the country, the club, and ourselves as people. We want to be better in reporting and better in preparing, because the better we are, the more efficiently we can use the money, and the more efficiently we can use other resources.”

Though today Barrington’s mission is to help Rotary do good in the world, that wasn’t always the case. He originally joined Rotary because he was dragged into it.

When he left the priesthood, he moved to California, where one of his sisters lives, and found a job as a social worker. (He had earned a master’s in psychology while he was in Puerto Rico.) Within nine months, he met his wife. He went on to become the CEO of a health care corporation, a position he’s held for 14 years. He found a true vocational passion – organizational management – and got a PhD in the field. “I love being an entrepreneur, refining systems, designing systems,” he says. “That’s what I do for Rotary.”

In 1999, a Rotarian who was one of the company’s directors insisted he join. “I went in kicking and screaming,” he says. At that time, his club wasn’t very active, and he wasn’t a joiner to begin with – he felt like he had a hard time fitting in. Eventually, the club became more energetic, and a club president invited him to serve on the international service committee. He and Rotary began to click. “I felt early on that I did not need Rotary for me to do my humanitarian work,” he says. “Now I do not know how I would work without it.”

He discovered that he could find fellowship and friendship among a group of people who come together once a week for one purpose: to help others. Today when he talks about Rotary, it’s with a preacher’s passion: “I was really into it. This is my life coming together. And I met really good people. I feel that Rotary has a soul.”

Someone – to this day he doesn’t know who – passed his name along to The Rotary Foundation, suggesting he’d make a great member of the Cadre of Technical Advisers. He received a brief phone call from someone at RI headquarters, who referred him to the application posted at www.rotary.org.

In addition to his club, he’s found the cadre to be a place where his past humanitarian experience and present work with organizations and systems come together. “I don’t need to go to church on a Sunday and hear sermons or whatever,” he says. “Right now, this is my vehicle where I can live out my gospel message.”

Decades later, and it ends up that his grandmother was right: Michael Barrington was born to serve. “Service Above Self – to me, Rotary was coming home,” he says.

It was the second time she had done so in as many years. The electricity had been shut off at her Richmond apartment and she couldn’t pay bills. Fights with her boyfriend were escalating into violence.

“I had to put my pride aside and make sure the children had what they needed,” said King, 25, in an interview at the busy downtown Oakland center. She talked frankly about what she went through when she was younger, including a period of drug use after watching her parents go through the same.

King is adamant that her boys will take a different path.

“I want them to have a better life than I had growing up,” said King, who is originally from Oakland and was placed in a foster family at age 12.

King is now looking forward to the holidays and the future. She has been accepted for an apartment in the San Francisco Housing Authority, where she plans to move next year. The Robinson center has helped her find a way in the world for herself and her boys, she said.

“The program here definitely works,” King said. She paused, and then added, “It works, but people really have to want to change.”

The Oakland facility provides transitional housing for 54 families for up to two years, as well as a variety of support services including meals and children’s programs. At the moment, it’s fully occupied by families, with 84 children living on the premises. Clients can get access to therapy, find jobs and housing and learn how to manage money before moving into permanent homes. A drop-in service for homeless clients is also managed at the site.

The Robinson center is operated by Concord-based Anka Behavioral Health, a nonprofit organization with a network of services around the state including facilities in Alameda and Contra Costa counties. Anka is one of 33 local nonprofit organizations that will benefit from money raised during Bay Area News Group’s annual Share the Spirit campaign.

From this year’s campaign, $6,000 will be spent on homeless clients at local centers and shelters run by Anka. For many, the gifts and holiday food they receive will be their only presents.

The sluggish economy has resulted in increased demand for services, said Chris Withrow, Anka executive vice president. “We’re seeing more need out there than ever before,” he said.

The organization is gearing up to open a winter shelter this week at the Oakland Army Base that will provide resources and help homeless individuals during the colder months.

“The Share the Spirit money makes all the difference,” said Brenda Shebanek, Anka’s regional director for homeless services. “If it weren’t for that, we would really be at a loss.”

King said the Anka program has made a big difference in her life. She is sober, and has training under her belt from Laney College’s culinary arts program and can work to help pay the bills.

During two years at Henry Robinson, she has attended therapy by herself and with her boys, to help break a self-destructive lifestyle, and her sons can talk frankly about the things they’ve experienced.

“I want them to know it’s OK to cry and talk about things,” King said.

James, 8, and Nathanial, 6, have easy smiles. On a recent morning in the center’s playroom, Nathanial carried around a toy police radio in his pocket, eager to demonstrate how it worked, while James played at another table with a boy. They are enjoying school and 17-month-old Malachi — born after King moved into the center — is thriving, too, King said.

If she hadn’t found a spot at the Robinson center, King said she probably wouldn’t have been able to pull herself up.

She shook her head. “I’d probably be stuck on stupid.”