Creating a Culture of Gentleness in MIchigan. by Sheldon Schwitek

progress Report

Center for Positive Living Supports A resource for gentle, compassionate, successful caregiving.

Dear Friends and Colleagues, Four years ago, the Center for Positive Living Supports was created as an affiliate of the Macomb-Oakland Regional Center (MORC) to lead a state-wide effort to build a culture in Michigan that supports those with complex needs as well as explores ways to keep dedicated caregiving teams feeling supported, competent and energized. With funding from the Michigan Department of Community Health and the assistance of numerous community partners, we have been on an amazing journey that has allowed us to spend valuable time with caregivers, managers, clinicians and executive leadership across the state in an endless quest to ensure that those we serve feel safe and deeply valued. It is with great pleasure that I present this report highlighting the many successes that we have achieved together. Since its inception, the Center has trained thousands of direct caregivers and administrators in Culture of Gentleness philosophies. We now have over 80 certified trainers in the state and have supported over 70 individuals through consultation and mobile mentor supports. We are partnering with many shareholders as we continue to evaluate system and cultural factors that prevent those we serve from leading the richest life possible. Our partners have included steadfast support from MORC, executive leadership and staff from MDCH, CHMSPs, service providers, psychiatric hospitals, our medical community, schools, families and advocates across the state and nation. As we move forward into the future, we look to deepen our current partnerships and forge new ones. We are enthusiastic about bringing additional training options to support families and mid-line managers and providing custom mentor development for agencies. By sponsoring additional conferences and learning opportunities we can review data that reflects quality of life improvements for those served, as well as receive feedback from those who have been affected by our work and services. We are proud of our progress thus far and look forward to continuing to partner with you in creating a Culture of Gentleness where we can all learn, heal, and grow. I thank you for your active involvement in this movement. We are making a difference. Sincerely,

Kym Juntti Director, Center for Positive Living Supports

contents Who We Are

4–5

What We Do

6–7

Training Outcomes

8–9

Mobile Response Outcomes

10–11

Stories

12–15

Organizational Certification

Tracking Results

Acknowledgements The Value of Gentle Care

18–19 20

“I learned what is most important in what we deal with is knowing that people may have ‘behaviors’ because they don’t feel safe or valued.” Keeley Stewart, RTII Bluewater Developmental Housing

WHO WE ARE The Center for Positive Living Supports is comprised of a small, but energetic, eight-person staff that has been supporting individuals with complex needs for over 30 years. Many of the staff began utilizing Culture of Gentleness approaches with individuals with developmental disabilities as employees of the Macomb-Oakland Regional Center (MORC). MORC is the largest agency in the world that has implemented gentleness approaches throughout its system of services, starting in the 1980s and steadily refining it ever since. The expertise and experience gained through this long and successful history make the Center a premier resource for supporting those with complex needs. The Center provides an array of services that include Culture of Gentleness training and crisis response for those who care for individuals with developmental disabilities, mental illness and other marginalized populations. We focus on individuals served in the public mental health system and related shareholders to instill hope and create healthy outcomes.

their emotional distress. Our central purpose is nurturing, teaching, and sustaining a sense of companionship, connectedness and community for those have repeatedly experienced an existence of disconnectedness, isolation and loneliness. The Center maintains an exceptional standard of quality in all of the services it provides. As part of MORC, the Cener received the rating of Exemplary Conformance from the Commission on Accreditation of the Rehabilitation Facilities (CARF) in 2010. Organizations throughout Michigan, the country, and even some internationally, have sought out the Center for expertise, training, and support in building a Culture of Gentleness as a replicable model for supporting those with complex needs. As our results in the following pages will show, the Center has proven that with the right supports, planning and training, everyone is capable of living successfully in the community as a full citizen.

Our approach is to support a Culture of Gentleness through compassionate care as an alternative to the reactive and restrictive practices that have become so commonplace in working with persons with complex needs. Instead of simply addressing the symptoms presented, we consider the individual’s disability, the history of trauma, neglect and loss that contributes to 4 6

“I wonder why everyone in this work can’t think like this. The world would truly be a better place.” Amanda Mettler, Direct Care LTSS

WHAT WE DO The Center was developed to assist organizations in building capacity to support individuals with complex needs. Our suite of services includes: • Consultations • Organizational Assessment and Planning • Transition Planning • Seminars • Training for All Organizational Levels including Certification Process • Parent Training Classes • Mobile Training and Crisis Team

structure, which may include setting limits and boundaries, and assisting with difficult transitions, both big and small.

We call these the Six Elements: 1. Safe 2. Valued 3. Uplifting Interactions 4. Demands

• Training and Crisis Transition Home • Evaluation and Follow-Up

METHODOLOGY Our experience and research has taught us that in order to develop long-term, sustainable positive outcomes for those with complex needs, we must address the need for all shareholders to feel safe, valued, confident and competent. Recommendations and methodologies are based on the understanding that everyone functions more effectively when there is a foundation of trusting relationships and effective communication. With methodology based on the positive psychology movement, we ask caregivers and providers to express warmth and unconditional valuing to those who are most disenfranchised from family, friends and community. This is accomplished through many uplifting and affirming interactions. We assess what the individual feels are stressors/ demands in their life and proceed to reduce them as much as possible. This provides needed 6

5. Structure 6. Transitions It is our strong belief that if an individual feels safe and valued, other treatment methods and modalities will be more successful and the individual will be more open to growing, recovering and healing.

REPLICATION A primary goal of the Center is to build a regional/ statewide network of persons skilled in creating and maintaining a Culture of Gentleness for individuals who present the most complex needs. This is accomplished by training statewide leaders from PIHPs/CMHSPs in using non-violent, positive support strategies that they can share with their staff. Ultimately, every local CMHSP will have the necessary expertise to meet the training needs of their region on their own, enabling them to support those who need it most. 7

“I learned that helping others to feel safe and respected and to provide them with positive experiences, interactions and structures will lead to all of us creating the gentler, kinder world we all want to inhabit.” SANDY, Parent

Additional providers and groups within Michigan that we have provided training to include: • Association of Rehabilitation Nurses • Association of Orthopedic Nurses • Michigan Federation of Families • Parent Training* • Children and Family Services

TRAINING Outcomes

• Kalamazoo Psychiatric Hospital

The Center’s training program is designed for the caregivers of individuals who are at risk of facing increasingly restrictive support strategies or environments. We realize this role is as critical as it is demanding and requires deep commitment to personal, organizational, and social change. The Center exists to instruct and empower organizations, leaders, clinical staff, caregivers and families of those served. The Center offers a variety of trainings that take stakeholders from the basics of providing positive supports and gentle caregiving through certification for trainers and mentors. Trainings run from three hours to three days, providing classroom instruction, discussion, and hands-on exercises. Re-certification for trainers and mentors is provided every two years.

Training Participation: Individuals Working with People:

1502

Gentle Mentor training:

450

Gentle Mentor Certification training:

Goal Development training: Train the Trainer/Working with People:

110

Certified to Train/ Working with People:

TOTAL NUMBER of

cmhsp participants *Excludes Sanilac CMH

460

* Developed, piloted and provided a Train the Trainer series for Center certified trainers across the state to provide this training locally.

TRAINING Outcomes

4,286

Three-day Gentle Teaching Practicum:

• Pine Rest

TOTAL NUMBER of

We measure participant satisfaction with training as well as the quality of the material that is shared, relevance, and knowledge gained.

TRAINED

Working with People Satisfaction Data

Gentle Teaching Practicum Satisfaction Data

July 2012–June 2013, 527 Surveys Completed

July 2012–June 2013, 331 Surveys Completed

INDIVIDUALS

6,919 *By Center or Center certified trainers

TOTAL NUMBER of

providers trained

331

Satisfied (99%)

Unsatisfied (1%)

mobile response team efforts by cmh through march 2013

“I wonder if everyone has a moment of some point in their lives when they realize we are all more alike than different. We’re really all human with different needs.” Mary Pagnelli, Team Supervisor Pine Rest

Hiawatha: 2

mobile response outcomes The Response Team is available to respond to crises and to provide hands-on assistance to CMHSPs and direct service providers around the state in supporting individuals with severely complex and challenging behaviors. Following an evaluation, the Center will send a Mobile Mentor into the individual’s home to work directly with the caregivers supporting an individual in crisis. The Center team member will mentor the caregivers in deepening their abilities to strengthen the relationship, provide structure, and to react to challenging interactions in a calm, supportive manner. The Mobile Mentor will provide assistance until the crisis is resolved and a support plan is in place to ensure the safety and quality of life of the individual being served and their caregivers.

Northeast Michigan: 1

COUNT BY GENDER

MALE

FEMALE

persons

SERVED

28.9 MEAN AGE

West Michigan: 2

10–51

Saginaw: 1

YEARS

Northcare Northern Affiliation

RANGE

Access Alliance of Michigan Other 17%

COUNT BY living arrangement FAMILY

Severe/ Profound 24%

Moderate 25%

Bay/Arenac: 2

CMH for Central Michigan: 3

Network 180: 5

Thumb Alliance PIHP 3

GROUP HOME

PERSONAL RESIDENCE

Lapeer: 1 Genesse: 3

Ottawa: 2

Oakland: 8

Northwest CMH Affiliation

Mild 34%

Au Sable Valley: 1

Northern Lakes CMH: 1

AGE

YEARS

Level of Cognitive Impairment

TOTAL NUMBER of

Allegan: 1

Kalamazoo: 2

Clinton/Eaton/ Ingham: 1 Summit Pointe: 2

Livingston: 3

Macomb: 6

Washtenaw: 5 Lifeways: 5

Detroit/Wayne: 7

CMH Affiliation of Mid-Michigan Southwest Michigan Urban and Rural Consortium

Cass: 1

St. Joseph: 4

Monroe: 2

Venture Behavioral Health CMH Partnership of Southeast Michigan Lakeshore Behavioral Health Alliance

2 OTHER

Unaffiliated Over 20,000 11

STORIES Nothing illustrates our work more than the stories of those we serve. Here are just five of the many we strive to support.

Sarah Sarah lived with her family until her behaviors to self and others became so aggressive, her family could no longer support her. She was then placed at the Mount Pleasant Center, where her injurious behaviors continued. She was placed in four or five point restraints numerous times a week in addition to the chemical restraints used to calm her. That’s how she was managed–until the Mount Pleasant Center was closed. There was a lot of concern from both her parents and her provider about moving her home due to a lack of confidence in any organization’s ability or resources to meet Sarah’s needs in a community setting.” Enter the Center for Positive Living Supports. Training was provided for caregivers, management, and administration. Numerous meetings were held with both Sarah’s family and the provider, Northeast Michigan Community Mental Health (NEMCMH) in order to develop a transition plan for a move to her new home. NEMCMH leadersvisited her on a regular basis, building trusting relationships and increasing caregiver confidence. Meanwhile, the Mobile Training/Crisis Team worked with Sarah and her caregivers, mentoring them every step of the way. The focus of the team member’s involvement was on building relationships, providing structure, increasing positive interactions and limiting demands in order to help Sarah and her caregivers feel safe and valued. Follow-up involvement continued through phone calls, training, and subsequent visits. Sarah’s life changed dramatically after her move. She lived happily with compassionate caregivers 12

and her days were filled with kindness, hugs and smiles. Over time, her feelings of security had led to greater self-worth and esteem. She felt comfortable and got to know her neighbors, meet new friends, and was introduced to a world of leisure activities. Three years after she moved from Mount Pleasant Center, Sarah’s health declined, and she fell. Suddenly, her needs changed all over again. Upset by her situation, Sarah felt increasingly unsafe and insecure and her caregivers found it difficult to support her. The Center responded immediately, evaluating her needs and working with her and her caregivers to create the structure needed to keep Sarah feeling safe. Support through the Center helped all involved to get Sarah through the crisis, and to transition her into a barrier-free home. Training and mentoring continued, emphasizing structure, positive interactions, and lowering demands. Happily, Sarah is doing very well, once again. She enjoys swimming at the local pool and seeing her family and friends whenever she can. Even through her most challenging times, physical and chemical restraint have not been necessary in order to support Sarah since leaving Mount Pleasant Center.

“I feel When Sarah is doing well and she is happy, all is right with the world!” Debra, Mother

Chris Chris was born with fetal alcohol syndrome, causing him many challenges as a child. Adopted at age one, Chris was welcomed by a family ready to give him the love and support he so deserved. But the path was not going to be easy. Easily over stimulated and impulsive, Chris often engaged in dangerous activities. At age 11, Chris accidentally set himself on fire. He suffered severe burns and was scarred from the waist up. After enduring over 30 surgeries and months of hospitalization, he suffered severe abuse while receiving neurological rehabilitation. This abuse significantly attributed to dangerous, aggressive and self-injurious behaviors. Placed in multiple institutions due to these behaviors, Chris seemed to have pervasive feelings of inadequacy, worthlessness, and guilt. He and his parents were also fearful about placement because so many had failed in the past. Thankfully, his parents and guardian worked diligently with the CMHSP on his community placement and supports. A transition plan was developed that focused on staff training needs, home management, limits, boundaries and structure. Since Chris was a high risk for elopement, the Center assisted with all facets of his placement.

Technical assistance was provided to plan the budget, location, security safeguards, and monitoring of his new home. The Center also assisted with his move by providing six days of Mobile Training/Crisis Response services. The Mobile Mentor helped the caregivers focus on building a relationship with Chris as well as increasing their confidence and skill level. Structure, engagement and environmental control were crucial to success. Staff meetings and consultations continued for the next year and a half with ongoing training and support. This was critical as Chris continued to challenge his caregivers. In the first year, he refused to go to school and had two occasions where elopement put him at serious risk. Despite all of it, his team remained strong and positive. Two and a half years later, Chris is reaping the benefits. Today, he is funny, relaxed, entertaining, and feels valued by others. He loves being with (and emailing) friends and family, has a job he adores, goes fishing, plays sports, and is involved in a variety of activities in his community and his church. Chris has even been successful in significantly reducing the amount of medication he takes on a daily basis. Rather than desiring to hurt himself, Chris now enjoys helping others and living without locked doors.

RIMA Rima was hospitalized as an adolescent and her family feared for her safety from mutilative selfabuse, aggression, and property destruction. She had lived in other community settings and she was not successfully supported which resulted in her placement at Mount Pleasant Center. When she lived there, her family feared its closure and was terrified at the thought of her being placed back in the community.

“I wonder why we didn’t see this way 20 years ago.”

She swallowed all types of objects, which frequently resulted in medical attention and surgery. Rima could have died many times. She once pushed a refrigerator across the room when she was upset.

Barb Watson, Home Manager Thornhill/BWDH

michael Michael lived at home until he was 21. His mother had been told he was developmentally delayed and things would get better in his teen years. Instead, they became more challenging. Despite her best efforts, when he was moved into a new home, he became aggressive and violent to the point he was handcuffed and hospitalized several times. This proved to be a very difficult transition for Michael. The Center’s Mobile Training/Crisis Response Team was brought in to assist, providing hands-on mentoring and training. Demands on Michael were reduced, a structure was established, and creating a feeling of safety became the priority. Over time, caregivers learned to identify and prevent areas of struggle, work through challenges and as relationships blossomed, his anxiety diminished. Today, Michael has two roommates and has lived in the same home for four years. He leads an active life paying basketball after school, taking daily walks in his neighborhood, and listening to music. He has a great sense of humor, keeps his caregivers smiling, and blows kisses to Mom whenever he sees her. Michael’s mother is living a more relaxed and fulfilling life herself. She has the time to do things she was not able to do when he lived with her. His mom reports that when visiting her, Michael will indicate when he wants to return to his own home. This gives her a sense of peace.

The Center provided extensive supports over 16 months to Rima and her family. Many key areas were addressed, including trust between the family and the professionals charged with supporting her. Numerous trainings occurred with her family, service provider and clinical staff with critical attention paid to her potentially explosive periods. By stabilizing staff and creating trust with her family, relationships deepened, and Rima began to feel safe. Today, she her family have developed a trusting and valued relationship with the service provider and her caregivers. Rima is much happier, often laughing and smiling. She is kept busy with many activities and is engaged in her community. Her family enjoys relaxed weekly visits. Rima recently hosted her large extended family at her home for this past year’s holiday celebration.

PRESTON Preston has a long history of psychiatric and institutional admissions dating back to 1981. His family life was not stable, and his grandmother assisted in raising him. He was placed on Mellaril and Stelazine when he was in the 2nd grade and placed in foster care. With a diagnosis of schizophrenia, he was admitted to Kalamazoo Psychiatric Hospital when he turned 18. From there, he was placed in Mount Pleasant Center in 1999 for ten years. Following its closure, Preston made his first move into the community in over 25 years. He lived in the community for a year, and was placed back at Kalamazoo Psychiatric Hospital after having auditory hallucinations and increased aggression that was exacerbated by medication refusals. The Center became involved in 2011 and helped develop a transition plan for Preston’s long-term placement back into the community. Substantial technical support coordinated clinical services prior to his discharge. He was moved to a new home in Ann Arbor with the help of the Mobile Training/Crisis Response Team. Mentoring and training assisted in managing medication refusals, along with other challenges. By learning to structure Preston’s activities with the normal flow of the day, with a consistent staff and approach, he has now built very strong relationships with his caregivers. His service provider continues to support ongoing training and close monitoring. Today, Preston is doing well without any elopements, psychiatric hospitalizations, 911 calls, or physical interventions reported. He is active in his community where he enjoys bowling, shopping, festivals and long walks. 15

“I learned that gentle, polite, kind gestures and comments can lift a person higher then you may expect.” Shane Ware, Program Manage Stauffer Home (Spectrum)

ORGANIZATIONAL CERTIFICATION

TRACKING RESULTS

We believe that individuals are best served when they are supported by organizations that embrace a Culture of Gentleness agency-wide. The Center has established an organizational certification process that recognizes those that have embraced the tenants of a Culture of Gentleness and have worked towards embedding those strategies in their business practices, training efforts and supports provided to those served and their work force.

We carefully measure the implementation of our program model to ensure consistency as well as success. Quantitative as well as qualitative data are collected to consistently track our efforts and the outcomes of our initiative.

JARC, a non-profit in Oakland County that serves those with disabilities and their families is the first organization to have received Organizational Certification in a Culture of Gentleness. JARC has been committed to a Culture of Gentleness for many years. They worked diligently over the last several years to incorporate a Culture of Gentleness into the culture of their organization by providing training to the executive leadership, board members, shareholders, and staff. They incorporated the tenants of a Culture of Gentleness into their policies and mission statement and have invested in developing internal teams of certified trainers and mentors to support those they serve and their work force. JARC recognized early the business benefits of this culture as a way to support its workforce, reduce cost associated with turnover, training, and support for those with complex needs. JARC has also been a strong and effective organizational mentor to other organizations wishing to deepen their existing culture to one of gentleness. 16

To enhance our tracking efforts, the Center has recently partnered with Wayne State University’s Developmental Disabilities Institute (DDI). DDI has been committed to providing services for children and adults with developmental disabilities since 1961 and is recognized as a leader in the field, committed to treatments and programs that are supported and refined by evidence based research in the field. We look forward to working closely with DDI as an administrative and research partner, building and enhancing regional crisis stabilization capacity and improving strategies surrounding adults, children and families. Our goals are to partner with DDI on providing follow up monitoring on the Center’s Mobile/Training Crisis Team services, as well as assisting PIHP’s in developing plans to serve individuals with complex needs in a proactive manner. We will work collaboratively on developing ongoing measurement of outcomes and proving a technical report outlining the outcomes achieved through Center services. MORC Executive Director Jerry Provencal (left) presenting the Culture of Gentleness certification plaque to JARC Chief Operating Officer Chris Hench (right).

ACKNOWLEDGEMENTS The Center for Positive Living Supports gratefully acknowledges the many individuals and agencies whose contributions have been critical to its successes in creating a Culture of Gentleness for individuals with complex needs throughout Michigan and beyond. • Macomb Oakland Regional Center, Inc • The Michigan Department of Community Health • The Developmental Disabilities Institute Wayne State University • Oakland County CMH Authority • JARC • Judy Webb • Bill Allen • Mike Head • Angela Martin • Rebecca Freier Community Mental Health Service Programs and their Service Providers:

• Lifeways CMH • Livingston County CMH Authority • Macomb County CMH Services • Monroe CMH Authority • Montcalm Center for Behavioral Health • CMH Services of Muskegon County • Network 180 • Newaygo County Mental Health Center • North Country CMH • Northeast Michigan CMH Authority • Northern Lakes CMH Authority

• St. Clair County CMH Services • Community Mental Health and Substance Abuse Services of St. Joseph County

Parents, Families and Guardians:

• Pathways • Pines Behavioral Health Services

• Shiawassee County CMH Authority

• Bay-Arenac Behavioral Health Authority

• Summit Poin–Tuscola Behavioral Health Systems

• Berrien Mental Health Authority

• Van Buren CMH Authority

• Cass County CMH Authority

• Washtenaw Community Health Organization

• Centra Wellness Network

• West Michigan CMH Systems

• Gogebic CMH Authority • Gratiot County CMH Services • Hiawatha Behavioral Health • Huron Behavioral Health • Ionia County CMH • Kalamazoo CMH and Substance Abuse Services • Lapeer County CMH Services

• Mosaic International, Impact Romania Barb and Richard Carman

A special acknowledgment to the Center certified Trainer and Mentors across the state who continue to work tirelessly to provide training opportunities and hands on mentoring support to those who are learning more about a Culture of Gentleness.

• Barry County CMH Authority

• Genesee Health System

• Motivation Romania Cristian Ispas and Corina Cociorva

• CMH of Ottawa County

• Au Sable Valley CMH Authority

• Detroit –Wayne CMH Agency

• Bios Corporation, Sapulpa, OK and Columbia, TN Eddie Miller

Certified Trainers and Mentors:

• Sanilac County CMH

• Copper Country CMH Services

• Home Society, Abbotsford, BC Cam Dore and Dave Lappin

• Oakland County CMH Authority

• Allegan County CMH Services

• CMH for Central Michigan

• Creative Options, Regina, CA Michael Lavis

• Northpoint Behavioral Healthcare Systems

• Saginaw County CMH Authority

• CMH Authority of Clinton-Eaton-Ingham Counties

National and International Supporters:

Regional Partners: • CMH Services of Muskegon County • Northeast Michigan CMH Authority

Regional Training Partners:

To all of the parents, family members and guardians that trusted us and provided us an opportunity to assist your loved ones, we thank you. Your continued advocacy and partnership is affecting cultural change in how we support those we care about with complex needs.

Caregivers: We would like to send a special acknowledgment to all of the hard working, dedicated caregivers who create miracles every day. Your dedication and commitment to honing the skills of your craft is inspiring. You create hope and a gentle place for those you support to heal, learn and grow.

• Macomb Oakland Regional Center, Inc • CMH Authority of Clinton-Eaton-Ingham Counties • Hope Network • North Country CMH • Consumer Link • ARC of Midland

• Lenawee CMH Authority

1719

“I feel confident in my ability to continue to model and cultivate a culture of gentleness, inclusion and positive interactions with my community.” Carlos Calderon Program Assistant, Hope Network

THE VALUE OF GENTLE CARE Crisis Prevention and Response training from the Center is more affordable than that of private training programs. We also provide services not found anywhere else in the state of Michigan. Working with People and Gentle Teaching Practicums are provided at no cost to CMHSPs and direct service providers when at the regional training sites. The cost of additional trainings and crisis response services are detailed below.

The fees for these trainings are as follows: • Train the Trainer Three days $200. per person • Mentor One day $100. per person • Mentor Certification One day $300. per person • Goal Development Half of day $100. per person

Crisis response services are billed to the MHSPs by CPLS at the following rates: • On-Site Evaluations or Assessments $1500. per day

The entire staff of the Center For Positive Living Supports is passionate about sharing our years of experience and expertise. We are dedicated to liberating many from an existence of disconnectedness, isolation and loneliness. We look forward to sharing our model of success with you to help create a kinder, gentler future for all individuals.

• Mobile Crisis Response $600. per day • Training and Crisis Transition Home: $500. per day (with local CMHSP staff participating) $650. per day (without CMHSP staff)

Trainings can be accessed through the Center’s website at www.positivelivingsupport.org Crisis response services can be accessed by calling Pat Watts at 586-263-8697 20

MAIN OFFICE 16200 19 Mile Road P.O. Box 380710 Clinton Township, MI 48038 (586) 263 - 8701 REGIONAL TRAINING SITES: METRO DETROIT REGION MORC, Inc. 1270 Doris Road Auburn Hills, MI 48326 New Horizons Auburn Hills 1814 Pond Run Auburn Hills, MI 48326 Consumer Link Network 1333 Brewery Park Blvd., Suite 300 Detroit, MI 48207 CEO Washington 59027 Van Dyke Washington, MI 48094 JVS 29699 Southfield Road Southfield, MI 48076 GRAND RAPIDS REGION Hope Network Knowledge Center 755-795 36th Street SE Grand Rapids, MI 49538 LANSING REGION CMHA of Clinton Eaton Ingham (2 sites) 812 E. Jolly Road Lansing, MI 48910 3200 Remy Drive Lansing, MI 48906 MIDLAND REGION Arc of Midland 220 W. Main Street, #101 Midland Township, MI 48640 NORTHERN MICHIGAN REGION North Country CMH University Center 80 Livingston Blvd. Gaylord, MI 49374 www.positivelivingsupports.org