GS o n
FALL / WINTER 2010
I would like to take a moment to share some statistics related to the level of effort in which
the APS HCQU was engaged during the 2009-10 fiscal year. Our associates conducted 792
instructor-led trainings to 10,533 participants, and an additional 3,700 people utilized the
44 online training modules that are hosted on our website. We were involved in 27 separate
capacity building projects in the community to increase quality and access of services for
those with ID/DD in associated support systems such as medical systems, dental systems,
behavioral health, and transportation, to name a few. In one hospital system, we provided 45
training sessions to 400 hospital employees on best practice supports for people with ID/DD
in an acute care setting. We also held three, one day sessions for 103 psychologists on various
topics related to best practice in the support of individuals with ID/DD. We continued to offer
technical assistance to providers and Administrative Entities related to supporting individuals
with both medical and behavioral challenges so that individuals can have the highest level of
quality service in the community. In this capacity, we invested 2,800 hours of staff involvement
in 48 technical assistance cases, of which 33 were successfully resolved. We have recently
enhanced our website with a blog and forum to provide both information and an environment
for the sharing of ideas related to the ID/DD system.
As we look forward to the 2010-11 fiscal year we anticipate training an even greater number of
direct support professionals, individuals, and caregivers as we expand the number of both our
instructor-led trainings and online course offerings to support the training needs of our service
delivery systems. We at APS continue to be committed to providing quality support for the
ID/DD community. Please visit us at www.hcqu.apshealthcare.com. As always, the APS HCQU
wishes you a safe and healthy fall and winter.
— By Kevin McElligott, MEd
Smoking Cessation Fall Prevention Weather Woes Surviving the
Pg. 2 Pg. 5 Pg. 6 Holidays
Smoking CESSATION — By Carrie Perrell, RN
“It’s easy to quit smoking. I’ve done it hundreds of times.” This famous quote by American writer
Mark Twain humorously illustrates the challenge of quitting the use of tobacco; however, people
who are trying to quit smoking may not find any humor in the process. This article contains
information about tobacco usage and quitting strategies.
History of Tobacco Use pleasant feelings which make smokers want
to smoke more. The nervous system adapts
Evidence of tobacco use in the Americas
to nicotine. Smokers develop tolerance to
can be traced back thousands of years with
nicotine, meaning it will take more nicotine
worldwide use of tobacco going back about
(more cigarettes) to get the same effect
500 years. Research into the effects of
previously attained from smaller amounts.
tobacco use, however, only began about 50
When smokers attempt to cut back, the lack
years ago. Globally, 14,500 people die each
of nicotine causes withdrawal symptoms, which
day from tobacco use, with the United States
may include: irritability, sleep disturbances,
reporting 433,000 deaths annually.
headaches and increased appetite. These
Addictive Properties of Tobacco symptoms can cause smokers to start
Nicotine, which is found in tobacco, is reported smoking again after quitting.
to be as addictive as heroin. Nicotine causes
Health Benefits of Quitting
In 1990 the US Surgeon General concluded that quitting smoking has immediate
and long-term health benefits such as:
• After 20 minutes: Heart rate and blood pressure drop
• After 12 hours: Carbon monoxide level in the blood drops to normal
• After 2 – 3 weeks: Circulation improves and lung function increases
• After 1 – 9 months: Shortness of breath and coughing decrease
• After 1 year: Risk of coronary heart disease is cut in half
• After 5 – 15 years: Stroke risk is reduced to that of a non-smoker
• After 10 years: Lung cancer death rate is cut in half; decrease in risk of mouth, throat,
esophagus, bladder, cervix, and pancreas cancers
• After 15 years: Risk of coronary heart disease is the same as a non-smoker’s
Financial Benefits of Quitting
The cost of a pack of cigarettes varies greatly from state to state. Taking an average of $6/
pack, a pack-a-day habit would amount to $2,190 per year for cigarettes or $21,900 after
10 years. This figure does not take into account increased costs for health and life insurance
and possible medical care costs associated with tobacco use.
Health Consequences of Smoking resources for smoking cessation are available
and are listed at the end of this article.
As many as 4000 chemicals, natural and
These resources contain various supports
added, may be found in tobacco products.
and methods for quitting smoking. For the
All tobacco products contain carcinogens
best chance of success, two or more of the
(cancer-causing agents). Diseases and other
methods recommended should be included in
ailments associated with tobacco usage
a plan to quit smoking.
include cancer of the lungs, mouth, voicebox,
throat, esophagus, bladder, kidney, pancreas, Withdrawal from nicotine is inevitable and may
cervix, stomach and certain leukemias, be divided into two parts: physical and mental.
lung diseases such as chronic obstructive The physical symptoms may be relieved with
pulmonary disease (COPD), bronchitis, heart medication or nicotine replacement products.
attacks, peripheral vascular disease, strokes, For the mental withdrawal it is recommended
macular degeneration (most common cause that individuals recognize and avoid
of blindness in older people), premature rationalizations such as “Life is not fun without
wrinkling of the skin, bad breath, gum and smoking” or “It’s my only vice.” There are
tooth problems, blood clots, many more. Write these down and
miscarriage and lower birth have a plan in place to deal with
weight babies for pregnant these thoughts. A change of
female smokers. routine and avoiding places
where the temptation
How To Quit to smoke exists may
There does not seem “It’s easy to quit smoking. help. Deep breathing
to be any one fail-safe I’ve done it hundreds of times.” is recommended
method to successfully by several smoking
quit smoking. The — Mark Twain cessation plans. Deep
American Cancer breathing reduces
Society outlines a four- stress. Remember that
step approach as follows: even very strong cravings
The decision to quit smoking will go away after just a few
should come from the smoker. minutes. Reward oneself as
Even though others may want the part of a plan to quit. Individuals
smoker to quit, it’s a decision that should could save the money that would
be made by the individual. Smokers should have otherwise been spent on cigarettes to
consider the reasons why they wish to quit. get a treat. The reward could also be doing
something enjoyable such as visiting a park,
Picking a specific quit date is an important seeing a play or attending a concert.
step. Time should be allotted for a physician
visit if prescription medication to aid in The maintenance phase is the period of time
quitting, such as Zyban or a nicotine patch, after an individual has gone through withdrawal.
is to be used. Individuals may wish to inform Months or years after quitting an unexpected
family and friends about the quit date as part strong desire to smoke may arise. The goal
of their plan to quit. Other tips include: getting during these moments is to avoid a relapse.
rid of cigarettes and ashtrays; stocking up on Reviewing the reasons for quitting in the first
oral substitutes such as gum, candy, cinnamon place may help. Also, the tips for quitting still
sticks; figuring out what worked best in any apply, such as avoiding rationalizations and
past attempts; joining a support group. Many remembering there is no such thing as “just
one puff “or “just one cigarette.”
How to Support Individuals with of successful smoking cessation is breaking
Smoking Cessation routines that have been associated with
smoking. Caregivers can be role models by
There is a lack of scientific research relating
refraining from smoking during their breaks.
to ways to assist individuals with intellectual
This will also increase the health benefits for all
and developmental disabilities (ID/DD)
who are trying to quit smoking. However,
there are websites that offer some tips in Caregivers may also help individuals with ID/DD
this regard. Common among the various to quit smoking by assisting with following the
smoking cessation resources is the caution steps suggested by the American Cancer Society.
to not threaten, lecture or nag about the Caregivers can create a social story illustrating
dangers of smoking. Focus on the benefits of the quitting process. Caregivers may help
quitting. If an individual is going to use oral individuals list reasons they wish to quit and
substitutes such as cinnamon sticks, hard assemble these in a booklet. Caregivers could
candy, low calorie snacks such as carrots help the individual create a calendar with
or fruit, the caregiver can make sure those pictures depicting the quit date. Caregivers
items are available. Be sympathetic. Realize can help individuals come up with pleasurable
that individuals who are attempting to quit or healthful activities to replace smoking.
may become edgy at times. Give praise and If an individual is prescribed a medication or
encouragement during the day, and offer oral substitute, caregivers can be helpful in
congratulations at the day’s end. assuring that these are given as prescribed
and when indicated. Caregivers may wish
The smell of smoke may trigger a desire to
to visit the various websites dedicated to
smoke. Therefore, environments should be
smoking cessation to learn of other methods
smoke-free. Caregivers may be in the habit of
enjoying cigarette breaks with individuals. Part
There are many sources of support available for people seeking help with quitting smoking.
People may call 1-800-QUIT NOW (1-800-784-8669). This service is provided nationally
through state health departments. People may speak with a live staff person who will offer
a choice of free services, materials, programs and one-on-one phone counseling. Other
resources include the American Heart Association, 1-800-242-8721, www.americanheart.
org; American Lung Association 1-800-548-8252, www.lungusa.org; Nicotine Anonymous
1-877-879-6422, www.nicotine-anonymous.org and QuitNet,
The Globalization of Tobacco Use: 21 Challenges For The 21st Century, A Cancer Journal for
Clinicians, retrieved on 7-6-10 from http://caonline.amcancersoc.org
Smoking quotes, retrieved 7-6-10 from http://thinkexist.com/quotations/smoking/
Guide to Quitting Smoking, retrieved 7-6-10 from www.cancer.org
Do You Want to Help Someone to Quit Smoking, retrieved on 7-7-10 from
Quitting Tips, retrieved on 7-2-10 from www.anti-smoking.org/quitting1.htm
How to Quit, Centers for Disease Control and Prevention, retrieved on 7-6-10 from
FALL PREVENTION — By Sharon Childs, RN
A ccording to the National Safety Council,
falls are the second leading cause of
accidental death in the United States and
availability of fall prevention strategies, care
providers are being held legally accountable.
Though many of these providers address fall
the leading cause of death due to injury for prevention in various ways, many are still in
individuals age 73 and over. It is interesting to need of a formal fall prevention program.
note that the Public Health Service estimates
A formal fall prevention program is a
that two-thirds of deaths due to falls are
multifaceted approach to the prevention and
reduction of falls. It involves staff at all levels
Although little information is available of an organization. Fall prevention should be
concerning the relationship of falls and the considered in strategic planning and resource
population with intellectual and developmental allocation.
disabilities (ID/DD), it is known that falls are
The APS HCQU has developed a resource
responsible for a large number of serious
manual to assist providers in the development
injuries within the population. Individuals
of an individualized fall prevention program
with ID/DD often have multiple factors that
specific to the population they support. The
place them at risk for falls. These may include
manual guides agencies through the steps
impaired cognition, impaired mobility as
needed to create a program and provides
a result of gait and balance disturbances,
tools and resources that can be utilized in the
visual impairment, seizures, adaptive and
implementation of the program. This resource
maladaptive behaviors, and the use of various
manual is available for download from the
medications that may contribute to instability
HCQU website (www.hcqu.apshealthcare.com)
Other Resources page (in the Fact Sheets and
There are wide-ranging consequences from Other Information drop-down window) or by
falls to one’s overall well-being. Physical health, calling the HCQU office at 1-888-321-5861.
emotional health, mental health, quality of life,
The benefits of having a fall prevention program
and financial well-being can all be affected.
in place are tremendous and may include include:
Fractures, traumatic brain injury, prolonged
hospitalization, and even death can occur. • Creates a teamwork culture
Mobility and independence can be affected, • Allows focus on prevention strategies
leading to a diminished quality of life. In many
instances, fallophobia, or the fear of falling, • Reduces number of falls
develops and can place a person at risk of • Reduces number of serious injuries
falling again. Extensive medical costs can be associated with falls
incurred due to hospitalization, rehabilitation,
• Preserves and improves quality of life
and possible long term care placement. All
of this can lead to anxiety and depression. • Reduces healthcare costs
Caregivers and families may incur injuries as a • Provides information on falls related to
result of trying to keep the person from falling individuals with ID/DD
or in trying to help them up after a fall.
• Can prove a valuable asset if litigation occurs
Preventing and reducing falls poses a significant
• Creates a culture of change, not a culture of
challenge to all agencies that provide care for
individuals with ID/DD. With the advent and
— By Mark Parker, RN
E nvironmental emergencies arise everyday and vary widely in nature. They include storms
(snow/rain), fires, floods, and power outages. Emergency situations can be stressful
and they require appropriate management to ensure the safety of all. Agencies should have
emergency management policies and procedures in place, and it is a good idea for staff to
review these documents on a regular basis.
Sometimes an emergency situation may lead to being confined at home for a period of time,
due to impassable road conditions or travel restrictions that are imposed due to a State of
Emergency that has been declared for the area. This was experienced by many last winter when
one of the worst winter storms in recent history hit the region. Were you prepared? It is best to
be prepared before an emergency occurs, rather than trying to gather items during one.
Some helpful hints for managing a home confinement situation are:
Water – Cookies, hard candy, cereals, instant
Store water in plastic containers coffee, and tea bags
such as soft drink bottles and plastic – Foods for people on special diets
milk containers. Refrain from using
containers that will decay or break, such – Have a supply of low salt, low fat, low
as paper milk cartons or glass bottles. sugar items available for people on
Store one gallon of water per person
per day; two quarts for drinking and two Paper cups, plates and plastic utensils
quarts for food preparation/sanitation. Manual can opener
Keep at least a three-day supply of Tools & Supplies
water for each person.
List of emergency numbers posted by
Food & Supplies each phone.
Store at least a three-day supply of Battery-operated radio and extra
non-perishable food per person. Select batteries
foods that require no refrigeration,
Flashlight and extra batteries
preparation or cooking, and little or no
water. Examples are: Cash
– Ready-to-eat canned meats, fruits Tape
and vegetables Electric generator, if permissible, for
– Canned juices, milk, soup (not electric powered medical equipment
condensed soup) Blankets
– Sugar, salt, pepper First aid kit
– Peanut butter, jelly, crackers, granola
bars, trail mix
In the event of loss of electricity, furnaces and air conditioners may cease to work. This may lead
to extremes in environmental temperature, putting some individuals at risk for hypothermia or
Hypothermia is when the body reaches a subnormal temperature, usually 95 F or less.
Symptoms of hypothermia include lack of coordination and shivering. This condition can be fatal
and emergency treatment should be sought. If the furnace stops working, wrap individuals in
blankets and outerwear, paying attention to cover the head, ears, and hands. Seek shelter in a
warm environment. Keep agency administrators aware of the situation.
Hyperthermia is when the body temperature is too high. It may be a result of heat exhaustion.
Symptoms of heat exhaustion are heavy sweating, muscle cramps, weakness, and fainting. If it
is extremely warm individuals should stay out of the sun, avoid strenuous activities, and drink
plenty of fluids.
People who are more at risk for developing these conditions are the elderly, the very young,
and those with chronic illnesses such as diabetes, chronic obstructive pulmonary disease, heart
disease, and compromised immune systems. Individuals who take a lot of medications may also
be at risk.
Emergencies can be frightening, and the inability to go about normal routines due to weather
conditions can be very stressful for both staff and individuals receiving services. It is important
for staff to manage their own stress so that they can assist individuals through an emergency
situation that requires being confined at home for a period of time. Some tips for staff
regarding personal stress management are:
• Recognize signs of stress in yourself. There are many signs of stress; some common ones
are irritability, racing heart, sweating, abdominal discomfort and symptoms, and anxiety.
• Practice stress reduction techniques. Common stress reduction techniques include
deep breathing, imagery, time out or counting to ten, muscle relaxation protocols, and
aromatherapy. The situation may demand that there is not a lot of time to spend on these
activities, but taking a few minutes at least every hour may be beneficial to positively impact
the effects of stress.
• Get adequate rest. In a care giving situation that requires 24 hour awake staff this may be
challenging. Discuss the situation with your supervisors and make arrangements to develop
a work schedule that allows for periods of rest and rejuvenation.
• Eat a healthy diet. Good nutrition in times of stress can minimize physical symptoms and
reduce feelings of fatigue.
Individuals receiving services may also experience stress related to being confined at home
during a state of emergency. There may be an increase in challenging behaviors due to
limitations that may be present in verbal communication abilities. It may be helpful to review
each individual’s support plan for information pertaining to working with him or her. Some
techniques that staff can utilize when working with individuals who may be experiencing a high
degree of stress are:
• Remain calm. Refrain from raising your voice or displaying fear. These measures will convey
confidence and safety to the individuals.
• Avoid continued exposure to media reports of the situation.
• Talk with individuals, explaining the situation in simple and concrete terms. Allow them to
express their feelings. Acknowledge their feelings, letting them know that these feelings are
normal and that everyone will get through this by working together.
• Encourage the use of relaxation techniques, such as deep breathing and imagery for those
who are able to participate.
• Provide diversional activities that are appropriate to the individual’s interest and skill level.
Be prepared to provide activities that do not require electricity, such as puzzles, games, arts
and crafts, storytelling, and completing household tasks.
• Encourage individuals who are able to participate in emergency management activities.
Perhaps someone can go to the storage area to retrieve food and water while someone
else shovels snow from the walkway.
Additional Suggestions And Reminders
The strategies listed here can help people to get through a home confinement situation due to
emergency conditions. Additional suggestions are:
• Store First-Aid kit in a convenient place known to all.
• Keep items in air-tight plastic bags.
• Change stored water and rotate stored food every six months to maintain freshness.
• Replace batteries yearly.
• Practice emergency situation drills on a regular basis.
The APS HCQU has an Emergency Preparedness Resource Manual available on the HCQU
website at (www.hcqu.apshealthcare.com). To download this manual, click on the Other
Resources tab and then on the Emergency Preparedness Resource link.
Please note, follow your agency’s policies and procedures regarding emergency management.
Disaster Preparedness, retrieved on July 29, 2010, from
United States Search and Rescue Task Force, Family Disaster Supplies, retrieved on July 29,
2010 from http://www.ussartf.org/family_disaster_supplies.htm
Emergency Preparedness Resource Manual, APS Healthcare
Southwestern Pennsylvania Health Care Quality Unit, retrieved on July 29, 2010, from
Heat Exhaustion, retrieved on July 29, 2010, from
the Holidays — By Amy Kanich, RN, BSN
“Chestnuts roasting on an open fire, Jack Frost nipping at your nose. Yuletide carols
being sung by a choir…” A familiar line from a popular Christmas song paints mental
images of a greeting card like festive season. For many, the holidays are looked forward
to with great anticipation, a time set aside for family and friends, invitations to festive
parties, and the excitement over the exchange of beautifully wrapped gifts. The holiday
season is so often referred to as the “most wonderful time of the year!” However, for
some individuals, the holiday season may be better described as one of the most
difficult times of the year. For these individuals, the holidays are looked to with dreaded
anticipation: days filled with less than merry emotions, often described as uninvited
loneliness, sadness, anxiety and depression. The familiar colors of red and green, so
often used to color the holiday season, are replaced with blue, dark blue — the
T he holiday blues are defined as “a feeling
of sadness, loneliness, depression and
even anxiety that often occurs in and around
Holiday Blues Coping Strategies:
Maintenance of routines – The hustle
and bustle of the holiday season can bring
the holiday season.” Individuals with ID/DD who
mayhem to the routines of everyday life.
are experiencing a loss in their lives, changes
Routines provide direction, consistency
in living environment, symptoms of an acute
and comfort to individuals. Ensuring the
or chronic medical condition or reliving painful
consistency of routines, with minimal
memories of past holidays are especially at risk
distraction, helps individuals avoid excessive
for the holiday blues. The holiday blues can
anxiety that often accompanies the uncertainty
also occur in individuals who are enthusiastic
and unfamiliarity. Giving the individual
about the holidays, but the stress of altered
an opportunity to prepare and anticipate
routines, lack of financial means, and unmet
events will likely lessen the anxiety that often
expectations soon overshadow the excitement
of the season. The symptoms of the holiday
blues often mimic those of depression. Unlike Choice – Allowing individuals to choose the
the characteristics of depression, the blues holiday activities in which they would like to
symptoms are short in duration and usually participate can increase the positive feelings
resolve once the holiday season has ended associated with the choice and decrease the
and the normalcy of everyday life returns. sense of anxiety that often accompanies lack
Although no prescriptive medical intervention of control and change in routine.
is usually needed for resolution of the blues, Create new traditions – Traditions can
a consultation with the individual’s physician provide a sense of excitement, familiarity
is recommended. Recognizing symptoms, and belonging. For some individuals
seeking medical advice and incorporating a though, memories of past traditions may
few coping strategies into the everyday lives of evoke feelings of depression and sadness
the individuals can help to provide them much surrounding this time of reminiscence.
needed support throughout this difficult time Talking to someone about past holiday events
of the year.
and exploring opportunities to create new in treating the holiday blues. Choosing safe
traditions may help the individual to connect winter activities can help people to enjoy the
to the past, while creating new memories that beauty of the season while combating any
provide hope for the future. unsettling feelings related to the holiday blues.
Talk about feelings – Giving an individual an Seek an increase in community
opportunity to talk about personal feelings participation – The holiday season often
in regard to holiday events can prove to be brings an assortment of wonderful community
very beneficial. Expressing one’s feelings activities such as holiday concerts, plays,
allows for “therapeutic venting” and gives parades and dinners. Participation in
caregivers an opportunity to see the holidays community activities allows one to celebrate
through the eyes of the individual. Validating the holidays with a larger group of people,
individuals’ feelings about the holidays which may help to combat feelings of
helps to acknowledge their heart’s concern loneliness. The holiday season also provides
and provides an increased opportunity of an increase for volunteer opportunities.
understanding for all involved. Individuals who are able to volunteer may find
Encourage healthy a sense of purpose
The symptoms of the holiday blues are: and pride when given
eating – Overeating of
sweet and rich foods • Headaches the opportunity to help
often associated with others. Volunteering
• Inability to sleep or sleeping to
the holidays can cause serves the recipient as
unhealthy weight gain well as the volunteer.
• Changes in appetite
and lead to fatigue, As noted previously, the
anxiousness and • Agitation and anxiety true “holiday blues” are
irritably. Enjoying rich • Excessive or inappropriate feelings usually short in duration
foods in moderation of guilt and often subside after
allows for people the holiday season
to fully enjoy the • Diminished ability to think clearly or ends. Individuals who
bounty of the holidays concentrate experience prolonged
while preventing • Decreased interest in activities that symptoms of irritability,
the ill-effects from are usually enjoyable anxiety, inability to
overeating. Providing sleep, lack of appetite
healthy alternatives to the season’s rich and decreased interest in activities beyond the
foods and encouraging individuals to make holiday season could possibly be exhibiting
healthy choices when celebrating can help to a more serious condition such as Clinical
combat symptoms associated with sugar and Depression or Winter Seasonal Affective
carbohydrate overload. Disorder. These mood disorders, unlike the
Participate in physical activities – holiday blues, usually present with symptoms
Encouraging participation in physical activities lasting 3-6 months or longer in duration
can help individuals lower stress and anxiety and therapeutic medical management
levels, and promote an overall feeling of interventions are often needed for a full
wellbeing. Winter provides an abundance of recovery. Any questions or concerns about the
outdoor activities that can be fun and provide symptoms of the blues should be directed to
ample amount of exercise. Exercising outdoors the individual’s personal care physician.
in the winter also exposes individuals to
sunlight, which has been proven to be effective
Mrazek MD, David (2008, December). Managing the Holiday Blues, Mayo Clinic, retrieved on
7-7-2010 from www.mayoclinic.com/health/holiday-blues/MY00492
Cleveland Clinic (2008, October). Managing Holiday Stress. Cleveland Clinic Healthy
Living. Retrieved on 7-7-2010 from http://my.clevelandclinic.org/healthy_living/Stress_
University of Maryland Medical Center ( 2006, May). Mental Health: Symptoms of Holiday
Blues. Retrieved on 7-7-2010 from www.umm.edu/mentalhealth/holsymps.htm
Colaborative and Responsive Educational Support
www.hcqu.apshealthcare.com 1-888-321-5861 or 742-864-0715 (Fax) 724-864-3750
North Huntingdon, PA 15642
8775 Norwin Avenue, Suite 103
Norwin Hills Office Center
APS CARES is published by APS Healthcare, Inc. / Southwestern PA Health Care Quality Unit (HCQU)
North Huntingdon, PA 15642
8775 Norwin Avenue, Suite 103
Norwin Hills Office Center
Southwestern PA Health Care Quality Unit (HCQU)
APS Healthcare, Inc.
INTRODUCING . . .
THE APS HCQU’S
BLOGS AND FORUMS
The APS HCQU recently added a “Blog” page to its website with the intent of providing an online
environment where users may gain new and useful information to support people with intellectual
and developmental disabilities (ID/DD).
By providing researched information, the APS HCQU hopes to inspire providers and caregivers
to share their own experiences and resources and to raise questions that will give others food for
thought and better insight into caregiving.
The Forum page is set up as a series of online “rooms.” Each room will address a different topic of
interest related to serving people with ID/DD. Users must register with an email address from an
approved agency to access these Forum rooms. Users are encouraged to post information to provide
opportunities for on-going dialogue with both the APS HCQU staff and people from other agencies.
The APS HCQU hopes that users will find the information posted to these Forums to be of use in the
care and support they provide to people with ID/DD.
To participate, please join us at our website: www.hcqu.apshealthcare.com
We look forward to hearing from you soon!