Oklahoma first established services for people with mental retardation during the second legislature in 1909 with the creation of the Oklahoma Institution for the Feeble Minded in the city of Enid. After several name changes, the institution became known as Enid State School. The Pauls Valley State School was established in 1907 as a state training school for boys and was operated as such until converted to a state hospital for people with epilepsy in 1945 and to a state facility for people with mental retardation in 1953.

In 1959, the 52nd legislature recognized the need for additional beds to serve a rapidly growing population of citizens with mental retardation and appropriated one million dollars for the construction of a third institution on land donated by Mr. and Mrs. Wiley Hissom, near Sand Springs. Later, in 1961, an additional 5 million dollars was appropriated to complete construction and fully equip the facility to be named The Hissom Memorial Center.

Until 1963, The Pauls Valley State School, the Enid State School and The Hissom Memorial Center, as well as the Taft State Hospital, were operated by the Department of Mental Health and Retardation. On July 1, 1963, these facilities were transferred to the Department of Public Welfare. At the time of the transfer, there were 2,300 residents in the Enid and Pauls Valley facilities, with a total of 709 employees. The Enid State School was extremely crowded with 1,444 children and adults in residence. The Hissom Memorial Center would be licensed for 500 additional beds.

To meet the needs of this growing population and to relieve overcrowding at the public facilities, the Medical Services Division of the Department of Human Services began contracting with private nursing homes to provide residential services for people with mental retardation.

In 1971, institutional services for children and adults with mental retardation were greatly influenced by the establishment of Medicaid reimbursement to facilities meeting the standard for care as Intermediate Care Facilities for the Mentally Retarded (ICF/MR). Regulations required compliance with standards of staffing levels, development of treatment plans, provision of active treatment, use of medications and appropriate physical environment. The state operated facilities as well as many private nursing homes became licensed as ICF/MRs to qualify for the Medicaid reimbursement.

Group Home Program
The Group Home program, established in 1981 by former first lady Donna Nigh, was the first community residential option for adults with mental retardation. These group homes gave people an opportunity to live in a home setting in the community with a small number of their peers, while receiving training for independent living skills. There are currently more than one hundred group homes around the state.

The Robert M. Greer Center became operational April 3, 1989 as a 48-bed unit of the Enid State School. This facility serves a maximum of 52 people with a dual diagnosis of mental retardation and mental illness. On January 1, 1992 the Greer Center began operation as a separate entity although remaining on the campus of Enid State School.

In 1992 Enid State School and Pauls Valley State School underwent another name change, and the two were renamed the Northern and Southern Oklahoma Resource Centers.

As of April, 1999 there were 418 residents at NORCE, SORC and the Greer Center, with 1,400 total staff members.

The Strategy
From 1909 until the 1980’s, Oklahoma’s strategy for serving people with developmental disabilities relied almost exclusively on institutional placement. In 1985, two developments occurred which continue to exert great pressure on the state to de-institutionalize its service program.

The first was the creation by the Health Care Financing Administration , now known as the Centers for Medicare and Medicaid Services (CMS), of a home and community-based waiver to the ICF/MR program. This waiver permitted ICF/MR level services to be provided outside an institutional setting. The second was the filing of the Homeward Bound class action lawsuit to compel the state to create community-based alternatives to institutional placements. The resulting court order also required the closure of The Hissom Memorial Center.

To comply with the federal court’s 1987 order in the Homeward Bound case, funding was appropriated to create a system of community-based services to serve the 950 members of the Homeward Bound class in community settings. Although there has been no similar mandate to serve people in the community who were not members of that class action lawsuit, the Department has offered these services to residents of the remaining two facilities and the general public as funding allows. Residents of the resource centers who wish to move have been "transitioned" from the facilities into community homes.

Alternative Care
People in Oklahoma, seeking an alternative to institutional care for family members, began applying for Home and Community-Based Waiver services. These services include residential service options such as: Specialized Foster Care, Agency Companion, Daily Living Supports and Group Homes. Employment programs include: Sheltered Workshops, Community Integrated Employment and Supported Employment.

As of June, 2001 there were 2954 people receiving services through the Home and Community Based Waiver. Approximately 950 of those are Hissom class members.

In 1992, the Oklahoma Legislature passed the Oklahoma Family Support Act. This bill authorized the Department of Human Services to set up a program which would provide assistance payments to families who wanted to keep their children with developmental disabilities at home. By 1993, the Developmental Disabilities Services Division had in place the Family Support Assistance Payment Program. This program provides a cash payment to families who are raising children with developmental disabilities under the age of 18. As a result of this program, there are 950 children living at home with their families.

Making a Difference
As of June, 2001, there are more than 5,000 people with developmental disabilities receiving community services through the Home and Community Based waiver or other state funded sources from the Oklahoma Department of Human Services (OKDHS).

In August 1999, the Department submitted applications for two new waivers to CMS , and these were approved effective July 1, 1999. The In-Home Support Waivers for children and adults were developed in response to the 1997 study of Oklahoma’s waiting list conducted by Oklahoma State University. This study surveyed the entire waiting list to identify what services people most needed.

The findings, based on a better than 50 percentage response rate, showed that 82 percentage of the waiting list lived in their own homes and that the most needed services were for help with daily living activities., respite care, and vocational services. The In-Home Support Waivers will provide a service authorization of $16,950 for adults and $11,300 for children, and the design of the program is for the services to be self-directed to the greatest extent possible. With the approval of these waiver programs, the Division believes it has the tools at hand to make rapid progress in serving individuals on the waiting list.

For questions or comments, please contact Sheree Powell