[MUSIC PLAYING] DEBRITTANY MITCHELL: Hello, and welcome to the Transit Planning 4 All podcast series. This is DeBrittany Mitchell speaking. And I am co-hosting today's podcast along with my colleague David Hoff from the Institute for Community Inclusion. In this series of conversations, we feature transportation planners and advocates who share lessons learned in their journey towards inclusive transportation planning. Inclusive processes for transportation planning actively involve older adults and people with disabilities, and lead to the development of community and public transit programs that effectively meet the needs of the people for whom they're designed to serve. 

Today's featured speaker is Julie Wilcke, the Executive Director of Ride Connection. Miss Wilcke has been instrumental in Ride Connection service expansion, the creation of innovative programs like The Dialysis Transportation Program, building new partnerships to ensure the most efficient use of resources, and so much more. With her knowledge, leadership, and support, Ride Connection has been able to grow innovatively and create programs and services that allow customers to access transportation in the way that best fits their individual needs. Listen as she shares about her experiences, successes, and lessons learned. Julie, could you give us just an overview of your background and experience, and how you got involved in transit planning initiatives? 

JULIE WILCKE: Sure. So I started down this journey in transportation, specifically independent mobility of older adults and people with disabilities, back in the early '90s. It's always interesting to talk to people, how they started in the transit industry. I came in as a volunteer driver. I was a stay at home mom. My mom had passed away from a condition that affected her ability to freely travel in her community. 

So I went to a local nonprofit and asked them how I could be of service as long as I could bring my children. And they asked if I had a vehicle. And before I knew it, I was driving people around in my vehicle. And it actually progressed from there. 

That was a life changing experience for me. And I've been in transit since. I have worked for Ride Connection since 2000. I started as a driver trainer. And my current position is CEO. 

DAVID HOFF: Can you tell us a little about what is Ride Connection? 

JULIE WILCKE: Ride Connection is a nonprofit organization that really supports the independent mobility of our community members. And we do this really, as not only a provider of direct service, but as a collaborator and convener of services throughout our community. So we provide service in a tri-county region. We provide that service by mainly coordinating with social service organizations within our region that provide direct service to their clients, including transportation services. So we provide support for smaller social service agencies to be able to do what they do best, which is serve their clients. 

In addition to that, where a social service agency has not been found to provide that service, then we will be a direct service provider. So we have a fleet of accessible vehicles. Our network has about 800 drivers in it, 2/3 are volunteers. So we have volunteer drivers providing service in their own private auto, as well as agency vehicles. 

We also have a multitude of mode options available based on the individual's ability level, and what they see as independent mobility. So we're teaching people how to ride the public bus system. We have community last mile connectors, as well as we have volunteers that are providing a ride to their neighbor and receiving mileage reimbursement in the process. 

DAVID HOFF: So I know that a particular project that we want to focus on today is one that, in regards to dialysis transportation-- so in terms of how you created-- got involved with a planning process and facilitated a planning process to get folks involved in improving that service-- so maybe start with telling us a little bit about how you identify-- I mean, what were some of the issues? And how did you identify that particular issue? 

JULIE WILCKE: Yeah. So again, with Ride Connection being kind of a convener of transportation for individuals in our community, we always are looking for trends in you know, not only best practices, but also issues that are arising, whether it be capacity issues or geographic region issues, or really just that the service may not match with the consumer's ability is. And so we're always looking for ways to improve our services. 

And in this particular project, which we started in 2013, we really wanted to tackle the challenges associated with getting individuals to and from hemodialysis treatment, which is in center treatment. From a transportation provider perspective, there are some challenges with that type of transportation. And then from the patient or the rider's perspective, there is even more significant challenges that really affect their health. 

So that's what we kind of set out to tackle, kind of our main goal, how we framed it was keeping people healthy involves more than just providing health care. It requires access to care and broad health supportive services, including high quality customer-focused transportation. So that was kind of the goal of the project. 

DAVID HOFF: So yeah. So I think that's an interesting in terms of just even I think that generally people don't think of transportation necessarily as health-related as impacting people's health. So it's really interesting that you know, obviously, you, in your work obviously, identify that as a significant issue. 

JULIE WILCKE: Most definitely. Access to services is crucial to keeping people healthy. 

DAVID HOFF: And access on a timely basis and all that. 

JULIE WILCKE: Correct. 

DEBRITTANY MITCHELL: And Julie, you mentioned that in some cases services did match the consumer needs. Can you tell us a little bit about how you directly engaged consumers to get their perspective on transportation issues? 

JULIE WILCKE: Sure, sure. So what we really set out to do was to create an environment where what we ended up with was really developed in a way that was people-centered or you know, human-centered with including the individuals that were affected by this problem or issue in being fully involved in what the outcomes would be. So we received support through Administration for Community Living as well as Community Transportation Association of America, Easterseals, [INAUDIBLE] and West [INAUDIBLE] to start this concept of creating a intentful approach in involving those that were affected by the problem in creating a solution. So that's in a nutshell what we were doing. I can go into more depth on how we did that, what we saw as results from that process. But it was really kind of creating this collaborative team-based cross disciplinary approach to getting at what needed to change. 

DAVID HOFF: So within that-- so I mean, share a little bit about how you were able to start to-- the process you undertook that the advisory committee undertook, how you recruited folks. What were the ways that you worked on to make this an inclusive planning process to get the folks who were impacted by this transportation challenge, how did you get them involved? And what message did you use in terms of [INAUDIBLE]? 

JULIE WILCKE: OK. Yeah. First of all, I mean, one of the things that I mean, right off the bat, I felt like we needed to overcome this challenge of that there are many advisory committees, right? And often times, when people have advisory committees, they're doing it because they want to get people's input and advice. But it may be a requirement that they have the advisory committee, or there's certain expectations of what the committee advises on and not. And we really wanted from the get-go to have individuals fully embraced with not only advising, but also implementation. 

So from the get-go, we recognized that this kind of generic outreach for recruiting, for support in this project was not going to work for us. There needed to be this personal touch in this ensuring that information that outreach and that engagement was at the level that the person we were reaching out to would be willing to be engaged, if that makes sense. So right away, we knew that we needed to have some people that were identified as stakeholders. We had some individuals that you know, would be advisory committee members and would be with us along the way. And that was a larger commitment and involvement and support, where stakeholders just wanted to be informed or were interested about the project. 

But they didn't really want to be-- have that level of engagement on a regular basis. We also knew that you know, there were some people that were subject matter experts that could help us with different aspects of this process. So we wanted to create this environment of work-group committees too that wouldn't take on necessarily the overreaching challenges of the advisory committee, but would focus on specific topics within kind of what we were implementing. 

We also knew that not all community members would feel comfortable being on an advisory committee, but maybe they wanted to share their own personal experience. So we set up focus group opportunities. We also set up one on one interview opportunities, as well as survey work. So we wanted to have both electronic and paper, in-person, so assisted and unassisted surveys available to get at even more information, and have more areas of involvement from a wide range of voices. 

DEBRITTANY MITCHELL: Julia, it sounds like you've used a variety of methods to get people engaged in outreach to people. Can you explain to us a little bit more about some of the success that resulted in some of your engagement and outreach efforts and how you measure that success? 

JULIE WILCKE: OK. So I would say for me, the overreaching success of this was when the project was over, we actually had made small operational changes, larger systemic changes, as well as this subject was being talked about more often. And in addition to that, we were able to hire on a project basis two of the patients that were involved in our advisory committee to support implementation and ongoing training. So to me, those were the larger, more broad measurements of success. So how we really supported the work, I think we need to recognize who the individuals are that you want to get involved. And you have to create an environment where they feel their voice is truly heard. 

So for us in this particular situation, we're working with-- we wanted 50% of our advisory committee to be individuals that were receiving in center treatment. So we needed to recognize as facilitators of this advisory committee that that meant we were working with individuals that had compromised health. So we needed to be aware of that. 

In addition to that, when we're doing the survey work, to get even more people's voices heard, we need to be fully aware that in this community of people that are receiving life sustaining treatment on a regular basis, they're getting quality of life surveys that they have to do all the time in the center. And so we kind of deemed them as survey weary. So they're taking these quality of life surveys all the time. And they aren't necessarily seeing any changes. So their voice isn't truly being heard. So we needed to also ensure in our surveys that there was-- we incentivize them, our survey taking. 

So we were very cognizant that we wanted to make sure that we were saying that there was a value added in their voices being heard. We also made sure that the surveys were done in different ways, so that no matter if you needed assistance or not, if you could get online, or you felt more comfortable doing a paper copy, if you spoke English or a different language, that you would have access to that survey. That was important to us. And then the other piece is really making sure that there is that feedback loop. So we got back to them about what results we found in the surveys, what the information was that had been generated from their voices being heard, and what we were going to do about that. 

So it's kind of a process as we-- we used kind of design thinking techniques when we're going through this process. So what is the problem now? So kind of framing what we need to think about. And then kind of reaching out like, what if we did differently-- what could we do differently? 

And then kind of coming up with building upon that. So not only the what ifs, but wow, what if we did something incredibly different or outside the box thinking? And then from that, we took some of those and experimented with them. So what would it look-- one example is in one of our work groups a driver was talking to a consumer. And they started talking about the difficulty in actually connecting with somebody if they're return time home changed. 

So they came up with this idea well what if you had a dedicated dispatcher that would talk to each of the dialysis centers, and they could confirm what the return right time was, or if there was any last minute changes, they could make those changes quickly. And just that conversation got us to a aha moment. And then we experimented to see if that would work. 

So I think [INAUDIBLE] probably. That's how we measured success is that we engaged, we continue to that and check in with those that were a part of the advisory and had surveyed, and then we experimented and demonstrated our successes or challenges too. Because we had some challenges also. 

DAVID HOFF: So maybe I mean a few things, just to summarize a little bit of what I've heard you say, is number one, you used a variety of ways to engage people to make sure that they were truly engaged. This was not just yes, we're going to survey you and get your input, and then just go about our business. But that we're really going to engage you in this process. And that you're going to also that you are very much part of the process of developing solutions. 

So again, that you are-- the folks who are impacted this are very much you know, very much fully included in this planning at a level-- and we talk about our projects about the pathway to inclusion. But this sounds like it's pretty high up there in terms of really them being truly involved in developing ideas and helping to implement them. Correct? 

JULIE WILCKE: Yes, definitely. And there are challenges was within that, in the framework of transit planning. 

DAVID HOFF: So what are some of those? 

JULIE WILCKE: Well, let me give you one example. And I think part of it is when you accept this groundwork, when you have truly created an advisory committee that's more than just advising, but supporting implementation, you're letting go control a little bit. And so one of-- I'll give you an example. So the committee wanted to name this project. We were going to test some applications at a clinic. 

We were going to purchase some vehicles that would be available for this clinic. And so they wanted to name it. And there was a big discussion about what it should be named. They felt that it needed to show growth and vitality and change. And they wanted something beautiful. 

And so they wanted-- they came up with the idea that the name of the projects should be Dahlia. It's not an acronym that means anything, but it's a beautiful flower. And they wanted the vehicles and everything associated with this pilot project to be splashed with beautiful bright vibrant colors. So I took that to our marketing team, and they were a little concerned that that didn't really match any of our branding. 

But again, this is what the committee had decided. And it made sense. Because we were trying to move beyond this hemodialysis transportation to life sustaining treatment and move into this new era of how we could do things differently. So we were called the Dahlia pilot project. And we continue to have that today. 

DAVID HOFF: I think it's also a good-- you said about giving up control, you've got to be OK with that too. 

JULIE WILCKE: Oh definitely. Right. And that takes-- OK, so that takes in the committee work having a facilitator that ensures that all voices are heard. And then outside the committee work, within the organization or entity that's managing this change that's really inclusive, you need to do work to support everybody else's evolution within the organization too. 

DAVID HOFF: That people really understand and respect the process. 

JULIE WILCKE: Yes. 

DAVID HOFF: Even if it's going in a direction they don't necessarily agree with. 

JULIE WILCKE: Correct. 

DAVID HOFF: I mean, if we really going to have an inclusive planning process, that means that we may be going a direction here that is not you know, the quote unquote, "experts" or whoever thought the way to go. 

JULIE WILCKE: Right. So you have to-- Yeah, you have to spend time building these trusting relationships you know, on both sides. That building that committee so that you're insured-- because you have people-- if you're doing a-- if you know, if the main work is kind of focused on the decision making powers within this committee, you need to ensure that you have a good cross disciplinary team. So you have-- we had patients, we had a quality assurance coordinator from a dialysis clinic, we had a social worker, we had drivers, we had transportation providers, as well as transportation planners on the committee. 

So we needed to create an environment where the patient who only knew from their experience how transportation affected them, have enough information so that their voice could be heard at the same level as everyone else's in that committee. And that they felt comfortable about that. So I guess, that is the other challenge is doing that, it takes time. You have to have a quality facilitator that's really truly willing to engage those. And you have to spend time in ensuring that all committee members feel that they're in an environment where their voice is respected and heard. 

DAVID HOFF: So, two thoughts on that. One, is obviously I think one thing it felt like you did really well was also being very thoughtful about who are the stakeholders and making sure that the right-- that people, as you said, you know, there's individuals who as patients or consumers in a more general sense, they have their perspective. And they're always like, why can't we do this or that? But if you can bring lots of different folks to the table who recognize and understand whether it's the health care provider, the drivers, whoever it might be coming together in a fairly safe environment to share their experiences and perspectives. But having those constituencies represented is really, really important. 

JULIE WILCKE: It is. I will tell you though too, you know, the kind of concept of right people at the table, when you are working with a group of patients that have been asked to do surveys before, but have never been truly engaged, they don't necessarily believe or know that they're the right people to be at the table yet. And I think that takes time. And my example on that is the person that had the idea to call this project the Dahlia program, she came to me after the first meeting and said I don't know what I'm doing here. This is over my head. I don't feel value added. But with working with her, and helping her build her knowledge base outside the committee work, she gave this phenomenal idea to us that just transformed this project. 

DAVID HOFF: So you talked a little bit about creating that right atmosphere of trust and just an effort to sort of really have the group work well together. Any specific strategies in terms of that you haven't mentioned already? 

JULIE WILCKE: Yeah. OK. So I'm going to just go back to that, taking the time. It does take time. And I think that you have to create a space where people understand that it's OK to have time for personal growth in this process. So the other piece of it is I think that you need to make sure that they're-- what we did is we had ground rules that we developed as a committee. So that there would be respectful listening, that there would be respectful bantering back and forth about opinions, that we would turn off all distractions and write all ideas on the board, that we would do processes where we kind of backtracked on certain aspects of it to ensure we had it right, we created an environment where-- well, I just remember at one of the patients came up to me after the meeting and said that they really appreciated kind of the intro being done the way it was, because it felt like a support group. I mean, these were patients that didn't necessarily-- weren't necessarily seeing each other outside this advisory committee. 

And we wanted to make sure everybody had a moment to come together and share if they wanted to. So we carved out, just at the beginning of the end of every committee meeting, we had a sharing where everyone would go around and say you know, what has gone really great for me since the last meeting, and what hasn't gone so well, so that people would have time to share if they wanted to do so. And it's kind of like that, you know, these stories paint bigger pictures of our lives and really helped-- I think helped set the groundwork for people to develop respect for each other and create the respectful listening environment. 

DAVID HOFF: And obviously the facilitator having a good facilitator. You mentioned that already. You know, I would agree that can't be emphasized enough. Somebody who's good at reading a room, making sure that everybody has the opportunity to engage, structures things well, allows people to sort of wander a little bit, but then brings people back. And there is an art and a science to that. 

JULIE WILCKE: Oh, there definitely is, because what I call kind of our introductory session, you could have that become, without managed well, it could take up your whole committee meeting and turn it into more of a complaining session. And you just don't want-- That's not productive in that environment either. So yes, facilitation is crucial. 

And I'll just say one other thing on that too. I think having an idea-- whatever approach you're going to take to really kind of make sure you have that thought out, we use kind of a design thinking model. And so we had this foundation of how we were going to move the group forward. It also provided us with just ideas or ways to approach subjects. And some of them were just so simple, but so enlightening. 

When you're in-- I remember the one activity that we did where instead of we were building on ideas and you use the yes and instead of yes but, just framing that in that we can do anything instead of we can't do that because, can move you to a larger more broad fluid conversation. So having kind of whatever it is, whether it's design thinking or another term, having a model and a process that you use really helps me. 

DAVID HOFF: And it's the little things as you said. 

JULIE WILCKE: Yes. 

DAVID HOFF: Not the yes but, but yes and. It's all those little things [INAUDIBLE]. 

JULIE WILCKE: Yes! 

DAVID HOFF: So what did you end up. Ultimately, I know you did the planning. So what [INAUDIBLE] concretely? What changes did ultimately you make? I know you had a phase two there. 

JULIE WILCKE: Right. So I think ultimately what we did, from an inclusive planning process, I would say the most exciting you know, effects of that were that we hired two of the patients to continue this project. We implemented change in-- we took our pilot from one clinic to and added a second more rural clinic to see if there were other things that we could do differently. We also then took our concepts learned to what we would call frontier organ community to support their work in inclusive planning, which you know, it's different when you have fewer people in a community that you're working with and that you can reach out to. So we learned some new things from that. 

We created training for drivers so that they were more receptive and had empathy in providing the transportation service. We changed operational aspects of our systems in order to better serve those that were receiving transportation to and from dialysis treatment. And then I think that another big component of this-- and I had a social worker that told me this one time-- it is that it's just we had people's attention on a subject that hadn't been talked about a lot. And so we engaged not only local social workers to help support and spread the word on this process, but we were asked to come to the Kidney Foundation annual meeting. We were in the Journal of Nephrology with our results from our project. 

I was asked to be on a Transportation Research Board panel to really look at dialysis transportation on a national level. So I think there were many, many good outcomes within our initial project goals, as well as we've used this technique not only for all new planning processes, but I was just thinking about in my new role as CEO, I kind of use a lot of the same techniques when I'm making organizational changes now that I've learned from this inclusive planning process. 

DAVID HOFF: So where do things stand today? It's been a few years. These changes have been sustained? And with better receptivity? 

JULIE WILCKE: Yeah, I think as far as the inclusive planning piece, everyone is receptive that. And we've tried it on multiple different projects. That really involving those that are affected by the problem, the issue, or the new service by involving them, engaging them in more than just advice role is crucial in order to make quality new programs. And from a dialysis perspective, I think that the small changes that we made were definitely successful, and are still being used throughout our community. The larger issues around funding for dialysis transportation to dialysis treatment is still an ongoing conversation. And we hope to have more focus on that in the future. 

DAVID HOFF: But you have a structure as you deal with these ongoing challenges to ensure that you really are getting those who are impacted are really engaged in those conversations [INAUDIBLE]. 

JULIE WILCKE: Yes. On an ongoing basis, yes. It's changed the framework in which we do transit planning. Two thoughts that I have. I have this Albert Einstein quote that I like to use, because oftentimes in the transit world, we think about moving the masses and data driven projects that have data driven results. So I think that it's important to remember that not everything that counts can be counted, and not everything that can be counted counts. 

So that's one thing to remember. I think the other thing that I didn't mention earlier that to me, is another wonderful reason to involve those that are affected by the condition in creating results is when you need to have buy-in to really effect change. And it's buying at many levels, patients, clinics, transportation providers, drivers. And if you create an environment where you are involved the people in the decision making process, there is that buy-in. And you have what I would consider street cred. 

So when I would take one of my advisory committee members a patient to a forum where we were asking for funds to support this project, and they were the ones speaking, and I was just there to support them, it provides you more opportunity, I think, for the true story to be told by the people that they're affected by, and it's more impactful and more powerful. 

DEBRITTANY MITCHELL: We want to thank Julie for joining us on this edition of the Transit Planning 4 All podcast. Miss Wilckie's story of transportation advocacy had some wonderful lessons learned and highlights the success of Ride Connection, and improving access to high quality health care in the community. 

DAVID HOFF: For me, the most important overall takeaway is that person-centered approaches involve riders in coming up with solutions. The key is creating an environment where they feel their voices are being heard. 

DEBRITTANY MITCHELL: I agree, David. This podcast is a production of Transit Planning 4 All, an inclusive and coordinated transportation planning project seeking to increase inclusion in transportation planning and services for people with disabilities and older adult. 

DAVID HOFF: Transit Planning 4 All is funded by the Administration on Community Living at the US Department of Health and Human Services. Transit Planning 4 All is operated by the Community Transportation Association of America, CTAA, in conjunction with N4A, the National Association of Area Agencies on Aging, DJB Evaluation Consultation, and the Institute for Community Inclusion at the University of Massachusetts, Boston. 

DEBRITTANY MITCHELL: Our project website is ACLtoolkit.com. If you have any questions or comments on this podcast, please go to our website, ACLtoolkit.com, and click on the Ask the Expert section. Episodes of the Transit Planning 4 All podcasts are released monthly via our website and various podcast platforms. This is DeBrittany Mitchell. 

DAVID HOFF: And this David Hoff. Thank you for listening and please join us again. 

[MUSIC PLAYING]