Letter from Bill Turenne, Chair of the Board

If the past is a compass for the future, then ITNAmerica is going to have a very busy and successful year. In 2007 we added six affiliate communities, bringing our total to ten, and we are on track to add at least ten more in 2008. Some affiliates will be joining us in state clusters, four from New York for example, in collaboration with the New York State Office on Aging. Replication in clusters is something we hadn't initially anticipated, but we are glad to see it happen, as it enhances the sharing of best practices and resources within communities and creates stronger and more viable networks.

We are pleased to welcome former U.S. Secretary of Transportation Norman Y. Mineta to our Council of Advisors. We are honored to have one of America's most prominent leaders join us. Also serving on the Council is Orlando Delogu, Emeritus Professor at the University of Maine School of Law, who has been a stalwart supporter of ITN from its inception. Others will be added to the Council of Advisors in the coming months. The Board also created an Affiliate Community Advisory Board (ACAB) as an integral part of the governance of our organization to assure that as we move forward, communities are well represented in the Board's deliberations. The ACAB annually elects a Chair who serves as a voting member of the ITNAmerica Board of Directors.

In a year that has seen much national and international interest, ITNAmerica was featured in The Small Business Economy: A Report to the President, an annual series used by policymakers, academics, librarians, and others to learn about small firms. ITNAmerica is one of eight examples of social entrepreneurship included in a chapter by Andrew Wolk of Root Cause titled "Social Entrepreneurship and Government: A New Breed of Entrepreneurs Developing Solutions to Social Problems." Wolk's chapter represents one of the first explorations of the relationship between social entrepreneurship and government. We are honored to be included in a report to the President.

One of the most important innovations at ITNAmerica is our software. We learned years ago that our sustainability is directly connected to information technology. ITNPortland, and now our new affiliates, run their operations on ITNRides™ version 1, uniting ITN affiliate communities and their families across our nation. It has proven to be very stable. In 2008, ITNAmerica is releasing ITNRides version 2, which will be a truly scalable Internet based software service.

The continued growth of the ITN model lends credence to the increasing importance of transportation issues for older Americans. At the recent White House Conference on Aging, mobility was ranked the third highest policy priority for older people–-ahead of Social Security and Medicare. This challenges each of us to continue the work of our organization for the future.

On behalf of the entire Board, please join us as we continue our work for the dignified mobility of older people through the mission and ideals of ITNAmerica.

Sincerely,
Bill Turenne

ITNAmerica welcomes ITNSanDiego™ to the family of affiliates offering dignified transportation to adults over 60 and the visually impaired. The roots of the new nonprofit can be traced to 2003 when Barbara Workman's husband Bill died in a car accident on a hilly two-lane canyon road, less than two miles from home. An 82-year old woman was driving down the road and lost control of her car. She hit the gas instead of the brakes.

Three years later, Barbara read an article about the Independent Transportation Network (ITN^®) in her local newspaper. She said, "It seemed like a very good idea to provide transportation for seniors who should no longer be driving... and it still seems like a good idea."

In true grassroots fashion, Barbara, a retired high school administrative secretary, sent in an application to establish an affiliate. Barbara's story resembles that of Katherine Freund, the founder of ITN, whose 3 year old son was run over by an 84 year old driver who thought he'd hit a dog. (Katherine's son survived a traumatic brain injury.)

Both women understood that crashes caused by older drivers were the result of a transportation system that wasn't meeting the needs of an aging population. And both women were determined to change that.

The first thing Barbara needed to do was find a partner. Floyd Willis of Aging & Independence Services turned out to be the perfect person. He had heard Katherine speak in 2006 at a meeting of the Older Californians Traffic Safety Task Force.

"Katherine introduced ITNAmerica as a safe option for those who need to stop driving. I knew the program would catch on nationally. I was so impressed that I worked to get Katherine to speak at the California Association of Area Agencies on Aging (C4A) later that Spring," Floyd said.

"Once back home, things fell into a lull until Barbara Workman called wanting to know if we at the Area Agency on Aging in San Diego County could help her establish an ITNAmerica chapter. Now I started getting excited about ITN all over again," said Floyd.

Just so happened that Floyd was planning a summer workshop on transportation and was trying to choose a topic. Not a problem now. The topic became the volunteer driver/private vehicle mode of transportation for seniors.

"I had the ITN PowerPoint on the big screen and we piped Katherine's voice in over a conference call all the way from Maine. This stirred a lot of interest. I liked Katherine's spirit -- she was saying there is room for all in this transportation mission," Floyd said.

Around the same time, Chuck Overbey, who is now the project coordinator for ITNSanDiego, saw the same article in the newspaper. "My response was that we had to have this in San Diego."

ITNAmerica introduced Barbara and Chuck, and within months they were working on submitting an application. Barbara, Chuck and Floyd secured support from the City and County of San Diego, and after nearly two years of planning and fundraising, ITNSanDiego officially became an affiliate in December.

Anyone can become a member, regardless of whether you qualify to ride. Everyone benefits. Businesses retain their valuable customers, adult children find relief from a complex problem, public safety is improved, and older adults stay connected to family, friends and community.

ITNSanDiego plans to begin offering rides in the summer of 2008. To find out how you can support the nonprofit service by becoming a charter member, volunteering, or donating a vehicle or money, please call Chuck Overbey at (619) 298-2903 or send him an email at info@ITNSanDiego.org.

As ITNAmerica receives requests for information from around the globe, it's become clear that senior mobility is a problem in every industrialized country in the world. Executive Director Katherine Freund recently returned from Alberta, Canada, where she was keynote speaker at the "Roundtable on Seniors' Transportation," hosted by the Edmonton Seniors Coordinating Council and the Alberta Motor Association.

Attendees at the Round Table included directors of senior's organizations, social workers, volunteer coordinators, seniors who are members of advocacy groups, urban planners, government representatives, and many others.

"As we consider international development, we want to choose an environment where government, private sector and community share the ITN vision of a connected system, and it doesn't get any better this," Freund said of the collaborative approach she encountered in Edmonton.

"There has been tremendous stakeholder buy-in and enthusiasm about bringing ITN to Edmonton," said Bonnie Dobbs, a Professor in the Department of Family Medicine at the University of Alberta, Edmonton.

A lot of that is due to the Edmonton Seniors Coordinating Council, established in 2004 to link all senior serving agencies in Edmonton. "It is evident that the vision of the Council is being realized in that so many of the players were around the table," Dobbs said. "So having an Edmonton Seniors Coordinating Council in place to move this initiative forward is instrumental."

Many of the issues that seniors face in Portland, Maine, home of the model ITN program, are the same issues they face in Edmonton. Both locales have a significant percentage of senior population and the same climatic situations – ice and snow and inclement weather that affect senior's mobility.

"The big surprise was that the senior mobility issues were virtually identical," Freund said. She went to Edmonton making no assumptions, but as she spoke, she kept seeing audience members nodding their heads. "They have the same attitudes regarding self-reliance and volunteerism," Freund said, noting that her audience consisted of many nonprofit and volunteer groups who understand the importance of not relying on limited government support for ongoing expenses.

The limitations of public transportation in both countries include safety concerns, vehicles that are not suited to people with the physical changes associated with aging, schedules and routes that do not accommodate the needs of seniors, and affordability, to name a few.

"Transportation is more than getting from Point A to Point B. It's really about independence and freedom and the ability to decide where to go and how to get there," said Alberta Motor Association spokeswoman Caroline Gee.

Many wonderful volunteer transportation groups exist in both countries, but few with the characteristics of an ITN affiliate. "The ITN model that delivers alternate dignified transportation to seniors on a 24 hour basis, 7 days a week, 365 days a year, is so tremendously exciting. It allows people who either choose not to drive or who can no longer drive to meet their mobility in a way that is consistent with what they did as drivers," said Dobbs.

Dobbs described the ITN model as one of the critical elements in a 'programmatic approach' for drivers who are no longer able to drive. She breaks this 'programmatic approach' model into three steps: First, identify those who may be at risk for declines in driving competence, such as someone with dementia. Second, assess them using a science-based evaluation; and the third, critical component is support for people who can no longer drive and for their families.

"Often, jurisdictions have pieces of this model, but few jurisdictions have an integrated, holistic model. The possibility of ITN coming to Edmonton is so exciting, because it will enable us, as a community, to put a holistic model of identifying, assessing, and supporting medically at-risk/impaired drivers into place."

For Dobbs, that support comes in two formats: support groups to help individuals make the transition from behind the wheel to passenger (supporting them on a psycho-therapeutic level) and for family members as they deal with the myriad of consequences associated with driving cessation; and, the support for continued mobility, which is just as critical. "That's where the ITN model fits in. Revoking someone's license without addressing mobility is unsatisfactory on a number of levels. For individuals and families and from a community perspective, it's imperative that we address all three areas," Dobbs said.

Since Katherine's visit, work on the initiative continues. "It is very clear that Katherine has developed a sophisticated, comprehensive transportation model that provides accessible, affordable, alternative transportation for seniors," said Dobbs.

Don Szarko, Manager of Advocacy and Community Services for the Alberta Motor Association, said, "Katherine's perspective and insight conveyed a critical message that the creation of mobility alternatives for an aging population has no borders and is a global phenomenon. The ITNAmerica model of non-profit and individualized service with a capacity to address both urban and rural needs is of great interest to us. We hope to work more closely with ITNAmerica to explore its applications in Canada. ITNAmerica provides a practical approach towards ensuring the mobility, independence, good health and safety of an aging population across North America."

Over the past year we have welcomed several new affiliates to the ITNAmerica family, bringing the grand total to ten active affiliates. Four affiliates, part of what ITNAmerica calls its first "Learning Cluster," are currently offering rides: ITNPortland™ (Portland, ME), ITNOrlando™ (Orlando, FL), ITNCharlestonTrident™ (Charleston, SC) and ITNGreaterLA™ (Los Angeles, CA).

A second Learning Cluster is quickly taking shape, building membership and community support while working toward giving their first ride. These affiliates are ITNQuadCities™ (Davenport and Bettendorf, IA and Moline and Rock Island, IL), ITNBluegrass™ (Lexington, KY), ITNNorthCentralConnecticut™ (Enfield, CT), ITNCentralCT™ (Middlesex, CT), ITNChicago™ (Chicago, IL), and ITNSanDiego™ (San Diego, CA).

In a new venture, ITNAmerica is collaborating with the New York State Office for the Aging (NYSoFA), which will be using an RFA process (request for applications) to establish four ITN affiliates in New York State. This partnership began in the mid-1990s when Greg Olsen, Director of NYSoFA, heard Katherine Freund speak at a conference in New York when she was a Fellow of the Federal Transit Administration's National Transit Institute.

He said, "The idea of a public/private partnership built upon engaging the community in solving community problems was an idea that had to be supported. Years later I was fortunately in a position in the New York State Legislature to call Katherine about developing an economically sustainable demonstration program in New York State that would support the implementation of the ITN model."

"It is through our collaboration with ITNAmerica that we will be the first state in the country to help finance the development of these models to ensure that older adults have access to transportation when and for whatever reason they want it," Olsen said.

The State of Connecticut also plans to create a cluster of four affiliates throughout the state.

ITNAmerica's Affiliate Support Department (ASD) assists with training and coaching to assure that affiliates progress steadily toward sustainability; meet operating and financial goals, and that best practices are shared among affiliates. The primary goal of the ASD is to maintain a supportive relationship with the affiliates and guide each one to success.

Research and impact measurement are essential areas of activity for ITNAmerica — part of the organization's commitment to integrating practice, research and policy as it works to support replication of the ITN model and serve as a leading voice for senior mobility. Our recent projects are summarized below.

Health Care Practitioners' Willingness to Address the Driving Issue with Patients
Families and the state government often call upon the health care community to make recommendations regarding driving safety. However, the state motor vehicle licensing division is the only legal entity with authority to remove or limit driving privileges. Families increasingly turn to their physicians and other health care practitioners for guidance, but the health care community is generally poorly trained to address these issues and is largely unfamiliar with associated ethical and legal responsibilities. In addition, because driving is such a powerful symbol of independence and because the transportation options are inadequate, practitioners are reluctant to address these concerns with the patient or to involve the state. Communication practices range from ignoring the issue completely, to aggressively prescribing cessation of driving and reporting a patient to the state.

Funded by a grant from the Silver Century Foundation, ITNAmerica initiated a pilot study to measure the impact of training on the knowledge, attitudes and practice behavior of health care practitioners regarding their elderly patients who drive. Dr. Germaine Odenheimer, a member of the ITNAmerica Research Group and an AMA designated trainer, presented AMA older driver materials and local alternative transportation options at the Maine Medical Center ‘Geriatric Education Day' conference in April 2007. We conducted pre- and post-test surveys onsite and conducted a three month follow-up survey. The objective was to learn how the availability of alternative transportation, such as the ITN, impacts the health care practitioner's willingness to address the driving issue with patients.

Immediately following the presentation by Dr. Odenheimer, 91% of survey participants said a reliable transportation program would increase the likelihood that they would advise a patient to stop driving (n=96). Three months later, 70% said they had increased the frequency with which they discussed driving cessation with their patients (n=53). Dr. Odenheimer presented findings from this project as part of an ITNAmerica symposium at the Annual Scientific Meeting of the Gerontological Society of America (GSA) in November 2007.

The Impact of ITN on Quality of Life
This four-year evaluation project funded by the Atlantic Philanthropies received IRB approval and officially launched in May 2007. The first phase of the study is designed to understand the impact of ITN on the quality of life for older adults who stop or limit their driving.

We are recruiting subjects and conducting telephone interviews in four ITN affiliate communities: Charleston, South Carolina; Orlando, Florida; Portland, Maine; and Santa Monica, California. ITN members in these communities are eligible for the evaluation when they initially register to become involved with the local ITN program; follow-up telephone interviews are planned at six months and twelve months after baseline. The evaluation plan also calls for identifying and conducting telephone interviews with older adults, not involved in the ITN program, in similar-sized communities geographically near selected ITN affiliate communities. Other planned evaluation components include interviews with family members of ITN members, and with volunteer drivers in ITN affiliate communities.

Mobility Patterns of Older Adults Who Stop or Limit Driving
Little is known about the travel patterns of older adults after they stop driving. When alternative transportation is readily available, where do older adults go, and to what extent are their choices influenced by gender and age? For more than 10 years, ITNPortland has provided rides in greater Portland, Maine to older adults and people with visual impairments who have stopped or limited their driving. The organization's data base provides a unique opportunity to examine actual destinations from home of ITNPortland customers.

Using the ITNRides data base, we are able to provide a portrait of mobility patterns among a cohort of older adults who stopped or limited their driving. For this study, we included only members aged 65 and older who used ITN for at least one ride between January 2004 and December 2006. The sample includes 586 ITN members. Results from this research were presented as part of an ITN symposium at the Annual Scientific Meeting of the GSA in November 2007. We are preparing a journal article for publication review based on this research.

Mapping the Older Driver Evaluation Process: A Case Study
With a grant from the Silver Century Foundation, ITNAmerica is conducting research to "map" the older driver evaluation process. The objectives are: to document how the driving evaluation process is presently carried out by three of the most common professionals conducting individualized driving evaluations with older adults—driving training instructors, occupational therapists, and geriatricians; to determine when during this driving evaluation process it is most feasible to introduce information about alternative transportation options; and to determine how the introduction of alternative transportation options into the driving evaluation process affects older adults' acceptance of the transition to driving cessation.

By achieving these objectives, we expect that an important gap in knowledge transfer to older adults having driving difficulties will be directly and practically addressed, so that the transition to driving cessation can become a planned and supportive process for these older drivers and their family members.

If you have questions about ITNAmerica research, please contact Research@ITNAmerica.org.

ITNAmerica works with organizations and individuals to help develop dignified and sustainable transportation in communities across the country. We welcome your interest.

To become an affiliate, please be one of the following:

• A non-profit organization (501c3)
• An organization such as, but not limited to, an Area Agency on Aging, a United Way affiliate, a faith-based organization, a transit provider, or a service organization
• Any of a number of government organizations (municipality, county, or state), such as a Department of Transportation
• A private individual, but you must partner with an appropriate sponsoring organization.

Application process
There is a thorough application and demographic worksheet. If you would like to apply, please contact us at AffiliateApplication@ITNAmerica.org. After the acceptance process, new ITN affiliates join together in a "Learning Cluster" to begin planning and learning together.

Each Learning Cluster embarks on a four year endeavor similar to a collegiate process, with the first year being the freshman year, the second the sophomore, and so forth. At the end of this period the affiliate community has an operation that is fully sustainable without taxpayer support, operating entirely on fares from riders and a diversified base of local community support.

ITNAmerica accepts applications on a rolling basis. If you have any questions about the application process, please do not hesitate to contact us at AffiliateApplication@ITNAmerica.org.

How does ITNAmerica support affiliate communities?
ITNAmerica provides full and complete support for affiliate communities, including:

• ITNRides software plans and tracks rides and distances to maximize efficiency; manages community outreach, finance and billing, volunteer and membership accounts
• Membership reciprocity among affiliates, uniting families across the nation 
• Inclusion in national corporate sponsorship and grant programs
• A complete business plan and timeline
• Marketing and promotional materials
• Site visits to the model ITN in Maine, and to your community by ITNAmerica staff
• Tools, budget models and consulting for staff development and fund raising
• Training through site visits, conference calls, national conferences, and retreats with other affiliates
• ITNAmerica's AmeriCorps*VISTA program access.

What financial resources are needed?
We work with prospective affiliate communities to help raise the $125,000 necessary to begin the first year of planning.