RSA-227 - Annual Client Assistance Program (CAP) Report

Maine (C.A.R.E.S., Inc.) - H161A110020 - FY2011

General Information

Designated Agency Identification

NameBureau of Rehabilitation Services
Address150 State House Station
Address Line 2
CityAugusta
StateMaine
Zip Code04333
E-mail AddressPaul.E.Cote@state.me.us
Website Addresshttp://www.maine.gov
Phone207-624-5977
TTY 207-624-5977
Toll-free Phone1-888-755-0023
Toll-free TTY1-888-755-0023
Fax207-624-5980

Operating Agency (if different from Designated Agency)

NameC.A.R.E.S., Inc.
Address134 Main St.
Address Line 2Suite 2C
CityWinthrop
Zip Code04364
E-mail Addresssteve.beam@caresinc.org
Website Addresshttp://www.caresinc.org
Phone207-377-7055
TTY207-377-7055
Toll-free Phone1-800-773-7055
Toll-free TTY1-800-773-7055
Fax207-377-7057

Additional Information

Name of CAP Director/CoordinatorSteve Beam
Person to contact regarding reportSteve Beam
Contact Person Phone207-377-7055

Part I. Agency Workload Data

A. Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Information regarding the Rehabilitation Act165
2. Information regarding Title I of the ADA3
3. Other information provided95
4. Total I&R services provided (Lines A1+A2+A3)263
5. Individuals attending trainings by CAP staff (approximate)75

B. Individuals served

An individual is counted only once during a fiscal year. Multiple counts are not permitted for Lines B1-B3.

1. Individuals who are still being served as of October 1 (carryover from prior year)38
2. Additional individuals who were served during the year54
3. Total individuals served (Lines B1+B2)92
4. Individuals (from Line B3) who had multiple case files opened/closed this year. (In unusual situations, an individual may have more than one case file opened/closed during a fiscal year. This number is not added to the total in Line B3 above.)1

C. Individual still being served as of September 30

Carryover to next year. This total may not exceed Line I.B3. 27

D. Reasons for closing individuals' case files

Choose one primary reason for closing each case file. There may be more case files than the total number of individuals served to account for those unusual situations, referred to in Line I.B4, when an individual had multiple case files closed during the year.

1. All issues resolved in individual's favor32
2. Some issues resolved in individual's favor (when there are multiple issues)12
3. CAP determines VR agency position/decision was appropriate for the individual18
4. Individual's case lacks legal merit; (inappropriate for CAP intervention)0
5. Individual chose alternative representation1
6. Individual decided not to pursue resolution0
7. Appeals were unsuccessful0
8. CAP services not needed due to individual's death, relocation, etc.2
9. Individual refused to cooperate with CAP0
10. CAP unable to take case due to lack of resources0
11. Other (please explain)

E. Results achieved for individuals

1. Controlling law/policy explained to individual26
2. Application for services completed.2
3. Eligibility determination expedited1
4. Individual participated in evaluation2
5. IPE developed/implemented19
6. Communication re-established between individual and other party6
7. Individual assigned to new counselor/office8
8. Alternative resources identified for individual1
9. ADA/504/EEO/OCR/ complaint made0
10. Other0
11. Other (please explain)

Part II. Program Data

A. Age

As of the beginning of the fiscal year. Multiple responses are not permitted.

1. 21 and under16
2. 22 - 4034
3. 41 - 6440
4. 65 and over2
5. Total (Sum of Lines A1 through A4. Total must equal Line I.B3.)92

B. Gender

Multiple responses not permitted.

1. Female49
2. Male43
3. Total (Sum of Lines B1 and B2. Total must equal Line I.B3.)92

C. Race/ethnicity

1. Hispanic/Latino of any race2
For individuals who are non-Hispanic/Latino only
2. American Indian or Alaskan Native1
3. Asian1
4. Black or African American2
5. Native Hawaiian or Other Pacific Islander0
6. White86
7. Two or more races0
8. Race/ethnicity unknown0

D. Primary disabling condition of individuals served

Multiple responses not permitted.

1. Blindness (both eyes)2
2. Other visual impairments2
3. Deafness3
4. Hard of hearing1
5. Deaf-blind2
6. Orthopedic impairments9
7. Absense of extremities0
8. Mental illness36
9. Substance abuse (alcohol or drugs)0
10. Mental retardation7
11. Specific learning disabilities (SLD)16
12. Neurological disorders0
13. Respiratory disorders1
14. Heart and other circulatory conditions2
15. Digestive disorders0
16. Genitourinary conditions0
17. Speech Impairments0
18. AIDS/HIV positive0
19. Traumatic brain injury (TBI)6
20. All other disabilities5
21. Disabilities not known0
22. Total (Sum of Lines D1 through D21. Total must equal Line I. B3.)92

E. Types of individuals served

Multiple responses permitted.

1. Applicants of VR Program5
2. Clients of VR Program88
3. Applicants or clients of IL Program1
4. Applicants or clients of other programs and projects funded under the Act0

F. Source of individual's concern

Multiple responses permitted.

1. VR agency only91
2. Other Rehabilitation Act sources only1
3. Both VR agency and other Rehabilitation Act sources0
4. Employer0

G. Problem areas

Multiple responses permitted.

1. Individual requests information92
2. Communication problems between individual and counselor67
3. Conflict about services to be provided37
4. Related to application/eligibility process14
5. Related to IPE development/implementation34
6. Other Rehabilitation Act-related problems2
7. Non-Rehabilitation Act related0
8. Related to Title I of the ADA0

H. Types of CAP services provided

Choose one primary CAP service provided for each case file/service record.

1. Information/referral8
2. Advisory/interpretational18
3. Negotiation35
4. Administrative/informal review1
5. Alternative dispute resolution1
6. Formal appeal/fair hearing2
7. Legal remedy0
8. Transportation0

Part III. Narrative

Narrative

NARRATIVE REPORT FISCAL YEAR 2011

I. Introduction

The Bureau of Rehabilitation Services is the designated agency for the Client Assistance Program (CAP) in Maine. Since 1984 the State Agency has subcontracted with outside agencies to provide CAP services throughout the state of Maine. C.A.R.E.S., Inc., in existence since November 1, 1988, is a closely held, for-profit corporation making the Maine CAP an external-other organization. Since September 1992, Consulting, Advocacy, Research and Evaluation Services, Inc. (C.A.R.E.S., Inc.) has been effectively administering the CAP in Maine. CAP offers the full range of services required by Section 112 of the Rehabilitation Act. The CAP is staffed by three professionals for a total of three (3) person-years. Two of the professionals are full-time (2.0 FTE), the third is part-time (.10 FTE). Additionally, C.A.R.E.S., Inc. has a retainer agreement with a qualified attorney for the purpose of and legal consultation to CAP personnel and, if required, providing legal representation to CAP consumers

The FY 2011 budget is enclosed as Attachment II. In FY 2011 the federal funds expended for the CAP were supplemented by SSA-VR funds.

During FY 2011 the CAP achieved all program goals and objectives in the following areas: Informing the general public and consumer organizations about CAP; informing consumers of their rights to services under the Act and advocating for these rights; developing a positive working relationship with appropriate agencies; advising the state agency about systemic issues and obtaining training for CAP personnel.

Our Consumer Advisory Board (CAB) met 4 times during the fiscal year. The CAB assists program staff to identify systemic issues in delivering vocational rehabilitation and independent living services to people with disabilities as well as assessing consumer satisfaction concerning services received from the Client Assistance Program. During the year the CAB received information about DVR and DBVI (staffing issues, Wait List, systemic concerns) and also revised the Consumer Satisfaction Survey Form that we mail out to our clients after a case is closed by CAP.

CAP has an open and productive relationship with both directors and with the management staff of the 2 agencies. While we have regularly scheduled meeting (as stipulated in our contract) to discuss systemic issues, we are able to access key staff on an “as needed” basis. CAP’s viewpoint, while not always agreed to, is clearly welcomed by state agency personnel. CAP’s scheduled access was provided via quarterly meetings with the agency directors and with other key staff from Central Office, and through our participation in both State Rehabilitation Councils (SRCs). CAP is a mandated member of and an active participant in the SRC for both the Division for Vocational Rehabilitation (DVR) and the Division of the Blind and Visually Impaired (DBVI). (See Section V).

II. Information and Referral

During the reporting period, 263 individuals received information and referral (I&R) services from C.A.R.E.S., Inc. Of this total, 165 individuals received information and referral services regarding the Rehabilitation Act, 3 regarding Title I of the ADA and 95 individuals were provided other information. Examples of “other” information and referral services include a variety of requests such as social security, special education, guardianship, disability/advocacy agencies and community rehabilitation providers, adult day care, MaineCare, child protective issues, fuel assistance, assistive technology, housing, resources for people who are homeless, health insurance, resources for veterans, etc.. CAP staff uses VR/IL I&R related requests to emphasize self-advocacy and empowerment of people with disabilities. The CAP staff also used information obtained from I&R requests to identify trends, patterns and issues of a systemic nature. This information was provided to State Agency staff during our regularly scheduled quarterly meetings and as appropriate. Finally, requests for information and referral were used to identify potential training needs within both the CAP and the state agencies.

III. Client Data

Along with the 263 individuals who requested and received information and referral services, 92 individuals were served as “cases” as defined by the RSA-227 reporting instructions. Of the 92 individuals served as open/active cases, 38 were pending as of October 1, 2010. Another 54 individuals had cases opened with CAP during the fiscal year. Four (4) individuals were applicants of Title I, Vocational Rehabilitation (VR) Program and 87 individuals were Title I consumers. CAP also represented one individual who was receiving services the Independent Living Program administrated by Alpha One. Of the open 92 cases, individuals with mental illness comprised the largest group of individuals served (36 cases). They were followed by individuals with learning disabilities (16), orthopedic impairments (9), mental retardation (7), and traumatic brain injury (6).

During the past fiscal year, 65 cases were closed. Of this figure, 32 were closed with all issues resolved in the individual’s favor, while another 10 cases were closed with some issues resolved in the individual’s favor when there were multiple case problems. In 18 cases CAP determined that the VR agency had taken appropriate action. CAP did not represent any individuals at either a due process hearing or mediation during FY 2011. We estimate that CAP resolved 12 potential due process hearings via alternative dispute resolution during the past fiscal year. 9 issues pertained to Employment Plan goals and services in areas such as self-employment, post secondary education services; while 3 cases pertained to potential case closure.

CAP staff responded to the following problem areas for the 92 individuals we represented: Information requested (92), communication problems between individual and counselor (67), conflict regarding services to be provided (37), problems related to IPE development/implementation (34) and problems related to the application/eligibility process (14). Obviously, multiple responses are permitted for open cases.

During the past fiscal year Maine’s CAP represented individuals in all five VR regions; 23 cases were in Region 1; 30 in Region 2; 25 in Region 3; 11 in Region 4 and 3 case in Region 5. Of the 92 individuals we represented during the year, 49 were females and 43 were males. There were 16 individuals served under age 21; 34 clients from ages 22-40; 40 from ages 41-64 and there were 2 clients represented who were over the age of 65.

(Please see Attachment I for examples of cases handled during FY 2011)

IV. Training, Outreach and Linkage Activities

A. Training Received. During FY 2011 CAP staff received the following training to enhance our skills:

1. CAP staff attended the Statewide Bureau of Rehabilitation Services training in November, 2011. The sessions that we attended include: Access to Distance Education and Collaboration; Promoting Assistive Technology in Maine; Neuropsychological Evaluations and VR; Ethics; and, Working with Individuals with Borderline Personality Disorder.

2. CAP staff attended the Maine APSE “Employment for All” conference.

3. A CAP staff member attended the Council of State Administrators of VR Annual Conference in Bethesda, MD. A portion of that conference is dedicated to training for members of the State Rehabilitation Councils throughout the country. No CAP funds were used to attend this conference.

4. CAP staff attended the Northeast Association for Education and Rehabilitation Conference in Rockport, ME.

5. CAP staff received training at the 2 SRC Annual Conferences on topics such as the role of council members and the Federal regulations governing the SCR.

6. In conjunction with the Region 1 TACE, CAP staff received training on Individuals with Brain Injury and the VR process.

7. Finally, CAP staff attended the Association of Computer Technicians and Educators in Maine conference in Rockland, ME.

B. Training Provided. During FY 2011, CAP staff provided the following training to consumers, family members and professionals:

1. CAP staff provided a training session on the VR process and the role of CAP to a rehabilitation counseling class at the University of Maine in Rockland.

2. We provided an overview and information on the role of CAP to a group of people at the Maine State House.

3. CAP staff provided an overview of the role of CAP and the appeals process as part of new counselor orientation. We provided this training 2 times during FY 2011.

4. CAP provided information on the Role of CAP in the SRC and the Role of CAP in a 107 Review to staff in the Region 1 TACE program.

C. Linkages/Outreach with consumers, family members, advocacy organizations and community agencies occurred on a regular and as-needed basis during the past year. Examples of those contacts are as follows:

1. Alpha One 2. Maine Consumer Information and Technology Exchange (Maine CITE) 3. Pine Tree Legal Services 4. State Rehabilitation Councils (both DVR and DBVI) 5. Committees and Councils on Transition 6. Maine Parent Federation 7. Mental Health Providers 8. Houlton Band of Maliseet Indians 9. Disability Rights Center 10. Goodwill of Northern New England 11. Maine Vocational Rehabilitation, Assoc. 12. Employment Support Services 13. Assumption College/TACE 14. Alliance for the Mentally Ill 15. Developmental Disabilities Council 16. Kennebec/Somerset Mental Health Advisory Council 17. Alternative Services, Inc. 18. Creative Works Systems 19. National Protection & Advocacy Services 20. Rehabilitation Services Administration 21. York County Parent Awareness 22. Motivational Services, Inc. 23. Statewide Independent Living Council 24. Catholic Charities of Maine 25. Employment Specialists of Maine 26. Maine Children’s Alliance 27. Maine Center on Deafness

V. Systemic and Policy Issues

The Client Assistance Program continues to place considerable emphasis and program resources on systemic advocacy. During the past year our involvement in the State Rehabilitation Councils for both agencies presented us with many opportunities to provide input on issues that have systemic implications for individuals with disabilities. Over the past several years, CAP staff has played a significant role in the 2 councils. Fiscal year 2011 was no difference. For example, a CAP staff person served as the Chair for the DBVI SRC. CAP staff was instrumental in the creation of a consumer satisfaction survey for the DVR SRC website. Within the framework of the SCR, we reviewed and commented on the proposed State Plans for both agencies. Additionally, we provided input to proposed changes to the DBVI State Rules.

CAP staff continues to be involved in numerous committees that have systemic implications. Examples of these committees include:

• DVR/SRC Policy Group. This committee provides input into the State Plan, Comprehensive Needs Assessment, agency procedural directives and important topical areas. During the past year, CAP staff assisted in the Memo of Understanding (MOU) between the state agency and the Veterans Administration, clients being served jointly by DVR and DBVI, development of the FY 2012 State Plan and a MOU between the state agency and the Maine Department of Education.

• Participation in internal BRS Committees such as Transition and Self-Employment Services. CAP’s role in these committees has been to present individual case considerations as the agency develops procedural directives and training for staff members.

CAP staff met with the Director of the Independent Living Center during the past fiscal year. We discussed IL issues such as assistive technology and case management as well as notification of CAP services for consumers of IL services.

CAP staff was significantly involved in the Federal Monitoring review conducted by Rehabilitation Services Administration (RSA) during the past year. CAP participated in a series of phone conference calls prior to the visit by the RSA team and then met with federal staff when they were conducting their 107 review in state. CAP staff shared our input regarding the improvements we have observed (IE elimination of the wait list) as well as the challenges facing DVR and DBVI (IE timeframe for developing an Employment Plan in DVR). CAP was able to participate in the review in 2 separate capacities: as representatives of the CAP and as members of the SRC. Regarding the latter, RSA plans to provide technical assistance pertaining to the Council’s role in developing the State Plans for both agencies.

Staff from Maine’s CAP continued to be a member of the Region I Technical Assistance and Continuing Education (TACE). TACE has replaced the Rehabilitation Continuing Education Programs (RCEP) and is responsible for designing and implementing training for all VR staff in New England. We feel our participation on the TACE Advisory Committee presents an excellent opportunity to provide input on VR staff training needs. As a member of this committee, the Maine CAP staff person also plans and organizes staff training for all New England CAP personnel, a target group within the TACE. During the past year, staff from the Maine CAP was instrumental in developing a regional CAP training at Assumption College in Worcester, MA. As reported earlier, the agenda dealt with Brain Injury and VR, the Role of CAP on the SRC and the recently completed RSA 107 Review in Maine.

The CAP program director was asked to become a member of the Wabanki Vocational Rehabilitation Program’s Advisory Committee. This program is the first Maine recipient of Section 121 funds under the Rehabilitation Act. CAP represented its first 121 client during the year and also had some additional inquiries involving clients of the 121 VR Program that were handled as information and referral.

VI. Other Activities

During the past year, CAP staff met with the Directors of both agencies and other staff from Central Office on a quarterly basis per the contract between C.A.R.E.S. Inc and the Bureau of Rehabilitation Services. The purpose of the meetings is to review cases being handled ay the CAP, and to identify and discuss any trends and systemic issues concerning the delivery of employment services for people with disabilities. We feel this provides CAP with an excellent forum to share information about clients are feeling about their experience with the state agency.

ATTACHMENT I

THE FOLLOWING CASES ARE REPRESENTATIVE OF OUR ADVOCACY EFFORTS IN FY 2011 ON BEHALF OF PEOPLE WITH DISABILITIES

(Client names have been changed to protect confidentially)

Problem: Patty is a client that recently came from another state and was working with the CAP in that State. Upon moving to Maine Patty enroll with Maine VR, hoping to continue with her vocational goal of become an Engineer. Patty met with resistance to this goal and called upon the CAP program in Maine.

Intervention Summary: CAP reviewed the case file and spoke with the VRC and CWS. A change of counselor was requested and granted. Because DVR questioned client’s ability to return to school a Psychoeducational assessment was requested and client participated in the assessment. Because of the new information gathered with the assessment and a new and better relationship with the VRC the client’s case began to take shape.

Outcome: CAP successfully negotiated with DVR to working within the boundaries of the Federal Regulations. A mutually agreed upon IPE was written, the client is now a successful student at the University of Maine in the Engineering School. ¬

Problem: Ben called CAP at DVR suggestion, after they denied letting his small business plan enter into the small business process within the DVR system. The problem being the client wanted to become a “Registered Primary Caregiver” (RPC) or a grower and distributor of medical marijuana. A business that is legal in the State of Maine but not legal to the Federal government.

Intervention Summary: CAP reviewed the legality of being a RPC in the State of Maine and once it was determined it was a viable option for a Maine resident, set to work. CAP discussed this case with everyone from the VRC to the Director of DVR, from California to Rhode Island CAP’s and States in between. CAP secured a pro bono lawyer to represent the case upon appeal because of the possible national implications of the case.

Outcome: Though the fair hearing process was initiated by the client, in the end the client’s lawyer found some language with the United States Code which supported the DVR position. The case was withdrawn from the fair hearing process. The client is now seeking another, less contentious, small business.

Problem : William is 46 year old man with an orthopedic impairment and PTSD. He contacted CAP when he felt his VRC was not working in his best interests as far as supporting his goal of being self-employed doing snow removal and landscaping.

Intervention Startegy: A review of the case record indicated that the VR-sanctioned business consultant and that he had an approved business plan. The case record also revealed that the VR counselor has asked for revisions to the business plan. The Counselor also stipulated that William meet with a Social Security Benefit Specialist before the disbursement of any VR Funds.

Outcome: Because this was a time sensitive self employment venture, William balked at what he considered to be stalling tactics by the VRC. CAP agreed and facilitated a meeting between William and the Casework Supervisor. William requested and was granted a change of counselor. He met with the new counselor the same day and they immediately developed a positive working relationship. William got his business up and running with the assistance of VR.

Problem: Molly is a 27 year old woman with an anxiety disorder. She contacted CAP after her request to have her Employment Plan amended was denied. She wanted VR’s help to attend a master’s program in library science.

Intervention strategy: A review of the case record revealed that Molly had reached her VR goal to be Literacy Specialist. However, further review indicated her initial goal was to be a librarian and she was discouraged from pursuing this. Additionally, she had experienced great anxiety when she attempted to student teach. CAP assisted the client to obtain labor market information for librarians as well as information about her anxiety disability and if librarian was a goal consistent with her abilities.

Outcome: When the labor market information and additional information about her disability was presented, VR supported her request to amend her employment plan. Therefore, a due process hearing was avoided.

Problem: John is a 42 year old man with chronic depression. He has had 3 previous unsuccessful attempts with VR. He called CAP when he felt VR was using his past experience with VR to essentially deny him access to services in his current involvement with VR.

Intervention Strategy: CAP reviewed the case record and spoke with the VRC and the supervisor. VRC was interpreting the Comprehensive Assessment as a reason to deny the client’s request to be a Class A truck driver. CAP’s review indicated VRC was not returning client’s phone calls and that there appeared to be a conflict between the client and VRC.

Outcome: While discussing the case with CAP, the VRC shared that he had difficulty working with the client in question. The two had exchanged heated comments in the past. CAP suggested he be assigned to a new VRC. Once this was done, an employment plan was developed and John started to attend Class A truck driving classes.

ATTACHMENT II

CAP BUDGET - FY 2011

Salaries and Wages: 1. Program Director $ 49,000.00 2. Field Advocate $ 40,000.00 3. Executive Director (.10 FTE) $ 4,055.00 Sub-total $ 93,055.00 Fringe Benefits:

1. FICA $ 7,147.93 2. Unemployment Compensation $ 692.00 Sub-total $ 7,839.93

Consultant Fees:

1. Legal Fees $ 4,000.00 2. Accounting Fees $ 3,300.00 3. Bookkeeping Fees $ 3,500.00 4. Data Entry $ 1,500.00 Sub-total $ 12,300.00 Equipment Rental $ 0

Rent $ 3,000.00

Maintenance: $ 750.00

Telephone: $ 3,800.00 Materials/Supplies/Copying/Postage: $ 2,688.07

Staff Travel: $ 5,200.00 Bonding/Insurance $ 2,800.00

Worker’s Compensation $ 676.00 Other: $ 500.00 Total Project Costs: 132,609.00

Certification

Approved

This Report is Complete and Correct.Yes
Date Signed:28-Dec-11
Name of Designated Agency Official:Paul Cote
Title of Designated Agency Official:Regional Manager