RSA-509 - Protection & Advocacy of Individual Rights (PAIR) Program Performance Report

Massachusetts (DISABILITY LAW CENTER, INC.) - H240A110022 - FY2011

General Information

Designated Agency Identification

NameDisability Law Center
Address11 Beacon Street Suite 925
Address Line 2
CityBoston
StateMassachusetts
Zip Code02108
E-mail Addressmail@dlc-ma.org
Website Addresshttp://www.dlc-ma.org
Phone617-723-8455
TTY 617-227-9464
Toll-free Phone800-872-9992
Toll-free TTY800-381-0577
Fax617-723-9125
Name of P&A Executive DirectorAlan Kerzin
Name of PAIR Director/CoordinatorAlan Kerzin
Person to contact regarding reportAlan Kerzin
Contact Person phone617-723-8455
Ext.146

Part I. Non-Case Services

A. Individual Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas63
2. Individuals receiving I&R outside PAIR priority areas2,872
3. Total individuals receiving I&R (lines A1 + A2)2,935

B. Training Activities

1. Number of trainings presented by PAIR staff26
2. Number of individuals who attended training (approximate)2,000

DLC employs an innovative model of trainings and conferences for events which we sponsor. Conferences are targeted to individuals with disabilities, family members, advocates and other service providers. The training events pair an interactive "formal" educational component, generally consisting of a PowerPoint presentation with written materials and extensive opportunity for Q&A, with in-person clinics to provide 1:1 follow up advice, referral and/or representation. Many of these conferences are geared to communities which face linguistic and/or cultural barriers. By focusing on strategies for securing the legal rights of persons with disabilities, DLC is able to leverage resources to ensure effective advocacy on issues affecting individuals’ ability to live independently in the community and to have full and equal access to social, educational, communal, economic and vocational opportunities. By providing education and advice, bringing together community partners, and by working in the community’s preferred language, DLC is often able to reach clients who would not otherwise advocate for themselves and/or contact DLC or their regional legal services program. All of our trainings are held in fully accessible community locations, with lunch provided, and CART and ASL and other language interpreters are made available upon request. Community partners include regional legal services programs, other community-based social service providers, and local culturally specific organizations.??Conferences and Trainings? Health Care and Disability Law Trainings: It Takes More Than Ramps Conference: DLC has been working on a systemic advocacy project with MA Department of Public Health (DPH) and Independent Living Centers (ILC) throughout the State to increase the accessibility of medical services in hospitals through communication assistance or medical equipment. On May 3, 2011, DLC, DPH and Ad-Lib, an ILC, presented a conference at the Crowne Plaza Hotel in Pittsfield titled Accessible Health Care: It Takes More Than Ramps.  This all-day conference was geared to over 50 health care practice managers, hospital administrators, ADA coordinators, facility managers, and health care practitioners. It featured Dr. Lisa Iezzoni, Partners Healthcare, Institute for Health Policy and Jonathan O’Dell, MA Commission for the Deaf and Hard of Hearing as key-note speakers.  The conference included informative panels and workshops on making your practice compliant with federal and state accessibility laws and Department of Public Health policies.  The day ended with concrete tools for designing and implementing policies and procedures, conducting site surveys and creating transition plans. DLC has since followed up with attendees to offer technical assistance on various access issues and medical equipment ADA compliance guidance. The impact of this conference will reach the health care consumers of the various facilities and medical centers represented, which would be over 117,000 people.

Spaulding Rehabilitation Center InService on Disability Law: DLC provided an overview of its services and priorities, as well as common disability law topics faced by rehabilitation centers. This InService was presented to 20 staff at Spaulding Rehabilitation Center’s Outpatient Clinic and will positively impact the individuals with disabilities that they service.

Housing Law Trainings: Northampton Housing Authority Training:?In response to a complaint that DLC received about the Northampton Housing Authority, DLC offered and provided training to over 30 administrators and staff on the ADA and disability awareness. The training was greatly appreciated and the Northampton Housing Authority Executive Director has asked DLC to repeat the training in the coming year. Following the training, DLC received two inquiries from Housing Authority staff about wanting to assist residents with reasonable accommodation requests, and DLC provided technical assistance.

MA Statewide Independent Living Center (ILC) Deaf and Hard of Hearing Program: DLC trained the MA ILC Deaf and Hard of Hearing Program staff on housing laws and reasonable accommodations and modifications. This training was directed toward ILC staff and consumer advocates and focused on housing laws that impact over 1000 individuals who are deaf and hard of hearing and served by MA ILCs.

Tenant Advocacy Project (TAP) Housing Law Training: DLC presented a workshop to 40 TAP advocates on reasonable accommodation and modification requests in housing at Harvard Law School. This training was geared toward increasing capacity at TAP to successfully advocate for clients with disabilities who have housing legal issues.

Special Education and Transition Law Trainings and Clinics: DLC continued this year its series of community-based special education and transition trainings and clinics, targeted to underserved communities, conducted in partnership with grassroots community based organizations. DLC hosted 5 trainings: Allston, targeting the Portuguese community with 70 attendees; Springfield, targeting the Hispanic community, with 90 attendees; Boston’s Chinatown neighborhood, targeting the Chinese community with 70 attendees; Southbridge, targeting the Hispanic community with 60 attendees; and Dorchester, targeting the Haitian community with 55 attendees. Over 1,400 materials have been distributed during these trainings.

DLC holds these trainings in community centers, libraries and churches in order to attract people in the community to places they may already attend. DLC also collaborates and co-sponsors these trainings with the local legal service agency and community groups such as Urban Pride, the Asian American Civic Association, and the Brazilian Immigrant Center.

Special Education Law Training for Students at Lesley University: DLC presented on special education law to 15 graduate students at Lesley University who will become special education teachers in an effort to increase capacity and awareness of disability related issues and legal standards for future teachers. This training will also improve DLC’s advocacy efforts by making connections with special education teachers in training and building those relationships early on in those teachers’ careers.

Federation for Children with Special Needs Vision of Community Annual Conference: DLC presented a workshop in partnership with Federation for Children with Special Needs (FCSN) on special education transition services and planning for effective outcomes. Topics included the transition planning process, including age-appropriate transition assessments and development of individualized, measurable post-secondary goals and objectives. DLC discussed the effect of the US District Court’s decision in Dracut School Committee v. BSEA on school district practices, as well as graduation and State Performance Plan indicators. Over 100 other attorneys and advocates attended the workshop.

MA Rehabilitation Commission Transition Conference: DLC presented at this conference on the US District Court’s decision in Dracut School Committee v. BSEA on school district practices, the Transition Coordinator bill and the Bridges to Success legislative initiative. 300 conference attendees were trained as to their rights and how to better advocate for students with disabilities.

Special Education Training for Cambridge Family and Children’s Service: DLC presented to 40 individuals on the most common special education issues for parents with students with disabilities. Parents and advocates learned how to better advocate for students with disabilities, standards for legal advocacy, and other resources available to them.

Boston College Law School Public Services Scholars Conference: DLC participated in a panel presentation and discussion on children’s law issues and the impact that legal advocacy has on the life of a child with a disability. There were 90 attendees of public service scholars and the discussion included how to use the law to make social change.

Council of Parent Attorneys and Advocates, Inc. (COPAA) Training: DLC presented a webinar to COPAA members on the overlap and commonality of race and disability issues in school discipline. The audience was COPAA member special education attorneys and advocates, over 20 of whom participated. Each student that these members interact with and advocate for will be positively affected by their increased knowledge of these school discipline issues.

Special Education Surrogate Parent Program Conference: DLC was an Exhibitor at the Professional Development and Recognition Conference of the Special Education Surrogate Parent Program. DLC distributed special education materials and materials on DLC and our priorities to 50 attendees.

Transition Vendor Night, Newton Public Schools: DLC exhibited materials about DLC and transition age youth to 40 parents and advocates of special education students.

Other: Boston Red Sox Staff Training: The topic of the training was legal requirements under Title III of the ADA for places of public accommodation, reasonable accommodation for fans with disabilities, and etiquette tips regarding interacting with and accommodating fans with disabilities. Over 400 personnel attended the training and included Red Sox staff, ushers, ticket takers and security personnel and the impact of the training will be to over 76,000 individuals who attend Red Sox games. DLC also continues to work with the Boston Red Sox to ensure access for people with disabilities. Over the past several years, large-scale renovations have been conducted at Fenway, and during FY11 DLC continued its involvement and technical assistance in the planning process, providing guidance and feedback on issues of physical and architectural access as well as visual and communication access.

Emergency Planning in Schools Conferences and Trainings: DLC presented at four day-long conferences on the legal standards for emergency planning for students with disabilities and coordinating with first responders during school emergency drills. These conferences were offered to school districts and first responders in Western MA in an effort to build capacity and partnerships and had over 200 attendees. DLC also served as an independent evaluator for the Project and submitted a report to the Western MA Homeland Security Counsel. DLC continues to offer trainings on personal preparedness and school preparedness to school officials and staff, as well as first responders.

Additionally, DLC trained 140 staff at Berkshire County Head Start on Emergency Preparedness and Evacuation for students who are deaf or hard of hearing and other physical disabilities. The number of individuals impacted by these trainings is the number of individuals served by the Western MA school systems and community service organizations that were in attendance - over 99,000 individuals.

Crisis Intervention Training (CIT) Series for First Responders: DLC has worked with the local District Attorney’s Office, NAMI, Soldier On, the Veterans Administration, and first responders to develop and implement crisis intervention training for all police officers responding to 911 calls when an individual with a disability is in crisis. These trainings also include information about how to provide effective communication with a deaf or hard of hearing individual and common challenges for veterans with disabilities returning from deployment. DLC has consulted with Berkshire County on their CIT program and continues to provide trainings and technical assistance to police departments upon request.

BNN Cable TV Show — Disability Connections: Hosted by various DLC staff on a bi-monthly basis, this media event has already reached over 268,000 individuals. Show topics include information about DLC and disability law topics ranging from human rights to education law to abuse and neglect in facilities. Shows also increase DLC’s visibility in the community to individuals we might not otherwise reach and/or be able to educate about our services and their rights.

Disability 101 Training for New State Legislators and Staff: In Spring 2011, DLC presented a 90 minute ’Disability 101’ Training for state legislators (especially new legislators) and their staff that included an orientation to DLC with an overview of disability law on Social Security, employment, housing, and special education. The training was well attended with over 45 participants, including numerous legislators.

Disability Disclosure: The Professionals’ Viewpoint Conference: DLC was a panelist for the Boston University School of Management’s Conference Disability Disclosure: The Professionals’ Viewpoint. The audience was comprised of people who are career service people working at schools of social work across the country, seeking to help social work students who have disabilities. The main topic discussed was under what circumstances an individual may disclose their disability and the potential positive and negative consequences of that disclosure. There were 35 conference attendees.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff8
2. Newspaper/magazine/journal articles5
3. PSAs/videos aired2
4. Hits on the PAIR/P&A website163,405
5. Publications/booklets/brochures disseminated2,000
6. Other (specify separately)2

Narrative

Distributed 2 e-newsletters to e-mail list of over 7,500

Part II. Individuals Served

A. Individuals Served

Count individual once per FY. Multiple counts not permitted for lines A1 through A3.

1. Individuals still served as of October 1 (carryover from prior FY)18
2. Additional individuals served during the year101
3. Total individuals served (lines A1 + A2)119
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)5

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 17

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility5
2. Employment28
3. Program access3
4. Housing8
5. Government benefits/services5
6. Transportation0
7. Education45
8. Assistive technology1
9. Voting0
10. Health care22
11. Insurance1
12. Non-government services0
13. Privacy rights0
14. Access to records1
15. Abuse1
16. Neglect4
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor92
2. Other representation found0
3. Individual withdrew complaint6
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.5
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit3
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

List the highest level of intervention used by PAIR prior to closing each case file.

1. Technical assistance in self-advocacy0
2. Short-term assistance91
3. Investigation/monitoring1
4. Negotiation11
5. Mediation/alternative dispute resolution1
6. Administrative hearings2
7. Litigation (including class actions)1
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 46
2. 5 - 2244
3. 23 - 5956
4. 60 - 649
5. 65 and over4

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females64
2. Males55

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race8
2. American Indian or Alaskan Native0
3. Asian4
4. Black or African American19
5. Native Hawaiian or Other Pacific Islander1
6. White87
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent43
2. Parental or other family home61
3. Community residential home0
4. Foster care0
5. Nursing home5
6. Public institutional living arrangement4
7. Private institutional living arrangement2
8. Jail/prison/detention center1
9. Homeless3
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

Identify the individual's primary disability, namely the one directly related to the issues/complaints

1. Blind/visual impairment7
2. Deaf/hard of hearing21
3. Deaf-blind0
4. Orthopedic impairment19
5. Mental illness1
6. Substance abuse1
7. Mental retardation0
8. Learning disability16
9. Neurological impairment4
10. Respiratory impairment4
11. Heart/other circulatory impairment2
12. Muscular/skeletal impairment21
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability23

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities16

2. Number of individuals potentially impacted by policy changes511,000

Describe your systemic activities. Be sure to include information about the policies that were changed and how these changes benefit individuals with disabilities. Include case examples of how your systemic activities impacted individuals served.

The total number of individuals potentially impacted by Disability Law Center’s systemic activities is 1,710,571. This is the total number of people impacted by the Disability Law Center when counting each individual systemic advocacy project individually. The estimated number of people with disabilities in Massachusetts is 511,000, therefore, the total number of individuals impacted counts individuals more than once, as they are being positively impacted by different systemic advocacy efforts made by the Disability Law Center. The numbers of individuals potentially impacted by each policy and/or practice change are itemized in the descriptions detailed below.

Hospital Communication Access for Deaf and Hard of Hearing: DLC has monitored and investigated concerns raised by an Independent Living Center that Western Mass hospitals have not been providing ASL interpreters for deaf patients after hours. This problem has increased since the MA Commission for the Deaf and Hard of Hearing (MCDHH) cut back on their after-hours interpreter referral program. DLC has been monitoring local hospitals and working with interpreter coordinators to improve services. This project has led to individual client representation and a successful advocacy outcome in that case (see Part V, Section A, Priority 4, Number 6, ‘Amy’ case example, below). This monitoring work and changes in policies to improve coordinator services positively impacts the 124,000 individuals with hearing disabilities in Massachusetts.

Boston Curb Cuts Cleared for Snow Collaboration: DLC partnered with Boston Center for Independent Living (BCIL) to address complaints about the City of Boston not clearing curb cuts from the excessive amount of snow during the 2010-2011 winter season. DLC and BCIL worked together on researching the laws in this area and presented them to the Boston Attorney General’s Office. The Attorney General (AG) then wrote to the Boston Commission for Persons with Disabilities (BCPD) explaining the challenges to individuals with disabilities when snow and ice are not cleared, and demanding action from the City. DLC, BCIL, the AG and BCPD jointly resolved the issue as Boston acknowledged their legal obligation to clear curb cuts and began doing so. Boston also agreed to work on a plan for the following winter season. This policy change positively impact approximately 32,000 individuals with mobility disabilities in Boston.

Nursing Home and Rehabilitation Center Monitoring: DLC currently monitors 5 privately owned and operated nursing homes and/or rehabilitation centers throughout MA. DLC visits and investigates these facilities for allegations of abuse and neglect and to improve facility policies and practices. For example, DLC is currently working with one facility to improve new resident orientation by using SKYPE to meet out of state individuals before they are brought to MA. DLC is also reviewing admission policies and forms for each of these facilities, and is currently working with General Counsel for one of these Health Care Providers to revise an admission form to bring it into compliance with patient rights and MA laws. These positive policy and practice changes positively impact approximately 800 residents of nursing homes and rehabilitation centers.

Employment NOW Coalition: DLC participates in a cross-disability coalition of advocates and service providers which seeks to increase opportunities for competitive employment statewide for individuals with disabilities. The goal of the Coalition is to reduce stigma and to promote pro-employment, consumer-focused changes in the state’s employment support and educational systems and other private and public sector policies and practices. This systemic advocacy positively impacts 164,000 individuals with disabilities who are working, and actively looking for work, in Massachusetts.??Paid Sick Days Advocacy: DLC continued its collaboration with other civic and legal services organizations to promote passage of an Act Establishing Paid Sick Days. The legislation, which was re-filed in FY11, would ensure that all Massachusetts workers have a minimum of seven days of paid time off annually to take care of their own health needs and those of family members. DLC believes that the legislation would expand employment opportunities for individuals with disabilities because workers would be able to take time off to deal with their own health problems without fear of repercussion. The legislation would also likely reduce the spread of illness at work; reduce the risk of individuals coming into contact with workers who have been forced to go to work sick instead of staying home and missing a day’s pay; allow workers time off to care for a sick child or family member and not have to worry that they may lose their job; and reduce the risk of retaliation against a worker with a disability who had been forced to self-identify in order to take time off to address a medical need. DLC submitted testimony in favor of the legislation and facilitated the addition of other disability organizations into the coalition through our membership in the Adult Onset Disability Alliance. This advocacy will positively impact approximately 75% of the current workforce of people with disabilities in MA, or 107,250 individuals.??Massachusetts Bay Transportation Authority (MBTA) Accessibility Advocacy: The MBTA made several renovations or alterations to five Boston transit stations that were not accessible. DLC received complaints about the changes and investigated the situation. DLC found that certain changes were in violation of the Architectural Access Board Regulations and the ADA. DLC partnered with Boston Council for Independent Living, North West Independent Living Center, and Greater Boston Legal Services to advocate for accessible improvements and accessible changes. This advocacy was successful and the MBTA agreed to make changes. This policy change positively impact approximately 32,000 individuals with mobility disabilities in Boston.

Education Law Task Force (ELTF) — Anti-Bullying and Disciplinary Practices: DLC has continued to participate in bi-monthly ELTF meetings where Task Force members representing children and families gather to network, discuss cases, and receive updates and trainings on changes in law and on pending legislation. In particular, DLC worked with a small subcommittee on preparing public comments to proposed Department of Elementary and Secondary (DESE) anti-bullying law regulations. DLC also continues to participate in drafting and lobbying for state legislation to ameliorate some of the more ineffective and punitive provisions of the current law concerning school discipline. While the legislation was not enacted in the recently concluded legislative session, the ELTF is revising and re-filing the legislation for the upcoming legislative session. DLC also participated in a national Coalition for Dignity in Schools campaign to reform unfair and punitive disciplinary practices. This work is part of DLC’s long-standing priority to prevent the exclusion from school of children with disabilities due to their behavioral disabilities. This advocacy positively impacts 166,000 students with disabilities who are enrolled in special education services in MA.??MCAD Regulations Committee: The Massachusetts Commission Against Discrimination (MCAD) is the state agency charged with enforcing the Massachusetts Anti-Discrimination statute, which protects employees and job applicants from discrimination in employment on the basis of disability. DLC is participating on a committee to redraft the MCAD Guidelines on Employment Discrimination on the Basis of Disability. The new regulations will make clear that in determining whether an individual has a disability under the Massachusetts anti-discrimination law, use of mitigating measures, such as assistive technology, medical supplies, equipment or appliances should not be considered.  This systemic advocacy positively impacts 164,000 individuals with disabilities who are working, and actively looking for work, in Massachusetts.? Online Job Applications Community of Practice: DLC participated as a member of a community of practices organized by the Institute for Community Inclusion (ICI) to look at barriers to employment for individuals with disabilities posed by electronic and online job application processes. The group also considered alternatives and/or accommodations that have been used to apply for jobs when on-line applications are the norm, and identify legal remedies that could be considered for the future. A position paper was drafted and an informational survey was developed by the committee and distributed throughout MA as a resource for job seekers experiencing employment barriers, those who work with them, and employers. This practice change positively impacts 15,400 individuals with visual and/or cognitive disabilities in MA who are actively seeking employment.

Reduction of Restraints and Seclusion in Schools: DLC has worked on efforts to prevent over-reliance on the use of restraint and seclusion in schools. On the National level, DLC participated in strategy conference calls organized by the National Disability Rights Network concerning proposed federal legislation. At the state level, DLC is part of an inter-agency task force to reduce the use of restraint and seclusion in schools. As the only legal advocacy agency in the task force, we have played a major role in guiding the work of the task force. These initiatives are part of DLC’s core work to protect persons with disabilities from abuse. This advocacy positively impacts 166,000 students with disabilities who are enrolled in special education services in MA.???Special Education Collaborative Group — Transition Services and Supports: DLC continues to be a member of the Special Education Collaborative group which is composed of major statewide stakeholders on both sides of the special education issue. The Collaborative Group identified as a shared concern the need for improved transition services and supports for young adults under the special education law. DLC participates on a subcommittee working on state legislation which would require Transition Specialists in schools to meet the needs of students with disabilities ages 14-22. Last session’s bill did not pass. DLC worked with the subcommittee this year to redraft and re-file the bill for this legislative session.  The bill (H. 3720 - An Act to Promote Successful Transition of Students with Disabilities to Post-Secondary Education, Employment, and Independent Living) will help ensure that special education teachers and rehabilitation counselors can receive advanced training regarding transition planning and services. The bill was favorably reported out of the Education Committee this session and DLC is hopeful it will pass this year. This systemic advocacy positively impacts 31,900 students of transition age who are currently receiving special education services. ?Coalition to Defend Special Education: DLC is a member of the Coalition to Defend Special Education, a collaborative group comprised of private and public interest attorneys and advocates formed to combat legislative efforts to erode parental and students’ special education rights under Chapter 766, the state special education law. The Coalition meets every two months and includes a training topic at each meeting. This advocacy positively impacts 166,000 students with disabilities who are enrolled in special education services in MA.??Health Care Systemic Advocacy, Collaborations and Task Forces: DLC continues to work systemically to improve access to medical settings for individuals with disabilities. DLC has been working on a systemic advocacy project with the Department of Public Health (DPH) and Independent Living Centers (ILCs) throughout the State to increase the accessibility of medical test equipment. The project initiated by looking at mammogram tests in Western Massachusetts, but has since expanded to other medical outpatient tests and the use of medical equipment. DLC is also tracking common issues and providing technical assistance to policy makers and consumers, as issues arise. This partnership has expanded to local health providers, health advocacy organizations, private durable medical equipment vendors and private sector legal counsel. It has been extremely successful and we look forward to continuing the work with more specific trainings to hospitals on site, and coordinating efforts with other advocacy groups in the year to come. This systemic advocacy positively impacts all individuals with disabilities in Massachusetts, or approximately 511,000 individuals.

Governor’s Accessible Health Care Task Force: DLC participated in a group convened by MA Governor Deval Patrick to address accessibility of medical settings.  The group included the Massachusetts Hospital Association, EOHHS, Partners, Department of Public Health, Boston Center for Independent Living, Greater Boston Legal Services, and other advocates working on these issues.  The group developed a training that was held on March 8, 2011 for all Massachusetts Hospital Association members.  The training was attended by over 100 people.  The training objective was to heighten awareness of disability concerns, compliance training, discuss case studies and to offer resources and best practices for hospitals to utilize in improving staff awareness, assessing facility compliance and monitoring impact. This training impacted at least 110 individuals who attended. It is difficult to determine how far-reaching the impact of the training was once the policy-makers began implementing changes at their facilities.   Health and Disability Advisory Committee: Additionally, the Massachusetts Department of Public Health Office on Health and Disability has asked the Disability Law Center to participate on the Health and Disability Advisory Committee.  This Committee is charged with helping to develop the 2012-2017 Massachusetts Plan for Promoting the Health of People with Disabilities.  The plan will guide the Office on Health and Disability in strategic planning, implementation, and evaluation of proposed activities for CDC funding.  This planning committee currently impacts 11 individuals who serve on the committee but it is expected to impact significantly more next fiscal year once new policies are implemented.

Private Duty Nursing Systemic Advocacy: Starting last Spring, DLC began to receive calls from a number of families that had received notice of modifications reducing the number of MassHealth covered Private Duty Nursing (PDN) hours received by a family member with severe disabilities.  These PDN hours, also known as block nursing, allow children and adults with severe disabilities to remain at home with their families and still receive the level of nursing care needed to manage complex medical conditions and medical equipment and procedures.  DLC staff reviewed many of these cases, provided representation in some and advice in others.  In this process DLC staff identified problems with the review, application of the standards, and review of the medical evidence.  When DLC learned of an ad hoc group of parents caring for minor children that wanted to take some action, DLC worked with the group to provide information and tips on how to meet with MassHealth managers and with policy makers at the Executive Office of Health and Human Services.   The group felt that they were at the meeting, got some immediate relief (longer approval periods), and the promise of additional changes to come.     In addition to families caring for younger children, DLC also started to hear from a number of families caring for young adults over age 21.   They had been receiving over 112 PDN hours per week but were suddenly being cut back to 112 hrs without any evidence that medical necessity had changed.  MassHealth regulations set a limit of 112 hrs per week on PDN services, but the federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) statute prevents states from putting such limits on medical necessity for people younger than 21 years of age.  This reduction in PDN hours put these individuals at risk of institutionalization, and DLC began to prepare for representation leading to a court challenge representation.  However, after gathering a number of case examples, DLC meet with EOHHS.  An agreement was reached to reinstate the PDN hours of those that had been automatically reduced to 112  for a period of three months while new regulations were drafted to provide new criteria to provide more accurate evaluations of medical need for community living.  This change eliminated the risk of institutionalization for those individuals who received automatic reductions to 112 hours.  The new criteria will also benefit families caring for younger children at home with PDN hours.  This impacts 500 individuals now and more in the future.  

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts164,600
2. Number of individuals named in class actions0

Describe your litigation/class action activities. Explain how individuals with disabilities benefited from your litigation activities. Be sure to include case examples that demonstrate the impact of your litigation.

164,600 individuals are potentially impacted by the outcome of the Simmons v. Joulé litigation described below. This is the approximate number of individuals with disabilities in MA who are either currently employed or actively seeking employment.

Simmons v. Joulé Amicus Brief:

DLC signed onto this Amicus Brief with fifteen other organizations in support of a Court decision that would allow employees who had signed an arbitration agreement to still be able to file a complaint with the Massachusetts Commission Against Discrimination (MCAD).

Simmons v. Joulé Case Summary: The Massachusetts Supreme Judicial Court recently held that an employee could file a complaint with the Massachusetts Commission Against Discrimination (MCAD), despite that she was subject to a valid arbitration agreement that expressly covered claims of employment discrimination.  In Joulé, Inc. v. Simmons, Randi Simmons claimed that her employer, Joulé, subjected her to a hostile work environment and discriminated against her on the basis of gender and pregnancy.  Although Simmons had signed an employment contract in which she expressly agreed to arbitrate any claims of discrimination, harassment and hostile work environment, Simmons filed a complaint with the MCAD instead of pursuing arbitration.  Joulé then sued Simmons in Superior Court, requesting that the Court compel her to arbitrate her claims. Simmons opposed Joulé’s request, arguing that the arbitration provision was unenforceable, and regardless, did not prevent her from participating in the MCAD proceeding.  The MCAD intervened in the case and argued that the parties’ agreement to arbitrate did not affect its authority to investigate and adjudicate Simmons’s claims.  The Superior Court agreed with the MCAD.  It denied Joulé’s motion to compel arbitration, held that Simmons could participate as a party in the MCAD matter, and stayed the court action pending resolution of her claims at the MCAD.  The Court did not address whether the arbitration agreement was unenforceable. ??With the support of the DLC and fifteen other organizations who partnered to file an Amicus Brief in support of her claim, Joulé appealed the decision of the Superior Court arguing that she should be able to pursue her MCAD complaint, even though she signed an arbitration clause. 

Simmons v. Joulé Case Outcome: DLC and fifteen other organizations filed an Amicus Brief in support of Joulé’s claim that she should be able to pursue her MCAD complaint, even though she signed an arbitration clause.  On appeal, she won. The Court stated that if an employer and an employee enter into a valid agreement to arbitrate disputes relating to discrimination, the party seeking arbitration is entitled to have the agreement enforced, even if that means the arbitration and MCAD case proceed concurrently. 

This decision benefits individuals with disabilities who may sign arbitration clauses with employers, but still want to file a complaint with MCAD. It is important to keep open every avenue of advocacy for an individual with a disability who may be experiencing discrimination to promote a fully integrated work environment that practices equality.

Simmons v. Joulé Collaboration: Disability Law Center partnered with the following organizations on the Amicus Brief in an effort to make the strongest argument to the Court in support of an outcome that would favor individuals with disabilities: American Civil Liberties Union of MA; Charles Hamilton Houston Institute for Race and Justices; Fair Employment Project, Inc; Gay & Lesbian Advocates and Defenders; Greater Boston Civil Rights Coalition; Greater Boston Legal Services Corp.; Jewish Alliance for Law and Social Action; Lawyers’ Committee for Civil Rights Under Law of the Boston Bar Assoc.; League of United Latin American Citizens MA; MA AFL-CIO; MA Law Reform Institute; MA Transgender Political Coalition; National Lawyers Guild MA Chapter; National Organization for Women MA Chapter; and Union of Minority Neighborhoods.

Part V. PAIR'S Priorities and Objectives

A. Priorities and Objectives for the Fiscal Year Covered by this Report

For each of your PAIR program priorities for the fiscal year covered by this report, please:

  1. Identify and describe priority.
  2. Identify the need, issue or barrier addressed by this priority.
  3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.
  4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.
  5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.
  6. Provide at least one case summary that demonstrates the impact of the priority.

Priority 1 General Education Priority?1. PAIR General Education Priority?To reduce the number of students who are out of school due to unilateral action by school districts. Increase the quality and availability of inclusive programs for students with disabilities, and decrease the number of placements in restrictive settings. To reduce incidents of abuse, particularly bullying and the use of restraint and seclusion in public and private schools. To ensure that students 14 years or older receive appropriate transition goals and services in their IEPs. Special consideration will be given to cases where the family has refused a high school diploma.??2. Identify the need, issue or barrier ?Rationale: ?Based on intakes, previous priority setting meetings and the mandates as a Protection and Advocacy Center, DLC has identified these 4 sub-priorities as being of critical importance. Harsh disciplinary practices, lack of appropriate transition services, failure to include students with disabilities in regular education and incidents of abuse and neglect usually result from lack of teacher training and support, as well as lack of knowledge of best practices in educational methodology. Bringing advocacy efforts which focus on the underlying reasons for these problems is best done on both an individual student and systemic level.??3. Identify and describe indicators?1. Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.??2. Collaboration: work collaboratively with legal services and private law firms to address systemic issues through legislation, policy and litigation.??4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.??DLC’s individual representation of clients did not involve collaboration with other entities. Our systemic work (see Section IV above) and trainings (see Priority 2 below)?Involved a high amount of collaboration with other advocacy agencies??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.??32??6. Provide at least one case summary that demonstrates the impact of the priority.??Joe is a ten year old boy with learning disabilities (borderline intellectual functioning) and ADHD who was inappropriately placed in a substantially separate classroom for students with behavioral challenges. Joe has a history of abuse and neglect by his biological parents whose parental rights were terminated. Since he was adopted in 2009 and in a stable home and educational environment, he has thrived and made progress socially and academically. He has not had behaviors and has made effective progress since being placed in the substantially separate class. Yet, the school district proposed moving him from his current class to a life skills class for the upcoming school year. Joe tests at a first grade level across the curriculum and is considered a ’non-reader’ due to difficulties with decoding. The school district believes he needs specialized programming to correspond to his speed of learning. Joe’s parents rejected the proposed placement because they wanted more inclusive programming and rejected the education plan in part. The family came to DLC looking for assistance with placement in the least restrictive educational setting. As part of our representation, DLC hired an educational consultant to observe the student in his current and proposed placements, review his student record, interview the parents and school staff, and assess the strengths of the claim for inclusion. DLC met with the educational team in June 2011 and planned more inclusive opportunities for the 2011-2012 school year with placement in science and social studies with supports and services.

Simon, a 13-year-old with ADHD and an anxiety disorder, was enrolled in middle school. The school suspended him for bringing a Swiss army knife to school. A manifestation determination hearing concluded that Simon’s disability and infraction were unrelated, and the school decided to expel him. Simon’s mother sought DLC’s assistance to ensure continuity of educational services for her son and to review the likelihood of getting the expulsion removed from his record. The LEA then arranged for an interim alternative placement, and Simon’s mother was satisfied. DLC’s Attorney explained there was no likely success of obtaining an expungement, but Simon’s mother stated she was no longer concerned, as long as the student continued to receive educational services and an adequate IEP. DLC then consulted with the student’s counselor and determined that the services offered were adequate. DLC also counseled Simon’s mother about how to negotiate for different services, should the need ever arise, and the level of clinical support that was necessary.

Priority 2 FAPE Priority?1. PAIR FAPE Priority?To ensure that parents of special education students of diverse racial backgrounds are educated about their rights.??2. Identify the need, issue or barrier ?Rationale: Studies have documented that parents of special education students of diverse racial backgrounds have less training and knowledge about their rights than their Caucasian counter-parts.??3. Identify and describe indicators?1. Pursuant to the grant received from the Massachusetts Bar Foundation, DLC will provide trainings across the state on special education transition law with parents of diverse racial backgrounds as the primary targeted audience.??4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.? All of the trainings were co-sponsored by one or more legal services programs, as well as the Children’s Law Center of Massachusetts and the Federation for Children with Special Needs. We also worked with many other community agencies to help publicize the trainings. Finally, several agencies made brief presentations about their services during the trainings’ lunch hour.??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.? 0 ??6. Provide at least one case summary that demonstrates the impact of the priority.??Because this project focuses on trainings and short consultations, we cannot report with any detail on client stories. We can report to you that we received emails from lay advocates and participants after the trainings expressing appreciation for being able to attend these events. In addition, the clinics offer us an opportunity to provide useful legal advice on a 1: 1 basis.

DLC has made an effort to do specific outreach to underserved communities, particularly to those people for whom English is not their primary language. DLC held a series of trainings around the state which were presented in English plus a second language: Spanish, Portuguese or ASL. The trainings covered many different areas such as special education, benefits and employment and combined a large group presentation followed by an opportunity to meet with advocacy staff on a 1:1 basis. DLC presented these training events in conjunction with various community organizations, legal services and independent living centers. DLC conducts joint outreach with these other community organizations.

DLC’s series of community-based special education and transition trainings and clinics were targeted to underserved communities, conducted in partnership with grassroots community based organizations. DLC hosted 5 trainings: Allston, targeting the Portuguese community with 70 attendees; Springfield, targeting the Hispanic community, with 90 attendees; Boston’s Chinatown neighborhood, targeting the Chinese community with 70 attendees; Southbridge, targeting the Hispanic community with 60 attendees; and Dorchester, targeting the Haitian community with 55 attendees.

DLC holds the trainings in community centers, libraries and churches in order to attract people in the community to places they may already attend. DLC also collaborates and co-sponsors these trainings with the local legal service agency and community groups such as Urban Pride, the Asian American Civic Association, and the Brazilian Immigrant Center. Priority 3 Effective Access and Communication Priority?1. Effective Access and Communication Priority PAIR?Ensure that students who are deaf or hard of hearing or students who are blind or visually impaired are provided with effective access and communication services in their educational settings.??2. Identify the need, issue or barrier ?Rationale: ?Meeting the special education access and communication needs of deaf and hard of hearing students or blind or visually impaired students is complex, whether a student is placed in a public school or a specialized setting. For this reason, many students do not receive appropriate services and are unable to communicate effectively. The decision as to the most appropriate placement should be based on the educational needs of the student. While it is certainly desirable to place impaired students in the local school district setting, qualified teachers with specialized knowledge of instructional methodologies, training and experience, and required certifications may not be available in a school district. In these situations, short or long term placement at a specialized may be needed to provide the most appropriate and essential educational services for the student. Every case must be considered individually to ensure the best possible outcome and placement.??3. Identify and describe indicators?1. Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.??4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.??DLC collaborated with independent experts in deaf education and case managers from the MA Commission for the Deaf and Hard of Hearing.??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.??8??6. Provide at least one case summary that demonstrates the impact of the priority.? Audrey is four years old and profoundly deaf. Audrey is the veteran of two surgeries --- both before turning two --- to outfit her with cochlear implants. They enable her to hear some things, and she is learning spoken English. Audrey will always need to be part of the Deaf community, which uses ASL. Audrey’s school district proposed an educational placement for her that uses Signed Exact English (SEE-2), a manual coding system of English. Unlike ASL, SEE-2 is not a language and not widely used among persons who are deaf. Audrey’s mother unsuccessfully tried to persuade the school district that Audrey had been exposed to ASL almost since birth, and that a placement using SEE-2 would deny her a free and appropriate public education (FAPE). She then unilaterally placed Audrey in a private preschool that uses spoken English and ASL and wanted the school district to fund it. That is when she sought DLC’s help. The DLC attorney first wrote to the school district. Receiving no response, she filed a hearing request at the Bureau of Special Education Appeals (BSEA). A Resolution Session and Settlement Conference were both unsuccessful. Then, after nearly one year, the school district agreed to pay full tuition for the preferred school, and it offered to pay for transportation as well.

Ralph is deaf and lives at home with his parents and younger sister who are also deaf. American Sign Language (ASL) is the natural and primary language of the home. Ralph is at a 17-18 month developmental level with significant learning challenges. His receptive and expressive abilities are less developed than other children of deaf parents his age and a language rich environment is essential for his growth. Ralph has been evaluated by one of the leading neuropsychologists who work with children who are deaf and hard of hearing. In her report, the doctor recommended that Ralph receive direct instruction from trained teachers of the deaf who are experienced in working at the early childhood level, that ASL be the language of instruction and interaction in his schooling, that he be grouped with genuine peers (close to him in age, also deaf, and acquiring language through visual access to ASL), and that he receive individual language stimulation with a specialist proficient in ASL. The school district proposed placement in their preschool classroom for deaf and hard of hearing children. After observing the classroom, Ralph’s parents rejected the proposed placement because they believed it was not appropriate to meet their son’s individual needs since the other students they observed in the preschool communicate primarily through spoken English with limited signing and are older than Ralph. His parents requested placement at a school for deaf children. Based on their significant concerns about the school district’s preschool program and fear of regression to their son, Ralph’s parents retained the Disability Law Center to file a Hearing Request at the Bureau of Special Education Appeals. Once the Hearing Request was filed, the school district immediately settled the matter. The student has been placed and is reported to be doing well. Bill is a 3 year old hearing-impaired boy who was in the process of transitioning from Early Intervention to Special Education. Despite extensive professional support recommending placement in a specialized school for hearing-impaired students, the school district proposed placing him in a regular education preschool classroom. DLC filed a hearing request with the Bureau of Special Education Appeals. The parties subsequently participated in a Settlement Conference which led to an agreement for the district to fund the Bill’s placement at the specialized school for hearing-impaired students that the parents were seeking.

4. PAIR Appropriate Treatment Priority 1. PAIR Appropriate Treatment Priority?To increase the number of individuals with disabilities, including children and adolescents, who have adequate discharge planning resulting in access to community placement with appropriate supports. To ensure the rights of individuals who reside in facilities and residential programs, including CBFS programs, to fully participate and exercise leadership in decisions about their care and treatment. Increase the number of specialty beds in the community in order to increase the number of psychiatrically stable individuals to be discharged to the community. To protect rights related to admission, informed consent, medical treatment, medication and/or appropriate services (e.g. ISP appeals). To protect human rights of persons in facilities? 2. Identify the need, issue or barrier ?Rationale: ?To increase the number of individuals with disabilities, including children and adolescents who have adequate discharge planning to community placement with appropriate supports, and to ensure the right of individuals with disabilities to fully participate and exercise leadership in decisions about their care, treatment and discharge planning, including their rights related to admission, informed consent and appropriate medical and psychiatric treatment and services, and to increase the number of Medically Ill/Mentally Ill (MIMI) beds in the community in order to increase the number of psychiatrically stable individuals to be discharged to the community, and to promote community integration.??3. Identify and describe indicators Priorities Strategies:?1. Provide discharge advocacy for individuals with psychiatric disabilities, including children and adolescents who currently reside in inpatient facilities and residential programs; and to ensure that discharge planning is client directed and that the individual’s right to provide or withhold consent regarding treatment and services is respected.??2. Monitor the creation and supply of appropriate community placements for all individuals, including those who require specific care and services.? 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.??In pursuing this priority, DLC works closely with several entities and agencies. Primarily DLC, when possible, collaborates with the administration, medical, nursing, social work and direct care staff at the facility to address and resolve issues and problems. In addition, because DLC is a law office we often work collaboratively with legal counsel for the facility to facilitate the facilities understanding of DLC’s role as the P&A and our authority to monitor facilities, as well as increasing their understanding of the relevant law. In addition, in cases of this type, DLC works closely with Massachusetts Ombudsman program which is housed within the Office of Elder Affairs. The Ombudsman can be greatly effective in providing insight into the history of the program, and who are the best persons to contact to help address and resolve a problem. Lastly, DLC works closely with the Massachusetts Department of Public Health, which in addition to licensing facilities, promulgates regulations regarding the rights of clients and the responsibility of facilities. DPH also has the authority to investigate facilities and to order remedial action when necessary. Through strengthening DLC’s relationship with these entities, we are able to be more effective in addressing the needs of our clients.??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.??5??6. Provide at least one case summary that demonstrates the impact of the priority.??Amy contacted DLC after she was refused effective communication at her local hospital. She is deaf and has several family members that are also deaf and they communicate using American Sign Language. DLC took the case and met with the administration at the hospital. The hospital agreed that finding interpreters has been hard especially after MCDHH stopped acting as the referral source for nights and weekend requests. After our meeting the hospital contracted with a video relay service that will provide 24/7 coverage, trained staff, and issued new policies regarding the need to request a live interpreter and then use the video relay as back up. These new policies will provide much better ASL access at the hospital. ?Priority 5 Facilities Abuse and Neglect Priority?1. PAIR Facilities Abuse and Neglect Priority?Reduce the incidence of abuse and neglect of individuals with disabilities in facilities and residential programs. To reduce or eliminate the use of restraint and seclusion in private and public facilities serving individuals with disabilities. To ensure that use of restraint and seclusion in facilities conforms with state law, federal law and administrative regulations, with an emphasis on those instances which will have the largest impact in reducing the use of restraint and seclusion. Reduce the incidents of inappropriate treatment by guardians.??2. Identify the need, issue or barrier?Persons with disabilities who live in facility are at risk of abuse and neglect. The basis for this priority is that often staff at facilities is poorly trained and are often entry-level employees with inadequate experience in how to respectfully and appropriately meet the needs of the persons in their charge. In addition, there are often language problems where staff cannot adequately understand the needs of clients. Also, economic difficulties often result in too little staff, or staff that are spread too thin to attend to the needs of clients. Lastly, the shear number of facilities of this type are scattered throughout the state, so it is very challenging for state agencies like the Ombudsman program to efficiently monitor these programs. Therefore, DLC must be vigilant to ensure that persons with disabilities residing in facilities are not victims of abuse and neglect due to these factors.??3. Identify and describe indicators?1. To ensure access for individuals in facilities and residential programs to adequate and appropriate health, dental and mental health care.??2. Provide monitoring and analysis of investigation of abuse and neglect allegations, including incidents of restraint and seclusion, conducted by providers, guardians, and state agencies, including hospital emergency departments, and advocate for changes in policies and practices to increase the effectiveness of the investigation of administrative complaints.??3. Conduct direct, independent investigations into allegations of abuse or neglect, including incidents of restraint and seclusion, of individuals with disabilities. Additionally, assist consumers in appealing inadequate investigations and corrective action plans.??4. Review the mortality reports of all individuals in Massachusetts who die while receiving inpatient or residential mental health services from the Department of Mental Health or the Department of Developmental Services. Where appropriate, request that the Department of Mental Health or the Department of Developmental Services investigate cases in which DLC has probable cause to believe that agency action or inaction was a factor in the individual’s death.??5. Review selected death investigations, request additional fact-finding as needed and monitor the implementation of required corrective action plans.??6. Conduct outreach and trainings to consumers of mental health services and peer support organizations of the right to be free from abuse and neglect as well as working to ensure the autonomy of Human Rights Officers in Public and Private Psychiatric Facilities.??4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration. In pursuing this priority, DLC works closely with several entities and agencies. Primarily DLC, when possible, collaborates with the administration and direct care staff at the facility to address and resolve issues and problems. In addition, because DLC is a law office we often work collaboratively with legal counsel for the facility to facilitate the facilities understanding of DLC’s role as the P&A and our authority to monitor facilities, as well as increasing their understanding of the relevant law. In addition, in cases of this type, DLC works closely with Massachusetts Ombudsman program which is housed within the Office of Elder Affairs. The Ombudsman can be greatly effective in providing insight into the history of the program, and who are the best persons to contact to help address and resolve a problem. Lastly, DLC works closely with the Massachusetts Department of Public Health, which in addition to licensing facilities, promulgates regulations regarding the rights of clients and the responsibility of facilities. DPH also has the authority to investigate facilities and to order remedial action when necessary. Through strengthening DLC’s relationship with these entities, we are able to be more effective in addressing the needs of our clients.??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions. ??11??6. Provide at least one case summary that demonstrates the impact of the priority.??Rafael is a federal prisoner who is experiencing end stage renal disease. He is in a federal facility that houses prisoners with serious medical needs. Rafael has sought a kidney transplant, even willing to accept a new kidney which would be poor functioning or otherwise compromised. The medical team reviewing Rafael’s case refused to place him on the transplant list on the grounds that Rafael is undocumented and will be deported to his Latin American country of origin when his sentence completes within the next two years. The team reasoned that he would be unable to receive adequate follow up care in his home country. DLC reviewed the case, including the medical records and the health care system in Rafael’s home country. We worked extensively with the embassy from Rafael’s country to produce affidavits which refuted the culturally biased and inaccurate assumptions beneath the decision to deny Rafael a place on the transplant list. After extensive advocacy, the prison and the medical team revised its decision and placed Rafael on the transplant list.? Martha is a 57-year old with many medical issues. She resides in a nursing home that decided to discharge her, and she sought DLC’s assistance with her appeal. Upon review of her records the DLC attorney found that the nursing home had no discharge plan for Martha and it had not followed the regulations in its procedure for deciding to discharge her. DLC became involved to represent Martha at her hearing. The attorney contacted nursing home administration and staff to gather information and express interest in working with them for a better solution. Soon after, the nursing home started working with Martha searching for an appropriate placement for her. As the hearing approached, the nursing home withdrew its intent to discharge Martha and the DLC attorney, upon obtaining Martha’s agreement, cancelled the appeal hearing. Martha then worked with her social worker to find a different, better placement for her, while remaining at the nursing home where her medical needs could be met. After we closed the case, we heard from Martha that she had found a place to live and she was moving to her own apartment in a 55 and older community.

Lucie is a person with a psychiatric history who is residing on the long-term care side of Tewksbury Hospital. Lucie called DLC and alleged, among other things, that she had fallen out of bed and was left there for five hours. DLC contacted and spoke with the HRO and the client’s legal guardian. A formal investigation into this matter has been initiated by the Department of Public Health. ?6. Community Inclusion Priority?Although state and federal laws designed to protect people with disabilities from discrimination, such as the Americans with Disabilities Act, the Fair Housing Amendments Act, and M.G.L. c. 151B have been in effect for twenty or more years, individuals with disabilities still face significant difficulties in achieving full inclusion in the economic, communal and social aspects of our society. The Community Team’s Community Inclusion Priority seeks to ensure integration to the fullest extent possible for people with disabilities through enforcement and education regarding anti-discrimination laws, removal of barriers to inclusion, equal access to services, programs and activities and provision of reasonable accommodations, modifications and auxiliary aids and services.??Objectives:?1. Individual Representation on Civil Rights Issues?DLC will accept a limited number of cases for individual representation which will primarily be focused on achieving systemic change and/or having a beneficial impact beyond that of the individual client??Focus Areas:?i. Employment (priority for representation given to certain types of cases involving larger employers and current employees seeking reasonable accommodation)?ii. Housing (priority given to cases in the United Way Mass Bay and Merrimack Valley service area)?iii. Public Accommodations (priority given to cases involving potential to benefit large numbers of people with disabilities)?iv. Abuse & Neglect (including independent investigations into allegations of abuse or neglect of individuals with disabilities in the community)?v. Access to Transportation??2. Provision of information/materials to promote self-advocacy?DLC will leverage its limited resources by expanding knowledge within the disability community on issues of full inclusion and equal opportunity in an effort to empowers people with disabilities to advocate for their individual rights.?Focus Areas:?i. Employment?ii. Housing (non-United Way service area)?iii. Public Accommodations?iv. State/local Government Services, Programs and Activities?v. Access to Transportation?vi. Deaf Community??3. Systemic & Impact Advocacy?DLC will seek to create positive change and promote community inclusion through impact litigation, systemic reform, legislative activities, policy development, training and education. ?Focus Areas:?i. Olmstead work - avoiding re-institutionalization?ii. Hospital Access?iii. Entertainment/recreation/health & fitness?iv. Abuse & Neglect prevention and policy advocacy, including monitoring and analysis of investigation of abuse and neglect allegations conducted by provider and state agencies ?v. Training & Education on community inclusion issues?vi. Legislative/Policy work on community inclusion issues?vii. Access to Transportation? 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.??The systemic and impact advocacy described above involved collaboration with: ?The Massachusetts Bar Association?Institute for Community Inclusion (ICI)?Suffolk University School of Law?Housing Authorities throughout MA Independent Living Centers throughout Massachusetts?MA Commission for Deaf and Hard of Hearing MA Department of Public Health Nursing Home Ombudsman Directors Program??5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions. ??42??6. Provide at least one case summary that demonstrates the impact of the priority.

Claudia is a 61 year old woman with multiple sclerosis and a severe visual impairment. When she entered a pharmacy with her service animal, a dog, the pharmacy staff informed her that pets were not allowed. Claudia explained that her dog was not a pet, but a service animal to help her with balance. The CVS staff nonetheless reiterated that Claudia could not return with her dog. The store also had a conspicuous sign that pets were not allowed, with no clarification that service animals were welcome. A DLC attorney wrote to the store manager and enclosed the applicable law, explaining that persons with disabilities had a right to have their service animals accompany them. The attorney also spoke to the attorney for the store chain. This resulted in training of the store personnel, advising them that persons with disabilities are allowed to bring service animals into the store. The store also modified its signage to state that service animals are allowed.

Rachel enjoyed her job as Program Director for an adult day health program at a nursing home. However, as her job responsibilities increased, she struggled to stay focused and complete the tasks of her job in a timely manner. Rachel has attention deficit disorder and depression and came to Disability Law Center ’DLC’ seeking help making a reasonable accommodation request. DLC worked with Rachel to submit a request to her employer. DLC was then able to successfully negotiate several accommodations with her employer that greatly improved Rachel’s employment experience. Rachel now enjoys being Program Director and is able to work more effectively with the accommodations she needs.? Raul is a 5-year-old boy with Type 1 diabetes who uses an insulin pump. He attended a sumner camp which initially had two on-site nurses. Raul’s diabetes management required monitoring of his blood sugar level by using a finger prick test. It was also necessary for someone to adjust his insulin pump, based on his carbohydrate consumption. For the 9th week of the camp session, the camp planned to reduce its nursing staff to only one on-site nurse. Camp representatives suggested that Raul should not attend for this 9th week because there would be insufficient staff to accommodate his diabetic care management. With the guidance of a DLC staff attorney, the parents formally requested a reasonable accommodation for Raul, to allow him to continue attending camp. They asked that the camp ensure that someone be available to accommodate him. In response, the camp discontinued its request that Raul not attend camp for the 9th week. It also agreed to assign a 1:1 aide to Raul.

?7. PAIR Health/Benefits Systemic Advocacy Priority?Systemic advocacy (administrative advocacy, systemic work, research, impact litigation, technical assistance) for assess to treatment, and medical care. ?To improve the MassHealth prior approval decision-making and appeal process.?Prevent or ameliorate coverage/service limitations in MassHealth programs and other health coverage programs for people with disabilities.?Research on Systemic Concerns??2. Rationale?Access to MassHealth covered equipment and services is important to the ability of many individuals with disabilities to live and work in the community. MassHealth uses prior approval as a cost control measure to make sure it is paying for the least costly, effective, medically necessary item or service. The Massachusetts budget crisis has resulted in increased scrutiny and utilization review of the MassHealth program as a source of savings. Most individuals do not understand MassHealth standards and procedures for obtaining equipment and services or how to protect their rights in those procedures. Many do not appeal when they are denied, requiring time consuming resubmissions. There are few resources for legal advice or representation on MassHealth denials for equipment and services. Private lawyers do not take these cases because there is no source of payment, and legal services programs have experienced staff reductions.??3. Priority Strategies: ?1. Continue to assist individuals with access to MassHealth covered items and services by providing STA, representing a limited number of individuals who have been denied prior approval for MassHealth covered services necessary to living and working in the community (e.g., DME, PCA, dental, transportation, or pharmacy services), and providing developing consumer materials as needed. ??2. Continue to work in concert with other advocates to improve MassHealth prior approval procedures and hearing processes as issues arise, e.g., through advocates’ meetings with MassHealth, commenting on proposed regulations, investigating whether MassHealth is correctly applying eligibility standards and procedures, developing consumer or practice materials. ?4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.??The systemic work completed under this priority was done in collaborations with the MA Commission for Deaf and Hard of Hearing, other legal service organizations, NDRN, and consumer advocacy groups.? DLC has reached out to partner and collaborate with Nelson Kinder to create additional legal representation resources for MassHealth prior approval appeals and civil rights cases.   DLC is also working with the Health Law Section of the BBA to create mentoring project to increase access to legal representation in a wide range of health law areas.  Principles have been created.  The current work consists of finding mentors with the necessary areas of expertise.  Likely mentors include attorneys at HLA, GBLS and DLC.

DLC staff have also worked with a large group of advocates, ILC staff, agency staff and individuals to help ensure that MassHealth’s plans to develop an ACO (accountable care organization) for individuals with disabilities dually eligible for Medicare and MassHealth require accessibility and choice and are consumer driven and patient centered and cover what individuals with disabilities need to live and work in the community.

?5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions. ??9??6. Provide at least one case summary that demonstrates the impact of the priority.??Mary is deaf and uses ASL as her primary form of communication. She is also able to understand basic written English, but not complicated matters. Mary goes to a family eye doctor for routine vision care every year. She knows the doctor well and has been able to write notes back and forth for routine matters. During her last appointment, the doctor raised a concern about her eyes and referred her to a specialist. She was very concerned and she did not understand the information. DLC got involved, helped sort out the information and made sure that she would have an interpreter for her appointment with the specialist in Boston. Mary was very relieved to know that she would have an interpreter for this appointment and that she would get the information she needs to properly care for her eyes.

Cherise, a young adult SSI recipient from a west coast state, contacted DLC seeking help with finding personal care attendant services (PCA) in Massachusetts where she planned to move after being accepted at a prestigious local university. Her mother had been serving as her PCA and she did not know where to start to ensure continued eligibility for SSI and Medicaid or how to access PCA services in MA. A DLC attorney worked closely with Cherise and her family to facilitate a smooth transition with these benefits. The first step was to get evaluated for PCA services in her native state, which would facilitate the evaluation process in Massachusetts. The second step was to pave the way to quickly change her SSI living arrangement to Massachusetts, which would make her automatically eligible for MassHealth. The DLC attorney also worked in cooperation with the Boston Independent Living Center (BCIL) to help her arrange for a timely evaluation of her PCA needs for MassHealth PCA coverage. With the help of the DLC attorney she was able to document her medical needs and receive prior approval for the required number of PCA services in time to start classes. She is gradually settling into her new academic routine without the added stress of being left without SSI, health benefits or PCA services. She continues to work closely with BCIL on skills training and with the university administration for any necessary accommodations and to fully use other resources available to students with disabilities   Elena is an adult woman with ALS.  She lives at home with her much older spouse, who would not be able to mange all her care at home without the help of private duty nursing (PDN) services from MassHealth.  Their adult daughter lives nearby and is able to provide some care, but increasingly Elena needs the skilled services of a nurse as her condition progresses.  Elena’s family contacted DLC when MassHealth cut her PDN hours from 122 per week to 112 hours per week, fearing that Elena would no longer be able to remain safely at home.  MassHealth recently starting enforcing a ceiling of 112 hours per week  for people 21 and older.  As described in systemic activities above, DLC was able to obtain a moratorium on the reductions in PDN hours and a restoration of services to the previously determined number of medically necessary hours, pending agency review of its PDN eligibility criteria and processes.  

Systemic Advocacy: Disability Advocates Advancing our Healthcare Rights (DAAHR): DLC staff participate in Disability Advocates Advancing our Healthcare Rights (DAAHR), a response to Massachusetts efforts to create a service delivery and global payment system for people dually eligible for Medicare and Medicare.  DAAHR is a collaboration of cross disability community and legal advocates committed to development of a person centered healthcare delivery system that provides healthcare services that maximize function for community living.  Activities have included developing a set of principles, submitting comments on the RFI for providing services, and meetings with EOHHS.   

DLC staff are also working with a large group of advocates, Independent Living Center staff, agency staff and individuals to help ensure that MassHealth’s plans to develop ACOs (accountable care organization) for individuals with disabilities dually eligible for Medicare and MassHealth.   MassHealth was awarded funding from CMS to develop an innovative service delivery system that would combine both funding streams to maximize community living services and savings through fewer hospitalizations and nursing home admissions.  The fear of individuals and advocates is that the proposed ACOs would not offer consumer choice and would not provide access to items and services with a maximum independent living philosophy.  This work is ongoing and the goal of the group is to ensure that any ACO developed in the process is consumer driven and patient centered and covers what individuals with disabilities need to independently live and work in the community.

Related Health Care Advocacy & Training: DLC staff participates in the quarterly meetings of the AT Advisory Council.  The Council is made up of community members and professionals who understand the importance of assistive technology for people with disabilities. A majority of the council members (not less than 51%) are individuals with disabilities who use assistive technology or are family members or guardians of individuals who use AT. Other council members are representatives of state agencies concerned with creating better access for people who would benefit from AT.  The Council provides insight and recommendations for "best practices" for how to advance the use of AT. Specifically the Council advises on the Commonwealth’s priorities for federal AT Act funding, and on the design and implementation of state-level and leadership initiatives funded by the AT Act grant.

DLC staffs continue to collaborate with health care advocates to meet with MassHealth policy staff about every other month.  Issues have included the transition issues involved in the national health care reform legislation, and improving access customer service and MassHealth enrollment centers. DLC staff provided training at the December 2010 meeting of the AT Advisory Council.  The subject of the training was the MassHealth prior approval process and appealing prior approval denials.  The purpose was to demystify the prior approval process and provide tips on how to avoid denials.  Also provided was information on how to prepare and present a case for fair hearing.

B. Priorities and Objectives for the Current Fiscal Year

Please include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:

  1. a statement of each prioirty;
  2. the need addressed by each priority; and;
  3. a description of the activities to be carried out under each priority.

1. PAIR General Education Priority To reduce the number of students who are out of school due to unilateral action by school districts. Increase the quality and availability of inclusive programs for students with disabilities, and decrease the number of placements in restrictive settings. To reduce incidents of abuse, particularly bullying and the use of restraint and seclusion in public and private schools. To ensure that students 14 years or older receive appropriate transition goals and services in their IEPs. Special consideration will be given to cases where the family has refused a high school diploma.

Rationale: Based on intakes, previous priority setting meetings and the mandates as a Protection and Advocacy Center, DLC has identified these 4 sub-priorities as being of critical importance. Harsh disciplinary practices, lack of appropriate transition services, failure to include students with disabilities in regular education and incidents of abuse and neglect usually result from lack of teacher training and support, as well as lack of knowledge of best practices in educational methodology. Bringing advocacy efforts which focus on the underlying reasons for these problems is best done on both an individual student and systemic level.

Priority Strategies: Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.

Collaboration: work collaboratively with legal services and private law firms to address systemic issues through legislation, policy and litigation.

Outcome Measures: 1. Number of students represented to obtain meaningful relief in each of the sub-priority areas.

2. Number of coalition meetings attended and related policy, legislation or litigation accomplishments.

Case Selection Criteria: 1. Special education students who are being illegally excluded, not included in regular education, are subject to abuse and neglect or have not received appropriate transition services.

2. PAIR Effective Access and Communication Priority Ensure that students who are deaf or hard of hearing or students who are blind or visually impaired are provided with effective access and communication services in their educational settings.

Rationale: Meeting the special education access and communication needs of deaf and hard of hearing students or blind or visually impaired students is complex, whether a student is placed in a public school or a specialized setting. For this reason, many students do not receive appropriate services and are unable to communicate effectively. The decision as to the most appropriate placement should be based on the educational needs of the student. While it is certainly desirable to place hearing impaired and visually impaired students in the local school district setting, qualified teachers with specialized knowledge of instructional methodologies, training and experience, and required certifications may not be available in a school district. In these situations, short or long term placement at a specialized may be needed to provide the most appropriate and essential educational services for the student. Every case must be considered individually to ensure the best possible outcome and placement.

Priority Strategies: Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.

Outcome Measures: Number of deaf or hard of hearing or blind or visually impaired students represented to obtain meaningful relief.

Case Selection Criteria: 1. Deaf or hard of hearing students or blind or visually impaired students who are not receiving specialized education services necessary for them to receive FAPE.

3. PAIR Appropriate Treatment Priority To increase the number of individuals with disabilities, including children and adolescents, who reside in the community, facilities or residential programs, who receive appropriate treatment, in which they fully participate and exercise leadership in decisions about their care and treatment, including discharge planning that promotes community integration and ensures timely access to community placement with appropriate supports that guarantee that said individuals are equally protected and planned for during an emergency and obtain appropriate and efficient aid from first responders and emergency department staff.. To protect rights related to admission, informed consent, medical treatment, medication and/or appropriate services..

Rationale: To increase the number of individuals with disabilities, including children and adolescents who have adequate discharge planning to community placement with appropriate supports, and to ensure the right of individuals with disabilities to fully participate and exercise leadership in decisions about their care, treatment and discharge planning, including their rights related to admission, informed consent and appropriate medical and psychiatric treatment and services, and to increase the number of Medically Ill/Mentally Ill (MIMI) beds in the community in order to increase the number of psychiatrically stable individuals to be discharged to the community, and to promote community integration.

Priorities Strategies: Provide discharge advocacy for individuals with disabilities, including children and adolescents who currently reside in inpatient facilities and residential programs; and to ensure that discharge planning is client directed and that the individual’s right to provide or withhold consent regarding treatment and services is respected.

Monitor the creation and supply of appropriate community placements for all individuals, including those who require specific care and services.

Outcome Measures: Number of individuals for whom DLC provides discharge advocacy, including individuals for whom DLC reviews medical records, provides technical assistance, informal advocacy or legal representation.

Case Selection Criteria: Individuals who are ready for discharge from a facility or residential program who are being denied discharge either because of lack of appropriate community placements, or because the facility or residential program disagrees with the client-directed discharge plan.

4. PAIR Facilities Abuse and Neglect Priority Reduce the incidence of abuse and neglect of individuals with disabilities in facilities and residential programs. To reduce or eliminate the use of restraint and seclusion in private and public facilities serving individuals with disabilities. To ensure that use of restraint and seclusion in facilities conforms to state law, federal law and administrative regulations, with an emphasis on those instances which will have the largest impact in reducing the use of restraint and seclusion. Reduce the incidents of inappropriate treatment by guardians

Rationale: Many individuals with disabilities in facilities and residential programs, including children and adolescents, are not fully aware of their rights to be free from abuse and neglect. Additionally, many of those who are aware that they do have rights do not understand the often complicated processes to have their allegations investigated and remedied. Virtually all allegations of abuse and neglect of individuals with disabilities are investigated by involved government agencies and service providers that lack independence and impartiality. In addition, because of budget reductions, resources and expertise devoted to investigating abuse and neglect may be insufficient.

Priorities Strategies: To ensure access for individuals in facilities and residential programs to adequate and appropriate health, dental and mental health care.

Provide monitoring and analysis of investigation of abuse and neglect allegations, including incidents of restraint and seclusion, conducted by providers, guardians, and state agencies, including hospital emergency departments, and advocate for changes in policies and practices to increase the effectiveness of the investigation of administrative complaints.

Conduct direct, independent investigations into allegations of abuse or neglect, including incidents of restraint and seclusion, of individuals with disabilities. Additionally, assist consumers in appealing inadequate investigations and corrective action plans.

Review selected death investigations, request additional fact-finding as needed and monitor the implementation of required corrective action plans.

Outcome Measures: Number of complaints of abuse and neglect reviewed and investigated

Case Selection Criteria: Cases in which there is an allegation of abuse and or neglect of a person with disability in a facility.

Cases involving deaths that appear to have been directly or indirectly caused by the act or omission of a facility or residential program

5. PAIR Community Inclusion Priority Rationale: Although state and federal laws designed to protect people with disabilities from discrimination, such as the Americans with Disabilities Act, the Fair Housing Amendments Act, and M.G.L. c. 151B have been in effect for twenty or more years, individuals with disabilities still face significant difficulties in achieving full inclusion in the economic, communal and social aspects of our society. The Community Team’s Community Inclusion Priority seeks to ensure integration to the fullest extent possible for people with disabilities through enforcement and education regarding anti-discrimination laws, removal of barriers to inclusion, equal access to services, programs and activities and provision of reasonable accommodations, modifications and auxiliary aids and services.

Objectives: Individual Representation on Civil Rights Issues DLC will accept a limited number of cases for individual representation which will primarily be focused on achieving systemic change and/or having a beneficial impact beyond that of the individual client

Focus Areas: Employment (priority for representation given to certain types of cases involving larger employers and current employees seeking reasonable accommodation) Housing (priority given to cases in the United Way Mass Bay and Merrimack Valley service area) Public Accommodations (priority given to cases involving potential to benefit large numbers of people with disabilities) Abuse & Neglect (including independent investigations into allegations of abuse or neglect of individuals with disabilities in the community)

Provision of information/materials to promote self-advocacy DLC will leverage its limited resources by expanding knowledge within the disability community on issues of full inclusion and equal opportunity in an effort to empower people with disabilities to advocate for their individual rights. Focus Areas: Employment Housing (non-United Way service area) Public Accommodations State/local Government Services, Programs and Activities Access to Transportation Deaf Community

3. Systemic & Impact Advocacy DLC will seek to create positive change and promote community inclusion through impact litigation, systemic reform, legislative activities, policy development, training and education. Focus Areas: Olmstead work - avoiding re-institutionalization Hospital Access Entertainment/recreation/health & fitness Abuse & Neglect prevention and policy advocacy, including monitoring and analysis of investigation of abuse and neglect allegations conducted by provider and state agencies Training & Education on community inclusion issues Legislative/Policy work on community inclusion issues Access to Transportation

6. PAIR Health/Benefits Systemic Advocacy Priority Systemic advocacy to improve access to health care facilities and access to MassHealth covered services.  Systemic advocacy may include administrative advocacy, impact work, outreach & training, or technical assistance. 

Focus Area A: Systemic advocacy to provide full access to medical care for people with disabilities.   Rationale: People with disabilities are denied effective medical care when health care facilities are not fully accessible. This includes physical access, communication access, program access, and equipment access. DPH and the ILCs have requested that DLC work on these issues. This Project began by looking at access to Mammography units and then expanded to include all barriers to Hospital Access. DLC completed a training series for providers and is now a member of a number of committees working to further address these issues.   Priority Strategies: Continue to participate in committee work and collaborate with other advocates. Provide select STA and representation to address these barriers. Provide outreach and training to providers or consumers as needed.   Outcome Measure:  Systemic activities that implement the above Priority strategies   Case Selection Criteria: 1. Any case involving a person with a disability who is denied equal access to a Massachusetts health care facility based on his/her disability will be reviewed as part of the project with the goal being systemic change.   Focus Area B: Systemic advocacy to prevent/ameliorate coverage/service limitations in MassHealth programs for people with disabilities.   Rationale: Access to MassHealth covered equipment and services is important to the ability of many individuals with disabilities to live and work in the community. Many individuals are denied items and services they need because they do not understand how to use the provider systems, utilization controls, and appeals processes to assert their rights. There are few resources for legal advice or representation on MassHealth denials for equipment and services. Private lawyers do not take these cases because there is no source of payment, and legal services programs have experienced staff reductions. In addition the budget crisis has resulted in increased scrutiny and utilization review of the MassHealth program as a source of savings and increased interest  in creating cost saving service delivery systems.

Priority Strategies: Continue to assist individuals with access to MassHealth covered items and services by providing STA, by strategically representing a limited number of individuals who have been denied prior approval for MassHealth covered services necessary to living and working in the community (e.g., DME, PCA, dental, transportation, or pharmacy services), and providing developing consumer materials as needed.   Continue to collaborate with other advocates to improve access to MassHealth covered items and services requiring prior approval. Continue to collaborate with other advocates as issues arise that affect access to access to MassHealth delivery systems and access to covered items and services necessary for community living.   Outcome Measures:  Systemic activities that implement the above Priority strategies   Case Selection Criteria: 1. Individuals who have been denied prior approval for MassHealth coverage of DME, prescription drugs, PCA services, transportation, or other MassHealth coverage services medically necessary for living or working in the community.

Part VI. Narrative

At a minimum, you must include all of the information requested. You may include any other information, not otherwise collected on this reporting form that would be helpful in describing the extent of PAIR activities during the prior fiscal year. Please limit the narrative portion of this report, including attachments, to 20 pages or less.

The narrative should contain the following information. The instructions for this form outline the information that should be contained in each section.

  1. Sources of funds received and expended
  2. Budget for the fiscal year covered by this report
  3. Description of PAIR staff (duties and person-years)
  4. Involvement with advisory boards (if any)
  5. Grievances filed under the grievance procedure
  6. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency

Income Income 3060 · US DOE 288,901.27 3145 · Mass Bar 8,000.00 3147 · Shapiro Foundation 35,000.00 3340 · Program Income 4,524.81 Total Income 336,426.08 ??B.Budget for the fiscal year covered by this report? Expense 5010 · Gross Payroll 184,011.36 5190 · Fringe Allocation 71,684.31 5210 · Temporary Office Help - Boston 514.11 5211 · Temporary Office Help - W Mass 46.66 5220 · Data Processing 372.04 5230 · Audit / Accounting 2,144.89 5260 · Interpreters 15,731.63 5290 · Professional Services 2,440.70 5310 · Staff Travel 3,030.50 5320 · Conferences - Local 11,208.06 5330 · Conferences / Travel 2,740.72 5340 · Dues / Memberships 619.17 5350 · Publications 1,169.35 5360 · On Line Services 2,493.93 5370 · Malpractice Insurance 1,357.34 5410 · Supplies - Boston 1,850.92 5415 · Supplies - W Mass 214.26 5420 · Postage- Boston 411.91 5425 · Postage - W Mass 63.51 5430 · Advertising 551.15 5440 · Reproduction 351.33 5610 · Equipment Rental - Boston 806.13 5615 · Equipment Rental - WM 235.05 5630 · Equipment R/M - Boston 1,178.87 5635 · Equipment R/M - WMass 35.29 5710 · Boston Office 21,438.98 5720 · W. Mass Office 6,028.27 5740 · Property Insurance 253.84 5750 · Telephone-Boston 1,918.33 5760 · W. Mass Telephone 896.23 5810 · Meetings Expense 482.33 5840 · Bank Interesr/Serv Charge 144.91 Total Expense 336,426.08 Net Income 0.00 ??C. Description of PAIR staff (duties and person-years)? Attorney  26,972.18 33%  Attorney  5,872.79 12%  Attorney  13,177.74 16%  Attorney  15,628.55 32%  Attorney  3,051.59 4%  Attorney  3,206.06 6%  Attorney  12,935.75 18%  Attorney  2,922.53 4%  Attorney  20,647.50 29%  Attorney  5,471.03 10%  Attorney  5,400.11 14%  Director of Administration  9,063.98 13%  Director of Finance/IT  13,870.18 13%  Executive Director  12,396.26 11%  Litigation Director  11,530.65 11%  Paralegal  6,607.25 13%  Paralegal  6,632.46 13%  Support Staff  4,678.05 13%  Support Staff  3,946.70 13% Total 184,011.36 2.75

? D. Involvement with advisory boards (if any)? Board of Boston Center for Independent Living?Boston Housing Authority Transfer Working Group?Center Club of Boston CHAPA Committee on Access for People with Disabilities?Coalition for the Legal Rights of People with Disabilities?Coalition to Defend Special Education?DDS Human Rights Advisory Committee?Department of Developmental Services Investigation Advisory Committee?Department of Mental Health Human Rights Task Force?Disability Abuse Prevention Task Force?DMH Human Rights Advisory Committee?Education Law Task Force?Employment Rights Coalition?Human Rights Advisory Committee?Long Term Care Ombudsman Program Directors Advisory Council?MA 21 Coalition?Massachusetts Disability Determination Services Advisory Committee?Massachusetts Rehabilitation Commission MassMatch Advisory Committee?Massachusetts Systems Transformation Grant Housing Subcommittee?Paid Sick Days Coalition?Personal Care Attendant Coalition?Social Action Committee of the Health Task Force of the Boston Bar Association?Special Education Collaborative Group?State DMH Planning Committee?Western Mass Legal Services??E. Grievances filed under the grievance procedure??A Grievance was filed in late May and DLC responded upholding the staff position.  The issue had to do with a service animal on the MBTA Ride, whether a service animal could be place in the seat as opposed to on the floor.  DLC staff position was that legal assistance would not result in achieving client’s goals.

A grievance was filed in May and DLC responded upholding the staff position.  This gentleman is incarcerated in prison and requested DLC help to obtain appropriate treatment and taking Motrin was insufficient to care for his neck pain.  Staff counseled him to provide us documentation if he is denied appropriate treatment.

A grievance was filed in September 2011.  He is a gentleman incarcerated in Prison. DLC wrote him a letter the end of September letting him know that DLC has provided him assistance several times before and asked whether he had any new issue to pursue  The individual has been sending information periodically and often calls but no new issue has surfaced.  He has had ongoing concerns about health issues.

?F. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency? DLC attorneys also regularly provide Technical Assistance to MOD staff and Nursing Home Ombudsman on issues related to housing, employment, voting, community services and architectural access. ? Nursing Home Ombudsman Directors Outreach: DLC works closely with Massachusetts Ombudsman program that is housed within the Office of Elder Affairs. The Ombudsman can be greatly effective in providing insight into the history of the program, and who are the best persons to contact to help address and resolve a problem. DLC is an active member of the Western MA Nursing Home Ombudsman Directors bi-monthly meetings, in partnership with Community Legal Aid (formerly Western MA Legal Services). These meetings serve as a forum to provide legal assistance to the Ombudsman Directors and to coordinate efforts with Community Legal Aid. This ensures that both organization offer different, and complimentary, legal services and eliminates redundancy. The meetings have also led to several individual client referrals from the Ombudsman Directors and have alerted DLC to systemic issues to focus on in the coming year.

Coalition of Legal Rights for Persons with Disabilities (CLRD): The Coalition for the Legal Rights of People with Disabilities (CLRD) is a broad coalition of legal and other advocates, including people with disabilities and their family members, united to promote empowerment, liberation, and integration of all people with disabilities in the Commonwealth of Massachusetts. The Coalition seeks to preserve and extend the supports for and rights of people with disabilities through education, legislative lobbying, legal intervention, and systematic advocacy. A DLC Attorney is the Chairperson of CLRD and works to organize meetings, set agenda topics, secure guest speakers, and coordinate advocacy efforts. This past fiscal year, CLRD partnered to education law makers about the potential impact of proposed severe budget cuts on individuals with disabilities. CLRD expressed its commitment to the principals of the Olmstead decision and to community living for people with disabilities by restoring adequate funding to all human services programs. Many of the proposed budget cuts were restored to the budget.

Other Coordination: DLC works closely with the Massachusetts Department of Public Health, who in addition to licensing these facilities; promulgate regulations regarding the rights of clients and the responsibility of facilities. DPH also has the authority to investigate facilities and to order remedial action when necessary.

Lastly, Greater Boston Legal Services provided legal services to persons, particularly seniors living in nursing homes and similar types of facilities. Through our collaborative efforts DLC has entered into a co-counseling relationship with lawyers at GBLS where we each benefit from each others expertise. Through strengthening DLC’s relationship with these entities we are able to be more effective in addressing the needs of our clients.? Our work on behalf of PAIR eligible client in nursing homes and other facilities requires additional collaboration as well. DLC coordinates with the administration, medical, nursing, social work and direct care staff at the facility to address and resolve issues and problems. In addition, because DLC is a law office we often work collaboratively with legal counsel for the facility to facilitate the facilities understanding of DLC’s role as the P&A and our authority to monitor facilities, as well as increasing their understanding of the relevant access law.??G. Other Narrative Information? Online Transition Manual -- Northeastern University School of Law Legal Skills in Social Context (LSSC) Social Justice Program: Through our work in the Dracut litigation and through our experience conducting transition conferences and clinics in underserved communities, we realized that there was a need for simple, accessible training materials on transition services for students and parents. We decided that the best way to approach this need was to develop an online manual on transition issues written in a style modeled on Massachusetts Law Reform Institute’s Legal Tactics series. Legal Tactics uses a visually pleasing, easy-to-follow format, with more detailed endnotes or footnotes for attorneys or experienced advocates.

We developed a collaboration with the Institute for Community Inclusion (ICI), the Federation for Children with Special Needs (FCSN) and Massachusetts Advocates for Children (MAC), with DLC acting as the lead partner. Together we applied for assistance from Northeastern University School of Law’s Legal Skills in Social Context (LSSC) Social Justice Program for the September 2010 to May 2011 academic year. With our partnership acting as the “client” and providing regular guidance, a group of about 13 Northeastern law students completed a first draft of the transition manual. MLRI provided valuable assistance on web publishing issues. As of May, 2011, we had a first draft of a web-based manual for students, parents and parent advocates to assist them in advocating for effective transition services.

After May, we began working with our partners and a group of volunteer “guest editors” from the private bar to complete the edition. Our editors include, in addition to our original partners, private attorneys, a clinical instructor, parents, and a former special education teacher. The Manual was posted on the DLC website this fall at http://www.dlc-ma.org/manual.

MA Tornado Legal Service Response: This is a partnership and collaboration between legal service organizations to coordinate legal advocacy responses to the June 2011 tornado that ripped through MA. These organizations include DLC, Mass Justice Project, Community Legal Aid, Mass Law Reform Institute, Senior Partners for Justice, and others. This partnership maximizes legal resources throughout the State and is developing a best practice manual for legal service organizations advocating for individuals after a disaster. DLC’s advocacy around emergency preparedness has been publically praised this year by both Mary Clark, Director of the Emergency Preparedness Bureau of the MA Department of Public Health and also the Disability Policy Consortium.

Cross Disability Advocacy Coalition: The project goal for the Cross Disability Advocacy Coalition is to promote and enhance inclusion and community living opportunities for people with developmental and other disabilities through a process of developing joint policy, budget, and legislative objectives.??The major activities of the project include: identifying representatives from statewide cross disability groups in Massachusetts; selecting a Coordinator for the Coalition; providing logistical support to the cross disability coalition; leading the coalition through a process to develop policy, legislative, and/or budget priorities; conduct outreach to publicize the work of the coalition; developing a "user friendly" report on the issues selected to be submitted to the Massachusetts Developmental Disability Council (the grantor), the Administration, Legislature, and Disability Community; highlighting activities of the coalition on the DLC website; working with the media, and social network to inform Commonwealth residents on the work of the coalition; providing updated reports on project outcomes to Massachusetts Developmental Disability Council (MDDC); and meeting with legislators and other policy makers on the work of the coalition. ?This is a project that will bring together leaders in the disability rights movement in the Commonwealth to work specifically on substantive systemic issues that will have a huge impact on the daily lives of people with all disabilities whether it be transportation, employment, health care, or other issues.

In June 2010, DLC hired Jonathan Gale as the part time Coordinator for the Cross Disability Coalition. The Coordinator (with assistance from key staff) is charged with identifying up to 8 statewide disability advocacy organizations to participate on the coalition. The Coordinator is responsible for conducting extensive outreach all over the state to solicit interest to serve on the Coalition. The Coordinator (with assistance from the ED and Team Leader) will bring in outside "experts" to discuss major policy, legislative, and budget issues for the coalition’s consideration. This will include legislators, other policy makers, administration officials, and disability advocates. After this process, the Coordinator will work with the coalition to prioritize advocacy objectives for the grant project. The Coordinator will be responsible (with assistance from the ED and Team Leader) to ensure compliance with meeting grant objectives and will report back to the MDDC quarterly (or more frequent if requested) on the progress of the project. The Coalition will produce a "user friendly" report at the end of the grant period to the MDDC, the Administration, Legislature, and the disability community. Funds permitting; the Coalition will produce a video of the project for public distribution. ?The DLC hopes and expects the Cross Disability Advocacy Coalition will achieve major systemic change in the area(s) of focus it selects. Additionally, the Coalition will publicize its efforts statewide and will work with media outlets to advertise the efforts of the coalition. The Coalition will also be active in budget advocacy addressing cuts that impact people’s lives everyday.

Social Action Committee (SAC): A DLC attorney is the co-chair of SAC of the Health Task Force of the Boston Bar Association. The SAC has continued to organize and present a series of trainings on End of Life Care that includes issues for people with disabilities and chronic conditions. Those issues include decision making, access to information about options, and access to needed equipment. Events included Long Term Care: Delivery, Quality and Financing, and A Cost-Effective Care Model for Frail Elders and Those With Chronic Illness.

MA Technology Committee: DLC’s Finance and IT Director Rich Contente is a member of the Massachusetts Technology Committee, a state-wide group charged with setting the technology agenda for Legal Services in Massachusetts. The Committee is focused on using emerging technologies to help serve clients more efficiently and effectively. In addition, the Committee looks at how new technologies can provide opportunities for people with disabilities in the legal services world and in all areas of employment. Rich has given several presentations to the Committee on assistive technologies he and others at DLC use to perform their job functions. In the past year Rich has been focusing on the accessibility of Apple’s iPhone and iPad.

MassHealth Accessibility of Written Materials: DLC partnered with Greater Boston Legal Services, Bay State Council for the Blind and Disability Policy Consortium to investigate, review and monitor barriers to accessibility for individuals who are blind or visually impaired.

Certification

Signed?Yes
Signed ByAlan Kerzin
TitleExecutive Director
Signed Date12/13/2011