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

North Dakota (PROTECTION and ADVOCACY PROJECT) - H240A140035 - FY2014

General Information

Designated Agency Identification

NameNorth Dakota Protection and Advocacy Project
Address400 East Broadway
Address Line 2Suite 409
CityBismarck
StateNorth Dakota
Zip Code58501
E-mail Addresspanda@nd.gov
Website Addresshttp://www.ndpanda.org
Phone701-328-2950
TTY
Toll-free Phone800-472-2670
Toll-free TTY800-366-6888
Fax701-328-3934
Name of P&A Executive DirectorTeresa Larsen
Name of PAIR Director/CoordinatorTeresa Larsen
Person to contact regarding reportPamela Mack
Contact Person phone701-328-2950
Ext.

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 areas114
2. Individuals receiving I&R outside PAIR priority areas255
3. Total individuals receiving I&R (lines A1 + A2)369

B. Training Activities

1. Number of trainings presented by PAIR staff17
2. Number of individuals who attended training (approximate)82

1. 11/18/2013 — Comprehensive System of Personnel Development — Purpose of the training was to educate Fargo Public Schools Student Support Services Coordinators regarding student’s rights to education. The intent of the training was to ensure that all staff who are in leadership roles within the department understand student’s rights and can ensure that they are protected on an ongoing basis throughout their professional positions. 12 people participated in the training.

2. 11/21/2013 — Vulnerable Adult Protective Services (VAPS) & P&A Joint Training — Joint state-wide training was held with VAPS and P&A staff. The purpose of the training was to increase the understanding of the interplay between VAPS and P&A statutes and responsibilities. Discussion occurred regarding differences and similarities in definitions, strategies and procedures. Flowcharts regarding processing of reports were discussed also. 4 people participated in the training.

3. 2/4/2014 — Family Educator Enhancement Team — Purpose of the training was to ensure that education staff within a large special education district had knowledge of best practices regarding supports for students with disabilities educational needs. The training session included parents, teachers and school administration. The goal of these efforts is to ensure that parents and students are aware of P&A services as well as rights of students and parents relative to education. 6 people participated in the training.

4. 2/25/2014 — Minot Intra Agency Group — The purpose of the training was to ensure that members of the Minot Intra Agency Group are familiar with P&A services and potential referrals that are appropriate. Participants include human service center staff, county social services staff, aging services, hospital and assisted living personnel and various advocacy organizations. 5 people participated in the training.

5. 3/4/2014 — Bismarck Foster Care Association — The purpose of the training was to provide foster care parents in the Bismarck community with information regarding P&A’s services, priorities and programs. Information regarding children’s rights to education and eligibility for 504 and special education was also provided. The hope is that more foster parents will be aware of the supports and services that are available to support kids who have disabilities in the foster care system. 6 people participated in the training.

6. 3/14/2014 — Student training on P&A services — The purpose of the training was to ensure that students who are part of the special education system have knowledge of P&A services, along with information regarding their educational rights. 1 student with disabilities participated in the training.

7. 3/19/2014 — United Tribes Technical College — Special Education students at United Tribes Technical College were educated on P&A services, educational rights of students with disabilities and the role that P&A can play through our advocacy and protective services. 4 college students participated in the training.

8. 4/8/2014 — Rehab Services Inc, -- Training was provided to administrative staff at Rehab Services, Inc. regarding P&A’s services and investigative authority, laws regarding abuse, neglect & exploitation, mandatory reporting and client’s rights. As a new provider in the Developmental Disabilities system, P&A recognizes the importance of ensuring that new providers develop the competencies necessary to support people with disabilities in a quality manner. 2 people participated in the training.

9. 4/14/2014 — Individual Justice Planning (IJP) Training — The purpose of the training was to educate staff from the Pathfinder Parent Center, DPI, Souris Valley Special Education and Family Voices on the IJP process, eligibility and how an IJP can be used for people with disabilities. Information regarding how the human service and criminal justice systems can work together was also included in this training. 2 people participated in the training.

10. 4/23/2014 — Independence, Inc. Center for Independent Living — The purpose of this training was to provide staff from the Independent Living Center with information so they can better serve people who have sight loss. Information regarding the various stages of vision loss, how to better understand vision loss and how to accommodate vision loss was included in the training. 16 people participated in the training.

11. 5/5/5014 — University of Mary — Education 392 students — The purpose of the training was to educate students about 504 and special education eligibility, students’ rights to education and how they as future educators play a role in this process. Information regarding educator’s responsibilities in identifying and supporting students. Information was also provided regarding P&A services, the role that P&A can play with students and how P&A and educational systems can work together. 4 college students participated in the training.

12. 5/9/2014 — Individual Justice Planning Process in North Dakota — ND Association of Community Providers Annual Conference -- The purpose of the training was to educate people on the Individual Justice Planning (IJP) process within North Dakota. The primary participants were professionals within the service delivery system. 2 people participated in the training.

13. 5/22/2014 — Vocational Rehabilitation Teacher Internship Program — Information regarding P&A programs, priorities and services was provided to the staff within the VR Teacher Internship Program. 1 person participated in the training.

14. 6/5/2014 — Salvation Army Homeless Veterans Support Services — The purpose of the training was to provide the Salvation Army Veterans Support Services employees with information regarding P&A’s program, services and priorities. Information was shared regarding the resources and information that can be provided by P&A. 2 people participated in this training.

15. 6/7/2014 — Family Voices Leadership Institute — The Family Voices “Parent Leadership Institute” works to provide family members with the tools to expand their grassroots advocacy efforts through coalition building and mentoring activities. Participants in this program must be a family member of a child with special health care needs and have an interest in leadership development and carrying that motivation to the next level. Through this educational activity family members receive information on Developing Advocacy Plans, How to have an Effective Voice, and other resource information. 10 people participated in this training.

16. 6/10/2014 — Individual Justice Planning Training — The purpose of the training was to educate staff from the Ward County Social Services office on the IJP process, eligibility and how an IJP can be used for people with disabilities. Information regarding how the human service and criminal justice systems can work together was also included in this training. 3 people participated in the training.

17. 7/2/2014 — Rehab Services Inc, — Follow-up training was provided to administrative staff at Rehab Services, Inc. regarding P&A’s services and investigative authority, laws regarding abuse, neglect & exploitation, mandatory reporting and client’s rights. As a new provider in the Developmental Disabilities system, P&A recognizes the importance of ensuring that new providers develop the competencies necessary to support people with disabilities in a quality manner. 2 people participated in the training.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles0
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website17,303
5. Publications/booklets/brochures disseminated693
6. Other (specify separately)14

Narrative

PAIR, Part I C, Information Dissemination 6. Other 10/7/2013 — West Fargo High School Transition Fair — This event focuses on providing information regarding transition services to students and their parents who are of transition age in the West Fargo School district. This event, which is held annually in the fall of each school year, focuses on students with disabilities who are planning their transition and subsequent graduation in the coming years. P&A had a booth at the transition fair and provided information regarding our programs and services that are specific to the transition area of education, employment, community integration and independent living. 6 people attended this year’s event. 11/14/2013 — Standing Rock Transition Fair — This annual event focuses on the transition needs of students with disabilities who live and are educated on the Standing Rock American Indian Reservation. Students with disabilities and their parents are invited to the Transition Fair to learn more about the services that are available upon graduation. This effort to better prepare students to adult life has been helpful in getting people connected with services prior to graduation. 351 people attended this year’s event. 3/19/2014 — Edgewood Vista Health Fair — Edgewood Vista, an assisted living facility, recently opened in an urban community. As part of their ongoing efforts to inform the public regarding their services, they hosted a health fair. P&A provided a booth and information regarding P&A’s services at the health fair. Information regarding the agency’s priorities and how our services might be of benefit to someone living in an assisted living facility was the focus of this effort. 40 people received information regarding P&A and our services at this event. 4/7/2014 — Ft. Totten Student and Parent Fair — Students and parents at Four Winds School and surrounding schools attended the fair that provided information and community resource information. There were 820 students and 255 community members who attended the fair. There were 106 booths with information regarding how to support students and families. P&A is an active participant in the planning of the event and also sponsors a booth at the event. 4/14/2014 — Pathfinders Conference — This annual conference is held and attended by people with disabilities, their family members, advocates and educational professionals. The conference focuses on educational and social needs of students with disabilities. 114 people attended this year’s conference. P&A did have a booth at the event and participated as part of the planning committee for the event. 4/30/2014 — Williston State College — Staff at the college in the Disability Services and Adult Learning Center were provided with information regarding P&A’s services, our priorities and information regarding how our services can benefit students in the higher education system. 5/1/2014 — Williston Veteran’s Stand Down — In conjunction with the local VA office, the regional Human Service Center, Independence Independent Living Center and Salvation Army, the first Veteran’s Stand Down was hosted in Williston, ND. 40 veterans and family members were in attendance and learned about P&A services, advocacy supports and ways that P&A could assist them with disability-related needs. 5/6/2014 — Autism Walk & Parent Fair — This annual event is held to provide people with Autism and their families with information regarding available disability-related services. P&A hosted a display and provided attendees information regarding P&A services and priorities. These efforts are to ensure that people have an increased knowledge of their rights and ways to obtain the supports and services to be independent in their community. 5/12/2014 — Burleigh County Detention Center — P&A provided information to the staff at the Burleigh County Detention Center regarding disability-related issues, P&A services and effective ways to support people with disabilities within the county jail. 5/20/214 — Minot State University Spring Symposium — Each spring, Minot State University sponsors a symposium on disabilities with the intention of creating a better understanding of disability-related issues for students on the college campus. Special attention is provided to students who will have significant exposure in their professional lives to people with disabilities. P&A provided information regarding our services and priorities. 50 students participated in the spring symposium. 6/16/2014 — South West Conference of Social Welfare — This annual event is held to connect various service entities within the social services system with one another. Participants also include people with disabilities, their family members and caregivers. P&A had a booth at this year’s event and the 200 participants were provided information regarding P&A and our services. 7/16/2014 — Williston Community Housing — A growing concern in the western part of the state is with the housing needs of people who live in the community and also people who are moving into the community. With the current oil boom and production, housing issues are a significant factor which is affecting a number of people who are aging and people with disabilities. Community meetings are being held to share information regarding available resources, one of which is P&A’s advocacy services. Information regarding our priorities was provided, along with input regarding ways to positively impact the housing market within this part of the state. 8/28/2014 — Bismarck Veteran’s Stand Down — This annual event focuses on the service and support needs of veterans in Bismarck and the surrounding communities. In conjunction with the Department of Human Services, local housing authority, Social Security Administration, Ruth Meier’s Hospitality House, P&A and other entities, this event is held to provide veterans and their families with information regarding available resources and information to meet their needs. With the growing number of veterans who have disabilities, this has been a significant way for P&A to ensure that veterans are aware of our services and priorities. This year’s event hosted 128 participants. 9/2/2014 — Behavioral Health Conference — The annual Behavioral Health Conference was hosted in a large city and included a number of disability-related entities. P&A sponsored a booth at the conference in an effort to support people with disabilities and their right to live, work and participate in the community. A significant focus was on the employment needs of people with disabilities at this conference. Information regarding P&A’s services and priorities was provided to the 250 people in attendance at this year’s conference.

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)39
2. Additional individuals served during the year44
3. Total individuals served (lines A1 + A2)83
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)83

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 44

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment9
3. Program access4
4. Housing0
5. Government benefits/services2
6. Transportation0
7. Education42
8. Assistive technology0
9. Voting0
10. Health care9
11. Insurance0
12. Non-government services9
13. Privacy rights0
14. Access to records0
15. Abuse3
16. Neglect5
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor37
2. Other representation found1
3. Individual withdrew complaint0
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.1
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit0
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-advocacy1
2. Short-term assistance31
3. Investigation/monitoring2
4. Negotiation4
5. Mediation/alternative dispute resolution1
6. Administrative hearings0
7. Litigation (including class actions)0
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 - 42
2. 5 - 2244
3. 23 - 5929
4. 60 - 643
5. 65 and over5

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females35
2. Males48

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race1
2. American Indian or Alaskan Native10
3. Asian1
4. Black or African American1
5. Native Hawaiian or Other Pacific Islander0
6. White69
7. Two or more races1
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent24
2. Parental or other family home54
3. Community residential home0
4. Foster care1
5. Nursing home2
6. Public institutional living arrangement1
7. Private institutional living arrangement0
8. Jail/prison/detention center1
9. Homeless0
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 hearing6
3. Deaf-blind1
4. Orthopedic impairment20
5. Mental illness1
6. Substance abuse1
7. Mental retardation0
8. Learning disability17
9. Neurological impairment17
10. Respiratory impairment4
11. Heart/other circulatory impairment5
12. Muscular/skeletal impairment2
13. Speech impairment2
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability0

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities13

2. Number of individuals potentially impacted by policy changes14,208

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.

Money Follows the Person — 1 policy change

The ND Money Follows the Person program, funded through a Medicaid grant, targets the movement of individuals with physical disabilities in nursing facilities, and individuals with developmental disabilities in ICF’s/IDD, to community placements. P&A staff has been active in the Stakeholders’ Committee. The Stakeholders provide significant input to the Money Follows the Person Coordinator through quarterly meetings. 2014 transitions total 58 individuals (17 from the Life Skills & Transition Center (ND’s state institution for individuals with developmental disabilities) and 41 from nursing facilities). This is a significant increase from 2013 where the total was 46 transitions. 41 PAIR eligible people were impacted.

Provisional Transition Plan for the Home and Community Based Services (HCBS) Aged and Disabled Waiver — 1 policy change

On March 17, 2014, the Center for Medicare and Medicaid Services (CMS) issued a final rule for home and community based services that require states to review and evaluate Home and Community-Based Services (HCBS) Settings, including residential and nonresidential settings. States are required to ensure all HCBS Settings comply with the new requirements, and analyze all settings where HCBS participants receive services to determine if current settings comply with the Final Rule. The ND Department of Human Services (Department) created a preliminary Transition Plan to assess compliance with the HCBS Settings Rule and identify strategies and timelines for coming into compliance with the new rule as it relates to the HCBS (elderly and disabled) waiver only. This was required because the Department is seeking a new service that would be available to HCBS recipients. On July 31, 2014, P&A submitted its input along with a recommendation that as the Department moves forward with the transition process, it involve stakeholders, advocates and people served by the waiver. 12,450 PAIR eligible people were impacted.

Waivered Services for Children Legislation — 1 policy change

P&A was a strong advocate in partnering to support HB 1378 which calls for a Department of Human Services (DHS) study, to take place during the 2013-14 interim. The legislation, which passed, states that DHS shall identify the estimated cost to implement a Medicaid waiver or amend an existing Medicaid waiver, to provide coverage for children who have continued and substantial medical and support needs, but who, at the age of three years, no longer qualify for services under the developmental disabilities waiver. The study further states that, in preparing the estimate, DHS shall secure input from stakeholders, including families, providers, and advocates. DHS is to report its findings to the sixty-fourth legislative assembly. The report shall include the estimated number of children eligible, criteria for the provision of services under the waiver, the services to be offered, and a timeline for implementation of the waiver. During this past fiscal year, the Task Force working on this potential legislation met a number of times and developed an assessment/level of need tool. In addition, the Task Force identified potential methods of implementation and services to be included in the waiver. 265 PAIR eligible children were impacted.

Public Schools Extra-Curricular Accommodations — 1 policy change

In the spring of 2014, P&A received a concern from a parent that the registration form for a school-sponsored band camp did not contain a place to identify health issues and accommodations that may be needed by a student. The child is on a 504 plan. Their concern was that their child’s health-related accommodations may be overlooked while she was at the school participating in the camp. P&A brought this concern to the attention of the school district so that this concern could be addressed. P&A worked with the district to understand their responsibilities to ensure that accommodations extend beyond the classroom to all of their extra-curricular activities. The registration forms were revised district-wide to ensure that accommodations that are needed are documented and included in extra-curricular activities. This will also result in the instructors and leaders of the activities awareness of the circumstance under which students can participate, ensuring accommodations are made. 240 PAIR eligible students were impacted.

Morton County Housing Authority — 1 policy change

P&A was contacted regarding an urban public housing office and a written letter that they sent to a person who had applied for housing assistance benefits. The letter identified that the person would need to provide their own interpreter at the appointment in order to ensure that they understood the material that would be provided and completed at the appointment. P&A researched the applicable regulations and provided information regarding the housing authority’s responsibility to provide interpreter services in order to access and benefit from services. The housing office does have a 5 year HUD approved plan that also identifies their commitment to carry out the public housing program in conformity with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act of 1990, and will affirmatively further fair housing. P&A’s efforts resulted in the client being provided the necessary accommodations by the public housing office so that they could access benefits through the housing program. P&A also supported the client’s efforts to ensure that the public housing office was aware of their ongoing responsibilities to support non-discriminatory practices in their service to others. 47 PAIR eligible people were impacted.

Metro Plains Property Management Company — 1 policy change

In the winter of 2014, P&A received a reported concern from a tenant that their apartment manager was not cleaning snow and ice from sidewalks and the parking lot. They reported that the ice and snow was building up, creating a hazard for people with mobility concerns. The public transportation system was having difficulty pulling into the driveway due to the compaction of snow and ice, creating obstacles for people to safely access the transit bus. In addition, it was found that one tenant experienced a fall as a result of the conditions on the sidewalks of the building. P&A brought the concern to the attention of the landlord/management company and educated them on their responsibility to ensure the safety and access of their tenants. As a result of these efforts, the property manager was able to work with their maintenance contractor to address the situation. Through these contacts, P&A also became aware that tenants in the building were not aware of how to remedy potential snow removal or safety concerns that they became aware of, which was also concerning. P&A worked with the landlord/management company to ensure that all tenants who live at the properties were informed in writing of what steps they can take and who to notify should they have concerns with the snow removal or safety concerns with the apartment complex. This will allow for people to further exercise their rights in the future and will result in increased safety of the apartment complex as a whole. 96 PAIR eligible people were impacted.

Jail Intervention Coordinating Committee — 1 policy change

The Jail Intervention Coordinating Committee was developed to assist people with mental illness who have been incarcerated at the Cass County Jail. The collaborative effort included professionals from P&A, the human service center, Mental Health America, the Cass County Jail, Fargo Police and Cass County Sheriff’s office and the homeless coalition. The goal of the group was to develop an inmate mentoring program to assist an inmate with the re-entry process. Inmates who have mental health issues were assigned a mentor who would begin working with them while incarcerated in order for the two people to develop a relationship with one another. The mentor then assisted the inmate with the re-entry process, that includes addressing the person’s need to establish relationships, along with identifying their residential and housing needs, medical and healthcare needs, along with future employment. The mentoring relationship has been very successful and assisted approximately 15 inmates during the fiscal year. 15 PAIR eligible people were impacted.

State IDEA Advisory Committee — 2 policy changes

P&A serves as a member at large representing consumer/advocate groups. The IDEA Advisory Committee, strengthened by its diverse membership, exists to identify and address unmet needs of all children in ND through policy advisement to the ND Department of Public Instruction and others to facilitate positive outcomes in all educational environments. P&A participated in committee meetings and provided recommendations and advice which resulted in the following positive outcomes: 1. provided input to update ND DPI Autism guidelines which resulted in the Guidelines for the Identification and Programming of Students with Autism in the Education Setting, which became available in September 2014

2. provided ongoing input on the updated FBA/BIP guidelines and process, which are currently being piloted.

871 PAIR eligible people were impacted. Services to Native American reservations — 1 policy change

P&A currently provides advocacy and legal services to all four Native American reservations within the state of North Dakota. One reservation, which is the most populated in the state, does have a full time advocate who serves the reservation and surrounding counties. The other three reservations are served by regional P&A advocacy staff through routine scheduled outreach activities. P&A staff has built a strong network of contacts to include Indian Health Services, Sacred Child Project Coordinators, Job Service offices, colleges, Employment & Training Programs, Mental Health providers, juvenile and adult court systems and school staff. P&A staff has been available for parent information fairs and other community events in an effort to increase exposure to students, parents and others who reside or work on the reservation. These efforts have resulted in an increased number of referrals to P&A for people that have disabilities and live on the reservation. 367 PAIR eligible people were impacted.

Seclusion & Restraint in Schools North Dakota does not currently have a comprehensive mechanism for addressing seclusion and restraint policy or procedures. Nor do we have existing mechanisms for collecting data about the current use of seclusion and restraint in schools. P&A does have anecdotal information of school districts using restraints and using specially-constructed seclusion rooms. Currently, P&A is responding to individual reports, but we also see a need, as an agency, to address the problem systemically by pursuing development of a task force on this issue.

For this purpose, P&A has had meetings with the ND Department of Public Instruction, the ND Education Association, and the ND School Board Association. These entities have expressed willingness to participate in a task force, but not to take a leadership role. To move forward with the project, it is clear P&A, as an agency, will have to assume the lead.

The task force, as P&A envisions it, will be comprised of a collaborative team of stakeholders from across the state who have a positive approach to solving problems and who promote the rights of students. The members of the task force will be drawn from a broad range of disciplines within the field of education as well as from the disability rights community.

P&A has created a three-person committee charged with the responsibility for creating the task force and implementing task force initiatives. To date, the committee has determined that, to achieve a credible task force process in this state, it will be important to work with a facilitator with extensive experience in consensus-building processes. The committee has met with a facilitator from the Consensus Council, Inc., a local nonprofit that possesses a good track record of achieving consensus agreements among people holding diverse points of view. The Consensus Council is willing to work with P&A to set up the task force and to conduct a series of stakeholder meetings over the course of one year. The purpose of these meetings is to: • develop a process for obtaining baseline data on seclusion and restraint usage in the state, • develop a statewide policy for ongoing reporting of seclusion and restraint in the schools, • develop best practices—based in part on examples of credible programs in other states, and • develop statewide policy and procedures for use of seclusion and restraint in North Dakota.

Based on past experience dealing with consensus building in similar types of issues, the facilitator has recommended planning a series of at least six full-day, in-person meetings. P&A anticipates bringing in a national expert (from National Disabilities Rights Network) on seclusion and restraint issues for one or more of the initial meetings. We also anticipate calling on local, in-state professionals with expertise on specific issues.

P&A has set a goal of completing the task force process and achieving implementable policies within one year.

School Medication Administration Issues — 1 policy change

P&A became aware that schools in North Dakota changed the medication administration policies regarding administration of emergency medication for students. The change was identified as affecting students with seizure disorders and diabetes. Of significant concern was the administration of Glucagon injections for diabetes and Diastat gel for the management of seizures. P&A formed an internal task force of staff to begin researching the issues. Through this process it was learned that schools were interpreting legislation from 2013 to indicate that injectable medications could only be administered by a nurse; therefore, they were discontinuing protocols that had been included in student’s 504 plans and/or their IEPs. The school’s identified response that would be taken if a nurse was not in the school, was to call 911 and not perform any intervention. P&A’s research also identified that the issue was caused by misinterpretations related to recent legislation. P&A legal staff provided detailed information in response to questions on issues related to Glucagon administration in schools. P&A staff worked with students, parents and agencies to gather information about related issues and to address concerns. Work was done to address specific issues that arose at different schools for students with these healthcare needs. P&A also worked with the American Diabetes Association, the ND Board of Nursing, and a Diabetes Coalition to resolve the issue. As a result of these efforts, the ND Board of Nursing updated a web-based frequently asked questions list regarding medication administration in schools. These questions addressed issues regarding responsibilities of schools in administering Glucagon, Insulin and Diastat rectal gel. This information is being used as a state-wide resource for schools, students, parents and professionals to address emergency medication administration issues in schools. In addition, P&A worked collaboratively with the American Diabetes Association and a Diabetes Coalition, to develop plans for distribution of information about educational rights related to diabetes management and Glucagon administration in schools. Information has been distributed to parents, schools and diabetes educators throughout the state. P&A has also distributed information through meetings, advocacy groups and on the P&A web site. 150 PAIR eligible people were impacted. Sanford Pediatric Rehabilitation Forum — 2 policy changes

In conjunction with outreach conducted by Dr. Kevin Murphy of Gillette Children’s Hospital-St. Paul, MN, a group of Bismarck regional hospital therapists and Bismarck service providers have formed this group to assess and develop plans of action to address healthcare and systemic issues that people with disabilities face. Service providers involved include: P&A, Anne Carlsen Center, Great Plains Rehabilitation and the Interagency Program for Assistive Technology. Each month the group meets to discuss current trends and service barriers that they are encountering in the work that they do. This group was instrumental during the 2013 legislative session in identifying a potential gap in Medicaid coverage for children who have a developmental disability, but not an intellectual disability. This resulted in the mandated study through HB 1378, which will explore this issue further and identify and respond to the unmet needs within North Dakota. P&A is a member on the interim legislative study team to address this issue. The group has also been instrumental in addressing other funding and gaps in service for children with rehabilitation needs. The group has developed a formal program and protocol for baclofen pump services for children with significant spasticity due to physical disabilities, which has been a huge success. The group is also currently working on procedures for requesting habilitative therapies for children who are insured by a particular insurance carrier. 240 PAIR eligible people were impacted. Procedurally, schools identified that they would not intervene and would call 911, which in many cases, could result in a student’s death before emergency personnel could arrive. Following legislation in 2013, the ND Board of Nursing and ND School Board Association interpreted a law that was passed inappropriately, which subsequently impacted school personnel’s ability to administer injectable medication in an emergency. The exception to this was epinephrine, which was identified under separate legislation. Upon becoming aware of this issue, P&A developed a workgroup comprised of a Disability Advocate who is a nurse, P&A’s Legal Director, a Program Director and other Disability Advocates who were working on individual cases with families. P&A became aware that other medications that are also injectable, such as Diastat for seizure control, was also included in the school’s determination that it could not be administered by anyone other than a nurse. P&A began working with the National Diabetes Association, the ND School Board Association, the ND Board of Nursing and local school districts. Education regarding the law and the exclusion for emergency medication administration was provided by P&A, to include an understanding that these emergency situations in which injectable medication must be given was not affected by the change in legislation and thus, school districts can and must continue to administer these life-saving emergency medications. At the close of the fiscal year, P&A had achieved an understanding by the ND Board of Nursing to identify that injectable medication could be given in an emergency situation. Further efforts to correct information and public materials that were disseminated is needed, along with individual follow-up and action to remedy plans and services within local schools. These efforts will continue throughout FY 2015.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts12,450
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.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts

P&A currently has five cases that are at the legal level of services during FY 2014. At the present time, all five cases are open and will be carried over to FY 2015.

Summary of cases:

The client is a 12 year old female who has dual cochlear implants and significant speech language delays as a result of her hearing loss. Despite her cochlear implants and the recommendation that her educational services be focused on a hearing child, the hearing impaired teacher at her school refused to alter her educational supports and insisted that she continue to be educated using sign language and learning modalities of a child who cannot hear. Her parents attempted to work with the school for a number of years and their daughter’s skills continued to lag significantly behind her age-related peers. In addition, the relationship between the student and the hearing impaired teacher was so destructive that the student began experiencing emotional difficulties with attending school. P&A attempted to negotiate with the local school district regarding services that were needed, which was supported by evaluations; however, the district continued to refuse to change the focus of the educational plan and learning methods for the student. As a result, P&A filed Due Process and is currently addressing the student’s needs through this process. Currently the school has begun to identify additional learning methods for the student; however, the follow-through and implementation of the agreed upon services has not yet been achieved. Case activities will continue into FY 2015 to ensure that the needed services and supports are identified and implemented, along with the assurance that the student is making progress.

The client is a 41 year old female with a diagnosis of Paralytical Lock-In Syndrome as the result of a stroke. The client also has a trach and a feeding tube. The client was receiving 24 hour nursing services which was funded through her private health insurance company. Despite the recommendation that 24-hour nursing be provided, the client’s private health insurance company determined that the family could provide the level of care needed. The client’s physicians have identified that the cares needed cannot be provided by non-nursing staff and have identified that in doing so, would place both the client and the caregiver at significant risk. The ND Board of Nursing has also identified that the cares needed cannot be delegated to a non-nurse caregiver. P&A is currently providing legal services to appeal the denial of nursing services by the client’s private health insurance provider and the appeal hearing is pending at this time.

The client is a three year old child with a diagnosis of Langerhans Cell Histiocytosis (LCH). To treat this diagnosis, a medication and follow-up treatment was ordered to treat the condition; however, the medication and follow-up treatments were denied by Medicaid. The client’s physicians determined that the medication identified and the necessary tests and follow-up to assess the effectiveness of the medication was medically necessary; however, ND Medicaid disagreed with this decision and denied payment for the services. P&A is currently in the process of appealing this denial to ensure that the child is able to receive the medication and medical follow-up that he needs to address his medical needs.

The client is a six year old child who has a seizure disorder and is supported by a service animal that can detect when the child is going to have a seizure. On two occasions the service animal has been able to alert his family to the onset of a seizure at night time, which has resulted in intervention that has been determined to be life-saving. The family moved into a small town and after doing so, received a citation from the city identifying that the breed of dog that they had was a violation of city ordinance and was said to have been observed to be a pit bull, which is not allowed within city limits. The family responded to the citation by providing documentation regarding the dog’s breed, to indicate that it is not a pit bull, along with paperwork to show the training and certification of the dog as a service animal. A hearing has been scheduled to address the citation at this time because efforts to resolve the issue have not been successful. P&A is providing legal services to the child and his family to address his need for the service animal. Efforts will continue into FY 2015.

The client is a 38 year old male with a diagnosis of Empty Nose Syndrome, Chronic Pain Syndrome and migraine headaches. He began employment with an oil company approximately two years ago and upon hire, disclosed that he was taking prescription medication due to his diagnoses. At the time of hire, no concerns were noted by his employer and he did not need and/or request any reasonable accommodations as he did not feel that any were needed. After approximately two years of employment, the client was involved in a motor vehicle accident that was insignificant in nature. Following the accident, the client was informed that his employment was being terminated as a result of him taking prescription medication for pain related to his diagnoses. The client attempted to negotiate with his employer regarding the termination; however, he was not successful. He then came to P&A and requested assistance with filing a discrimination complaint with the State Department of Labor. P&A is providing legal services to assist the client with filing the complaint and with complaint-related remedies. At the end of the fiscal year, the complaint had been filed and the state DOL office determined that there was sufficient cause to investigate. Further activities regarding this case will carry-over into FY 2015.

2. Number of individuals named in class actions 0

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.

In July of 2014 P&A became aware that a number of students within North Dakota’s schools were informed that Glucagon administration for Diabetes management would no longer be administered by school personnel, other than a nurse.

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 1. Identify and describe priority: ABUSE, NEGLECT & EXPLOITATION People with disabilities are at reduced risk of abuse, neglect & exploitation. 2. Need, issue or barrier addressed by this priority: The combination of the personal effects of a disability and associated factors, such as support of multiple caregivers, creates high levels of vulnerability. Therefore, the provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities. The ND Department of Human Services has authority to address abuse, neglect, and exploitation under state statute through its Long Term Care Ombudsman program and through funding to regional human service centers for Vulnerable Adult Protective Services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals. 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: Fifteen (15) allegations of mistreatment will be investigated, resulting in positive outcome for the person. P&A received eight (8) allegations of suspected abuse, neglect and exploitation which were investigated during this fiscal year. Four (4) of these were completed by the end of the fiscal year and all were closed with positive outcomes for the clients. Four (4) remained open at the end of the fiscal year and will be carried over to FY 2015. Objective 2: P&A will ensure effective and appropriate reporting through review and assessment of ten (10) contacts from providers and other stakeholders re: ANE and Serious Events. P&A had thirty-five (35) contacts with family members, people with disabilities, concerned members of the public, and providers regarding suspected abuse, neglect, or exploitation. Through these contacts, P&A provided information and technical assistance to create a better understanding of reportable incidents. Objective 3: Through advocacy and/or training, P&A will affect one (1) systemic change/best practice approach that reduces the risk of ANE for people with disabilities. During FY 2014, P&A and staff from the Aging Services Division of the Department of Human Services Vulnerable Adult Protective Services (VAPS) Division conducted joint training regarding the two entities roles and responsibilities. The training included P&A and VAPS staff and included presentations regarding both state and federal authority, along with the mandatory reporting laws within the state of North Dakota. Through these efforts, an agreed upon system was developed to outline how reports would be processed to ensure that resources are used effectively and that investigations of potential abuse, neglect and exploitation of vulnerable adults occurs in a timely and thorough manner. In addition, P&A staff provided two trainings to a new provider in one area of the state who is serving people with physical disabilities. These trainings were specific to their responsibilities as mandated reporters, prevention of abuse, neglect and exploitation and risk management. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: Aging Services and Vulnerable Adult Protective Services (VAPS) In follow-up to Senate Bill 2323, which was passed during the 2013 legislative session, P&A and the Aging Services Division of the Department of Human Services has continued to address the abuse, neglect and exploitation (ANE) needs of vulnerable adults and people with disabilities in North Dakota. P&A continues to collaborate both at the state and regional level with aging services staff and VAPS regional workers to investigate and address reports of ANE and to address protective services. P&A and Aging Services/VAPS staff continue to refer reports to one another, collaborative on investigations and work together to address training needs relative to mandatory reporting and investigation needs. These efforts will continue throughout FY 2015. 5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Eight (8) cases were opened with the priority of Abuse, Neglect & Exploitation. None of the cases were class actions. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is a 57 year-old white male with diagnoses of physical orthopedic impairments to include quadriplegia. The client lives independently and receives in home support from qualified service providers. The client has family who lives in the same urban community in the state. P&A received a report that a caregiver, who was a QSP for the client, was financially exploiting the client during a period of time that the client was hospitalized. P&A provided protective services assistance to support involvement from the local police department. Law enforcement conducted a formal investigation, with involvement by P&A. While there was concern from family members regarding the situation, it was determined that the client had consented to loaning money to the staff member. P&A was able to confirm that the client had been repaid for some of these monies loaned, which was acceptable to the client. As a result of the investigation efforts, the client and alleged person no longer have a relationship personally or professionally, which has resulted in the long term concerns being mitigated. Through the investigation it was learned that the staff member did have access to the client’s personal information; therefore, it has been recommended that the client obtain a credit report, at least annually, to safeguard his financial interests and rights. Self-advocacy teaching was also provided to the client regarding his ability to protect his personal finances from potential misuse by caregivers or others. Priority 2 1. Identify and describe priority: COMMUNITY INCLUSION People with disabilities live in the least restrictive community setting with appropriate supports, assistive technology, and services. 2. Need, issue or barrier addressed by this priority: People with disabilities in the state of North Dakota do not have sufficient access to or knowledge about community based living options. ND continues to spend a disproportionate amount of funding on institutional placements and this often is the default choice for individuals needing a higher level of care or assistance. Sufficient flexibility in the use of funds has not been established within our current system of services. This has negatively impacted communities’ abilities to provide appropriate services that enable people with disabilities to remain or return to their communities of choice. 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: Five people with disabilities who are at risk of being placed in an institution (ND Developmental Center, ND State Hospital, Basic Care, Long Term Care facility, and private psychiatric facilities) will be provided the necessary services, including AT, to maintain services in the least restrictive environment or achieve community placement. P&A received nine (9) requests from people at risk of placement in an institution. Four (4) of these were resolved by the end of the fiscal year and all were closed with positive outcomes for the clients. Five (5) cases remain open and will be carried over to fiscal year 2015. P&A also handled two referrals in which the issues were identified to be systemic in nature and affected people with disabilities and their ability to remain living in the community. Both activities related to failure to provide appropriate accommodations in order to maintain their supports, services and access to services. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: Olmstead Commission P&A’s Executive Director is appointed by the Governor to the Olmstead Commission. The Commission is co-chaired by the Executive Director of the Department of Human Services and a liaison from the Governor’s office. The Commission had 2 meetings this fiscal year (Feb. 20, 2014 and June 10, 2014). It has been updating the Olmstead Plan for ND in collaboration with Olmstead Policy Academy Committees. Community Elder Service Network In collaboration with 39 other entities that serve the Bismarck and Mandan communities, P&A staff continue to work towards achieving a cohesive plan to address aging and disability service needs within these communities. Meetings are held monthly and P&A participates on a regular basis. A monthly program is held to inform participants of ongoing services within the Bismarck and Mandan communities. In addition, monthly reports are completed by each entity to ensure that updates are shared amongst all participants. The CESN has been instrumental in developing programmatic and educational information for people who are aging and who have disabilities throughout the two communities that are represented.

Interagency Groups P&A staff participate in a number of interagency work groups to address the needs of people with disabilities who are living in rural communities. Currently P&A staff participate with groups in the cities of Minot, Devils Lake, and also within County programs of McLean, Renville, Burleigh, Morton and Nelson Counties. P&A also participates in a group that serves the Turtle Mountain Indian reservation.

Community Coordinating Councils P&A staff attends community coordinating meetings in ND’s larger communities. These are meetings of community/regional providers that focus on strengthening and building local infrastructure to better support people with mental health issues. These meetings are primarily held to discuss local issues, barriers, strengths, and challenges. In some instances, discussion may be used to prevent placement and movement to the ND State Hospital or other more restrictive settings. Informational topics are also discussed on an ongoing basis, which strengthens the knowledge of the people involved.

Bismarck/Mandan & Burleigh/Morton Transportation P&A staff participated in a collaborative activity with city officials in Bismarck and Mandan communities, along with the county officials of Morton and Burleigh Counties to address the transportation needs of people who reside in these communities. A transportation study was conducted by a contracted firm and identified a number of issues related to transportation. The group identified the most significant issues that were identified through the study and will now be working to address these through long range strategic planning. P&A’s participation ensured that the transportation needs of people with disabilities were included in this study, discussion and planning.

North Dakota Disability Advocacy Consortium P&A is an active member of the North Dakota Disabilities Advocacy Consortium, (NDDAC), a non-profit corporation representing sixteen disability-related advocacy organizations across the state. P&A’s Executive Director is an officer of the Consortium. The NDDAC does not have staff. The work is done by the membership. Information about the organization and its activities can be found on the following website: http://nddac.org/.

In FY 2014, the NDDAC applied for, and received, a Bremer grant as well as a Bush grant to support its work. While some activities related to healthcare (implementation of the Affordable Care Act) continued, the NDDAC’s priority shifted to developing its first Legislative Training Institute (LTI). The LTI, to be held in October 2014, is a three-day conference with the goal of teaching individuals with disabilities, family members, and advocates, about the legislature and how they can be involved. It will be very interactive, with participants forming their own “state government” and serving in the roles of Legislators in the Senate and the House, as well as the Governor. They will draft bills and take them through the legislative process, including committee hearings. Two team leaders will be assigned to each group of approximately ten participants to help ensure they have the support necessary to be engaged in the Institute. This is a very exciting endeavor! Region IV Unmet Needs — Youth with Disabilities A group met to discuss needs for students with disabilities including developmental disabilities and mental illness. The group identified issues including a lack of community-based services/institutional bias, lack of community based structured programs for students with autism spectrum disorders and emotional/behavioral issues. There was also discussion regarding access to services in rural areas. The group identified possible solutions. Input from this group was shared with staff collecting information for a behavioral health care study. 5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Nine (9) cases were opened under this priority. Five of the cases involved people who were at risk of institutionalization and one case involved a gentleman who was in an institution and wanted advocacy services to move into the community. Three cases are public accommodation issues that affect people with disabilities and their ability to remain living in the community with full access to their needed services and the outcome will result in positive impacts for a significant number of people. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is a 49 year old gentleman who is paralyzed from the waist down and has renal failure. He lives in an urban community with his wife. P&A was contacted by the client and his wife and requested assistance with issues that he was experiencing with discharge planning from a Transitional Acute Care Rehabilitation Hospital. Issues were identified specifically with providers in the community being unwilling to provide the support and accommodations necessary for the client to receive the therapies and dialysis services that he needed in order to return to his home. P&A provided advocacy services to the client and negotiated with entities to address what were failures to accommodate the client’s needs. The public transportation system in his community was unwilling to provide the door-to-door service, despite this being an available service, because his home was on a hill. In addition, it was clear that transportation was going to be an ongoing issue for the client; therefore, P&A provided advocacy support and assistance to help them obtain an accessible vehicle of their own, which allowed for more opportunity, flexibility and access; thus not making the client dependent on public transportation. P&A also provided advocacy services to the client to focus on his discharge needs and worked with his team to address his needs, which allowed for him to leave the acute care hospital and receive the services that he needed to return to his family home with his wife.

Case Two: The client is a 40 year old female with a diagnosis of Multiple Sclerosis. At the time of referral, the client was in the hospital and her discharge was pending due the hospital not establishing a discharge plan that the client and her family agreed to. The client was hospitalized as a result of dehydration and malnutrition. When concerns were identified with the potential care that the client was receiving prior to her hospitalization, hospital personnel were planning discharge to a skilled nursing facility; however, the client was not in agreement with this. Of noted concern by the client’s doctors was her need for additional therapy and rehabilitation services because her physical health had been compromised by the lack of proper care. P&A provided advocacy assistance to the client and worked with her team at the hospital to identify an appropriate discharge plan from the hospital. The client did agree that she needed additional rehabilitation services and was transferred to a rehab facility with the plan to then return to living in the community. Additional advocacy services were also provided to ensure that the client had access to her personal things as her significant other was not initially forthcoming with them when it was learned that she would not be coming back into the home. With law enforcement assistance, the client’s personal items were retrieved from her previous residence and steps were taken to ensure her safety and well-being, along with appropriate services to assist with her ongoing care needs.

Priority 3 1. Identify and describe priority: CRIMINAL JUSTICE People with disabilities, who are involved or at risk of becoming involved in the criminal justice system, will have appropriate supports and services to meet their disability-related needs. 2. Need, issue or barrier addressed by this priority: It is recognized that there is a lack of understanding regarding disability-related issues in the criminal justice system. P&A believes that both systemic and individual efforts are necessary to facilitate change regarding the provision of quality, appropriate services to people with disabilities involved at any level of the criminal justice process (i.e. questioning, arrest, arraignment, hearings, trial, sentencing, incarceration, and re-entry into the community). 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: P&A advocacy will be provided to at least 3 people needing representation with Individual Justice Plans, Forced Medication Hearings, and/or disability-related identification service issues in the correctional/judicial system with 90% of the closed cases being closed in the client’s favor. P&A provided case advocacy to four (4) people. One (1) case was closed during FY 2014 and was closed successfully. Three (3) cases remained open at the end of the fiscal year and will be carried over to FY 2015. Objective 2: P&A will provide information/referral to at least three people who contact the agency regarding disability-related criminal justice issues. P&A provided Information and Referral services to twelve (12) people regarding disability-related criminal justice issues. Objective 3: P&A will build local capacity & disability awareness through education and training to one person in targeted populations and through systems activities. Three trainings regarding the Individual Justice Planning (IJP) process were held during FY 2014. Through these activities, seven PAIR eligible people were trained on how the IJP process can be used to support people with disabilities who are involved in, or at risk of becoming involved in the criminal justice system. These three trainings were provided to county social service staff, advocates at an Independent Living Center and at an annual provider conference. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: Individual Justice Planning As a state, North Dakota recognizes that there is a lack of understanding regarding disability-related issues in the criminal justice system. P&A believes that both systemic and individual efforts are necessary to facilitate change regarding the provision of quality, appropriate services to people with disabilities involved in the criminal justice process. In an effort to impact the disability and the criminal justice systems, P&A, in collaboration with the ND Department of Human Services and ND Department of Corrections has developed an Individual Justice Planning (IJP) process. The IJP process is a tool used by multi-disciplinary teams that allows for identification, assessment and a plan to address at-risk criminal behavior. The process can also be used when someone has already become involved in the criminal justice system. The implementation component of this project continued throughout fiscal year 2014 with a focus on ensuring that professionals within the disability, educational and legal system have the knowledge to ensure full implementation. P&A staff have been actively engaged with clients and the disability and legal community to implement IJP’s throughout the state, which has proven to be very successful. 5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Four (4) cases were opened under this priority. None of the cases involved class actions. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is a 24 year old married Native American female. Her and her husband live in an apartment in a rural community. She has a diagnosis of Fetal Alcohol Syndrome. P&A was contacted on behalf of the client to assist her with criminal charges as a result of the client’s impulsive stealing. This has created problems with her employment and places her at an ongoing risk for continued involvement in the criminal justice system. P&A provided advocacy support to develop an Individual Justice Plan. A significant part of the client’s plan was developed to address her self-advocacy skills and also ways to help her problem solve and make positive choices. The client’s IJP also identified supports and services that she could receive and participate in to address her at-risk behaviors. As a result of the IJP, the client’s needs have been addressed and she has been able to remain out of the criminal justice system. She is also able to remain living in the community. Priority 4 1. Identify and describe priority: EDUCATION Students with disabilities will receive services consistent with their disability-related rights. 2. Need, issue or barrier addressed by this priority: Educational Services for children are not provided consistent with requirements of the Individuals with Disabilities Education Act or Section 504 of the Vocational Rehabilitation Act. One barrier is a lack of understanding of the process by both parents and professionals in the educational system. A second barrier occurs because there is sometimes a conflict between the needs of individuals, which are to be addressed by each IEP team, and the collective needs of all students. These issues are exacerbated by a divided system of education that views students as two separate populations: students with disabilities and students without disabilities. There is a need for education and understanding of the intent of the law by all parties involved in the identification, evaluation, child-find activities, behavioral supports, implementation of IEPs, and transition of students with disabilities. There is also a need for individual support and representation for students whose rights are being violated. 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: P&A will increase knowledge of 35 students, parents/guardians, community advocates, and educational professionals through information & referral services and training. Six (6) training events were held during FY 2014 in which 33 students, parents/guardians, community advocates and educational professionals received disability-related training within the education priority. These training events included special education students at United Tribes Technical College, special education students at the University of Mary, special education staff through the Comprehensive System of Personnel Developmental and the Family Educator Enhancement Team, Foster Care Association, Region II Transition Roundup, St. Johns Parent Night, Standing Rock Reservation Parent Involvement Conference and the Turtle Mountain Community Elementary School Special Education Parent Night. Topics included children’s rights to special education, effective communication when working with parents and personal decision making Information & Referral was also provided to Twenty-one (21) parents/guardians, family members and students within the education priority. Objective 2: P&A will provide case level services to enable 15 students with disabilities to experience successful resolution of educational rights issues in the areas of AT, identification/eligibility, implementation, least restrictive environment, positive behavioral supports, high school transition, preschool transition and extended school year services. P&A received forty-two (42) requests from people with educational rights issues. Nineteen (19) of these were resolved by the end of the fiscal year and all nineteen were resolved in the student’s favor. Twenty-three (23) remain open and will be carried over to fiscal year 2015. Objective 3: P&A will actively participate in collaborative activities at national, state, regional, and local levels in order to effect at least one favorable policy change in the education of students with disabilities. ND Secondary Transition of Community Practice Advisory Council and Regional Transition Committees P&A staff participates in the Secondary Transition of Community Practice Advisory Council meetings quarterly. The Council has addressed issues regarding transition services for students with significant disabilities state-wide, and P&A staff provided input regarding these services. P&A staff is on a guardianship sub-committee for the Council, and has provided information regarding rights issues concerning alternatives to guardianship during the sub-committee meetings. P&A assisted with the development of a guardianship information sheet that included information on alternatives to guardianship. This identified P&A and other agencies who can provide information regarding this topic. P&A has also provided information regarding Mental Health Advance Directives as an alternative to guardianship to the Council.

P&A staff also participate in a Regional Transition Committee and provide input regarding disability-related issues based on regional needs. A focus of a regional community of practice sub-committee has been formed to address a lack of community based services, disability awareness, stigma, a lack of services for students in rural areas, and continued updating of an Education Beyond High School brochure.

Special Education Unit Directors Meetings P&A staff collaborate across the state with Special Education Directors. Ongoing discussions regarding policies, procedures, disability issues, and student’s needs take place. These pro-active efforts allow P&A staff and Special Education Directors to address needs that students with disabilities are facing. Targeted efforts are currently being done in the following areas of the state: cities of Bismarck, Mandan, Fort Yates, Minot, Fargo, West Fargo and Grand Forks, Morton and Sioux Counties and the Upper Valley Special Education Consortium.

Pathfinder Parent Center (ND’s Parent Training & Information Center P&A staff currently serves on Pathfinder’s Planning Committee which coordinates their annual conference. The conference is a collaborative effort between many advocacy agencies, to include: Pathfinder Parent Center, Department of Public Instruction, Family Voices, Designer Jeans, and Department of Human Services; Part C programs. The committee works to ensure that parents, students and professionals in the education system are educated and have access to information regarding disability issues within the area of education. P&A also sponsors a booth at the annual Pathfinder conference to ensure that students and parents have knowledge of the services provided by P&A throughout the state.

Parents Informed on Education In FY 2013, Pathfinder Parent Center and P&A wrote a successful application to the State Council on Developmental Disabilities (SCDD) to develop a website for parents on educational information. The two entities spent fiscal year 2013 working on website development and continued this project into FY 2014.

Life After High School A subcommittee of the Region IV Transition Community of Practice Committee is working to obtain information about the development of educational programs for individuals with disabilities who have completed high school. There are 20 or more individuals with disabilities in the northeast section of the state who have indicated an interest in taking classes for learning and enjoyment or entering into a program of study that will result in attaining a degree from an institution of higher education. This will lead to increased employment opportunities for individuals.

There are programs of study located in other parts of the country, many with assistance from “Think College”, a national organization dedicated to developing, expanding, and improving inclusive higher education options for people with intellectual disabilities. Although one program, Adult Student Transition Education Program, A-STEP, has been developed in our state, it is believed one or more additional programs would be beneficial. The local collaborators plan to invite A-STEP program staff to provide technical assistance to the group to determine if an education beyond high school program can be developed in this area. Possible sites for such a program and grant writing have been discussed.

The collaborators of this committee have produced and distributed a brochure entitled: “Education for Life, Programs for Lifelong Learners,” which lists educational opportunities in the northeast section of the state. Reports are that some individuals with disabilities are attending community classes and some are taking university level courses.

Turtle Mountain Disabilities Committee The committee works to share information regarding services for persons with disabilities, and to identify gaps in services within the region. The committee is comprised of multiple agencies at the tribal, county, state, and federal level. The committee identified that there was a lack of education about disabilities, a lack of education about providing services to those with disabilities, and a lack of information about resources/services for individuals with disabilities. The committee agreed that the best way to address this need was to collaborate in coordinating an annual disabilities conference with the target population as the tribal population and service providers. This committee has made significant accomplishments in having two annual conferences, one in 2013, and the second in 2014. The committee obtained funding and resources for the conference. Service providers and speakers from across the state attended, presented and had information booths. The turnout was 134 individuals for the first conference and 94 for the second, which was held during the summer. The results of this conference have had a ripple effect in the region with increased participation and support for the committee as well as providing an additional outlet for outreach for agencies serving individuals with disabilities.

P&A played an integral role in bringing these agencies together and increasing the communication and collaboration with agencies to meet the needs of individuals with disabilities. This has provided positive visibility for P&A in the tribal community. It has also resulted in community members as well as other agencies contacting P&A for information and referrals, and has assisted individuals with disabilities to access services on the reservation and in outlying rural areas. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: See collaborative activities above with Objective 3. 5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Forty-two (42) cases were opened under this priority. None of the cases involved class actions. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is an eight year old girl diagnosed with a sensory processing disorder. She lives with her parents and three older sisters and attends school in a large urban community. Her difficulties with learning have also created difficulties with her emotionally, which is also impacting her learning. At the time of referral, she was receiving Occupational Therapy services for her sensory disorder. P&A was contacted by the student’s parent as the school denied eligibility for a 504 educational plan, despite the student experiencing significant difficulties at school. P&A provided advocacy services to address the student’s right to receive the necessary accommodations through the educational system. Detailed information was obtained from the client’s Occupational Therapist and Psychologist to support the student’s need for a 504 plan. As a result of these efforts, a 504 plan was developed with the necessary accommodations and services to support educational success. At the time of case closure, the student was attending school regularly with a 504 plan in place and she was doing well both academically and socially. Case Two: The client is a 17 year old female who lives with her parents in an urban community. At the age of 15 she began attending the alternative high school within her home school district because she had missed a lot of school due to severe migraines. The schedule allowed by the alternative high school worked well for her for an extended period of time; however, during a period of time in which she began having more intensive and longer-lasting migraines, the school determined that they would not allow her to miss days because their policy for the alternative high school and absences would not be accommodated because of her migraines. P&A provided advocacy services to the student and during this time, she also turned 18 years of age. P&A ensured that the student was able to work with the principal of the school to ensure that her disability-related accommodations were provided. As a result, she was able to remain in school and receive the necessary credits to continue to move towards her high school graduation. Priority 5 1. Identify and describe priority: EMPLOYMENT People with disabilities have the opportunity for meaningful employment, in their chosen field, at a fair wage. 2. Need, issue or barrier addressed by this priority: People with disabilities often have difficulty going to work due to barriers such as inadequate or inappropriate vocational services and supports, healthcare coverage, reasonable accommodations in the workplace and knowledge about work incidents. People with disabilities often encounter workplace discrimination and need assistance with addressing this issue. 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: At least five people with disabilities will exercise their employment rights in the areas of reasonable accommodation in the work place and in responding to employment discrimination through formal and informal remedies. P&A received nine (9) requests from people with employment-related issues. Four (4) of these were resolved by the end of the fiscal year and all four were resolved successfully. Five (5) cases remain open and will be carried over to fiscal year 2015. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: State Rehabilitation Council The purpose of the Advisory Council is to advise the Director of the Division of Vocational Rehabilitation concerning policy and program issues, delivery of services to clients, and methods for reaching potential clients. The Bismarck CAP advocate participates on the SRC and is the chairperson of the Public Awareness/Membership Committee. This year the committee has met the goal of bringing the SRC in compliance in regards to membership. All mandatory positions are filled and over 51% of the membership are people with disabilities. The committee assists new members to go through the SRC modules as part of their orientation to the council. A fact sheet was developed and approved by the council which provides a brief overview of the SRC for members to use to educate the public. The SRC receives quarterly budget updates for Vocational Rehabilitation to monitor the progress in service to clients since order of selection.

Mayor’s Committee on Employment of People with Disabilities P&A serves on this committee that works to bring awareness to the needs of people with disabilities in the Williston area. The Committee networks with agencies, people with disabilities and the mayor’s office. The group considers issues related to a local oil boom, and the impact of this on the employment of people with disabilities. During this year, the group has addressed issues to include audible traffic signals, accessibility of buildings in the downtown renovation project, public transit and restaurant accessibility. The committee worked in conjunction with the Independent Living Center and Center for Persons with Disabilities to host an Independent Living Fair to bring organizations and providers together to showcase available local services.

ND Transition Consortium In March 2013, the ND Transition Consortium (NDTC) formed as a partnership of programs and agencies who share a goal to promote, improve, and educate about services that help young adults with disabilities move from high school into college, training, or a job. The NDTC includes: ND Center for Persons with Disabilities (Minot State University), ND Dept. of Public Instruction, P&A (including CAP), State Council on Developmental Disabilities, and ND Vocational Rehabilitation. The NDTC continued to be active in FY 2014, especially in making enhancements to its website, "Launch My Life ND". It can be viewed at www.launchmylifend.com. P&A has contributed State General Fund dollars as well as Federal CAP monies to this project.

Governor’s Committee on the Employment of People with Disabilities The ND Employment First Task Force worked to introduce Senate Bill 2271, which passed during the 2013 ND Legislative Session. This bill revives/re-establishes the Governor’s Committee on Employment of People with Disabilities. The outcome of the committee is to further the goal of public and private employers considering competitive and integrated employment as a first option when supporting people with disabilities. Specific focus is on removing and identifying barriers that prevent this from occurring for individuals with disabilities who are of working age to obtain employment.

The Committee on the Employment of People with Disabilities met three times this Federal Fiscal year (February, May and August 2014). The primary focus for the initial meetings was to fill all of the positions on the committee and for all members to be educated on all the employment related initiatives that are currently active in the state. This included the Olmstead Academy, the Transition Community of Practice, the Employment Learning Community, APSE and a working group within the ND Association of Community Providers. One action that was initiated was a letter to the Governor requesting that funding be made available to eliminate all waiting lists for employment services. The waiting lists are for the extended services that individuals need after they have completed the time limited supported employment services provided by VR. Currently there are waiting lists for mental health and the "other" (stated dollars for individuals not eligible for DD waiver or mental health) category and the DD waiver is running out of slots as well. The committee has a budget to use for travel for non-state employee members and for projects. At the August meeting the committee approved expenditures for two projects. The first was to repeat a survey of community rehab providers that was done in 2012 which provides information regarding employment status of individuals served. The second is match dollars for two SCDD employment grants.

VR Teacher Internship Program P&A also had the opportunity to provide education and training to participants of the VR Teacher Internship Program. Through this effort one PAIR eligible was informed of their rights relative to Employment. 5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Nine (9) cases were opened under this priority. None of the cases involved class actions. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is 45 years old and recently moved to North Dakota to live closer to her adult children. She has a hearing impairment which is a severe to profound sensori-neural hearing loss in the right ear and a severe sensori-neural hearing loss in the left ear. At the time of referral she worked as a cashier at a large discount store. She had requested reasonable accommodations at work to allow her to communicate with customers and ensure her hearing aids do not break down due to heat and humidity. When these accommodates were not provided by her employer, the client came to P&A for advocacy services. One accommodation that the client requested was to work in a location in the store that is less likely to become warm and humid so that her hearing aids would work properly. She also requested to work at a register that was to her left so that she could hear customers better. A new system at the store was installed that randomly assigned cashiers to their locations based upon when they clocked in for their shift of work. When the client requested formal accommodation to not be included in the random assignments of registers, the request was denied by her employer. The employer gave her suggestions of wearing a sticker on her name badge informing customers that she was hearing impaired or recommended that she apply for another position in the store. P&A provided advocacy to the client and assisted her with negotiating with her employer. As a result of these negotiations, the client received the necessary reasonable accommodations at work to address her hearing difficulties and she has been able to maintain her employment since that time. Priority 6 1. Identify and describe priority: HEALTHCARE People with disabilities have the health care necessary to meet their disability-related needs. 2. Need, issue or barrier addressed by this priority: As federal dollars diminish for health care, there is a push within the state to limit and cut Medicaid services, when the opposite needs to occur. There is a need for greater and better health care services for Medicaid eligible individuals. Individuals with disabilities are often denied benefits without understanding the basis for the denial or the complex procedures required to effectively appeal those denials or obtain needed services. There is also a need for individuals with disabilities to access support in the initial application process to ensure that the application contains relevant information to support the right to the specific benefit. 3. Indicators PAIR used to determine successful outcome of activities pursued under this priority: Objective 1: Through case advocacy and legal representation P&A will successfully resolve five complaints, ensuring that people receive appropriate disability-related health care P&A received nine (9) requests from people with healthcare issues. Five (5) of these were resolved by the end of the fiscal year and all were resolved in the client’s favor. Four (4) cases remain open and will be carried over to fiscal year 2015. 4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: State Medicaid Advisory Committee The State Medicaid Advisory Committee meets on a quarterly basis throughout the year and reviews data, information and proposed changes on a broad range of Medicaid issues that affect people with disabilities. During FY 2014, these topics included: updates on the Medicaid Management Information System (MMIS), anticipated implementation dates, and explanations for missing the most recent anticipated implementation dates; updates to progress on the eligibility system project, upcoming revisions to the state Medicaid plan, all pending and recent changes to the Administrative Rules, recent changes to the estate recovery methods, updates to Pharmacy Services including services requiring prior authorization, report on Long-Term Care, updates to HCBS transition plan progress for the new HCBS rule, updates to progress on implementation of HB1378 from the 2013 Legislative Session, changes to personal care with supervision, review of the DD payment system, review of quarterly budgets, impact and effectiveness of the expansion of Medicaid under the Affordable Care Act, as opted by the Legislature, utilization reviews, progress and timelines for training on the Affordable Care Act and ND Medicaid, and updates on quality control (“program integrity”). Efforts will continue during FY 2015. 11,056 people were impacted through this activity.

ND Disabilities Health Project The ND Disabilities Health Project is a collaborative project whose mission is to promote the health and wellness of ND citizens with disabilities with a focus on increasing capacity in health programs, healthcare access and emergency preparedness for people with disabilities. North Dakota is one of eighteen (18) states to receive this award, which is funded by the Centers for Disease Control and Prevention. This is a collaborative project between ND Center for Persons with Disabilities at Minot State University, the Center for Rural Health at the University of North Dakota, P&A, and the ND State Department of Health-Division of Chronic Disease.

The project is building on a previous 5 year funding period from the Centers for Disease Control (CDC) in which the focus was to establish an office on disability health and raise awareness of health disparities between people with and without disabilities in North Dakota. Over the past year there were two workshops held for people with disabilities to learn more about health and wellness strategies and 21 people received training through this activity. In addition, an emergency preparedness video was designed and aired on Good Health TV, which is a TV network that is placed in the waiting areas of Indian Health Services clinics on all of ND’s reservations. It is estimated that 79% of people who visit HIS offices for healthcare view this video while waiting for their appointment. The project also sent mailings out to 60 public health units and 110 county emergency managers regarding emergency shelter accessibility and disability awareness.

Health Care-Related Public Education P&A is an active member of the North Dakota Disabilities Advocacy Consortium, (NDDAC), a non-profit corporation representing fourteen disability-related advocacy organizations across the state. P&A’s Executive Director is an officer of the Consortium. Implementation of the Affordable Care Act is one of NDDAC‘s highest priorities. Its special emphasis has been on public education about health care reform. NDDAC received grants from the Bremer Foundation for the purpose of developing public education and outreach programs and resources about the Affordable Care Act.

This NDDAC grant program is entitled My Rights: My Healthcare. P&A staff has served on the My Rights: My Healthcare planning committee for the past two years. One of the primary goals of this grant program was to develop a major public education presentation on the Affordable Care Act designed to be replicated widely in public forums across North Dakota. The My Rights: My Healthcare committee developed a PowerPoint presentation designed to be used as a training tool by the individual Consortium member organizations to educate their own staff and consumers, as well as by the public at large. The committee is planning to revise and update the presentation in the first part of 2015.

The Consortium staff is continuously working with its partner organizations to provide updated information and materials for wide distribution among the members. For example, the ND Association for Community Providers members, through their Executive Director, received the My Rights: My Healthcare information. Several of these providers groups have, in turn, now linked to the NDDAC website so their staff and clients can access all of the educational resources.

In March, 2014 the Consortium helped recruit people to attend an Affordable Care Act enrollment event held in Bismarck at the First Presbyterian Church. This event was sponsored by the North Dakota Center for Persons with Disabilities. It featured remarks from Ms. Kim Gillan, Region VIII Director of the US Department of Health and Human Services. The My Rights: My Healthcare committee is helping to plan and will participate in another enrollment event in January of 2015.

The committee is also in the process of planning a Town Hall meeting providing information about enrolling in the ACA to take place in January, 2015. This Town Hall meeting will include a panel presentation designed to educate people about shopping for health care coverage through the federal marketplace. The meeting will be televised by community access TV and will be broadcast throughout the state.

5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions: Eight (8) cases were opened under this priority. None of the cases involved class actions. 6. Provide at least one case summary that demonstrates the impact of the priority: Case One: The client is a 50 year old male who suffered a stroke. Prior to his stroke, he was employed full-time and living with his wife in an urban community. The client’s wife contacted P&A on behalf of her husband to request assistance with coverage for rehabilitation services due to his stroke. Initially, the client’s prognosis was poor and he was placed on hospice; however, his condition began to improve and hospice was discontinued. At that time, his neurologist recommended intensive rehabilitation services; but his private insurance company denied coverage for these therapies and services. P&A provided advocacy services to the client and assisted him with an appeal of this denial. Detailed information was obtained from the client’s neurologist and treating physicians. As a result of the appeal and advocacy efforts, approval for rehabilitation services has been obtained for the client and he is continuing to show improvement in his condition. Case Two: The client is a 51 year old male who resides with his wife in a large urban community. He requires a knee brace to provide stability to his knee when walking and/or standing. He has a number of these devices which Medicaid has purchased for him over the years, with the last one being purchased about a year and a half ago; however, the new brace has never fit well. Medicaid denied the necessary changes to ensure that the client’s brace fit well. P&A provided advocacy service to the client to ensure that his rights to coverage was appropriate. Funding was obtained to ensure that the client had a brace that fit well, supported his knee well in the correct position and allowed him to be supported with his medical needs.

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.

Priority 1 1. A statement of the priority. INSTITUTIONS & FACILITIES More people with disabilities receiving services in institutions and facilities will receive quality services and increased opportunities to live in less restrictive settings. 2. The need addressed. ND continues to spend a disproportionate amount of funding on institutional placements and this often is the default choice for individuals needing a higher level of care or assistance. Sufficient flexibility in the use of funds has not been established within our current system of services. This has negatively impacted communities’ abilities to provide appropriate services that enable people with disabilities to remain or return to their communities of choice. The combination of the personal effects of a disability and associated factors, such as support of multiple caregivers, creates high levels of vulnerability. Therefore, the provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities who reside within institutions and facilities. The ND Department of Human Services has authority to address abuse, neglect, and exploitation under state statute through its Long Term Care Ombudsman program and through funding to regional human service centers for Vulnerable Adult Protection Services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals. 3. A description of the activities to be carried out. Objective 1: P&A will investigate suspected abuse, neglect and exploitation and in 90% of the cases will achieve positive outcomes for people with disabilities who are institutionalized or supported in facilities. Objective 2: P&A will achieve positive outcomes through systemic advocacy and monitoring of disability services.

Objective 3: P&A will provide training to clients and staff in institutions and facilities, resulting in increased knowledge or understanding of abuse, neglect, exploitation, and disability-rights issues. Objective 4: People who are institutionalized and able to live in the community will receive the disability-related supports necessary to meet their needs in less restrictive settings in the community. Priority 2 1. A statement of the priority. JUSTICE The disability-related rights of people with disabilities will be protected and enforced. 2. The need addressed. Seeking justice to promote the ongoing commitment to assert the human, civil and legal rights of people with disabilities is imperative throughout the advocacy work done by the agency. People with disabilities often cannot articulate and act to protect deprivations in the areas of employment, education and access to healthcare. In addition, systems, such as the criminal justice system, are not equipped to offer the protections and accommodations necessary to ensure that people with disabilities are afforded their due process rights. Promoting self-actualization and self-advocacy is a common thread throughout these efforts, with the goal of ensuring that the system as a whole becomes stronger with the eventual goal of people achieving their greatest potential. 3. A description of the activities to be carried out. Objective 1: P&A will achieve positive outcomes for people with disabilities who have been discriminated against on the basis of disability in employment. Objective 2: P&A will eliminate barriers to employment of people with disabilities. Objective 3: People with disabilities who are involved, or who are at risk of becoming involved, in the criminal justice system will have the necessary supports and services to meet their disability-related needs. Objective 4: P&A will achieve positive outcomes for students with disabilities who are being denied the right to education in the least restrictive environment, needed behavioral supports, or where denial results in health or safety concerns, or will impact a substantial number of students with disabilities. Objective 5: People with disabilities will have equal access to the voting process. Objective 6: P&A will enforce the rights of people with disabilities when denied eligibility, access, or coverage to Medicaid, Medicare, Veterans’ benefits, private insurance, or other responsible entities/organizations for disability-related healthcare. Priority 3 1. A statement of the priority. INCLUSION More people with disabilities will have access to quality services appropriate to their needs in the community. 2. The need addressed. People with disabilities in the state of North Dakota do not have sufficient services to ensure full participation in the community or adequate supports to ensure that they can live in the least restrictive environment. Communities often have not devoted resources to ensure that public sites and services are fully accessible and that barriers to inclusion and participation are eliminated. The lack of supports in the community creates higher levels of vulnerability to potential abuse and neglect. The provision of protective services and responding to identified concerns in the service delivery system are necessary to ensure the health, safety, and quality of life for people with disabilities who live in the community. The ND Department of Human Services has authority to address abuse, neglect, and exploitation through funding to regional human service centers for Vulnerable Adult Protection Services. Overlapping authority, staffing changes, and funding issues have prevented a consistent approach to providing services to eligible individuals. 3. A description of the activities to be carried out. Objective 1: People who are at risk of institutionalization will receive the disability-related supports necessary to remain in their community. Objective 2: P&A will investigate complaints of suspected abuse, neglect and exploitation and in 80% of the cases will achieve positive outcomes for people with disabilities who reside in the community. Objective 3: P&A will provide training to clients and staff in the community, resulting in increased knowledge or understanding of abuse, neglect, exploitation, and disability-rights issues. Objective 4: People with disabilities will have physical access to an increased number of public or commercial sites in the community.

Priority 4 1. A statement of the priority. COMMUNITY PARTNERSHIPS & COLLABORATION Collaboration between people with disabilities and community partners will result in systemic change to service delivery systems and rights of people with disabilities. 2. The need addressed. Through the provision of protective services and advocacy work, P&A often finds issues that identify a lack of consistency, availability, and affordability in services for people with disabilities. In addition, there are also times when a gap in services is identified which is negatively impacting people with disabilities. These issues often bring to light the necessity to address the entire system and impact change at a much larger model than through individual casework or through outreach and information means. Addressing these issues through collaboration and systemic advocacy will ensure the effective use of resources, empower people with disabilities and their family members to get engaged, while also ensuring the people with disabilities have the full range of available options to resolve issues on a larger scale. 3. A description of the activities to be carried out. Objective 1: In partnership with others, P&A will provide training to people with disabilities, family members and the general public regarding P&A’s services and priorities, disability-related issues, the legislative process, and communicating with policy-makers to empower people to become effective advocates on disability-related issues. Objective 2: P&A, in collaboration with advisory councils, self-advocates, other advocacy organization, and stakeholders, will achieve system changes by informing policy-makers about the potential impact of legislation, policies, regulations, and rules, on people with disabilities and their families.

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

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.

Sources of funds received and expended Budget for the fiscal year covered by this report Description of PAIR staff (duties and person-years) Involvement with advisory boards (if any) Grievances filed under the grievance procedure 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

A. SOURCES OF FUNDS RECEIVED AND EXPENDED:

2014 PAIR federal grant $93,836

2013 PAIR federal grant $95,501

TOTAL: $189,337

B. BUDGET FOR THE FISCAL YEAR COVERED BY THIS REPORT:

salaries 117,819.60

temp salaries 226.76

benefits 46,963.80

travel 3,029.46

professional supplies 598.60

office supplies 155.78

postage 173.74

printing 274.95

IT equipment < $5,000 265.36

office equipment & furniture 145.77

utilities 58.31

insurance 376.75

office leases 11,611.45

repairs/copier maintenance 155.75

IT data processing 3,755.07

IT communications 1,481.50 IT contractual services 22.75

professional development 1,421.57

operating fees & services 800.00

TOTAL: $189,336.97

C. DESCRIPTION OF PAIR STAFF: P&A has ten offices in the State. Each site has from one to three Disability Advocates (13 in total) and all 13 have time allocated to the PAIR Program. Additional staff allocated PAIR Program time include the two Directors of Program Services, three attorneys, a 1/2 time Support Staff position (who also drives the Disability Advocate as she has a visual impairment), the Director of Policy & Operations, a Program Coordinator & the Executive Director. Of the total 27.5 FTE’s (28 staff), 22 have some PAIR time. Other staff also support the PAIR Program (e.g., Intake Advocates and the Fiscal Manager) but are paid with non-federal funds.

POSITIONS PAIR % FILLED TOTAL

Disability Advocate - Williston 20% 100% .20

Disability Advocate - Minot 15% 100% .15

Disability Advocate - Devils Lake 10% 100% .10

Disability Advocate - Belcourt 20% 100% .20

Disability Advocate - Grafton 10% 100% .10

Disability Advocate - Grand Forks 10% 100% .10

Disability Advocate - Fargo 10% 100% .10

Disability Advocate - Fargo 15% 100% .15

Disability Advocate - Jamestown 10% 100% .10

Disability Advocate - Bismarck 30% 100% .30

Disability Advocate — Bismarck 10% 100% .10

Disability Advocate — Bismarck 10% 100% .10

Disability Advocate - Dickinson 10% 100% .10

Support Staff (.5 FTE) - Williston 20% 100% .10

Attorney - Fargo 5% 100% .05

Attorney - Bismarck 10% 100% .10

Attorney - Bismarck 10% 100% .10

Dir. of Program Services 15% 100% .15

Dir. of Program Services 7.5% 100% .075

Dir. of Policy & Operations 5% 100% .05

Program Coordinator 5% 100% .05

Executive Director 10% 100% .10

TOTAL: 2.675

D. INVOLVEMENT WITH ADVISORY BOARDS (IF ANY): P&A is an independent State agency with its own seven-member governing board. It does not have a separate advisory council.

E. GRIEVANCES FILED UNDER THE GRIEVANCE PROCEDURE:

No grievances were received relative to the PAIR program during FY 2014.

F. COORDINATION WITH THE CAP AND THE STATE LONG-TERM CARE PROGRAM (IF NOT PART OF THE P&A): P&A is now administering the Client Assistance Program (CAP) under a contract with the Dept. of Human Services/Vocational Rehabilitation Division. P&A administrative staff has been meeting frequently with staff from the Long Term Care Ombudsman Program in order to better define roles and responsibilities. Referrals are shared between P&A and the Long Term Care Ombudsman Program on an ongoing basis.

Certification

Signed?Yes
Signed ByTeresa Larsen
TitleAuthorized Certifying Official
Signed Date12/19/2014