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

North Dakota (PROTECTION and ADVOCACY PROJECT) - H240A150035 - FY2015

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 711
Toll-free Phone800-472-2670
Toll-free TTY
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 areas97
2. Individuals receiving I&R outside PAIR priority areas260
3. Total individuals receiving I&R (lines A1 + A2)357

B. Training Activities

1. Number of trainings presented by PAIR staff9
2. Number of individuals who attended training (approximate)116

Training Activities for FY 2015 1. 11/5/2014 — Northwest Human Service Center (NWHSC) Advisory Board — The NWHSC Advisory Board serves a three county region in the northwest corner of the state of ND. The Board also serves the Trenton Indian Reservation area. The Advisory Board includes representatives from all locations in the region and provides guidance to the administration of the human service center. This region of the state has experienced significant growth over the past five years and is the major hub of oil industry in the Bakken. P&A conducted a presentation regarding P&A services, our priorities and types of services was provided to the 8 member Board. P&A brochures and materials were provided to members for their knowledge and also to share with others in their communities. 8 people participated in the training. 2. 1/26/2015 — North Central Human Service Center (NCHSC) Advisory Board — The NCHSC Advisory Board serves a nine county region in the north central part of the state of ND. This area of the state has also been significantly impacted over the last 5 years with a major flood disaster and also the impact of the oil industry in ND. A presentation was done to the 18 member Board regarding P&A services and our priorities. P&A brochures were provided to members also. 18 people participated in the training. 3. 2-12-15 — Governor’s Committee on Aging — The Governor’s Committee on Aging is a Committee that focuses on the issues and services that impact older North Dakotans. The Committee acts as an advisory board to the ND Department of Human Services (DHS) and is comprised of 14 members who are appointed by the Governor. The Committee also sponsors community educational forums, for which P&A was a presenter. P&A provided information regarding our services, the various priority areas of work, both abuse, neglect and exploitation and advocacy services. Brochures regarding P&A services were provided to members; along with a detailed insert regarding P&A’s priorities for the fiscal year. Examples of cases were also shared with members to give them further knowledge of the types of cases that P&A receives. Information regarding how P&A works in collaboration with other entities was also a focus of the training and presentation. 14 people participated in the training. 4. 3-3-15 — South Central Human Service Center (SCHSC) Mental Illness & Chemical Dependency Unit — A presentation on mandatory reporting under both state and federal law was provided to the employees who work within the MI and CD units at the human service center. The presentation included information on mandatory reporting as it pertains to people with disabilities, implementation of risk management, and long term quality assurance of services provided by the two units within the human service center. 37 people participated in the training, with 9 people being PAIR eligible. 5. 4-14-15 — Jamestown Crisis Residential Unit (CRU) — As a result of a number of abuse, neglect and exploitation investigations that were completed during the fiscal year, it became apparent that the staff working at CRU could benefit from additional training on ANE and mandatory reporting. CRU is a short term step down facility that is managed and supported by the human service center in the south central part of North Dakota. This is also the region in which the state’s acute care mental health hospital is located. P&A provided training to the staff who work in the facility on abuse, neglect and exploitation definitions, mandatory reporting, and risk management. Information regarding how this affects the quality of services was also included in the training. 10 people participated in the training, with 3 of them being identified as PAIR eligible. 6. 4-30-15 — Horizon Middle School — After the completion of an investigation that involved a report of potential verbal and physical abuse of a child with a disability, P&A provided training to the special education staff within the school. P&A provided information on abuse, neglect and exploitation, mandatory reporting, conducting interviews, and short and long term risk management. 38 people were trained as part of this activity, with 13 of them being identified as PAIR eligible. 7. 5-12-15 — Elk’s Youth Day — Elks Youth Day is an event in which high school seniors in Williston visit and learn about city government and its functions. As part of this activity, a presentation to Williston seniors is given regarding P&A, our services and the role that the agency plays within state government in North Dakota. 20 students were trained as part of this activity, with 6 of them being PAIR eligible. 8. 9-15-15 — Williston Public School — In response to a number of educational cases regarding students with disabilities and the special education staff within the district not promoting inclusion of students with disabilities, P&A provided a training to the special education staff in the district on P&A’s services and most specifically, the advocacy services that P&A provides in regards to community inclusion. This included information on people’s rights to live, work and play in the least restrictive environment. Information regarding student’s rights and how the district needed to be planning and promoting this model was the message shared through the training. 12 people were trained as part of this activity, with 4 of them being identified as PAIR eligible. 9. 9-18-15 — Joint training with P&A and ND Department of Human Services (DHS) Aging Services staff — The joint training included staff from P&A, Vulnerable Adult Protective Services and the Long Term Care Ombudsman in ND. The exchange of information between the three entities resulted in an increased understanding of the roles, services and supports to people with disabilities by the three agencies. P&A presented on our services, priorities, both protective services and advocacy based, and how to access services through the centralized intake process. 41 people were trained as part of this activity.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles2
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website22,955
5. Publications/booklets/brochures disseminated598
6. Other (specify separately)16

Narrative

Newspaper/magazine/journal/newsletter articles In an effort to reach a significant number of parents of students with disabilities regarding children’s rights to a free and appropriate education, P&A submitted articles to two newsletters during the fiscal year. Both newsletters were sent to parents of children in the school district to ensure that they had knowledge of their child’s rights, along with information regarding P&A services. The Spirit Lake Nation and the Fort Totten school newsletters included the article, and between the two schools 290 families received the information regarding P&A services and our priorities. Other Dissemination Activities 10/1/2014 — Minot Veterans Stand Down - P & A was able to talk with Veterans that attended the conference about disability-related issues and encourage them and inform them of P&A’s services and priorities. — 85 participants. 10/1/2014 — Committee on the Employment and Advancement of People with Disabilities (CEAD) — P&A provided information regarding disability-related rights issues regarding employment to the members of CEAD. This included employment discrimination and reasonable accommodations. Information regarding P&A’s advocacy and systemic efforts regarding this area of our priorities was also included in the information shared. — 30 participants. 10/7/2014 — Williston Independent Living Fair — P&A sponsored a booth at the 2014 Independent Living Fair that was sponsored in Williston, ND. The event was a huge success, especially with the influx of people into the community due to the oil boom. Information regarding P&A’s services was provided, along with the distribution of brochures. — 54 participants 10/8/2014 — ND Department of Public Instruction 2014 Fall Conference — P&A sponsored a booth at the event. Information regarding P&A’s services and more specifically our Justice priority was shared with participants. The agenda included a significant amount of information regarding the educational trends across the nation, along with information pertaining to ND’s educational system. — 200 participants 10/20/2014 — ND State Autism Conference — The ND Autism Task Force sponsored a conference to include 40 national and regional experts on Autism. The focus of the conference was on appropriate supports and services for children and adults with Autism diagnosis. Information regarding new research, effective interventions, supports and resources comprised the three day agenda. Participants included people with disabilities, parents, healthcare professionals, educators, first responders, autism service providers, and advocacy organizations. P&A also sponsored a booth at the event. — 400 participants 11/3/2014 — West Fargo School Education Fair — P&A sponsored a booth at the 2014 Education Fair, which was the first event of this kind that has been hosted by the West Fargo School District. P&A provided information throughout the event on the types of services provided by P&A, along with information regarding our priorities. — 250 participants 11/17/2014 — Dickinson State University Disability Support Services — P&A provided information to the disability support services staff regarding students’ rights to accommodations in the higher education system, along with information regarding P&A’s services and priorities. — 6 participants 2/12/2015 — Disability Awareness Day at the capitol — Legislators and the general public attended the event and participated in activities. P&A set up a booth during the event to share information about P&A services and priorities. — 126 participants 3/10/2015 — Social Justice Advocacy Day — The National Association of Social Workers in North Dakota sponsored this event to encourage Social Workers within the state to strengthen their knowledge of organizations across the state that support the needs of North Dakotans. P&A sponsored a booth at the event. — 36 participants 4/2/2015 — Standing Rock Disability Awareness Day — Students and teachers from the area attended the event and included groups such as P&A, State Vocational Rehabilitation, Tribal 121 Vocational Rehabilitation and Minot State University. — 25 participants 4/9/2015 — Parent Involvement Conference — Sponsored by Pathfinders of ND, in partnership with P&A and a number of other organizations, the conference provides information to parents of children needing specialized services and provides an opportunity for parents to network, interact and learn. P&A maintained a booth during the two-day conference to share information about P&A and its services. — 106 participants 4/17/2015 — Fort Totten Student and Parent Fair - There were 300 community members/parents and 1000 students who attended the parent and student fair (from Fort Totten and surrounding communities and schools). There were 150 booths from Fort Totten and surrounding communities (Devils Lake, Minnewaukan, Maddock, Warwick, Jamestown) that provided information on their services and programs. — 1300 participants 6/12/2015 — ND Association of the Blind Conference — P&A sponsored a booth at the annual conference. Information regarding P&A’s services and priorities was shared with conference attendees. — 50 participants Other Events/Activities P&A also provided information regarding P&A services and our priorities to the Adult Learning Center Advisory Board, the Interagency Project for Assistive Technology Consumer Advisory Council, and the Sanford Mental Health Clinic. Through this activity, 15 people received information regarding P&A and our priorities.

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)45
2. Additional individuals served during the year29
3. Total individuals served (lines A1 + A2)74
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)2

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 39

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment10
3. Program access3
4. Housing0
5. Government benefits/services2
6. Transportation0
7. Education32
8. Assistive technology0
9. Voting0
10. Health care8
11. Insurance0
12. Non-government services8
13. Privacy rights0
14. Access to records0
15. Abuse5
16. Neglect9
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.0
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 assistance19
3. Investigation/monitoring6
4. Negotiation10
5. Mediation/alternative dispute resolution1
6. Administrative hearings0
7. Litigation (including class actions)1
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 44
2. 5 - 2236
3. 23 - 5927
4. 60 - 642
5. 65 and over5

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females35
2. Males39

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 Native6
3. Asian1
4. Black or African American0
5. Native Hawaiian or Other Pacific Islander0
6. White65
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 home43
3. Community residential home1
4. Foster care0
5. Nursing home3
6. Public institutional living arrangement0
7. Private institutional living arrangement1
8. Jail/prison/detention center2
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 impairment2
2. Deaf/hard of hearing2
3. Deaf-blind1
4. Orthopedic impairment17
5. Mental illness1
6. Substance abuse1
7. Mental retardation1
8. Learning disability16
9. Neurological impairment14
10. Respiratory impairment6
11. Heart/other circulatory impairment3
12. Muscular/skeletal impairment3
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability7

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities9

2. Number of individuals potentially impacted by policy changes12,143

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. Funds are also made available to patients moving from the State Hospital to community placement to help with deposits on apartments, the purchase of home goods, etc. 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. Calendar year 2015 transitions total 36 individuals as of Oct. 1, 2015. 12 PAIR eligible people were impacted. FY 2015 — Legislative — Heath Care Reform - 1 policy change During the 64th Legislative Assembly (2015 session), P&A monitored legislation pertaining to the implementation of the Affordable Care Act North Dakota. The primary legislation passed during the session related to this topic was House Bill 1378. This bill required a Legislative Management study, decisions, and a directive regarding the federal Affordable Care Act, the state’s benchmark plan, and the state-based essential health benefits package for the 2017 plan year and beyond. The bill essentially required the legislative management to assign a committee during the 2015-16 interim to study proposed and final federal rules issued by the federal Health and Human Services Department relating to essential health benefits under the Affordable Care Act; which resulted in the creation of the Healthcare Reform Review Committee. During the most recent meeting of the Committee, insurance carriers had the opportunity to do a short presentation. All providers confirmed that they will cover the ten essential health benefits defined by the ACA and will comply with the federal mental health parity law. After the presentations, the Committee selected the Blue Cross/Blue Shield small-group benchmark plan as the state’s essential health benefits package. It is estimated that there are 51,920 people in ND who are uninsured, and it is estimated that 9,346 have a disability. Waivered Services for Children Legislation — 1 policy change Through the past two legislative sessions, P&A has been a strong advocate in partnering to support the expansion of waivered services for children with disabilities. An interim study was held leading up to the 2015 legislative session which identified a gap that exists; however, there was an inability to identify the number of children who were part of this gap and what it would cost the state to support the needs of children who are currently un-served or under-served by the existing service delivery system. This resulted in formal legislation not being adopted during the 2015 session. The efforts that P&A has engaged in with other advocacy organizations and the Department of Human Services will potentially address this need. Current efforts include discussion and development of an assessment tool that could be used to identify potential eligibility. The key to this will be a model that looks at the needs that a child has that are functionally based, without consideration of what causes the identified impairment. This will be significant because a child would not be required to have an intellectual disability, which is currently required in most instances to be eligible for the DD waiver in ND. These efforts continued throughout FY 2015 and will continue into the next fiscal year, with planned legislative impact in 2017. 250 PAIR eligible people were impacted. State IDEA Advisory Committee — 1 policy change 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 on revisions to the State Systemic Improvement Plan. This will have a significant impact on students with disabilities in the coming years. 889 PAIR eligible students will be affected by this outcome. 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 impacted. Seclusion & Restraint in Schools — 1 policy change North Dakota does not currently have a comprehensive mechanism for addressing seclusion and restraint policy or procedures in our ND schools, nor does the state have existing mechanisms for collecting data about the current use of seclusion and restraint in schools. In an effort to work towards potential legislation to address this, a group of advocacy organizations joined together to seek an outcome. P&A’s legal director drafted legislation for the 2015 legislative session and the legislation was introduced to the Senate Education Committee. As a result of these efforts, a legislative management study on the use of seclusion & restraint in schools was passed, to include a formal report and recommendations being brought to the 2017 legislative session. These efforts will continue in FY 2016. 889 students with disabilities will be positively affected by this policy. 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 staff worked with representatives of the American Diabetes Association, the ND Board of Nursing, and a Diabetes Coalition to obtain clarification on the expected standards as they pertain to the legislation that was passed. It was clear that the school and the School Board Association did not accurately interpret the change in law. With all of the necessary parties, P&A provided education to the involved entities to ensure that they understood the law, along with the fact that emergency medications can be administered by school staff other than a nurse. P&A also worked with the ND Department of Public Instruction to ensure that all schools in ND are aware of their responsibilities to students with these healthcare conditions and the administration of emergency medications. This resulted in districts across the state having updated information on the laws and expectations for students. As a result, students with these healthcare conditions will have the support they need to be safe within ND’s schools. 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 has been instrumental in the last two legislative sessions to address a gap in Medicaid coverage for children who have a developmental disability, but not an intellectual disability. This has resulted in a formal study and the establishment of a workgroup to address this need, with anticipated legislation in 2017. The group has also been instrumental in addressing other funding needs for private insurance carriers who are limiting pediatric therapies for children who have physical and developmental disabilities. 240 PAIR eligible people were impacted.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts177
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.

P&A currently has seven cases that are at the legal level of services during FY 2015. Four of these cases were closed during the fiscal year, with successful resolutions. The remaining three cases were pending at the end of the fiscal year and will be carried over to FY 2016. Summary of cases: The client is a 3 year-old child with a diagnosis of Cat Eye Syndrome. Her family lives in a rural part of North Dakota where they own and operate a farm. As a result of her diagnosis, the client has a number of circulatory, lung, heart and respiratory conditions. As a result of these medical issues, the client has spent a great deal of time in and out of hospitals. When healthy enough to return home, the team of physicians who have been coordinating her care have been adamant that she receive 24-hour nursing services to assist with the management of her tracheostomy, oxygen saturation levels and administration of oxygen and respiratory and lung functioning. For a two and a half year period of time, the private insurance policy that the family purchases provided payment for the 24-hour nursing services. These services were not part of the core coverage of the insurance policy, but were provided under a flexible benefit option for complex and/or chronic health issues. The insurance provider agreed to provide the nursing services under this aspect of the plan and a written agreement was executed. The insurance company also identified that this service would continue as long as the services were determined to be medically necessary. The nursing services were successful in keeping the client stable and out of the hospital for a period of time. The family received a letter from their health insurance provider that their internal Case Manager had reviewed the case and because the child had improved, without hospitalization, the nursing services were no longer medically necessary. This is contrary to the physician’s recommendations, along with a formal opinion provided by the ND Department of Health that the services that the child needs cannot be provided by anyone other than a nurse. P&A is currently appealing the discontinuation of the nursing services by the private health insurance carrier. This case was still open at the end of the fiscal year and will continue into FY 2016. The client is a 13 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. P&A filed Due Process on behalf of the student, which resulted in the acceptance of a mediation agreement. As a result of these efforts, the school has contracted with an expert in cochlear implant therapy, who is directly supervising and overseeing the work that is done within the child’s school on a weekly basis. Through telemedicine, school staff are observed and coached by the expert. In addition, the student is also obtaining direct therapy services outside of the school day, as compensatory education. P&A will maintain involvement for a period of time to ensure that the student is making progress with the identified services. Further advocacy and legal efforts will be provided if the child is not making adequate progress within her educational setting. The client is a 42 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 4 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 sought an appeal of the denial for coverage of this medication and was successful in obtaining the ongoing approval for coverage. As a result of these legal services, the child was able to receive the needed medication and the condition is in remission. He is a healthy growing boy. The client is a 6 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. P&A assisted the mother of the child, who had been formally cited by the city for owning the dog, with obtaining a defense attorney to represent her at the hearing. P&A also provided education and technical assistance to the defense attorney to ensure that he had the knowledge regarding the ADA, a client’s rights to have a service animal and the protections that are afforded to the client. This case was successfully resolved and the child and family were able to keep their service animal. 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 diagnosis. 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 diagnosis. 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. A hearing has been scheduled, with further activities being conducted in FY 2016. The client is an 89 year-old woman who lives in a small town in a very rural part of North Dakota. P&A received a report in regards to the woman, who was reported to not be making decisions in her own best interest. The report identified that she is not handling her financial affairs appropriately and is unable to pay her bills. This was identified to have affected her ability to have heat within her home because she had not paid her propane bill. As a result, the gas company was no longer willing to fill her propane tank prior to winter months. P&A partnered with the Vulnerable Adult Protective Services (VAPS) staff within the region that she lives in to assess the situation and determine whether the person had capacity to manage her financial affairs. Through the investigation, it was found that the report was accurate and she did not have propane to heat her home. In North Dakota, this is of significant concern because winters are bitter cold and she definitely needed heat. The investigation also revealed that the client was spending money on things other than her basic needs and this was compromising her safety. At the end of the fiscal year, P&A and VAPS identified a need to move forward with steps to address her need for assistance with financial decision-making. These activities will carry over into FY 2016. 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 emergency medications would not be administered by school personnel, other than a nurse. This included the emergency administration of medications for allergens, diabetes and seizure control. Of significant concern that was identified in casework, schools informed parents that the school would no longer administer Glucagon, in response to a child having a low blood sugar that is life threatening. In addition, Diastat administration for seizure control and Epinephrine for an allergic reaction would no longer be administered, unless a nurse was present. Most North Dakota schools do not have on-site school nurses, so this posed a significant degree of risk to students with these healthcare concerns. 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. These difficulties were a result of legislation in 2013, in which 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. Despite Epinephrine being identified as acceptable in another law, this was also included by schools in their determination. The workgroup that was initiated at that time did a significant amount of work and sought input from 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. As a result of these efforts throughout this past fiscal year, the ND Board of Nursing has issued clarifying information to all ND school districts regarding their ability to administer these medications in emergency situations. P&A’s efforts included insuring that school districts were then implementing this guidance, along with ensuring that the individual cases that P&A was providing representation for, were resolved. As a result, students with healthcare conditions that require the administration of emergency medications will now be safe within the schools and have trained personnel to administer their medications, should the need arise.

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. 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, issue or barriers 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. Indicators used to determine successful outcome of activities pursued under this priority. Activities within this priority will include investigations of reports of abuse, neglect and exploitation, client casework completed by P&A advocates and attorneys, education and training activities and systemic and collaborative activities. 4. Objectives & Progress 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. P&A provided information & referral services to six people who contacted the agency regarding abuse, neglect and exploitation. P&A investigated five reports of suspected abuse, neglect and exploitation within an institution or facility and all five cases resulted in positive outcomes for the person. P&A is also in the investigation phase of three additional reports of suspected abuse, neglect and exploitation that will remain open and carried over into FY 2016. Objective 2: P&A will achieve positive outcomes through systemic advocacy and monitoring of disability services. On a regional and state level, P&A staff routinely meet with Vulnerable Adult Protective Services (VAPS) staff and the Long Term Care (LTC) Ombudsman to address abuse, neglect and exploitation needs of people with disabilities. The VAPS program in North Dakota has recently implemented mandatory reporting laws within the state and added positions to each regional human service center. Through this growth and changes that have been made, P&A has been an engaged partner to address how investigative activities would be coordinated within the state. This has resulted in coordinated efforts and processes to identify who will be conducting investigation activities for vulnerable people within the state. P&A has also conducted joint investigations with VAPS staff, when appropriate. P&A, VAPS and the LTC Ombudsman staff also held a joint training to continue to coordinate these efforts on an ongoing basis. 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. Four training activities occurred during FY 2015 relative to clients and staff within institutions and facilities regarding abuse, neglect and exploitation and disability-related rights. 66 PAIR eligible people participated in these training activities and all participants identified that they increased their knowledge relative to ANE and services that are available for people with disabilities. The trainings included the Jamestown Crisis Residential Unit, Horizon Middle School, South Central Human Service Center Chemical Dependency Unit and joint training with P&A, DHS Aging Services (VAPS and LTC). 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. P&A provided information & referral services to three people relative to community inclusion who were in institutions and were seeking information to support community integration. P&A also provided representation level services to one client who was wanting to live in the community with supports versus an institutional placement. P&A was instrumental in the client achieving their goal of living in the community and the issue was resolved favorably. 5. Collaboration with other entities North Dakota Long Term Care Ombudsman P&A continues to partner with the Long Term Care Ombudsman to support the efforts of people with disabilities who live in both basic care and skilled care facilities. Over the past year, P&A has partnered to ensure that all staff within the respective organizations have knowledge of one another’s services. In addition, if a person’s issues do not fit within P&A’s priorities, P&A often refers clients to the LTC Ombudsman program for advocacy support 6. Case Summaries that demonstrate the impact of the priority Case One: The client is a seven year-old boy who lives in a small town in North Dakota with his mother and stepfather. The client is on an IEP with learning deficits being seen as a result of chromosomal abnormalities that caused neurological impairments. The client also has a sensory processing disorder and a significant seizure disorder. P&A received a report of suspected neglect regarding the client’s school and the staff within the school. The report identified that the client’s healthcare plan, which is part of his IEP, was not followed, which resulted in significant harm to the child. The child experienced fifteen seizures in a 30 minute time frame. According to his physician’s order, the school should have administered Diastat medication rectally to control his seizures and called 911. Neither of these were done. The child’s IEP also indicates that after fifteen minutes, his mother is to be called if he is continuing to experience seizures. After 30 minutes of seizures, the school called his mother. She immediately went to the school and accessed emergency medical attention to stop his seizures. P&A conducted a primary investigation regarding this report of neglect and did substantiate neglect. The school did not follow the child’s healthcare plan regarding the administration of the Diastat medication, nor did they notify his mother in a timely manner, which resulted in the seizures continuing for an extensive period of time without medical attention. As a result of the investigation, P&A identified deficiencies in the training that had been provided to the school staff regarding the IEP, Diastat administration and the child’s seizure disorder. Training and follow-up with all school personnel who work with the child was done, along with updates and clarifications to his IEP and healthcare plan. This report and investigation, along with a number of other reports that were similar in nature, occurred within a relatively short period of time. P&A did find in the early stages of this investigation that the ND School Board Association and the group of school nurses had inappropriately interpreted a change in medication administration laws from the 2013 legislative session. The interpretation resulted in schools making a determination that they could not administer emergency medication unless they had medical training or were a nurse. While this appeared to have been a contributing factor in the above investigation; the child’s IEP and his healthcare plan clearly identified what the school had agreed to do. With the identification of this systemic concern regarding the interpretation of the medication administration practices within the school systems, P&A did develop a short term task force to address this issue formally and to ensure clarity regarding the school’s ability and responsibility to administer emergency life-saving medication. Case Two: The client is a 45 year-old survivor of polio with a physical disability as result of the disease. She requires the use of a power wheelchair for mobility. The client and her 16 year old son moved to the state of North Dakota. When moving to ND, the client and her son lived with a man and woman who they referred to as ‘mom and dad’; although they were not her birth or adoptive parents. The client was referred to P&A as she had been moved into a basic care facility by her son as she was experiencing barriers to living in the community. Her payee was not paying her rent or other expenses on time, which resulted in her losing her community placement. The eviction and loss of services to meet her disability-related needs resulted in placement in a more restrictive setting, which compromised her ability to keep her son living with her. P&A’s advocacy efforts initially focused on assisting the client with changing her representative payee and obtaining housing, which was more accessible and could allow for increased independence for the client. P&A also facilitated arrangements for other services for the client and her son so that they had an increased degree of support and services coming into the home. The changes that were made as a result of P&A’s advocacy services resulted in positive changes for the client and her son and allowed her to live in the community with her son. 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, issue or barriers 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. Indicators used to determine successful outcome of activities pursued under this priority. Activities within this priority will include client casework completed by P&A advocates and attorneys, education and training activities and systemic and collaborative activities. 4. Objectives & Progress Objective 1: P&A will achieve positive outcomes for people with disabilities who have been discriminated against on the basis of disability in employment. Information & Referral services were provided to five people regarding employment issues during FY 2015. Case services were provided to five clients relative to employment discrimination. Three cases were closed at the end of the fiscal year and all three cases were resolved in the client’s favor. One case involved discrimination in the hiring process, two cases involved discrimination in the workplace by a client’s employer, and two cases involved unlawful firing of an employee as a result of their disability. The other two cases will be carried over to FY 2016. Objective 2: P&A will eliminate barriers to employment of people with disabilities. Five people were provided with information & referral services relative to barriers to employment and the need for reasonable accommodations within the work place. Four clients were provided advocacy representation to address a denial of reasonable accommodations in their employment. Two cases were closed at the end of the fiscal year and both cases were resolved in the client’s favor. The two other cases will be carried over to FY 2016. 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. One person contacted P&A regarding disability-related criminal justice issues within a county jail and received information regarding how they could resolve the issue. In addition, five people were provided with advocacy services related to involvement in the criminal justice system. Three of the clients were currently in jail or prison and were denied disability-related services within the criminal justice system. The other two cases involved Individual Justice Planning. One case was closed at the end of the fiscal year and was closed in the client’s favor as the IJP was accepted by the court and prevented incarceration. The remaining four cases were still open at the end of the fiscal year and will be carried over into FY 2016. 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. Twenty-six students/parents were provided with information and referral services within the priority area of education. P&A also provided advocacy services to thirty-one students who had rights violations relative to their education. The cases in this priority focused on identification and eligibility, positive behavioral supports, IEP planning and development and least restrictive environment. Fifteen of these cases were closed at the end of the fiscal year and all fifteen cases were resolved in the client’s favor. Sixteen of the cases remained open at the end of the fiscal year and will be carried over to FY 2016. In addition to client related services, P&A also conducted a training to staff within a school setting regarding educational rights and more specifically, children’s rights to receive educational services in the least restrictive environment. This training was sought in response to a number of educational cases regarding students with disabilities and the special education staff within the district not promoting inclusion of students with disabilities, P&A provided a training to the special education staff in the district on P&A’s services and most specifically, the advocacy services that P&A provides in regards to community inclusion. This included information on people’s rights to live, work and play in the least restrictive environment. Information regarding student’s rights and how the district needed to be planning and promoting this model was the message shared throughout the training. 12 people were trained as part of this activity, with 4 of them being identified as PAIR eligible. Objective 5: 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. Information and referral services were provided to eight people who contacted P&A regarding healthcare related issues. In addition, seven people were provided with advocacy and legal services within the healthcare priority. These cases included eligibility, access and coverage with Medicaid, private insurance and Veterans’ benefits. Three of the cases were closed at the end of the fiscal year and all three were closed favorably. Four cases remained open at the end of the fiscal year and will be carried over to FY 2016. 5. Collaboration with other entities 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 addresses issues related to transition services on a statewide basis. P&A staff provide input regarding disability related issues. P&A staff also served on a guardianship sub-committee for the Council. P&A staff researched and reviewed information regarding alternatives to guardianship. P&A has also encouraged the use of Mental Health Advanced Directives as one of the alternatives to guardianship. 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. The committee plans the annual conference, which is attended by parents of children who have disabilities and professionals working with children with a disability. The conference is a collaborative effort between many advocacy agencies, to include: Pathfinder Parent Center, Department of Public Instruction, Director of Special Education, Independence Living Center, P&A, Family Voices, Designer Jeans, and Department of Human Services; Part C programs. The conference included topics: Tips for a Successful Transition, Comprehensive Coordinated Transition Planning, Apps for Success, Parent Support Organizations, Guardianship, Improving Post-School Outcomes with Evidence-Based Special Ed, Transition to Independence Program, Disability Disclosure, A-STEP Program, Self -Advocacy Presentation: L.I.S.T.E.N. Drop-In Center SAS, Engaging Parents in the Transition Planning Process, Planning for the Transition to College, and Social Skills for Adolescents. P&A assists with the conference as a committee member and sponsors a booth at the annual Pathfinder conference to ensure that students, parents and professionals have knowledge of P & A services. Services to Native American reservations 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. 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 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. The committee worked to explore the option of starting a program of study for students with intellectual disabilities, called "Adult Student Transition Education Program" (A —STEP) in the Grand Forks area. There is one A-STEP in our state, and it is believed one or more additional programs would be beneficial. 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 People 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 focus on making enhancements to its website, "Launch My Life ND". It can be viewed at www.launchmylifend.com. P&A has contributed funding to this project. 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. 6. Case Summaries that demonstrate the impact of the priority Case One: The client is a 30 year-old male who currently lives in a rural community in central North Dakota. The client has a diagnosis of Type 1 Diabetes. At the time of referral to P&A, the client had obtained training in power plant work, but was struggling to find work within the field. At the time of referral the client was working at a car dealership, but had sought employment at a large power plant in the county where he lived. As part of the employment screening process the client had to participate in a physical. When the physical identified that the client’s A1C was elevated and that he had diabetes, the job offer that had been conditionally extended to the gentleman was rescinded by the company. P&A provided advocacy representation to the client and assisted the client with preparing a written letter to the power plant’s human resources department. A few weeks after receiving the letter that the client sent to the employer, the client received a written letter granting him the original position that he applied for. As a result of P&A’s advocacy efforts, the client’s issue of discrimination in hiring was resolved and he successfully obtained employment that was consistent with this training. Case Two: The client is a 65 year-old woman who was employed with the county office in the rural town that she lived in. At the time of referral to P&A she had been employed by the county for over thirteen years and had received promotions throughout her employment. While employed she was diagnosed with asthma and lung disease. Her condition worsened when she was exposed to second hand smoke. As a result of her physician’s recommendation, after a determination that her condition had worsened, she requested a reasonable accommodation that the other employees not smoke within the area in which the office building is located and that the smoking be done in a different area or outside of the building. This request was denied by the Director of the county office. When this was not granted, the client requested an accommodation to work from home, which had been done for other employees who had disabilities. After becoming seriously ill, the client again requested an accommodation. P&A also assisted the client with writing a letter to the County Board so that they would be further educated on the ADA so that other employees did not have to experience the challenges that she did throughout her employment. While the client’s health deteriorated to the point that she chose to retire, she did receive a response from the County Board, which resulted in the firing of the Director who had denied her reasonable accommodations throughout her employment. Case Three: The client is a 25 year-old male who lives in an apartment in a small rural town in the middle of the Bakken oil patch. He does have a significant learning disability that impacts him in many ways, to include understanding social cues and to understand what is happening around him. The client was with a group of people who decided to burglarize a business. The client was initially adjudicated and sentenced; however, once the state penitentiary became aware of the challenges that the client faced, they sought involvement of a court appointed defense attorney who submitted a request for reconsideration of sentencing to the court system. The judge assigned to hear the case, court ordered the client to seek P&A services to develop an Individual Justice Plan to assist the client with supports and services in the community in place of incarceration. P&A provided advocacy services to assist the client,and his team of professionals and natural supports to develop an IJP that included structured work and services to support his disability-related needs. P&A also assisted with establishing additional support services as part of the IJP which was presented to the court. The judge did accept the IJP in place of the client’s original sentencing, which resulted in the client not having to serve the remaining jail time. With the structured supports and services from his team and probation officer, the client is now working and living in the community. Case Four: The client is a 10 year-old boy who lives with his mother, 12 year-old sister, and his mother’s fiancĂ© in an urban community in eastern North Dakota. The boy is a 3rd grader in public school and is on an IEP. He has diagnosis to include Pervasive Developmental Disorder, Dysgraphia, Phonological Disorder and ADHD. Despite taking medications to assist with the ADHD, the symptoms do impact his learning and compounds the other learning challenges that he experiences. The challenges that the child faces with learning on a daily basis do become quite challenging and he has what has been described as melt-downs. During one incident, the child threw a book and his mother was called to the school, along with the police. Up to this point, the school had identified a number of behavioral incidents that had occurred; however, they had not completed an assessment of the behaviors within the school setting and had not continually told the parent to seek a change in medication or increase the child’s medication. P&A provided advocacy representation services to the child and formally requested involvement of the school psychologist to evaluate his behavior and to assist with development of a formal plan to support his behavior and learning within the school setting. In addition, training and support was provided to the school personnel who supported him regarding how to best approach situations. The plan focused on identifying early signs of agitation and frustration, along with planned opportunities in which the student could take a break from work and have some time away from the focused learning that often became overwhelming. In addition, formal accommodations were added to his IEP to support him when activities became overwhelming. As a result of these efforts and the addition of a formal plan, the student’s behaviors decreased significantly and law enforcement involvement was not an option that was identified as acceptable. As his behaviors became less of an issue at school, the student’s performance improved and he was much more eager to learn. The need for formal intervention by school personnel also decreased and he was able to learn more acceptable forms of calming. At case closure, the student was doing well in school and was progressing through the elementary curriculum. Case Five: The client is a 5 year-old white male with diagnoses of benign hydrocephalus, strabismus, gross and fine motor delays, and speech delays. The client lives with his parents and siblings in an urban community in the northeast part of the state. He attends a preschool special education program as well as therapies at a private clinic that is also a child care center. The client was referred to P&A by an occupational therapist as the child’s therapies were not getting paid for through the family’s employer-sponsored health insurance plan. P&A provided advocacy services and assisted the family with exploring their benefits within their health insurance plan. P&A also facilitated involvement by the therapists who were working with the child to create a clear understanding of why the therapies were medically necessary; therefore, requesting coverage for the services being recommended. P&A also assisted the family with obtaining information regarding the Children Special Health Services wavier in order to obtain additional supports and Medicaid coverage. As a result of these efforts, the child’s insurance coverage began covering the needed therapies. The child was also found Medicaid eligible and was able to obtain waivered services through the Children’s Special Healthcare Waiver. At the time of case closure, the child’s therapies are being fully covered between the family’s private health insurance and Medicaid. 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, issue or barriers 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. Indicators used to determine successful outcome of activities pursued under this priority. Activities within this priority will include investigations of reports of abuse, neglect and exploitation, individual casework completed by P&A advocates and attorneys, education and training activities and systemic and collaborative activities. 4. Objectives & Progress Objective 1: People who are at risk of institutionalization will receive the disability-related supports necessary to remain in their community. Four people were provided with information and referral services by P&A within this area of the inclusion priority. In addition, four people were provided advocacy services to resolve their disability-related rights violations. Three of the cases were closed during the fiscal year with all three cases being resolved in the client’s favor. The third case will be carried over to FY 2016. 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. P&A received four reports of suspected abuse, neglect and exploitation of people with disabilities. Investigations were conducted regarding all four reports with findings issued. Three of the reports and the follow-up activities had been completed by the end of the fiscal year and were closed successfully. The fourth report was investigated and a determination made with a finding that exploitation had occurred and that mismanagement of the client’s funds had occurred. Following the completion of the investigation, P&A then approved legal services to seek resolution of the issues that were discovered during the investigation. These efforts will continue into FY 2016. 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. P&A works very collaboratively with other entities within the state to provide protective services for people who are vulnerable and who have disabilities. In an effort to ensure that these efforts are well-coordinated, P&A conducted joint training with P&A staff, ND Department of Human Services (DHS) Aging Services staff, and the Long Term Care Ombudsman’s Office. The joint training included staff from all three entities and included an exchange of information between the three entities. The goal of the training, which is done annually, is to develop an increased understanding of the roles, services and supports to people with disabilities by the three agencies. P&A presented on our services, priorities, both protective services and advocacy-based, and how to access services through the centralized intake process. 41 people were trained as part of this activity. Objective 4: People with disabilities will have physical access to an increased number of public or commercial sites in the community. P&A did provide advocacy and legal services to three clients in the area of public accommodations. Two of the cases involved advocacy services and in the third case, P&A did provide legal representation to seek resolution of the issues. The two advocacy cases were closed at the end of the fiscal year and both were resolved in the client’s favor. The third case, which is currently a legal case, will remain open and activities will continue into FY 2016. 5. Collaboration with other entities Aging Services and Vulnerable Adult Protective Services (VAPS) ND state law requires mandatory reporting to the Department of Human Services, Aging Services Division, Vulnerable Adult Protective Services (VAPS) when abuse or neglect of eligible individuals is suspected. This created overlapping authority with P&A for individuals with disabilities who may be vulnerable and abused or neglected. Through collaborative efforts, it was decided that VAPS has primary responsibility to respond to allegations involving people with mental illness living in the community who do not receive services. P&A’s focus is on individuals with developmental disabilities and individuals with mental illness and other disabilities living in facilities or receiving other publicly-funded services. In FY 2015 P&A conducted a joint training of P&A staff and Aging services staff to ensure understanding of P&A’s priorities, case selection criteria, and protocols and procedures for cross-referrals and collaboration. This resulted in a greater understanding of the role and differences of the two agencies and assisted in fine-tuning collaborative efforts. P&A and VAPS continue to collaborate at the state and regional level to refer reports to one another, collaborate on investigations and work together to address training needs relative to mandatory reporting and investigations. These efforts will continue throughout FY 2016 and P&A will continue to pursue regular administrative meetings with the Aging Services Division and VAPS program. Community Elder Service Network In collaboration with 40 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. One supportive activity that has been established during the past year is the process for people, who cannot afford the cost, to submit requests to attend trainings or workshops and CESN will cover the cost of the activity. 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. 6. Case Summaries that demonstrate the impact of the priority Case One: The client is a 65 year-old woman who lives in an urban community in North Dakota. At the time of referral, the client was in the hospital and was being treated actively for breast and brain cancer. The client had recently been informed that she had an inoperable tumor that was on her spine, which was creating significant difficulties with her mobility and her ability to care for herself. P&A was contacted by the client’s family, who had recently become her Power of Attorney, due to a concern with the hospital’s intent to discharge the client without adequate supports in place, which would have created a significant concern for the client’s safety. P&A provided advocacy representation to the client and her family and negotiated with the hospital personnel. One area of significant concern was that the hospital discharge planning staff had not adequately assisted the family with seeking support services that could go into the family’s home to provide support and assistance. Through the process of working with the hospital personnel, P&A was also able to educate the new Social Worker regarding the array of services that are available, beyond what was being recommended, which was a nursing home. As a result of advocacy services, the full array of available options for services was provided to the client and her family so that they were able to choose how to best support her medical and care needs. Case Two: The client is a 29 year-old female who resides in an urban community in the eastern part of North Dakota. She does have a learning disorder and also speech difficulties. The client lives in a high rise apartment complex in the community. P&A did receive a report of suspected exploitation and neglect in regards to the client’s representative payee. The report identified that the client’s payee, who is a formal not-for-profit organization, is not paying her bills in a timely manner. P&A conducted a primary investigation regarding this report and did find that the payee had not paid the client’s rent on a timely basis, which had resulted in her receiving late fees. In addition, it was also identified that another one of the client’s bills had an increase in the amount owed and despite receiving the information regarding the new amount, the payee continued to pay the lower amount to the business, which resulted in late fees being assessed as the full amount of the bill was not being paid each month. P&A did assist the client with seeking a change of payee, which was granted and put in place. Efforts were made after the completion of the investigation to ensure that the payee covered the cost of the late fees. In addition, P&A assisted the client with sending correspondence to the entities that were involved to explain the situation and to ensure that she did not have a negative standing with her landlord or the other entity who had not received adequate payments. P&A also found during the course of the investigation that the client was not being provided with copies of her bank statements or an accounting of her monies on a monthly basis. P&A assisted the client with making arrangements with her new payee to put this in place, along with a monthly meeting with the payee to ensure that she has knowledge of her financial situation, her expenses and her available funds for her personal use. P&A also worked with the original payee, who was involved in the investigation to put additional quality assurance steps in place with the person who was handling their payee services. This will positively impact all current recipients of representative payee services from this provider. Case Three: The client is a 7 year-old boy who lives with his family in an urban community. He does have a very severe seizure disorder that includes symptoms that typically occur before the seizure activity begin. To assist with early detection of the seizures, the family obtained a trained service animal that was able to identify the early signs of his seizure disorder, which allowed his parents the opportunity to administer medication immediately as this was very effective in lessening the intensity of the seizures. The city that the family moved to after coming to North Dakota informed the family that they were unable to keep the dog because the breed of dog, which was a mixed bread with bit bull included, was banned by the city. When the family tried to explain to the city that the dog was a trained service animal, the city refused to listen and charged the mother criminally with harboring a dangerous animal, a class B misdemeanor punishable with up to 30 days in jail. The city attorney denied the client's mother the right to a court appointed attorney. Through P&A legal services, the city attorney eventually agreed that the client's mother was indeed entitled to a free court appointed criminal defense attorney. The court appointed criminal defense attorney requested P&A's assistance in obtaining an expert witness who was able to testify on the American with Disabilities Act as it pertains to service animals and the client's right to have a service animal regardless of the breed of dog. As a result of the expert testimony provided during the hearing, the court found that the dog was in fact a protected service animal under the ADA. Consequently, the client was able to keep his service animal despite the fact that it was a mixed pit bull breed. Accordingly, the client's right to public accommodations afforded to him under the ADA was protected as a result of P&A legal services. 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, issue or barriers 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 that people with disabilities have the full range of available options to resolve issues on a larger scale. 3. Indicators used to determine successful outcome of activities pursued under this priority. Activities within this priority will include education and training activities and systemic and collaborative activities carried out by P&A staff throughout the agency. 4. Objectives & Progress 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. P&A provided a number of trainings regarding P&A services, our priorities and how to connect with P&A for services. These trainings included the Northwest Human Service Center (NWHSC) Advisory Board, the North Central Human Service Center (NCHSC) Advisory Board, the Governor’s Committee on Aging, Elk’s Youth Day, and Williston Public Schools. Through these efforts seventy-two (72) people received information regarding P&A services and priorities. 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. Money Follows the Person 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. Funds are also made available to patients moving from the State Hospital to community placement to help with deposits on apartments, the purchase of home goods, etc. 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. Calendar year 2015 transitions total 36 individuals as of Oct. 1, 2015. Legislative Mailings Disability-related legislative information was disseminated through e-mails 83 (eighty-three) times the month prior to (December) and during the Legislative Session (January through April 2015). These e-mails were specific to disability-related legislation and included factual information (a table of bills and their status, notes from hearings, and budget information). These e-mails were sent to approximately 315 agencies and individuals (many of whom forward this information on to others). Waivered Services for Children Legislation Through the past two legislative sessions, P&A has been a strong advocate in partnering to support the expansion of waivered services for children with disabilities. An interim study was held leading up to the 2015 legislative session which identified a gap that exists; however, there was an inability to identify the number of children who were part of this gap and what it would cost the state to support the needs of children who are currently un-served or under-served by the existing service delivery system. This resulted in formal legislation not being adopted during the 2015 session. The efforts that P&A has engaged in with other advocacy organizations and the department of human services will potentially address this need. Current efforts include discussion and development of an assessment tool that could be used to identify potential eligibility. The key to this will be a model that looks at the needs that a child has that are functionally based, without consideration of what causes the identified impairment. This will be significant because a child would not be required to have an intellectual disability, which is currently required in most instances to be eligible for the DD waiver in ND. These efforts continued throughout FY 2015 and will continue into the next fiscal year, with planned legislative impact in 2017. State IDEA Advisory Committee 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 revisions to the State Systemic Improvement Plan. Seclusion & Restraint in Schools North Dakota does not currently have a comprehensive mechanism for addressing seclusion and restraint policy or procedures in our ND schools, nor does the state have existing mechanisms for collecting data about the current use of seclusion and restraint in schools. In an effort to work towards potential legislation to address this, a group of advocacy organizations joined together to seek an outcome. P&A’s legal director drafted legislation for the 2015 legislative session and the legislation was introduced to the Senate Education Committee. As a result of these efforts, a legislative management study on the use of seclusion & restraint in schools was passed, to include a formal report and recommendations being brought to the 2017 legislative session. These efforts will continue in FY 2016. Legislative — Heath Care Reform During the 64th Legislative Assembly (2015 session), P&A monitored legislation pertaining to the implementation of the Affordable Care Act North Dakota. The primary legislation passed during the session related to this topic was House Bill 1378. This bill required a Legislative Management study, decisions, and a directive regarding the federal Affordable Care Act, the state’s benchmark plan, and the state-based essential health benefits package for the 2017 plan year and beyond. The bill essentially required the legislative management to assign a committee during the 2015-16 interim to study proposed and final federal rules issued by the federal Health and Human Services Department relating to essential health benefits under the Affordable Care Act; which resulted in the creation of the Healthcare Reform Review Committee. During the most recent meeting of the Committee, insurance carriers had the opportunity to do a short presentation. All providers confirmed that they will cover the ten essential health benefits defined by the ACA and will comply with the federal mental health parity law. After the presentations, the Committee selected the Blue Cross/Blue Shield small-group benchmark plan as the state’s essential health benefits package. ND currently has 51,920 uninsured children and adults, and it is estimated that 3,374 have a disability. 5. Collaboration with other entities North Dakota Disability Advocacy Consortium P&A is an active member of the North Dakota Disabilities Advocacy Consortium, (NDDAC), a non-profit corporation representing about twenty 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/. The NDDAC has been successful in grant-writing to help 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) which was held in October 2014. The LTI was 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 was 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 drafted bills and took them through the legislative process, including committee hearings. Two team leaders were assigned to each group of approximately ten participants to help ensure they had the support necessary to be engaged in the Institute. This was a very exciting endeavor with participation from approximately 80 self-advocates and family members. 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 SRC met four times in 2015 in addition to sub-committee meetings. The Bismarck CAP representative participates on the SRC and is the chairperson of the Public Awareness/Membership Committee. The CAP representative was elected co-chair of the SRC for 2015 and will automatically become the chair for 2016. During 2015 the SRC has been receiving information regarding the Workforce Innovation and Opportunity Act (WIOA) in preparation for the regulations to roll out. SRC also formed an Ad Hoc committee to begin work on an initiative to promote a Governor’s or State Hiring Initiative for people with disabilities similar to what is imposed for federal agencies. The committee is working to support this effort from the bottom up and has a one year goal to establish language and gather support to move the effort forward. In 2015 the SRC also approved inviting all Tribal 121 Projects to apply for membership to the council. Governor’s Committee on the Employment of People with Disabilities The purpose of the Governor's Committee on Employment of People with Disabilities is to further the goal of considering competitive and integrated employment as the first option when supporting individuals with disabilities who are of working age to obtain employment. 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 Protection & Advocacy Project holds a position on this committee per legislation. The Committee on the Employment of People with Disabilities met four times in 2015 (October 2014-September 2015). In 2015 the committee engaged in information gathering regarding activities of existing employment committees and work groups. Information was also provided to the committee on the Workforce Innovation and Opportunity Act and the State Hiring Initiative being proposed by the State Rehabilitation Council. The committee is working on developing a work plan based on the top goals of the different committees and work groups in order to support an overall unified plan. The committee is providing money for an employment survey through the ND Association of Community Providers. The survey is in the development stage through NDCPD. 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 2015, these topics included: updates on the Medicaid Management Information System (MMIS), which went into effect October 5, 2015; updates to progress on the eligibility system project, upcoming revisions to the state Medicaid plan, pending and recent changes to the Administrative Rules, updates to the new HCBS rule, review of the DD payment system, utilization reviews, and updates on quality control (“program integrity”). Efforts will continue during FY 2016. 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. More importantly, a subcommittee was formed to look at revisions to the Olmstead Plan. The P&A Executive Director is part of this group. With new leadership from the Department of Human Services, its meetings have been meaningful and promise a better educated, effective and purposeful Commission. This priority did not contain individual client casework.

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 Protective 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: 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 that 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 organizations, 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

A. SOURCES OF FUNDS RECEIVED AND EXPENDED: 2015 PAIR federal grant $95,117 2014 PAIR federal grant $77,762 TOTAL: $172,879 B. BUDGET FOR THE FISCAL YEAR COVERED BY THIS REPORT: Salaries 103,076.40 Temp salaries 25.00 Benefits 41,812.90 travel 3,250.71 IT software 71.64 Professional supplies 596.12 Office supplies 88.59 Postage 195.08 Printing 48.00 IT equipment < $5,000 0 Office equipment & furniture 0 Utilities 0 Insurance 110.25 Office leases 12,570.74 Repairs/copier maintenance 302.61 IT data processing 3,823.51 IT communications 1,243.61 IT contractual services 0 Professional development 1,350.38 Fees-professional services 5,113.27 TOTAL: $173,678.81 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: 2.575 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 2015. 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 Department 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
TitleExecutive Director
Signed Date12/08/2015